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PT 3 Endocrine, Diabetes Flashcards

1
Q

Give a simple summary of how hormones work

A

Hormones work like a “lock and key” - where they can only fit into specific “key holes” on cells to get them to do things

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2
Q

What are 5 functions of the endocrine system

A
  1. Reproductive and CNS development in fetus
  2. Stimulating growth and development during childhood and adolescence
  3. Sexual reproduction
  4. Maintaining homeostasis
  5. Responding to emergency demands
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3
Q

What four specific mechanisms control hormone secretion

A
  1. Negative feedback
  2. Positive feedback
  3. Nervous system control
  4. Rhythms
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4
Q

How does negative feedback work

A

Works like a thermostat. Cold air activates the thermostat, but if it’s warm, the thermostat won’t turn on. Low calcium levels will stimulate the parathyroid gland to release PTH, which will then tell your bones to increase blood calcium levels. Then the increase in calcium levels will stop anymore release of PTH.

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5
Q

How does positive feedback work

A

A hormone will keep secreting unless something stops it (think about oxytocin and babies - you keep releasing oxytocin until you have your baby)

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6
Q

How does the nervous system control hormones

A

The nervous system can release hormones when there is pain, fear, sexual excitement or other stresses (like releasing epinephrine when there is a threat)

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7
Q

How does rhythm control hormones

A

Think about the circadian rhythm (24 hour clock) you will have certain hormones that will release at certain times of the day based on this rhythm (cortisol rises early in the day, then declines in the evening)

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8
Q

What are 6 consequences from impaired hormonal regulation

A
  1. Alterations in growth and development
  2. Alterations in cognition
  3. Alterations in metabolism
  4. Changes in growth
  5. Altered adaptive responses
  6. Changes in reproduction
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9
Q

How can aging effect the endocrine system 5

A
  1. Decreased production and secretion of hormones
  2. Altered metabolism and biologic activity
  3. Decreased responsiveness of target tissue to hormones
  4. Changes in circadian rhythms
  5. Comorbid conditions and medications that change the body’s response
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10
Q

How is the hypothalamus important for hormones

A

It’s usually the hypothalamus that will stimulate or inhibit the production and release of hormones from the pituitary

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11
Q

What hormones are released by the anterior pituitary 6

A
  1. Adrenocorticotropic hormone (ACTH) (fosters growth of adrenal cortex and stimulates corticosteroid secretion)
  2. Gonadotropic hormones (follicle-stimulating hormone (FSH) and luteinizing hormone (LH)) - stimulates sex hormone secretion, reproductive organ growth, reproductive processes
  3. Growth hormone
  4. Melanocyte0stimulating hormone (MSH) - increases melanin to make our skin darker
  5. Thyroid-stimulating hormone (TSH)
  6. Prolactin - stimulates milk production
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12
Q

What hormones are secreted from the posterior pituitary 2

A
  1. ADH

2. Oxytocin

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13
Q

What hormones are released from the thyroid 3

A
  1. Calcitonin - reduces calcium and phosphorus levels
  2. Thyroxine (T4) - turns into T3
  3. Triiodothyronine (T3) - regulates metabolism
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14
Q

What hormone is released from your parathyroid

A
  1. parathyroid hormone (PTH) - increases calcium and phosphorus levels
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15
Q

What 2 hormones are released from the adrenal medulla

A

Epinephrine and norepinephrine - enhances and prolongs effects of sympathetic nervous system “fight or flight”

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16
Q

What 3 hormones are released from the adrenal cortex

A
  1. Androgens and estradiol - promotes growth spurts, sex characteristics and libido
  2. Glucocorticoids - Promotes metabolism, anti-inflammatory
  3. Mineralocorticoids (aldosterone) - retains salt, loses potassium = water balance
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17
Q

What 5 hormones are released from the pancreas

A
  1. Amylin - decreases gastric motility, makes you feel full
  2. Glucagon - stimulates glycogenolysis and gluconeogenesis
  3. Insulin
  4. Pancreatic polypeptide - helps with metabolism of absorbed nutrients
  5. Somatostatin - inhibits insulin and glucagon secretion
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18
Q

What is the purpose of ADH and how does it work

A

The purpose is to regulate fluid volume - when our fluid volume is low (hypovolemia) the hypothalamus will stimulate the release of ADH from the posterior pituitary, so we stop getting rid of so much fluid in our urine

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19
Q

What do thyroxine (T4) and triiodothyronine (T3) do

A

They affect our metabolic rate, caloric requirements, O2 consumption, carbohydrate and lipid metabolism, growth and development, brain function and more….

