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BCACP > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What medications can cause hypothyroidism?

A

-Amiodarone
-Lithium
-Immune Checkpoint Inhibitors
-Tyrosine Kinase Inhibitors

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2
Q

What are symptoms of hypothyroidism?

A

-Extreme fatigue
-Weight gain
-Cold intolerance
-Dry skin, loss of hair
-Bradycardia
-HTN
-Depression
-Goiter

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3
Q

What labs are used to diagnosis hypothyroidism?

A

-TSH > 5 w/ symptoms or > 10 without symptoms or positive antithyroid antibodies
(normal TSH 0.4-4)

-Low total T4
(normal T4 5-12)

-Low total T3
(normal T3 80-180)

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4
Q

When is treatment for hypothyroidism usually started?

A

TSH > 5

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5
Q

What is the preferred initial treatment for hypothyroidism?

A

Levothyroxine (T4)

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6
Q

What initial dose of levothyroxine is appropriate for most patients?

A

1.6 mcg/kg/day

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7
Q

Which patient populations may benefit from an initial levothyroxine dose of 12.5 mcg?

A

-Elderly
-Severe hypothyroidism
-History of CAD
-Arrhythmias

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8
Q

How often do TSH levels need to be checked while taking levothyroxine?

A

-Every 6-8 weeks after each dose change
-Every 3-6 months during first year of diagnosis
-Annually thereafter

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9
Q

Which medications may decrease levothyroxine absorption?

A

-Calcium
-PPIs
-Ferrous sulfate
-Aluminum hydroxide
-Magnesium

**Take 1-2 hours before or 4-6 hours after

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10
Q

What is the conversion of desiccated thyroid hormone to levothyroxine?

A

1 grain (65 mg) = 60-100 mcg of T4

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11
Q

What lab results would be expected in subclinical hypothyroidism?

A

-High TSH
-Normal T3/T4

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12
Q

When are patients with subclinical hypothyroidism supposed to receive treatment?

A

-TSH 10 or more
-TSH 5-9 (personalized on basis of symptoms, age, quality of life, risk factors, co-morbidities)

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13
Q

What dose of levothyroxine is recommended for subclinical hypothyroidism?

A

25-75 mcg

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14
Q

Which patients should not receive treatment for subclinical hypothyroidism?

A

> 60 years old

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15
Q

What are symptoms of hyperthyroidism?

A

-Heat intolerance or increased sweating
-Tremor
-Palpitations or tachycardia
-Nervousness/anxiety
-Weight loss despite increased appetite

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16
Q

What labs are used to diagnosis hyperthyroidism?

A

-Low TSH
(normal TSH 0.4-4)

-High total T4
(normal T4 5-12)

-High total T3
(normal T3 80-180)

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17
Q

What non-medication treatment options are available for hyperthyroidism?

A

-Radioactive iodine
*Contraindicated in pregnant or nursing mothers

-Thyroidectomy

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18
Q

What medication treatment options are available for hyperthyroidism?

A

-Methimazole
*Less hepatotoxicity
*Not recommended in first trimester or if breastfeeding

-Propylthiouracil
*Recommended during first trimester and if breastfeeding
*More hepatotoxicity

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19
Q

What are severe side effects of methimazole and propylthiouracil?

A

-Agranulocytosis
-Hepatitis
-Vasculitis

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20
Q

Which class of medications may provide symptom relief of hyperthyroidism symptoms?

A

Non-selective beta blockers (propranolol & nadolol)

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21
Q

Which medications are recommended in PCOS if patients are infertile?

A

-Clomiphene
-Metformin

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22
Q

Which medications are recommended for insulin resistance associated with PCOS?

A

-Metformin*
-Pioglitazone
-GLP-1 agonists

23
Q

Which medications are recommended for menstrual irregularities associated with PCOS?

A

-Oral contraceptives
-Metformin

24
Q

What medications can cause hyperprolactinemia?

A

-Dopamine antagonists (antipsychotics, TCAs, metoclopramide)
-SSRIs
-Verapamil
-GnRH analogs

25
Q

What is the recommended treatment for hyperprolactinemia?

