Clin Med 3 Exam 1 Meds

biguanide

metformin (Glucophage)

sulfonylureas

glipizide (Glucotrol)

DPP 4 inhibitor

sitagliptin (Januvia)

SGLT2-inhibitor

canagliflozin (Invokana)

GLP 1 agonist

semaglutide (Ozempic)

biguanide

indication: first line oral agent for T2D

biguanide

MOA: inhibits glucose production and intestinal glucose absorption, and ↑ insulin sensitivity in muscle and fat

biguanide

AEs: GI distress, long-term B12 deficiency

biguanide

PT concerns: low risk of hypoglycemia, monitor for B12 deficiency symptoms (can mimic peripheral neuropathy)

sulfonylureas

indication: T2D (low cost)

sulfonylureas

MOA: binds to receptors on pancreatic beta cells, triggers depolarization and insulin release

sulfonylureas

AE: high risk of hypoglycemia, BEERS list — increased risk if skip meals, weight gain

sulfonylureas

PT concerns: high risk for exercise induced hypoglycemia

DPP 4 inhibitor

indication: T2D

DPP 4 inhibitor

MOA: inhibits an enzyme to prolong active incretin hormone levels (GLP1, GIP), increasing insulin synthesis/release and reducing glucagon secretion

DPP 4 inhibitor

AE: well tolerated, rare case reports of arthralgia

DPP 4 inhibitor

PT concerns: low risk of hypoglycemia

SGLT 2 inhibitor

indication: T2D (also approved for HF and CKD without DM)

SGLT 2 inhibitor

MOA: inhibits SGLT2 cotransporters in proximal renal tubules, blocking glucose reabsorption and increasing urinary glucose excretion

SGLT 2 inhibitor

AE: volume depletion, genitourinary infections, rare euglycemic DKA

SGLT 2 inhibitor

PT concerns: monitor hydration status and OH symptoms, low hypoglycemic risk

GLP 1 agonist

indication: T2D, CV risk reduction, obesity management

GLP 1 agonist

MOA: incretin mimetic that increases glucose dependent insulin secretion, decreases glucagon secretion and slows gastric emptying to increase satiety

GLP 1 agonist

AE: GI symptoms

GLP 1 agonist

PT concerns: low hypoglycemia risk, monitor GI tolerability

Insulin

Indication: mandatory for T1D, used in advanced or poorly controlled T2D

insulin

MOA: binds to tyrosine kinase receptors, promoting GLUT 4 receptor translocation to cell surfaces in muscle and fat to stimulate glucose uptake while inhibiting endogenous glucose production

insulin

AE: marked hypoglycemia and weight gain

insulin

PT concerns: exercise enhances glucose uptake, drastically increasing hypoglycemia risk

basal

working in the background, duration varies greatly by product

bolus

rapid and regular, typically inject before a meal, also given to correct hyperglycemia

endocrine glands

ductless, secrete hormones into the interstitial fluid into the blood directly

exocrine glands

secretes a variety of products into ducts that lead to the skin or GI tract (body surface/internal lumen)

ACTH, FSH, LH, GH, TSH, prolactin

anterior pituitary hormones

oxytocin and vasopressin/ADH

posterior pituitary hormones

peptides/proteins and catecholamines

water soluble

peptides/proteins and catecholamines

can exert rapid effects (enzymes) or delayed effects (transcription)

peptides/proteins and catecholamines

receptors in plasma membrane

peptides/proteins and catecholamines

metabolized fast (within mins)

peptides/proteins and catecholamines

free (unbound) in plasma

peptides/proteins and catecholamines

activate intracellular pathways and often use second messengers

thyroid hormones

derived from thyroxine and iodine, are not catecholamines

steroid and thyroid hormones

cortisol, aldosterone, estrogen, progesterone, testosterone, T3 and T4

steroid and thyroid hormones

poorly soluble, lipid soluble

steroid and thyroid hormones

intracellular receptors

steroid and thyroid hormones

synthesized from cholesterol

steroid and thyroid hormones

slow and protein bound

steroid and thyroid hormones

small amount is in plasma (free hormones) = only these interact with target cells

steroid and thyroid hormones

alter gene transcription and protein synthesis

thyroid hormone + epinephrine

_________ and ______ = greater metabolic response

tropic

a hormone controls secretion of another hormone

trophic

TSH stimulates T3 and T4 from thyroid and promotes thyroid growth

a hormone controls secretion of another hormone and the growth of the endocrine gland that secretes the second hormone. What is an example?

