Endo Flashcards by Kayli Nabigon

Nonpharm diabetes

weight loss

Nutrition (mediterranean, DASH, alt healthy eating index)

Exercise >150 min/ week with resistance training

Ongoing monitoring
-BP every visit
-foot exam yearly
-SCr, random ACR yearly
-lipid profile (@diagnosis and yearly)
-ophthalmologist referral
-immunizations (influenza/ PneuC23 x1 dose// 2nd dose still required at >65) , Covid 19

How well did you know this?

Not at all

Perfectly

Pharm T1DM

Rapid acting
+
Long acting insulin

How well did you know this?

Not at all

Perfectly

What are the rapid acting agents

LAG

Lispro (humalog)
Aspart (trurapi, Novorapid)
Glulisine (apidra)

How well did you know this?

Not at all

Perfectly

Most lean T1DM pharm insulin targets

0.5 units / kg in first few months

May have honeymoon period when insulin need is less

Adjust insulin Q2-3 days according to results

How well did you know this?

Not at all

Perfectly

Biguanides

Metformin

-not associated with weight gain
-lowers A1C by 1-1.5%
-Risk of hypoglycaemia low
-Safe to use with HF, liver disease,
-Reduce dose when SCr <30ml/min
-Hold if acutely ill

How well did you know this?

Not at all

Perfectly

Alpha glucosidase inhibitors

acarbose

Does not cause hypoglycaemia but may increase risk with insulins

Need TID dosing and only effective with meals

How well did you know this?

Not at all

Perfectly

GLP1RA

“TIDES”

Dulaglutide
Liraglutide
Semaglutide (ozempic/ rebelsus)
Lixisenatide

Evidence in preventing CVD
Nausea upon initiation
Weight loss

SE/ NVD, acute pancreatitis (rare)

CI/ family history of thyroid cancer

How well did you know this?

Not at all

Perfectly

Sulfonylureas

Pre fix •GLY•

Gliclazide *** lowest hypoglycaemia risk
Glimepiride
Glyburide (greatest risk of hypoglycemia)

Considered an add on/ less often as monotherapy

increase risk of hypoglycaemia, weight gain

How well did you know this?

Not at all

Perfectly

Meglitinides

Repaglinide
** considered for irregular eating**

If meal skipped , skip dose

AE/ flatulence, diarrhea , nausea

How well did you know this?

Not at all

Perfectly

SGLT2i

“Flozins”

Canagliflozin
Dapagliflozin
Empagliflozin

Associated with weight loss
Cause a small decrease in BP
Associated with a low hypoglycaemia risk

Side effects: UTI; mycotic genital infections, small change in volume causing hypotension

Used for HF, CVD, CKD

How well did you know this?

Not at all

Perfectly

When do you treat subclinjcal
Hypothyroidism

If abnormal lipid profile
If symptoms of hypothyroidism
Who are planning pregnancy
Who are anti TPO positive

How well did you know this?

Not at all

Perfectly

What is hypothyroidism levels and subclinical hypothyroidism levels

Hypothyroidism >10 (normal 0.45-4.5)
Low T4 (normal 9-19)

Subclinixal is 4-10
Normal T4 and T3

How well did you know this?

Not at all

Perfectly

Treatment for hypothyroidism

Synthroid 1.6mcq/kg
Usually start at 12.5-25 mcq

First thing in am on empty stomach before breakfast

How well did you know this?

Not at all

Perfectly

What is hyperthyroidism treatment

Methimazole (tapazole) #1

Monitor 6 weeks

How well did you know this?

Not at all

Perfectly

What is diagnostic of hyperthyroidism and subclinical hyperthyroidism

TSH < 0.1
High T4 (N: 9-19)

TSH <0.3 (N: 0.45-4.5)
Normal T4 / T3

How well did you know this?

Not at all

Perfectly

Second line for hypo

Liothyronine
- useful for thyroid cancer undergoing withdrawal of T4 .

