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Med Surg 1 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What 5 things do T3/T4 play an important role in regulating?

Part of Endocrine system

A

Role in Regulation of:
1. Weight
2. Energy
3. Temperature
4. Skin, hair, nail growth
5. Metabolism

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2
Q

Are symptoms of hypo/hyper-thyroidism based on thyroid hormone or TSH?

thyroid stimulating hormone

A

Thyroid hormones
(T3/T4)

TSH secreted by pituitary gland

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3
Q

What are possible S/Sx occuring in both hypo/hyper-thyroidism?

A
  1. Amenorrhea
  2. Thinning/brittle hair

Variability in dry skin (hypo) and sweating (hyper)

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4
Q

What is the main cause of Hyper-thyroidism?

A

Grave’s Disease

AIDS

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5
Q

What is the main cause of Hypo-thyroidism?

A

Hashimoto’s

AIDS

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6
Q

What is the treatment for hypo-thyroidism?

A
  1. levothryoxine (Synthroid)
  2. High Bulk, low calories diet*

addresses constipation and weight gain.

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7
Q
  • What is levothyroxine (Synthroid) taken for?
  • What is an expected abnormal finding for patients taking levothyroxine (Synthroid)?
A
  • Treats hypo-thyroidism
  • Increased HR (tachycardia)
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8
Q

What are the treatment options for hyper-thyroidism?

A
  1. Methimazole (Tapazole)
  2. Radioactive iodine therapy
  3. Surgery (Thyroidectomy)
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9
Q
  • What is Methimazole (Tapazole) taken for?
  • What is a side effect?
A
  • Treats hyper-thyroidism
  • Decrease production of RBC, WBC, and platelets (risk for anemia, infection, and bleeding)
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10
Q

What hormone is released by the hypothalamus, pituitary gland and thyroid gland?

A

TRH → TSH → T3/T4

Hypothalamus → Pituitary → Thyroid Gland

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11
Q

What does the negative feedback loop causes when thyroid hormone increases?

A

Decrease TRH and TSH

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12
Q

Which is more common primary or secondary thyroid disorders?

A

Primary
Hypo/hyper-thyroidism

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13
Q

Interpret the findings:

↑ T3/T4
↓ TSH

A

Primary Hyper-thyroidism

inversed directions it is primary

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14
Q

Interpret the findings:

↑ T3/T4
↑ TSH

A

Secondary Hyper-thyroidism

same direction that would be secondary

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15
Q

Interpret the findings:

↓ T3/T4
↑ TSH

A

Primary Hypo-thyroidism

inversed directions it is primary

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16
Q

Interpret the findings:

↓ T3/T4
↓ TSH

A

Secondary Hypo-thyroidism

same direction that would be secondary

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17
Q

What are the possible causes of secondary hypo/hyper-thyroidism?

A
  • Pituitary tumor (cancer)
  • Brain damage
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18
Q

What is the clinical emergency for hypo-thyroidism?

A

Myxedema

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19
Q

What is the clinical emergency for hyper-thyroidism?

A

Thyroid Storm (clinical emergency)

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20
Q

What are the four S/Sx a patient is experiencing Thyroid Storm?

A
  1. Tachycardia
  2. Hyperprexia (fever)
  3. AMS (altered mental status)
  4. GI issues (cramping, nausea/vomiting)
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21
Q

What medications may be given for patient w/ Thyroid Storm

A
  1. methimazole (Tapazole)
  2. Beta Blocker/Calcium Channel Blocker*
  3. Acetaminophen

*-Lol and -dipine

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22
Q

What is the treatment for Myxedema?

A

Levothyroxine (Synthroid)

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23
Q

What are the three clinical manifestations of Myxedema?

A
  1. Peri-orbital edema
  2. Pre-tibial edema (swelling of lower legs)
  3. Coma

Non-Pitting

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24
Q

What are the causes of Thyroid Storm?

A
  1. Chronic untreated hyper-thyroidism
  2. Events such as stress, surgery, trauma, infection (think SSTI, like sti’s are stressful)
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25
Q

What are the causes of Myxedema?

A
  1. Chronic untreated hypo-thyroidism
  2. Cold weather
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26
Q

What hormone is released by the adrenal medulla?

A

catecholamines
(norepinephrine, epinephrine)

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27
Q

What hormone is released by the adrenal cortex?

A
  1. sex hormones
  2. mineralocorticoids
  3. glucocorticoids (cortisol)

Steroids

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28
Q

Addison’s disease is characterized by insufficiency of which two hormones?

A
  1. Aldosterone
  2. Cortisol
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29
Q

Decreased aldosterone leads to what 3 issues?

A
  1. Hypo-natremia (< 135)
  2. Hypotension*
  3. Hyper-kalemia (> 5)

hypotension r/t decreased water

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30
Q

Decreased cortisol levels lead to what 2 issues?

