Endocrine- DM, Lipids, Thyroid, Adrenal, Pituitary Flashcards
What DM meds have hypoglycemia risk?
Sulfonylureas- Glyburide, Glipizide, Tolbutamide
Meglitinide Analogs- Repaglinide (Prandin)
~Acarbose (Precose) if used in combination
What DM meds are also good for weight loss
Incretins
GLP-1 Receptor Agonist- Victoza, Byetta
DPP-IV Inhibitors- Sitagliptan (Januvia), Saxagliptan(Onglyza)
SGLT2 Inhib- Invokana
What DM meds stimulate insulin secretion?
Sulfonylureas- Glyburide, Glipizide, Tolbutamide
Meglitinide Analgos- Repaglinide (Prandin)
D-phenylalanine Deriv- Nateglinide (Starlix)
?DPP-IV- Januvia, Onglyza
What DM med decrease renal reabsorption of glucose?
SGLT 2 Inhibitors- Invokana
Newly diagnosed DMII, initial therapy
lifestyle changes
Metformin 500mg BID
HTN management, lipids if indicated
DM patient who is going to have imaging for renal stones
Should D/C metformin prior to any contrast procedures
risk of lactic acidosis
Normal A1C
6.0= 125 average bs
Every 1% A1C rises is ~ equal to what blood sugar increase
30
What comes first, targeting blood sugar or targeting lipids?
Target sugars first
then lipids
What DMII med is preferred in renal disease or elderly?
Metiglinide
What DMII med should not be used in heart failure patients?
Thiazolid- Pioglitazone
In diabetes Insipidus the serum osmolarity is_____ and the urine osmolarity is _______
serum high
urine low
With a vasopressin challenge test _____ causes of diabetes insipidus will respond, but _____ causes will not
Central responds
nephrogenic will not
Patho of diabetes insipidus
failure of central of peripheral ADH
hyperkalemia results
will have excessive intake of fluids (polydipsia)
so free body water increase and plasma osmolarity decreases
will have compensatory increase in urinary free water excretion (polyuria)
serum osm now high compared to urine osm
TOC nephrogenic diabetes insipidus
indomethacin
+/- HCTZ, desmopressin, amiloride
TOC diabetes Insipidus associated with pregnancy
desmopressin and good hydration
TOC central diabetes insipidus
desmopressin, hydration
look for neoplasms
Treatment of thyroid storm
Methimazole
Lyte abnormalities seen in Addison’s Disease
Na- low
K- high
Glucose- ~low
Calcium- ~high
MCC Addison’s Disease
autoimmune destruction of adrenals
Addison’s disease is from deficiency in _______
cortisol
20 y/o M presents c/o 1 week of fatigue and 2 days of HA, n/v, and weight loss. Is craving chips and french fries. On exam he is hypotensive and you notice darker pigmentation on his arms and face.
Work up
plasma cortisol
TOC for Addisons
hydrocortisone PO BID
Cushings “disease” is
d/t ACTH hypersecretion by pituitary adenoma
Initial work up for cushing syndrome
dexamethasone suppression test
Hypoparathyroid causes______ calcemia
hypocalcemia
MCC hypothyroidism
Hashimotos
MCC hyperthyroidism
Graves disease
Severe life threatening hypothyroidism with lyte abnl and CNS manifestations is called
Myxedema Crisis/thyroid storm?
what radiographs are taken to determine bone age in pt with short statue?
L wrist and hand
what hormones are produced in the posterior pituitary?
oxytocin
vasopressin (ADH)
mcc of hyperparathyroidism
parathyroid adenoma
kidney stones, depression, constipation, and bone pain
hyperparathyroidism
chvostek sign
facial muscle contraction on tapping facial nerve in front of ear
sign of low calcium
hypoparathyroid
tx for hypoparathyroidism
calcium and vitD replacement
