Endocrine Flashcards
1
Q
metabolic syndrome
A
any three of obesity, HTN, dyslipidemia, and hyperglycemia
2
Q
deformity to foot caused by trauma due to peripheral neuropathy.
A
charcots foot
3
Q
what is the cause of type one DM
A
destruction of pancreatic beta cells
4
Q
Pre-diabetes
A
A1C between 5.7%-6.4%
Fasting glucose 100-125 mg/dL
2hr random glucose 140-199 mg/L
5
Q
Diagnostic Criteria for DM
A
A1C >6.5%
Fasting glucose = or >126 mg/dL
2hr random glucose equal or >200 mg/dL
Symptoms of hyperglycemia (polyuria, polydipsia, polyphagia)
6
Q
Check AIC
A
Q3 months until glucose controlled, then Q6 months.
7
Q
Goal AIC should be under
A
7
8
Q
Goal for AIC for elderly is
A
<8
9
Q
Metformin do not use in
A
renal disease, hepatic acidosis, alcoholics, hypoxia
10
Q
Metformin should be held for IV contrast testing when
A
48 hours prior to procedure, check creatinne clearance
11
Q
sulfonylureas cause what
A
weight gain
12
Q
if AIC > 9 should start what
A
insulin
13
Q
max dose of metformin is
A
2,000
14
Q
pheochromocytoma s.s
A
random attacks of HA, diaphoresis, tachycardia, HTN
15
Q
triggers of Pheochromocytoma
A
physical exertion, anxiety, stress, surgery, labor and delivery, foods ↑ tyramine (some cheeses, beer, wine, chocolate, cold cuts), MAOIs
16
Q
Cushing Syndrome
Hypercortisolism
cause is
A
too much cortisol levl for a long time
17
Q
cushings s/s
A
buffalo hump, moon face, purple stretch marks, pot belly
18
Q
Addison’s disease
Hyporcortisolism
A
adrenal produce insufficient insulin
19
Q
s.s of addisons are
A
fatigue, nausea, hyperpigmentaton of the skin, salt cravings
20
Q
common autoimmune disorder. Due to ↑ metabolism: osteopenia/osteoporosis, RA, pernicious anemia. (Supplement w/ Ca + Vitamin D 1,200mg)
A
graves
21
Q
Primary hyperthyroidism s.s
A
Weight ↓, anxiety, insomnia, palpitations, HTN, Afib, warm skin, diaphoresis, exophthalmos, frequent BM, thyroid nodules, tremors
22
Q
meds for primary hyperthyroidism are
A
PTU, methimazole (tapazole), BB
23
Q
Primary hypothyroidism
A
Presentation: ↑TSH, ↓T3/T4.
* Weight ↑, fatigue, cold intolerance, constipation, menstrual abnormalities, alopecia, cholesterol ↑,
Cause: Decreased production of T3/T4. Attention
* Hashimoto’s Thyroiditis
* Myxedema: severely advanced hypothyroidism, changes in LOC, depression, dementia, hypotension, hypothermia.
Meds: Levothyroxine (Synthroid).
24
Q
Recheck TSH every
A
6 - 8 weeks, stable check yearly
25
Lupus commonly seen in
women of child bearing age
15-45
black , asian, latino higher risk
26
symptoms of lupus are
4 - 11 criteria is needed to diagnose
malar rash (butterfly rash)
Discoid rash
photosensitivity
Oral and nasal ulcers
cardio pulmonary complaints
nuerological
Positive ANA
Hemotological disorders
27
Lupus malar rash (butterlfy rash)
Spares the nasolabial folds - occurs in majority of patients
28
Sjogrens syndrome can also be part of
lupus
29
Sjogrens syndrome s/s
dry eyes and dry mouth
30
Lupus impacts the patients
kidneys and they end up with lupus nephritis
31
which lab do you monitor in lupus frequently
Urinalysis - SLE is an auto-immune condition that can affect the kidneys, causing lupus nephritis. A urinalysis could help monitor for this condition, by analyzing the urine for the presence of blood and protein, indicating kidney damage. A glycosylated hemoglobin, or hemoglobin A1C, would not be altered by the presence of SLE.
32
TSH is produced by the
pituitary gland - controls T3 and T4
The pituitary gland produces TSH which then signals the thyroid gland to release T3 and T4. The adrenal gland is responsible for regulation of metabolism and the body’s response to stress.
