lOMoAR cPSD| 37917070
Advanced Pharmacology For Nurse Practitioners (The
University Of Texas At Arlington DIABETES 2025-2026
- Know Diagno C Criteria For DB O F Ng Glucose Of 126 O Casual Glucose Of 200 Or
Higher O A1c Of 6.5 Or Greater
o NO NEED TO DO ANY OTHER TESTS – THIS IS DEFINITIVE
- BP Of 140/90 Or Higher (HTN) Per JNC8
- BP Of 130/90 Or Higher (HTN) Per ACE/ACCE O Treat These Pt’s For HTN
- Review Rip’s Pearls For Insulin (Not Expected To Memorize All The Insulins) - KNOW
ABOUT THE BASAL INSULINS!!!
o When To Prescribe O How To 昀椀 Gure Dosages On Long-Ac 琀椀 Ng Insulins
Etc.
o Basal Is Always The 昀椀 Rst Insulin For DM2 If Orals Are Not Working
- Me 琀昀 Ormin Is Always 昀椀 Rst Med To Be Given
- Lifestyle Changes And Me 琀昀 Ormin: Step 1
- Step One Plus Adding A Second Drug Such As Sulfonylurea, TZD, DPP-4 Inhibitor, SLG2
Inhibitor, GLP1 Receptor Agonist, Or Basal Insulin: Step 2
- Same As Step Two, With A Three Drug Combo (Including Me 琀昀 Ormin): Step 3
- If 3 Drug Combo Does Work, As Basal Insulin: Step 4
- Know Percentages Of A1C Reduc 琀椀 Ons; Weight Gain, Weight Neutral, Weight Loss
Of Medica 琀椀 Ons (TABLE IN PRESCRIBERS LETTER ABOUT THIS)
- Me 琀昀 Ormin Side E 昀昀 Ects Most Common –
GI E 昀昀 Ects O Need To 琀椀 Trate This Med Up
o Lac 琀椀 C Acidosis Is Only An Issue In Pa 琀椀 Ents With CKD
Typically – But Does Not Make Kidney Func 琀椀 On Worse
o Inhibits Glucose Produc 琀椀 On In The Liver; Reduces Glucose
Absorp 琀椀 On In The Gut, Sensi 琀椀 Zes Insulin Receptors In The
Target 琀椀 Ssue And Increases Glucose Reuptake To Whatever
Insulin Is Available
o 1-2 % A1C Reduc 琀椀 On !!!!! O Can Cause Weight Loss O Used In
PCOS Because It Helps With Weight Loss And Insulin Resistance
- Sulfonylureas: Glipizide (Liver Toxicity), Glyburide
(Renal Toxicity), Glimepiride (Renal And Liver
Toxicity)
o Cause Hypoglycemia And Weight Gain (KNOW THESE) O 1.5%-2 %
A1C Reduc 琀椀 On !!!!! O Very Inexpensive
Downloaded by Heather Matheson ()
, lOMoAR cPSD| 37917070
- Megli 琀椀 Nides – Repaglinide, Nateglinide O
Cause Hypoglycemia And Weight Gain O 0.5%-1.5
% A1C Reduc 琀椀 On !!!!!!
- TZD’s – Rosiglitazone, Poglitazone O Reduces
Insulin Resistance And Decreased Glucose Produc
琀椀 On
O Weight Gain O 0.5%-1.4 %
A1C Reduc 琀椀 On !!!!!
- Alpha Glucosidase
Inhibitors – Miglitol,
Acarbose O Act In The
Intes 琀椀 Ne To Delay
Glucose Absorp 琀椀 On O
Can Cause Explosive
Diarrhea – Not Always A
Good Choice O Does Not
Cause Weight Gain Or
Weight Loss – Weight
Neutral O 0.5%-0.8 % A1C
Reduc 琀椀 On !!!!!
