Endocrine Flashcards
(133 cards)
1
Q
Caused by the autoimmune destruction of the beta cells within the islets of Langerhans in the pancreas
A
Type I diabetes
2
Q
insulin resistance and impaired beta cell function.
A
Type II diabetes
3
Q
ADA criteria for diagnosis of diabetes:
A
- A1C> 6.5%, or
- FPG> 126 mg/dL or
- 2-hour plasma glucose >200 mg/dL during an OGTT with 75 g or
- Random plasma glucose > 200 mg/dL
4
Q
Early morning hyperglycemia is controlled by
A
basal insulin
5
Q
post-meal glucose spikes are controlled by
A
prandial insulin
6
Q
onset, peak, and duration of rapid acting insulin
A
onset: 15 min
peak: 1-3 hours
duration: 3-5 hours
7
Q
ex of short acting insulin
A
Regular and Humulin R
8
Q
onset, peak, and duration of short acting insulin
A
onset: 30 min
peak: 1-5 hours
duration: 6-8 hours
9
Q
Onset, peak, and duration of intermediate acting insulin
A
onset: 1 hour
peak: 6-14 hours
duration: 24 hours
10
Q
onset, peak, and duration of long acting insulin
A
onset: 1 hour
peak: NONE
duration: 24 hours
11
Q
example of long acting insulin
A
Levemir, Lantus
12
Q
example of intermediate acting insulin
A
NPH
13
Q
Insulin should be used as first line trx if
A
A1C greater than 10% or glucose above 250
14
Q
Normal fasting insulin between
A
70-100
15
Q
postmeal insulin should be less than
A
180
16
Q
A hormone co-secreted with insulin; role is a decrease in glycolysis and slowing of gastric emptying, thereby increased satiety.
A
pramlintide (Symlin)
17
Q
administration of pramlintide (Symlin)
A
given SQ 10-15 min before meals; a decrease dose of insulin given at end of meal
18
Q
MOA of metformin
A
suppressive hepatic glucose production
19
Q
important education for metformin
A
hold for at least 48 hours after injection of IV contrast
20
Q
metformin should be discontinued if
A
creatinine greater than 1.5
21
Q
MOA of sulfonyureas
A
stimulate insulin secretion
22
Q
can cause severe hypoglycemia in elderly
A
sulfonyureas
23
Q
act in the small intestine, delaying the digestion of polysaccharides which leads to lower postprandial glucose levels.
A
alpha glucosidase inhibitors
24
Q
acarbose (Precose)
A
alpha glucosidase inhibitors
25
miglitol (Glyset)
alpha glucosidase inhibitors
26
administration of alpha glucosidase inhibitors
take with first bite of meal that contains carbs; hold if not eating
27
pioglitazone (Actos)
Thiazolidinediones
28
MOA of Thiazolidinediones
improve the sensitivity of liver, fat, and muscle to insulin
29
Side effects of Thiazolidinediones
weight gain and edema
30
Thiazolidinediones are contraindicated in those with
CHF
31
baseline labs with Thiazolidinediones
LFT
32
Exanatide (Byetta)
glucagon-like peptide (GLP-1) agonist
33
MOA of GLP1 agonist
stimulate insulin secretion
34
administration of exanatide (Byetta)
injected SQ 60 min before breakfast and dinner
35
sitagliptin (Januvia)
DPP-4 inhibitor
36
MOA of DPP4 inhibitors
slowly inactivate incretin hormone --> increases insulin release
37
F/U for those with DM
A1C and diabetic foot exam every 3 months, lipid panel annually, annual urine microalbumin, annual eye and dental exam
38
hypoglycemia is glucose less than
70
39
trx for mild to moderate hypoglycemia
15 g of carb
40
education for diabetics for sick days
may need to use insulin, monitor glucose every 4 hours, continue taking meds even if not eating
41
when to screen for gestational diabetes
24-28 weeks
42
Diagnosis for gestational diabetes is made by OGTT if
fasting plasma glucose is greater than 92 mg/dL,
1-hour glucose greater than 180 mg/dL, or
2-hour glucose greater than 153 mg/dL.
