Endocrine Disorders Flashcards
(43 cards)
What is metabolic syndrome?
- Waist circumference: >40 inches/101.6cm in men, >35 inches/88.9cm in women
- BP > or = 130/85
- Triglycerides > 150
- FBG > 100
- HDL: <40 in men and <50 in women
What are some distinguishing factors of DM 1?
- ketonuria and ketonemia
- acute onset
- HLA/pancreatic islet cell antibody production
- Treatment/management is insulin
- nocturnal enuresis
- weight loss
- weakness/fatigue
- p/p/p
What are some distinguishing factors of DM 2?
-insidious onset
-circulating insulin exists enough to prevent ketoacidosis,
but is inadequate to meed pt’s insulin needs
-in females, often the first symptom is recurrent vaginitis;
chronic skin infections
-mostly managed with oral anti-diabetics; also with
weight reduction and dietary treatment
-peripheral neuropathy
-blurred vision
-polyuria/polydipsia
What is the recommended intake of carbs, fats, fiber, and protein?
Carbs: 50-60% total caloric intake
Fat: 20-30%
Fiber: 25g/1000 calories
Protein: 10-20%
What do sulfonylureas do?
Examples?
Any specific drug class-associated precautions?
-Stimulate pancreas to release insulin/enhances insulin
release
- glipizide
- glyburide
- glimepiride
What do biguanides do?
Example?
Any specific drug class-associated precautions?
-Good adjunct to sulofonylureas, but can be used alone,
especially in obese patients
-Reduces hepatic glucose production and intestinal
glucose absorption + insulin sensitizer via increased
peripheral glucose uptake and use
Metformin
**Monitor Cr
**lactic acidosis is a possible side effect
(presents as muscle pain)
What do alpha-glucosidase inhibitors do?
Example?
Any specific drug class-associated precautions?
Binds to disaccharidases so less glucose is absorbed by
the gut/delays intestinal carbohydrate absorption–>
helpful in managing post-prandial hyperglycemia
- acarbose (Precose)
- miglitol (Glyset)
-Monitor for GI side effects; take with 1st bite of meal
What do thiazolidinediones do?
Example?
Any specific drug class-associated precautions?
-Decreases gluconeogenesis; insulin sensitizer
- rosiglitazone (Avandia)
- pioglitazone (Actos)
Monitor ALT; may take up to 12 weeks for therapeutic
effect
What do non-sulfonylurea insulin release stimulators do?
Example?
Any specific drug class-associated precautions?
- Rapidly absorbed from the intestine and mimics the
effect of rapidly acting insulin - repaglinide (Prandin)
- nateglinide (Starlix)
Take within 30 mins prior to meal
What does exenatide (Byetta) do?
Any specific drug class-associated precautions?
-Mimics the effects of incretins - signals the pancreas to
increase insulin secretion and the liver to stop
producing glucagon
Injectable
N/V, D
What do DD-4 inhibitors do?
Example?
Any specific drug class-associated precautions?
-Breaks down incretins so that the level increases which
stimulates release of insulin
-sitagliptin (Januvia)
What do amylin analogues do?
Example?
Any specific drug class-associated precautions?
-Slows absorption of glucose and inhibits the action of
glucoagons
- pramlinitide (Symlin)
- Promotes weight loss while decreasing blood glucose
What is the Somogyi effect and how do you manage it?
-When you get early morning hyperglycemia (peaking
around 7am; is hypoglycemic at 3am) as a result of
nighttime hypoglycemia. Counter regulatory hormones
surge, raising blood sugar.
-Decrease or omit night-time dose of insulin
What is the Dawn phenomenon and how do you manage it?
-Gradually elevating glucose levels through the night that
result in morning hyperglycemia due to tissues
becoming desensitized to insulin nocturnally
-Increase or add bedtime insulin dose
What is Cushing’s Syndrome?
-Caused by the overproduction/hypersecretion of
adrenocorticoid hormone (ACTH) by the pituitary gland
-Increase in cortisol
-Can be caused by chronic use of glucocorticoids or
adrenal tumors
What are key signs/symptoms of Cushing’s Syndrome?
Moon face and buffalo hump Weakness (so much so it is hard to walk up stairs) HTN Labile mood Hirsutism/acne/purple striae Frequent infections Hyperglycemia, Hypernatremia, and Hypokalemia Elevated plasma cortisol in the AM
How do you treat Cushing’s Syndrome?
Depends on cause: DC medications inducing symptoms;
surgery for removal of adrenal tumors
Electrolyte balance
What is Addison’s Disease?
A deficiency of cortisol, aldosterone, and androgens
Results from an autoimmune destruction of adrenal gland
Pituitary failure resulting in decreased ACTH
What are key signs/symptoms of Addison’s Disease?
Hyperpigmentation of mucous membranes, palms, and
knuckles
Orthostasis and hypotension
Hypoglycemia, Hyponatremia, and HYPERkalemia
Plasma cortisol low in AM
How do you treat Addison’s Disease?
Glucocorticoid (hydrocortisone) and mineralcorticoid
(fludrocortisone) replacement
Referral to endocrinology
When you hear HYPERthyroidism, what do you think?
- less common than hypothyroid
- Grave’s disease
- Low TSH and High T3 (80-230)
- Tachycardia, exopthalmos, nervousness/anxiety, heat intolerance, fine hair, weight loss, increased appetite
- Treament: Propanolol (start with 10mg, titrate to as high as 80mg QID) for tremors/tachycardia; PTU or methimazole; Radioactive iodine 131-I used to destroy goiters
- Adverse outcomes: Thyroid crisis
When you hear HYPOthyroidism, what do you think?
Hashimoto’s thyroiditis most common cause
Everything slows down
Elevated TSH, Low T4, hyponatremia, hypoglycemia
Treatment: Levothyroxine 50-100mcg/day, may titrate
dose by 25mcg every 1-2 weeks until symptoms
stabilize
Draw levels after 2 months of consistent therapy
Adverse outcome: myxedema coma
What are the normal values for BUN and Cr?
BUN: 10-20 (dehydration most common cause for elevation)
Cr: 0.5-1.5 (most sensitive indicator for renal function/failure)
What is normal blood glucose?
60-99
