Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PC612 Module 9 Endocrine > Module 9 Endocrine-PC612 > Flashcards

Module 9 Endocrine-PC612 Flashcards

1
Q

Blood Pressure in a Diabetic

A

Should be 130/80 or under

If renal damage 125/75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

First generation sulfonylureas

A

Orinase, Diabinese, Tolinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2nd generation sulfonyluureas

A

glyburide, micronized, Amaryl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sulfonylureas

A

Stimulate pancreas insulin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sulfonylureas-not a contraindication if allergic to sulfa drugs!!

A

SE: hypoglycemia, weight gain, increased risk of cv

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

First Line-Biguanide

A

Metformin

  • decreases hepatic glucose output/slow release from liver
  • increases insulin sensitivity
  • decreases LDL and triglycerides
  • decreases C-reactive protein
  • causes weight loss or stabilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Metformin

A 
No risk for hypoglycemia
causes nausea, cramps and diarrhea
TAKE WITH MEALS
-metallic taste in mouth
-lactic acidosis (rare)
-don't take is liver disease or renal impairment or if over 80 yrs of age
-Can interfere with folate & vitamin B-12 absorption causing megaloblastic anemia over time
Start at lower dose and then increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Thiazolidinediones (Glitazones)

A

Increase muscle uptake of glucose, decrease FFA, incrase HDLs, decrease triglycerides
SE: may cause weight gain, and edema, may increase LFTs, decrease C-reactive protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Thiazolidinediones (Glitazones)

A

Actos and Avandia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Meglitinides/Nateglinide

A

Increase pancreatic insulin release & act immendiately in response to fodd, short acting, take before meals,
SE: weight gain, and hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Meglitinides

A

Prandin and Starlix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Alpha-Glucose Inhibitors

Precose and Glyset

A

Decreases breakdown & absorption of CHO in the small intestine.
SE: cause flatulence, increase in LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DPP-4 inhibitors

Januvia

A

affect incretin system, which in turn controls blood sugar by affecting alpha and beta cells. Works only when bs is elevated.
SE: seem to free of major side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GLP-1 Agonists?incretin mimetic

Byetta or Bydureon

A

Stimulates GLP receptors which increase insulin in response to high bs levels
inhibit postprandial glucagon release
Slows gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hep B vaccine

A

is a new recommendation for diabetics to receive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Recommend ASA therapy to

A

75-162 mg in type ! or II diabetics with CV risks.
Men>50 and women >60 who have at least one additional risk factor
smoking
HTN, CVD, FH of CVD
Do not recommend for CVD prevention in adults with low CVD risk ie: men <60 with no major additional risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diabetes in pregnancy

A

insulin is the drug of choice

Should be monitored 6-7 times per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Intensive Insulin therapy

A

risk of causing hypoglycemia
Beta blockers can delay awareness of hypoglycemic by masking hypoglycemic induced signs that caused by activation of the sympathetic nervous system
(tachycardia, palpitations) Beta blockers inhibit the breakdown of hepatic glycogen to glucose, with otherwise would help restore or normalize bg levels if hypo should occur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diabetes in the elderly

A

Check Creatinine levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rapid-acting insulin

A

covers insulin needs for meals eaten at the same time as the injection. This type of insulin is used with longer-acting insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Short-acting

A

short acting covers insulin needs for meals eaten within 30-60 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Intermediate -Acting

A

Insulin covers needs for about half the day or overnight. Often combined with rapid or short acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pre-mixed

A

Ususally taken twice a day before mealtime.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Osteoporosis

A

DEXA scan is best
For all women over 65
Any adult over 50 with a fracture
Younger if medical problems associated with bone loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Osteoporosis

A

risk factors
female, older age, asian or white, petite family hx, low body weight, eraly menopause without HRT
low calcium intake, smoker, amenorrhea, low testosterone in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Calcium supplements

A

Post-menopausal women
1200-1500 per day
Better in divided doses
avoid taking with high fiber meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Calcium carbonate

A

Tums are most common. Absorbed best when taken with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Calcium Citrate

