Hormonal Regulation Flashcards
Where is insulin secreted from?
The pancreas
(T/F) Insulin stops glucose creation in the liver
True
What does low insulin levels do?
It releases three things
Releases glucose from liver
Releases fat from adipose tissue
Releases protein from skeletal muscle
When insulin is secreted, it stops glucose creation from liver, encourages fat storage in adipose, and increases protein synthesis.
Which Diabetes type is a combo of inadequate insulin secretion and insulin resistance?
Type 2
Which Diabetes type is autoimmune?
Type 1
Insulin making cells in the pancreas (islet cells) are destroyed
Which Diabetes type has fast onset and characterized by the three P’s?
Type 1
What are the three P’s of Type 1 Diabetes? Name them and what they mean.
Polydipsia: Excessive thirst
Polyphagia: Excessive hunger
Polyuria: Excessive urination
-Phagia suffix means to swallow/eat (ex: Aphagia is the inability (a) to swallow (phagia))
-Dipsia suffix means thirst (ex: polydipsia is excess (poly) thirst (dipsia))
(T/F) Type 1 Diabetes will need outside insulin (exogenous insulin) for life
True
(T/F) Type 2 Diabetics can still make their own insulins
True
What are other clinical manifestations aside from the 3 P’s for Diabetes?
There are four
Weight loss
Weakness
Recurrent infections/Poor healing
Vision problems
What is the gold standard for diabetes diagnosis?
A1C of 6.5% or higher
What do we want diabetics A1C to be?
Less than 7.0%
(T/F) Biguanides is a non-insulin drug
True, only for Type 2 DM
What is the mechanism of action for biguanides?
Increase insulin sensitivity, reduce glucose production in the liver
What is a drug in the Biguanides class?
You need to know this, it’s a highlighted drug
Begins with M
Metformin
What are the education points for Metformin?
There are two
GI side effects
Must be held 48 hrs before and after IV contrast
What do Glucagon-Like Peptide-1 (GLP-1) Receptors Agonists do?
There are three things
It’s a Glucagon AGONIST. what would that do to glucose and by proxy insulin?
Increase insulin from pancreas, stop glucagon release, slow gastric emptying
What is a drug in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists?
Highlighted drug
Liraglutide (Victoza)-SQ
What are the Rapid/Immediate-Acting insulin drugs (onset of 10-30 mins-for meals)
There are 3
Aspart (NovoLog)
Glulisine (Apidra)
Lispro (Humalog)
What drug is short-acting insulin (onset of 30-60 min-for meals)
There is 1
Regular Insulin (Humulin R, Novolin R)
Which drug is intermediate-acting insulin (12-18 hours, potential for hypoglycemia at 4-12 hours)
There is 1
NPH (Humulin N, Novolin N)
What are the long-acting insulin drugs (Duration 16-24 hours, no defined peak, low risk of hypoglycemia)
There are three
Degludec (Tresiba)
Detemir (Levemir)
Glargine (Basaglar, Lantus, Toujeo)
What are the combination insulin drugs? (Short or rapid mixed with intermediate acting (usually 2x daily)
There are two
Aspart protamine/Aspart 70/30 (NovoLog Mix 70/30)
NPH/Regular 70/30 (Humulin 70/30, Novolin 70/30)
Remeber at least brand names
What is the A1C goal for patients with diabetes?
Less than <7.0
Which drugs can impair insulin actions?
There are 3, think group and not specific medicayion
Corticosteriods
Certain Antihypertensives (thiazide diuretics, beta-blockers)
Certain Antipsychotic Medications
What are the clinical manifestations of DKA in regards to blood glucose, pH, and HCO3?
Blood Glucose: 250+
pH: <7.30
HCO3: <16
What are clinical manifestations of DKA?
There are four, two important ones
Dehydration (dry mucous membranes, tachycardia, orthostatic hypotension)
FRUITY BREATH
Kussmaul respirations (respiratory compensation)
Fruity breath, kussmaul
Which disorder is the “Rule of 15” for?
Hypoglycemia
Rule of 15: Ingest 15-20g fast-acting carbohydrates, Recheck glucose 15 min later - if <70, repeat above, Notify HCP if no improvement after 2-3 doses, Hospital setting - may use 50% dextrose IV or glucagon IM
What does the blood glucose have to be to have a clinical manifestation of hypoglycemia?
<70
What disease is characterized by extensive degeneration and destruction of liver cells?
Liver Cirrhosis and Failure
What is the liver tissue replaced with in liver cirrhois and failure?
Scar tissue (fibrosis)
What are clinical manifestations of liver cirrhosis or failure?
There are five
He’s staring at you, look at his eyes. She’s pulling down his nose to check the true skin down. He’s showing his belly. What’s that on their skin, it looks like an Arachnide
Jaundice (bilirubin buildup)
Edema and ascites
Liver enlargement
Hematologic problems (LIVER PATIENTS BLEED)
Skin lesions-spider angiomas
What is a complication of liver cirrhosis?
Portal hypertension
What are things that happen because of portal hypertension?
Portal hypertension is increased blood pressure in liver and surrounding structures. What happens to those surrounding structures?
Spleen enlargement
Enlargement of surrounding veins
Ascites
What is the main characteristic of hepatic encephalopathy?
Mental status changes
What is the main characteristic of hepatorenal syndrome?
Kidney failure
What is the gold standard of liver cirrhosis and failure diagnosis?
Liver biopsy
What is management for ascites?
There are two
Ascites is fluid in third spacing, think what you would do to help that.
