Module 9: Endocrine System, Hormones, & Synthetic Substitutes Practice Flashcards

Comprehensive vocabulary flashcards covering the endocrine system agents including diabetes medications, hormones, thyroid agents, and reproductive health agents based on the Module 9 lecture transcript.

Diabetes Mellitus (DM)

A chronic, progressive metabolic disorder resulting from abnormalities in glucose, protein, and fat metabolism.

Type 1 Diabetes Mellitus (T1DM)

Diabetes resulting from beta-cell destruction leading to the absolute deficiency of insulin.

Type 2 Diabetes Mellitus (T2DM)

Diabetes resulting from a progressive insulin secretory defect or the presence of insulin resistance.

Other Causes of DM

Includes genetic defects in beta-cell function, diseases of the exocrine pancreas (e.g., cystic fibrosis), and drug- or chemical-induced diabetes.

Gestational DM (GDM)

Diabetes that is first diagnosed during pregnancy.

GDM Treatment Drug of Choice (DOC)

Insulin.

Goal: Near-normalization of blood glucose

Helps prevent microvascular complications in patients with DM.

Goal: Prevention of target organ damage

A primary goal in treating chronic DM to hinder disease progression.

DM Treatment Targets

Includes glucose/HgbA1c, BP, and lipids.

Standard Diabetic Prophylaxis

ACEI, statin, and aspirin are used to prevent complications.

Insulin Primary MOA

Binds to receptors on the cell membrane to facilitate the transport of glucose into the cell for energy.

Glycogenesis

The process of increasing storage of glucose as glycogen in muscle and liver cells, promoted by insulin.

Glycogenolysis

The production of glucose in liver and muscle cells, which is inhibited by insulin.

Insulin Proteotropic effect

Promotes protein synthesis by increasing amino acid transport into cells.

Lipogenesis

Enhancement of fat storage promoted by insulin.

Lipolysis

Mobilization of fat for energy, which is inhibited by the action of insulin.

Ketogenesis

The formation of ketones from fats, which is inhibited by insulin.

Gluconeogenesis

The formation of glucose from noncarbohydrate sources (e.g., amino acids), inhibited by insulin.

Humalog (Lispro) Onset

$$0.25-0.5\,h$$

Humalog (Lispro) Peak

$$0.5-2.5\,h$$

Novolog (Aspart) Onset

$$0.2-0.3\,h$$

Novolog (Aspart) Peak

$$1-3\,h$$

Apidra (Glulisine) Onset

$$0.2-0.5\,h$$

Apidra (Glulisine) Peak

$$1.6-2.8\,h$$

Rapid-acting Insulin Duration

$\le 5\,h$ or $3-5\,h$

Regular Insulin Onset (Humulin R, Novolin R)

$$0.25-0.5\,h$$

Regular Insulin Peak

$$0.8-2\,h$$

Short-acting Insulin Duration

$$4-12\,h$$

Isophane (NPH) Category

Intermediate-acting insulin.

Isophane (NPH) Onset

$$1-2\,h$$

Isophane (NPH) Peak

$$4-12\,h$$

Intermediate-acting Insulin Duration

$$14-24\,h$$

Lantus (Glargine) Peak

None.

Lantus (Glargine) Onset

$$3-4\,h$$

Long-acting Insulin Duration

$20-24\,h$ or $> 24\,h$

Levemir (Detemir) Peak

$$3-9\,h$$

70/30 Fixed-combination Ratio

$70\%$ NPH / $30\%$ regular ratio.

75/25 Fixed-combination Ratio

$75\%$ NPH / $25\%$ lispro.

Fixed-combination Onset (Aspart/Lispro base)

$$5-15\,min$$

Dual Insulin Duration

$$10-16\,h$$

Insulin Clinical Use (Non-DM)

Treatment of hyperkalemia.

Lipohypertrophy

An adverse effect of insulin injections characterized by abnormal fat accumulation under the skin.

HgbA1c Monitoring Frequency

Every $3-6\,months$

Long-acting Insulin Mixing Rule

Cannot be mixed with other insulins.

Insulin Mixing (Drawing Order)

Clear insulin should be drawn into the syringe first (clear to cloudy).

U-500 Insulin Mixing Rule

Do not mix with other insulins.

Basal Insulin Initiation (T2DM units)

Start with $10\,units$ at bedtime or morning.

Basal Insulin Initiation (Weight-based)

$$0.2\,units/kg$$

Insulin Titration Frequency

Increase dose typically every $3\,days$ if fasting levels are not in target range.

