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Endocrine Flashcards

1
Q

Caused by the autoimmune destruction of the beta cells within the islets of Langerhans in the pancreas

A

Type I diabetes

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2
Q

insulin resistance and impaired beta cell function.

A

Type II diabetes

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3
Q

ADA criteria for diagnosis of diabetes:

A
  • A1C> 6.5%, or
  • FPG> 126 mg/dL or
  • 2-hour plasma glucose >200 mg/dL during an OGTT with 75 g or
  • Random plasma glucose > 200 mg/dL
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4
Q

Early morning hyperglycemia is controlled by

A

basal insulin

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5
Q

post-meal glucose spikes are controlled by

A

prandial insulin

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6
Q

onset, peak, and duration of rapid acting insulin

A

onset: 15 min
peak: 1-3 hours
duration: 3-5 hours

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7
Q

ex of short acting insulin

A

Regular and Humulin R

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8
Q

onset, peak, and duration of short acting insulin

A

onset: 30 min
peak: 1-5 hours
duration: 6-8 hours

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9
Q

Onset, peak, and duration of intermediate acting insulin

A

onset: 1 hour
peak: 6-14 hours
duration: 24 hours

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10
Q

onset, peak, and duration of long acting insulin

A

onset: 1 hour
peak: NONE
duration: 24 hours

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11
Q

example of long acting insulin

A

Levemir, Lantus

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12
Q

example of intermediate acting insulin

A

NPH

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13
Q

Insulin should be used as first line trx if

A

A1C greater than 10% or glucose above 250

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14
Q

Normal fasting insulin between

A

70-100

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15
Q

postmeal insulin should be less than

A

180

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16
Q

A hormone co-secreted with insulin; role is a decrease in glycolysis and slowing of gastric emptying, thereby increased satiety.

A

pramlintide (Symlin)

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17
Q

administration of pramlintide (Symlin)

A

given SQ 10-15 min before meals; a decrease dose of insulin given at end of meal

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18
Q

MOA of metformin

A

suppressive hepatic glucose production

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19
Q

important education for metformin

A

hold for at least 48 hours after injection of IV contrast

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20
Q

metformin should be discontinued if

A

creatinine greater than 1.5

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21
Q

MOA of sulfonyureas

A

stimulate insulin secretion

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22
Q

can cause severe hypoglycemia in elderly

A

sulfonyureas

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23
Q

act in the small intestine, delaying the digestion of polysaccharides which leads to lower postprandial glucose levels.

A

alpha glucosidase inhibitors

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24
Q

acarbose (Precose)

A

alpha glucosidase inhibitors

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25
Q

miglitol (Glyset)

A

alpha glucosidase inhibitors

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26
Q

administration of alpha glucosidase inhibitors

A

take with first bite of meal that contains carbs; hold if not eating

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27
Q

pioglitazone (Actos)

A

Thiazolidinediones

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28
Q

MOA of Thiazolidinediones

A

improve the sensitivity of liver, fat, and muscle to insulin

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29
Q

Side effects of Thiazolidinediones

A

weight gain and edema

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30
Q

Thiazolidinediones are contraindicated in those with

A

CHF

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31
Q

baseline labs with Thiazolidinediones

A

LFT

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32
Q

Exanatide (Byetta)

A

glucagon-like peptide (GLP-1) agonist

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33
Q

MOA of GLP1 agonist

A

stimulate insulin secretion

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34
Q

administration of exanatide (Byetta)

A

injected SQ 60 min before breakfast and dinner

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35
Q

sitagliptin (Januvia)

A

DPP-4 inhibitor

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36
Q

MOA of DPP4 inhibitors

A

slowly inactivate incretin hormone –> increases insulin release

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37
Q

F/U for those with DM

A

A1C and diabetic foot exam every 3 months, lipid panel annually, annual urine microalbumin, annual eye and dental exam

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38
Q

hypoglycemia is glucose less than

A

70

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39
Q

trx for mild to moderate hypoglycemia

A

15 g of carb

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40
Q

education for diabetics for sick days

A

may need to use insulin, monitor glucose every 4 hours, continue taking meds even if not eating

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41
Q

when to screen for gestational diabetes

A

24-28 weeks

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42
Q

Diagnosis for gestational diabetes is made by OGTT if

A

fasting plasma glucose is greater than 92 mg/dL,
1-hour glucose greater than 180 mg/dL, or
2-hour glucose greater than 153 mg/dL.

