Endocrine Flashcards

Question

How do you preform insulin therapy

Answer 1

BID after the animal eats Only given if the animal eats Cats: glargine (human product) or ProZinc (veterinary product) Dogs: Caninsulin (veterinary product), maybe ProZinc?

Answer 2

Goal: ideal BCS Obesity causes insulin resistance Warning: weight loss can correct insulin resistance Diabetic diet: Low carbohydrates – especially important in cats Increased protein – easier to digest for diabetics Soluble fiber – slows down sugar release

Answer 3

New medications: Bexagliflozin (Bexacat ®) and Velagliflozin (Senvelgo ®) Once daily dosing Action: decrease reabsorption of glucose by the kidneys Increased urinary losses help to reduce blood glucose levels Give pancreatic beta cells at rest – may start producing insulin again

Answer 4

Cats that are early diabetic are better candidates – more likely to start producing insulin again Not recommended for sick or geriatric cats, cats with stage 4-4 CRF, pancreatitis, infections, hyperthyroidism, hypertension, or neoplasia Not increasing glucose movement into cells so still at risk of developing DKA

Answer 5

Human medications Action: work by stimulating pancreatic beta cells to secrete insulin; therefore some pancreatic function is needed Example: glipizide Limited success in animals; seldom used Relatively high potential for undesired side effects

Answer 6

If uncomplicated – treated as an outpatient and manage at home Fluid therapy may be required in some cases Diet and feeding schedule MUST be consistent Teach owner how to handle, store and administer insulin

Answer 7

Changes in PU/PD BCS Strength and mobility Blood glucose curve (12-24h) Fructosmaine

Answer 8

Glucurve Product approved for use in cats and dogs Glucose curves

Answer 9

Serial blood glucose measurements Every 1-2h Usually done from immediately before morning dose of insulin until evening dose of insulin Determines the effectiveness of insulin and can help to determine if dose needs to be adjusted or insulin needs to be changed Duration of action How high and how low blood glucose is going Difficult to do in clinic in cats due to “stress hyperglycemia” Seed glucometer home – teach O how to check glucose levels and perform a curve Continuous glucose monitor

Answer 10

remission in type 2 diabetes Remission rates of 65% or higher have been reported in cats with good diabetic management

Answer 11

Discuss fasting protocol with vet before going over pre-surgical instructions with the owner Have the client bring their pets insulin with them when they drop the patient off for surgery Blood glucose needs to be checked periodically throughout the procedure and once recovered Feed ASAP once recovered

Answer 12

Low blood glucose concentration Most commonly occurs in diabetic patients Starvation, seizures, insulinomas, toxins (xylitol) Can be fatal rapidly

Answer 13

Diabetic patient that is “off” Neurological signs Weakness Lethargy Disorientation Restlessness Ataxia Tremors, shaking Collapse Seizure Loss of consciousness/coma IS AN EMERGENCY

Answer 14

Give sugar – rub syrup on gums Call vet: and bring patient in Always err of the side of caution if unsure and have the owner treat for insulin shock HIGH blood glucose is SAFER than LOW blood glucose

Answer 15

NORMALLY FUNCTIONING thyroid gland Thyroid hormone feedback loops

Answer 16

Dogs Some breeds are commonly affected Doberman, golden retriever, irish setter, cocker spaniel

Answer 17

Atrophy or auto-immune damage of the thyroid gland Decreased thyroid hormone production

Answer 18

Effects of low metabolism obesity/weight gain Lack of energy Heat-seeking behaviour Alopecia and skin issues Immunosuppression Other (reproductive issues, megaesophagus, neuropathies, seizures, ocular disorders)

Answer 19

Screening tests Total T4, free T4 TSH Ask the vet which tests they would like to have run Testing to monitor response to treatment

Answer 20

Levothyroxine – synthetic T4, treatment is lifelong T4 is converted to T3 in the tissues on an as needed basis Side effects mostly related to iatrogenic overdose; if not addressed will eventually be fatal V/D Rapid weight loss Hyperactivity Tachycardia/murmur/arrhythmia (HCM) Therapeutic monitoring Recheck T4 in 4-6 weeks: After treatment is initiated Every time levothyroxine dosage is adjusted Performed every 6-12 months Blood must be collected 4-6 hours post-pill for testing Ensure that there have been no recent missed doses

Answer 21

Low thyroid function due to ANOTHER underlying illness Normal function of a normal thyroid gland Often misdiagnosed as pathological hypothyroidism

Answer 22

Middle age to older cats Excess production of thyroid hormone Idiopathic Neoplastic Benign Carcinoma

