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Medications used to Tx. Endocrine Disorders : 

Medications used to Tx. Endocrine Disorders

Diabetic Mellitus : 

Diabetic Mellitus

Slide 3: 

Hypoglycemia Fasting blood glucose levels < 60 mg/dL Hyperglycemia Fasting blood glucose level >100 mg/dL Hemoglobin A1C less than > 8 Complication of Hyperglycemia Microvascular Capillaries Eyes Kidneys Peripheral tissue Macrovascular heart brain neuropathic parathesia

Type 1 and Type 2 DMsee page 571 Table 36-1 : 

Type 1 and Type 2 DMsee page 571 Table 36-1 Diabetis Mellitus Type 1 (10%) Onset prior to age 20 Rapid onset Polydipsia Polyuria Increase appetite Decrease weight Ketoacidosis Requires insulin Beta cells of pancreas no longer secrete insulin Diabetis Mellitus Type 2 (90%) Onset generally after age 40 Insulin deficiency Insulin resistance Increase glucose productivity by liver Does not necessarily require insulin Oral antidiabetic agents

Tx. of Diabetic Mellitus : 

Tx. of Diabetic Mellitus Diet Healthy weight Exercise Education Medication

Special Attention : 

Special Attention Feet Skin Teeth Infections Dyslipidemia Hypertension Clotting disorders

Slide 7: 

Comprehensive Diabetes Evaluation: Initial Laboratory Evaluation Hemoglobin A1C Fasting lipids U/A Microalbuminuria (yearly) BUN/Cr (Yearly) TSH (Yearly) EKG (Yearly) Anti-GAD antibodies (Once) (Type 1 DM) C-peptide level (yearly for 5 years) Every Visit Labs FBS A1C every 3 months or fructosamine every 2-3 weeks U/A

Slide 8: 

Comprehensive Diabetes Evaluation: Referrals Eye examination (yearly) Medical Nutrition therapy (at lease once) Podiatry (yearly)

Signs and Symptoms : 

Signs and Symptoms Hyperglycemia Headache Nausea & vomiting Abdominal pain Dizziness Tachycardia Tachypnea Shallow respirations Fruity breath Can also result in coma and death Hypoglycemia Early Symptoms Nervousness Tremors Headache Apprehension Sweating, cold, clammy (diaphoretic) Hungry Late Symptoms Blurred vision Poor coordination Incoherence Coma death

Treatment of early hypoglycemia : 

Treatment of early hypoglycemia Fruit juice 1 cup of skim milk 4 ounces of soda Piece of candy Glucose Repeat in 10-15 minutes if relief of symptoms not evident

Treatment of hyperglycemia : 

Treatment of hyperglycemia Hydration if applicable Insulin Close monitoring (hospitalized)

Monitoring Glucose Level : 

Monitoring Glucose Level Check blood glucose level just before meals 1 to 2 hours after meals before bed b/t 2:00 and 3:00 am

Hemoglobin A1C : 

Hemoglobin A1C Measures the percent of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. Provides a reflection of the average blood sugar level attained over the past 8 to 10 weeks.

Factors r/t insulin : 

Factors r/t insulin Onset-time required for the medication to have an initial effect Peak- when the agent will have the maximum effect Duration-length of time the agent remains active in the body

Insulinsee page 587 : 

Insulinsee page 587

Slide 16: 

Inhaled insulin Exubera 0.05 mg/kg inhaled tid (immediately prior to meals) 1 mg = 3 units regular insulin 3 mg = 8 units regular insulin

Mixing Insulin : 

Mixing Insulin Start with Cloudy (air) Clear (air) Clear (withdraw) End with Cloudy (withdraw)

Oral Antidiabetic Agents : 

Oral Antidiabetic Agents Treatment: Three classes of oral agents for treatment of type 2 diabetes biguanides sulfonylureas Thiazolidinediones

Biguanides: : 

