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

Endocrine / Diabetes Flashcards

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
Q

Presentation if too much Synthroid?

A

Patient takes too much or dose is too high:
- heart palpitations
- nervousness
- tremors

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26
Q

Hyperthyroidism s/s

A
  • 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
Q

Hyperthyroidism Tx

A

Depends on underlying cause
- methimazole (Tapazole)
- Proplythiouracil (PTU) - lots of monitoring and several doses per day
- radioactive iodine therapy
- thyroidectomy = hormone replacement

28
Q

What if the patient has hyperthyroidism and is pregnant?

A
  • Proplythiouracil (PTU)
  • 1st trimester then transition to methimazole
29
Q

Grave’s Disease patient population
(hyperthyroid)

A

~ 60% to 80% of hyperthyroid patients
- women 7:1 ratio

30
Q

Grave’s Disease Tx
(hyperthyroid)

A
  • Radioactive iodine therapy
  • if this does not work then thyroidectomy, but will need lifelong Synthroid replacement
31
Q

Grave’s Disease increases risk of…
(hyperthyroid)

A
  • rheumatoid arthritis
  • pernicious anemia
  • osteopenia / osteoporosis
32
Q

Grave’s Disease Diagnosis
(hyperthyroid)

A

TRaB: thyroid stimulating hormone receptor antibodies
TPO: Thyroid peroxidase antibodies
TSI: Thyroid Stimulating Immunoglobulin

33
Q

Levothyroxine initial dosing for adults v. elderly?

A

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
Q

Complications of Hyperthyroid

A
  • heart disease (constant high output state)
  • atrial fibrillation
  • osteoporosis d/t decreasing bone mineral density
  • infertility
35
Q

Drug induced hyperthyroid

A
  • lithium
  • amiodarone
  • high doses of iodine
  • interferone alpha
  • dopamine
36
Q

Alternative Therapy for hyperthyroid

A

Armour thyroid produced from desiccated dried pig thyroid glands (contains T3 and T4)

37
Q

What labs to check for parathyroid?

A

Calcium
Phosphorus

Hyperparathyroidism: calcium is high, phosphorus will be low (inverse relationship)

  • elevated calcium levels has strong association with underlying malignancy
38
Q

Diabetes Screening

A
  • start at age 45, screen every 3 years
  • high risk screened early: overweight, hypertension
  • PCOS
39
Q

Diabetes Type 1
insulin dependent

A

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
Q

Diabetes Type 2

A

Most patients lost 40-60% of beta cells, insulin production slows down

41
Q

DM-2
Risk Factors

A
  • most of these are modifiable
    obesity
    sedentary lifestyle
    unhealthy eating
    family history
    age
    hypertension
    smoking
    hyperlipidemia
42
Q

Diabetes
s/s

A

Polyuria (increased urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger)

43
Q

Diabetes
Diagnostics

A

HgbA1C
Fasting blood glucose
Randome plasma glucose
Two-hour oral glucose tolerance test

44
Q

Pre/Diabetes
HgbA1c

A

Pre: 5.7%-6.5%
Diabetes: > 6.5%

45
Q

Pre/Diabetes
Fasting blood glucose

A

Pre: 100-125
Diabetes: >125

46
Q

Pre/Diabetes
*Random plasma glucose

A

Pre: 140-199
Diabetes: > 200 with symptoms

47
Q

Pre/Diabetes
Two-hour oral glucose tolerance

A

Pre: 140-199
Diabetes: >200

48
Q

DM-2 initiate insulin

A

HgbA1c > 9% (or > 10%)

49
Q

metformin (Glucophage)

A
  • 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
Q

SGLT2 Inhibitors
-flozin

A
  • empagliflozin / jardiance
  • dapagliflozin / arxiga
  • cardioprotective

do not prescribe for:
- frequent UTIs
- incontinence
- BPH

51
Q

GLP-1 agonists
glucagon-like peptide-1 receptor agonist
-tide

A
  • semaglutide / Ozempic
  • dulaglutide / Trulicity
  • cardioprotective

do not prescribe for:
- pancreatitis
- thyroid cancer

52
Q

TZDs
thiazolidinediones
-zone

A
  • rosiglitazone
  • pioglitazone

do not prescribe for:
- heart failure and liver issues
- fluid retention
- weight gain

53
Q

Sulfonylureas
-ide

A
  • Diabinese / chlorpropamide
  • Glucotrol / glipizide
  • hypoglycemia
  • cheap/affordable
  • weight gain
54
Q

Pregnant Patients with diabetes

A

metformin for gestational diabetes
insulin

55
Q

Glucagon-like peptide-1 (GLP-1) and
glucose-dependent insulinotropic polypeptide (GIP)

A
  • tirzepatide / Mounjaro
  • enhances insulin secretion
  • improves insulin sensitivity
  • reduce appetite
56
Q

Postprandial insulin higher increase…

A

short acting insulin titrate up 1 to 2 units every 2-3 days

57
Q

Fasting blood glucose is higher increase…

A

basal insulin (long or intermediate insulin) titrate up by 2 units per day
*novolin NPH or novolin regular is the cheapest options

58
Q

Regular Screenings for DM patients and preventative care

A

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
Q

Microvascular

A
  • neuropathy
  • retinopathy
  • nephropathy
60
Q

Macrovascular

A
  • coronary artery disease
  • peripheral artery disease
  • stroke
61
Q

Somgyi Effect

A

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
Q

Dawn Phenomenon

A

Blood glucose steadily rises all night resulting in elevated blood glucose upon awakening
- increase hormone release in body (commonly seen in adolescence)

63
Q

Addison’s

A
  • too little cortisol
  • skin will show hyperpigmentation
  • labs: high potassium
  • Addisonian Crisis: emergency kit of steroids
64
Q

Cushings

A
  • 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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