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### A Boards Review - ROWE ###*** > Endocrine > Flashcards

Endocrine Flashcards

1
Q

metabolic syndrome

A

any three of obesity, HTN, dyslipidemia, and hyperglycemia

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2
Q

deformity to foot caused by trauma due to peripheral neuropathy.

A

charcots foot

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3
Q

what is the cause of type one DM

A

destruction of pancreatic beta cells

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4
Q

Pre-diabetes

A

A1C between 5.7%-6.4%
Fasting glucose 100-125 mg/dL
2hr random glucose 140-199 mg/L

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5
Q

Diagnostic Criteria for DM

A

A1C >6.5%
Fasting glucose = or >126 mg/dL
2hr random glucose equal or >200 mg/dL
Symptoms of hyperglycemia (polyuria, polydipsia, polyphagia)

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6
Q

Check AIC

A

Q3 months until glucose controlled, then Q6 months.

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7
Q

Goal AIC should be under

A

7

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8
Q

Goal for AIC for elderly is

A

<8

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9
Q

Metformin do not use in

A

renal disease, hepatic acidosis, alcoholics, hypoxia

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10
Q

Metformin should be held for IV contrast testing when

A

48 hours prior to procedure, check creatinne clearance

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11
Q

sulfonylureas cause what

A

weight gain

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12
Q

if AIC > 9 should start what

A

insulin

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13
Q

max dose of metformin is

A

2,000

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14
Q

pheochromocytoma s.s

A

random attacks of HA, diaphoresis, tachycardia, HTN

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15
Q

triggers of Pheochromocytoma

A

physical exertion, anxiety, stress, surgery, labor and delivery, foods ↑ tyramine (some cheeses, beer, wine, chocolate, cold cuts), MAOIs

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16
Q

Cushing Syndrome
Hypercortisolism
cause is

A

too much cortisol levl for a long time

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17
Q

cushings s/s

A

buffalo hump, moon face, purple stretch marks, pot belly

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18
Q

Addison’s disease
Hyporcortisolism

A

adrenal produce insufficient insulin

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19
Q

s.s of addisons are

A

fatigue, nausea, hyperpigmentaton of the skin, salt cravings

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20
Q

common autoimmune disorder. Due to ↑ metabolism: osteopenia/osteoporosis, RA, pernicious anemia. (Supplement w/ Ca + Vitamin D 1,200mg)

A

graves

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21
Q

Primary hyperthyroidism s.s

A

Weight ↓, anxiety, insomnia, palpitations, HTN, Afib, warm skin, diaphoresis, exophthalmos, frequent BM, thyroid nodules, tremors

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22
Q

meds for primary hyperthyroidism are

A

PTU, methimazole (tapazole), BB

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23
Q

Primary hypothyroidism

A

Presentation: ↑TSH, ↓T3/T4.
* Weight ↑, fatigue, cold intolerance, constipation, menstrual abnormalities, alopecia, cholesterol ↑,
Cause: Decreased production of T3/T4. Attention
* Hashimoto’s Thyroiditis
* Myxedema: severely advanced hypothyroidism, changes in LOC, depression, dementia, hypotension, hypothermia.
Meds: Levothyroxine (Synthroid).

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24
Q

Recheck TSH every

A

6 - 8 weeks, stable check yearly

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25
Q

Lupus commonly seen in

A

women of child bearing age
15-45
black , asian, latino higher risk

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26
Q

symptoms of lupus are

A

4 - 11 criteria is needed to diagnose
malar rash (butterfly rash)
Discoid rash
photosensitivity
Oral and nasal ulcers
cardio pulmonary complaints
nuerological
Positive ANA
Hemotological disorders

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27
Q

Lupus malar rash (butterlfy rash)

A

Spares the nasolabial folds - occurs in majority of patients

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28
Q

Sjogrens syndrome can also be part of

A

lupus

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29
Q

Sjogrens syndrome s/s

A

dry eyes and dry mouth

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30
Q

Lupus impacts the patients

A

kidneys and they end up with lupus nephritis

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31
Q

which lab do you monitor in lupus frequently

A

Urinalysis - SLE is an auto-immune condition that can affect the kidneys, causing lupus nephritis. A urinalysis could help monitor for this condition, by analyzing the urine for the presence of blood and protein, indicating kidney damage. A glycosylated hemoglobin, or hemoglobin A1C, would not be altered by the presence of SLE.

