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AANP Class - Leik, Sarah Michell, MedMastery, & Other > Endocrine / Diabetes > Flashcards

Endocrine / Diabetes Flashcards

(64 cards)

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1
Q

Lupus erythematosus
“great mimicker”
population

A
  • women in childbearing years
  • 15-45 y.o.
  • Black, Asian, Latino
  • maybe genetics
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2
Q

Lupus erythematosus
(“great mimicker” =
signs/symptoms are vague)

A
  • Fatigue
  • Joint pains comes and goes
  • Mental fog
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3
Q

Lupus erythematosus
Diagnostic Criteria

A

Must have 4 out of 11
1. positive ANA (antinuclear antibody) test, but cannot be diagnose with ANA test alone
2. malar rash
3. discoid rash
4. photosensitivity
5. oral / nasal ulcers
6. non-erosive arthritis
7. cardio-pulmonary complaints
8. renal complaints
9. neurological concerns
10. immunological disorders
11. hematologic disorder

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4
Q

If we suspect Lupus, who do we refer them to?

A

Rheumatology

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5
Q

Malar rash looks like…

A
  • butterfly rash
  • spares nasolabial folds (80% lupus patients) which distinguishes it from roseacea
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6
Q

Sjogren’s Syndrome (secondary to Lupus)
What is it?
s/s

A

chronic autoimmune disorder when the immune system attacks the glands that make moisture in the eyes, mouth, and other parts of the body

Think desert
- dry itchy eyes (artificial tears)
- dry mouth (hard candies)

because the tear and salivary gland no longer produce lubrication appropriately

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7
Q

Lupus nephritis (secondary to Lupus) labs

A
  • glomerulonephritis
  • protein urea
  • urinalysis
  • do not need follow-up ANA
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8
Q

Who else do we refer out Lupus patients to and why?

A

Nephrology because over 50% of patients have kidney issues

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9
Q

Thyroid functions

A
  • hormone gland
  • metabolism regulation of every cell
  • growth & development
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10
Q

What is TSH? Normal Values?

A

Pituitary gland produces thyroid stimulating hormone and signals the thyroid gland when to release T3 and T4 (order this first)

  • normal TSH: 0.5 to 5 milli-units per liter (mU/L)
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11
Q

Hypothyroidism Labs

A

TSH: high
T3/T4: low

If TSH is high, order free T4, if T4 is low = diagnosis

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12
Q

Hyperthyroidism Labs

A

TSH: low
T3/T4: high

If TSH is low, order free T3 and free T4. If TSH low, T3 or T4 is high = diagnosis

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13
Q

Hypothyroidism
Tx

A

levothyroxine (Synthroid)
*strong association with cardiac issues

check 4-8 weeks regarding the dose

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14
Q

Hyperthyroidism
Tx

A

Propanolol
Propylthiouracil / PTU
Radioactive Iodine

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15
Q

What if pregnant? Tx for hyperthyroidism?

A

PTU first trimester. Safe to take synthroid during pregnancy, but may need more Synthroid (increase of ~ 25-50%)

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16
Q

Hypothyroidism s/s

A
  • weight gain
  • constipation
  • dry skin
  • cold intolerance
  • fatigue
  • big tongue
  • coarse hair
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17
Q

When to initiate levothyroxine (Synthroid)?

A

TSH > 10 initiate levothyroxine (Synthroid)

TSH 5-10 may initiate levothyroxine, if T4 is normal, this is subclinical hypothyroidism, recheck in 6 months

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18
Q

When to take levothyroxine (Synthroid) - remember synthetic T4?

A
  • first thing in the morning
  • empty stomach
  • before other meds
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19
Q

When to recheck TSH level after starting levothyroxine (Synthroid)

A

~ recheck every 6-8 weeks after starting Synthroid until goal of TSH < 5 is reached
~ once stable recheck every 6 to 12 months

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20
Q

Levothyroxine initial dosing for adults v. elderly?

