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Fel Med > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Insulin dose should be decreased when BG is

A

< 80mg/dL

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2
Q

BG in a diabetic cat should be maintained between

A

100-200mg/dL

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3
Q

The insulin products most effective in first-line treatment of DM are

A

Protamine zinc, lente insulin, and glargine insulin (determine has been used in cats, but less often)

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4
Q

The gold standard for fT4 measurement is __

A

Equilibrium dialysis

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5
Q

Bexagliflozin (Bexacat) belongs to __ class of drugs

A

“flozins” class; Sodium glucose cotransporters (SGLTs)

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6
Q

__% of glucose is resorbed via __ in glomerular proximal tubules and __% is resorbed via __

A

> 90%; SGLT2; ~3%; SGLT1

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7
Q

“Flozins” class of SGLT inhibitors reduce glucose resorption to

A

40% - 50%

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8
Q

Hypoglycemia is prevented with an SGLT inhibitor because

A

SGLT1 resorption of glucose increases when SGLT2 is inhibited

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9
Q

Bexacat dosing

A

1 tablet per cat per day

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10
Q

Minimum patient weight for Bexacat dosing

A

3kg (1.5mg/kg)

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11
Q

Bexagliflozin (Bexacat) dosing is independent of ___ or ___

A

BG or cat weight

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12
Q

Bexacat tablet is ___ flavored

A

Beef

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13
Q

Bexacat tablets can be

A

Crushed/mixed with food

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14
Q

Cats treated with bexagliflozin are at an increased risk of

A

DKA or euglycemic DKA

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15
Q

If cat treated with bexagliflozin develops DKA, the bexagliflozin should be

A

Discontinued and insulin therapy initiated

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16
Q

Cats are NOT bexagliflozin (Bexacat) candidates if they

A

Are Type 1 diabetics (insulin-dependent) or have been treated with insulin. (They need healthy beta cells capable of making insulin)
Are geriatric (>/= 13 yrs) esp. with comorbidities (suboptimal candidate)

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17
Q

Lab work parameters for bexagliflozin (Bexacat) treatment

A

No renal/hepatic disease (CKD >/= stage 3 is contraindication, b/c drug works on renal tubules)
No lab values consistent with DKA
Spec FPL > 5.3 mcg/L
BHBA > 37 mg/dL (or > 25 mg/dL if renal dz or metabolic acidosis Hx)

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18
Q

If a cat on bexagliflozin exhibits___, discontinue the drug and assess for DKA

A

Hypo-/anorexia
Lethargy
Dehydration or diarrhea unresponsive to standard therapy
Or weight loss

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19
Q

The longer a cat is treated with insulin, the greater the likelihood of __ development

A

Amyloid plaque

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20
Q

The predominant ketoacid in DKA

A

Beta-hydroxybutyric acid (BHBA)

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21
Q

The ketoacid detected by urine dipsticks

A

Acetoacetate (acetoacetic acid)

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22
Q

The only monitor that is validated for measuring serum ketones in cats (May 2023)

A

The Abbott Precision Xtra Monitor

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23
Q

Approximate turnaround time for BHBA through Idexx

A

1-3 days

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24
Q

Euglycemic DKA describes

A

DKA in the face of normoglycemia and almost exclusively affects cats on SGLT2 inhibitors

25
Q

In patient with (BHBA) DKA and normoglycemia, immediate treatment includes

A

Short-acting insulin with 2.5-5% dextrose, once stable, permanently transition cats to insulin therapy

26
Q

Bexagliflozin monitoring schedule

A

At 3-5 days (PE, weight, BHBA level), then at 2,4, and 8 weeks (PE, weight, BHBA, fructosamine, glucose curve), then every 90 days

27
Q

If wanting to check for DM remission in catvtreated with bexagliflozin, __

A

Discontinue drug and check BG in 3-5 days

28
Q

Time to effect (euglycemia) with bexagliflozin

A

8 hours

29
Q

Low-carb diet + bexagliflozin?

A

Data unclear. In humans on SGLT2 inhibitors, low-carb diets linked to DKA.

