fnp exam 2

Question 1

Prediabetes glucose and A1c levels

Answer 1

BG: 101-125 mg/dL (fasting plasma glucose) & 140-199 (oral glucose tolerance test)
HgbA1C: 5.7-6.4

Question 2

Metabolic syndrome triglycerides, HDL, and fasting glucose levels

Answer 2

Triglycerides: >150 mg/dL
HDL: <40 mg/dL in men, <50 mg/dL in women
Fasting glucose: >100 mg/dL

Question 3

Diabetes glucose and A1c levels

Answer 3

BG: 126 or above (fasting plasma glucose) & 200 or above (oral glucose tolerance test)
A1C: 6.5 or above

Question 4

What weeks of pregnancy is gestational diabetes tested for

Answer 4

between 24th and 28th

Question 5

Rule of 15 for hypoglycemia

Answer 5

-give 15 grams CHO (1 serving) in liquid or readily absorbed form
-re-check blood glucose 15 minutes later
*follow with a snack or meal once youve reached >70

Question 6

Sick Day management for diabetics

Answer 6

-8 oz fluid every hour (every 3rd electrolytes)
-monitor BG every 2-4 hours
-ketone testing every 4 hours until negative (for type 1 only)
-continue meds as usual

Question 7

When to contact pcp for diabetic sick symptoms

Answer 7

-more than one episode of vomiting
-more than 6 hours of diarrhea
-bg>200 on 2 measurments
-moderate to large urine ketones

Question 8

What patients are acceptable to have an A1c of 8%

Answer 8

elderly, limited life expectancy, h/o hypoglycemia, extensive CVD complications

Question 9

how many times a day to type 1 diabetics need to check sugar (if not on continuous)

Answer 9

4 times daily

Question 10

Starting total insulin dose

Answer 10

0.4 to 1.0 units/kg/day

Question 11

Metformin and renal failure causes? What must GFR be to start?

Answer 11

can cause lactic acidosis, GFR must be 30 or greater

Question 12

Best dose and time to start metformin at

Answer 12

500 mg at bedtime (try XR if this still causes GI upset)

Question 13

GLP 1 Receptor Agonists name and action

Answer 13

TIDES!
-injectables that cause glucagon suppression and delay gastric empyting

Question 14

pros and cons of glp-1 agonists

Answer 14

Pros:
-reduce a1c
-low risk of hypoglycemia
-weight loss
cons:
-expensive
-GI side effects

Question 15

SGLT2 inhibitors names and action

Answer 15

FLOzin! oral meds that curb the action of proteins called “sodium-glucose cotransporter 2” that help your kidneys reabsorb glucose from the blood > causes urination of excess glucose

Question 16

Pros and cons of SGLT2 inhibitors

Answer 16

Pros:
-helps with volume in those with h/o CHF
-weight loss
-Prevents progression of CKD
-CV benefit
Cons:
-UTIs and Yeast infections
-decrease in eGFR
-euglycemic DKA

Question 17

DPP4 inhibitors name and action

Answer 17

GLIPTIN! oral meds that works similarly to GLP1 agonists by delaying breakdown of GLP-1

Question 18

DPP-4 pros and cons:

Answer 18

Pros:
-moderately effective in reducing A1C
-low risk hypoglycemia
-neutral weight loss
-few side effects
Cons:
-expensive
-CANNOT use w h/o medullary thyroid cancer
-reports of pancreatitis and hypersensitivity reaction including SJS

Question 19

sulfonylureas names and action

Answer 19

IDES! stimulates insulin release from the pancreas

Question 20

pros and cons of sulfonylureas

Answer 20

pros:
- effective and cheap
cons:
-moderate hypoglycemia risk
-possible weight gain
-No CV benefit

Question 21

Thiazolidinediones (TZDs) names and action

Answer 21

GLITAZONES! (rosiglitazone and pioglitazone) sensitize peripheral tissue to insulin and decreases gluconeogenesis in the liver

Question 22

pros and cons of TZDs (glitazones)

Answer 22

pros:
-effective in lowering A1C
-lowers risk of hypoglycemia then SUs
cons:
-weight gain
-r/o edema and HF
-several weeks to be effective
-more expensive
-bladder cancer risk!