Biguanides: Actions: Decrease Gluconeogenesis and increases insulin sensitivity Reduce absorption of glucose from Small Intestine Recommended initial medical therapy in almost all Type 2 pts. Decrease A1C by 1-2. Advantage: No hypoglycemia Metformin (Glucophage): 500 mg PO q day then up to 1000 mg PO bid Avoid use in situations where lactic acidosis is more likely. Liver disease. Renal insufficiency (Cr >1.5 male / Cr >1.4 female)

Sulfonylureas: : 

Sulfonylureas: Increase insulin secretion by stimulating beta cell function of the pancreas Metabolism of insulin by liver Decrease A1C by 1-2. Glipizide (Glucotrol) 2.5 mg PO q day (start), 20 mg PO bid (max) Glyburide (Micronase) 2.5 mg PO q day (start), 20 mg PO q day (max) Glimepizide (Amaryl) 1 mg PO q AM 8 mg PO q day (max) Biggest risk is hypoglycemia.

Slide 21: 

Thiazodiolidinediones (TZD’s) This action leads to increased insulin sensitivity in peripheral tissues. Decrease glucose production by liver A1C lowering of 1-1.5. Pioglitazone (Actos) 15 mg PO q day (start), 45 mg PO q day (max) Rosiglitazone (Avandia) 2 mg PO q day (start) 8 mg PO q day (max) Advantage of class is ability to dose in renal insufficiency. Disadvantages are increase in weight / increase peripheral edema / precipitate CHF / lower Hemoglobin / precipitate MI (not shown in randomized trial, but shown in recent meta analysis).

Slide 22: 

DPP-IV Inhibitors Dipeptidyl peptidase IV. Enzyme that deactivates GLP-1 and GIP. A1C reduction of 0.5-1.0. Sitagliptin (Januvia) 100 mg PO q day Approved for Type 2 DM. Monotherapy or ideally as add on to metformin or TZD. Advantages: Oral dosing Disadvantages: Cost Renal adjustment required.

Slide 23: 

A patient presents with symptoms of polyuria, polyphagia, and polydipsia. Which of the following casual plasma glucose levels meets the criteria for a diagnosis of diabetes? A. 111 mg/dL B. 134 mg/dL C. 152 mg/dL D. 183 mg/dL E. 200 mg/dL

Slide 24: 

Because of the correlation between mean plasma glucose and hemoglobin (Hb) A1c levels, the American Association of Clinical Endocrinologists recommends an HbA1c goal of: A. Less than 7.5% B. Less than 7% C. Less than 6.5% D. Less than 6% E. Less than 5.5%

Slide 25: 

Which of the following oral antidiabetic agents does not cause hypoglycemia when given alone? A. Metformin B. Acarbose C. Repaglinide D. Glyburide

Hypothyroidism : 

Hypothyroidism Inadequate thryoid hormone myxedema (adult onset) cretinism (congenital onset) Low serum levelvs of T3 and T4 Replacement of thyroid hormone Levothyroxine (Synthroid)-synthetic form of natural thyroid hormone (T4) Usual dosage: 0.1-0.2 mg daily See page 611 for drug interactions

Corticosteroids : 

Corticosteroids Mineralocorticoids Aldosterone Maintain fluid and electrolyte balance a nd are used to treat adrenal insufficiency caused by hypopituitarism or Addision’s disease Glucocorticoids Cortisone Hydrocortisone Prednisone Regulate carbohydrate, protein, and fat metabolism Have antiinflammatory anitallergenic and immunosuppressant activity

Corticosteroids : 

Corticosteroids Betamethasone (Celestone)-many forms Cortisone-tablet Desoximetasone (Topicort) –creamz Dexamethasone (Decadrone)-many forms Hydrocortisone (Cortef, Solu-Cortef, Hydrocortone)-many forms Methylprednisolone (Solu-Medrol, Depo-medrol, Medrol)- many forms Prednisone Triamcinolone (Aristocort, Kenalog, Nasocort)-many forms

Corticosteroids : 


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