A

Citrical

absorbed when stomach ph is higher, as with older adults. can be taken anytime

29
Q

Also 800-1000 mg of Vitamin D3 is recommended

A

Purpose of calcium is to decrease fractures

30
Q

Drugs for Osteoporosis

A

Decrease bone resorption & called resorption inhibiting drugs

31
Q

Meds for Osteoporosis

A
  1. Biphosphonates
  2. Estrogens
  3. Calcitonin
    $ Selective estrogen receptor modulators (SERMs)
    Hormone modifiers
32
Q

Biphosphonates

A

Alendronate (Fosamax) taken daily or once/week
SE: upset stomach, GERD, abdominal pain
calcium supplements and mag antacids prevent absorption. Take at different times

33
Q

Biphosphonates

A

Riseronate (Actonal) taken daily or once/week

SE: arthralgia, GI, HA, leg cramps, abdominal pain, bone pain)

34
Q

Both Biphophonates cause

A

GI problems. Must remain upright for 30 minutes after taking and should swallow whole and taken with 8 oz of water before eating or drinking at least 30 minutes

35
Q

Boniva

A

po taken daily or once/month
Can be given in a IV bolus 15-30 sec every 3 months
Reclast taken once a year IV or 15 minutes
BOTH are contraindicated in esophageal abnormalities, inability to sit upright for 30 min, hypoglycemia and a creatinine clearnace ,30

36
Q

Al Biphosphonates

A

have the ability to cause osteonecrosis of the jaw and therefore patients taking them should avoid dental implants, tooth extractions, and dental surgery.

37
Q

SERMs and Hormone modifiers

A

Evista
Decrease bone resorption, lower total cholesterol and LDL
-may cause hot flashes and leg cramps
DC 72 hours before surgery with prolonged immobilization
Hormone modifier (Forteo) only med that increases bone formation
-may cause hypercalcemia, dizziness, leg cramps, et.
Used in women with high risk of fracture who have failed with other therapies

38
Q

Calcitonin

A

inhibits action of osteoclasts. Not effective in early post menopausal women
-decreases risk of vertebral compression fxs
has analgesic effect
injectable or nasal spray

39
Q

Hyperthyroidism

A

Graves-
May be caused by thyroid stimulating antibodies directed against receptors on the surface of the thyroid cell
May be due to TSH secreting tumors
Results in hypermetabolic state: tremor, tachycardia, and heat intolerance. May have exopthalmos and pretibila edema

40
Q

Hyperthyroidism Tx

Benefits of PTU may take 6-12 months

A

Surgical ablation of the thyroid tissue or antithyroid medications
PTU-Propylthiouracil blocks thyroid stimulating hormone synthesis. Methimazole has a simialr mechanism of PTU. ANP may treat with Inderal to help with symptoms of tachycardia and anxiety

41
Q

PTU is preferred in pregnancy even though Category D

A

Highly protein bound, so less transfer to the fetus.

42
Q

PTU and Methimazole

A

both safe for breastfeeding. PTU is the safer of the two.

43
Q

Hypothyroidism

A

hypometabolic state; lethargy, fatigue, weight gain, skin changes, sensitivity to cold, weight gain. Treat with Synthroid

44
Q

Synthroid (Levothyroxine)-
Take on empty stomach 30 minutes before meal.
Calcium or iron seperate by two hours.

A 
Treatment is usually lifelong
Patients may not notice a difference for a week or more. 6-8 weeks to reach a steady state
Absorbed in the GI tract
Monitor serum TSH levels
test 6-8 weeks after initial therapy 
then at 6 months,
45
Q

Synthroid interactions

A

calcium reduces absorption
Cholestyramine reduces absorption
iron reduces absorption
Anticoagulants are enhanced
estrogen can reduce the availability of the Levothyroxine and the levothyroxine can increase metabolism of HRT and oral contraceptives
may decrease effects of oral hypoglycemeics
Some SSRIs and anticonvulsants increase metabolism of levothyroxine

46
Q

Hypothyroidism and pregnancy

A

Category A =Synthroid
First line in pregnancy
monitor TSH levels
Safe while breastfeeding