- DPP4 Inhibitors – Glip 琀椀
Ns O Side E 昀昀 Ects Are
UTI’s O Weight Loss
O 0.6%-0.8 % A1C Reduc 琀椀 On
- SLG2 Inhibitors – 昀氀 Ozins O Have Been Shown To Block The Reabsorp 琀椀
On Of 昀椀 Ltered Glucose, Leading To Glucosuria Which Can Lead To Yeast
Infec 琀椀 Ons And UTI’s
o Do Not Work Well With Pt’s Who
Have A GFR Of Less Than 45, So These
Should Not Be Ini 琀椀 Ated In Them
Unless They Are Already Taking – Then
You Can Give Un 琀椀 L They Have A
GFR Of 30 Or Less
o Come In Combo Forms With Me 琀昀
Ormin O Can Cause Weight Loss O
0.7%-0.99 % A1C Reduc 琀椀 On !!!!
- Colesevelam And Bromocrip 琀椀 Ne – Not O 昀琀 En Given In DM
Downloaded by Heather Matheson ()
, lOMoAR cPSD| 37917070
- Injectables O GLP1 Receptor Agonists (Incre 琀椀 N Mime 琀椀 Cs) – Exana 琀
椀 De Bye 琀琀 A, Liraglu 琀椀 De, Dulaglu 琀椀 De, Lixisena 琀椀 De, Semaglu
琀椀 De (Comes In PO Also)
Slows Gastric Emptying, S 琀椀 Mulates Glucose Dependent Release
Of Insulin, Inhibits Post-Prandial Release Of Glucagon, And Suppresses
Appe 琀椀 Te
INCREASES RISK FOR MEDULLARY THYROID CANCER SO AVOID IN PT’S
WHO ARE AT RISK FOR THIS - Amylin Mime 琀椀 Cs – Pramlini 琀椀
De
THYROID
Hypothalamus Produces Thyrotropin Releasing Hormone, Which S 琀椀 Mulates The Pituitary
To Release Thyroid S 琀椀 Mula 琀椀 Ng Hormone, Which S 琀椀 Mulates The Thyroid To
Produce T4 And Then Converts To T3 In The Periphery
- T3 Is Highly Protein Bound (99% Protein Bound) And 1% Of Freely Circula 琀椀 Ng
Which Is Where We Get Our Func 琀椀 On From
- Any Break In This Cycle Will Cause Hypo Or Hyperthyroidism
- If This Occurs At The Hypothalamus Level – Ter 琀椀 Ary Hypo Or Hyper
- If It Occurs At The Pituitary – Secondary Hypo Or Hyper
- We Will Focus On The Primary Hypo And Hyperthyroidism
- Check Females Older Than 40 Yearly For Thyroid Issues
- Hardly Every Refer These Pa 琀椀 Ents Out Unless They Have Hyperthyroidism Or
Uncontrolled Hypothyroidism
- Only Check TSH – Then If That Is Abnormal, You Can Order The Other Labs O
Hypothyroidism: TSH Elevated And Free T4 Low (Because Free T4 Is The Circula 琀椀 Ng
One)
O Hyperthyroidism: TSH Low And Free T3 And T4 Are Elevated
O Subclinical: TSH Low Or High With Normal Free T4
Only Treat IF It Is 10 Or Higher
These Pa 琀椀 Ents Will Convert To Either Hypo Or Hyper At Some Point,
Or They May Never
- To Get Your Pt To A Euthroid State With Medica 琀椀 On O 1.6-1.8 Mcg/Kg/Day For
Adults That Are Healthy Under 50 Years Old O Pa 琀椀 Ents Who Are Over 50, Start
Them On 50 Mcg/Day
o Older Pa 琀椀 Ents Who Have CAD Should Be On 12.5-25 Mcg/Day – Remember
To Start Low And Go Slow
o DO NOT HAVE TO KNOW THE YOUNGER DOSAGES
Pa 琀椀 Ents Younger Than 3 Months, Give 10-15 Mcg/Kg/Day
Downloaded by Heather Matheson ()
, lOMoAR cPSD| 37917070
Pa 琀椀 Ents Aged 3 Months To 5 Months, Give 8-10 Mcg/Kg/Day
Pa 琀椀 Ents Aged 6 Months To 11 Months, Give 6-8 Mcg/Kg/Day
Pa 琀椀 Ents A 昀琀 Er 1 Year To 5 Years, Give 6 Mcg/Kg/Day
Pa 琀椀 Ents Aged 6 Years To 12 Years, Give 4-5 Mcg/Kg/Day O
WILL HAVE A DOSAGE CALCULATION OVER THIS!!!!! NEED TO KNOW THE 1.6-
1.8
MCG/KG/DAY EXCEPT FOR PATIENTS 50 OR OLDER (50 MCG DAILY)
- Medica 琀椀 Ons O Thyroid Hormone Prepara 琀椀 Ons
Levothyroxine