A

Adults: 25 mcg-50 mcg PO Qday
Elderly: 12.5 mcg-25 mcg PO Qday

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21
Q

Myxedema Coma (hypothyroidism)

A
  • life threatening = send ED
  • precipitated by meds lithium, amiodarone
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22
Q

Myxedema Coma (hypothyroidism)

A
  • endocrine emergency with 30%-40% mortality rate
  • low body temp
  • swelling
  • confusion / hallucinations
  • lethargy
  • difficulty breathing
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23
Q

Hashimoto’s Thyroiditis (hypothyroidism)

A

Autoimmune disorder of thyroid gland that produces destructive thyroid peroxidase antibodies (TPOs)

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24
Q

Hashimoto’s s/s and gold standard diagnosis (hypothyroidism)

A
  • overweight
  • fatigue
  • cold intolerance
  • constipation
  • menstrual abnormalities
  • alopecia on 1/3 of one or both eyebrows
  • Gold Standard: TPO test
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25
Presentation if too much Synthroid?
Patient takes too much or dose is too high: - heart palpitations - nervousness - tremors
26
Hyperthyroidism s/s
- rapid weight loss - anxiety - insomnia - Cardiac overstimulation s/s - enlarged goiter - lid lag - exophthalmos (eyes are bulging out of head) in one or both eyes - frequent loose stools - heat intolerance - increased appetite
27
Hyperthyroidism Tx
Depends on underlying cause - methimazole (Tapazole) - Proplythiouracil (PTU) - lots of monitoring and several doses per day - radioactive iodine therapy - thyroidectomy = hormone replacement
28
What if the patient has hyperthyroidism and is pregnant?
- Proplythiouracil (PTU) - 1st trimester then transition to methimazole
29
Grave's Disease patient population (hyperthyroid)
~ 60% to 80% of hyperthyroid patients - women 7:1 ratio
30
Grave's Disease Tx (hyperthyroid)
- Radioactive iodine therapy - if this does not work then thyroidectomy, but will need lifelong Synthroid replacement
31
Grave's Disease increases risk of... (hyperthyroid)
- rheumatoid arthritis - pernicious anemia - osteopenia / osteoporosis
32
Grave's Disease Diagnosis (hyperthyroid)
TRaB: thyroid stimulating hormone receptor antibodies TPO: Thyroid peroxidase antibodies TSI: Thyroid Stimulating Immunoglobulin
33
Levothyroxine initial dosing for adults v. elderly?
Adults: 25 mcg-50 mcg PO Qday Elderly: 12.5 mcg-25 mcg PO Qday - also low for Heart Hx: angina, acute MI, afib patients
34
Complications of Hyperthyroid
- heart disease (constant high output state) - atrial fibrillation - osteoporosis d/t decreasing bone mineral density - infertility
35
Drug induced hyperthyroid
- lithium - amiodarone - high doses of iodine - interferone alpha - dopamine
36
Alternative Therapy for hyperthyroid
Armour thyroid produced from desiccated dried pig thyroid glands (contains T3 and T4)
37
What labs to check for parathyroid?
Calcium Phosphorus Hyperparathyroidism: calcium is high, phosphorus will be low (inverse relationship) * elevated calcium levels has strong association with underlying malignancy
38
Diabetes Screening
- start at age 45, screen every 3 years - high risk screened early: overweight, hypertension - PCOS
39
Diabetes Type 1 insulin dependent
Autoimmune destruction of pancreatic beta cells, insulin production will cease all together, never get them back - diagnosed no later than 30 y.o. - diabetic ketoacidosis (DKA) - do not decrease insulin when sick
40
Diabetes Type 2
Most patients lost 40-60% of beta cells, insulin production slows down
41
DM-2 Risk Factors
* most of these are modifiable obesity sedentary lifestyle unhealthy eating family history age hypertension smoking hyperlipidemia
