Pharm 2: Diabetes, Pituitary, Bone, Cushings, Addisons

  1. Name 2 short-acting regular insulins 

    And the primary uses
    • Humalin R 
    • Novolin R 

    • Acute illness ( emergency) ex. DKA, surgery 
    • Pregnancy 

    Type 2 uncontrolled oral hypoglycemia
  2. How to give Regular Insulin Short acting
    Only type of insulin that can be given IV push or IV gtt
  3. Timing of Short Acting Regular Insulin
    • Starts 30 min-1 hr 
    • Peak 2-4 hrs 
    • Duration 3-6 hrs 
    • Max 6-8 hrs
  4. When to give Regular short acting insulin
    • 30 min before a meal sliding scale 
    • Subcut 
    • insulin syringe 
    • -- eat a snack at peak times ( 2-4 hrs )
  5. Name 2 Long Acting Insulins 

    For what kind of use?
    • Glargine ( lantus)
    • Detemir ( levemir) 

    Long term use
  6. Long Acting Insulin timing
    • Starts 1-2 hrs
    • No Peak
    • Lasts 20 hrs
  7. How to give long acting insulin
    • Dont dilute
    • Dont mix
    • Normally given at bedtime
  8. Name 2 intermediate insulins

    The primary use
    NPH insulins 

    • Humalin N
    • Novolin N 

    Long term admin
  9. Adverse effects of intermediate insulin
    Hypoglycemia mostly in the mid late afternoon
  10. How to give intermediate insulin
    • Only give Sub Q usually before breakfast or dinner 
    • Can be mixed with short-acting ( clear to cloudy) 

    • Air into NPH ( cloudy)
    • Air into Regular
    • Draw up Regular
    • Draw up NPH
  11. The timing of Intermediate Insulin
    • Starts 2-4 hrs 
    • Peak 8-10 hrs
    • Lasts 10-18 hrs
    • Max 14-20 hrs
  12. What to do if you have too much insulin ( hypoglycemia)
    • hypoglycemia= below 70,
    • dangerous below 40 
    • signs: tachy, palpitations, diaphoresis, headache, weakness) 

    • Conscious: 
    • foods with 15g carbs, liquid fruit juice
    • 4tsps sugar 
    • symptoms should go in 5-20 min if not give more carbs 

    • Unconscious:
    • Dont call MD 1st. treat with 25-50% dextrose IV push 
    • or at home Sub Q or IM glucagon
  13. What makes hypoglycemia worse?
    • sufonylureas
    • meglitinides
    • beta-blockers
    • alcohol
    • tetracyclines
  14. What drugs raise glucose levels
    • thiazide diuretics
    • glucocorticoids
    • pheynytoin
    • levothyroxine
    • estrogen/oral contraceptives 
    • adrenergics
  15. What drugs can mask symptoms of hypoglycemia ( tachy tremors)
    beta blockers ex propranolol
  16. 3 Drugs in the sulfonylurea class

    and how they work 

    when to give
    • Glyburide
    • glimepiride
    • glipizide

    insulin release from the pancreas 

    give 30 min before meals 

    older adults are sensitive to glyburide

    check A1C ( should be less than 7%)
  17. Drug in the class of biguanides 

    how it works

    when to take
    metformin ( glucophage) 

    increases the use of glucose by muscle and fat cells, decreases liver glucose production and GI absorption of glucose

    - absorbed in the liver

    - taken with meals
  18. Metformin considerations/ adverse effects
    Least likely to cause hypoglycemia 

    can cause lactic acidosis ( hyperventilation, myalgia, sluggishness) -- stop treatment then--> not for people over 80! 

    • GI upset  ( lose weight ) 
    • B12 + folic acid deficiency

    Held at least 24 hrs before tests and 48 hrs after tests with contrast dye to avoid renal failure
  19. Name 2 alpha glucosidase inhibitors 

     when to take

    how do they work?


    Take at the start of each meal 

    The med works in the GI and delays the digestion of complex carbs ( glucose lowers after meals)
  20. What drugs do alpha glucosidase inhibitors not work with?

    which ones do they work well with?
    • Acarbose can decrease digoxin levels 
    • and when used with metformin can increase the risk of hypoglycemia and GI effects 

    • Works well with sulfonylureas
    • (glyburide, glimepiride, glipizide)
  21. 2 Drugs in Thiazolidinediones 

    how they works
    • Rosiglitazone
    • Pioglitazone 

    • Stimulates insulin receptors on muscle, fat, and liver cells
    • ( used for insulin resistance) 

    • - meds should be taken with meals 
    • -can take up to 12 weeks to work
  22. Adverse effects of Thiazolidinedione
    • Hepatotoxicity 
    • CHF
    • Weight gain ( 2-3 lbs in 2-4 hrs) 

    • don't give to people with heart failure 
    • monitor liver function
  23. 2 drugs in Meglitinides 

    When to take?
    • Repaglinide
    • Nateglinide 

    • Takes 30 minutes before meals 
    • Not commonly prescribed
  24. Drug in Amylin Analogs 

    how it works?