43
meds for DM that are safe during pregnancy
insulin, glyburide, metformin
44
this med can mask the effect of hypoglycemia
beta blockers
45
s/s of DKA
abd pain, N/V, Kussmaul respirations, tachycardia, fruity odor to breath, hypotension
46
DKA is characterized as
hyperglycemia, ketonemia, and metabolic acidosis
47
trx for DKA
isotonic fluid, IV insulin as long as k+ is greater than 3.3
48
HHNK is common in those who
have type 2 diabetes and older than 65
49
HHNK s/s
polyuria, polydipsia, AMS
50
diagnostics in HHNK
hyperglycemia greater than 1000, hyponatremia
51
differences between DKA and HHNK
DKA: type 1 DM whereas HHNK: type 2 DM;
DKA: occurs rapidly; HHNK: occurs gradually;
DKA: ketones; HHNK: little to no ketones
52
diagnostic for metabolic syndrome
fasting insulin is greater than 10, fasting blood glucose greater than 100
53
a thyroid nodule greater than ___ is indicative of thyroid cancer
2.5 cm
54
diagnostics for thyroid cancer
radioactive iodine reuptake will show a "cold" nodule
55
s/s of pheochromocytoma
random episodes of severe HTN (BP greater than 200/110), headache, tachycardia, anxiety
56
can be a sign of pituitary adenoma
hyperprolactinemia
57
The ____ stimulates the ____ into producing stimulating hormones that tell the _____ to produce "active" hormones
hypothalamus; anterior pituitary; target organs
58
The only hormone the hypothalamus actually produces
oxytocin
59
The anterior pituitary gland produces these stimulating hormones
FSH, LH, TSH, growth hormone, ACTH, prolactin
60
The posterior pituitary gland produces these stimulating hormones
vasopressin (ADH), oxytocin
61
FSH stimulates the ____ to produce ____
ovaries; estrogen
62
LH stimulates the ___ to produce _____
ovaries; progesterone
63
TSH stimulates the ___ to produce _____
thyroid; thyroid hormones
64
ACTH stimulates the ___ to produce _____
adrenal glands; glucocorticoids (cortisol) and mineralcorticoids (aldosterone)
65
hormone responsible for calcium balance
PTH
66
Those with Grave's disease are at high risk of developing
RA, pernicious anemia, osteoporosis
67
s/s of hyperthyroidism
weight loss, irritability, anxious, insomnia, frequent BM, amenorrhea, heat intolerance , goiter, tachycardia
68
diagnostic for hyperthyroidism
TSH will be low, high T3 and T4. Check TSI for Grave's disease;
Thyroid US for nodule/goiter
69
Meds for hyperthyroidism
PTU, Methimazole (Tapazole)
70
side effects of PTU and Tapazole
skin rash, granulocytopenia, hepatic necrosis
71
monitor these labs in those with Grave's taking meds
CBC and LFT
72
Only med indicated for pregnant women with hyperthyroidism
PTU
73
common causes of hypothyroidism
Hashimoto's thyroiditis, postpartum thyroiditis
74
An autoimmune disease where the body produces antibodies against the thyroid.
