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AGNP review > Endocrine > Flashcards

Endocrine Flashcards

(46 cards)

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1
Q

DKA Criteria

A

Anion Gap (arterial pH < 7.3, serum bicarb < 15)
Ketonuria
Hyperglycemia (> 250)

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2
Q

Hyperprolactinemia

A

Can be a sign of a pituitary adenoma

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3
Q

Hypoglycemia

A

Level 1: FBS < 70 - > 54
Level 2: FBS < 54
Level 3: severe characterized by AMS or physical status requiring assistance for hypoglycemia

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4
Q

Myxedema Coma

A

Severe hypothyroidism w/ progression to decreased mental status, hypothermia and decrease in organ function.

check T4 (usually low, TSH (may be high), cortisol

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5
Q

Pheochromocytoma

A

Rare hormone-releasing adrenal tumor. Typically occurs in persons 20-50. sx HA, diaphoresis and tachy w/ HTN

Triggers: physical exertion, anziety, stress, surgery, anesthesia, changes in body position, L&D. Foods high in Tyramine as well as MAOIz and stimulants.

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6
Q

Hormes stimulated by Pituitary Gland

A

FSH
LH
TSH
Adrenocorticotropic hormone (ACTH)
growth hormone (GH)

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7
Q

Addison’s Disease Symptoms

A

Lethargy, nausea, anorexia w/ diarrhea, and pain.
Tanned skin and hyperpigmentation
Hyperkalemia and hypothermia

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8
Q

FSH

A

stimulates ovaries to enable growth of follicles (or eggs); production of estrogran

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9
Q

LH

A

Stimulates steroid release from ovaries, ovulation, and the release of progesterone after ovulation; stimulates testicles (Leydig cells) to produce testosterone

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10
Q

ACTH

A

Stimulates adrenal glands; production of glucocorticoids(cortisol) and mineralocorticoids (aldosterone)

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11
Q

Melanocyte-stimulating hormone

A

Production of melatonin in response to UV light; highest levels at night btwn 11 pm and 3 am

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12
Q

Posterior Pituitary Gland hormones

A

antidiuretic hormone (vasopressin) and oxytocin

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13
Q

Melatonin is produced by..

A

Pineal Gland

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14
Q

Addison’s disease

A

adrenal glands do not produce enough essential hormones, resulting in mineralocorticoid and glucocorticoid deficiency

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15
Q

Symptoms of Addison’s Disease

A

hyperpigmentation in buccal mucosa and skin creases, diffuse tanning and freckles, orthostasis and hypotension, scant axillary and pubic hair

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16
Q

Addison Disease electrolyte findings

A

hyponatremia, hyperkalemia

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17
Q

Primary Adrenal Insufficiency

A

Low serum cortisol and high ACTH concentration

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18
Q

Secondary (pituitary) and Tertiary (hypothalamic) adrenal insufficiency

A

Serum cortisol and ACTH are low

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19
Q

How to differentiate between secondary and tertiary adrenal insufficiency

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A

Corticotropin-releasing hormone (CRH)

20
Q

Chronic primary adrenal insufficiency treatment

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A

Replacement of glucocorticoids (hydrocortisone, dexamethasone, or prednisone) and mineralocorticoids (often fludrocortisone)

Dehydroepiandrosterone (DHEA) therapy may be considered for some women w/ impaired mood or sense of well-being

21
Q

Cushing’s Disease

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A

Hypersecretion of ACTH by pituitary or exogenous admin of glucocorticoids

Symptoms: moon face w/ buffalo hump, acne, poor wound healing, purple striae, hirsutism, HTN, weakness, amenorrhea, impotence, HA, polyuria and thirst, labile mood, freq infections

22
Q

Metabolic Syndrome

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A

Presence of 3 of the 5 traits:
- waist circumference: male > 40 inch, female > 35 inch
- HTN: BP >/= 130/85 or on drug treatment for HTN
Triglycerides: >/= 150 or on drug treatment
HDL: < 40 in males and < 50 in females or on drug tx
Hyperglycemia: FPG >/= 100 or drug tx for glucose