    How to give?
    Pramlintide acetate 

    Suppresses postprandial glucagon secretion which slows gastric emptying 

    Comes in pen form, given subcut before meals  ( dont admin if skipped meal) 

    - associated with weight loss
  25. 3 drugs in the dipeptidyl peptidate 4 inhibitor

    how they work?

    when to take?
    • sitagliptin phosphate
    • linigliptin
    • saxagliptin 

    balance the release of insulin and limit the release of additional glucose from liver ( helps with insulin resistance) 

    take daily with no regard to meals ( po)
  26. Adverse effects of dipeptidyl peptidate -4 inhibitors
    • Not for type 1 at all 
    • not for heart failure, or renal disease 

    can cause upper resp infection, stuffy runny nose
  27. 2 drugs that are incretin mimetics 

    How to take it? 

    how does it work?
    • Exenatide
    • Liaglutide 
    • Other 2 drugs: albigutide, dulaglutide 

    Sub cut BID within 1 hr of breakfast & dinner 

    Stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten ( it increases the feeling of fullness/ weight loss)
  28. Contraindications of Incretin Mimetics
    • Do not lactate 
    • C-cell thyroid cancer link 
    • -- Make sure to refrigerate and protect from light
  29. Drug thats a Sodium glucose cotransporter 2 inhibitor 

    When to take it 

    How it works?

    Take it with breakfast

    Works by inhibiting glucose reabsorption in proximal renal tubules
  30. What to check while on Cenagliflozin
    Assess K+ and blood pressure levels 

    Avoid salt substitutes, st johns wort

    Check for dehydration, hypotension, syncope, genital mycotic( yeast infection)
  31. 3 hormones produced by the thyroid
    thyroxine ( T4), triiodothyronine ( T3), calcitonin ( high blood Ca = more calcitonin)

    T4, and T3 depend on the amount of iodine and tyrosine in the thyroid gland 

    thyroid hormones are released when its stimulated by TSH from the anterior pituitary gland
  32. Signs of hyperthyroidism 
    - lab signs
    - physical signs 

    include a thyroid storm
    • TSH goes down 
    • T3, T3 is high

    Caused by graves disease: where thyrotropin receptor antibodies simulate TSH 

    thyroid storm ( severe): extreme symp, heart fail, coma

    other signs: goiters, thyroditis, thyroid carcinoma, pituitary adenoma, thyroid storm
  33. Whats propylthiouracil ( PTU) used for 

    what to remember

    A beta blocker for hyperthyroidism 

    taken around the clock q8hr 

    PTU may increase the effects of anticoagulants = risk of bleeding goes up 

    Monitor live functions tests 

    If the HR is 100+ the dose isnt high enough
  34. Methimazole is used for
    what to remember beforehand

    take a pregnancy test before starting
  35. What are Lugols Solution

    Potassium iodide 

    Sodium iodide used for?
  36. How doses should be on hyperthyroidism
    Higher at the start because of a rapid metabolism 

    need to restrict seafood/salt

    some OTC have iodine : cough syrup, asthma meds, and multivit
  37. Describe hypothyroidism 
    TSH is high ( trying to compensate): T3, T4 normal 

    Cause: cretinism ( child born without a thyroid gland) 

    myxedema ( low basal temp, and low hr, card dysrh)

    Hashimoto ( autoimmune)

    Goiter radiation
  38. Points to remember about hypothyroid pts
    Need a low dose for pain and anesthesia

    • Increase the effects of levothyroxine: 
    • Antidepressants
    • asthmatic agents
    • nasal decongestants 

    • Decrease the effects..
    • antacids, iron
    • antihypertensives, proppranolol 
    • estrogen, oral contraceptives

    If the pts has Addisons treat that first
  39. Drug for hypothyroidism

    Give PO empty stomach 30 minutes before meals or IV ( IV dose in half)
  40. Hormones made by the anterior pituitary gland

    and the related conditions

    Dwarfism= not enough GH

    Acomegaly= too much GH
  41. Somatropin is for? 