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32
Q

TSH is produced by the

A

pituitary gland - controls T3 and T4
The pituitary gland produces TSH which then signals the thyroid gland to release T3 and T4. The adrenal gland is responsible for regulation of metabolism and the body’s response to stress.

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33
Q

Go to test for thyroid symptoms only order what

A

TSH

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34
Q

TSH normal levels

A

0.5 - 5

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35
Q

only order T3 and T4 when what is abnormal

A

TSH

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36
Q

parathyroid is responsible for

A

calcium regulation

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37
Q

hypothalamus is responsible for

A

body temp, appetitei and helps to control emotional responses

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38
Q

Hypothyroidism TSH is

A

TSH is high and T3/T4 are high

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39
Q

Hypothyroidism s/s

A

fatigue, cold, weight gain, dry skin, constipation

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40
Q

Recheck levothyroxine in

A

4 - 8 weeks

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41
Q

Levothyroxine take when

A

first thing in Am without any other medications

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42
Q

Initial dosage of levothyroxine

A

young adults 25 mcg
elederly 12.5 low and slow do to cardiac affects

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43
Q

Myxedema coma (hypothyroidism)

A

low body temp
swelling
confusion
lethargy
diff breathing
tongue swelling

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44
Q

what can exacerbate myxedema coma if on synthroid

A

lithium
amiodarone

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45
Q

Hyperthyroidism TSH would be

A

Low and High T3/T4

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46
Q

what is the medication for hyperthyroidism

A

Methimazole (tapzole)/PTU

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47
Q

what medication is given in pregnancy in Hyperthryodism

A

PTU first trimester
then we try to switch them to Tapazole

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48
Q

graves disease treatment

A

radioactive iodine therapy

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49
Q

Complications of hyperthyroidism thyroid storm

A

increase temp
increase HR,
Increase BP

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50
Q

Hyperthyroism increase risk of

A

osteoporosis

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51
Q

Levothyroxine can also lead to

A

osteoporosis

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52
Q

Gold standard treatment for graves disease is

A

radioactive iodone therapy

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53
Q

Three P’s of Dm2

A

polyuria, polydipsea, polyphagia

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54
Q

metformin given for

A

type 2 DM

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55
Q

what are side effects of metformin

A

GI - diarrhea

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56
Q

metformin does it cause hypoglycemia

A

no

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57
Q

does metformin cause weight increase

A

no

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58
Q

what is the max dose of metformin

A

2,000 to 2,5000

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59
Q

typical starting dose of metformin

A

500 mg daily

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59
Q

when is metformin contraindicated

A

GFR less than 30

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60
Q

metformin should be stopped before contrast dye when

A

48 hours before

61
Q

metformin can cuase what vitamin deficiency

A

b12

62
Q

what medication is metformin also used for

A

PCOS

63
Q

what is the highest risk of hypoglcymia

A

glipizide sulfonylureas

64
Q

TZD avoid with

A

heart failure

65
Q

which is cardiac protective

A

flozin

66
Q

sulfonylureas end in

A

ide
do affect pt weight, weight gain
cheap
cause hypoglycemia

67
Q

Long acting insulin

A

Lantus and levimir
basal insulin - give at night
2 units every three days

68
Q

Post prandial is high increase

A

bolus insulin

69
Q

microvascular

A

neuropathy, retinopathy,

70
Q

macrovascular complication

A

CAD, stroke, PAD

71
Q

BP for diabetics should be less than

A

130/80

72
Q

levothyroxine is associated with

A

cardiac issues

73
Q

how often do we recheck TSH levels

A

4 - 8 weeks ( usually around 6 week mark)

74
Q

Possible meds for hypethryoidism

A

Beta blockers for heart rate
PTU
Tapazole
PTU in first trimester of pregnancy

75
Q

parathyroid does what

A

regulates calcium and phosphorus in check

76
Q

hyperparathryoidism what is high

A

calcium

77
Q

when you see high calcium levels on labs what is importnat to note

A

malignancy

78
Q

Somogyi effect

A

dip in BS in middle of night then rebound rise in AM
Take snack before bed or decrease the insulin

