endocrine Flashcards
functions of endocrine system:
enables body to ______ energy
metabolize
functions of the endocrine system:
_____, _____, and develop
- reproduce
- grow
endocrine system maintains ______
homeostasis
endocrine system responds to _____ and ____
stress and injury
2 major classes of hormones
- steroids
- thyronines
age related changes have a _______ response
compensatory
effects of aging:
thyroid gland ____ and activity decreases
atrophies
____ metabolic rate with aging
lower
reduced ____ _____ uptake with aging
radioactive iodine
less secretion and release of ______ w aging
thyrotropin
diminished ____ function with aging
adrenal
_______ secretion decreases
ACTH
decreased secretion of ACTH further reduces ____, ____, ______, _______ and _____
- estrogen
- progesterone
- androgen
- 17-ketosteroids
- glucocortiocoids
volume of _____ gland decreases
pituitary
decreased volume of pituitary gland causes _____ _____ hormone level reduction
somatotropic growth
seventh leading cause of death in older adults
type 2 diabetes
glucose intolerance due to increased amounts of ____ ___ in obese older adults
fat tissue
___% of older adults have diabetes
20
symptoms of type 2 diabetes
- hypotension
- periodontal disease
- stroke
- gastric hypotony
- impotence
- neuropathy
- confusion
- glaucoma
- Dupuytens contracture
fasting blood sugar recommended every ___ years for persons over ___ years
- 3 years
- 45
most effective test for diabetes
glucose tolerance test
ADA recommends ____g of carbs ingested several days before blood work
150g
test should be performed more than once to avoid
false positive results
criteria for diagnosis of type 2 diabetes:
symptoms and random blood glucose concentration greater than or equal to _____ mg/dL
200
criteria for diagnosis of type 2 diabetes:
fasting blood glucose concentration greater than or equal to ____mg/dL
126
criteria for diagnosis of type 2 diabetes:
blood glucose concentrations 2 hours after oral glucose intake greater than or equal to ____mg/dL
200
criteria for diagnosis of type 2 diabetes:
glycosylated hemoglobin (HbA1C) greater than or equal to ___%
6.5%
meds that decrease glucose tolerance (5)
- furosemide
- diuretics
- estrogen
- ethacrynic acid
- nicotinic acid
meds that lower blood sugar levels (3)
- MAIOs
- propanolol
- high dosage of salicylates
hypoglycemia:
blood glucose less than ____mg/dL
70
hyperglycemia s/s (6)
- increase in urination
- increase in appetite, followed by lack of appetite
- weakness, fatigue
- blurred vision
- headache
- glycosuria
hypoglycemia s/s (5)
- cold, clammy skin
- numbness of fingers, toes, mouth
- tachycardia
- nervousness, tremors
- faintness, dizziness
diabetes management:
choose foods low in _____ fat and ___ fat
- saturated
- trans
_______ respirations are the body’s attempt to reverse metabolic acidosis through the exhalation of CO2
Kussmaul
teach pt about prevention, recognition, and management of hypoglycemia if pt is taking _____ or ______
- sulfonylureas
- metformin
diabetic ketoacidosis most likely to occur in pts with type ___
1
s/s of diabetic ketoacidosis (4)
- hyperglycemia
- ketosis
- acidosis
- dehydration
what is it called when ketone bodies are excreted in the urine?
ketonuria
during ketonuria, _____ that are cations are excreted with the anionic ketones to try to maintain _____ _______
- electrolytes
- electrical neutrality
insulin deficiency stimulates the production of glucose from _____ _____ in the liver furthering hyperglycemia
-amino acids
s/s of dehydration in DKA (3)
- dry mucous membranes
- tachycardia
- orthostatic hypotension
acetone is noted on breath as a sweet, fruity odor in what condition?
diabetic ketoacidosis
common causes of hyperosmolar hyperglycemia syndrome (5)
- UTIs
- pneumonia
- sepsis
- acute illness
- newly diagnosed type 2 diabetes
what is it called when a pt w diabetes is able to make enough insulin to prevent diabetic ketoacidosis but not enough prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion?