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20
Q

What is the purpose of calcitonin, which is stimulated by the thyroid

A

Control calcium levels

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21
Q

What are catecholamines, and why are they important

A

These are our epinephrine, norepinephrine and dopamine that are essential for our “fight or flight” response

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22
Q

What do corticosteroids do

A

Effect glucose metabolism, anti-inflammatory and help maintain fluid and electrolyte balance

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23
Q

What does cortisol do 3

A
  • Helps regulate blood glucose
  • Helps maintain vascular integrity and fluid volume
  • Decreases the inflammatory response
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24
Q

Why is aldosterone important

A

It helps maintain extracellular fluid volume by promoting the renal reabsorption of sodium and the excretion of potassium and hydrogen

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25
When can a patient have a goiter
If they have hypothyroidism or hyperthyroidism
26
What should you be careful of when inspecting to see if a patient has a goiter
To not push too hard on the thyroid gland, because you could cause the sudden release of thyroid hormone in a patient who already has hyperthyroidism
27
What are some diagnostics that we can run on a patient
- Imaging (look at the organ) - Labs - Biopsy
28
What are some primary prevention techniques to avoid a hormonal imbalance 8
- Education - Diet - Exercise - Weight control - Injury avoidance - Avoiding extreme temperatures - Stress management - Maintaining routine sleep and wake patterns
29
What is a hypophysectomy
Removes the pituitary gland
30
What is adrenalectomy
Remove the adrenal glands
31
What is a thyroidectomy
Remove the thyroid
32
What is a parathyroidectomy
Remove the parathyroid
33
What are 5 parathyroid/thyroid disorders that we will see
1. Thyrotoxicosis (hyperthyroidism) 2. Primary hypothyroidism 3. Congenital hypothyroidism 4. Hyperparathyroidism 5. Hypoparathyroidism
34
What are 6 pituitary disorders that you might see
1. Hypopituitarism 2. Gigantism 3. Acromegaly 4. Dwarfism 5. Diabetes insipidus 6. SIADH
35
What are 4 adrenal disorders that you might see
1. Cushing's syndrome (hypercortisolism) 2. Hyperaldosteronism 3. Adrenal insufficiency (Addison's disease) 4. Pheochromocytoma
36
Where are the adrenal glands located
On top of each kidney
37
Who controls the adrenal glands
The anterior pituitary
38
What can adrenal insufficiency lead to
Addison's disease
39
In Addison's disease, what three things are reduced
1. Mineralocorticoids (aldosterone) 2. Glucocorticoids (cortisol) 3. Androgens (testosterone) (you have low steroids)
40
What is the difference between primary and secondary adrenal insufficiency
In primary, there is an actual problem with the adrenal gland and you're unable to produce and secrete cortisol and aldosterone, whereas in secondary the problem is from the pituitary gland, where we are not getting enough stimulation (ACTH) from the pituitary (ACTH stimulates the adrenal gland to release cortisol and aldosterone)
41
What is Addison's disease usually caused from
An autoimmune disorder
42
What are some clinical manifestations of Addison's disease 9
1. Anorexia 2. Nausea 3. Progressive weakness 3. Fatigue 4. Weight loss 5. Increased ACTH causes bronze-colored skin (only in primary, not secondary) 6. Orthostatic hypotension 7. Irritability 8. Abdominal pain 9. Salt craving
43
What are 8 symptoms of an adrenal crisis
1. Profound fatigue 2. Dehydration 3. Vascular collapse (decreased BP) - this can lead to shock 4. Renal shut down 5. Hyponatremia 6. Hyperkalemia 7. Dehydration 8. Hypoglycemia
44
What can cause an adrenal (Addisonian) crisis 4
1. Stress (from an infection, surgery, psychologic distress) 2. Sudden withdrawal of corticosteroid hormone therapy 3. Adrenal surgery 4. Sudden pituitary gland destruction
45
Should we be worried if someone goes into an Addisonian crisis
Yes - it can be a life-threatening emergency
46
What diagnostic tests can you do for someone with Addison's disease
1. ACTH stimulation (injected with ACTH, little to no increase in cortisol levels and a high ACTH = Addison's disease) 2. CRH test if ACTH comes back abnormal (given CRH, high ACTH levels and no cortisol = Addison's disease, no ACTH = secondary adrenal insufficiency)
47
When someone is having an Addisonian crisis, what can we do
