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Flashcards in endocrine Deck (47):
1

severe hypoglycemia

glucose

2

DM 1

school aged,
eats but still loses weight
"fruity odor breath"

3

thyroid cancer

nodule >2.5cm
24 hour radioactive iodine uptake (RAIU) will show "cold" nodule

4

FSH

estrogen

5

LH

progesterone
stimulates testicles to produce testosterone

6

hyperthyroidism

very low TSH, >t3 t4.

graves disease is most common cause

7

grave's disease

Look for LOW TSH (women (8:1)
>risk for osteoporosis, RA, pernicious anemia

classic case: middle age female, weight loss, hyperactive, lower stool, amenorrhea

8

radioactive iodine

permanent distruction of thyroid
PTU treatment
do not give during pregnancy

9

thyroid storm (thyrotoxicosis)

dt stress/infection

10

cold vs hot spot

cold- not metabolically active (concern is cancer). biopsy
hot- active and usually benign

11

normal range of TSH

.01-6.0
check q6-8wks

12

drug induced thyroid disease

lithium, dopamine, amiodarone, interferon alfa (cancer)

13

hypothyroid most common cause

hashimotos
other: postpartum,

most have elevatd antimicrosomal antibody titers, goiter

classic case: overweight woman, fatigue, constipation. a fib in older adult.

** Heavy menstrual, irregular bleeding

14

myxedema

severe HYPOthyroid

puffy hands, face, feet. thickening of the skin, thinning of outer 1/3 eyebrow,

15

tx plan for hypothyroid

synthroid 25-50 mcg
increase every few weeks prn, re check 6-8 wks TSH until normalized (

16

preferred tx for pregnant women

PTU

17

thyroid cancer risk

hx of neck irradiation in childhood
PAINLESS nodule >2,5 cm

18

supplement in chronic amenorrhea (hyper thyroid)

calcium , vit D, weight bearing exercise ( dt osteoporosis)

19

metabolic syndrome aka..

aka: insulin resistance syndrome or syndrome x

obesity, HTN, Hyperglycemia, Hyperlipidemia.
High risk for DM 2 and CVD

20

prediabetes a1c

a1c

21

diabetes a1c/glucose fasting/random glucose

>6.5%
>126mg/dl (fasting, no food 8 hours)
>200 random glucose (plus polyuria, polydipsea, polyphagia)

22

a1c elderly

8% ok

23

high risk hypoglycemia

50mg/dl or less

24

dawn phenomenon

hypoglycemia
>in FBG early in the morning dt INCREASE insulin resistance between 4-8am

25

somogyi effect (rebound hyperglycemia)

S=sugar
noctornal hypoglycemia stimulates glucagon to be released by liver= high FBG by 7am.

** DUE TO over treatment bedtime insulin.
dsg- check glucose 3am for 1-2 weeks
tx: snack before bedtime, or

26

diabetic retinopathy

microaneurysms, cotton wool exudates, neovasculariazion (can rupture in the eye) (cotton wool also with HTN)

27

first line DM rx

metformin (glucophage)
decrease new glucose, decrease insulin resistance

28

contraindications for metformin

hepatic disease, alcoholics
risk for lactic acidosis (PH

29

sulfonylureas

beta cells to MAKE more insuin- risk of hyPOglycemia!!!

glipizide (glucotrol)
glyberide (diabeta)
glimepriride (amaryl)

increaser risk sun sensitivity (use spf)
blood dyscrasias ( monitor cbc)


30

Thiazolidinedoines TZD

z=zone

rosiglitazone (avandia)
pioglitazone (actos)


AVOID in CHF (nyha class 3/4)
associated with rare bladder cancer (UA, cytology)

31

key points for insulin

rapid acting - 1/2 day work ( 4 hours). "one meal at a time"
regular insulin ( or short acting) - covers work day ( 8 hours) "meal to meal "
NPH - extra work shift almost all day (16 Plus hours) breast fast to dinner
lantus- once a day 24 hours

32

rapid acting drugs

(Log=Lispro)

humalog (insulin lispro)

33

short acting (regular)

humulin R

34

NPH

humulin N

35

lantus

insulin glargine, levimir (insulin detimir)
considered a "basal insulin"
no peaks. lasts 24 hours.

36

incretin mimetic or glycogen like peptide 1 (glp-1)

exenatide (byetta)
victoza (once a day injection)

risk for pancreatitis
monitor amylas/lipase!

incretin inhancer (januvia, onyglyza)- don't mix.

37

when does regular insulin peak

1-5 hours
aka: meal to meal (breakfast to lunch)
by lunch time its gone

38

type 1 DM usually takes what insulin before each meal

rapid acting (humalog/lispro)

39

premixed mostly for type 1 or 2 DM

2

40

metformin dosage

500mg daily bid ( max dose is 2550 mg/dl)

if metformin is at max at blood sugar still high, add SU (risk for hypoglycemia)

41

if pt is on BOTH metformin and SU max dose (metformin 2550mg/dl and gloctrol XL 20mg) and glucose still high..

add basil insulin (LANTUS)

42

other options beside insulin

thioglitazone (avandia, actos)- don't use in CHF
byetta - risk for pancreatitis (incretin mimetic)

43

which DM causes weight loss

metofmrin
incretin mimetic (byetta)
amyin analog (symlin)

44

which DM causes weight gain

SU, TZD (actos, avandia), insulin

45

DM lifestyle management

weight loss,
fiber whole grains
exercises increases cellular glucose uptake

weight loss- 7% of body weight
physical activity (150/min/week)

46

somogyi versus dawn phenomenon

somogyi is also called "rebound hyperglycemia." Although the cascade of events and end result -- high blood sugar levels in the morning -- is the same as in the dawn phenomenon, the cause is more "man-made" in the Somogyi effect (a result of poor diabetes management).

dawn phenomenon happens to everyone, 3a-8a blood hormones cause >glucogon=>glucose. tx: give insulin, earlier dinner, exercise after dinner.

47

what is considered "low blood sugar"

Your blood sugar is considered low when it drops below 70 mg/dL.