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
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
3
Q
What are possible S/Sx occuring in both hypo/hyper-thyroidism?
A
- Amenorrhea
- Thinning/brittle hair
Variability in dry skin (hypo) and sweating (hyper)
4
Q
What is the main cause of Hyper-thyroidism?
A
Grave’s Disease
AIDS
5
Q
What is the main cause of Hypo-thyroidism?
A
Hashimoto’s
AIDS
6
Q
What is the treatment for hypo-thyroidism?
A
- levothryoxine (Synthroid)
- High Bulk, low calories diet*
addresses constipation and weight gain.
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)
8
Q
What are the treatment options for hyper-thyroidism?
A
- Methimazole (Tapazole)
- Radioactive iodine therapy
- Surgery (Thyroidectomy)
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)
10
Q
What hormone is released by the hypothalamus, pituitary gland and thyroid gland?
A
TRH → TSH → T3/T4
Hypothalamus → Pituitary → Thyroid Gland
11
Q
What does the negative feedback loop causes when thyroid hormone increases?
A
Decrease TRH and TSH
12
Q
Which is more common primary or secondary thyroid disorders?
A
Primary
Hypo/hyper-thyroidism
13
Q
Interpret the findings:
↑ T3/T4
↓ TSH
A
Primary Hyper-thyroidism
inversed directions it is primary
14
Q
Interpret the findings:
↑ T3/T4
↑ TSH
A
Secondary Hyper-thyroidism
same direction that would be secondary
15
Q
Interpret the findings:
↓ T3/T4
↑ TSH
A
Primary Hypo-thyroidism
inversed directions it is primary
16
Q
Interpret the findings:
↓ T3/T4
↓ TSH
A
Secondary Hypo-thyroidism
same direction that would be secondary
17
Q
What are the possible causes of secondary hypo/hyper-thyroidism?
A
- Pituitary tumor (cancer)
- Brain damage
18
Q
What is the clinical emergency for hypo-thyroidism?
A
Myxedema
19
Q
What is the clinical emergency for hyper-thyroidism?
A
Thyroid Storm (clinical emergency)
20
Q
What are the four S/Sx a patient is experiencing Thyroid Storm?
A
- Tachycardia
- Hyperprexia (fever)
- AMS (altered mental status)
- GI issues (cramping, nausea/vomiting)
21
Q
What medications may be given for patient w/ Thyroid Storm
A
- methimazole (Tapazole)
- Beta Blocker/Calcium Channel Blocker*
- Acetaminophen
*-Lol and -dipine
22
Q
What is the treatment for Myxedema?
A
Levothyroxine (Synthroid)
23
Q
What are the three clinical manifestations of Myxedema?
A
- Peri-orbital edema
- Pre-tibial edema (swelling of lower legs)
- Coma
Non-Pitting
24
Q
What are the causes of Thyroid Storm?
A
- Chronic untreated hyper-thyroidism
- Events such as stress, surgery, trauma, infection (think SSTI, like sti’s are stressful)
25
What are the causes of Myxedema?
1. Chronic **untreated** hypo-thyroidism
2. Cold weather
26
What hormone is released by the adrenal medulla?
catecholamines
(norepinephrine, epinephrine)
27
What hormone is released by the adrenal cortex?
1. sex hormones
2. mineralocorticoids
3. glucocorticoids (cortisol)
| Steroids
28
Addison's disease is characterized by insufficiency of which two hormones?
1. Aldosterone
2. Cortisol
29
Decreased aldosterone leads to what 3 issues?
1. Hypo-natremia (< 135)
2. Hypotension*
3. Hyper-kalemia (> 5)
| hypotension r/t decreased water
30
Decreased cortisol levels lead to what 2 issues?
1. Risk for infection
2. Hypo-glycemia
31
What will a patient experiencing Addisonian Crisis present with?
Severe (clinical emergency):
1. Hypo-tension
2. Hypo-glycemia
3. Hyper-kalemia (r/t decreased aldosterone)
32
What would be the treatment for Addisonian Crisis?