33
Go to test for thyroid symptoms only order what
TSH
34
TSH normal levels
0.5 - 5
35
only order T3 and T4 when what is abnormal
TSH
36
parathyroid is responsible for
calcium regulation
37
hypothalamus is responsible for
body temp, appetitei and helps to control emotional responses
38
Hypothyroidism TSH is
TSH is high and T3/T4 are high
39
Hypothyroidism s/s
fatigue, cold, weight gain, dry skin, constipation
40
Recheck levothyroxine in
4 - 8 weeks
41
Levothyroxine take when
first thing in Am without any other medications
42
Initial dosage of levothyroxine
young adults 25 mcg
elederly 12.5 low and slow do to cardiac affects
43
Myxedema coma (hypothyroidism)
low body temp
swelling
confusion
lethargy
diff breathing
tongue swelling
44
what can exacerbate myxedema coma if on synthroid
lithium
amiodarone
45
Hyperthyroidism TSH would be
Low and High T3/T4
46
what is the medication for hyperthyroidism
Methimazole (tapzole)/PTU
47
what medication is given in pregnancy in Hyperthryodism
PTU first trimester
then we try to switch them to Tapazole
48
graves disease treatment
radioactive iodine therapy
49
Complications of hyperthyroidism thyroid storm
increase temp
increase HR,
Increase BP
50
Hyperthyroism increase risk of
osteoporosis
51
Levothyroxine can also lead to
osteoporosis
52
Gold standard treatment for graves disease is
radioactive iodone therapy
53
Three P's of Dm2
polyuria, polydipsea, polyphagia
54
metformin given for
type 2 DM
55
what are side effects of metformin
GI - diarrhea
56
metformin does it cause hypoglycemia
no
57
does metformin cause weight increase
no
58
what is the max dose of metformin
2,000 to 2,5000
59
typical starting dose of metformin
500 mg daily
59
when is metformin contraindicated
GFR less than 30
60
metformin should be stopped before contrast dye when
48 hours before
61
metformin can cuase what vitamin deficiency
b12
62
what medication is metformin also used for
PCOS
63
what is the highest risk of hypoglcymia
glipizide sulfonylureas
64
TZD avoid with
heart failure
65
which is cardiac protective
flozin
66
sulfonylureas end in
ide
do affect pt weight, weight gain
cheap
cause hypoglycemia
67
Long acting insulin
Lantus and levimir
basal insulin - give at night
2 units every three days
68
Post prandial is high increase
bolus insulin
69
microvascular
neuropathy, retinopathy,
70
macrovascular complication
CAD, stroke, PAD
71
BP for diabetics should be less than
130/80
72
levothyroxine is associated with
cardiac issues
73
how often do we recheck TSH levels
4 - 8 weeks ( usually around 6 week mark)
74
Possible meds for hypethryoidism
Beta blockers for heart rate
PTU
Tapazole
PTU in first trimester of pregnancy
75
parathyroid does what
regulates calcium and phosphorus in check
76
hyperparathryoidism what is high
calcium
77
when you see high calcium levels on labs what is importnat to note
malignancy
78
Somogyi effect
dip in BS in middle of night then rebound rise in AM
Take snack before bed or decrease the insulin
79
Dawn phenomenon
steady increase in BS rises all night
might need increase in insulin
80
who should be screened for DM
age 45 and repeat every 3 years
overweight obese, HDL, history of gestational DM
81
what HGAIC determines pt has DM
>6.5 or greater
82
Metformin (glucophage) main side effect
GI side effects
83
Max dose of metformin
2,000
84
does metformin cause Hypoglycemia
no
85
metformin does it cause weight gain
no
86
labs monitor when prescribe metformin
GFR <30 cant give
87
why is metformin not given to alcoholics due to
lactic acidosis
88
Semaglutide (ozempic) contraindicated in type one DM due to risk of
DK
89
Rapid acting insulin (lispro, humalog)
onset, 15 min
peak one hour
duration 2- 4
90
intermidiate acting
onset 1 - 2 hours
peak 6 - 12 hours
duration 24 hours
91
Long acting insulin (lantus and levemir)
onset 2 hours
last 24 hours
92
Metformin (biguanides) (glucophage)
max dose
2,000
93
metformin is
weight neutral - dose not cause wt gain
94
Monitor what on metformin
Renal function
95
metformin can cause what anemia
B12
96
Metformin does not cause
hypoglycemia - inhibits glucose producction in liver
97
SGLT - inhibitors Flozin (jardiance)
reduce absopriton in the renal tubules
check the renal function to prescribe safely
can help with cardiac issues
98
DPP-4 inhibitors - gliptins (januvia) avoid in pt with history of
pancreatitis and renal impairement
99
Sulfonylureas (ide) glipizide,
they cause the pancreas to secrete insulin, but do not reduce insulin resistance
they cause hypoglycemia and weight gain
They are affordable
100
Thiazaolidendiones Zones (actos)
they are toxic to liver
Toxic in heart failure
cause weight gain and edema
101
GLP - 1 agonist (trulicity) end in tides
increase fullness
delays gastric emptying
cardioprotective
one thing pt dont like is injection
102
A 63-year-old male patient who is diabetic is on the max dosage of glucophage (Metformin) and his hemoglobin A1C is still high. The nurse practitioner educates the patient that he will be starting a new medication that requires him to keep hydrated. He is also educated to report any new urinary issues. Which medication is the nurse practitioner likely starting him on?
