Endocrine Flashcards by Shelby Sheppard

What is type 1 diabetes?

Chronic metabolic disorder as a result of destruction of Beta-cells in the islet of Langerhans resulting in abrupt cessation of insulin production

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What are signs and symptoms of DM?

Polydipsia, polyuria, polyphagia, weight loss. Blurred vision, fruity breath, ketones in urine

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What are microvascular complications of DM

Retinopathy, nephropathy, neuropathy

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What are macrovascular complications of DM

Atherosclerosis, CAD, MI

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What are risk factors for T2DM

BMI >25
Abdominal Obesity
Sedentary lifestyle
Metabolic Syndrome
Family Hx
Hispanic, black, Asian, pacific islander or American Indian descent
Hx of GDM
Impaired FBG

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Dx criteria for DM

A1C >/= 6.5% *
FPG >/= 126 mg/dL *
OGTT >/= 200mg/dL *
Random glucose >200mg/dL

*Requires confirmation on repeat test unless hyperglycemia is unequivocal

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Impaired FBG is defined by an A1C of between ____ and/or _____, FPG between ____ and ____, and/or 2hr OGTT (75g) between ____ and _____

A1C 5.7%-6.4%
FPG: 100-125mg/dL
OGTT: 140-199mg/dL

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What is the goal A1C according to the ADA in

a) Most T2DM
b) Older patients
c) T1DM and pregnancy

a) 7%
b) 8%
c) 6%

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You should check A1C q____ months until target or when adjusting therapy then ____

3 months then 6-12 months

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What labs aside from A1C should be ordered in a newly diagnosed DM

Fasting lipids, lytes, TSH, LFTs, Kidney Function, Microalbuminuria

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At every visit with a diabetic patient what should you assess?

BMI
BP
Feet
Blood glucose control

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What is the ADA’s screening recommendation for T2DM

1) Annually with a BMI >25 with 1 or more risk factor

2) Q3 years in individuals 45 years old or older

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In Impaired fasting glucose when would you consider adding metformin?

A1C 5.7-6.4%
<60 years old
BMI >35
Hx of GDm

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What is 1st line treatment for T2DM

Metformin

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What are the side effects of metformin?

GI upset (nausea, vomiting, diarrhea), lactic acidosis

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What decrease in A1C is noted with metformin use?

1-2%

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What is level 1 HYPOglycemia?

Blood glucose = 70mg/dL

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What is level 2 HYPOglycemia?

Blood glucose = 54 mg/dL

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What are the signs and symptoms of hypoglycemia?

Sweaty palms, fatigue, dizziness, rapid heart rate, confusion, weakness, hand tremors, anxiety, coma, death

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What drug can blunt the body’s hypoglycemic response?

Beta Blockers

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What is the function of FSH?

Stimulates ovaries to enable growth of follicles

- Stimulates production of estrogen

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What is the function of LH

Stimulates ovaries to ovulate
Stimulates production of progesterone by corpus luteum
In males stimulates the testicles (leydig cellst to produce testosterone)

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What is the function of TSH?

Stimulates the thyroid to produce T3 and T4

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What is the function of ACTH?

Stimulates the adrenal glands to produce cortisol and aldosterone

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What is the Dawn Phenomenon

An hormonal event causing elevations in the FPG daily in the am (between 4-8am) - Without a normal insulin response, there will be a rise in FPG - Normally people produce enough insulin to combat

What is the Somogyi Effect?

Severe nocturnal hypoglycemia stimulates counterregulatory hormones (ie. glucagon) into systemic circulation resulting in an increase in FPG by 7am

What is the treatment for hypoglycemia

-Rule of 15s | 15g of Carbs to raise BG in 15 minutes

How should a T2DM adjust BG and meds with illness and surgery

No change to meds unless FBG is lower than normal | -Frequently monitor BG

What are fundoscopic eye changes that can be noted on exam of a patient with diabetic retinopathy?

- Neovascularization - Microaneurysms - Cotton Wool Spots - Soft and Hard Exudates

What is Charcots Foot

Deformity of the foot and ankle caused by bone and joint deformity (dislocation and fracture) related to neuropathy and loss of sensation

What are examples of Sulfonylureas?

Glipizide, Glyburide

What is the MOA of sulfonylureas

Stimulates beta cells to secrete more insuline

What are AE of Sulfonylureas

Increase risk of CV mortality, hypoglycemia, blood dyscriasis, weight gain

What drop in A1C is expected with a sulfonylurea?

1-2%

What is an example of a thiazolidinediones

Pioglitazone (Actos)

What is the mechanism of action of a thiazolidinedione?

Enhances insulin sensitivity in the muscle tissue (decreasing peripheral resistance) and decreasing hepatic glucagon production

What are contraindications to thiazolidinediones?

Heart failure (causes water retention and edema), bladder cancer, active liver disease, T1DM and pregnancy

What is an expected drop in A1C with Actos?

0.7%

What is the MOA of Bile Acid Sequestrants in DM?

-Decreases hepatic glucose production and decreases intestinal absorption of glucose

What are side effects of bile acid sequestrants?

- Nausea - Bloating - Constipation - Increased triglycerides

What is an example of a meglitinide (glinides)

Repaglinide (Prandin), nateglinide (starlix)

What is the MOA of Meglitinide?

Stimulates pancreatic secretion of insulin

If a patient has irregular meal times, what T2DM could be considered?

Meglitinide r/t rapid action

What is the onset of rapid acting insulin | Lispro/aspart/glulisine

15 minutes

What is the peak of rapid acting insulin | Lispro/aspart/glulisine

0.5-2.5 hrs

What is the duration of rapid acting insulin | Lispro/aspart/glulisine

4.5 hrs

What is the onset of short acting regular insulin?

