NR565 Final Exam Study Guide
,Week 5
, Chapter 48 Chapter 49
Glycemic Goals in Type 2 Diabetes Hypothyroidism
Diabetic Nephropathy Prevention: o Treatment in Infants Dose
1st generation vs 2nd generation decreases with age. Doses adjusted
Sulfonylurea: to normalize TSH and free T4.
The second-generation agents are much more o Levothyroxine Administration
potent than the first-generation agents, and hence Levothyroxine is almost always
dosages are much lower (as much as 1000 times administered by mouth. Oral doses
lower in some cases). More important, with the should be taken once daily on an
second-generation agents, significant drug–drug empty stomach (to enhance
interactions are less common, and the outcomes absorption). Dosing is usually done in
tend to be milder. Because of these differences, the the morning, at least 30 to 60 minutes
second-generation agents have nearly completely before eating.
replaced the first-generation agents in clinical o Levothyroxine: Drug interactions
practice. Among these are phenytoin (Dilantin),
DDP4I: Adverse Effects: patients have carbamazepine (Tegretol, Carbatrol),
developed pancreatitis, including fatal rifampin (Rifadin), sertraline (Zoloft),
hemorrhagic or necrotizing pancreatitis and phenobarbital. Accordingly, to
according to postmarketing reports. maintain adequate levothyroxine
Patients should be informed about signs levels, patients taking these drugs
and symptoms of pancreatitis (e.g., may need to increase their
severe and persistent abdominal pain, levothyroxine dosage.
with or without vomiting) and instructed to o Levothyroxine: Adverse Effects
stop sitagliptin immediately With an acute overdose,
DDP4I: MOA: Sitagliptin (Januvia) thyrotoxicosis may result. Signs and
enhances the actions of incretin symptoms include tachycardia,
hormones angina, tremor, nervousness,
GLP-1 receptor agonists: MOA it slows insomnia, hyperthermia, heat
gastric emptying, stimulates glucose- intolerance, and sweating
dependent release of insulin, inhibits o Levothyroxine Monitoring
postprandial release of glucagon, and Measurement of serum TSH is an
suppresses appetite. important means of evaluation.
Successful replacement therapy
Adverse rxn: Exenatide poses a risk for causes elevated TSH levels to fall.
pancreatitis. Severe cases have led to pancreatic However, TSH will not normalize
necrosis, pancreatic hemorrhage, and even death. quickly and often lags behind
Patients should be informed about signs and normalization of serum T3 and T4.
symptoms of pancreatitis—typically severe and Hyperthyroidism
persistent abdominal pain, with or without vomiting— o Methimazole: MOA- First,
and instructed to stop exenatide immediately
methimazole prevents the oxidation of
iodide, thereby inhibiting incorporation
GLP-1 receptor agonists: Monitoring
of iodine into tyrosine. Second,
Glycemic Control Targets:
methimazole prevents iodinated
Hypoglycemia is the biggest concern.
tyrosines from coupling. Both effects
Pramlintide does not cause hypoglycemia
result from inhibiting peroxidase, the
when used alone but poses a risk for
enzyme that catalyzes both reactions.
severe hypoglycemia when combined
Adverse effects: should be avoided by
with insulin, especially in patients with
women who are pregnant or
type 1 diabetes.
breastfeeding. Agranulocytosis is the
Incretin Mimetics: mimics the effects of
most dangerous toxicity. The reaction is
amylin, reduce postprandial levels of
,Week 5
, Chapter 48 Chapter 49
Glycemic Goals in Type 2 Diabetes Hypothyroidism
Diabetic Nephropathy Prevention: o Treatment in Infants Dose
1st generation vs 2nd generation decreases with age. Doses adjusted
Sulfonylurea: to normalize TSH and free T4.
The second-generation agents are much more o Levothyroxine Administration
potent than the first-generation agents, and hence Levothyroxine is almost always
dosages are much lower (as much as 1000 times administered by mouth. Oral doses
lower in some cases). More important, with the should be taken once daily on an
second-generation agents, significant drug–drug empty stomach (to enhance
interactions are less common, and the outcomes absorption). Dosing is usually done in
tend to be milder. Because of these differences, the the morning, at least 30 to 60 minutes
second-generation agents have nearly completely before eating.
replaced the first-generation agents in clinical o Levothyroxine: Drug interactions
practice. Among these are phenytoin (Dilantin),
DDP4I: Adverse Effects: patients have carbamazepine (Tegretol, Carbatrol),
developed pancreatitis, including fatal rifampin (Rifadin), sertraline (Zoloft),
hemorrhagic or necrotizing pancreatitis and phenobarbital. Accordingly, to
according to postmarketing reports. maintain adequate levothyroxine
Patients should be informed about signs levels, patients taking these drugs
and symptoms of pancreatitis (e.g., may need to increase their
severe and persistent abdominal pain, levothyroxine dosage.
with or without vomiting) and instructed to o Levothyroxine: Adverse Effects
stop sitagliptin immediately With an acute overdose,
DDP4I: MOA: Sitagliptin (Januvia) thyrotoxicosis may result. Signs and
enhances the actions of incretin symptoms include tachycardia,
hormones angina, tremor, nervousness,
GLP-1 receptor agonists: MOA it slows insomnia, hyperthermia, heat
gastric emptying, stimulates glucose- intolerance, and sweating
dependent release of insulin, inhibits o Levothyroxine Monitoring
postprandial release of glucagon, and Measurement of serum TSH is an
suppresses appetite. important means of evaluation.
Successful replacement therapy
Adverse rxn: Exenatide poses a risk for causes elevated TSH levels to fall.
pancreatitis. Severe cases have led to pancreatic However, TSH will not normalize
necrosis, pancreatic hemorrhage, and even death. quickly and often lags behind
Patients should be informed about signs and normalization of serum T3 and T4.
symptoms of pancreatitis—typically severe and Hyperthyroidism
persistent abdominal pain, with or without vomiting— o Methimazole: MOA- First,
and instructed to stop exenatide immediately
methimazole prevents the oxidation of
iodide, thereby inhibiting incorporation
GLP-1 receptor agonists: Monitoring
of iodine into tyrosine. Second,
Glycemic Control Targets:
methimazole prevents iodinated
Hypoglycemia is the biggest concern.
tyrosines from coupling. Both effects
Pramlintide does not cause hypoglycemia
result from inhibiting peroxidase, the
when used alone but poses a risk for
enzyme that catalyzes both reactions.
severe hypoglycemia when combined
Adverse effects: should be avoided by
with insulin, especially in patients with
women who are pregnant or
type 1 diabetes.
breastfeeding. Agranulocytosis is the
Incretin Mimetics: mimics the effects of
most dangerous toxicity. The reaction is
amylin, reduce postprandial levels of
