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AANP Study Cards > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is type 1 diabetes?

A

Chronic metabolic disorder as a result of destruction of Beta-cells in the islet of Langerhans resulting in abrupt cessation of insulin production

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2
Q

What are signs and symptoms of DM?

A

Polydipsia, polyuria, polyphagia, weight loss. Blurred vision, fruity breath, ketones in urine

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3
Q

What are microvascular complications of DM

A

Retinopathy, nephropathy, neuropathy

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4
Q

What are macrovascular complications of DM

A

Atherosclerosis, CAD, MI

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5
Q

What are risk factors for T2DM

A
  • BMI >25
  • Abdominal Obesity
  • Sedentary lifestyle
  • Metabolic Syndrome
  • Family Hx
  • Hispanic, black, Asian, pacific islander or American Indian descent
  • Hx of GDM
  • Impaired FBG
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6
Q

Dx criteria for DM

A

A1C >/= 6.5% *
FPG >/= 126 mg/dL *
OGTT >/= 200mg/dL *
Random glucose >200mg/dL

*Requires confirmation on repeat test unless hyperglycemia is unequivocal

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7
Q

Impaired FBG is defined by an A1C of between ____ and/or _____, FPG between ____ and ____, and/or 2hr OGTT (75g) between ____ and _____

A

A1C 5.7%-6.4%
FPG: 100-125mg/dL
OGTT: 140-199mg/dL

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8
Q

What is the goal A1C according to the ADA in

a) Most T2DM
b) Older patients
c) T1DM and pregnancy

A

a) 7%
b) 8%
c) 6%

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9
Q

You should check A1C q____ months until target or when adjusting therapy then ____

A

3 months then 6-12 months

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10
Q

What labs aside from A1C should be ordered in a newly diagnosed DM

A

Fasting lipids, lytes, TSH, LFTs, Kidney Function, Microalbuminuria

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11
Q

At every visit with a diabetic patient what should you assess?

A

BMI
BP
Feet
Blood glucose control

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12
Q

What is the ADA’s screening recommendation for T2DM

A

1) Annually with a BMI >25 with 1 or more risk factor

2) Q3 years in individuals 45 years old or older

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13
Q

In Impaired fasting glucose when would you consider adding metformin?

A
  • A1C 5.7-6.4%
  • <60 years old
  • BMI >35
  • Hx of GDm
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14
Q

What is 1st line treatment for T2DM

A

Metformin

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15
Q

What are the side effects of metformin?

A

GI upset (nausea, vomiting, diarrhea), lactic acidosis

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16
Q

What decrease in A1C is noted with metformin use?

A

1-2%

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17
Q

What is level 1 HYPOglycemia?

A

Blood glucose = 70mg/dL

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18
Q

What is level 2 HYPOglycemia?

A

Blood glucose = 54 mg/dL

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19
Q

What are the signs and symptoms of hypoglycemia?

A

Sweaty palms, fatigue, dizziness, rapid heart rate, confusion, weakness, hand tremors, anxiety, coma, death

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20
Q

What drug can blunt the body’s hypoglycemic response?

A

Beta Blockers

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21
Q

What is the function of FSH?

A
  • Stimulates ovaries to enable growth of follicles

- Stimulates production of estrogen

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22
Q

What is the function of LH

A
  • Stimulates ovaries to ovulate
  • Stimulates production of progesterone by corpus luteum
  • In males stimulates the testicles (leydig cellst to produce testosterone)
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23
Q

What is the function of TSH?

A

Stimulates the thyroid to produce T3 and T4

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24
Q

What is the function of ACTH?

A

Stimulates the adrenal glands to produce cortisol and aldosterone

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25
Q

What is the Dawn Phenomenon

A

An hormonal event causing elevations in the FPG daily in the am (between 4-8am)

  • Without a normal insulin response, there will be a rise in FPG
  • Normally people produce enough insulin to combat
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26
Q

What is the Somogyi Effect?

A

Severe nocturnal hypoglycemia stimulates counterregulatory hormones (ie. glucagon) into systemic circulation resulting in an increase in FPG by 7am

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27
Q

What is the treatment for hypoglycemia

A

-Rule of 15s

15g of Carbs to raise BG in 15 minutes

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28
Q

How should a T2DM adjust BG and meds with illness and surgery

A

No change to meds unless FBG is lower than normal

-Frequently monitor BG

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29
Q

What are fundoscopic eye changes that can be noted on exam of a patient with diabetic retinopathy?

