Endocrine Flashcards
In what endocrine disorder are 1/3 of its cases undiagnosed?
DM
DM is characterized by _____ due to defects in _____ and _____.
Hyperglycemia. Insulin production. Insulin action.
What are the functions of insulin?
Transports and metabolizes glucose, signals the liver to stop releasing glucose, and the liver and muscles to store glycogen, fat to adipose tissue, amino acids to cells, and inhibits the breakdown of glucose, proteins, and fats.
What drug class causes type 1, 2, and gestational Diabetes?
Corticosteroids
What kind of disease is Type 1 DM? What happens? What % of all DM are type 1?
Autoimmune. Beta cells destroyed. 5-10%
In what endocrine disorder are 1/3 of its cases undiagnosed?
DM
In what demographic is type 2 more prevalent?
Over age 30 and obese
Type 2 is slow and progressive, to initially, what is the best way to treat it?
Diet and exercise
What are the risk factors for type 1 DM?
Not inherited, but genetic predisposition, combined with immunologic and possibly viral
What are some type 2 DM risk factors?
Family hx, obesity, ethnicity, HTN above 140/90, hx of gestational DM, HDL 250, baby over 9lb
What races are more apt to get Type 2 DM?
Native Americans, African Americans, Asian Americans, Pacific Islanders
What are the s/s of hyperglycemia?
3 P’s, fatigue, weakness, vision changes, numbness in extremities, wounds won’t heal, recurrent infections
Type 1 DM?
Weight loss, N/V, abd pain if DKA has developed
What diagnostic defines DM?
Fasting blood glucose of 126 or higher, random of 200 or higher
What does intensive control reduce?
Vascular and neuropathic complications
What % of the diabetics diet should be carbs? Fats? Cholesterol?
50-60% carbs. 20-30% fat with <300 mg cholesterol
What is the glycemic index?
It describes how much a food raised blood glucose
What do you combine starchy foods with to slow glycemic response?
Protein and fat containing foods
What is the difference between nutritive and non-nutritive sweetener?
Nutritive contain calories. Fructose, sorbitol, xylitol
How does exercise affect the diabetic?
It lowers blood sugar, aids in weight loss, and lowers CV risk
When should a diabetic avoid exercise?
BS above 250 or ketones in blood
If you are taking exogenous insulin, what should you do before exercise? After?
Eat a 15 g carbohydrate snack. Check BS
Explain and give tx for insulin waning, dawn phenomenon, and Somogyi effect
Waning = slow rise in BS from bedtime to am (Increase evening dose of intermediate/long acting insulin), Dawn = 3am rise in BS (Change time of intermediate insulin from dinner to bedtime), Somogyi = normal or elevated BS drops at 2-3am (Decrease evening intermediate, or give bedtime snack)
Which insulins are rapid acting, short acting, intermediate, long? Name trade and generic if you can.
Rapid = Lispro (Humalog), Aspart (Novalog), Glulisine (Apidra). Short = Regular insulin (Humalin R, Novolin R, Ilentin), Intermediate = NPH (Humulin N, Novolin N, Ilente II). Long = Glarhine (Lantus) and Detemir (Levimir)
When should diabetics get a stress test?
30 and over with 2 or more risk factors
What BS level is considered hypoglycemia?
Below 50-60
What are its adrenergic symptoms?
Sweating, tremors, tachycardia, palpitations, nervousness, hunger
CNS symptoms?
HA, confusion, memory lapses, slurred speech, numbness of lips and tongue, irrational, combative, double vision, drowsiness
What can sever hypoglycemia cause?
Disorientation, seizure, LOC
What is the tx for hypoglycemia?
15 g of carbs, 3-4 glucose tablets, 4-6 oz juice, 6-10 hard candies, 2-3 tsp honey
When do you retest and what do you do next?
Retest after 15 minutes. If <70 retreat. Give snack with protein/carbs, unless pt will eat a meal in 30-60 minutes
What BS levels cause DKA, high or low?
High
What cells does the endocrine affect, and what systems does it work closely with?
Almost every cell in the body. Nervous and immune
Where do steroids and peptides (proteins) work?
Steroids - in the cell. Peptides - on cell surface
Name all of the glands in the endocrine system.
Hypothalamus, pineal, pituitary, thyroid, parathyroid, thymus, adrenals, islets of Langerhans, ovaries, and testes
Is SIADH too much or too little of _____?
Too much ADH (Vasopressin)
What is often the result of SIADH?
Fluid overload and hyponatremia. All electrolytes will be low too
What do you monitor for in SIADH?
Neuro, cardio, fluids, electrolytes, weight, STRICT I&O
What type of meds would you administer for SIADH? Why?
K+ sparing diuretics for fluid overload and demeclocycline to prevent UTIs
What is the most common cause of hypothyroidism?
Hasimoto’s disease
What is the most common cause of hyperthyroidism?
Grave’s disease
Who gets hypo/hyperthyroidism the most, men or women?
Women. Hypo 5X more than men. Hyper 8X more. Also hyperparathyroidism
What are the s/s of hypothyroidism?
Fatigue, hair/skin/nail changes, menstrual disturbances, low temp & pulse, weight gain, mentally slow, cardiac/resp changes
What’s myxedema? Cretinism?