    How to give it
    Stimulates GH ( skeletal, linear, muscle and organ growth) 

    • Subcut or IM
    • 2 nurses must check dose calculation
  42. Adverse effects and considerations for Somatropin

    what to monitor
    Hyperglycemia, mild edema 

    Monitor serum and urine calcium, glucose, and thyroid function

    Avoid if Prader Willi syndrome
  43. Hormones made by posterior pituitary gland
    ADH/Vasopressin : to regulate water 

    -- Diabetes inspidus: is a ADH deficiency kidneys are filtering but not reabsorbing water 

    Oxytocin: childbirth, lactation
  44. Drug for Diabetes Inspidius and how it works 

    how is it given
    • Desmopressin acetate 
    • Vasopressin

    synthetic ADH: increases water permeability, and osmolality and decreases urine volume 

    • Desmopressin: oral, intranasal, subcut, IV
    • Vasopressin: subcut, IM, IV

    Monitor IV sites== necrosis
  45. Desmopressin acetate adverse effects and considerations
    hyponatremia: lethary, confusion, seizures

    fluid volume shift = dysrhythmia 

    Assess for signs of rehydration
  46. Drugs that increase the effects of desmopressin
    Carbamazepine and chloropropamide , tricyclic antidepressants

    selective serotonin
  47. Drugs that decrease the effects of desmopressin
    alcohol ( decreases the diuretic effect), heparin, lithium, phenytonin
  48. Drug that suppress GH and IGF1 for acromegaly 

    How to give it
    Octreotide acetate 

    Deep IM ( not the deltoid) 

    between meals to prevent fat malabsorption 

    Med has to be withdrawn for 4 weeks out of the year
  49. what to consider while on octreotide acetate
    prolonged QT interval 

    • Monitor sugar levels and for gallbladder disease 
    • IV gtt may be used for GI bleed
  50. Hypocalcemia drugs 

    how they are given
    • oral calcium products ex. GERD 
    • IV : calcium chloride, calcium gluconate for acute hypocalcemia 

    • Slow IV push
    • PO 2 hrs apart from other meds
  51. Considerations for hypocalcium drugs
    Increases risks of digoxin toxicity 

    Calcium citrate is better absorbed 

    Iv calcium gluconate is the antidote for calcium channel blocker overdose
  52. Drugs that increase the effects of calcium
    thiazide diuretics 

    vitamin D
  53. drugs that decrease the effects of calcium


  54. Drugs that help with osteoporosis and pagets disease 

    How is it given
    Bisphosphonates  ( end in -dronate)

    Main drug: Alendronate 

    PO: must take with a full glass of water 30 minutes before breakfast with no other meds

    should sit or stand for 30 minutes after or esophagus erodes
  55. How does alendronate work?

    Supresses osteoclast activity to gain bone mass 

    Dont take calcitonin with salmon allergy

    Aspirin/NSAID: increase the risk of GI adverse effects 

    Antacids decrease the effectiveness
  56. Signs of Addisons
    loss of sodium, water and chloride 

    cardiac output, dehydration, hyperkalemia, hypoglycemia

    Acute adrenal crisis: othostatic, muscle weakenss, bronze, body hair changes
  57. What are 2 adrenocorticoids and what are they used for 
    how to give
    Adrenocorticoids : bind to receptors to decrease inflammation and increase sodium retention for addisons disease 

    • Hydrocortisone cypionate
    • hydrocortison sodium succinate 

    PO with food to decrease GI upset 

    Never stop randomly , and increase calcium intake , and montior blood sugar ( it can cause hyperglycemia)
  58. Considerations while taking adrenocorticoids
    No live viruses if on hydrocortisone 

    assess for htn, chf , and decreased cardiac output
  59. What are mineralcorticoids used for and how do they work

    what to be aware of while on them
    Sodium retention and potassium excretion to increase BP

    for addisions taken lifelong 

    limit salt intake, and assess sodium potassium levels, bp, weight
  60. Signs of Cushings disease
    • Too much adrenocortico 
    • (from tumors or long term glucocorticoid uses) 

    moon face, facial hair , buffalo hump , thin skin
  61. Name a 11-Deoxycortisol inhibitor , what is it used for 

    how to take it
    • Ketoconazole 
    • used to help cushings 

    Take with fluids to decrease stomach acid, and food
  62. Considerations with Ketoconazole
    • Dont take with antacids 
    • can cause hepatotoxicity 

    monitor liver enzymes
  63. Antineoplastics drugs are used for ?
    How to give them
    Miotane decreases production of cortisol

    used for cushings disease 

    its a high alert med, hold if trauma ( its just pallative not a cure)
  64. Miotane considerations
    used for inoperable adrenocorticol carcinomas

    causes lethargy
Card Set
Pharm 2: Diabetes, Pituitary, Bone, Cushings, Addisons
rx for diabetes, pituitary, bone, cushings, addisons