Sodium restriction (2g/day)
Diuretics (Spironolactone, Furosemide)
What are the managements for varices and bleeding?
There are two
Avoid NSAIDs (ibuprofen, aspirin)
Avoid high risk bleeding procedures
What is management for treating portal hypertension?
There are 2
Beta-Blockers
Vasopressin
What drug is used to prevent hepatic encephalopathy during liver cirrhosis?
Lactulose: Decreases ammonia by trapping ammonia in gut with lacative effect to expel from body
What are health risks associated with obesity?
There are two named
Type 2 Diabetes-High insulin and insulin resistance
Metabolic Syndrome
What is the BMI scale for overwieght and obese?
25-29.9: Overweight
30+: Obese
(T/F) When asking/doing history or exam for obesity, be non-judgmental, sensitive, and use leading questions
True
Duh
Metabolic syndrome characterized by insulin __ realted to ___ visceral fat
Fill in the blank
Resistance
Excess
The anteripr pituitary gland makes which hormone?
TSH (Thyroid stimulating horomone)
In response to TSH, the thyroid makes what two hormones?
T3 and T4
What is Goiter? Is it a symptom or a disease with thyroid gland problems?
Throat
Enlarged thyroid gland; Symptom
What is thyroiditis?
Think what -itis means
Inflammation of thyroid gland
What can cause thyroiditis?
Hashimoto thyroiditis (Chronic autoimmune)
In Autoimmune Hashimoto, T3 and T4 levels are _ and TSH levels is _
Fill in the blank
Low; High
What group of drugs can help manage acute thyroiditis?
Antiinflammatories (NSAIDs, Corticosteriods)
What can cause hyperthyroidisim?
There are 3
Graves disease (autoimmune disease)
Excess iodine
Thyroid cancer
Hyoerthyroidism is characterized by _ TSH levels and _ T3 and T4 levels
Fill in the blank
Low
High
What are clinical manifestations of hyperthyroidism?
Think speeding up
There are five; It’s so hot, HES LOOKING AT YOU, Pregnant women are big in stomach but not supposed to be big where
Goiter
Exophthalmos (eye bulging)
Increased appetite, weight loss
High BP, High HR
Heat intolerance
What is a life-threatening complication of hyperthyroidism?
Acute Thyrotoxicosis (thyroid Storm)
Severe tachycardia, heart failure, shoc, high temp
What group of drugs are used to manage hyperthyroidism? What two drugs are in this category?
Antithyroids; Propylthiouracil (PTU)
Methimazole
What drug inhibits thyroid horomone synthesis and relase-often used before surgery? Name a drug in it.
Iodine; Saturated Solution of Potassium Iodine (SSKI)
Used for hyperthyroidism
Which drug class decreases heart rate, tremors, nerveousness? Name a drug in this class.
For hyperthyroidism
Beta-Adrenergic Blockers; Propranolol
Think Adrenergic, ADRENaline, adrenaline makes you go fast, it’s opposite of that
What radiaction therapy can be used for hyperthyroidism?
It was in another drug class
Radioactive Iodine Therapy (RAI)
Teaching point is radiation exposure to others
What are the primary and secondary causes of hypothyroidism?
Primary: Thyroid problem
Secondary: Problem with the pituitary gland
What are clincial manifestations of hypothyroidism?
Think slowing down
There are five
Low appetite, weight gain
Faitgue (weakness, slow movements)
Dry skin, pallor
Cold intolerance
High cholesterol
(T/F) Hashimoto thyroiditis can cause hypothyroidism
True, think that if your immune system is having an exaggerated response and destroying thyroid cells, eventually you will have a deficiency in the thyroid horomone
Hypothyroidism is characterized by _ TSH levels and _ T3 and T4 levels
High
Low
What are diagnostic tests for hypothyroidism?
There are three, think of the symptoms and put it to tests
TSH, free T3 and T4
Antithyroid Antibodies (for Hashimoto thyroiditis)
Cholesterol levels
What is a complication of Hypothyroidism?
Myxedema Coma
Medical emergency, impaired conciousness or coma, Low temp, low BP, low respirations
What drug is used to manage hypothyroidism?
Levothyroxine (synthroid): Synthetic T4
Teaching points: Started low and slow, taken 30-60 min before food or other meds on an empty stomach (usuallu early morning)
What is hyperparathyoridism characterized by?
Hypercalcemia: Fatigue, weakness, osteroporosis, kidney stones, cardiac changes
What drugs are used to manage hyperparathyroidism?
There are two
Loop diuretics (Furosemide)-Encourages fluid and calcium loss
Bisphosphonates (Alendronate): Encourage calcium to go back into bone
What is the clinical manifestation of hypothyroidism?
Hypocalcemia: Tetany, spasms, anxiety
Acromegaly is the overproduction of growth hormone by the _ due to benign tumor
Anterior Pituitary gland
Cushing Syndrome is characterized by _ cortisol levels
Fill in the blank
High
Cushing synfrome is caused by medications or tumors that secrete what hormone?
Which gland makes corticosteriods?
ACTH (Adrenal cortex stimulating hormone)
Addison’s Disease is characterized by _ cortisol levels
Fill in the blank
Low
(T/F) Addison’s Disease is mostly autoimmune
True, antibodies against adrenal cortex causing low function of adrenal cortex and decreased corticosteriods
Does Addison’s Disease have early or late symptoms? What are they
There is six, I’ll take knowing two important ones
Late; Hyperpigmentation, fatigue, weight loss, anorexia, nausea, weakness