30 minutes

What is the peak of short acting regular insulin?

1-5 hrs

What is the duration of short acting regular insulin?

6-8 hrs

What is the onset of Intermediate NPH insulin?

1 hr

What is the peak of Intermediate NPH insulin?

6-14 hr

What is the duration of Intermediate NPH insulin?

18-24 hr

What is the onset of basal insulin Lantus (glargine) and Levemir (Detemir)

1 hr

What is the peak of basal insulin Lantus (glargine) and Levemir (Detemir)

None

What is the duration of basal insulin Lantus (glargine) and Levemir (Detemir)

24 hrs

What are examples of GLP-1 receptor agonist?

Exenatide, liraglutide

What is the mechanism of action of GLP-1 RA

stimulates GLP-1 increasing insulin production , inhibiting postprandial glucagon release -increasing satiety, decreased postprandial hyperglycemia

What are contraindications to a GLP-1 RA

Hx or Fhx of medullary thyroid cancer, multiple endocrine neoplasia syndrome

What is the benefits of a GLP-1 RA

- Decreases CV events - Renal protective - Weight loss

What is the expected drop in A1C with a GLP-1 RA

1-1.5%

What are examples of SGLT2i

Canagliflozin (Invokana), Dapagliflozin (Farxiga), empagliflozin (jardiance)

What is the MOA for SGLT2i

Blocks glucose reabsorption by the kidneys in the proximal nephron, increased glycosuria

What are benefits of SGLT2i

- weight loss - reduced CV events - renal protective

What are AE of SGLT2i

- DKA - Polyuria - Increased creatinine - Increased UTIs

What are examples of DPP-4 inhibitor

Sitagliptin, saxagliptin, linagliptin

What are adverse effects of DPP-4 inhibitor

Joint pain, angioedema, urticaria, pancreatitis

What is the expected drop in A1C with a DPP-4 inhibitor

0.7%

What is the expected drop of A1C with SGLT2i

0.6-1%

Rapid insulin covers ___

1 meal at a time

Regular insulin lasts ___ to ___

meal to meal

NPH lasts ___ to ____

Breakfast to dinner

Lantus lasts ___

24 hours

What is a recommendation for treatment with an A1C >/= 9

Dual Therapy

What is the recommendation for an A1C >/= 10

Injectable insulin

What med do you need to consider stopping if you are going to initiate insulin therapy and why?

-sulfonylureas because of increased risk of weight gain

What T2DM meds cause weight gain

Sulfonylureas, insulin, TZD

What oral T2DM has highest risk of hypoglycemia

Sulfonylureas

What are symptoms of thyroid cancer

Single thyroid nodule on upper 1/2 of the lobe, cervical lymphadenopathy, hoarseness, swallowing issues

What are RF for thyroid cancer?

Radiation in childhood, low iodine diet, asian, women (3:1)

What are the lab findings for HYPERthyroid

Low or undetectable TSH, elevations in T4 +/- T3

What is the most common cause of HYPERthyroid

Graves- an autoimmune disorder causing hyperfunction and production of excess thyroid hormone

What are sx of HYPERthyroid

Weight loss, anxiety, insomnia, cardiac (palpitations, tachycardia, atrial fibrillation, premature atrial contractions, hypertension), warm/moist skin, opthalmopathy, lid lag, increased frequency of bowel movements, amenorrhea, heat intoleranace, enlarged thryoid (goiter), pretibial myexedma, tremors, brisk reflexes

What are the treatments for HYPERthyroid?

PTU preferred (safe in pregnancy) Methimazole (Tapazole) Radioactive iodine Beta blockers for symptom control

What are the lab values for Hypothyroidism

``` Elevated TSH (>5mU/L) Low T4 ```

What would be a difference in lab values for a subclinical hypothyroidism

Elevated TSH but normal T4

What is a risk of chronic amenorrhea and hypermetabolism in hyperthyroidism

Osteoprosis

How do you initiate basal insulin

Start at 0.1-0.2 u/kg or 10 units | -Adjust 2-4u 1-2x weekly until you reach target FBG (80-125)

What is the dosing for synthroid

1. 6mcg/kg - In older adults start at 12.5- 25mcg *Note: 1/2 life of synthroid is 1 week so if overdose sx can take a while to revert

What are risks of levothyroxine (synthroid)

A.Fib, accelerated bone loss

What education should be provided re: insulin pump in water

Disconnect when showering, bathing or swimming

What is a pheochromocytoma

A rare adrenal tumor that releases hormones

What are sx of pheochromocytoma

Diaphoresis, tachycardia, hypertension that occurs episodically

What triggers attacks of hormone surges with a pheochromocytoma?

Stress, physical exertion, anxiety, surgery, anesthesia, foods with tyramine, stimulants, foods that are MAOI rich

What are the characteristics of metabolic syndrome?

1) Abdominal Obesity (men >40 inches, women >35 inches) 2) HTN BP >130/85 3) Hyperglycemia FPG >100 or T2DM 4) Elevated triglycerides (>150mg/dL) or being treated for same 5) Low HDL (<40mg/dL in men, <50mg/dL in women) or tx for same

If a patient has an elevated TSH (>5) what other blood work is needed

-repeat TSH and add a free T4

In a patient with an elevated TSH but normal T4 when should you recheck the TSH and T4?

6 months

How often should you check a TSH when monitoring response to treatment?

q6-8 weeks | *No earlier than 6 weeks

Alopecia of the outer 1/3rd of the eyebrow and myxedema are symptoms of

Hypothyroidism

Lid lag is a symptom of

Graves' opthalmopathy

If a patient's A1C is >/= you should consider

Dual therapy or basal insulin, | if already on 2 drugs start basal insulin

Endocrine Flashcards

(100 cards)