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AGNP review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

DKA Criteria

A

Anion Gap (arterial pH < 7.3, serum bicarb < 15)
Ketonuria
Hyperglycemia (> 250)

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2
Q

Hyperprolactinemia

A

Can be a sign of a pituitary adenoma

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3
Q

Hypoglycemia

A

Level 1: FBS < 70 - > 54
Level 2: FBS < 54
Level 3: severe characterized by AMS or physical status requiring assistance for hypoglycemia

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4
Q

Myxedema Coma

A

Severe hypothyroidism w/ progression to decreased mental status, hypothermia and decrease in organ function.

check T4 (usually low, TSH (may be high), cortisol

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5
Q

Pheochromocytoma

A

Rare hormone-releasing adrenal tumor. Typically occurs in persons 20-50. sx HA, diaphoresis and tachy w/ HTN

Triggers: physical exertion, anziety, stress, surgery, anesthesia, changes in body position, L&D. Foods high in Tyramine as well as MAOIz and stimulants.

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6
Q

Hormes stimulated by Pituitary Gland

A

FSH
LH
TSH
Adrenocorticotropic hormone (ACTH)
growth hormone (GH)

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7
Q

Addison’s Disease Symptoms

A

Lethargy, nausea, anorexia w/ diarrhea, and pain.
Tanned skin and hyperpigmentation
Hyperkalemia and hypothermia

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8
Q

FSH

A

stimulates ovaries to enable growth of follicles (or eggs); production of estrogran

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9
Q

LH

A

Stimulates steroid release from ovaries, ovulation, and the release of progesterone after ovulation; stimulates testicles (Leydig cells) to produce testosterone

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10
Q

ACTH

A

Stimulates adrenal glands; production of glucocorticoids(cortisol) and mineralocorticoids (aldosterone)

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11
Q

Melanocyte-stimulating hormone

A

Production of melatonin in response to UV light; highest levels at night btwn 11 pm and 3 am

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12
Q

Posterior Pituitary Gland hormones

A

antidiuretic hormone (vasopressin) and oxytocin

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13
Q

Melatonin is produced by..

A

Pineal Gland

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14
Q

Addison’s disease

A

adrenal glands do not produce enough essential hormones, resulting in mineralocorticoid and glucocorticoid deficiency

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15
Q

Symptoms of Addison’s Disease

A

hyperpigmentation in buccal mucosa and skin creases, diffuse tanning and freckles, orthostasis and hypotension, scant axillary and pubic hair

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16
Q

Addison Disease electrolyte findings

A

hyponatremia, hyperkalemia

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17
Q

Primary Adrenal Insufficiency

A

Low serum cortisol and high ACTH concentration

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18
Q

Secondary (pituitary) and Tertiary (hypothalamic) adrenal insufficiency

A

Serum cortisol and ACTH are low

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19
Q

How to differentiate between secondary and tertiary adrenal insufficiency

A

Corticotropin-releasing hormone (CRH)

20
Q

Chronic primary adrenal insufficiency treatment

A

Replacement of glucocorticoids (hydrocortisone, dexamethasone, or prednisone) and mineralocorticoids (often fludrocortisone)

Dehydroepiandrosterone (DHEA) therapy may be considered for some women w/ impaired mood or sense of well-being

21
Q

Cushing’s Disease

A

Hypersecretion of ACTH by pituitary or exogenous admin of glucocorticoids

Symptoms: moon face w/ buffalo hump, acne, poor wound healing, purple striae, hirsutism, HTN, weakness, amenorrhea, impotence, HA, polyuria and thirst, labile mood, freq infections

22
Q

Metabolic Syndrome

A

Presence of 3 of the 5 traits:
- waist circumference: male > 40 inch, female > 35 inch
- HTN: BP >/= 130/85 or on drug treatment for HTN
Triglycerides: >/= 150 or on drug treatment
HDL: < 40 in males and < 50 in females or on drug tx
Hyperglycemia: FPG >/= 100 or drug tx for glucose

23
Q

Prediabetes

A

A1C btwn 5.7%-6.4%
OR
FBG 100-125
OR
2-hr oral glucose tolerance test 140-199

24
Q

DM

A

AI1 >/= 6.5%
OR
FBG >/= 126
OR
Classis symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) plus random BG >/= 200
OR
two-hr plasma glucose >/= 200