- Correct fluid and electrolyte imbalances - Give fluids - Get daily wts, Is and Os - Note any drugs that interact with corticosteroids - Watch for signs of cushing syndrome - Protect against extremes (we want to watch for things that can trigger stress) (light, noise, temp) - Give high-dose hydrocortisone
48
How can we manage Addison's desease
- Lifelong glucocorticoid replacement (hydrocortisone) (two thirds in morning, rest at night) - Instead of glucocorticoid replacement, they may take mineralocorticoid (fludrocortisone) instead (once in the morning) - Increase salt in diet - Increase dose during times of stress - Teach patient signs and symptoms of corticosteroid deficiency and excess - Wear med alert bracelet - Diet high in protein and carbs
49
What is serious to report to your HCP if you have Addison's disease
Diarrhea or vomiting, because you will probably need electrolyte replacement right away
50
Why do we need to limit stress with Addison's disease
Because the patient cannot make corticosteroids (cortisol), which helps a person respond to stress
51
Basically what is it called if you don't have enough cortisol
Addison's disease
52
What is it called if you have too much cortisol
Cushing's syndrome
53
How do we treat Addisonian crisis
- High-dose hydrocortisone | - Large volumes of 0.9% saline and 5% dextrose (to help restore electrolyte imbalance and BP
54
Corticosteroids are good to treat a lot of diseases, however, they can often lead to many side effects, what are some of these side effects 7
1. Slow wound healing 2. Increase for infection 3. Hypokalemia 4. Hypertension 5. Suppressed inflammatory response 6. Hypocalcemia (can lead to osteoporosis) 7. Glucose intolerance (monitor sugars - this drug can cause hyperglycemia)
55
Should you ever abruptly stop taking your corticosteroids
No - this can lead to Addisonian crisis and death
56
What is it called when you have too much corticosteroids, particularly glucocorticoids
Cushing syndrome
57
What is the typical cause of cushing's syndrome
An ACTH secreting pituitary adenoma (growth or tumor on the pituitary) (cushing disease)
58
What are some other causes of cushing's syndrome 3
- Administration of corticosteroids - Adrenal tumors - ACTH secretion by tumors in the lung or pancreas
59
What is weird about cancer and hormones
Cancer can actually secrete their own hormones, so they can mimic cortisol for example, which causes your body to continually make this hormone even when it is not needed
60
What are clinical manifestations of cushing's syndrome
- Weight gain (fat in the trunk, face ("moon face") and back ("buffalo hump") - Hyperglycemia - Weakness - Osteoporosis - Back pain - Skin becomes weaker, thinner and more easily bruised - Purplish red striae (stretch marks on abdomen, breast and buttock) - Women can get male characteristics, acne, hirsutism - Males (gynecomastia) - women breasts - Hypokalemia - Hypernatremia - High blood pressure - Red cheeks - Thin arms and legs
61
What are the 3 ways we begin to diagnosis cushing's syndrome
By confirming increased cortisol levels 1. Midnight or late night salivary cortisol 2. Low-dose dexamethasone suppresion test 3. 24 hour urine cortisol (higher than 100mcg/24hrs indicates cushing disease)
62
What would high or normal or low ACTH levels indicate
Cushing disease
63
What would low or undetectable ACTH levels indicate
Adrenal or medication cause
64
How would you use imaging to determine cushing's syndrome
Use CT or MRI to detect a pituitary or adrenal tumor
65
What is seen in ectopic (abnormal place) ACTH syndrome and adrenal cancer
Hypokalemia and alkalosis
66
How do we normally treat cushing's syndrome
We try to remove the tumor
67
What is lung or pancreas cancer called when they are secreting ACTH and causing cushing syndrome
We call them Ectopic ACTH secreting tumors
68
If a patient is a poor surgical candidate, then how do we treat
Medication, we want to suppress the secretion of cortisol from the adrenal gland. We can use ketoconazole or mitotane.
69
What if cushing syndrome is caused by prolonged corticosteroid use
Then we gradually want to taper the patient off the medication
70
As nurses, what should we be monitoring for patients with cushing syndrome
- Monitor VS, daily wts, glucose - Assess for infection - Assess for inflammation because signs and symptoms may be minimal for absent - Monitor for thromboembolic events (chest pain, dyspnea, tachypnea) - Help patient deal with the physical changes of the disease (reassure them that physical changes will resolve with treatment)
71
Why do we want to watch for blood clots with cushing syndrome
Because hypercoagulant ability has increased
72
What should be done preoperatively before surgery
