Diabetes and Endocrine/Metabolic Disorders Flashcards
How to treat hyperthyroidism (grave’s disease)?
Ablative therapy with radioactive iodine.
PTU and Methimazole (inhibit iodination and synthesis of thyroid hormones).
Methimazole is preferred agent, PTU is recommended in 1st trimester.
What else can be used in hyperthyroidism?
Beta blockers - primarily for symptomatic improvements.
Iodines - block release
How do you dose levothyroxine?
1.6 mcg/kg/day IBW in otherwise healthy adult.
50-60 mcg/day in those 50-60 years of age.
12.5-25 mcg/day in those with CVD.
How to treat cushing’s disease?
Surgical resection is treatment of choice.
Pasireotide - somatostatin analogue (block pituitary ACTH secretion). Significant ADR profile - Hyperglycemia, bradycardia, gallstones, HA. Baseline EKG, glucose and A1C, LFTs, gall bladder ultrasound
Ketoconazole, Mitotane, Osilodrostat, Etomidate (IV reserved for rapid cortisol control).
What treats hyperglycemia cushing’s disease?
Mifepristone.
How does Orlistat work?
Inhibits gastric and pancreatic lipases (reduced fat absorption). FDA warning for kidney stones.
Does lorcaserin increase cancer risk?
YES. No longer FDA available.
Do you have to have a negative pregnancy test before receiving phentermine/extended release topiramate?
YES. Need at least a 5% weight loss.
What to know about bupropion/naltrexone?
Weekly dose titration over 4 weeks, reduce in moderate/severe renal impairment. Nausea, constipation, etc. Do not use in seizure DO, uncontrolled HTN, eating DO, chronic opioid use, concurrent use of other products containing naltrexone or bupropion. Need about a 5% weight loss.
What is the A1C cut off for diabetes?
> 6.5%
What are the goals for blood pressure in diabetes?
ADA - CV risk <15% is 140/90. <130/80 if high risk.
ACC/AHA is <130/80
What are your basal insulins?
Determir/Glargine/Degludec/ (NPH)
What are your bolus insulins?
Glulisine/Aspart(s)/Lispro/Inhaled (regular)
What is the weight based dose of insulin?
TDI is 0.6 units/kg/day. 50% is basal and 50% is bolus (split 3 days).
What are the side effects for metformin?
GI. Severe but rare (lactic acidosis).