A
  1. Risk for infection
  2. Hypo-glycemia
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31
Q

What will a patient experiencing Addisonian Crisis present with?

A

Severe (clinical emergency):
1. Hypo-tension
2. Hypo-glycemia
3. Hyper-kalemia (r/t decreased aldosterone)

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32
Q

What would be the treatment for Addisonian Crisis?

A
  1. Glucocorticoids
  2. IV fluids
  3. Sugar
  4. Insulin or sodium polystyrene (Kayexalate)
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33
Q

What does Cushing syndrome increase the risk of developing?

A

Diabetes

R/T hyperglycemia

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34
Q

What must be monitored with insulin tx for Addisonian Crisis hyperkalemia?

A

Further blood glucose level drops (hypoglycemia)

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35
Q

Addisonian Crisis experiencing hyperkalemia increases the risk of what to occur?

A

Dysrhythmias

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36
Q

Buffalo hump, moon face, and striae in the abdomen are commonly associate w/ which condition?

A

Cushings syndrome

37
Q
  • Long-term steroid use can increase the risk of what?
  • Why?
A
  • Cushing syndrome
  • r/t elevated glucocorticoids
38
Q

ADH is also known as what

Anti-Diuretic Hormone

A

Vasopressin

39
Q

What hormone causes the body to retain water?

A

ADH

40
Q

What are 4 signs of dilutional hyponatremia?

A
  1. Nausea/vomiting
  2. Confusion/restless
  3. Muscle issues
  4. Seizures
41
Q

What are the three treatments for SIADH

Syndrome of inappropriate antidiuretic hormone secretion

A
  1. vasopressin (ADH) antagonist
  2. Fluid restriction
  3. Na+ replacement (salt pill)*

alternative = 3-5% NaCl in NS, but IV solution adds fluids

42
Q

What is Diabetes Insipidus?

A

Decreased ADH (think an injury to the pituitary gland or hypothalamus);
kidneys unable to retain water

43
Q

How is DI diagnosed?

Diabetes Insipidus

A

Water deprivation test

44
Q
  1. What is the treatment for DI?
  2. What is a sign the tx is working?

Diabetes Insipidus

A
  1. Nasal vasopressin agonist (DDAVP, desmopressin)*
  2. Decreased UO and thirst

Nasal spray

45
Q

Is urine to dilute or concentrated w/ DI?

Diabetes Insipidus

A

Urine is to dilute
(thirst causing excess water consumption)

inability to concentrate urine

46
Q

What S/Sx does DI share w/ Diabetes Mellitus?

A
  1. Polydipsia (thirst)
  2. Polyuria (UO)
47
Q
  • Hypoglycemia glucose levels
  • Hyperglycemia glucose levels
A
  • Hypoglycemia < 70 mg/dl
  • Hyperglycemia > 300 mg/dl
48
Q

What is the difference between DM Type I and II regarding insulin?

A
  • DM Type I is associated w/ abscence of insulin production by the pancreas.
  • DM Type II is associated w/ decreased insulin production or resistance to insulin
49
Q

Which diabetes is most often associated with early onset

sometimes referred to as juvenile diabetes

A

DM type I

50
Q

What is the difference in treatment for Type I and II DM?

A
  • Type I DM always requires Insulin
  • Type II DM can be controlled by lifestyle changes, diabetic medications, or insulin.
51
Q
  • What is the greatest risk w/ DM?
  • What is the most common cause of that risk?
A
  • Hypoglycemia
  • Physical activity w/o food
52
Q
  1. How is insulin administered?
  2. Which is the only exception?
A
  1. Insulin is SubQ (abdomen, back of the arm)
  2. Insulin Regular (R) is IV.
53
Q

Which insulin is normally found cloudy?

A

Insulin NPH

54
Q

What is the conversion from units to milliliters?

A

100 units/ml
(U-100)

55
Q
  • What is the rapid-acting insulin?
  • What is the onset?
A
  • Humalog Novolog Apidra
  • 10 to 30 mins
56
Q
  • What is the short-acting insulin?
  • What is the onset?
A
  • Regular (R)
  • 30 mins to 1 hour
57
Q
  • What is the Long-acting insulin?
  • What is the onset?
A
  • Lantus Levemir
  • 0.8 to 4 hours
58
Q

If you need to combine Insulin NPH; what is the correct order to draw it?

A

Clear to cloudy

59
Q

What is the difference in MOA b/w the oral diabetic medications glyburide (Diabeta) and metformin (Glucophage)?

A
  • Glyburide causes beta cells in pancreas to produce more insulin.
  • Metformin decreases glucose production in the liver.
60
Q
  • What is required for glyburide to work?
  • What risk is associated w/ Glyburide?

sulfonylureas

A

Oral Diabetic Medication
* working beta cells
* Risk of hypoglycemia

61
Q
  • What are Beta cells?
  • Where are they located?
A
  • Insulin producing cells
  • Located in pancreas
62
Q

What labs are suspected for Kidney impairment?