• Synthe 琀椀 C Prepara 琀椀 On Of T4 And Drug Choice For
Hypothyroidism
• Conversion To T3
• Half Life Is 7 Days
• Used For ALL Forms Of Hypothyroidism
• Extremely Inexpensive
• Have These Pa 琀椀 Ents Back In 6-8 Weeks A 昀琀 Er Star 琀椀
Ng (Only Do A TSH Lab)
• If TSH Is S 琀椀 Ll High, Increase The Dosage (Typically By 12.5-25
Mcg) And Have Them Come Back In Another 6-8 Weeks
• If It Is Good, Come Back In 6 Months, And Then If It Is Normal
Come Back In A Year
Liothyroxine (Cytomel)
Synthe 琀椀 C T3
Liotrix (Thyrolar)
• Mixture Of Synthe 琀椀 C T4 Plus Synthe 琀椀 C T3 In A 4:1 昀椀
Xed Ra 琀椀 O
• Because Levothyroxine Alone Produces The Same Ra 琀椀 On Of
T4 To T3, This O 昀昀 Er No Advantage Over Levothyroxine For
Most Indica 琀椀 Ons
Thyroid (Armour Thyroid, Others)
• Consists Of Desiccated Animal Thyroid Glands
• Standardiza 琀椀 On Is Based On Content Of Iodine,
Levothyroxine, And Liothyronine
• The Ra 琀椀 O Of Levothyroxine To Liothyronine Is Not Less Than
5:1
• Thyroid Is Available In Tablets (15-300 Mg)
o Drug Interac 琀椀 Ons
Downloaded by Heather Matheson ()
Advanced Pharmacology For Nurse Practitioners (The
University Of Texas At Arlington DIABETES 2025-2026
- Know Diagno C Criteria For DB O F Ng Glucose Of 126 O Casual Glucose Of 200 Or
Higher O A1c Of 6.5 Or Greater
o NO NEED TO DO ANY OTHER TESTS – THIS IS DEFINITIVE
- BP Of 140/90 Or Higher (HTN) Per JNC8
- BP Of 130/90 Or Higher (HTN) Per ACE/ACCE O Treat These Pt’s For HTN
- Review Rip’s Pearls For Insulin (Not Expected To Memorize All The Insulins) - KNOW
ABOUT THE BASAL INSULINS!!!
o When To Prescribe O How To 昀椀 Gure Dosages On Long-Ac 琀椀 Ng Insulins
Etc.
o Basal Is Always The 昀椀 Rst Insulin For DM2 If Orals Are Not Working
- Me 琀昀 Ormin Is Always 昀椀 Rst Med To Be Given
- Lifestyle Changes And Me 琀昀 Ormin: Step 1
- Step One Plus Adding A Second Drug Such As Sulfonylurea, TZD, DPP-4 Inhibitor, SLG2
Inhibitor, GLP1 Receptor Agonist, Or Basal Insulin: Step 2
- Same As Step Two, With A Three Drug Combo (Including Me 琀昀 Ormin): Step 3
- If 3 Drug Combo Does Work, As Basal Insulin: Step 4
- Know Percentages Of A1C Reduc 琀椀 Ons; Weight Gain, Weight Neutral, Weight Loss
Of Medica 琀椀 Ons (TABLE IN PRESCRIBERS LETTER ABOUT THIS)
- Me 琀昀 Ormin Side E 昀昀 Ects Most Common –
GI E 昀昀 Ects O Need To 琀椀 Trate This Med Up
o Lac 琀椀 C Acidosis Is Only An Issue In Pa 琀椀 Ents With CKD
Typically – But Does Not Make Kidney Func 琀椀 On Worse
o Inhibits Glucose Produc 琀椀 On In The Liver; Reduces Glucose
Absorp 琀椀 On In The Gut, Sensi 琀椀 Zes Insulin Receptors In The
Target 琀椀 Ssue And Increases Glucose Reuptake To Whatever
Insulin Is Available
o 1-2 % A1C Reduc 琀椀 On !!!!! O Can Cause Weight Loss O Used In
PCOS Because It Helps With Weight Loss And Insulin Resistance
- Sulfonylureas: Glipizide (Liver Toxicity), Glyburide
(Renal Toxicity), Glimepiride (Renal And Liver
Toxicity)
o Cause Hypoglycemia And Weight Gain (KNOW THESE) O 1.5%-2 %
A1C Reduc 琀椀 On !!!!! O Very Inexpensive
Downloaded by Heather Matheson ()
, lOMoAR cPSD| 37917070
- Megli 琀椀 Nides – Repaglinide, Nateglinide O
Cause Hypoglycemia And Weight Gain O 0.5%-1.5
% A1C Reduc 琀椀 On !!!!!!