30
Q

Patient on bexagliflozin may be at increased risk of DKA if ___

A

Increased or persistently elevated cholesterol or triglycerides

31
Q

A tumor of the adrenal medulla is referred to as

A

A pheochromocytoma, which causes hyper secretion of epinephrine and norepinephrine (effect is of continuous sympathetic nerve stimulation: hypertension, hyperglycemia, elevated metabolism)

32
Q

The anterior pituitary (adenohypophysis) generates these trophic hormones

A

Adrenocorticotropic hormone (ACTH)
Thyroid-stimulatin hormone (TSH)
Growth hormone (GH)
Follicle stimulating hormone (FSH)
Prolactin (PRL)
Luteinizing hormone (LH)

33
Q

The hypothalamic hormones and how they are involved in control of anterior pituitary

A

Corticotropin releasing hormone (CRT; –> ACTH)
Gonadotropin releasing hormone (GnRH; –> FSH, LH)
Prolactin inhibiting hormone (PIH; dopamine; –x PRL)
Somatostatin (–x GH)
Thyrotropin releasing hormone (TRH; –>TSH)
Growth hormone releasing hormone (GHRH; –> GH)

34
Q

Action of ACTH

A

Stimulates secretion of glucocorticoids

35
Q

Action of TSH

A

Stimulates secretion of thyroid hormones

36
Q

Action of GH

A

Promotes protein synthesis and growth, lipolysis and increased BG

37
Q

FSH action

A

Promotes gamete production and stimulates estrogen production in females

38
Q

PRL action

A

Promotes milk production in lactating females, additional actions in other organs

39
Q

LH action

A

Stimulates sex hormone secretion, ovulation and corpus luteum formation in females; stimulates testosterone secretion in males

40
Q

The posterior pituitary (pars nervosa/neurohypophysis) stores and secretes these hormones

A

Antidiuretic hormone (ADH) and oxytocin (both of which are produced in the hypothalamus)

41
Q

Action of antidiuretic hormone (ADH)

A

Promotes water retention by the kidneys, so that less water is excreted in the urine and more retained in the blood; at high doses has a “pressor” effect (vasoconstriction)

42
Q

Oxytocin action

A

Stimulates contraction of the uterus in labor and of the mammary gland alveoli and ducts, resulting in the milk-ejection reflex in lactating women

43
Q

Describe the hypothalamus-pituitary-thyroid axis

A

Hypothalamus secretes TRH, which stimulates TSH secretion from the anterior pituitary, which stimulates thyroxine secretion from the thyroid, which has a negative feedback mechanism whereby thyroxine inhibits anterior pituitary response to TRH

44
Q

The functional categories of corticosteroids (corticoids)

A

Mineralocorticoids, glucocorticoids, and sex steroids

45
Q

The most potent mineralocorticoid

A

Aldosterone

46
Q

Mineralocoricoid action

A

Stimulate kidneys to retain Na+ and water while excreting K+ in the urine; this increases blood volume and pressure and regulates blood electrolyte balance

47
Q

Describe the pathogenesis of a goiter in iodine deficiency (in humans)

A

Without sufficient dietary iodine, the thyroid gland doesn’t produce sufficient amounts of T3 and T4 to generate the negative feedback (inhibition) of TSH secretion, the abnormally high level of TSH stimulates abnormal thyroid gland growth

48
Q

Describe the pathogenesis of a goiter in a hyperthyroid (human)

A

Aka Graves’ disease, autoantibodies exert TSH-like effect on the thyroid. Because the generation of these Abs is not checked by negative feedback, high levels of thyroxine are secreted that cannot decrease the TSH production/stimulation of the thyroid; aka thyrotoxicosis

49
Q

Glucocorticoid action

A

Stimulate gluconeogenesis, inhibit glucose utilization, promote lipolysis and release of free fatty acids into blood

50
Q

The predominant human glucocorticoid

A

Cortisol/hydrocortisone

51
Q

A positive SNAP fPL test result should prompt __ because __

A

Measurement of a Spec fPL because the SNAP does not differentiate between grey-zone results and high results

52
Q

__ is the most biologically active thyroid hormone

A

T3 (triiodothyronine)

53
Q

The primary hormone secreted by the feline (& canine) thyroid gland is __, which is metabolized to __

A

Thyroxine (T4); T3

54
Q

The reason T3 isn’t tested

A

25% - 33% of cats with confirmed hyperthyroidism have a T3 WRR

55
Q

The tT4 concentration includes both the __ & __

A

Protein-bound fraction (> 99%) & the free, unbound, (<1%)

56
Q

Only the __ of thyroid hormone is available for entry into cells & biologically active and is therefore a more __

A

Free fraction; consistent assessment of thyroid gland function than [tT4]

57
Q

Ectopic hyperplastic thyroid tissue may be found in the neck or thorax of up to __ of cats

A

20%

58
Q

TSH aka

A

Thyrotropin

Fel Med (24 decks)

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