Endocrinology

Question 1

diagnostic criteria for metabolic syndrome

Answer 1

Any 3 or the following:

1. Abdominal obesity:
   waist>40inches (male)
   waist>35 (female)
2. TG>150 mg/dL
3. HDL130/85 mmHg
4. FSG> 100mg/dL (or 2hr post oral glucose>140mg/dL)

associated with stroke, other CV complications

Question 2

diagnostic criteria for DM2

Answer 2

FSG>126
Random serum glucose 200
OGTT>200
HbA1C>6.5%

Question 3

Metformin

Answer 3

decreases hepatic gluconeogenesis
no weight gain
no hypoglycemia

adverse effects:
GI disturbances
decreased B12 absorption
lactic acidosis (metabolized by kidney, and builds up with inadequate kidney function, heart failure etc would increase the changes of this happening)

Question 4

how much do DM meds drop the A1C reading?

Answer 4

1-2% on average, per drug
more obvious effect if it starts higher

this might be a reason to start multiple drugs (one at a time)

Question 5

sulfonylureas

glimepiride
glipizide
glyburide

Answer 5

stimulate insulin release from beta cells by activating potassium-ATP channel

caveat- requires functional pancreas, and puts patient at risk of hypoglycemia

use with caution in patients who have hepatic or renal insufficiency, can cause some weight gain

Question 6

thiazolidinediones (TZD)
rosiglitazone
pioglitazone

Answer 6

decrease hepatic gluconeogenesis, increase insulin sensitivity

adverse effects: weight gain, fluid retention
pulmonary edema
CHF exacerbation
peripheral edema

use with caution in patients who have liver dysfunction

Question 7

DPP-4 inhibitors

sitagliptin
saxagliptin
linagliptin
alogliptin

Answer 7

These drugs inhibit enzyme DPP-4.
The DPP-4 enzyme metabolizes GLP-1 (glucagon like peptide 1)

Endogenous GLP-1 decreases glucagon secretion, increases insulin secretion, and also delays gastric emptying

Not super effective (0.5% decrease in A1C), but advantage is that they don’t cause a lot of side effects, no hypoglycemia, no weightgain, and not many contraindications

Question 8

GLP1 receptor agonists (incretin mimetics)

exenetide
liragletide
dulaglitide

Answer 8

Decrease glucagon secretion
Increase glucose- dependent insulin secretion
Delay gastric emptying

Exenatide- analog of exendin (Gila monster saliva), with similar effects to GLP-1

Liraglutide and dulaglutide are similar in effect, if not stronger, and are synthetic analogs of human GLP1

These are active peptides and must be injected

Adverse effect: nausea (slowed gastric effect), weightloss

Question 9

SGLT-2 inhibitors

dapagliflozin
canagliflozin
empagliflozin

Answer 9

SGLT-2 transporters are found in the kidney, and they help with glucose reabsorption in the tubules.

These medications augment the inhibition of SGLT 2 receptors so that more glucose gets lost in the urine instead of being reabsorbed

similar effect to metformin
caveat- relies on functional kidneys

recurrent urinary tract infections and major mycotic infections

Question 10

alpha- glucosidase inhibitor

acarbose

Answer 10

alpha-glucosidase enzyme is in the brush border of the intestines and breaks down complex carbohydrates into glucose so they can be absorbed

adverse effects:

• diarrhea
• flatulence
• abcominal cramping

acarbose- reactive hypoglycemia following gastric bypass surgery

Question 11

Pramlintide

Amylin analog

Answer 11

Amylin hormone is released with insulin in response to food, and this is unique because it is the only non-insulin drug approved for type 1

injected TID

not popular

Question 12

Meglitinides

nateglinide
rapaglinide

Answer 12

similar effect as sulfonylureas, but with shorter active time

Question 13

lactic acidosis is a rare but worrisome side effect

Answer 13

metformin

Question 14

most common side effect is hypoglycemia

Answer 14

sulfonylureas, meglitinides

Question 15

oldest and cheapest of the oral agents

Answer 15

metformin, sulfonylureas (40years)

Question 16

often used in combination with any of the other oral agents, first-line for 2DM

Answer 16

metformin

Question 17

also helps lower TG and LDL cholesterol

Answer 17

metformin

Question 18

not safe in settings of CHF

Answer 18

TZDs

Question 19

should not be used in patients with elevated serum creatinine, or renal dysfunction

Answer 19

metformin, SGLT2 inhibitors

Question 20

should not be used in patients with IBD

Answer 20

alpha- glucosideas inhibitors, GLP1 agonists, metformin

Question 21

hepatic serum transaminase levels should be carefully monitored when using these agents

Answer 21

metformin, TZDs

Question 22

not associated with weight gain, often used in overweight diabetic patients

Answer 22

metformin, DPP-2 inhibitors, GLP1 agonists, SGLT 2

Question 23

metabolized by liver, acceptable choice in patients with mild to moderate renal disease

Answer 23

TZDs, DPP4 inhibitors

Question 24

Hyperthyroid and palpation of single thyriod nodule

Answer 24

toxic thyroid adenoma

Question 25

hyperthyroid and palpation of multiple thyroid nodules

Answer 25

multinodular goiter

Question 26

hyperthyroid and recent study using IV contrast (iodine) in someone who was previously didn’t have enough iodine

Answer 26

Jod-Basedown phenomenon

Question 27

hyperthyroid and recent eye changes including proprosis, edema, injection

Answer 27

Graves disease

Question 28

History of thyroidectomy or radioablation of thyroid with hyperthyroid

Answer 28

excess thyroid hormone replacement