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FNP ANCC > Endocrine > Flashcards

Endocrine Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Hypoglycemia

A

Level 1 hypoglycemia (glucose alert): FBS ≤70 mg/dL
Level 2 hypoglycemia: Blood glucose ≤54 mg/dL

More common with DMT1
If non-diabetic usually from fasting or diet related

S&S: weak, hand tremors, anxiety, feeling like passing out, sweaty hands, rapid pulse, confusion
Sx can be blocked by beta-blocker
Can progress to coma

Tx: 15-15 Rule
15g carbs
Check BS in 15 min

Edu: keep taking meds when sick
May need to reduce medication when exercising if they do not compensate with diet (simple carbs before, complex carbs after)

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2
Q

Thyroid cancer

A

S&S: engirded cervical LN, swelling, pain. Hoarseness, trouble swallowing

Risk factors: Asian, family history, Radiation as a child, low-iodine diet

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3
Q

Pheochromocytoma

A

Hormone-releasing adrenal tumor
Rare
S&S: Random episodes of headache, diaphoresis, tachycardia, HTN
Triggers; exercise, anxiety, surgery, change in body position

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4
Q

Hyperprolactinemia

A

Can be sign of pituitary adenoma
S&S: amenrhea, galactorrhea

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5
Q

What does the hypothalamus secrete?

A

follicle-stimulating hormone [FSH], luteinizing hormone [LH], thyroid-stimulating hormone [or thyrotropin; TSH]

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6
Q

What does the Anterior pituitary secrete?

A

FSH:
Stimulates the ovaries to enable growth of follicles (or eggs)
Production of estrogen
LH:
Stimulates the ovaries to ovulate
Production of progesterone (by corpus luteum)
In males, LH stimulates the testicles (Leydig cells) to produce testosterone
TSH:
Stimulates thyroid gland
Production of triiodothyronine (T3) and thyroxine (T4)
GH:
Stimulates somatic growth of the body
ACTH:
Stimulates the adrenal glands (two portions of gland: medulla and cortex)
Production of glucocorticoids (cortisol) and mineralocorticoids (aldosterone)
Prolactin:
Affects lactation and milk production
Melanocyte-stimulating hormone:
Production of melatonin in response to UV light; highest levels at night between 11 p.m. and 3 a.m.

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7
Q

What does the posterior pituitary secrete?

A

antidiuretic hormone (vasopressin) and oxytocin, which are made by the hypothalamus but stored and secreted by the posterior pituitary.

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8
Q

Lab results in Thyroid disease

A

Normal range: TSH of 0.5 to 5.0 mU/L

Hypothyroidism TSH >5.0 mU/L, Free T4 Low, T3 Low

Subclinical hypothyroidism TSH >5.0 mU/L, Free T4 Normal, T3 Normal

Hyperthyroidism TSH <0.05 mU/L, Free T4 High, T3 High

Subclinical hyperthyroidism TSH <0.05 mU/L Free T4 Normal, T3 Normal

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9
Q

Primary Hyperthyroidism

A

Cause: 60-8-% caused by Grave’s disease

S&S: Weight loss, anxiety, insomnia, tachycardia, HTN, afib, inc perspiration, eye lid lag, frequent BMs, amenorrhea, heat intolerance, enlarged thyroid (goiter), pretibial myxedema. Tremors, exophthalmos

Dx: Low THS, High T3& free T4
If Frave’s - positive thyrotropin receptor antibodies (TRAb) aka thyroid-stimulating immunoglobulins
TPO + for Graves and Hashimoto
Thyroid ultrasound
RAIU

Tx:
Thionamides:
Methimazole (Tapazole): Shrinks thyroid gland/decreases hormone production.
Propylthiouracil (PTU): Shrinks thyroid gland/decreases hormone production. Use w/ moderate to severe hyperthyroidism (can cause liver failure).
Can use beta-blocker for HR
Radioactive iodine - will destroy thyroid gland, will need supplementation for life

Thyroid storm (thyrotoxicosis): Dangerously high HR, PB, temp. D/t stress/infection. Lifethreatening

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10
Q

Primary hypothyroidism

A

Cause: Hashimoto’s thyroiditis, postpartum, thyroid ablation
Hashimoto: chronic autoimmune disorder, Cx destructive antibodies (TPOs) against the thyroid gland. More common in women