47
Q

Testosterone Deficiency

A

It can improve sexual, physical and increase energy
increase risk of prostate cancer
TD is considered primary if it is testicular in origin
Draw a LH level and a total testosterone in the morning after an overnight fast and values below normal 2 x are required for Dx

48
Q

TD

A

HDL decreases with therpay
Blood sugar may be lowered
Can cause sleep apnea, acne, etc.
Transdermal patches are preferred in older men due to convenience and reversible action

49
Q

TD

A

prostate cancer and breast cancer are absolute contraindications
TRT PSA levels quarterly for the first year then annually A DRE every 6 months TT every 3 months Hct >54% require discontinuation of the TRT

50
Q

Glucocorticoids

A

Used to suppress immune function such as in asthma, COPD, allergic reactions, sever pain, RA, IBD, which is unresponsive to first line therapy
Treat MS, and other autoimmune conditions
Mainstay for treatment of Lupus

51
Q

When used for prolonged periods of time

A 
Cause adrenal insufficiency
osteoporosis
risk for infection
muscle wasting
thinning of skin
electrolyte imbalance
glucose intolerance, and possible PUD
52
Q

Glucocorticoids

A

cause potassium loss and increase risk for Digoxin toxicity
Used with NSAIDS cause PUD
Taper to prevent adrenal problems
Take before 0900 to reduce burst released naturally by adrenal glands in the body.

53
Q

Glucocorticoids in Pregnancy

A

Betamethsone (most common)
Dexamethasone for women betwee 24-34 weeks gestation. Avoid use longer than two weeks in . When prednisolone is needed for PUPPS use short time only. Taper if discontinued.During breastfeeding, never use a topical around mipple. Weight the risk for others if breastfeeding. Prednisone is considered safe with breastfeeding. Use for a short time only

54
Q

Asthma

A

Albuterol is safe and considered 1st line. ICS is next. Systemic corticosteroids are contraindicated.

55
Q

RA and DMARDS

A

Used to prevent joint destruction

Ideally treatment is started within 3 mos of Dx

56
Q

Methotrexate (Rheumatrex)

A

first line and is a folic acid antagonist. It achieves 70-75% improvement in symptoms in 3 to 8 weeks. Contraindicated in breastfeeding and pregnant women
Also contraindicated for those with leukopenia

57
Q

Rheumatrex

A

SE: leukopenia, GI effects, oral ulcers, hepat and pulmonar toxicity

58
Q

Drugs that are preferred are

A

Sulfasalazine, hydroxychloroquine and leflunomide

59
Q

Newer DMARDs

A

from organic sources
The tumor necrosis factor inhibitors are Etanercept (enbrel), infliximab (Remicade) Humira and Simponie. These produce rapid results within dayts to weeks.

60
Q

Obesity

A

Screen over 6 and older and refer for conseling and behavioral interventions Grade B reccomendation

61
Q

Obesity is BMI over 30

A

21-24% children and adolescents are overweight
16-18% obese
BMI over 85th to 95th percentile need a discussion

62
Q

First line

A

lower calories and increase physical activity

63
Q

Two categories of medications

A

Studies show people gain weight right back after stopping the medications

64
Q

Sympathomimeticamines

A

mimic amphetamines
-Diethylproprion, Phentermine for short term use (addiction potential)
Phentermine & Topiramiate ER- combines stimulant with suprresant

65
Q

Lorcaserin (Belviq)

A

Seratonin 2C agonist that targets the stiety center of the brain. Modestly effective. coming out in 2013

66
Q

Orlistat (Alli)

A

induction of lipid maldigestion, Causes gas, opily spotting, fecal incontinence pain,
2. Patients taking this should take a multivitamine containg A, D,E,K and beta carotene 2 hours before or after orlistat or at bedtime.

67
Q

Bupropion

A

Byeta, Topamax, HCG, Thyroid hormone .

68
Q

Gastric bypass

A

still the most effective 30% weight reduction

Band is 20%

PC612 Module 9 Endocrine (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions