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BCGP > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the expected extent of decrease of A1c of metformin?

A

1.5-2%

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2
Q

What is the mechanism of action of metformin?

A

decrease gluconeogenesis and increase insulin sensitivity

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3
Q

At what level of renal function should metformin dosing be reduced?

A

< 45mL/min

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4
Q

Extent of effect on A1c of sulfonylureas?

A

1.5%

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5
Q

What is the mechanism of action of sulfonylureas?

A

Increase Beta cell secretion

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6
Q

What is the mechanism of action of thiazolidinediones?

A

Enhance insulin sensitivity > decrease gluconeogenesis

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7
Q

Which DPP4 inhibitors increase heart failure hospitalization risk?

A

Saxagliptin and alogliptin

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8
Q

Which GLP1 has renal benefit?

A

Liraglutide

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9
Q

What is the expected extent of effect on A1c of tirzepatide?

A

1.5-2.3%

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10
Q

Which biphosphonates are indicated for steroid induced prevention of osteoporosis?

A

Risedronate, zoledronic acid

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11
Q

Which biphosphonates are indicated for treatment of steroid induced osteoporosis?

A

Alendronate, risedronate, zoledronic acid

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12
Q

Which biphosphates are indicated for treatment of osteoporosis in men?

A

Alendronate, Risedronate, zoledronic acid

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13
Q

What is the timeframe to fracture risk reduction from initiation of biphosphonate treatment?

A

6-12 months

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14
Q

When is the Plateau of therapeutic affect after biphosphonate treatment initiation ?

A

2-5 years

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15
Q

Diagnostic criteria for diabetes (US units) (2)

A

HbA1C >= 6.5%
8-hour fasting plasma glucose >= 126 mg/dL

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16
Q

which conditions result in
Decreased reliability of hemoglobin A1c, for diagnosing diabetes?

A

Increased RBC turnover: sickle cell disease, hemodialysis, recent blood loss/transfusion, EPO therapy, some HIV drugs, iron deficiency anemia

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17
Q

What is the average Plasma glucose of a patient with an A1c of 7%?

A

154 mg/dL

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18
Q

A Change in A1c by 1% changes the plasma glucose average by how many milligram/dL?

A

30 mg/dL

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19
Q

A1c goal for an older adult with fewer than 3 medical conditions and intact cognition?

A

Under 7-7.5%

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20
Q

A1c goal for an older adult with 3 or more medical conditions, impairment in ADLs or mild-moderate cognitive impairment?

A

Under 8%

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21
Q

Very complex/poor health patients A1c goal?

A

Not applicable.
Focus on avoiding hypoglycemia and symptomatic hyperglycemia. Pre-meal glucose goal 100 -180 mg/dL
Bedtime glucose goal 110 to 220 mg/dL

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22
Q

Glycemic goals for an older adult with 3 or more medical conditions, impairment in ADLs or mild-moderate cognitive impairment?

A

Pre-meal glucose 90 -150 mg/dL
Bedtime glucose 100 -180 mg/dL

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23
Q

Which GLP1s have demonstrated cardiorenal risk reduction?

A

Dulaglutide
Liraglutide
Semaglutide (inj)

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24
Q

Which SGLT2s have demonstrated cardiorenal risk reduction?

A

Canagliflozin
Dapagliflozin
Empagliflozin

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25
Q

Hypoglycemia symptoms

A

Shaky
Light-headed
Nausea
Nervous
Irritable
Anxious
Confused
Unable to concentrate
Hungry
Increased heart rate
Sweaty, headachy
Weak, drowsy
Numbness or tingling of tongue or lips

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26
Q

Hyperglycemia symptoms

A

Tired
Thirsty
Increased urinary frequency

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27
Q

What is the starting dose for basal insulin?

A

10-20 units
Or 0.1-0.2 units/kg/day

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28
Q

Duration of action of Detemir insulin?

A

14-24 hours

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29
Q

What is an appropriate speed of titration for long acting insulins?

A

2 units Every three days, slower for degludec

30
Q

What is the initial dosing of inhaled insulin?

A

Four units

31
Q

What is the speed of dose titration of inhaled insulin?

A

4 units twice weekly

32
Q

What is the onset of action of degludec insulin?

A

1-2 hours

33
Q

What is the dose for initiation of short acting or regular insulin?

A

4 units.
Or 10% of the basal insulin dose

34
Q

What is the onset of action of Lispro and other rapid acting analog insulins?

A

5 to 15 minutes 

35
Q

What is the peak effect of rapid acting insulins?

A

45-75 minutes

36
Q

How do you initiate u-500 insulins?

A

80% percent of all their total daily doses of basal plus prandial insulins. Administer to the three times a day. largest dose at breakfast.

37
Q

What is the starting dose of Soliqua (No prior basal insulin)?

A

15 units

38
Q

What is the starting dose (No prior insulin) of Xultophy?

A

10 units

39
Q

The maximum dose of Xultophy is:

A

50 units

40
Q

The maximum dose of Soliqua is:

A

60 units

41
Q

common symptoms of hypothyroidism in older adults (4):

A

Fatigue
dyspnea.
Changes in taste/hearing
Ataxia


42
Q

Defining labs for overt hypothyroidism

A

TSH greater than 10 mIU/L
Free T4 under 0.7 ng/dL

43
Q

Subclinical hypothyroidism-lab results

A

TSH 4 to under 10
Free T4 normal

44
Q

What would be an equivalent levothyroxine dose for a patient receiving liothyronine 12.5 µg daily 

A

Levothyroxine 50 mcg daily

45
Q

What is the equivalent levothyroxine dose for a patient receiving desiccated porcine thyroid, one grain/60 mg daily

A

Levothyroxine 100 mcg daily

46
Q

Which drugs increase protein or binding, and therefore decrease the activity of thyroid hormones?

A

Estrogen
Estrogen agonist/antagonist.
Methadone.
5-FU.
Liver disease
HIV

47
Q

Which drugs decrease proteins or binding and therefore increase the activity of thyroid hormones?

A

Acute illness
Androgens
Anti epilepsy drugs
Corticosteroids.
Furosemide.
Salicylates.

48
Q

Which conditions impair absorption of thyroid hormones?

A

Celiac disease.
Chronic diarrhea.
G.I. bypass surgery

49
Q

Which Medications reduce absorption of thyroid hormones?

A

Minerals.
Fiber.
Acid suppression therapy.
Foods
Bile acid sequestrants

50
Q

Osteoporosis medication risk factors

A

Glucocorticoid (5 mg of prednisone equivalent for >= 3 months)
Anti-androgens
Thyroid supplementation
AEDs
Aluminum
PPIs
TZDs

51
Q

How much does a 10% decrease in bone mass increase fracture risk ?

A

1.5-2.5 times

52
Q

Osteopenia definition

A

T-score -1 to -2.5

53
Q

Osteoporosis definition

A

T-score -2.5 or less
Or fragility fracture
Or
Osteopenia + 10 yr probability >= 3% for hip fracture
or >=20 % for major osteoporotic fracture

54
Q

Deficiency of vitamin D, serum level:

A

< 20 ng/mL

55
Q

Which osteoporosis treatment medications are for those at highest risk i.e. fractured hip over 4.5% or major OPC fracture risk over 30%, multiple fractures, T score less than or equal to 3)

A

Abaloparatide
Denosumab
Romosumab
Teriparatide
Zoledronic acid

56
Q

Biphosphonates should not be used with what medications (2)?

A

Diuretics
Nephrotoxic drugs

57
Q

What is the labelled maximum duration of treatment of abaloparatide?

A

2 years

58
Q

What is the dose of abaloparatide?

A

80 mg SQ daily

59
Q

What is romosozumab approved for?

A

Treatment of post menopausal women at high risk of fracture

60
Q

What is the black box warning for romosozumab?

A

Increased risk of stroke, MI and CV death

61
Q

What is romosozumab dosing?

A

210 mg monthly ( for 12 months)

62
Q

Which medications or substance use can make sensor readings higher than actual glucose when using CGM?

A

Acetaminophen > 4g/day
Alcohol
Ascorbic acid > 500 mg/day
Hydroxyurea

63
Q

What goals are appropriate for those using continuous glucose monitoring who are frail or at high risk of hypoglycemia?

A

How many rains over 50% with time below range less than 1%

64
Q

What blood glucose is considered level 2 hyperglycemia?

A

> 250 mg/dL

65
Q

What blood glucose is level 1 hyperglycemia?

A

181-250 mg/dL

66
Q

What blood glucose is level 1 hypoglycemia?

A

54-69 mg/dL

67
Q

What blood glucose is level 2 hypoglycemia?

A

< 54 mg/dL

68
Q

At what fasting triglyceride level should medical therapy be initiated?

A

> = 500 mg/dL

69
Q

What is the target bedtime glucose for complex/ intermediate patient?

A

100-180 mg/dL

70
Q

What is the target fasting or preprandial glucose for a complex/intermediate patient?

A

90-150 mg/dL

BCGP (10 decks)

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