A

Elevated BUN/Creatinine

63
Q

What labs are suspected for Liver impairment?

A

Elevated AST/ALT

64
Q

Why is Insulin unable to be taken orally?

A

digested in stomach & intestines before reaching bloodstream

65
Q

What is the major risk associated w/ metformin?

A

Lactic acid build-up due to liver or kidney impairment

66
Q

What is the cause of diabetes sick day?

A

Infection or stressful event

67
Q

What is released during an infection that increase blood sugar levels?

A

During infections, cortisol is released → increased blood sugar

68
Q

If a patient can not eat meals during a diabetes sick day;
* what should be eaten, how much, and how often?

A

50 grams of carbohydrate every 4 hours

69
Q

What are the four common S/Sx associated w/ DKA and HHS?

A
  1. Hyperglycemia (vary in levels)
  2. Tachycardia
  3. Obtunded, confused (AMS)
  4. Dehydrated

Potassium: varies, watch!

70
Q

What is the difference in blood glucose levels b/w DKA and HHS?

diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome

A
  • DKA; BG > 300-600; suddenly
  • HHS; BG > 600-1000; over time
71
Q

Which serious hyperglycemic complication is associated w/ Type 1 vs 2 DM?

A

Type 1 = diabetic ketoacidosis (DKA)
Type 2 = hyperglycemic hyperosmolar syndrome (HHS or HHNK)

72
Q
  • what is the expected ABG concern with DKA?
  • What is the compensatory response?
A
  • metabolic acidosis
  • Kussmaul breaths (fast, deep breaths)
73
Q

What is the classic sign of DKA?

diabetic ketoacidosis

A

Fruity breath
(r/t Ketones)

74
Q

Why do ketones occur w/ Type 1 DM?

A
  • No endogenous insulin in the body, the body has to turn to a different source for energy.
  • Fat gets broken down and see ketones as a byproduct.
75
Q

What are the 4 main symptoms to look for w/ hypoglycemia?

other symptoms listed too

A
  1. Dizzy
  2. Shaking
  3. Sweating
  4. Hangry (hungry and irritable)
  5. tachycardia, blurry vision, fatigue, headache
  6. Loss of consciousness (if severe)
76
Q

What is the treatment for hypoglycemia?

A
  • Orange juice followed by a protein snack
    or
  • 1 amp of D50 (50% sugar)
77
Q

When would an amp of D50 given for hypoglycemia?

A

When patient can’t do oral intake.

78
Q
  • ____glycemia can lead to vascular damage.
  • What are the three main macro/microvascular damages that occur primarily w/ uncontrolled diabetes?
A
  • Hyperglycemia
    Macro- & microvascular damage
  • Retinopathy - blindness
  • nephropathy - kidney damage
  • Neuropathy - loss of sensation in hands and feet.
79
Q

DM is the #1 cause of non-traumatic amputation. What are the 3 factors that increase risk of amputation?

A
  1. Neuropathy causes patients to not feel injuries.
  2. Hyperglycemia itself increases risk of bacterial infection.
  3. Diabetes causes slower tissue healing
80
Q

Which class of oral diabetic medications is associated w/ hypoglycemia and weight gain?

A

sulfonylureas
(glyburide)

81
Q

What is the MOA of (“-glifozins”)?

SGLT-2 inhibitors

A

Increase glucose excretion in urine by blocking reabsorption

Flozin = Flows right out through urine.

82
Q

What is the MOA of (“gliptins”) ?

DPP-4 inhibitors

A

Blocks enzyme in gut that inhibits insulin release & stimulates glucagon release.

83
Q

What is the MOA of (“glutides”)?

GLP-1 RAs

A

Enhances insulin secretion from pancreas.

1x/week injection

84
Q

Which oral diabetic medication is associated w/ joint pain?

A

DPP-4 inhibitors (“gliptins”)
Sitagliptin

“Tin” man has no real joints

85
Q

Which oral diabetic medication is associated w/ weight loss?

A
  1. SGLT-2 inhibitors (“-glifozins”)
  2. GLP-1 RAs (“glutides”)
86
Q

What test can be run to determine little or no insulin secretion present?

T1DM indicator

A

C-peptide

87
Q
  • What hormone would a transwoman take?
  • What risk is associated w/ medication?

AMAB

A
  • Estrogen - Risk for blood clots
  • Spironolactone - Risk for hyperkalemia

BMP conducted

88
Q
  • What hormone would a transman take?
  • What risk is associated w/ medication?

AFAB

A
  • Testosterone - Risk for increase RBC = Risk for stroke

CBC conducted

Med Surg 1 (7 decks)

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