Answer 23

Excess T4 causes increased metabolic rate Increased metabolism → Weight loss, wasting, increased physical activity Increased blood flow → Hypertension Tachycardia and 2° HCM to meet the increased blood demand Hypertension → Retinal detachment Heat intolerance Ravenous appetite Diarrhea – increased GI motility PU/PD

Answer 24

HyperT4 Neoplasia Late stage CKD Diabetes mellitus FeLV FIV Starvation Chronic infection Parasitism

Answer 25

Oral meds (Felimazole) – most common Topical medication - has inconsistent absorption Hill’s y/d diet – limited iodine content which effectively “starves” the thyroid tumor of iodine needed to produce T3 and T4 Need new bowls and de-ionized drinking water Surgical resection of the affected gland Radioactive iodine treatment – destroys thyroid tumor Methimazole

Answer 26

Anti-thyroid drug Prevents iodine from being incorporated into T3 and T4 Adverse effects: BM suppression, bleeding issues, GI issues, facial pruritis, unmasking pre-existing renal disease Oral tablets Tapazole® (human),Felimazole® (licensed for use in cats) Compounded fish paste – high palatability Also available as compounded transdermal gel Convenient for cats that are difficult to pill Usually applied to the inside of the pinna (can damage pinna after chronic use) Must wear gloves when applying There is an applicator pen available Questionable efficacy/absorbency Increased risk of facial pruritis?

Answer 27

The adrenal cortex is the outer part of the adrenal gland Hormones produced by the adrenal cortex include: Mineralocorticoids (aldosterone) Glucocorticoids (cortisol) Glucocorticoids regulate nutrient levels in blood (increase blood glucose levels)

Answer 28

(cushing's disease) Excessive production of glucocorticoids Dogs, horses, ferrets, rare in cats Middle aged to older animals

Answer 29

Functional tumor of Pituitary gland Adrenal gland

Answer 30

PU/PD Polyphagia Panting Pot-bellied appearance Thin skin and coat

Answer 31

Steroid hepatopathy Immunosuppression Seizures (related to high blood pressure) Other Type III DM Tumor compression causes blindness and neuropathy Clots, hypertension, hypercalcemia

Answer 32

LDDST Low dose dexamethasone suppression test Diagnostic 8hr test Book appropriately ACTH stim test Adrenocorticotropic hormone stimulation test Used to diagnose cushings and to monitor response to therapy Cortrosyn injection Blood collection before cortrosyn and then 2-4 hours later

Answer 33

Treatment involves destroying part of the adrenal cortex Trilostane (Vetoryl®) – most common, reversible Mitotane – older drug, still used but more significant side effects (irreversible damage to the adrenal gland) Owner monitors at home How? Watch for signs of overdose Could damage adrenal glands to point of causing iatrogenic Addison’s disease

Answer 34

Identifying there is a problem Notifying the prescribing DVM Creating a program to wean off the steroid

Answer 35

hypoadrenocorticism (decreased function of the adrenal glands) Over 85% gone Autoimmune hypothalamus/pituitary damage Atrophy

Answer 36

Mineralocorticoid Na+ loss K+ gain Loss of body water Affects function of muscles and nerves Corticosteroid Lack cortisol Devresed BG Decreased sympathetic tone GI symptoms Standard poodles are over represented

Answer 37

Vague presenting signs – lethargy, weakness, anorexia, vomiting, diarrhoea, PU/PD Stress component Related to inability to mount proper sympathetic response Due to lack of corticosteroid production

Answer 38

Diagnosed by the ACTH stimulation test For life Fludrocortisone: both glucocorticoid and mineralocorticoid activity Desoxycorticosterone pivalate (DOCP): mineralocorticoid that mimics the effects of aldosterone Prednisone: used with DOCP

Answer 39

Emergency Acute event Rapidly fatal Occurs in patients with addisons disease Triggered by stress At risk for shock

Answer 40

Hypovolemic + cardiogenic shock Low Na+ → water follows Na+ into the renal tubules → water loss in the urine High K+ → bradycardia Prevent sympathetic response from compensating Low aldosterone → aldosterone is required for optimal vasoconstriction Low glucocorticoids → glucocorticoid is required for the optimal sympathetic response

Answer 41

Patient diagnosed with addisions disease V/D; often bloody Shiver/shake/lethargy/collapse Stress event in the history Signs of shock such as Decreased CRT Pale mm Bradycardia Weak pulses Hypothermia

Answer 42

Place IV catheter IV fluids – at shock rates Get vet Emergency steroids Correct electrolyte imbalances Protect heart Remove stress Increase BP (vasoconstrictors)

Endocrine Flashcards

(67 cards)