S&S: Weight gain, goiter, fatigue, cold intolerance, constipation, alopecia, elevated cholesterol. At risk w/ other autoimmune disorder

Dx: Order TSH first, if elevated order freeT4. If T4 low, dx is hypothyroidism, order TPO to confirm Hashimotos

Tx: Start Levo (25-50 mcg/day starting), caution with heart disease
Increase every few weeks until TSH is normalized

Complications: Myxedema - emergency, s&s slowed thinking, short-term memory loss, depression, hypotension, hypothermia

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11
Q

Diabetes Mellitus Long term damaged

A

Microvascular damage: Retinopathy, nephropathy, and neuropathy
Macrovascular damage: Atherosclerosis, heart disease (coronary artery disease, MI)

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12
Q

DMT1

A

Destruction of B-cells in the islets of Langerhans
Untreated, body fats will be used for energy, ketones build up causing diabetic ketonic acidosis

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13
Q

DMT2

A

Progressive decreased secretion of insulin with insulin resistance

Risk factors: Obesity, metabolic syndrome, gestational diabetes

S&S: hyperglycemia = polyuria, polydipsia, polyphagia

Dx: when first diagnoses, checked A1C every 3 months until controlled, then every 6 months
Lipid panel yearly
Urine microalbuminuria yearly

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14
Q

Normal glucose levels - non-diabetic

A

FPG: 70 to 100 mg/dL
Peak postprandial plasma glucose: <180 mg/dL
Glycosylated hemoglobin (A1C <6.0%)

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15
Q

Metabolic syndrome qualifications

A

Presence of any three of the following four traits:
Obesity, abdominal obesity. Waist size:
Male: >40 inches (102 cm)
Female: >35 inches (88 cm)
Hypertension: BP >130/85 mmHg
Dyslipidemia: Triglycerides >150 mg/dL, high-density lipoprotein (HDL) <40 in males or <50 in females
Hyperglycemia: Fasting plasma glucose (FPG) >100 mg/dL or type 2 DM

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16
Q

Lab criteria for diabetes

A

Prediabetes
A1C - 5.7% and 6.4%
Fasting glucose of 100 to 125 mg/dL (impaired FPG)
Two-hour oral glucose tolerance test (OGTT; 75 g load) of 140 to 199 mg/dL

Diabetes Mellitus
A1C ≥6.5%
FPG ≥126 mg/dL (fasting 8 hours)
Symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) plus random blood glucose ≥200 mg/dL
Two-hour plasma glucose ≥200 mg/dL during an OGTT with a 75-g glucose load

17
Q

Diabetes preventative care recommendations

A

The CDC recommends adults >50 years be given Shingrix in two doses, 2 to 6 months apart.
Influenza immunization every year.
Pneumococcal polysaccharide vaccine: If vaccinated before 65 years of age, give one-time revaccination in 5 years; if age 65 years, give one dose of the vaccine only.
Prescribe aspirin 81 mg if high risk for MI, stroke (if <30 years, not recommended).
Ophthalmologist: Yearly dilated eye exam needed. If type 2, eye exam at diagnosis; if type 1 DM, first eye exam needed 5 years after diagnosis.
Podiatrist: Refer to once or twice a year, especially with older diabetics.
BP: Goal is 130/80 mmHg.
Dental/tooth care: Important (poor oral health associated with heart disease).

18
Q

Dawn Phenomenon

A

Surge in blood sugar between 4-8am

19
Q

Somogyi Effect

A

Severe noctural hypoglycemia, then high levels of glucagon resulting in high FBG by 7am
D/t over-treatment in the evening/bedtime
Tx: eat a snack before bed or lower nightime dosing

20
Q

Biguanides

A

Metformin
First-line DMT2
Decreases gluconeogenesis and decreases peripheral insulin resistance
Rarely causes hypoglycemia
Neutral weight change
GI side effects: diarrhea and nausea

Contraindications: Do not use if renal disease, hepatic disease acidosis, alcoholics, hypoxia.
Hold if getting IV contrast, day of and 48 hr later
Monitor renal function

21
Q

Sulfonylureas

A

1st gen: Chlorpropamide
2nd gen: Glipizide (Glucotrol), glyburide (DiaBeta)