Severe adult hypothyroidism. Severe child hypothyroidism
What form of myxedema is a medical emergency?
Myxedema coma
What is the name of the synthetic replacement for thyroid hormone? How does it effect blood sugar?
Levothyroxine. It raises it
What 2 types of drugs does levothyroxine cause a dangerous increase in effect, and should be admin at 1/2 or 1/3 the normal dosing?
Hypnotic and sedative agents
What major complications can arise from levothyroxine admin, after having hypothyroidism for a long time?
Cardiac
What is the second most common endocrine disorder?
Hyperthyroidism. Graves. Goiter
What are the s/s of hyperthyroidism?
Everything speeds up, skin warm/moist except elderly may be dry and pruritic, exophthalmos, elevated systolic BP, may progress to cardiac dysrhythmias and failure
What is PTU?
Propylthiouracil - blocks coversion of T3 to T4 to treat hyperthyroidism
What is another drug to treat hyperthyroidism?
Methamizole - blocks synthesis of hormone; more toxic than PTU
What are some side effects of these drugs that tx hyperthyroidism?
Rash, N/V, Lupus
3 other types of meds are mentioned for tx of hyperthyroidism, what are they?
Iodine, dexamethasone, and beta blockers
How many parathyroid glands is it normal to have and what do they regulate?
Four. Calcium and phosphorous
What are the s/s of hyperparathyroidism?
High serum calcium, bone loss, renal calculi, apathy, N/V, constipation, HTN, cardiac, psycho
What are the tx for hyperparathyroidism?
Surgery, hydration therapy, mobility, diet
What is hypercalcemic crisis defined as and how is it treated?
Serum calcium level of 15 mg/dL or higher, lots of fluids, and diuretics
What usually causes hypoparathyroidism?
Surgery due to thyroid cancer; Removed part of the parathyroid gland when removing the thyroid gland
What electrolyte levels change in hypoparathyroidism?
Low calcium and phosphorous
What are the s/s of hypoparathyroidism?
Tetany, extremity numbness, stiffness of the hands and feet, muscle spasm, anxiety, delirium, ECG changes
How is hypoparathyroidism treated?
Calcium gluconate, parathormone (potential allergic rxns), calm environment, diet high in calcium/low in phosphorous, vitamin D
What does the adrenal medulla produce?
Catecholamines - epinephrine and norepinephrine
What does the adrenal cortex produce?
Glucocorticoids, mineralocorticoids, and androgens
What is Addisons disease?
Adrenal insufficiency brought on by an auto immune response; May be due to steroids
What are the s/s of Addisons disease?
S/S include muscle weakness, anorexia, GI symptoms, fatigue, dark pigmentation of skin and mucosa, hypotension, low blood glucose, low serum sodium, high serum potassium, mental changes, apathy, emotional instability, confusion
What exacerbation of Addisons does hypotension lead to?
Addisonian crisis. Circulatory shock
What diagnostics are done to determine Addisons disease?
ACTH levels, ACTH stimulation test
What are some therapies for Addisons disease?
Steroids
What causes Cushings syndrome?
Excessive adrenal activity or steroid meds
What are the s/s of Cushings syndrome?
Central weight gain w/thin extremities, buffalo hump, moon face, thin/fragile skin, weakness, sleep disturbances, facial hair
What are the risk factors for hypothyroidism?
Age 50+, woman, hx, pregnancy, thyroid illness, iron deficiency, meds, lifelong health conditions
What do many Cushings pts end up getting?
DM
What is pheochromocytoma?
Tumor of the adrenal medulla that produces catycholamines
What are catecholamines and what effect does this have on the body?
Epinephrine and norepinephrine. Sustained HTN. Pt must be monitored for hypertensive crisis
What is the most prevalent endocrine disorder? Second?
DM. Hyperthyroidism (AKA Graves disease/goiter)
Does hypothyroidism increase cholesterol levels leading to CAD?
Yes
Should you taper steroid meds when you quit? For what endocrine disorder are steroids the usual tx?
Yes, Addisons disease
Are most pituitary tumors malignant resulting in oversecretion?
No
What is the most common symptom of endocrine disorders?
Changes in energy level/fatigue
What does a deficiency of ADH cause? What is ADH?
Diabetes Insipidus (DI). Vasopressin
Cushings and Addisons are examples of abnormal _____ activity?
Adrenocortical
What endocrine gland’s hormones control cellular activity and regulates metabolism?
Thyroid
Which DM is most prevalent, and can you prevent or delay it?
Type 2. Yes, by diet and exercise
Will insulin drop during exercise in a patient taking insulin?
No
What are the 3 P’s associated with DM? What is the glycemic index?
Polyuria, polydipsia, polyphasia. How much a certain food raises blood glucose
What test average blood glucose over a 2-3 month period?
Hemoglobin A1C
What is the most common risk of insulin pump therapy?
DKA
What are the 3 major complications of diabetes related to short term imbalances?
Hypoglycemia, DKA, HHS
What does steroid withdrawal cause and what is usually given to combat it?
Adrenal crisis. Cortisol is given to get levels up, then taper off steroid
How is Synthroid taken?
Same time each day, empty stomach/full glass of water, 30-60 mins before breakfast
Is 0.025 mg of Synthroid a normal dose?
It is a starting dose