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43
Q

meds for DM that are safe during pregnancy

A

insulin, glyburide, metformin

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44
Q

this med can mask the effect of hypoglycemia

A

beta blockers

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45
Q

s/s of DKA

A

abd pain, N/V, Kussmaul respirations, tachycardia, fruity odor to breath, hypotension

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46
Q

DKA is characterized as

A

hyperglycemia, ketonemia, and metabolic acidosis

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47
Q

trx for DKA

A

isotonic fluid, IV insulin as long as k+ is greater than 3.3

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48
Q

HHNK is common in those who

A

have type 2 diabetes and older than 65

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49
Q

HHNK s/s

A

polyuria, polydipsia, AMS

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50
Q

diagnostics in HHNK

A

hyperglycemia greater than 1000, hyponatremia

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51
Q

differences between DKA and HHNK

A

DKA: type 1 DM whereas HHNK: type 2 DM;
DKA: occurs rapidly; HHNK: occurs gradually;
DKA: ketones; HHNK: little to no ketones

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52
Q

diagnostic for metabolic syndrome

A

fasting insulin is greater than 10, fasting blood glucose greater than 100

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53
Q

a thyroid nodule greater than ___ is indicative of thyroid cancer

A

2.5 cm

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54
Q

diagnostics for thyroid cancer

A

radioactive iodine reuptake will show a “cold” nodule

55
Q

s/s of pheochromocytoma

A

random episodes of severe HTN (BP greater than 200/110), headache, tachycardia, anxiety

56
Q

can be a sign of pituitary adenoma

A

hyperprolactinemia

57
Q

The ____ stimulates the ____ into producing stimulating hormones that tell the _____ to produce “active” hormones

A

hypothalamus; anterior pituitary; target organs

58
Q

The only hormone the hypothalamus actually produces

A

oxytocin

59
Q

The anterior pituitary gland produces these stimulating hormones

A

FSH, LH, TSH, growth hormone, ACTH, prolactin

60
Q

The posterior pituitary gland produces these stimulating hormones

A

vasopressin (ADH), oxytocin

61
Q

FSH stimulates the ____ to produce ____

A

ovaries; estrogen

62
Q

LH stimulates the ___ to produce _____

A

ovaries; progesterone

63
Q

TSH stimulates the ___ to produce _____

A

thyroid; thyroid hormones

64
Q

ACTH stimulates the ___ to produce _____

A

adrenal glands; glucocorticoids (cortisol) and mineralcorticoids (aldosterone)

65
Q

hormone responsible for calcium balance

A

PTH

66
Q

Those with Grave’s disease are at high risk of developing

A

RA, pernicious anemia, osteoporosis

67
Q

s/s of hyperthyroidism

A

weight loss, irritability, anxious, insomnia, frequent BM, amenorrhea, heat intolerance , goiter, tachycardia

68
Q

diagnostic for hyperthyroidism

A

TSH will be low, high T3 and T4. Check TSI for Grave’s disease;
Thyroid US for nodule/goiter

69
Q

Meds for hyperthyroidism

A

PTU, Methimazole (Tapazole)

70
Q

side effects of PTU and Tapazole

A

skin rash, granulocytopenia, hepatic necrosis

71
Q

monitor these labs in those with Grave’s taking meds

A

CBC and LFT

72
Q

Only med indicated for pregnant women with hyperthyroidism

A

PTU

73
Q

common causes of hypothyroidism

A

Hashimoto’s thyroiditis, postpartum thyroiditis

74
Q

An autoimmune disease where the body produces antibodies against the thyroid.

A

Hashimoto’s thyroiditis

75
Q

s/s of hypothyroidism

A

weight gain, fatigue, depression, cold intolerance, constipation, skin coarse and dry

76
Q

diagnostics for hypothyroidism

A

high TSH, elevated antimicrosmal antibodies (Hashimoto’s)

77
Q

monitoring TSH in those with thyroid condition

A

every 6-8 weeks until TSH is normal

78
Q

eye exam recommendations for diabetics

A

For Type 2: at time of diagnosis and annually;

For Type 1: first eye exam 5 years within diagnosis and annually

79
Q

a normal physiologic elevation of blood sugar that occurs every morning between 4 and 8 am

A

Dawn Phenomenon

80
Q

severe hyperglycemia in the morning due to overtreatment with bedtime dose of insulin