hyperosmolar hyperglycemia syndrome
HHS causes severe ______
hyperglycemia
HHS causes ______ ______ depletion
extracellular fluid
HHS causes ____ ______
osmotic diuresis
HHS often related to impaired ______ ______
thirst sensation
HHS related to functional inability to replace _____
fluids
the main difference between HHS and DKA is that the pt with HHS usually has enough circulating ______ so that ketoacidosis does not occur
insulin
lab values for HHS:
blood glucose greater than ____mg/dL
600
lab values for HHS:
marked increase in serum _____
osmolality
HHS treatment:
when blood glucose falls to about ____mg/dL IV fluids containing ______ are given to prevent hypoglycemia
- 250
- dextrose
first goal of therapy for DKA is to begin _____ and ______ replacement
fluid and electrolyte
obtain serum _____ level before starting insulin in pt with DKA
-potassium
3 major types of glucose lowering agents
- insulin
- oral agents (OAs)
- noninsulin injectable agents
_____ (injected) insulin is needed when a pt has inadequate insulin to meet specific metabolic needs
exogenous
type ___ diabetes is a progressive illness
2
rapid acting insulin:
-peak: ___min- __ hours
30 min-3 hours
rapid acting insulin examples (3)
- Humalog
- Novolog
- Apidra
rapid acting insulin duration: __-___ hours
3-5 hours
short acting insulin examples (2)
- Humulin R
- Novolin R
short acting insulin duration:
__-___ hours
5-8 hours
intermediate acting insulin examples (2)
-NPH– Humulin N, Novolin N
intermediate acting insulin duration:
___-___ hours
12-18 hours
long acting insulin examples (3)
- Lantus
- Levemir
- Tresiba
long acting insulin duration:
__-___ hours
16-24 hours
inhaled insulin example (1)
afrezza
inhaled insulin duration:
___1/2-___ hours
2 1/2-3 hours
fastest subcutaneous absorption is from the ______
abdomen
what is it called when a high dose of insulin causes a decline in blood glucose levels during the night causing counterregulatory hormones to be released?
Somogyi effect
what counter regulatory hormones are release during somogyi effect (4)
- glucagon
- ephinephrine
- growth hormone
- cortisol
if the pt has morning hyperglycemia, checking blood glucose levels between
___ and ____a.m. for hypoglycemia to determine if the cause is the Somogyi effect
2-4am
_______ and _____ are excreted in increased amounts in the morning may be the cause of _____ ______
- growth hormone and cortisol
- dawn phenomenon
dawn phenomenon tends to be most severe during ______ and _____ adulthood bc _______ ______ is at its peak
- adolescents and young adulthood
- growth hormone
treatment for somogyi effect:
reducing ________ of _____
bedtime _____
- dosage of insulin
- snack
treatment for dawn phenomenon:
increase in ____
adjustment of ___________time
- insulin
- administration
most widely used oral agent
metformin
_____ is the most effective first line treatment for type 2 diabetes
metformin
primary action of ______ is to reduce glucose production to the liver
metformin
the primary action of metformin is to reduce ____ production by the _____
- glucose
- liver
_____ is a major side effect of sulfonylreas
hypoglycemia
primary action of ______ is to increase insulin production by the pancreas
-sulfonylureas
______ are more rapidly absorbed and eliminated by pancreas than sulfonylreas so they are less likely to cause hypoglycemia
meglitinides
______ ______ inhibitors work by slowing down carb absorption in the small intestine
alpha glucosidase inhibitors
alpha glucosidase inhibitors slow down the absorption of ______ in the _____ intestine
- carbohydrates
- small
if alpha glucosidase inhibitors are taken with the first bite of each main meal, they are most effective in lowering ______ blood glucose
postprandial
_______ most effective for pts with insulin resistance
thiazolidinediones
Avandia (thiazolidinediones) is associated with adverse ______ events
cardiovascular
Pioglitazone (Actos) can worsen ____ ____ and is associated with increased risk of ______ cancer
- heart failure
- bladder
sulfonylreas carries risk for _____due to delayed clearance in older adults
hypoglycemia
administer metformin _____ meals
after
take sulfonylureas ____ hour before meals
half hour
The recommendation for pts who use multiple insulin injections a day or insulin pumps is to monitor their blood glucose ___-___ times a day
4-8
_____ _______ agent is _____(short/long) acting with less adverse effects on older adults
- insulinotropic anti diabetic agent
- short
med class with the lowest risk of hypoglycemia
thiazolidinediones
hemoglobin A1C used to monitor effectiveness of disease control over a
__-__ week period of time
6-12
triglyceride levels below ____mg/dL is ideal
150