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8. Endocrinology & Reproductive
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
Mechanisms
Alpha Glucosidase Inhibitors
Delays Absorption of Carbohydrates
Indications
Type 2 Diabetes
Side Effects
Flatulence
Diarrhea
Anemia
Cramps
Considerations
Monitor LFTs
Oral Glucose for Hypoglycemia
2 mins
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
Mechanisms
1st Generation Sulfonylureas
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Possible Cardiovascular Toxicity
Weight Gain
Considerations
Exacerbated Hypoglycemia with Beta-blockers
Avoid During Pregnancy and Breast Feeding
Avoid Alcohol
2 mins
Euthyroid Sick Syndrome (ESS)
epi: hospitalized patients
pathophys: dec T4 → T3 conversion
workup: *dec total & free T3*
inc rT3
mgmt: supportive
Exenatide (Byetta)
Mechanism
Incretin Mimetic
GLP-1 Synthetic Analog
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Nausea and Vomiting
Diarrhea
Thyroid Cancer
Pancreatitis
Renal Failure
Considerations
(Give Exenatide) One Hour After Other Medications
Adjunct Therapy
3 mins
Glucagon (GlucaGen)
Mechanism
Increases Glucose
Indications
Hypoglycemic Emergency
Side Effects
Nausea and Vomiting
Considerations
Reconstitute Powder
Consume Oral Carbohydrates
50% Dextrose IV (If No Effect)
2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
-gliptin Suffix
Mechanisms
DPP-4 Inhibitor
Increases Insulin Release
Indications
Type 2 Diabetes
Side Effects
Pancreatitis
Upper Respiratory Infection and Inflammation
Stevens-Johnson Syndrome
Considerations
Used as Add-on Agents
2 mins
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
Pathophysiology
Hypersecretion of ADH
Increased Sensitivity to ADH
Signs & Symptoms
Serum Hypoosmolality
Coma and Seizure
Dilutional Hyponatremia
Cramps and Tremors
Euvolemia
Change in LOC
2 mins
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions
Monitor Serum and Urine Osmolality
IandOs with Daily Weights
Restrict Fluid Intake
Monitor Cardiovascular and Neurological Status
Seizure Precautions
2 mins
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions
Diuretics
Hypertonic IV Fluids
Demeclocycline
Tolvaptan and Conivaptan
1 min
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