Not useful in combination with synthroid

SE of synthroid

Palpitations
Tachycardia
Anxiety
Irritability
Elevated BP
Insomnia

Caution with who when taking synthroid ?

Elderly (Increase CV risk)
CVD
Decreases BMD
DM

What decreases synthroid level

PPI, antacids (H2 blockers)
sSRI
Calcium / iron salts
Estrogen
Soy

** glycemic control may decline with initiation of levothyroxine potentially needing dosing adjustment for AHA

Pregnancy and hypothyroidism

Advise to take 2 tabs of levothyroxine immediately following positive pregnancy test

Dose may increase up to 50% during pregnancy to maintain TSH between 2.5 and 4.5

Patients with known hypothyroidism who are taking thyroid hormone replacement therapy should be advised to increase their levothyroxine dose by 2 extra tablets per week immediately following a positive pregnancy test. Further dose adjustment should be based on TSH levels.[6][13] Thyroid-binding globulins increase during pregnancy, so requirements for L-T4 replacement may increase by up to 50% during pregnancy to maintain TSH between 2.5 mU/L and the lower limit of the normal range.[14] Throughout pregnancy, patients on thyroid hormone replacement should have a TSH level every 6 weeks or 4 weeks after a dosage adjustment.

When do you monitor TSH levels in pregnancy

Q6 weeks until 32 weeks

Q4 weeks after dose adjustment

Postpartum and hypo

TSH returns to prepregnancy values

Breastfeeding is safe

Myxedema coma what is it

Severe state of hypothyroid /
(Hypotension, decrease LOC)

Medical ER

IV corticosteroids and synthroid

When do you treat subclinical hyper

Treat if
Frail elderly
Has other RF for AFib
Osteoporosis
Symptoms or hyper

Side effects of Methimazole and PTU

Skin rash Allergic reaction Agranulocytosis Hepatotoxicity (rare) Neutropenia Cholestatic reversible jaundice

What med is also first line and can be used for Graves’ disease

Radioactive iodine - used to ablate thyroid tissue in pt with Graves’ disease / main risk is inducing hypothyroidism

Adjunct for hyperthyroidism for symptom control

Beta blocker Propanolol

Thyroid storm what is it

Life threatening hyper Medical ER Needs IV thyroid meds, corticosteroids and beta blockers

Pregnancy and hyperthyroidism

If receiving radioactive iodine - wait 6 months before conceiving 1st trimester: PTU (prophylthiouracil) /// Methimazole increases risk of congenital malformations 2nd/ 3rd trimester: Methimazole (PTU is seriously hepatotoxic) Beta blockers can be used for symptoms some cases, cessation of drug therapy can be considered. If only low doses of antithyroid medication are required, a trial without treatment should be considered. Beta-blockers can be used for mild symptoms to avoid exposing the fetus to antithyroid drugs. When planning permits, patients may wish to consider radioactive iodine ablation or thyroidectomy for treatment of hyperthyroidism over 6 months prior to actively trying to conceive. During pregnancy, patients typically require lower doses of antithyroid medication and often go into remission. Monitoring is best done by measuring TSH, fT3 and fT4 every 6–8 weeks,

Monitor what at conception for hyper

TSH and thyroid receptor antibodies titre

Titre thyroid receptor antibody - when do you measure again

Again 18-22 weeks If positive repeat thyroid antibodies titre at 30-34 weeks // high titre increases risk for fetus to have hyperthyroidism , if low titre in first trimesters risk is low

Hyper treatment and breastfeeding

Methimazole Could check babe if high dose

Thiazolidinediones (TZD)

“Glitazones” Pioglitazones Rosiglitazones Decrease A1C by 1-1.5% Causes wt gain, fluid retention, worsening HF, risk of fractures, possible bladder cancer CI- HF

DPP4

•gliptin• Alogliptin Linagliptin Saxagliptin Decrease A1C by 1% Most can be used as monotherapy All can be used in combination with other Antihyperglycemic agents AE/ nasopharyngitis, pancreatitis, severe joint pain