Carlos Shared "18 Endocrine Pharm" - 18 Picmonics

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18 Endocrine Pharm

Diabetes Treatment
Type 1 DM
Dietary modifications (low carb diet)
Insulin replacement
Type 2 DM
Dietary modifications
Exercise for weight loss
Oral agents (Like Metformin, which is First-line in DM2)
Non-insulin injectables
Insulin replacement
Gestational DM (GDM)
Dietary modifications
Exercise
Insulin replacement if lifestyle modification fails
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Insulin
Rapid Acting
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)
Short Acting
Regular Insulin (Humulin R)
Intermediate Acting
Isophane NPH (Humulin N)
Long Acting
Detemir (Levemir)
Glargine (Lantus)
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2 mins
Metformin
Indications
Diabetes Mellitus Type 2
Polycystic Ovary Syndrome (PCOS)
Mechanism of Action
Decreased Gluconeogenesis
Increased Insulin Sensitivity
Side Effects
Lactic Acidosis
GI Distress
Weight Loss
B12 Deficiency
Contraindication
GFR < 30 ml/min
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2 mins
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
Mechanisms
1st Generation Sulfonylureas
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Possible Cardiovascular Toxicity
Considerations
Beta-blockers Reduce Effects
Avoid During Pregnancy and Breast Feeding
Avoid Alcohol
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2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
Mechanisms
2nd Generation Sulfonylureas
Blocks Potassium Channels in Beta Cells
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Considerations
More Potent
Beta Blockers Reduce Effects
Avoid Alcohol
Avoid Breastfeeding
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2 mins
Pioglitazone (Thiazolidinediones)
-glitazones Suffix
Mechanism
Binds PPAR-Gamma
Decreases Insulin Resistance
Indications
Type 2 Diabetes
Side Effects
Weight Gain
Heart Failure
Myalgia
Hypoglycemia
Upper Respiratory Infection
Considerations
Increased Risk of Bladder Cancer
Increased Fracture Risk in Women
Monitor Liver Enzymes
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2 mins
Repaglinide and Nateglinide (Meglitinides)
Mechanisms
Meglitinides
Increased Insulin Release
Indications
Type 2 Diabetes
Side Effect
Hypoglycemia
Considerations
Eat Within 30 Minutes
Gemfibrozil Increases Risk of Hypoglycemia
Short Half-Life
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2 mins
Exenatide (Byetta)
Mechanism
Incretin Mimetic
GLP-1 Synthetic Analog
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Nausea and Vomiting
Diarrhea
Thyroid Cancer
Pancreatitis
Renal Failure
Considerations
(Give Exenatide) One Hour After Other Medications
Adjunct Therapy
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3 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
-gliptin Suffix
Mechanisms
DPP-4 Inhibitor
Increases Insulin Release
Indications
Type 2 Diabetes
Side Effects
Pancreatitis
Upper Respiratory Infection and Inflammation
Stevens-Johnson Syndrome
Considerations
Used as Add-on Agents
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2 mins
Pramlintide (Symlin)
Mechanism
Synthetic Amylin Analog
Indications
Diabetes Type 1 and 2
Supplement Mealtime Insulin
Side Effects
Nausea
Skin Reactions at Injection Site
Considerations
Hypoglycemia When Combined with Insulin
Delayed Absorption of Oral Drugs
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2 mins
Sodium-glucose co-transporter 2 (SGLT-2) inhibitors
-gliflozin suffix
Block reabsorption of glucose in PCT
Type 2 DM oral medication
Order kidney function tests; should be avoided in renal-impaired patients
Side Effects
Glucosuria
UTIs
Vaginal yeast infections
Hyperkalemia
Dehydration (orthostatic hypotension)
Weight loss
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Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
Mechanisms
Alpha Glucosidase Inhibitors
Delays Absorption of Carbohydrates
Indications
Type 2 Diabetes
Side Effects
Flatulence
Diarrhea
Anemia
Cramps
Considerations
Monitor LFTs
Oral Glucose for Hypoglycemia
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2 mins
Propylthiouracil (PTU) and Methimazole (MMI)
Indications
Hyperthyroidism
Mechanism
Inhibits Thyroid Peroxidase
PTU Blocks Peripheral Conversion of T4 to T3
Side Effects
Agranulocytosis
Skin Rash
Hepatotoxicity (PTU)
Teratogen (MMI)
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1 min
Levothyroxine
Indications
Hypothyroidism
Myxedema Coma
Mechanism of Action
Isomer of thyroid hormone (T4)
T3 has higher potency
Side Effects
Hyperthyroid symptoms
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56 secs
Octreotide
Indications
Acute Variceal Bleeds
Pituitary Tumors
GH Secreting Tumors
Carcinoid Tumors
VIPoma
Mechanism
Somatostatin Analog
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2 mins
Oxytocin (Pitocin)
Mechanism of Action
Increase Uterine Contractions
Indications
Labor Induction
Control Postpartum Hemorrhage
Side Effects
Uterine Rupture
Water Intoxication
Contraindications
Fetal Lung Immaturity
Cervix Not Ripened
Active Genital Herpes Infection
Considerations
Use Lowest Dose
IV Pump
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3 mins
Fludrocortisone
Synthetic analog of aldosterone with little glucocorticoid effects
Mineralocorticoid replacement in 1° adrenal insufficiency
Side Effects
Similar to glucocorticoids
Edema
Exacerbation of heart failure
Hyperpigmentation
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Cinacalcet
Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ leading to decreased PTH.
Clinical Use: 1° or 2° hyperparathyroidism.
ADVERSE EFFECTS: Hypocalcemia.
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