non-insulin drugs (T2 ONLY)
what is the function of alpha-glucosidase inhibitors (PO)? provide two examples.
slows down carb absorption in the small intestine; acarbose and miglitol
what is the function of Dopamine Receptor Agonists (PO) and provide and example.
unknown mechanism of action; Bromocriptine (Cycloset)
Duration 16-24 hours - no defined peak (low risk hypoglycemia)
○ Degludec (Tresiba)
○ Detemir (Levemir)
○ Glargine (Basaglar, Lantus, Toujeo)
what is the management of hyperthyroidism (6)
● Antithyroid drugs - inhibit thyroid hormone synthesis
○ Propylthiouracil (PTU)
○ Methimazole
● Iodine - inhibits thyroid hormone synthesis and release - often used before surgery
○ Saturated Solution of Potassium Iodine (SSKI)
○ Lugol Solution
○ Mixed with water or juice and taken after meals
○ Sip through straw (could stain teeth)
○ Watch for iodine toxicity - swelling of mouth, nausea, vomiting,
skin reactions
● Beta-Adrenergic Blockers - decrease heart rate, tremors, nervousness
○ Propranolol
● Radioactive Iodine Therapy (RAI)
○ Destroys thyroid tissue
○ Delayed effect (3 months)
○ Side effect of dry and irritated mouth/throat
○ Radiation exposure to others
■ Use private toilets, flush 2-3 times after use of toilet, separate
linens, separate laundry, don’t prepare food for others, avoid
pregnant women and children x 7 days
● Surgery
○ Thyroidectomy - beware of vocal cord and airway swelling or damage
● Nutrition Therapy
○ Frequent, high-calorie meals
○ Avoid caffeine
cushing syndrome and addison disease is from what?
cushing syndrome is from high cortisol and occurs from chronic exposure to excess corticosteroids also caused by medications or tumors that secrete ACTH (adrenal cortex stimulating hormone)
addison disease is from low cortisol and low function of adrenal cortex - decreased corticosteroids; mostly autoimmune and LATE symptoms
what if the function of thiazolidinediones (PO) and provide one example and 3 side effects.
improves insulin sensitivity; pioglitazone (actose); MI, HF, and bladder cancer
what is the function of Amylin Analogs (SQ) and provide an example and 1 side effect.
slows gastric emptying, reduces glucagon release, and increases satiety; Pramlintide (Symlin); Used with insulin; Side Effects: hypoglycemia
rapid/immediate-acting - what is the onset and 3 examples
For meals
○ Aspart (NovoLog)
○ Glulisine (Apidra)
○ Lispro (Humalog)
what is the management of hypothyroidism? (3)
● Drug management
○ Levothyroxine (synthroid) - synthetic T4
○ Started low and slow
○ Taken 30-60 min before food or other meds on
empty stomach (usually early morning)
○ B6?
● Nutrition therapy
○ Low calorie diet
● Symptom management
○ Constipation
what is the main cause of hyperthyroidism?
graves disease
what is the function of Dipeptidyl Peptidase-4 (DDP-4) Inhibitors (PO) and provide one example.
encourages insulin release, decreases glucagon release, and decreases gluconeogenesis; sitagliptin (Januvia)
short acting - what is the onset and 1 example
onset of 30-60 min - for meals
○ Regular Insulin (Humulin R, Novolin R)
how does the TSH and T3/T4 look like in hyperthyroidism and hypothyroidism?
HYPERTHYROIDISM: LOW TSH AND HIGH T3/T4
HYPOTHYROIDISM: HIGH TSH AND LOW T3/T4
describe goiter (causes, hormone levels, and is this a disease or symptom?)
Enlarged thyroid gland
Causes:
● Lack of dietary iodine
● Over or underproduction of thyroid hormones
● Thyroid nodules
Thyroid hormone levels may be normal, increased,
or decreased
More of a symptom than a disease
what is the function of Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors (PO) and provide 3 examples.
increases glucose excretion through urine; Canagliflozin (Invokana), Dapagliflozin (Farxiga), and Empagliflozin (Jardiance)
intermediate acting - what is the duration and 1 example
Duration of 12-18 hours: potential for hypoglycemia at 4-12 hours
○ NPH (Humulin N, Novolin N)
how does calcium and phosphate look in hyperthyroidism? how does calcium and PTH look in hypothyroidism?
hyperthyroidism:HIGH calcium and LOW phosphate
hypothyroidism: LOW calcium and LOW PTH
liver cirrhosis and failure - main management of ascites, management of varices/bleeding, and management of hepatic encephalopathy
ascites: diuretics (spironolactone and furosemide)
varices and bleeding: avoid NSAIDS and avoid high risk bleeding procedures
hepatic encephalopathy: lactulose (decreases ammonia)
what is the function of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (PO or SQ) and provide 3 examples and 3 side effects.
increases insulin from pancreas, stop glucagon release, slow gastric emptying; Semaglutide (Rybelsus) - PO, Liraglutide (Victoza) - SQ, and Dulaglutide (Trulicity) - SQ; Side Effects: Pancreatitis, kidney problems, thyroid cancer
combination insulins - what is being mixed here, how many times daily, and 2 examples with amount split up.
short or rapid mixed with
intermediate acting (usually 2x daily)
○ Aspart protamine/Aspart 70/30 (NovoLog Mix 70/30)
○ NPH/Regular 70/30 (Humulin 70/30, Novolin 70/30)
explain thyroid hormones (HARD)
● Anterior pituitary gland makes TSH (thyroid stimulating hormone)
● In response to TSH, the thyroid makes T3 (Triiodothyronine) and T4 (Thyroxine) hormones (and Calcitonin)
● T3 and T4 regulate energy metabolism and growth and development
● Calcitonin helps regulate Calcium and Phosphate in the blood
thyroiditis main cause, diagnostic tests, and management
cause is Hashimoto thyroiditis
diagnostic tests include
- Bacterial/Viral/Fungal: T3 and T4 high
- Autoimmune Hashimoto: T3 and T4 low, TSH high,
- Antithyroid Antibodies
management includes:
● Acute
○ May resolve without treatment
○ Antibiotics
○ Antiinflammatories (NSAIDS, Corticosteroids)
● Chronic Autoimmune
○ Treat as hypo or hyperthyroidism
○ Beware of more than one autoimmune disorder