- TZD’s – Rosiglitazone, Poglitazone O Reduces
Insulin Resistance And Decreased Glucose Produc
琀椀 On
O Weight Gain O 0.5%-1.4 %
A1C Reduc 琀椀 On !!!!!
- Alpha Glucosidase
Inhibitors – Miglitol,
Acarbose O Act In The
Intes 琀椀 Ne To Delay
Glucose Absorp 琀椀 On O
Can Cause Explosive
Diarrhea – Not Always A
Good Choice O Does Not
Cause Weight Gain Or
Weight Loss – Weight
Neutral O 0.5%-0.8 % A1C
Reduc 琀椀 On !!!!!
- DPP4 Inhibitors – Glip 琀椀
Ns O Side E 昀昀 Ects Are
UTI’s O Weight Loss
O 0.6%-0.8 % A1C Reduc 琀椀 On
- SLG2 Inhibitors – 昀氀 Ozins O Have Been Shown To Block The Reabsorp 琀椀
On Of 昀椀 Ltered Glucose, Leading To Glucosuria Which Can Lead To Yeast
Infec 琀椀 Ons And UTI’s
o Do Not Work Well With Pt’s Who
Have A GFR Of Less Than 45, So These
Should Not Be Ini 琀椀 Ated In Them
Unless They Are Already Taking – Then
You Can Give Un 琀椀 L They Have A
GFR Of 30 Or Less
o Come In Combo Forms With Me 琀昀
Ormin O Can Cause Weight Loss O
0.7%-0.99 % A1C Reduc 琀椀 On !!!!
- Colesevelam And Bromocrip 琀椀 Ne – Not O 昀琀 En Given In DM
Downloaded by Heather Matheson ()
, lOMoAR cPSD| 37917070
- Injectables O GLP1 Receptor Agonists (Incre 琀椀 N Mime 琀椀 Cs) – Exana 琀
椀 De Bye 琀琀 A, Liraglu 琀椀 De, Dulaglu 琀椀 De, Lixisena 琀椀 De, Semaglu
琀椀 De (Comes In PO Also)
Slows Gastric Emptying, S 琀椀 Mulates Glucose Dependent Release
Of Insulin, Inhibits Post-Prandial Release Of Glucagon, And Suppresses
Appe 琀椀 Te
INCREASES RISK FOR MEDULLARY THYROID CANCER SO AVOID IN PT’S
WHO ARE AT RISK FOR THIS - Amylin Mime 琀椀 Cs – Pramlini 琀椀
De
THYROID
Hypothalamus Produces Thyrotropin Releasing Hormone, Which S 琀椀 Mulates The Pituitary
To Release Thyroid S 琀椀 Mula 琀椀 Ng Hormone, Which S 琀椀 Mulates The Thyroid To
Produce T4 And Then Converts To T3 In The Periphery
- T3 Is Highly Protein Bound (99% Protein Bound) And 1% Of Freely Circula 琀椀 Ng
Which Is Where We Get Our Func 琀椀 On From
- Any Break In This Cycle Will Cause Hypo Or Hyperthyroidism
- If This Occurs At The Hypothalamus Level – Ter 琀椀 Ary Hypo Or Hyper
- If It Occurs At The Pituitary – Secondary Hypo Or Hyper
- We Will Focus On The Primary Hypo And Hyperthyroidism
- Check Females Older Than 40 Yearly For Thyroid Issues
- Hardly Every Refer These Pa 琀椀 Ents Out Unless They Have Hyperthyroidism Or
Uncontrolled Hypothyroidism
