Diabetes Pharm Pathophys
What is amylin? What are its actions?
What is a risk exclusive to SGLT2s that could prove a diagnostic challenge in an emergency setting?
euglycemic DKA
In hypothyroidism you would expect to see ____ TSH and ______ T4. In hyperthyroidism you would expect to see _______ TSH and ____ T4
high, low
low, high
What three classes of medications are used to treat excess of growth hormone?
Somatostatin analog, dopamine agonists, and GH receptor antagonist
What is first line treatment for hypercortisolism?
Surgery
Explain hot vs cold thyroid nodules. Which should be biopsied?
Hot- functioning, releasing hormones. Cold- nonfunctioning, more concerning for malignancy and should be biopsy
Note- also do not biopsy in hyperthyroidism, can cause thyroid storm
What are the three test options for Cushing's syndrome? If you have high suspicion how many should you perform?
Late-night salivary cortisol (2 measurements)
24 hour free urine cortisol excretion (2 measurements)
Overnight 1 mg dexamethasone suppression test
perform 2-3 of the tests if high suspicion
Which two acids are elevated in diabetic ketoacidosis? Which can you check on labs?
acetoacetate and beta-hydroxybutyrate
Which three GLP-1s are preferred for decreasing ASCVD?
Liraglutide (Victoza), Dulaglutide (Trulicity), Semaglutide (Ozempic)
What is the treatment for myxedema coma?
IV T3 + T4, glucocorticoids
Which somatostatin analog is short acting? Which is long?
Short acting- ocreotide (Sandostatin)
Long acting- lanreotide (Somatuline)
Mineralocorticoids are only used in ________ adrenal insufficiency. Why?
Primary; mineralocorticoid production is only affected by primary insufficiency because the problem is with the adrenal gland that produces them. In secondary and tertiary adrenal insufficiency the problem is with the pituitary and hypothalamus, which do not regulate mineralocorticoids (RAAS system does)
What imaging should be done if secondary hypothyroidism is suspected? What labs would lead you to suspect this?
Brain MRI; low T4 and low TSH
In diabetic ketoacidosis you expect sodium to be _____ and potassium to be ______. BUN and Cr are often ______
low, high, elevated
What are the three mechanisms through which the liver regulates blood glucose?
glycogenesis, glycogenolysis, and gluconeogenesis
Which DPP4 inhibitor can be used in patients with renal insufficiency?
Linagliptin (Tradgenta)
Why is T4 used to treat hypothyroidism more commonly than T3?
Because treating with T3 causes peripheral tissues to lose ability to control metabolic rate
What medications are used to treat prolactin excess? What patient populations are they contraindicated in and why?
Contraindicated in uncontrolled HTN, CAD, PAD- because they are ergot derivatives and cause vasoconstriction
What glucocorticoid is preferred in treatment of adrenal insufficiency? Why?
hydrocortisone- because it is given multiple times per day mimicking the endogenous release of cortisol, and it also has mineralocorticoid activity
In hypothyroidism, what antibodies should be tested for? What does a positive test indicate?
In hyperthyroidism, what antibodies should be tested for? What does a positive test indicate?
Hypo: test for thyroid peroxidase antibodies, positive test indicates Hashimoto's thyroiditis
Hyper: thyrotropin receptor antibodies, positive indicates Grave's disease
insulin; islet cell; T1DM; T2DM
What are the functions of pancreatic beta cells? Alpha cells?
Beta cells- insulin synthesis and secretion
Alpha cells- glucagon production
When should alpha-glucosidase inhibitors be used? What are contraindications?
As add-on therapy, not as first line or mono therapy. Contraindicated in liver disease and intestinal diseases
What five things do you use to treat thyroid storm?
beta blockers, thionamide, iodine, hydrocortisone, cholestyramine (bile acid sequestrant)
What medication is indicated for children with Laron syndrome? Why is this indicated instead of recombinant growth hormone?
Mescasermin (Increlex)- it is recombinant IGF-1, needed because the problem is with the growth hormone receptor not the growth hormone itself
For treatment of hypercortisolism, _________ causes __________ in men and __________ causes ________ in women
ketoconazole; feminization
metyrapone; hirsutism
What are five characteristics seen on ultrasound that would lead you to believe a nodule was malignant?
hypo echoic, incomplete halo, irregular margins, micro calcifications, central vascularity
What sodium and potassium abnormalities would you expect to see in Addison's disease and why?
hyponatremia and hyperkalemia due to lack of aldosterone
Diagnostic of diabetes established with:
A1C:
Fasting glucose:
2 hour post-glucose tolerance test:
Random plasma glucose:
A1C: > or = 6.5
Fasting glucose: > or = 126
2 hour post-glucose tolerance test: 200
Random plasma glucose: 200
What are the two thiazolidinediones and what are their MOA?
Pioglitazone (Actos), rosiglitazone (Avandia)
Stimulates PPAR-gamma causing increased insulin sensitivity and decreased fatty acids in plasma
What is the most common cause of requiring increased dose of T4? Most common cause of requiring decreased dose?
Increased: taking calcium or iron supplements
Decreased: aging
What are common side effects of somatotropin? What patient population do they affect?
carpal tunnel, edema, arthralgias, insulin resistance- mostly seen in adults, much fewer side effects in children
Dosing of fludrocortisone is adjusted base on ______ _______, and patients should be monitored for resolution of ________, __________, and _________
plasma renin; hypotension, hyponatremia, hyperkalemia
What would you expect to see on a radioactive iodine uptake scan in the following conditions?
Multinodular goiter:
Toxic adenoma:
Graves' disease:
Factitious thyrotoxicosis:
Multinodular goiter: multiple areas of focal increased and suppressed uptake
Toxic adenoma: focal increased uptake
Graves' disease: diffuse increase uptake
Factitious thyrotoxicosis: low uptake
What results would you expect to see on the following tests for patients with primary adrenal insufficiency? Secondary?
ACTH stimulation test:
ACTH level:
Primary- cortisol levels do NOT increase in ACTH stimulation test, ACTH is high
Secondary- cortisol levels may increase in ACTH stim, ACTH will be low