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FNP Review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Hypoglycemia

A

Blood glucose less than 50

sxs- weakness, feels like passing out, hand tremors, and anxiety, difficulty concentrating

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2
Q

Type I DM is more common in what group

A

school aged children

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3
Q

Type I DM sxs

A

onset of persistent thirst (polydipsia)

frequent urination (polyuria)

weight loss

feeling of hunger

may be accompanied by blurred vision

breath fruity odor

large amounts of ketones in urine

children may present with DKA (neurological sxs such as drowsiness and lethargy, which can progress to coma)

may report recent viral illness before onset of sxs

diagnosis peaks from ages 4-6 years and again from ages 10-14 years

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4
Q

primary hyperthyroidism (thyrotoxicosis)

A

very low TSH that is undetectable with elevations in both serum free T4 and T3 levels. Most common cause is graves disease

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5
Q

What is Grave’s disease?

A

(hyperthyroidism)

autoimmune causing hyper function and production of excess thyroid hormones (T3 and T4)

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6
Q

What autoimmune disease are women with Grave’s disease at risk for?

A

rheumatoid arthritis (RA) and pernicious anemia (PA) and for osteopenia/osteoporosis due to increased metabolism

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7
Q

Describe the classic signs for Grave’s disease

A

Middle-aged woman loses a large amount of weight rapidly with anxiety and insomnia.

Cardiac sxs- palpitations, hypertension, atrial fibrillation, premature atrial contractions

warm and moist skin with increased perspiration

ophthalmopathy and lid lag

frequent bowel movements (looser stools)

amenorrhea and heat intolerance

enlarged thyroid goiter/thyroid nodules

pretrial myxedema (thickening of the skin usually located in the shins giving an orange-peel appearance

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8
Q

Describe the OBJECTIVE findings for Grave’s disease

A

Thyroid: diffusely enlarged gland (goiter), toxic adenoma, or multi nodular goiter. May be tender to palpation or asymptomatic.

Extremities: Fine tremors on both hands, sweaty palms, pretrial myxedema

Eyes: lid lag, exophthalmos in one or both eyes

Cardiac: tachycardia, atrial fibrillation, congestive heart failure, cardiomyopathy

integumentary: fine hair, warm skin
neurological: brisk deep tendon reflexes

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9
Q

What labs are appropriator Grave’s disease

A

very low TSH <0.5 mU/L, elevated serum free T4 and T3

positive thyrotropin receptor antibodies (TRAb) aka thyroid-stimulating immunoglobulin (TSI)

positive thyroid antibody (TPO)

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10
Q

Drugs used for hyperthyroidism

A

Propylthiouracil (PTU)- shrinks thyroid gland/decrease hormone production

methimazole (tapazole)

SE: skin rash, granulocytopenia/aplastic anemia, thrombocytopenia (check CBC with platelets), hepatic necrosis (monitor CBC, LFTS)

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11
Q

What is the adjunctive treatment for hyperthyroidism

A

Usually given before thyroid under control to alleviate symptoms of hyperstimualtion (anxiety, tachycardia, palpitations)

Beta-blockers are effective (propranolol, metoprolol, atenolol)

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12
Q

Radioactive iodine tx for hyperthyroidism

A

Contraindicated in pregnancy-1st line treatment is PTU (propylthiouracil)

PTU is 1st line tx (can cause liver failure)

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13
Q

Hyperthyroidism complications

A

thyroid storm (thyrotoxicosis):

heart rate, blood pressure, and body temp can soar to dangerous high levels. Sx= Decreased LOC, fever, abdominal pain

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14
Q

what are the laboratory findings of thyroid disease

A

TSH-used for both screening and monitoring

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15
Q

Drug-induced thyroid disease

A

lithium, amiodarone, high doses of iodine, interferon-alfa, dopamine

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16
Q

Hypothyroidism

A

High TSH with low free T4 levels

most common cause-hashimoto’s thyroiditis, postpartum thyroiditis, and thyroid ablation with radioactive iodine