The correct answer is dapagliflozin (Farxiga). SGLT2 inhibitors, such as dapagliflozin, work in the body by preventing the kidneys from being able to absorb glucose. Glucose is then excreted via the urine. Due to the presence of glucose in the urine, this class of medication is not ideal for those with recurrent yeast infections or urinary tract infections. It is also imperative to keep well-hydrated due to this medication’s diuretic effects.
103
Levothyroxine should start at lower dose in elderly in
12.5 due to cardiac issues
104
when should we check TSH levels
4- 6 weeks
105
Long term use of synthroid increases risk of
osteoporosis
106
Hyperthyroidism treatment meds is the
third line treatment
107
what is common given to hyperthyroidism for heart rate
propranolol - Beta blockers
108
Propythiouracil (PTU)
must be taken several times a day
frequent labs
109
most serous of PTU
Low WBC angranulocytosis,
Follow CBC
Pt can get hepatitis
110
Tapazole (methimazole)
take once a day
preferred over PTU
Less side effects
111
Pregnant best option for Hyperthyroidism
PTU in first trimestester
After complete can transition to Tapazole
112
Which of the following labs is the most important to monitor in a patient being treated for hyperthyroidism with propylthiouracil (PTU)?
CBC
113
A 36-year-old pregnant female presents with complaints of worsening anxiety and tremors. She has noticed that despite increasing food intake, she is not gaining weight. She is at 18 weeks gestation. Her lab results are as follows: TSH 0.02 mU/L, free T4 12 ng/dL. What treatment is most appropriate in this patient?
Tapazole
114
A 41-year-old female with hyperthyroidism is complaining of anxiety and palpitations. She asks the nurse practitioner for something to help her symptoms. What can the nurse practitioner prescribe to directly treat her symptoms?
Beta Blocker - propranolol
115
Main medication to treat addisons disease
steroids - prednisone
should always have emergency steroids
116
chronic amenorrhea and hypermetabolism result in what
osteoprosis and need supplement with calcium and with vitamin D 1,200
117
pt with normal free T4 but with elevated TSH what do you do
do not treat recheck TSH in 6 months this is subclinical hypothyroidism
118
what is subclinical hypothyroidism
elevated TSH but normal T4
119
adivse pts on levothyroxine to report plapations, nervousness, tremors it might indicate that synthroid is
too high
120
pt has new onset of A-fib check what
TSH
121
lid lag is a sx of what
graves disease
122
Hyperthyroidism s/s
anxiety, jittery, hyper, skinnyha
123
what disease process is associated with hyperthyroidism is
graves diease
124
Meds for hyperthyroidism
PTU, tapazole
125
hyperthyroidism hour numbers are
low
126
hypothyroidism s/s
dry skin
brittle hair
overweight
constipation
fatigue
brittle nails
gain weight and cant lose
127
what is the disease process assoc with hypothyroidism
hashimotos
128
meds we give for hypothyroidism
synthroid for life
129
hypothyroidism numbers are
high
130
lab for hyper/hypo thyroidsim
TSH - 0.5 - 5
adjusting meds only based off TSH alone
131
which is more concerning a single nodule or multiple nodule
single nodule- more likely to be malignant
132
have nodule and have multiple nodules what do we use
radioactive iodine - need medication for life synthroid
133
pt has AIC of 9 or double digits what do you do
start on insulin - basal insulin
134
Dawn phenomenon
rise in Blood sugar at 7 am
BS keeps rising straight up
135
how do we stop dawn phenomenon what do we do
give more insulin
136
Somojy effect
Blood sugar drops around 3 am and blood sugar is low - then eat to bring up BS
Then at 7 am Blood sugar is elevated
give a snack at bedtime
137
Addisons presentation
hyperpigmentation - bronze skin - looks like laying in sun, Golden, sun kissed
salt craving
Typically thin
138
Addisons cortisol is
low - thin think JFK
Sodium is low
Potassium is high
139
cushings
obese
buffalo hump
purple strai
moon face
fatigued
140
cushings cortisol levels are
high cortisol
sodium high
potassium low
141
Long acting have
no peak and never mix with others
no plate - not food dependent
min risk of low sugar
142
long acting inulin is
determir (long acting) (levimir)
Glargine - large acting (lantus)
Tresiba (degludec)
duration 24 hours
143
NPH - intermittent
given twice a day
duration is 4 - 12 hours
usuallly worse 5 - 6 hours
144
Regular insulin
peak 2 - 4 hours
Duration is 5-8 hours
145
Rapid acting
aspart, lispro, glulisine - super fast
duration 3- 5 hours
most deadly onsent
30 - 90
pt must eat in 10 - 15 minutes
146
Metformin (glucophage)
Diabetic oral
147
Glipizide and glyburide is not good for
heart failure and MI
gain weight
toxic for elderly
148
Thiazolidinedone (TZD) pioglitazone
heart failure
fluid retention
edema
149
acarbose and precose
flatus and diarrhea
150