A
  • Neovascularization
  • Microaneurysms
  • Cotton Wool Spots
  • Soft and Hard Exudates
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30
Q

What is Charcots Foot

A

Deformity of the foot and ankle caused by bone and joint deformity (dislocation and fracture) related to neuropathy and loss of sensation

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31
Q

What are examples of Sulfonylureas?

A

Glipizide, Glyburide

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32
Q

What is the MOA of sulfonylureas

A

Stimulates beta cells to secrete more insuline

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33
Q

What are AE of Sulfonylureas

A

Increase risk of CV mortality, hypoglycemia, blood dyscriasis, weight gain

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34
Q

What drop in A1C is expected with a sulfonylurea?

A

1-2%

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35
Q

What is an example of a thiazolidinediones

A

Pioglitazone (Actos)

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36
Q

What is the mechanism of action of a thiazolidinedione?

A

Enhances insulin sensitivity in the muscle tissue (decreasing peripheral resistance) and decreasing hepatic glucagon production

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37
Q

What are contraindications to thiazolidinediones?

A

Heart failure (causes water retention and edema), bladder cancer, active liver disease, T1DM and pregnancy

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38
Q

What is an expected drop in A1C with Actos?

A

0.7%

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39
Q

What is the MOA of Bile Acid Sequestrants in DM?

A

-Decreases hepatic glucose production and decreases intestinal absorption of glucose

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40
Q

What are side effects of bile acid sequestrants?

A
  • Nausea
  • Bloating
  • Constipation
  • Increased triglycerides
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41
Q

What is an example of a meglitinide (glinides)

A

Repaglinide (Prandin), nateglinide (starlix)

42
Q

What is the MOA of Meglitinide?

A

Stimulates pancreatic secretion of insulin

43
Q

If a patient has irregular meal times, what T2DM could be considered?

A

Meglitinide r/t rapid action

44
Q

What is the onset of rapid acting insulin

Lispro/aspart/glulisine

A

15 minutes

45
Q

What is the peak of rapid acting insulin

Lispro/aspart/glulisine

A

0.5-2.5 hrs

46
Q

What is the duration of rapid acting insulin

Lispro/aspart/glulisine

A

4.5 hrs

47
Q

What is the onset of short acting regular insulin?

A

30 minutes

48
Q

What is the peak of short acting regular insulin?

A

1-5 hrs

49
Q

What is the duration of short acting regular insulin?

A

6-8 hrs

50
Q

What is the onset of Intermediate NPH insulin?

A

1 hr

51
Q

What is the peak of Intermediate NPH insulin?

A

6-14 hr

52
Q

What is the duration of Intermediate NPH insulin?

A

18-24 hr

53
Q

What is the onset of basal insulin Lantus (glargine) and Levemir (Detemir)

A

1 hr

54
Q

What is the peak of basal insulin Lantus (glargine) and Levemir (Detemir)

A

None

55
Q

What is the duration of basal insulin Lantus (glargine) and Levemir (Detemir)

A

24 hrs

56
Q

What are examples of GLP-1 receptor agonist?

A

Exenatide, liraglutide

57
Q

What is the mechanism of action of GLP-1 RA

A

stimulates GLP-1 increasing insulin production , inhibiting postprandial glucagon release
-increasing satiety, decreased postprandial hyperglycemia

58
Q

What are contraindications to a GLP-1 RA

A

Hx or Fhx of medullary thyroid cancer, multiple endocrine neoplasia syndrome

59
Q

What is the benefits of a GLP-1 RA

A
  • Decreases CV events
  • Renal protective
  • Weight loss
60
Q

What is the expected drop in A1C with a GLP-1 RA

A

1-1.5%

61
Q

What are examples of SGLT2i

A

Canagliflozin (Invokana), Dapagliflozin (Farxiga), empagliflozin (jardiance)

62
Q

What is the MOA for SGLT2i

A

Blocks glucose reabsorption by the kidneys in the proximal nephron, increased glycosuria

63
Q

What are benefits of SGLT2i

A
  • weight loss
  • reduced CV events
  • renal protective
64
Q

What are AE of SGLT2i

A
  • DKA
  • Polyuria
  • Increased creatinine
  • Increased UTIs
65
Q

What are examples of DPP-4 inhibitor

A

Sitagliptin, saxagliptin, linagliptin

66
Q

What are adverse effects of DPP-4 inhibitor

A

Joint pain, angioedema, urticaria, pancreatitis

67
Q

What is the expected drop in A1C with a DPP-4 inhibitor

A

0.7%

68
Q

What is the expected drop of A1C with SGLT2i

A

0.6-1%

69
Q

Rapid insulin covers ___

A

1 meal at a time

70
Q

Regular insulin lasts ___ to ___

A

meal to meal

71
Q

NPH lasts ___ to ____

A

Breakfast to dinner

72
Q

Lantus lasts ___

A

24 hours

73
Q

What is a recommendation for treatment with an A1C >/= 9

A

Dual Therapy

74
Q

What is the recommendation for an A1C >/= 10

A

Injectable insulin

75
Q

What med do you need to consider stopping if you are going to initiate insulin therapy and why?

