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Flashcards in Endocrine Deck (133):
1

Caused by the autoimmune destruction of the beta cells within the islets of Langerhans in the pancreas

Type I diabetes

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insulin resistance and impaired beta cell function.

Type II diabetes

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ADA criteria for diagnosis of diabetes:

• 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

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Early morning hyperglycemia is controlled by

basal insulin

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post-meal glucose spikes are controlled by

prandial insulin

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onset, peak, and duration of rapid acting insulin

onset: 15 min
peak: 1-3 hours
duration: 3-5 hours

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ex of short acting insulin

Regular and Humulin R

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onset, peak, and duration of short acting insulin

onset: 30 min
peak: 1-5 hours
duration: 6-8 hours

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Onset, peak, and duration of intermediate acting insulin

onset: 1 hour
peak: 6-14 hours
duration: 24 hours

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onset, peak, and duration of long acting insulin

onset: 1 hour
peak: NONE
duration: 24 hours

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example of long acting insulin

Levemir, Lantus

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example of intermediate acting insulin

NPH

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Insulin should be used as first line trx if

A1C greater than 10% or glucose above 250

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Normal fasting insulin between

70-100

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postmeal insulin should be less than

180

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A hormone co-secreted with insulin; role is a decrease in glycolysis and slowing of gastric emptying, thereby increased satiety.

pramlintide (Symlin)

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administration of pramlintide (Symlin)

given SQ 10-15 min before meals; a decrease dose of insulin given at end of meal

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MOA of metformin

suppressive hepatic glucose production

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important education for metformin

hold for at least 48 hours after injection of IV contrast

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metformin should be discontinued if

creatinine greater than 1.5

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MOA of sulfonyureas

stimulate insulin secretion

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can cause severe hypoglycemia in elderly

sulfonyureas

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act in the small intestine, delaying the digestion of polysaccharides which leads to lower postprandial glucose levels.

alpha glucosidase inhibitors

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acarbose (Precose)

alpha glucosidase inhibitors

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miglitol (Glyset)

alpha glucosidase inhibitors

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administration of alpha glucosidase inhibitors

take with first bite of meal that contains carbs; hold if not eating

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pioglitazone (Actos)

Thiazolidinediones

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MOA of Thiazolidinediones

improve the sensitivity of liver, fat, and muscle to insulin

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Side effects of Thiazolidinediones

weight gain and edema

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Thiazolidinediones are contraindicated in those with

CHF

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baseline labs with Thiazolidinediones

LFT

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Exanatide (Byetta)

glucagon-like peptide (GLP-1) agonist

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MOA of GLP1 agonist

stimulate insulin secretion

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administration of exanatide (Byetta)

injected SQ 60 min before breakfast and dinner

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sitagliptin (Januvia)

DPP-4 inhibitor

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MOA of DPP4 inhibitors

slowly inactivate incretin hormone --> increases insulin release

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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

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hypoglycemia is glucose less than

70

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trx for mild to moderate hypoglycemia

15 g of carb

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education for diabetics for sick days

may need to use insulin, monitor glucose every 4 hours, continue taking meds even if not eating

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when to screen for gestational diabetes

24-28 weeks

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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.

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meds for DM that are safe during pregnancy

insulin, glyburide, metformin

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this med can mask the effect of hypoglycemia

beta blockers

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s/s of DKA

abd pain, N/V, Kussmaul respirations, tachycardia, fruity odor to breath, hypotension

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DKA is characterized as

hyperglycemia, ketonemia, and metabolic acidosis

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trx for DKA

isotonic fluid, IV insulin as long as k+ is greater than 3.3

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HHNK is common in those who

have type 2 diabetes and older than 65

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HHNK s/s

polyuria, polydipsia, AMS

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diagnostics in HHNK

hyperglycemia greater than 1000, hyponatremia

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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

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diagnostic for metabolic syndrome

fasting insulin is greater than 10, fasting blood glucose greater than 100

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a thyroid nodule greater than ___ is indicative of thyroid cancer

2.5 cm

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diagnostics for thyroid cancer

radioactive iodine reuptake will show a "cold" nodule

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s/s of pheochromocytoma

random episodes of severe HTN (BP greater than 200/110), headache, tachycardia, anxiety

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can be a sign of pituitary adenoma

hyperprolactinemia

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The ____ stimulates the ____ into producing stimulating hormones that tell the _____ to produce "active" hormones

hypothalamus; anterior pituitary; target organs

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The only hormone the hypothalamus actually produces

oxytocin

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The anterior pituitary gland produces these stimulating hormones