Question 23

what 2 diabetes meds do you consider giving for patients with high risk ASCVD?

Answer 23

GLP-1s and SGLT-2s

Question 24

what diabetes med do you consider giving for patients with HF or CKD? even though given for CKD, what GFR is contraindicated with this med?

Answer 24

SGLT-2s
Cannot give if GFR < 45

Question 25

What conditions should make you avoid SGLTs?

Answer 25

frequent UTIs, yeast infections, decreased bone density, foot ulcers, increased r/o dka

Question 26

What diabetes med should you avoid using for patients with HF?

Answer 26

TZDs (glitazones)

Question 27

Along with insulin, what other diabetes medication has a hypoglycemic risk?

Answer 27

Sulfonylureas (IDES)

Question 28

Which 3 types of diabetes meds cause weight gain? which one is weight neutral?

Answer 28

-insulin, SUs, TZD
DDP4 is weight neutral

Question 29

When do you start insulin therapy? and what type of insulin is usually started first?

Answer 29

-insulin therapy is started when glycemic goal hasnt been reached from other meds, or A1C is >9.0%
-usually basal insulin is added first along with oral meds

Question 30

Dawn phenomenon

Answer 30

early morning INCREASE in BG between 2am-8am

Question 31

Somogyi effect

Answer 31

DECREASE in BG during 3am-7am (usually increases at 7am

Question 32

what time to check BG to distinguish between dawn and somogyi effect?

Answer 32

check at 3 am. if low, decrease insulin needs. if high, increase

Question 33

what is the honeymoon phase?

Answer 33

after diagnosis if type 1 DM, the first few months seem to be “better” and dont need much insulin

Question 34

what dose does insulin usually start at?

Answer 34

0.4 to 1.0 units/kg/day for type 1

Question 35

5 diagnosis from pituitary dysfunction

Answer 35

Glactorrhea, Gynecomastia, hirtisuism, hypogonadism, PCOS

Question 36

what TSH level is levothyroxine usually started? and how often is it rechecked to reach euthyroid? what is the usual dose? usual dose for elderly or cardiac pts?

Answer 36

> 10
q 4-6 weeks
75 mcg for every 100 lbs
12.5-25 mcg/day

Question 36

what is subclinical hypothyroidism? when to start treatment?

Answer 36

-normal t4 with mildly elevated tsh (>4.5)
-start treatment if patient is symptomatic and TSH is 4.5-10

Question 37

when/how to take levothyroxine?

Answer 37

early morning on an empty stomach with NO other meds

Question 38

treatment for hyperthyroidism?

Answer 38

PTU, methimazole (preferred), beta blockers (for symptoms), radioactive iodine, or surgery

Question 39

what is the diagnosis if T3, T4, and TSH are all low?

Answer 39

pituitary gland abnormality

Question 40

what are the 2 types of cushings?

Answer 40

endogenous - adrenal tumor
exogenous - steroid therapy

Question 41

diagnostic tests for cushings

Answer 41

-24 hour urine free cortisol
-dexamethasone suppression test
-serum ACTH
-AM plasma cortisol test

Question 42

lab values associated with addisons

Answer 42

hyperkalemia, hyponatremia, hypoglycemia and plasma cortisol <5mg/dL at 8 am

Question 43

tests to order for galactorrhea

Answer 43

Prolactin and TSH labs
mammogram to rule out mass
MRI r/t pituitary adenoma

Question 44

tests for PCOS

Answer 44

lipid panel, endocrine labs (tsh, LH, prolactin, testosterone), US *string of pearls

Question 45

PCOS is diagnosed with a pt has 2/3 of what 3 symptoms?

Answer 45

-irregular periods
-excess androgen
-polycystic ovaries

Question 46

labs to check for hirsutism? what to rule out before starting therapy?

Answer 46

-testosterone, FSH, LH, prolactin
-rule out ovarian or adrenal tumor

Question 47

GLP-1 agonists in pediatric patients

Answer 47

Liraglutide is a XR exenatide approved for peds > 10 yo

Question 48

what test is required to make definitive diagnosis of GHD?

Answer 48

GH stimulation tests