oxytocin

milk ejection reflex, uterine contractions, emotional bonding

vasopressin (ADH)

vasoconstriction and fluid retention

FSH and LH

increases

anterior pituitary hormones that are controlled by gonadotropin-releasing hormone (GnRH)

does it increase or decrease the production of these

GH releasing hormone (GHRH) — increases

GH inhibiting hormone (somatostatin) — decreases

what hypothalamic hormones control the secretion of GH

do they cause an increase or decrease in GH

TSH — increases

anterior pituitary hormones that are controlled by thyrotropin releasing hormone (TRH)

does it increase or decrease the production of these

prolactin — decreases

aka prolactin inhibiting hormone (dopamine)

anterior pituitary hormones that are controlled by dopamine

does it increase or decrease the production of these

ACTH

increases

anterior pituitary hormones that are controlled by corticotropin releasing hormone (CRH)

does it increase or decrease the production of these

increases metabolic activity and body temp regulation

what affect does T3 and T4 have on the body

T3

what is required for normal production of GH in anterior pituitary

hypothyroidism

hashimotos

due to iodine deficiency or loss of functional _____ tissue

hashimotos

hypothyroidism aka

weight gain, cold sensitivity, lethargy, mental fatigue

hypothyroidism/hashimotos symptoms

hyperthyroidism

graves disease

hypothyroidism

hashimotos

heat sensitivity, weight loss, increased appetite, increase HR, tremors, nervousness

hyperthyroidism/graves disease symptoms

cortisol and epinephrine

_____ and ______ increase during stress

↑ blood glucose and BP

promote metabolic fuel mobilization

↓ inflammation

fetal growth and development

cortisol functions

adrenal insufficiency

decreased cortisol levels

weak, fatigue

↓ appetite, weight, BP, blood sugar

adrenal insufficiency (↓ cortisol)

addison’s disease

primary adrenal insufficiency

decreased electrolytes and decreased BP

addison’s disease symptoms

cushing’s

hypercortisolism

hypercortisolism

remember because it is metabolising too much

may cause uncontrolled catabolism of bone, muscle, skin, other organs

osteoporosis, weakness, increased blood sugar, HTN

hypercortisolism/cushing symptoms

hypothalamus: ↑ GHRH + ↓ SST (somatosatin) —> ant pit: ↑ GH —> liver and other cells: ↑ IGF-1

secretion pathway of GH and IGF-1

fetal growth, protein synthesis, ↓ blood glucose

insulin functions

storage

bone calcium =

small circulating pool

plasma calcium =

signaling and contraction

intracellular calcium

decreases plasma calcium by inhibiting osteoclasts —> decreased bone resorption

calcitonin function

rickets (children)

osteomalacia (adults)

mineralization of the bone matrix is decreasing, causing bones to be soft and easily fx

vitamin d deficiency

rickets and osteomalacia major cause

osteoporosis

imbalance between bone resorption and formation

calcium

tired, lethargy, weakness, nausea and vomiting

hypercalcemia symptoms

increased excitability of nerves and muscles —> seizures, spasms, neuronal excitability

hypocalcemia symptoms

absorptive state

occurs after eating while GI tract is absorbing nutrients

absorptive state

body emphasizes storage and utilization of nutrients

absorptive state

insulin is prominent

postabsorptive state

occurs when nutrients are no longer entering the blood stream, rapidly from the GI tract

postabsorptive state

body emphasizes mobilization of stored fuel

postabsorptive state

liver plays a major role in maintaining blood glucose during this phase

↓ hepatic glucose

↑ glucose uptake by tissues

↑ glycogen synthesis, protein synthesis and fat storage

insulin major effects

insulin

______ promotes GLUT4 transporters to the plasma membrane, mainly in skeletal muscle and adipose tissue. this allows GLUT4s to do their job and increase glucose uptake

glucagon

directly opposes insulin

↑ hepatic glycogenolysis and gluconeogenesis

↑ availability of metabolic fuels

support of blood glucose during fasting

glucagon

storage

mobilization

insulin =

glucagon =

ketones

______ are an alternative fuel, and are not a source of glucose

lipolysis

breakdown of stored triglycerides