Medications Affecting the Endocrine Syst

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Medications Affecting the Endocrine System : 

Medications Affecting the Endocrine System Part 1-Diabetes Mellitus

Objectives : 

Objectives Discuss the physiologic effects of insulin on carbohydrate, lipid, and protein metabolism, and identify those body cells/tissues that most depend on insulin for providing glucose as the main metabolic fuel.   Differentiate between the two major types of diabetes mellitus based on etiology, demographics, and treatment. State three classic signs or symptoms of diabetes mellitus and identify the main pathophysiologic risks from long-term, poorly controlled diabetes mellitus. Describe the values and limitations of monitoring diabetes mellitus therapy based on urine testing and blood testing for glucose and ketones. Explain glycolated hemoglobin (HbA1c): what it reflects (in terms of blood chemistry) and why it is an important adjunct to static (total) blood glucose levels in monitoring the response of diabetes to therapy. State the main goals of therapy for all patients with diabetes in terms of both symptom control and quantitative targets for fasting blood glucose levels and for HbA1c.

Objectives : 

Objectives Differentiate among the different insulins for therapeutic use in terms of their mechanisms of action, pharmacokinetics (onset, duration), and administration routes. Identify those pharmaceutical formulations that can be given intravenously and those that cannot, and explain which pharmaceutic property governs whether IV administration is safe. Discuss insulin resistance in terms of what it means, factors that contribute to it, and things that can be done to reduce the problem.   Identify the main groups of drugs that can interfere with diabetes therapy (of any type), whether by directly altering blood glucose levels or by interacting with the current antidiabetic drug(s).   Identify the main groups of oral antidiabetic drugs (and a prototype in each); compare and contrast their main mechanisms of action, their main adverse responses, and drug-drug interactions (including mechanisms and likely outcomes) specific to the oral agents.   Describe appropriate interventions for managing acute or chronic hypoglycemia. Describe the potential maternal and fetal consequences of poorly controlled blood glucose levels during pregnancy. Assuming you have a pregnant woman who is being treated for diabetes (type 1 or 2), describe drug therapy changes that usually are indicated until parturition. Summarize the general cause, signs, symptoms, and clinical outcomes of diabetic ketoacidosis. What alterations in carbohydrate and fat (lipid) metabolism occur to contribute to the biochemical and clinical problems?

Drugs for Diabetes Mellitus : 

Drugs for Diabetes Mellitus Diabetes mellitus: overview of the disease and its treatment Insulin I: physiology Insulin II: preparations and administration Insulin III: therapeutic use Oral hypoglycemics for type 2 diabetes New injectable drugs for diabetes Diabetic ketoacidosis Glucagon for insulin overdose

Diabetes Mellitus: Overview of the Disease and its Treatment : 

Diabetes Mellitus: Overview of the Disease and its Treatment Diabetes mellitus Greek word “fountain” Latin word “honey” Disorder of carbohydrate metabolism – Deficiency of insulin – Resistance to action of insulin Sustained hyperglycemia polyuria, polydipsia, ketonuria, and weight loss

Types of Diabetes Mellitus : 

Types of Diabetes Mellitus Type 1 diabetes 5% to 10% of all cases Called insulin-dependent diabetes mellitus (IDDM) Or juvenile-onset diabetes mellitus Primary defect is destruction of pancreatic beta cells

Types of Diabetes Mellitus : 

Types of Diabetes Mellitus Type 2 diabetes Most prevalent form of diabetes Approximately 19 million Americans have it Called non–insulin-dependent diabetes mellitus (NIDDM) Or adult-onset diabetes mellitus Obesity is almost always present Insulin resistance and impaired insulin secretion

Figure 56-1 Conversion of proinsulin to insulin. : 

Figure 56-1 Conversion of proinsulin to insulin.

Complications of Diabetes : 

Complications of Diabetes Short-term Hyperglycemia and hypoglycemia Long-term Macrovascular damage Heart disease Hypertension Stroke Hyperglycemia Altered lipid metabolism

Complications of Diabetes : 

Complications of Diabetes Microvascular damage Retinopathy Nephropathy Neuropathy Gastroparesis Amputations Erectile dysfunction

Diagnosis of Diabetes : 

Diagnosis of Diabetes Excessive plasma glucose is diagnostic of diabetes. Patient must be tested on two separate days, and both tests must be positive. Three tests Fasting plasma glucose (FPG) Casual plasma glucose Oral glucose tolerance (OGTT)

Treatment Overview : 

Treatment Overview Type 1 Goal is to maintain glucose levels Insulin Diet Exercise Type 2 Goal is to maintain glucose levels Diet Exercise

Types of Insulin : 

Types of Insulin Seven types of insulin: Short duration: rapid acting Insulin lispro [Humalog] Insulin aspart [NovoLog] Insulin glulisine [Apidra] Short duration: slower acting Regular insulin [Humulin R, Novolin R] Intermediate duration Neutral protamine Hagedorn (NPH) insulin Insulin determir [Levemir] Long duration Insulin glargine

Figure 56-2 Time-effect relationship for different types of insulin following subcutaneous injection. : 

Figure 56-2 Time-effect relationship for different types of insulin following subcutaneous injection.

Administration : 

Administration Subcutaneous injection Syringe and needle Pen injectors Jet injectors Inhalation Exubera Subcutaneous infusion Portable insulin pumps Implantable insulin pumps Intravenous infusion

Oral Hypoglycemics : 

Oral Hypoglycemics Sulfonylureas Tolbutamide [Orinase] Meglitinides Repaglinide [Prandin] Nateglinide [Starlix] Biguanides Metformin [Glucophage] Thiazolidinediones (Glitazones) Rosiglitazone [Avandia] Pioglitazone [Actos]

Oral Hypoglycemics : 

Oral Hypoglycemics Alpha-glucosidase inhibitors Acarbose [Precose] Miglitol [Glyset] Muraglitazar [Pargluva] Combination products Glyburide/metformin Glipizide/metformin Rosiglitazone/metformin

New Injectable Drugs for Diabetes : 

New Injectable Drugs for Diabetes Pramlintide [Symlin] Supplement to mealtime insulin (type 1 or type 2) Adverse effects—hypoglycemia Exenatide [Byetta] Adjunctive therapy to improve glycemic control in patients with type 2 diabetes Adverse effects Hypoglycemia Gastrointestinal effects

Diabetic Ketoacidosis : 

Diabetic Ketoacidosis Characteristics Hyperglycemia Ketoacids Hemoconcentration Acidosis Coma

Diabetic Ketoacidosis : 

Diabetic Ketoacidosis Treatment Insulin replacement Bicarbonate for acidosis Water and sodium replacement Potassium replacement Normalization of glucose levels

Figure 56-3 Pathogenesis of diabetic ketoacidosis. : 

Figure 56-3 Pathogenesis of diabetic ketoacidosis.

Insulin Overdose : 

Insulin Overdose Glucagon Increases glucose levels Relaxes smooth muscle Response within 20 minutes

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