PHARM ENDO REVIEW:
1. Types of Diabetes Using Insulin Only vs. Oral Hypoglycemic Agents:
• Insulin Only: Type 1 Diabetes Mellitus (T1DM) requires insulin because the
body does not produce any insulin.
• Oral Hypoglycemic Agents: Type 2 Diabetes Mellitus (T2DM) can use oral
hypoglycemic agents because the body produces insulin but is resistant to
it. Examples include Metformin, Sulfonylureas, and DPP-4 inhibitors.
• Rationale: T1DM patients lack insulin production, making external insulin
essential. T2DM patients may manage with medications that enhance insulin
sensitivity or secretion.
1. Contraindications of Metformin:
• Contraindications: Renal impairment, metabolic acidosis, liver disease,
severe dehydration, heart failure, and conditions predisposing to hypoxemia.
• Rationale: Metformin is cleared by the kidneys, so renal impairment
increases the risk of lactic acidosis. Conditions that reduce oxygen levels
also increase this risk.
2. Interventions for Serious Hypoglycemic Overdose:
• Interventions: Administer IV glucose, provide glucagon injection if IV access
is unavailable, and monitor blood glucose levels closely.
• Rationale: Rapid correction of blood glucose levels is necessary to prevent
severe complications such as seizures, loss of consciousness, or death.
3. Side Effects of Levothyroxine:
• Side Effects: Palpitations, weight loss, increased appetite, heat intolerance,
anxiety, insomnia.
• Rationale: These symptoms arise from over-replacement or hyperthyroidism
effects due to excess thyroid hormone.
4. Methods of Reducing Steroid Use:
• Methods: Gradual tapering, using the lowest effective dose, alternating day
therapy, and using steroid-sparing agents.
• Rationale: Reducing steroid use minimizes adverse effects and allows the
adrenal glands to recover their function.
5. Purposes of Insulin:
• Purposes: Regulate blood glucose levels, manage hyperglycemia in
diabetes, and treat diabetic ketoacidosis (DKA) and hyperosmolar
hyperglycemic state (HHS).