- Control hypertension and hyperglycemia - Correct hypokalemia with diet and potassium - Increase protein in diet
73
What are some risks during surgery
- Because the adrenal glands are very vascular, there is a high risk of hemorrhage - When you cut into the gland, you can release all of the hormones into the body, which could cause the patient to go into crisis (unstable BP, fluid and electrolyte imbalances)
74
What do you want to monitor after surgery
- Is, Os, vital signs and wts. | - Monitor for acute adrenal insufficiency (vomiting, weakness, dehydration and hypotension)
75
What patient teaching do we provide for someone with cushing's syndrome
- Wear medical bracelet - Avoid exposure to extreme temperatures, infection and stress - Teach how to adjust medication and when to call the HCP (they'll be on corticosteroid replacement therapy) - You will be on lifetime replacement therapy (if they had a gland removed)
76
What is pheochromocytoma
Tumor in the adrenal medulla that results in an excess production of catecholamines (epinephrine, norepinephrine)
77
What are signs of pheochromocytoma
Severe hypertension, tachycardia, palpitations, headache, profuse sweating, unexplained chest pain (your fight or flight response is in overdrive)
78
What causes pheochromocytoma
- Direct pressure on the tumor - Stress - Drugs - Genetics
79
What is the most common test for pheochromocytoma
24 hour urine test
80
What are you looking for in a 24 hour urine test
95% increase in fractionated metanephrines (catecholamine metabolites), fractionated catecholamiens and creatinine
81
What should you never do with someone who has pheochromocytoma
Palpate their abdomen - this can cause the sudden release of catecholamines and severe hypertension
82
How can we treat pheochromocytoma
Surgically remove the tumor (it that's what causing it)
83
What do we use give to patients before surgery to help control their high blood pressure
Alpha and beta blockers
84
What is hyperaldosteronism known as
Conn's disease
85
What is Conn's disease and what does it cause in the body
It is excess aldosterone secretion, which causes sodium retention and potassium and hydrogen excretion
86
What are the hallmarks of Conn's disease
Hypertension with hypokalemic alkalosis (low potassium)
87
What are the clinical manifestations of Conn's disease
- The sodium retention causes hypernatremia, hypertension and headache - Edema doesn't occur, because the rate of sodium excretion also increases - Potassium wasting leads to hypokalemia (weakness, fatigue, dysrhythmias, glucose intolerance, metabolic alkalosis, tetany)
88
Due to the excess sodium, what do we really want to monitor
BP
89
How do we diagnosis Conn's disease
- Look at labs (aldosterone levels will be increased, as well as sodium, we will see a decrease in potassium and plasma renin) - CT/MRI to detect an adenoma (benign tumor) - If no tumor is not found, 18 hydroxycortisone level is measured overnight
90
How do we treat hyperaldosteronism
- Adrenalectomy to remove the adenoma
91
What will happen before surgery
- Given potassium sparing diuretics and antihypertensives (decrease sodium and save potassium) Spironoacton "actone" - Oral potassium supplements - Restricting sodium
92
What is the treatment for patients with bilateral adrenal hyperplasia
- Potassium sparing diuretics - Calcium channel blockers to control BP - Dexamethasone to decrease adrenal hyperplasia
93
What are we doing as nurses for someone with Conn's disease
- Monitoring fluid and electrolyte balance - Monitoring their BP frequently (at least every 4 hours) - Teach signs and symptoms of hypokalemia and hypernatremia
94
What is a severe form of hypothyroidism
Myxedema coma
95
What is a severe form of hyperthyroidism
Thyrotoxicosis
96
What does euthyroid mean
Having a normal functioning thyroid gland
97
What are signs and symptoms of hypothyroidism
- Hair loss - Tired - Dry skin - Constipation - Intolerance to cold - Facial and eyelid edema - Thick tongue (slow speech) - Brittle hair and nails - Menstrual issues - Bradycardia - Weight gain - Low temp
98
Who do we see diagnosed with hyperthyroidism more
Women ages 20-40
99
What happens in primary hypothyroidism
- Destruction of the thyroid gland (can be from an autoimmune disease (Hashimoto's), surgery, radiation, drugs that block production, iodine deficiency) - Defective hormone synthesis (genetic)
100
What happens in secondary hypothyroidism
Problem with hypothalamus or pituitary, where there is a decrease in TSH secretion
101
What is myxedma
From long-standing hypothyroidism, where there is an accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues (skin will look dull and puffy)
