Hormonal Regulation Flashcards by Isabella Diaz

Where is insulin secreted from?

The pancreas

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(T/F) Insulin stops glucose creation in the liver

True

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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.

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Which Diabetes type is a combo of inadequate insulin secretion and insulin resistance?

Type 2

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Which Diabetes type is autoimmune?

Type 1

Insulin making cells in the pancreas (islet cells) are destroyed

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Which Diabetes type has fast onset and characterized by the three P’s?

Type 1

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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))

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(T/F) Type 1 Diabetes will need outside insulin (exogenous insulin) for life

True

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(T/F) Type 2 Diabetics can still make their own insulins

True

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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

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What is the gold standard for diabetes diagnosis?

A1C of 6.5% or higher

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What do we want diabetics A1C to be?

Less than 7.0%

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(T/F) Biguanides is a non-insulin drug

True, only for Type 2 DM

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What is the mechanism of action for biguanides?

Increase insulin sensitivity, reduce glucose production in the liver

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What is a drug in the Biguanides class?

You need to know this, it’s a highlighted drug

Begins with M

Metformin

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What are the education points for Metformin?

There are two

GI side effects
Must be held 48 hrs before and after IV contrast

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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

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What is a drug in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists?

Highlighted drug

Liraglutide (Victoza)-SQ

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What are the Rapid/Immediate-Acting insulin drugs (onset of 10-30 mins-for meals)

There are 3

Aspart (NovoLog)
Glulisine (Apidra)
Lispro (Humalog)

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What drug is short-acting insulin (onset of 30-60 min-for meals)

There is 1

Regular Insulin (Humulin R, Novolin R)

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Which drug is intermediate-acting insulin (12-18 hours, potential for hypoglycemia at 4-12 hours)

There is 1

NPH (Humulin N, Novolin N)

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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)

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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

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What is the A1C goal for patients with diabetes?

Less than <7.0

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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 ## Footnote 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 ## Footnote 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? ## Footnote 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 ## Footnote 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 ## Footnote 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) ## Footnote 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. ## Footnote For hyperthyroidism

Beta-Adrenergic Blockers; Propranolol ## Footnote 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) ## Footnote 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 ## Footnote 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 ## Footnote Medical emergency, impaired conciousness or coma, Low temp, low BP, low respirations

What drug is used to manage hypothyroidism?

Levothyroxine (synthroid): Synthetic T4 ## Footnote 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