A

-sulfonylureas because of increased risk of weight gain

76
Q

What T2DM meds cause weight gain

A

Sulfonylureas, insulin, TZD

77
Q

What oral T2DM has highest risk of hypoglycemia

A

Sulfonylureas

78
Q

What are symptoms of thyroid cancer

A

Single thyroid nodule on upper 1/2 of the lobe, cervical lymphadenopathy, hoarseness, swallowing issues

79
Q

What are RF for thyroid cancer?

A

Radiation in childhood, low iodine diet, asian, women (3:1)

80
Q

What are the lab findings for HYPERthyroid

A

Low or undetectable TSH, elevations in T4 +/- T3

81
Q

What is the most common cause of HYPERthyroid

A

Graves- an autoimmune disorder causing hyperfunction and production of excess thyroid hormone

82
Q

What are sx of HYPERthyroid

A

Weight loss, anxiety, insomnia, cardiac (palpitations, tachycardia, atrial fibrillation, premature atrial contractions, hypertension), warm/moist skin, opthalmopathy, lid lag, increased frequency of bowel movements, amenorrhea, heat intoleranace, enlarged thryoid (goiter), pretibial myexedma, tremors, brisk reflexes

83
Q

What are the treatments for HYPERthyroid?

A

PTU preferred (safe in pregnancy)
Methimazole (Tapazole)
Radioactive iodine
Beta blockers for symptom control

84
Q

What are the lab values for Hypothyroidism

A 
Elevated TSH (>5mU/L)
Low T4
85
Q

What would be a difference in lab values for a subclinical hypothyroidism

A

Elevated TSH but normal T4

86
Q

What is a risk of chronic amenorrhea and hypermetabolism in hyperthyroidism

A

Osteoprosis

87
Q

How do you initiate basal insulin

A

Start at 0.1-0.2 u/kg or 10 units

-Adjust 2-4u 1-2x weekly until you reach target FBG (80-125)

88
Q

What is the dosing for synthroid

A
  1. 6mcg/kg
    - In older adults start at 12.5- 25mcg

*Note: 1/2 life of synthroid is 1 week so if overdose sx can take a while to revert

89
Q

What are risks of levothyroxine (synthroid)

A

A.Fib, accelerated bone loss

90
Q

What education should be provided re: insulin pump in water

A

Disconnect when showering, bathing or swimming

91
Q

What is a pheochromocytoma

A

A rare adrenal tumor that releases hormones

92
Q

What are sx of pheochromocytoma

A

Diaphoresis, tachycardia, hypertension that occurs episodically

93
Q

What triggers attacks of hormone surges with a pheochromocytoma?

A

Stress, physical exertion, anxiety, surgery, anesthesia, foods with tyramine, stimulants, foods that are MAOI rich

94
Q

What are the characteristics of metabolic syndrome?

A

1) Abdominal Obesity (men >40 inches, women >35 inches)
2) HTN BP >130/85
3) Hyperglycemia FPG >100 or T2DM
4) Elevated triglycerides (>150mg/dL) or being treated for same
5) Low HDL (<40mg/dL in men, <50mg/dL in women) or tx for same

95
Q

If a patient has an elevated TSH (>5) what other blood work is needed

A

-repeat TSH and add a free T4

96
Q

In a patient with an elevated TSH but normal T4 when should you recheck the TSH and T4?

A

6 months

97
Q

How often should you check a TSH when monitoring response to treatment?

A

q6-8 weeks

*No earlier than 6 weeks

98
Q

Alopecia of the outer 1/3rd of the eyebrow and myxedema are symptoms of

A

Hypothyroidism

99
Q

Lid lag is a symptom of

A

Graves’ opthalmopathy

100
Q

If a patient’s A1C is >/= you should consider

A

Dual therapy or basal insulin,

if already on 2 drugs start basal insulin

AANP Study Cards (20 decks)

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