MOA: stimulate beta cells of pancreas to secrete insulin

AEs: hypoglycemia, photosensitivity, weight gain

Avoid w/ hepatic or renal impairment

22
Q

Thiazolidinediones

A

-zone
Pioglitazone (Actos)

MOA: Enhances insulin sensitivity in muscle tissue, reduces hepatic glucagon production

Monitor LFTs, causes weight gain

Contraindicated: DO NOT USE WITH HF, causes water retention, bladder cancer, liver disease, pregnancy

23
Q

Bile-acid sequestrants

A

Cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid)
Reduce hepatic glucose production and may reduce intestinal absorption of glucose, lowers LDLs

AEs: GI related

24
Q

Meglitinides (Glinides)

A

Repaglinide (Prandin), nateglinide (Starlix)
Stimulates pancreatic secretion of insulin

Indicated: DMT2 w/ postprandial hyperglycemia
Rapid acting, short half-life
Hold if fasting
Can cause hypoglycemia, weight neutral
AEs: GI (bloating, abd cramps, diarrhea)

25
Q

Insulins

A

Rapid acting: Lispro/aspart.glulisine (Onset 15 min/Peak 30m-2.5h/Duration 4.5h)

Short acting: Regular (Onset 30m/Peak 1-5h/Duration6-8h)

Intermediate acting: NPH (Onset 1h/Peak 6-14h/Duration 18/24h)

Basil insulin analog: glargine(Lantus)/detemir(Levemir) (Onset1h/Peak none/Duration 24h)

Rapid-acting insulin covers “one meal at a time”
Regular insulin lasts “from meal to meal”
NPH insulin lasts “from breakfast to dinner”
Lantus is “once a day”

26
Q

Alpha-Glucosidase Inhibitor

A

Slows intestinal carbohydrate digestion and absorption; a nonsystemic oral drug
Does not cause hypoglycemia; modest effect on A1C level
GI side effects are flatulence, diarrhea

27
Q

Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs)

A

Exenatide (Byetta), liraglutide (Victoza), -tide

MOA: Stimulate GLP-1, inc insulin, dec postprandial glucagon, inc satiety
Reduces CVD, kidney dz, weight loss, no hypoglycemia
AEs: pancreatitis

Contraindication: medullary thyroid cancer, MEN-2

28
Q

Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2 inhibitors)

A

Canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance) -flozin

MOA: block reabsorption by kidney and inc glucosuria
No hypoglycemia
Reduce CVD, kidney dz
Weight loss, hypotension

AEs: polyuria, UTIs (pee sugar), pyelonephritis
Can lead to DKA

29
Q

Dipeptidyl Peptidase-4 Inhibitors (DPP-4 inhibitors)

A

-lip
Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta)

MOA: Increase insulin secretion and decrease glucagon

No hypoglycemia, renoprotective

AEs: joint pain, angioedema/urticaria, acute pancreatitis

30
Q

Amylin Mimetic/Analog (Symlin)

A

Decreases glucagon secretion; slows gastric emptying; leads to feeling satiety early; causes weight loss
Route: Injectable; frequent dosing; requires patient training
Causes hypoglycemia if used with insulin (decrease insulin dose)

31
Q

Do not combine incretin mimetics (_______) with any incretin enhancers (________). Both act on incretin.

A

GLP-1 Byetta, Victoza

DPP-4 Januvia, Onglyza

32
Q

T2DM medication steps

A
  1. Lifestyle changes
  2. Metformin (starting dose 500mg , max dose 2000mg daily)
  3. If Metformin maxed out, add sulfonylurea (can use other drugs also)
  4. Still high sugar, might need insulin

Presence of CVD and/or chronic kidney disease, or heart failure with reduced ejection fraction (HFrEF), start on an SGLT-2 inhibitor and/or GLP-1 RA.

33
Q

DM meds, effect on weight

A

Causes weight loss: Metformin, incretin mimetic, GLT-2 inhibitors
Causes weight gain: Insulins, sulfonylureas, TZDs (Actos)
Weight neutral: Meglitinides (Starlix, Prandin), bile-acid sequestrants (Welchol), alpha-glucosidase inhibitors

FNP ANCC (11 decks)

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