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joy's deck for FNP > endocrine > Flashcards

endocrine Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

severe hypoglycemia

A

glucose

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2
Q

DM 1

A

school aged,
eats but still loses weight
“fruity odor breath”

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3
Q

thyroid cancer

A

nodule >2.5cm

24 hour radioactive iodine uptake (RAIU) will show “cold” nodule

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4
Q

FSH

A

estrogen

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5
Q

LH

A

progesterone

stimulates testicles to produce testosterone

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6
Q

hyperthyroidism

A

very low TSH, >t3 t4.

graves disease is most common cause

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7
Q

grave’s disease

A

Look for LOW TSH (women (8:1)
>risk for osteoporosis, RA, pernicious anemia

classic case: middle age female, weight loss, hyperactive, lower stool, amenorrhea

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8
Q

radioactive iodine

A

permanent distruction of thyroid
PTU treatment
do not give during pregnancy

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9
Q

thyroid storm (thyrotoxicosis)

A

dt stress/infection

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10
Q

cold vs hot spot

A

cold- not metabolically active (concern is cancer). biopsy

hot- active and usually benign

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11
Q

normal range of TSH

A

.01-6.0

check q6-8wks

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12
Q

drug induced thyroid disease

A

lithium, dopamine, amiodarone, interferon alfa (cancer)

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13
Q

hypothyroid most common cause

A

hashimotos
other: postpartum,

most have elevatd antimicrosomal antibody titers, goiter

classic case: overweight woman, fatigue, constipation. a fib in older adult.

** Heavy menstrual, irregular bleeding

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14
Q

myxedema

A

severe HYPOthyroid

puffy hands, face, feet. thickening of the skin, thinning of outer 1/3 eyebrow,

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15
Q

tx plan for hypothyroid

A

synthroid 25-50 mcg

increase every few weeks prn, re check 6-8 wks TSH until normalized (

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16
Q

preferred tx for pregnant women

A

PTU

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17
Q

thyroid cancer risk

A

hx of neck irradiation in childhood

PAINLESS nodule >2,5 cm

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18
Q

supplement in chronic amenorrhea (hyper thyroid)

A

calcium , vit D, weight bearing exercise ( dt osteoporosis)

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19
Q

metabolic syndrome aka..

A

aka: insulin resistance syndrome or syndrome x

obesity, HTN, Hyperglycemia, Hyperlipidemia.
High risk for DM 2 and CVD

20
Q

prediabetes a1c

A

a1c

21
Q

diabetes a1c/glucose fasting/random glucose

A

> 6.5%
126mg/dl (fasting, no food 8 hours)
200 random glucose (plus polyuria, polydipsea, polyphagia)

22
Q

a1c elderly

A

8% ok

23
Q

high risk hypoglycemia

A

50mg/dl or less

24
Q

dawn phenomenon

A

hypoglycemia

>in FBG early in the morning dt INCREASE insulin resistance between 4-8am

25
Q

somogyi effect (rebound hyperglycemia)

A

S=sugar
noctornal hypoglycemia stimulates glucagon to be released by liver= high FBG by 7am.

** DUE TO over treatment bedtime insulin.
dsg- check glucose 3am for 1-2 weeks
tx: snack before bedtime, or

26
Q

diabetic retinopathy

A

microaneurysms, cotton wool exudates, neovasculariazion (can rupture in the eye) (cotton wool also with HTN)

27
Q

first line DM rx

A

metformin (glucophage)

decrease new glucose, decrease insulin resistance

28
Q

contraindications for metformin

A

hepatic disease, alcoholics

risk for lactic acidosis (PH

29
Q

sulfonylureas

A

beta cells to MAKE more insuin- risk of hyPOglycemia!!!

glipizide (glucotrol)
glyberide (diabeta)
glimepriride (amaryl)

increaser risk sun sensitivity (use spf)
blood dyscrasias ( monitor cbc)
30
Q

Thiazolidinedoines TZD

A

z=zone

rosiglitazone (avandia)
pioglitazone (actos)

AVOID in CHF (nyha class 3/4)
associated with rare bladder cancer (UA, cytology)
31
Q

key points for insulin

A

rapid acting - 1/2 day work ( 4 hours). “one meal at a time”
regular insulin ( or short acting) - covers work day ( 8 hours) “meal to meal “
NPH - extra work shift almost all day (16 Plus hours) breast fast to dinner
lantus- once a day 24 hours

32
Q

rapid acting drugs

A

(Log=Lispro)

humalog (insulin lispro)

33
Q

short acting (regular)

A

humulin R

34
Q

NPH

A

humulin N

35
Q

lantus

A

insulin glargine, levimir (insulin detimir)
considered a “basal insulin”
no peaks. lasts 24 hours.

36
Q

incretin mimetic or glycogen like peptide 1 (glp-1)

A

exenatide (byetta)
victoza (once a day injection)

risk for pancreatitis
monitor amylas/lipase!

incretin inhancer (januvia, onyglyza)- don’t mix.

37
Q

when does regular insulin peak

A

1-5 hours
aka: meal to meal (breakfast to lunch)
by lunch time its gone

38
Q

type 1 DM usually takes what insulin before each meal

A

rapid acting (humalog/lispro)

39
Q

premixed mostly for type 1 or 2 DM

A

2

40
Q

metformin dosage

A

500mg daily bid ( max dose is 2550 mg/dl)

if metformin is at max at blood sugar still high, add SU (risk for hypoglycemia)

41
Q

if pt is on BOTH metformin and SU max dose (metformin 2550mg/dl and gloctrol XL 20mg) and glucose still high..

A

add basil insulin (LANTUS)

42
Q

other options beside insulin

A

thioglitazone (avandia, actos)- don’t use in CHF

byetta - risk for pancreatitis (incretin mimetic)

43
Q

which DM causes weight loss

A 
metofmrin 
incretin mimetic (byetta)
amyin analog (symlin)
44
Q

which DM causes weight gain

A

SU, TZD (actos, avandia), insulin

45
Q

DM lifestyle management

A

weight loss,
fiber whole grains
exercises increases cellular glucose uptake

weight loss- 7% of body weight
physical activity (150/min/week)
46
Q

somogyi versus dawn phenomenon

A

somogyi is also called “rebound hyperglycemia.” Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more “man-made” in the Somogyi effect (a result of poor diabetes management).

dawn phenomenon happens to everyone, 3a-8a blood hormones cause >glucogon=>glucose. tx: give insulin, earlier dinner, exercise after dinner.

47
Q

what is considered “low blood sugar”

A

Your blood sugar is considered low when it drops below 70 mg/dL.

joy's deck for FNP (24 decks)

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