A

Somogyi effect

81
Q

Somogyi effect is common in

A

type 1 diabetics

82
Q

eye exam findings in diabetics

A

microaneurysms d/t neovascularization, cotton wool exudates

83
Q

Metformin is contraindicated in those with

A

renal disease, hepatic disease, alcoholics

84
Q

Labs to monitor for those taking metformin

A

LFTs, creatinine, UA, GFR

85
Q

Chlorpropamide (Diabenase)

A

sulfonyurea not used much anymore d/t high risk of hypoglycemia

86
Q

monitor these labs with any sulfonyurea

A

LFT, creatinine, UA, CBC

87
Q

dosing for TZDs

A

take daily at breakfast

88
Q

Med for diabetes that is associated with rare risk of bladder cancer

A

Actos

89
Q

Bile acid sequestrants for diabetes

A

Questran, Welchol

90
Q

Repaglinide (Prandin)

A

meglitinide

91
Q

nateglinide (Starlix)

A

meglitinide

92
Q

MOA of meglitinide

A

stimulate secretion of insulin

93
Q

administration of meglitinide

A

take with meals

94
Q

GLP1 and DPP-4 inhibitors can cause

A

pancreatitis

95
Q

Do not combine these two meds for diabetes

A

GLP-1 agonist (Byetta or Victoza) with DPP-4 inhibitors (Januvia)

96
Q

Rapid acting SQ insulin is mostly used in

A

type 1 diabetics

97
Q

Meglitinide is indicated for

A

type 2 diabetics with post-prandial hyperglycemia

98
Q

side effects of sulfonyureas

A

weight gain, hypoglycemia

99
Q

DM risk factors

A

age greater than 45, BMI greater than 25, family hx, sedentary lifestyle, HTN, HLD, PCOS, hx of GDM

100
Q

A1C goal for most adults

A

less than 7%

101
Q

A1C goal for elderly

A

less than 8%

102
Q

A1C goal for pregnant patients

A

less than 6%

103
Q

cholesterol management with type 2 DM

A

start on moderate to high dose statin in those 40-75

104
Q

expected decrease in A1c with metformin

A

1-2%

105
Q

Alogliptin (Nesina)

A

DPP-4 inhibitor

106
Q

linagliptin (Tradjenta)

A

DPP-4 inhibitor

107
Q

saxagliptin (Onglyza)

A

DPP-4 inhibitor

108
Q

Duloaglutide (Trulicity)

A

GLP-1

109
Q

Canagliflozin (Invokana)

A

SGLT2

110
Q

second choice med to add on with metformin

A

GLP1 or insulin

111
Q

expected decrease in A1c with sulfonyurea

A

1-2%

112
Q

expected decrease in A1c with DPP4 inhibitors

A

0.7%

113
Q

expected decrease in A1c with GLP1

A

1-1.5%

114
Q

high doses of TZDs are associated with

A

osteopenia

115
Q

MOA of SGLT2 inhibitors

A

prevents glucose reabsorption by increasing glucose excretion

116
Q

complications with SGLT2 inhibitors

A

UTI, yeast infections

117
Q

diabetic meds that help with weight loss

A

metformin, GLP1, SGLT2

118
Q

Do not combine insulin with these diabetic meds

A

sulfonyureas, TZD

119
Q

dosage when starting basal insulin

A

0.1-0.2 units/kg or 10 units at bedtime; increase 2-3 units every 2-3 days until goal reached

120
Q

goal fasting glucose for diabetics

A

80-130

121
Q

___ is 5 times more active on metabolism than __

A

T3; T4

122
Q

screening for thyroid disease

A

TSH only

123
Q

If screening TSH is high, then

A

repeat, add free T4

124
Q

if screening TSH is low, then

A

repeat, add free T4 and T3

125
Q

thyroid labs in primary hypothyroidism

A

high TSH, low T4, normal T3

126
Q

thyroid labs in subclinical hypothyroidism

A

high TSH, normal T3 and T4

127
Q

thyroid labs in primary hyperthyroidism

A

low TSH, high T4, normal T3

128
Q

dosing replacement for hypothyroidism

A

1.6 mcg/kg/day, base on ideal weight not actual weight

129
Q

levothyroxine tabs come in

A

25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200 mcg

130
Q

dosing replacement for hypothyroidism in elderly

A

25-50 mcg/day

131
Q

treat subclinical hypothyroidism if TSH is

A

greater than 10

132
Q

complications with levothyroxine therapy

A

accelerated bone loss, afib

133
Q

if patient takes levothyroxine with food, then

A

drug will not be absorbed as well and can increase TSH

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