23
Q

Prediabetes

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A

A1C btwn 5.7%-6.4%
OR
FBG 100-125
OR
2-hr oral glucose tolerance test 140-199

24
Q

DM

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A

AI1 >/= 6.5%
OR
FBG >/= 126
OR
Classis symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) plus random BG >/= 200
OR
two-hr plasma glucose >/= 200

25
Goals for DM
BP < 130/80 LDL < 70 AIC < 7% FBG 80-130 Postprandial glucose < 180
26
First-line medication for DM
Metformin (Biguanides) Decreases gluconeogenesis and intestinal absorption of glucose and improves insulin sensitivity May have GI side effects Monitor kidney and liver function
27
Metformin Dosing
If patient is on metformin 500 mg daily and A1C is high (>7%), increase dose to metformin 500 mg BID. If A1C is still high (>7%) after dose adjustment, increase dose to metformin 1,000 mg BID If taking maximum dose of metformin (1 g BID) and glycemic control is inadequate, can use combination therapy with additional oral agents such as a sulfonylurea, glipizide (Glucotrol XL) 5 mg PO daily (do not exceed maximum dose of glipizide 20 mg/day
28
Sulfonylureas
Stimulate beta cells of the pancreas to secrete more insulin, reduce glucose output from liver, increase insulin sensitivity Ex: Glipizide, Glimepiride SE: hypoglycemia, avoid if impaired hepatic or renal function, concurrent use w/ Warfarin Causes wt gain
29
How often should A1C be checked in DM
Twice a year Unless some frail older adults, hx of severe hypoglycemia, extensive comorbidity, limited life expectancy
30
Glucose Goals
Fasting blood glucose (FBG) 80-130 Postprandial: < 180
31
Metformin and IV contrast
Hold Metformin on day of precedure and 48 hrs after Check baseline Cr and recheck after procedure - Cr must normalize prior to restarting Metformin
32
Thiazolidinediones
Enhances insulin sensitivity and decreases gluconeogenesis Ex: Pioglitazone and rosiglitazone Take w/ meals Do not use w/ HF
33
GLP-1
Increase in insulin production and inhibits postprandial glucose release, slows gastric emptying Ex: Exenatide or Liraglutide Avoid if personal or family hx of medullary thyroid carcinoma
34
SGLT2
Promotes renal excretion of glucose Ex: Canagliflozin, Dapagliflozin, Empagliflozin Reduce CVD events/death and helps slow progression of CKD
35
Dipeptidyl Peptidase-4 (DPP-4 Inhibitors)
Enhancement of glucose-dependent insulin secretion, slowed gastric emptying, and reduction of postprandial glucagon Ex: Sitagliptin, saxagliptin, linagliptin, alogliptin Okay for CKD, though s/e include joint pain, angioedema, urticaria, acute pancreatitis, IBD
36
Which diabetic products should not be used in combination?
GLP-1 and DPP-4 No additive glucose lowering effects
37
DM Meds for pt's w/ CVD and/or CKD or HFrEF
SGLT2 or GLP-1
38
Recommended vaccines for pt's w/ DM
Influenza, pneumococcal, Tdap, hepatitis B, zoster, and COVID-19 vaccinations
39
Diabetic Retinopathy PE
- Neovascularization (new growth of arterioles in retina) - Microaneurysms (dot and blot hemorhages due to neovascularization) - Cotton-wool spots or soft exudates (nerve fiber layer infarcts) - hard exudates
40
Charcot's foot
Often seen in ppl w/ DM
41
Grave's Disease
Hyperthyroidism s/sx: lid lag, exophthalmos
42
Hyperthyroidism tx
Thionamides: Methimazole, Propylithiouracil
43
Hashimotos
Hypothyroidism Confirm w/ TPO blood test
44
Subclinical hypothyroidism
TSH > 5, but serum free T4 is w/in normal limits Often do not require tx - recheck in 6 mo
45
Myxedema coma
Severe hypothyroidism Sx: cognitive symptoms - slow thinking, poor short-term memory, depression (or dementia), hypotension, hypothermia
46
Levothyroxine for older patients
20-50 mcg and gradually increas to avoid cardiac effects from overstimulation (palpitations, angina, MI) Eval every 6-8 weeks until TSH has normalized

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