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Thera II > Endo > Flashcards

Endo Flashcards

1
Q

Nonpharm diabetes

A

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

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2
Q

Pharm T1DM

A

Rapid acting
+
Long acting insulin

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3
Q

What are the rapid acting agents

A

LAG

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

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4
Q

Most lean T1DM pharm insulin targets

A

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

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5
Q

Biguanides

A

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

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6
Q

Alpha glucosidase inhibitors

A

acarbose

Does not cause hypoglycaemia but may increase risk with insulins

Need TID dosing and only effective with meals

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7
Q

GLP1RA

A

“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

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8
Q

Sulfonylureas

A

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

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9
Q

Meglitinides

A

Repaglinide
** considered for irregular eating**

If meal skipped , skip dose

AE/ flatulence, diarrhea , nausea

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10
Q

SGLT2i

A

“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

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11
Q

When do you treat subclinjcal
Hypothyroidism

A

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

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12
Q

What is hypothyroidism levels and subclinical hypothyroidism levels

A

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

Subclinixal is 4-10
Normal T4 and T3

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13
Q

Treatment for hypothyroidism

A

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

First thing in am on empty stomach before breakfast

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14
Q

What is hyperthyroidism treatment

A

Methimazole (tapazole) #1

Monitor 6 weeks

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15
Q

What is diagnostic of hyperthyroidism and subclinical hyperthyroidism

A

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

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

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16
Q

Second line for hypo

A

Liothyronine
- useful for thyroid cancer undergoing withdrawal of T4 .

Not useful in combination with synthroid

17
Q

SE of synthroid

A

Palpitations
Tachycardia
Anxiety
Irritability
Elevated BP
Insomnia

18
Q

Caution with who when taking synthroid ?

A

Elderly (Increase CV risk)
CVD
Decreases BMD
DM

19
Q

What decreases synthroid level

A

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

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

20
Q

Pregnancy and hypothyroidism

A

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.

21
Q

When do you monitor TSH levels in pregnancy

A

Q6 weeks until 32 weeks

Q4 weeks after dose adjustment

22
Q

Postpartum and hypo

A

TSH returns to prepregnancy values

Breastfeeding is safe

23
Q

Myxedema coma what is it

A

Severe state of hypothyroid /
(Hypotension, decrease LOC)

Medical ER

IV corticosteroids and synthroid

24
Q

When do you treat subclinical hyper

A

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

25
Q

Side effects of Methimazole and PTU

A

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

26
Q

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

A

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

27
Q

Adjunct for hyperthyroidism for symptom control

A

Beta blocker
Propanolol

28
Q

Thyroid storm what is it

A

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

29
Q

Pregnancy and hyperthyroidism

A

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,

30
Q

Monitor what at conception for hyper

A

TSH and thyroid receptor antibodies titre

31
Q

Titre thyroid receptor antibody - when do you measure again

A

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

32
Q

Hyper treatment and breastfeeding

A

Methimazole

Could check babe if high dose

33
Q

Thiazolidinediones (TZD)

A

“Glitazones”
Pioglitazones
Rosiglitazones

Decrease A1C by 1-1.5%

Causes wt gain, fluid retention, worsening HF, risk of fractures, possible bladder cancer

CI- HF

34
Q

DPP4

A

•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

Thera II (12 decks)

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