FSH, LH, TSH, growth hormone, ACTH, prolactin

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The posterior pituitary gland produces these stimulating hormones

vasopressin (ADH), oxytocin

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FSH stimulates the ____ to produce ____

ovaries; estrogen

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LH stimulates the ___ to produce _____

ovaries; progesterone

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TSH stimulates the ___ to produce _____

thyroid; thyroid hormones

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ACTH stimulates the ___ to produce _____

adrenal glands; glucocorticoids (cortisol) and mineralcorticoids (aldosterone)

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hormone responsible for calcium balance

PTH

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Those with Grave's disease are at high risk of developing

RA, pernicious anemia, osteoporosis

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s/s of hyperthyroidism

weight loss, irritability, anxious, insomnia, frequent BM, amenorrhea, heat intolerance , goiter, tachycardia

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diagnostic for hyperthyroidism

TSH will be low, high T3 and T4. Check TSI for Grave's disease;
Thyroid US for nodule/goiter

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Meds for hyperthyroidism

PTU, Methimazole (Tapazole)

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side effects of PTU and Tapazole

skin rash, granulocytopenia, hepatic necrosis

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monitor these labs in those with Grave's taking meds

CBC and LFT

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Only med indicated for pregnant women with hyperthyroidism

PTU

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common causes of hypothyroidism

Hashimoto's thyroiditis, postpartum thyroiditis

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An autoimmune disease where the body produces antibodies against the thyroid.

Hashimoto's thyroiditis

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s/s of hypothyroidism

weight gain, fatigue, depression, cold intolerance, constipation, skin coarse and dry

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diagnostics for hypothyroidism

high TSH, elevated antimicrosmal antibodies (Hashimoto's)

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monitoring TSH in those with thyroid condition

every 6-8 weeks until TSH is normal

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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

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a normal physiologic elevation of blood sugar that occurs every morning between 4 and 8 am

Dawn Phenomenon

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severe hyperglycemia in the morning due to overtreatment with bedtime dose of insulin

Somogyi effect

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Somogyi effect is common in

type 1 diabetics

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eye exam findings in diabetics

microaneurysms d/t neovascularization, cotton wool exudates

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Metformin is contraindicated in those with

renal disease, hepatic disease, alcoholics

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Labs to monitor for those taking metformin

LFTs, creatinine, UA, GFR

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Chlorpropamide (Diabenase)

sulfonyurea not used much anymore d/t high risk of hypoglycemia

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monitor these labs with any sulfonyurea

LFT, creatinine, UA, CBC

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dosing for TZDs

take daily at breakfast

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Med for diabetes that is associated with rare risk of bladder cancer

Actos

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Bile acid sequestrants for diabetes

Questran, Welchol

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Repaglinide (Prandin)

meglitinide

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nateglinide (Starlix)

meglitinide

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MOA of meglitinide

stimulate secretion of insulin

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administration of meglitinide

take with meals

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GLP1 and DPP-4 inhibitors can cause

pancreatitis

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Do not combine these two meds for diabetes

GLP-1 agonist (Byetta or Victoza) with DPP-4 inhibitors (Januvia)

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Rapid acting SQ insulin is mostly used in

type 1 diabetics

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Meglitinide is indicated for

type 2 diabetics with post-prandial hyperglycemia

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side effects of sulfonyureas

weight gain, hypoglycemia

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DM risk factors

age greater than 45, BMI greater than 25, family hx, sedentary lifestyle, HTN, HLD, PCOS, hx of GDM

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A1C goal for most adults

less than 7%

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A1C goal for elderly

less than 8%

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A1C goal for pregnant patients

less than 6%

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cholesterol management with type 2 DM

start on moderate to high dose statin in those 40-75

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expected decrease in A1c with metformin

1-2%

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Alogliptin (Nesina)

DPP-4 inhibitor

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linagliptin (Tradjenta)

DPP-4 inhibitor

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saxagliptin (Onglyza)

DPP-4 inhibitor

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Duloaglutide (Trulicity)

GLP-1

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Canagliflozin (Invokana)

SGLT2

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second choice med to add on with metformin

GLP1 or insulin

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expected decrease in A1c with sulfonyurea

1-2%

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expected decrease in A1c with DPP4 inhibitors

0.7%

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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

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complications with SGLT2 inhibitors

UTI, yeast infections

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diabetic meds that help with weight loss

metformin, GLP1, SGLT2

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Do not combine insulin with these diabetic meds

sulfonyureas, TZD

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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

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goal fasting glucose for diabetics

80-130

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___ is 5 times more active on metabolism than __

T3; T4

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screening for thyroid disease

TSH only

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If screening TSH is high, then

repeat, add free T4

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if screening TSH is low, then

repeat, add free T4 and T3

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thyroid labs in primary hypothyroidism

high TSH, low T4, normal T3

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thyroid labs in subclinical hypothyroidism

high TSH, normal T3 and T4

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thyroid labs in primary hyperthyroidism

low TSH, high T4, normal T3

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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

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treat subclinical hypothyroidism if TSH is

greater than 10

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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