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17
Q

Hashimoto’s thyroiditis

A

chronic autoimmune disorder of the thyroid gland

no pain with thyroid swelling

Body produce destructive antibodies (TPO) against the thyroid gland that gradually destroy it

elevated TPOs

goiter present

18
Q

Hashimoto’s classic case

A

middle-aged-to-older woman who is overweight c/o fatigue, weight gain, cold intolerance, constipation, & menstrual abnormalities

alopecia on the outer one third on both eyebrows

serum cholesterol is elevated

could have hx of another autoimmune disorder

19
Q

Hypothyroidism labs

A

TSH 1st>elevated>TSH with free T4

TSH is elevated and serum T4 is low-confirmed diagnosis

then order TPO to confirm Hashimoto’s thyroiditis

20
Q

Subclinical hypothyroidism

A

TSH is greater than 5mu/L, serum free T4 is within normal range

21
Q

Hypothyroidism

A

Starting dose of levothyroxine(Synthroid) from 25-50 mcg/day

start with lowest dose for elderly or patients with hx of heart disease (watch for angina, acute MI, atrial fib)

increase Synthroid dose every few weeks until TSH is normalized <5.0

Recheck TSH every 6-8 weeks until TSH is normalized <5.0

once under control every 12 months

Patient education: advise patient to report if palpitations, nervousness, or tremors because this means that Synthroid dose is too high (decrease dose until symptoms are gone and TSH in normal range)

22
Q

Synthroid

A

start elderly at low dose (12.5-25 mcg) and gradually increase to avoid adverse cardiac effects

23
Q

When not to treat hypothyroidism

A

patient with normal free T4 but with elevated TSH (subclinical hypothyroidism)

24
Q

Radioactive iodine treatment

A

results in hypothyroidism for life, supplement thyroid hormone for life

25
Q

TSH is suppressed

A

Hyperthyroidism

TSH 0.1

workup needed for hyperthyroidism

26
Q

Tx for chronic amenorrhea and hyper metabolism

A

Cause osteoporosis

tx with calcium with vitamin D 1200 mg

weight bearing exercise

27
Q

Recommendations for Diabetic patients

A

CDC recommends adults older than 50 be given SHINGRID in two doses, 2-6 months apart

Influenza immunization every year

Pneumococcal polysaccharide vaccine: if vaccinated before 65 years of age; give one-time revaccination in 5 years; if age 65 years, give one dose of the vaccine only

ASA 81 mg if high risk for MI, stroke

TYPE II DM every at diagnosis; Type I eye exam 5 years after diagnosis

podiatrist 1-2 twice a year

Bp goal is 130/80

28
Q

Dawn Phenomenon

A

a hormonal surge in all people causing an elevation in the FBG occurs daily, early in the morning between 4:00 and 8:00 am. Without normal insulin responses, diabetics experience rising FBG levels.

29
Q

Somogyi effect

A

severe nocturnal hypoglycemia

high levels of glucagon in the systemic circulation result in high fasting blood glucose by 7am. Condition is due to over treatment with the evening and/or bedtime insulin (dose is too high)

Tx: check blood glucose very early in the morning around 3 am for 1-2 weeks

Eat a snack before bedtime, or eliminate dinnertime intermediate-acting insulin (NPH) dose or lower the bedtime dose for both NPH and regular insulin

30
Q

Rapid acting insulin

A

Covers one meal at a time

31
Q

regular insulin

A

last from meal to meal

32
Q

NPH insulin

A

last from breakfast to dinner

33
Q

Lantus

A

once a day

34
Q

What is 1st line treatment for type 2 DM

A

metformin (glucophage)

If patient on metformin 500 mg daily and A1C is high (>7%), increase dose to metformin 500 mg BID.

If A1C is still high (>7%) and on metformin 500 mg BID, increase dose to 1000 mg BID

If taking maximum dose of metformin (1g BID), add sulfonylurea like glipizide (glucotrol XL), 5mg PO daily (do not exceed maximum dose of 20mg, DPP-4 inhibitor (Januvia, Onglyza), TZD (ACTOs)

35
Q

A1C >/= 9

A

Start on basal insulin

36
Q

Diabetic retinopathy

A

cotton wool spots (soft exudates), neovascularization, micro aneurysms with dot and blot hemorrhages

37
Q

hypertensive retinopathy

A

silver wire/copper wire arterioles, arteriovenous nicking

38
Q

what can ACTOS cause

A

water retention>CHF

these meds are contraindicated in h/o heart failure, NYHA class III or IV (moderate to severe heart failure)

39
Q

Insulin pump education

A

disconnect if swimming, bathing, or showering

wrestling

40
Q

what are microvascular complications oF DM

A

retinopathy, nephropathy, or neuropathy

41
Q

what are microvascular complications of DM

A

coronary artery disease, peripheral arterial disease, or stroke

42
Q

Charcot’s foot & ankle

A

common in diabetics

FNP Review (4 decks)

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