endocrine

Question 1

MOA of metformin

Answer 1

decrease hepatic glucose production, sensitizes

Question 2

what DM medication is good for post prandial lowering?

Answer 2

DPP4 inhibitors, GLP-1 agonists, glinides

Question 3

CI to metformin

Answer 3

renal and liver failure…CHF (all cautions)

Question 4

side effects metformin

Answer 4

GI upset, rare is lactic acidosis

Question 5

MOA of actos (pioglitazone)

Answer 5

sensitize

Question 6

CI of pioglitazone

Answer 6

CHF class 3-4

Question 7

side effect pioglitazone

Answer 7

weight gain, osteoporosis, bladder cancer?

Question 8

what drugs are best for fasting blood glucose lowering?

Answer 8

metformin, pioglitazone, SU,

Question 9

DPP4 inhibitors

Answer 9

juanuvia (sitagliptin), tradjenta

Question 10

DPP4 inhibitor MOA

Answer 10

increase insulin synthesis

Question 11

GLP-1 agonists

Answer 11

byetta, bydureon (exenatide), victoza

Question 12

MOA of GLP-1 agonists

Answer 12

activates glucagon like peptide 1 receptor which increases insulin and delays gastric emptying . Sub Q injection.

Question 13

side effects GLP1 agonists

Answer 13

GI upset, weight loss, caution in renal failure

Question 14

SU MOA

Answer 14

stimulates pancreas to release insulin

Question 15

side effects of SU

Answer 15

hypoglycemia. caution in renal and liver dosing

Question 16

glinide (prandin, repaglinide) MOA

Answer 16

stimulates pancreas to release insulin

Question 17

hypoglycemia sxs

Answer 17

confusion, blurred vision, diplopia, anxiety, convulsions, sweating, palpitations, anxiety

Question 18

whipple’s triad

Answer 18

hx of hypoglycemia sxs, fasting BGS of 40 or less, immediate recovery with glucose

Question 19

DKA symptoms

Answer 19

polyuria, polydipsia, fatigue, N&V, mental stupor, rapid breathing, fruity odor, hypotension and tachy due to electrolyte depletion

Question 20

labs in DKA

Answer 20

plasma glucose over 350, hyperkalemia, serum ketones, hyponatremia, acidosis pH under 7.3, serum bicarb <15

Question 21

DKA TX

Answer 21

.1unit/kg IV bolus insulin then .1unit/kg/h, 1L .09% saline first hour, then IV infusion 300-400mL/h after 2 L given. NaHCO3, any other electrolyte replacement

Question 22

difference b/t DKA and hyperglycemic hyperosmolar state

Answer 22

HHS has normal blood pH, >600 serum glucose, bicarb >15, normal anion gap,

Question 23

treatment of hyperglycemic hyperosmolar state

Answer 23

fluid replacement major. insulin, KCl, phosphate if needed

Question 24

fatigue, lethargy, constipation, depression, menstrual abnormalities, cold intolerance and dry skin

Answer 24

hypothyroidism

Question 25

antithyroid peroxidase and antithyrgloblobulin antibodies

Answer 25

hashimoto's autoimmune hypothyroidism

Question 26

anti thyroid stimulating hormone...antithyroblobulin antibodies

Answer 26

grave's disease

Question 27

sweating, heat intolerance, weight loss, nervousness, loose stools, muscle cramps, irritability, hyperreflexia,

Answer 27

hyperthyroidism

Question 28

fever, tachycardia, vomiting, diarrhea, dehydration, weakness and muscle wasting, confusion, delirium

Answer 28

thyroid storm. usually occurs after illness, surgery, or radioactive iodine administration

Question 29

complications of hyperthyroidism

Answer 29

Afib, hypercalcemia, osteoporosis, nephrocalcinosis, decreased sperm count or libido

Question 30

subacute (deQuervain's) thyroiditis

Answer 30

viral cause - acute painful glandular enlargement with dysphagia, low grade fever, fatigue, malaise. radiation of pain to ears is common. Tx with aspirin

Question 31

supportive (infectious) and Riedels thyroiditis

Answer 31

invasive fibrous, woody, ligenous...rare and present with fever, pain, redness and fluctuant neck mass. needs antibiotics and surgery

Question 32

weakness, abdominal pain, fever, confusion, nausea, vomiting, diarrhea, low BP, dehydration and skin pigmentation

Answer 32

Addisonian crisis

Question 33

addison's disease treatment

Answer 33

hydrocortisone

Question 34

you suspect addisonian crisis. dx step?

Answer 34

draw serum electrolytes, cosyntropin stimulation test

Question 35

chronic adrenal insufficiency

Answer 35

weakness, fatigability, anorexia, weight loss, increased skin pigment, hypotension, small heart Addison's disease

Question 36

addison's disease lab values

Answer 36

low serum cortisol and sodium, high K and Ca

Question 37

central obesity, muscle wasting, hirsutism, purple striae, osteoporosis, poor wound healing

Answer 37

cushing's disease

Question 38

cushing's disease dx

Answer 38

dexamethasone suppression test

Question 39

labs in cushing's disease

Answer 39

hyperglycemia, glycosuria, hypokalemia, high serum cortisol and urinary cortisol

Question 40

tx for cushings

Answer 40

resection of pituitary adenoma or stop offending agent/exogenous cortisol