Hashimoto's thyroiditis
75
s/s of hypothyroidism
weight gain, fatigue, depression, cold intolerance, constipation, skin coarse and dry
76
diagnostics for hypothyroidism
high TSH, elevated antimicrosmal antibodies (Hashimoto's)
77
monitoring TSH in those with thyroid condition
every 6-8 weeks until TSH is normal
78
eye exam recommendations for diabetics
For Type 2: at time of diagnosis and annually;
| For Type 1: first eye exam 5 years within diagnosis and annually
79
a normal physiologic elevation of blood sugar that occurs every morning between 4 and 8 am
Dawn Phenomenon
80
severe hyperglycemia in the morning due to overtreatment with bedtime dose of insulin
Somogyi effect
81
Somogyi effect is common in
type 1 diabetics
82
eye exam findings in diabetics
microaneurysms d/t neovascularization, cotton wool exudates
83
Metformin is contraindicated in those with
renal disease, hepatic disease, alcoholics
84
Labs to monitor for those taking metformin
LFTs, creatinine, UA, GFR
85
Chlorpropamide (Diabenase)
sulfonyurea not used much anymore d/t high risk of hypoglycemia
86
monitor these labs with any sulfonyurea
LFT, creatinine, UA, CBC
87
dosing for TZDs
take daily at breakfast
88
Med for diabetes that is associated with rare risk of bladder cancer
Actos
89
Bile acid sequestrants for diabetes
Questran, Welchol
90
Repaglinide (Prandin)
meglitinide
91
nateglinide (Starlix)
meglitinide
92
MOA of meglitinide
stimulate secretion of insulin
93
administration of meglitinide
take with meals
94
GLP1 and DPP-4 inhibitors can cause
pancreatitis
95
Do not combine these two meds for diabetes
GLP-1 agonist (Byetta or Victoza) with DPP-4 inhibitors (Januvia)
96
Rapid acting SQ insulin is mostly used in
type 1 diabetics
97
Meglitinide is indicated for
type 2 diabetics with post-prandial hyperglycemia
98
side effects of sulfonyureas
weight gain, hypoglycemia
99
DM risk factors
age greater than 45, BMI greater than 25, family hx, sedentary lifestyle, HTN, HLD, PCOS, hx of GDM
100
A1C goal for most adults
less than 7%
101
A1C goal for elderly
less than 8%
102
A1C goal for pregnant patients
less than 6%
103
cholesterol management with type 2 DM
start on moderate to high dose statin in those 40-75
104
expected decrease in A1c with metformin
1-2%
105
Alogliptin (Nesina)
DPP-4 inhibitor
106
linagliptin (Tradjenta)
DPP-4 inhibitor
107
saxagliptin (Onglyza)
DPP-4 inhibitor
108
Duloaglutide (Trulicity)
GLP-1
109
Canagliflozin (Invokana)
SGLT2
110
second choice med to add on with metformin
GLP1 or insulin
111
expected decrease in A1c with sulfonyurea
1-2%
112
expected decrease in A1c with DPP4 inhibitors
0.7%
113
expected decrease in A1c with GLP1
1-1.5%
114
high doses of TZDs are associated with
osteopenia
115
MOA of SGLT2 inhibitors
prevents glucose reabsorption by increasing glucose excretion
116
complications with SGLT2 inhibitors
UTI, yeast infections
117
diabetic meds that help with weight loss
metformin, GLP1, SGLT2
118
Do not combine insulin with these diabetic meds
sulfonyureas, TZD
119
dosage when starting basal insulin
0.1-0.2 units/kg or 10 units at bedtime; increase 2-3 units every 2-3 days until goal reached
120
goal fasting glucose for diabetics
80-130
121
___ is 5 times more active on metabolism than __
T3; T4
122
screening for thyroid disease
TSH only
123
If screening TSH is high, then
repeat, add free T4
124
if screening TSH is low, then
repeat, add free T4 and T3
125
thyroid labs in primary hypothyroidism
high TSH, low T4, normal T3
126
thyroid labs in subclinical hypothyroidism
high TSH, normal T3 and T4
127
thyroid labs in primary hyperthyroidism
low TSH, high T4, normal T3
128
dosing replacement for hypothyroidism
1.6 mcg/kg/day, base on ideal weight not actual weight
129
levothyroxine tabs come in
25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200 mcg
130
dosing replacement for hypothyroidism in elderly
25-50 mcg/day
131
treat subclinical hypothyroidism if TSH is
greater than 10
132
complications with levothyroxine therapy
accelerated bone loss, afib
133
if patient takes levothyroxine with food, then
drug will not be absorbed as well and can increase TSH