79
Q

Dawn phenomenon

A

steady increase in BS rises all night
might need increase in insulin

80
Q

who should be screened for DM

A

age 45 and repeat every 3 years
overweight obese, HDL, history of gestational DM

81
Q

what HGAIC determines pt has DM

A

> 6.5 or greater

82
Q

Metformin (glucophage) main side effect

A

GI side effects

83
Q

Max dose of metformin

A

2,000

84
Q

does metformin cause Hypoglycemia

A

no

85
Q

metformin does it cause weight gain

A

no

86
Q

labs monitor when prescribe metformin

A

GFR <30 cant give

87
Q

why is metformin not given to alcoholics due to

A

lactic acidosis

88
Q

Semaglutide (ozempic) contraindicated in type one DM due to risk of

A

DK

89
Q

Rapid acting insulin (lispro, humalog)

A

onset, 15 min
peak one hour
duration 2- 4

90
Q

intermidiate acting

A

onset 1 - 2 hours
peak 6 - 12 hours
duration 24 hours

91
Q

Long acting insulin (lantus and levemir)

A

onset 2 hours
last 24 hours

92
Q

Metformin (biguanides) (glucophage)
max dose

A

2,000

93
Q

metformin is

A

weight neutral - dose not cause wt gain

94
Q

Monitor what on metformin

A

Renal function

95
Q

metformin can cause what anemia

A

B12

96
Q

Metformin does not cause

A

hypoglycemia - inhibits glucose producction in liver

97
Q

SGLT - inhibitors Flozin (jardiance)

A

reduce absopriton in the renal tubules
check the renal function to prescribe safely
can help with cardiac issues

98
Q

DPP-4 inhibitors - gliptins (januvia) avoid in pt with history of

A

pancreatitis and renal impairement

99
Q

Sulfonylureas (ide) glipizide,

A

they cause the pancreas to secrete insulin, but do not reduce insulin resistance
they cause hypoglycemia and weight gain
They are affordable

100
Q

Thiazaolidendiones Zones (actos)

A

they are toxic to liver
Toxic in heart failure
cause weight gain and edema

101
Q

GLP - 1 agonist (trulicity) end in tides

A

increase fullness
delays gastric emptying
cardioprotective
one thing pt dont like is injection

102
Q

A 63-year-old male patient who is diabetic is on the max dosage of glucophage (Metformin) and his hemoglobin A1C is still high. The nurse practitioner educates the patient that he will be starting a new medication that requires him to keep hydrated. He is also educated to report any new urinary issues. Which medication is the nurse practitioner likely starting him on?

A

The correct answer is dapagliflozin (Farxiga). SGLT2 inhibitors, such as dapagliflozin, work in the body by preventing the kidneys from being able to absorb glucose. Glucose is then excreted via the urine. Due to the presence of glucose in the urine, this class of medication is not ideal for those with recurrent yeast infections or urinary tract infections. It is also imperative to keep well-hydrated due to this medication’s diuretic effects.

103
Q

Levothyroxine should start at lower dose in elderly in

A

12.5 due to cardiac issues

104
Q

when should we check TSH levels

A

4- 6 weeks

105
Q

Long term use of synthroid increases risk of

A

osteoporosis

106
Q

Hyperthyroidism treatment meds is the

A

third line treatment

107
Q

what is common given to hyperthyroidism for heart rate

A

propranolol - Beta blockers

108
Q

Propythiouracil (PTU)

A

must be taken several times a day
frequent labs

109
Q

most serous of PTU

A

Low WBC angranulocytosis,
Follow CBC
Pt can get hepatitis

110
Q

Tapazole (methimazole)

A

take once a day
preferred over PTU
Less side effects

111
Q

Pregnant best option for Hyperthyroidism

A

PTU in first trimestester
After complete can transition to Tapazole

112
Q

Which of the following labs is the most important to monitor in a patient being treated for hyperthyroidism with propylthiouracil (PTU)?

