Endocrine (DM/HRT/Thyroid)

Question 1

Goal A1C

Answer 1

under 7%

Question 2

CAD/HF/DM

Answer 2

Insulin all pts + ACEI + Aspirin + statin

Question 3

How to calculate insulin dose

Answer 3

0.5 units/kg/day split between long acting and immediate acting.
Ex. pt 60kg= 30 units per day.
15 units long acting (Lantus)
5 units rapid acting before meals x 3

Question 4

When to screen for DM

Answer 4

all pts 45+ with BMI greater than 25
OR
All pts younger than 45 with additional risk factor

Question 5

Hypothyroidism r/t insulin

Answer 5

hypothyroidism delays insulin breakdown therefore reusing LESS insulin than average.

Hyper= more insulin faster metabolized.

Question 6

Monitor A1C every

Answer 6

6 months when stable

Question 7

ADR metformin

Answer 7

Weight loss, low risk for hypoglycemia.
watch for b12 deficiency!
lactic acidosis- increased risk.
#1 choice for type 2 DM.

DIARRHEA: mostly caused by increased amounts of carbs/sugars. Subsides within 2 weeks of tx.

Question 8

Metformin contraindicated in pts with

Answer 8

Renal or hepatic failure

Question 9

ADR sulfonurias

Answer 9

(glipizide, glyburide)
HYPOGLYCEMIA!
weight gain
leukopenia/thrombocytopenia

Question 10

ADR thiazolidinediones (TZD)

Answer 10

weight gain
hypoglycemia
cardiovascular symptoms (edema, CHF)
increased risk of bladder cancer

decreases birth control effectiveness

Question 11

DPP-4 ADR

Answer 11

weight neutral
nausea
(ex. Januvia)

Question 12

GLP-1 ADR

Answer 12

weight loss
low risk for hypoglycemia

(ex. trulicity, Victoza, mounjaro)

Question 13

SGLT-1 inhibitors

Answer 13

*Add to metformin if metformin isn’t effective. 2nd line tx for Dm2!

Also helps with HF.
GI issues, hypotension

ADR: Bladder cancer, yeast infections
ex. jardiance, “flozins”

Question 14

All HF pt’s are now being put on

Answer 14

SGLT-1 inhibitors!

Question 15

Pediatric pt with type 2 DM can use:

Answer 15

metformin
insulin
Victoza

Question 16

Tx for diabetic neuropathy

Answer 16

TCA or gabapentin

Question 17

Estrogen

Answer 17

maintains bone density
maintains normal skin

uses: treat vaginal changes/hot flashes/osteoporosis prevention

Question 18

HRT reduce the risk of:

Answer 18

Osteoporosis
Colon cancer

Question 19

HRT increases the risk of:

Answer 19

Breast cancer
cardiac disease/stroke
endometrial cancer (estrogen)

Question 20

Hypothyroidism labs

Answer 20

High TSH. Low t3/4.

Question 21

T4 contraindicated in pts with:

Answer 21

Acute MI.

Question 22

Can you take T4 while pregnant?

Answer 22

Yes! Safe for pregnancy and children.

Question 23

Target TSH

Answer 23

0.3-3.0
measure every 6-8 weeks

Question 24

Start T4 if TSH is greater than:

Answer 24

10
Or 5-10 with goiter

Question 25

Antithyroid meds

Answer 25

PTU & methimazole
(also treat with radioactive iodine, surgery)

*beta blockers can be used for symptoms until meds begin to work