42
Diabetes s/s
Polyuria (increased urination) Polydipsia (increased thirst) Polyphagia (increased hunger)
43
Diabetes Diagnostics
HgbA1C Fasting blood glucose Randome plasma glucose Two-hour oral glucose tolerance test
44
Pre/Diabetes HgbA1c
Pre: 5.7%-6.5% Diabetes: > 6.5%
45
Pre/Diabetes Fasting blood glucose
Pre: 100-125 Diabetes: >125
46
Pre/Diabetes *Random plasma glucose
Pre: 140-199 Diabetes: > 200 with symptoms
47
Pre/Diabetes Two-hour oral glucose tolerance
Pre: 140-199 Diabetes: >200
48
DM-2 initiate insulin
HgbA1c > 9% (or > 10%)
49
metformin (Glucophage)
- for DM-2 pts - does not cause hypoglycemia (inhibits glucose production in liver) - weight neutral - max dose: 2000 mg to 2550 mg - starting dose --500 mg BID, increase every week as tolerated or --850 mg qday, increase every 2 weeks as tolerated - GI side effect of diarrhea prohibits dose increase - eGFR < 30; 30-45 dose is 1/2 - stop leading up to procedures to protect kidneys and prevent lactic acidosis or CT contrast (48 hours before) - B12 deficiency anemia - may cause Polycystic Ovary Syndrome (enlarged ovaries/cysts) d/t association with insulin resistance - no alcoholics
50
SGLT2 Inhibitors -flozin
- empagliflozin / jardiance - dapagliflozin / arxiga - cardioprotective do not prescribe for: - frequent UTIs - incontinence - BPH
51
GLP-1 agonists glucagon-like peptide-1 receptor agonist -tide
- semaglutide / Ozempic - dulaglutide / Trulicity - cardioprotective do not prescribe for: - pancreatitis - thyroid cancer
52
TZDs thiazolidinediones -zone
- rosiglitazone - pioglitazone do not prescribe for: - heart failure and liver issues - fluid retention - weight gain
53
Sulfonylureas -ide
- Diabinese / chlorpropamide - Glucotrol / glipizide - hypoglycemia - cheap/affordable - weight gain
54
Pregnant Patients with diabetes
metformin for gestational diabetes insulin
55
Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)
- tirzepatide / Mounjaro - enhances insulin secretion - improves insulin sensitivity - reduce appetite
56
Postprandial insulin higher increase...
short acting insulin titrate up 1 to 2 units every 2-3 days
57
Fasting blood glucose is higher increase...
basal insulin (long or intermediate insulin) titrate up by 2 units per day *novolin NPH or novolin regular is the cheapest options
58
Regular Screenings for DM patients and preventative care
Ophthalmology annually - eyes: cotton wool spots, neovascularization, microaneurysms, cataracts, glaucoma Podiatry annually - restrictive blood flow to feet, neuropathy, injury Blood Pressure - < 130/80 AHA/ACC guidelines Immunizations - influenza, pneumococcal, Tdap, Hep B, zoster Renal Function annually - BUN, creatinine, eGFR, microalbumin in urine (chronic kidney disease) Aspirin - low dose aspirin therapy with higher cardiovascular risk
59
Microvascular
- neuropathy - retinopathy - nephropathy
60
Macrovascular
- coronary artery disease - peripheral artery disease - stroke
61
Somgyi Effect
a dip in blood sugar in middle of the night in their blood glucose before it rises in the morning - cutting back on night time insulin - do not skip nighttime snack
62
Dawn Phenomenon
Blood glucose steadily rises all night resulting in elevated blood glucose upon awakening - increase hormone release in body (commonly seen in adolescence)
63
Addison's
- too little cortisol - skin will show hyperpigmentation - labs: high potassium - Addisonian Crisis: emergency kit of steroids
64
Cushings
- too much cortisol - moon face, muscle wasting in extremities - labs: low potassium

AANP Class - Leik, Sarah Michell, MedMastery, & Other (20 decks)

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