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Flashcards in ENDOCRINE Deck (48):
1

What kind of antigens and antibodies are most associated with type 1 diabetes?

human leukocyte antigens
Islet cell antibodies

2

What is a unique development for Type 1 DM?

ketone development

3

What is the pathology of type 2 DM?

Tissue insensitivity to insulin or an insulin secretory defect resulting in resistance and/ or impaired insulin production

4

What is syndrome X

DM II and associated with obesity, HTN, and abnormal lipid profiles (low HDLs and high triglycerides)

5

What does metabolic syndrome entail and how is the diagnosis made

3 or more of the following:
1) wait circumference >40inches (102cm) in men and >35inches (89cm) in women
2)BP>130/85
3)triglycerides >150
4) FBG>100
5)HDL

6

Diagnostics for DM type 1 and type II

-Random plasma glucose >200 with polyuria, polydipsia and weight loss
-Serum fasting (8hrs) blood sugar >126 on 2 separate occasions
-Kenonemia, ketouria, or both for type 1
-Oral glucose tolerance test>200 2 hours post-prandial
-Hbg A1C- ROUTINE Diagnosis- normal 5.5-7%
-Impaired glucose tolerance test FBG >100and

7

Dietary teaching for diabetics

carb intake 55-60%
fats 20-30%
protein 10-20%
Fiber 25g/1000 calories

8

When is insulin therapy warranted and how do you start insulin?

if a patient presents with ketones
0.5units/kg/day giving 2/3 dose in the morning and 1/3 dose in the evening

9

What is the conventional split dose mixtures of insulin

morning dose of insulin is 2/3 NPH and 1/3 regular
evening dose of insulin is 1/2 NPH and 1/2 regular

10

What are the insulin analogs

Aspart (novolog)
Glargine (Lantus)- prolonged duration
Lispro (Humalog)- rapid onset

11

What are the 5 classes of oral antidiabetics?

Sulfonylureas
Biguanides
Alph-glucosidase inhibitors
Thiazolidinediones
Non-sulfonylurea insulin release stimulators

12

Sulfonylureas- how it works and names

stimulate the pancreas to release more insulin
2nd generations: glipizide(glucotrol), glyburide, glimepride

13

Biguanides- how it works and names

decreases hepatic glucose production and intestinal glucose absorption
Metphormin (glucophage)
Good adjunct to the sulfonylureas but can be used alone especially in obese patients

14

How do alpha-glucosidase inhibitors work and give some names

bind to disaccharides more readily than sucrose, so less glucose is absorbed by the gut
acarbose (precose)
miglitol (glyset)

15

What is a common thiazolidinediones and whats the popular brand?

glitazones decrease gluconeogenesis
Pioglitazone hydrochloride (actos)

16

How do the non-sulfonylurea insulin release stimulators work and what are 2 brands

Rapidely absorbed from the intestine and mimics the effects of rapidly acting insulin
Repaglinide (Prandin)
Nateglinide (starlix)

17

How does Exenatide ( Byetta) work?

Injectable that mimics the effects incretins (signals pancreas to increase insulin secretion and the liver to stop producing glucagon). Causes n/v/d

18

How does Sitagliptin (Januvia) work?

DD-4 inhibitor, breaks down incretins

19

How does Pramlintide (Symlin) work?

Injectable for type 1&2DM, resembles human amylin, slows the absorption of glucose and inhibits the actions of glucagons: promotes weight loss while decreased glucose levels

20

What happens during the somogyi effect

nocturnal hypoglycemia and morning hyperglycemia

21

treatment of the somogyi effect

reduce or omit the HS insulin

22

what happens during the dawn phenomenon

tissue becomes desensitized to insulin nocturnally, becomes progressively elevated throughout the night and morning hyperglycemia

23

How do you tx the dawn phenomenon

add or increase the HS dose of insulin

24

Diabetic Ketoacidosis (DKA) is a complication of

DM1

25

what state is DKA

intracellular dehydration

26

What is hyperosmolar hyperglycemic non-ketosis a complication of?

DMII

27

What happens in HHNK?

PAtients cannot produce enough insulin to prevent severe hyperglycemia, osmotic diuresis and extracellular depletion

28

When is kussmauls breathing seen?

in DKA

29

When is fruity breath seen?

DKA

30

What are the labs/ diagnostics for DKA

hyperglycemia (>250)
ketonemia, ketonuria
Marked glucosuria
metabolic Acidosis (Ph

31

What are the labs/ diagnostics for HHNK?

serum blood glucose >600
Hyperosmolality
elevated BUN and cr
elevated hbg a1c
normal Ph
Normal anion gap

32

What is the most common form of hyperthyroid

graves disease

33

What are some other causes of hyperthyroid

toxic adenoma, subacute thyroiditis, TSH, secreting tumor of the pituitary, high doses of amiodorone

34

Patho causes of hypothyroidism

pituitary deficiency of TSH
hypothalamic deficiency of TRH
iodine deficiency
hashimotos throiditis
damage to the gland
idiopathic

35

What is the most sensitive test for hyperthyroidism

TSH assay

36

What is the most important test for hyperthyroidism

t3

37

What else can elevate the ANA

lupus or collagen disease

38

What test should be performed to establish etiology of hyperthyroidism

thyroid radioactive iodine uptake

39

What 2 drug classes are used for hyperthyroidism

propranolol for symptomatic relief (especially for subacute)
Thiourea drugs for patients with mils cases, small goiters or fear of isotopes (Methimazole, propylthiouracil/ PTU)

40

Treatment dosing with levothyroxine

50-100mcg every day, increasing the dosage by 25mcg every 1-2 weeks until symptoms stabilize
decrease dosing for >60yo

41

Causes of Cushings syndrome

ACTH hyper secretion by the pituitary, adrenal tumor, chronic administration of glucocorticoids

42

S/SX of Cushing's syndrome

central obesity, moon face with buffalo hump, acne, poor wound healing, purple strake, hirsutism, HTN, weakness, amenorrhea, impotence, HA, polyuria and thirst, labile mood, frequent infections

43

Labs for Cushing's syndrome

HYPERGLYCEMIA
HYPERNATREMIA
HYPOKALEMIA
leukocytosis
elevated plasma cortisol in the morning
dexamethasone suppression test
serum ACTH
glycosuria

44

Causes of addisons disease

deficient cortisol, androgens, and aldosterone
Autoimmune destruction of the adrenal gland
CA with mets
Bilateral adrenal hemorrhage (from anticoagulation tx)
pituitary failure resulting in ACTH

45

s/sx addisons disease

hyperpigmentation in buccal mucosa and skin creases
diffuse tanning and freckles
orthostasis and hypotension
scant axillary and pubic hair
rapid worseing
acute fever
change in LOC

46

labs for addisons disease

HYPOGLYCEMIA
HYPONATREMIA
HYPERKALEMIA
elevated ESR
Lymphocytosis

47

management of addisons disease

glucocorticoid and mineralcortiocoid replacement (aldosterone and androgen)

48

what is the pathophysiology of graves disease

hyperthyroidism: when the thyroid gland overproduces the hormone thyroxine as a result of an immune system attack