1. Glucocorticoids
2. IV fluids
3. Sugar
4. Insulin **or** sodium polystyrene (Kayexalate)
33
What does Cushing syndrome increase the risk of developing?
Diabetes
| R/T hyperglycemia
34
What must be monitored with insulin tx for Addisonian Crisis hyperkalemia?
**Further** blood glucose level drops (hypoglycemia)
35
Addisonian Crisis experiencing hyperkalemia increases the risk of what to occur?
Dysrhythmias
36
Buffalo hump, moon face, and striae in the abdomen are commonly associate w/ which condition?
Cushings syndrome
37
* Long-term steroid use can increase the risk of what?
* Why?
* Cushing syndrome
* r/t elevated glucocorticoids
38
ADH is also known as what
| Anti-Diuretic Hormone
Vasopressin
39
What hormone causes the body to retain water?
ADH
40
What are 4 signs of dilutional hyponatremia?
1. Nausea/vomiting
2. Confusion/restless
3. Muscle issues
4. Seizures
41
What are the three treatments for SIADH
| Syndrome of inappropriate antidiuretic hormone secretion
1. vasopressin (ADH) antagonist
2. Fluid restriction
3. Na+ replacement (salt pill)*
| alternative = 3-5% NaCl in NS, but IV solution adds fluids
42
What is Diabetes Insipidus?
Decreased ADH (think an injury to the pituitary gland or hypothalamus);
kidneys unable to retain water
43
How is DI diagnosed?
| Diabetes Insipidus
Water deprivation test
44
1. What is the treatment for DI?
2. What is a sign the tx is working?
| Diabetes Insipidus
1. Nasal vasopressin agonist (DDAVP, desmopressin)*
2. Decreased UO and thirst
| Nasal spray
45
Is urine to dilute or concentrated w/ DI?
| Diabetes Insipidus
Urine is to dilute
(thirst causing excess water consumption)
| inability to concentrate urine
46
What S/Sx does DI share w/ Diabetes Mellitus?
1. Polydipsia (thirst)
2. Polyuria (UO)
47
* Hypoglycemia glucose levels
* Hyperglycemia glucose levels
* Hypoglycemia < 70 mg/dl
* Hyperglycemia > 300 mg/dl
48
What is the difference between DM Type I and II regarding insulin?
* 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
Which diabetes is most often associated with early onset
| *sometimes referred to as juvenile diabetes*
DM type I
50
What is the difference in treatment for Type I and II DM?
* Type I DM always requires Insulin
* Type II DM can be controlled by lifestyle changes, diabetic medications, or insulin.
51
* What is the greatest risk w/ DM?
* What is the most common cause of that risk?
* Hypoglycemia
* Physical activity w/o food
52
1. How is insulin administered?
2. Which is the only exception?
1. Insulin is SubQ *(abdomen, back of the arm*)
2. Insulin Regular (R) is **IV**.
53
Which insulin is normally found cloudy?
Insulin NPH
54
What is the conversion from units to milliliters?
100 units/ml
(U-100)
55
* What is the **rapid**-acting insulin?
* What is the onset?
* Humalog Novolog **Apidra**
* 10 to 30 mins
56
* What is the **short**-acting insulin?
* What is the onset?
* Regular (R)
* 30 mins to 1 hour
57
* What is the **Long**-acting insulin?
* What is the onset?
* Lantus Levemir
* 0.8 to 4 hours
58
If you need to combine Insulin NPH; what is the correct order to draw it?
Clear to cloudy
59
What is the difference in MOA b/w the **oral** diabetic medications **glyburide** (Diabeta) and **metformin** (Glucophage)?
* Glyburide causes beta cells in pancreas to produce more insulin.
* Metformin decreases glucose production in the liver.
60
* What is required for glyburide to work?
* What risk is associated w/ Glyburide?
| sulfonylureas
Oral Diabetic Medication
* working beta cells
* Risk of hypoglycemia
61
* What are Beta cells?
* Where are they located?
* Insulin producing cells
* Located in pancreas
62
What labs are suspected for **Kidney** impairment?
Elevated BUN/Creatinine
63
What labs are suspected for **Liver** impairment?
