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
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)
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
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
- Weight Gain
- Considerations
- Exacerbated Hypoglycemia with Beta-blockers
- Avoid During Pregnancy and Breast Feeding
- Avoid Alcohol
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
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
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
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
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
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
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
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
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)
1 min
Levothyroxine
- Indications
- Hypothyroidism
- Myxedema Coma
- Mechanism of Action
- Isomer of Thyroid Hormone (T4)
- T3 has Higher Potency
- Side Effects
- Hyperthyroid Symptoms
57 secs
Octreotide
- Indications
- Acute Variceal Bleeds
- Pituitary Tumors
- GH Secreting Tumors
- Carcinoid Tumors
- VIPoma
- Mechanism
- Somatostatin Analog
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
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
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.