A

-Bromocriptine
*Recommended for fertility and during pregnancy
*CI: ischemic heart disease, PVD, uncontrolled HTN

-Cabergoline
*Better GI tolerance
*CI: ischemic heart disease, PVD, uncontrolled HTN

26
Q

What medications can cause weight gain?

A

-Insulin
-TZDs
-SUs
-Atypical antipsychotics
-TCAs
-SSRIs
-Lithium
-VPA
-Glucocorticoids
-Oral contraceptives

27
Q

What is the goal amount of weight lost with treatment?

A

5-10% decrease in body weight over 6 months

28
Q

When is pharmacological treatment for obesity indicated?

A

BMI 30 or more
OR
BMI 27 or more PLUS co-morbidities (T2DM, HTN, OSA, etc.)

*Medications should only be recommended if patients do not meet goals with lifestyle changes

29
Q

When should a weight loss medication be deemed ineffective and discontinued?

A

If < 5% weight loss in 3 months

30
Q

How long should phentermine be used for?

A

3 months

31
Q

What are contraindications to phentermine therapy?

A

-HF
-CV disease
-Arrythmias
-Stroke
-Glaucoma
-Anxiety

32
Q

What are side effects of orlistat?

A

-GI effects (bloating, cramping, oily spotting)
-Fat-soluble vitamin deficiency

33
Q

What are contraindications to orlistat therapy?

A

-Chronic malabsorption therapy
-Cholestasis
-Hepatotoxicity

34
Q

How much weight should a patient lose during the first 12 weeks of Qsymia therapy?

A

at least 3% of body weight (if not, discontinue therapy)

35
Q

How much weight should a patient lose during the 12 weeks of highest Qsymia dose?

A

at least 5% of body weight (if not, taper off therapy)

36
Q

What are contraindications to Qsymia therapy?

A

-Pregnancy
-Severe depression
-Recent stroke or CV event
-Nephrolithiasis

*REMS program available

37
Q

What are contraindications to Contrave therapy?

A

-Seizure disorder
-Anorexia
-Bulimia

38
Q

How much weight should a patient lose during the first 12 weeks of Contrave therapy?

A

at least 5% of body weight (if not, discontinue therapy)

39
Q

How much weight should a patient lose during the first 16 weeks of Saxenda therapy?

A

at least 4% of body weight (if not, discontinue therapy)

40
Q

What are side effects of Qsymia?

A

-Paresthesia
-Dysgeusia
-Insomnia
-Dry mouth

41
Q

When should bariatric surgery be considered?

A

BMI 40 or more
OR
BMI 35 or more w/ comorbidities (DM, OSA, CV disease, joint disease)

42
Q

What deficiencies are typically associated with Roux-en-Y gastric bypass surgery?

A

-Iron
-B12
-Folate
-Calcium

43
Q

What are symptoms of primary adrenal deficiency (Addison disease)?

A

-Weakness/fatigue
-Anorexia
-Salt craving
-Hypotension
-Weight loss
-Dehydration

44
Q

What is the treatment of primary adrenal deficiency?

A

-Hydrocortisone
-Cortisone
-Prednisolone
-Fludrocortisone

45
Q

How should corticosteroid dosing be adjusted during sick-days/times of stress for primary adrenal deficiency?

A

Double or triple dose

46
Q

What are symptoms of Cushing Syndrome?

A

-Central obesity w/ moon/round face + buffalo hump
-HTN
-Striae
-Myopathy
-Osteopenia or osteoporosis

47
Q

What are symptoms of hyperaldosteronism?

A

-Fatigue
-Muscle cramping
-Paresthesia
-Polyuria/polydipsia
-HTN
-Hypo-K

48
Q

What is the treatment for hyperaldosteronism?

A

-Spironolactone
-Eplerenone

49
Q

What are symptoms of male hypogonadism?

A

-Decrease libido
-ED
-Loss of body hair
-Loss of energy

50
Q

What is the treatment for male hypogonadism?

A

-Testosterone

51
Q

What are side effects of testosterone?

A

-Increase in BP (oral and SQ)
-Edema
-Acne
-Gynecomastia
-Polycythemia
-Hair loss

52
Q

What are contraindications to testosterone?

A

-History of breast or prostate cancer
-Untreated BPH
-Untreated OSA
-Uncontrolled HF
-Pregnancy/breastfeeding

53
Q
A

BCACP (20 decks)

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