**Elevated** AST/ALT
64
Why is Insulin unable to be taken orally?
digested in stomach & intestines before reaching bloodstream
65
What is the major risk associated w/ metformin?
Lactic acid build-up due to liver or kidney impairment
66
What is the cause of diabetes sick day?
Infection or stressful event
67
What is released during an infection that increase blood sugar levels?
During infections, **cortisol** is released → increased blood sugar
68
If a patient can not eat meals during a diabetes sick day;
* what should be eaten, how much, and how often?
50 grams of carbohydrate every 4 hours
69
What are the four common S/Sx associated w/ DKA and HHS?
1. Hyperglycemia (vary in levels)
2. Tachycardia
2. Obtunded, confused (AMS)
3. Dehydrated
| Potassium: varies, watch!
70
What is the difference in blood glucose levels b/w DKA and HHS?
| diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome
* DKA; BG > 300-600; **suddenly**
* HHS; BG > 600-1000; **over time**
71
Which serious hyperglycemic complication is associated w/ Type 1 vs 2 DM?
Type 1 = diabetic ketoacidosis (DKA)
Type 2 = hyperglycemic hyperosmolar syndrome (HHS or HHNK)
72
* what is the expected ABG concern with DKA?
* What is the compensatory response?
* metabolic acidosis
* Kussmaul breaths (*fast, deep breaths*)
73
What is the classic sign of DKA?
| diabetic ketoacidosis
Fruity breath
(r/t Ketones)
74
Why do ketones occur w/ Type 1 DM?
* 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
What are the 4 main symptoms to look for w/ hypoglycemia?
| other symptoms listed too
1. **Dizzy**
2. **Shaking**
3. **Sweating**
4. **Hangry** (hungry and irritable)
5. tachycardia, blurry vision, fatigue, headache
6. **Loss of consciousness (if severe)**
76
What is the treatment for hypoglycemia?
* Orange juice followed by a protein snack
**or**
* 1 amp of D50 (50% sugar)
77
When would an amp of D50 given for hypoglycemia?
When patient can't do oral intake.
78
* ____glycemia can lead to vascular damage.
* What are the three main macro/microvascular damages that occur primarily w/ uncontrolled diabetes?
* Hyperglycemia
**Macro- & microvascular damage**
* **Retino**pathy - blindness
* **nephro**pathy - kidney damage
* **Neuro**pathy - loss of sensation in hands and feet.
79
DM is the #1 cause of non-traumatic amputation. What are the 3 factors that increase risk of amputation?
1. Neuropathy causes patients to not feel injuries.
2. Hyperglycemia itself increases risk of bacterial infection.
3. Diabetes causes slower tissue healing
80
Which class of oral diabetic medications is associated w/ hypoglycemia and weight gain?
sulfonylureas
(glyburide)
81
What is the MOA of (“-**glifozins**”)?
| SGLT-2 inhibitors
Increase glucose excretion in urine by blocking reabsorption
| Flozin = Flows right out through urine.
82
What is the MOA of (“gliptins”) ?
| DPP-4 inhibitors
Blocks enzyme in gut that inhibits insulin release & stimulates glucagon release.
83
What is the MOA of (“**glutides**”)?
| GLP-1 RAs
Enhances insulin secretion from pancreas.
| **1x/week injection**
84
Which oral diabetic medication is associated w/ joint pain?
DPP-4 inhibitors (“glip**tin**s”)
Sitagliptin
| "Tin" man has no real joints
85
Which oral diabetic medication is associated w/ weight loss?
1. SGLT-2 inhibitors (“-glifozins”)
2. GLP-1 RAs (“glutides”)
86
What test can be run to determine little or no insulin secretion present?
| T1DM indicator
C-peptide
87
* What hormone would a transwoman take?
* What risk is associated w/ medication?
| AMAB
* Estrogen - Risk for blood clots
* Spironolactone - Risk for hyperkalemia
| BMP conducted
88
* What hormone would a transman take?
* What risk is associated w/ medication?
| AFAB
* Testosterone - Risk for increase RBC = Risk for stroke
| CBC conducted