Insulin Titration Increment

Standard increase of $2\,units$ every $3\,days$

Fasting Glucose Target Range (mg/dL)

$$80-130\,mg/dL$$

Fasting Glucose Target Range (mmol/L)

$$4.4-7.2\,mmol/L$$

Insulin Titration (Large Increment)

Increase by $4\,units$ every $3\,days$ if fasting glucose is $> 180\,mg/dL$

Insulin Dose Reduction Rule

If fasting glucose is $< 80\,mg/dL$, reduce bedtime dose by $4\,units$ or $10\%$, whichever is greater.

Prandial Insulin Addition (A1C criteria)

Consider if A1C is $\ge 7\%$ after $2-3\,months$ of basal insulin with fasting glucose in target range.

Pre-dinner Glucose Out of Range (NPH)

Add NPH insulin at breakfast.

Pre-dinner Glucose Out of Range (Rapid)

Add rapid-acting insulin at lunch.

Pre-lunch Glucose Out of Range

Add rapid-acting insulin at breakfast.

Pre-bed Glucose Out of Range

Add rapid-acting insulin at dinner.

Metformin (Glucophage) Class

Biguanide.

Metformin MOA: Liver

Decreases hepatic glucose production.

Metformin MOA: Peripheral

Increases peripheral glucose uptake and utilization.

Metformin MOA: Intestine

Decreases intestinal absorption of glucose.

Metformin First-line Use

Standard first-line drug for Type 2 DM in both children and adults.

Metformin Contraindication: Renal

Absolutely contraindicated if eGFR is $< 30\,mL/min/1.73\,m^2$

Metformin eGFR Recommendation (30-45)

Use not recommended; do not initiate.

Metformin eGFR Recommendation (60+)

Safe to initiate or continue.

Metformin Contrast Rule

Temporarily hold prior to or at time of iodinated contrast; restart after confirming stable renal function ($\sim 48\,hrs$ post-contrast).

Metformin Major Adverse Effect

Lactic acidosis.

Metformin GI Disturbance Examples

Bloating, nausea, vomiting, and diarrhea.

Metformin Positive Comorbidity Effects

Weight loss and decreased lipids.

Metformin Renal Monitoring

Assess renal function before initiating and then annually.

Glipizide (Glucotrol) Class

Sulfonylureas.

Glyburide (Diabeta) Class

Sulfonylureas.

Sulfonylureas MOA

Stimulate insulin release from pancreatic beta cells.

Sulfonylureas Line of Therapy

Second-line therapy for Type 2 DM in adults.

Sulfonylureas Contraindication (Allergy)

Sulfa allergy.

Sulfonylureas Adverse Effects

Severe hypoglycemia, weight gain, GI upset, rash, and photosensitivity.

Sulfonylureas Patient Education

Hold the dose if unable to eat.

Pioglitazone (Actos) Class

Thiazolidinediones.

Rosiglitazone (Avandia) Class

Thiazolidinediones.

Thiazolidinediones MOA

Improve target-cell response to insulin; dependent on the presence of insulin.

Thiazolidinediones Boxed Warning

Can cause or exacerbate Congestive Heart Failure (CHF).

Thiazolidinediones Contraindication

Class III and IV heart failure.

Thiazolidinediones Common AE

Weight gain and edema.

Acarbose (Precose) Class

Alpha-glucosidase Inhibitors.

Miglitol (Glyset) Class

Alpha-glucosidase Inhibitors.

Alpha-glucosidase Inhibitors MOA

Delay digestion and absorption of carbohydrates in the small intestine.

Alpha-glucosidase Inhibitors Contraindications

Bowel disease and severe renal impairment.

Alpha-glucosidase Inhibitors Patient Education

Take with the first bite of a meal.

Repaglinide (Prandin) Class

Meglitinides.

Nateglinide (Starlix) Class

Meglitinides.

Meglitinides MOA

Block ATP potassium channels on beta islet cells, opening calcium channels to increase insulin secretion.

Meglitinides Patient Education (Timing)

Take $30\,mins$ before a meal.

Dapagliflozin (Farxiga) Class

Selective Sodium Glucose Cotransporter 2 (SGLT-2) Inhibitors.

Empagliflozin (Jardiance) Class

Selective Sodium Glucose Cotransporter 2 (SGLT-2) Inhibitors.

SGLT-2 Inhibitors MOA

Block reabsorption of glucose in the kidneys and promote excretion of excess glucose in the urine.

Empagliflozin Pediatric Use

Approved for children $\ge 10\,yo$

SGLT-2 Inhibitors Non-DM Uses

Used for Heart Failure (HF) and Chronic Kidney Disease (CKD).

SGLT-2 Inhibitors Adverse Effects

Genital fungal infections, UTIs, increased urination, and volume depletion.