- Only Check TSH – Then If That Is Abnormal, You Can Order The Other Labs O
Hypothyroidism: TSH Elevated And Free T4 Low (Because Free T4 Is The Circula 琀椀 Ng
One)
O Hyperthyroidism: TSH Low And Free T3 And T4 Are Elevated
O Subclinical: TSH Low Or High With Normal Free T4
Only Treat IF It Is 10 Or Higher
These Pa 琀椀 Ents Will Convert To Either Hypo Or Hyper At Some Point,
Or They May Never
- To Get Your Pt To A Euthroid State With Medica 琀椀 On O 1.6-1.8 Mcg/Kg/Day For
Adults That Are Healthy Under 50 Years Old O Pa 琀椀 Ents Who Are Over 50, Start
Them On 50 Mcg/Day
o Older Pa 琀椀 Ents Who Have CAD Should Be On 12.5-25 Mcg/Day – Remember
To Start Low And Go Slow
o DO NOT HAVE TO KNOW THE YOUNGER DOSAGES
Pa 琀椀 Ents Younger Than 3 Months, Give 10-15 Mcg/Kg/Day
Downloaded by Heather Matheson ()
, lOMoAR cPSD| 37917070
Pa 琀椀 Ents Aged 3 Months To 5 Months, Give 8-10 Mcg/Kg/Day
Pa 琀椀 Ents Aged 6 Months To 11 Months, Give 6-8 Mcg/Kg/Day
Pa 琀椀 Ents A 昀琀 Er 1 Year To 5 Years, Give 6 Mcg/Kg/Day
Pa 琀椀 Ents Aged 6 Years To 12 Years, Give 4-5 Mcg/Kg/Day O
WILL HAVE A DOSAGE CALCULATION OVER THIS!!!!! NEED TO KNOW THE 1.6-
1.8
MCG/KG/DAY EXCEPT FOR PATIENTS 50 OR OLDER (50 MCG DAILY)
- Medica 琀椀 Ons O Thyroid Hormone Prepara 琀椀 Ons
Levothyroxine
• Synthe 琀椀 C Prepara 琀椀 On Of T4 And Drug Choice For
Hypothyroidism
• Conversion To T3
• Half Life Is 7 Days
• Used For ALL Forms Of Hypothyroidism
• Extremely Inexpensive
• Have These Pa 琀椀 Ents Back In 6-8 Weeks A 昀琀 Er Star 琀椀
Ng (Only Do A TSH Lab)
• If TSH Is S 琀椀 Ll High, Increase The Dosage (Typically By 12.5-25
Mcg) And Have Them Come Back In Another 6-8 Weeks
• If It Is Good, Come Back In 6 Months, And Then If It Is Normal
Come Back In A Year
Liothyroxine (Cytomel)
Synthe 琀椀 C T3
Liotrix (Thyrolar)
• Mixture Of Synthe 琀椀 C T4 Plus Synthe 琀椀 C T3 In A 4:1 昀椀
Xed Ra 琀椀 O
• Because Levothyroxine Alone Produces The Same Ra 琀椀 On Of
T4 To T3, This O 昀昀 Er No Advantage Over Levothyroxine For
Most Indica 琀椀 Ons
Thyroid (Armour Thyroid, Others)
• Consists Of Desiccated Animal Thyroid Glands
• Standardiza 琀椀 On Is Based On Content Of Iodine,
Levothyroxine, And Liothyronine
• The Ra 琀椀 O Of Levothyroxine To Liothyronine Is Not Less Than
5:1
• Thyroid Is Available In Tablets (15-300 Mg)
o Drug Interac 琀椀 Ons
Downloaded by Heather Matheson ()