A

CBC

113
Q

A 36-year-old pregnant female presents with complaints of worsening anxiety and tremors. She has noticed that despite increasing food intake, she is not gaining weight. She is at 18 weeks gestation. Her lab results are as follows: TSH 0.02 mU/L, free T4 12 ng/dL. What treatment is most appropriate in this patient?

A

Tapazole

114
Q

A 41-year-old female with hyperthyroidism is complaining of anxiety and palpitations. She asks the nurse practitioner for something to help her symptoms. What can the nurse practitioner prescribe to directly treat her symptoms?

A

Beta Blocker - propranolol

115
Q

Main medication to treat addisons disease

A

steroids - prednisone
should always have emergency steroids

116
Q

chronic amenorrhea and hypermetabolism result in what

A

osteoprosis and need supplement with calcium and with vitamin D 1,200

117
Q

pt with normal free T4 but with elevated TSH what do you do

A

do not treat recheck TSH in 6 months this is subclinical hypothyroidism

118
Q

what is subclinical hypothyroidism

A

elevated TSH but normal T4

119
Q

adivse pts on levothyroxine to report plapations, nervousness, tremors it might indicate that synthroid is

A

too high

120
Q

pt has new onset of A-fib check what

A

TSH

121
Q

lid lag is a sx of what

A

graves disease

122
Q

Hyperthyroidism s/s

A

anxiety, jittery, hyper, skinnyha

123
Q

what disease process is associated with hyperthyroidism is

A

graves diease

124
Q

Meds for hyperthyroidism

A

PTU, tapazole

125
Q

hyperthyroidism hour numbers are

A

low

126
Q

hypothyroidism s/s

A

dry skin
brittle hair
overweight
constipation
fatigue
brittle nails
gain weight and cant lose

127
Q

what is the disease process assoc with hypothyroidism

A

hashimotos

128
Q

meds we give for hypothyroidism

A

synthroid for life

129
Q

hypothyroidism numbers are

A

high

130
Q

lab for hyper/hypo thyroidsim

A

TSH - 0.5 - 5
adjusting meds only based off TSH alone

131
Q

which is more concerning a single nodule or multiple nodule

A

single nodule- more likely to be malignant

132
Q

have nodule and have multiple nodules what do we use

A

radioactive iodine - need medication for life synthroid

133
Q

pt has AIC of 9 or double digits what do you do

A

start on insulin - basal insulin

134
Q

Dawn phenomenon

A

rise in Blood sugar at 7 am
BS keeps rising straight up

135
Q

how do we stop dawn phenomenon what do we do

A

give more insulin

136
Q

Somojy effect

A

Blood sugar drops around 3 am and blood sugar is low - then eat to bring up BS
Then at 7 am Blood sugar is elevated
give a snack at bedtime

137
Q

Addisons presentation

A

hyperpigmentation - bronze skin - looks like laying in sun, Golden, sun kissed
salt craving
Typically thin

138
Q

Addisons cortisol is

A

low - thin think JFK
Sodium is low
Potassium is high

139
Q

cushings

A

obese
buffalo hump
purple strai
moon face
fatigued

140
Q

cushings cortisol levels are

A

high cortisol
sodium high
potassium low

141
Q

Long acting have

A

no peak and never mix with others
no plate - not food dependent
min risk of low sugar

142
Q

long acting inulin is

A

determir (long acting) (levimir)
Glargine - large acting (lantus)
Tresiba (degludec)
duration 24 hours

143
Q

NPH - intermittent

A

given twice a day
duration is 4 - 12 hours
usuallly worse 5 - 6 hours

144
Q

Regular insulin

A

peak 2 - 4 hours
Duration is 5-8 hours

145
Q

Rapid acting

A

aspart, lispro, glulisine - super fast
duration 3- 5 hours
most deadly onsent
30 - 90
pt must eat in 10 - 15 minutes

146
Q

Metformin (glucophage)

A

Diabetic oral

147
Q

Glipizide and glyburide is not good for

A

heart failure and MI
gain weight
toxic for elderly

148
Q

Thiazolidinedone (TZD) pioglitazone

A

heart failure
fluid retention
edema

149
Q

acarbose and precose

A

flatus and diarrhea

150
Q
A

### A Boards Review - ROWE ###*** (16 decks)

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