25
Q

Goals for DM

A

BP < 130/80
LDL < 70
AIC < 7%
FBG 80-130
Postprandial glucose < 180

26
Q

First-line medication for DM

A

Metformin (Biguanides)

Decreases gluconeogenesis and intestinal absorption of glucose and improves insulin sensitivity

May have GI side effects

Monitor kidney and liver function

27
Q

Metformin Dosing

A

If patient is on metformin 500 mg daily and A1C is high (>7%), increase dose to metformin 500 mg BID. If A1C is still high (>7%) after dose adjustment, increase dose to metformin 1,000 mg BID

If taking maximum dose of metformin (1 g BID) and glycemic control is inadequate, can use combination therapy with additional oral agents such as a sulfonylurea, glipizide (Glucotrol XL) 5 mg PO daily (do not exceed maximum dose of glipizide 20 mg/day

28
Q

Sulfonylureas

A

Stimulate beta cells of the pancreas to secrete more insulin, reduce glucose output from liver, increase insulin sensitivity

Ex: Glipizide, Glimepiride

SE: hypoglycemia, avoid if impaired hepatic or renal function, concurrent use w/ Warfarin

Causes wt gain

29
Q

How often should A1C be checked in DM

A

Twice a year

Unless some frail older adults, hx of severe hypoglycemia, extensive comorbidity, limited life expectancy

30
Q

Glucose Goals

A

Fasting blood glucose (FBG) 80-130

Postprandial: < 180

31
Q

Metformin and IV contrast

A

Hold Metformin on day of precedure and 48 hrs after

Check baseline Cr and recheck after procedure - Cr must normalize prior to restarting Metformin

32
Q

Thiazolidinediones

A

Enhances insulin sensitivity and decreases gluconeogenesis

Ex: Pioglitazone and rosiglitazone

Take w/ meals

Do not use w/ HF

33
Q

GLP-1

A

Increase in insulin production and inhibits postprandial glucose release, slows gastric emptying

Ex: Exenatide or Liraglutide

Avoid if personal or family hx of medullary thyroid carcinoma

34
Q

SGLT2

A

Promotes renal excretion of glucose

Ex: Canagliflozin, Dapagliflozin, Empagliflozin

Reduce CVD events/death and helps slow progression of CKD

35
Q

Dipeptidyl Peptidase-4 (DPP-4 Inhibitors)

A

Enhancement of glucose-dependent insulin secretion, slowed gastric emptying, and reduction of postprandial glucagon

Ex: Sitagliptin, saxagliptin, linagliptin, alogliptin

Okay for CKD, though s/e include joint pain, angioedema, urticaria, acute pancreatitis, IBD

36
Q

Which diabetic products should not be used in combination?

A

GLP-1 and DPP-4

No additive glucose lowering effects

37
Q

DM Meds for pt’s w/ CVD and/or CKD or HFrEF

A

SGLT2 or GLP-1

38
Q

Recommended vaccines for pt’s w/ DM

A

Influenza, pneumococcal, Tdap, hepatitis B, zoster, and COVID-19 vaccinations

39
Q

Diabetic Retinopathy PE

A
  • Neovascularization (new growth of arterioles in retina)
  • Microaneurysms (dot and blot hemorhages due to neovascularization)
  • Cotton-wool spots or soft exudates (nerve fiber layer infarcts)
  • hard exudates
40
Q

Charcot’s foot

A

Often seen in ppl w/ DM

41
Q

Grave’s Disease

A

Hyperthyroidism

s/sx: lid lag, exophthalmos

42
Q

Hyperthyroidism tx

A

Thionamides: Methimazole, Propylithiouracil

43
Q

Hashimotos

A

Hypothyroidism

Confirm w/ TPO blood test

44
Q

Subclinical hypothyroidism

A

TSH > 5, but serum free T4 is w/in normal limits

Often do not require tx - recheck in 6 mo

45
Q

Myxedema coma

A

Severe hypothyroidism

Sx: cognitive symptoms - slow thinking, poor short-term memory, depression (or dementia), hypotension, hypothermia

46
Q

Levothyroxine for older patients

A

20-50 mcg and gradually increas to avoid cardiac effects from overstimulation (palpitations, angina, MI)

Eval every 6-8 weeks until TSH has normalized

AGNP review (16 decks)

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