102
What is myxedma coma
Where a patient will lose consciousness from having such low thyroid. It can be caused by an infection, drugs, exposure to cold or trauma. We will see subnormal temperatures, hypotension, hypoventilation and cardiovascular collapse . Treat with IV thyroid hormone
103
What are the TSH levels for primary and secondary hypothyroidism
Primary has high TSH levels. | Secondary has low TSH levels.
104
What would the presence of thyroid antibodies suggest in hypothyroidism
That the hypothyroidism is an autoimmune origin
105
What are other abnormal lab findings for hypothyroidism
- Anemia - High cholesterol and triglycerides - Increased creatinine kinase
106
Why do we give lose doses of levo initially
Because we don't want to increase resting HR and BP
107
Who should we monitor closely on levo
People with CVD (cardiovascular disease), too high of a dose may cause angina and dysrhythmias
108
How long until levo takes effect
6-8 weeks
109
When do we increase doses of levo based on TSH levels
Every 4-6 weeks as needed
110
What are we assessing for patients on levo
- Chest pain - Weight loss - Nervousness - Tremors - Insomnia (Basically things putting them in a hyperthyroid state)
111
If you are a diabetic with hypothyroidism, what should you be checking daily and why
Your blood glucose, because levo will return you back to your normal state, which usually requires a higher insulin amount
112
Should you switch brands of levo
No
113
What are risk factors for hypothyroidism
- Being a female - White - Advancing age - Hx of autoimmune disease - Down's syndrome - Family history - Previous hyperthyroidism - Previous radiation - Treatment with iodine or antithyroid medication - Thyroid surgery
114
What are we monitoring closely for a patient in a myxedma coma
- Mechanical respiration support (Have intubation kit in the room next to the patient because their RR is going to be so slowwwww) - Cardiac monitoring - IV thyroid hormone replacement - Monitoring core temp
115
What is the number one cause of hyperthyroidism
Grave's disease
116
Besides grave's disease, what else can cause hyperthyroidism
- Toxic nodular goiter - Thyroiditis - Excess iodine intake - Pituitary tumors - Thyroid cancer
117
What is thyrotoxicosis
When you have high levels of T3 and/or T3 circulating (thyrotoxicosis and hyperthyroidism usually occur together)
118
For hyperthyroidism would you have high or low levels of TSH
Low levels (T3/T4 and TSH are always going to be opposite)
119
How would you define Grave's disease
Thyroid enlargement and excess thyroid secretion. Autoimmune disease
120
What can cause Grave's disease
- Lack of iodine - Smoking - Infection - Stressful life event
121
How does Grave's disease work
It creates antibodies to the TSH receptor, where they bind to the receptors and stimulate the release of T3 and/or T4
122
What is bad about Grave's disease
It can actually destroy the thyroid gland
123
What are some signs and symptoms of hyperthyroidism
- Exophthalmos (protrusion of the eyeballs) - Tachycardia - Heat intolerance - Enlarged thyroid - Weight loss - Diarrhea - Finger clubbing - Increased appetite - Insomnia - Tremors - Irritable
124
What is thyrotoxicosis also known as
Thyroid storm or thyrotoxic crisis
125
What is happening in acute thyrotoxicosis
There are excess amounts of thyroid hormones being released into circulation
126
What usually causes thyrotoxicosis
Usually brought on by a stressor (infection, life-event, trauma, surgery)
127
What are the signs and symptoms of thyrotoxicosis
Hyperthyroid symptoms magnified - Tachycardia - Heart failure - Elevated temp (as high as 106) - Seizures - Abdominal pain - Vomiting - Diarrhea - Delirium - Coma - Agitation and confusion (usually the number one early indicator of thyrotoxicosis)
128
How can we test for hyperthyroidism
- Look for decreased TSH levels - Increased FT 4 levels (free thyroxine) - RAIU test to determine Grave's disease (see how much iodine collects in the thyroid - Grave's disease will have a higher uptake) - Scan the thyroid
129
How can we treat hyperthyroidism
- Medications (antithyroid meds (methimazole, PTU (report fever/sore throat), SSKI, Beta Blockers, iodine, and Beta blockers) - Radioactive iodine therapy - Surgery
130
What antithyroid meds can we give
- Propylthiouracil (PTU) | - Methimazole (Tapazole)
131
What do these drugs do
Inhibit the synthesis of thyroid hormones
132
What drug works faster
PTU
133
However, what is the downside to PTU
You have to take it 3 times per day, where as you only need to take methimazole once daily
134
When will you see results for these drugs
4-8 weeks
135
Do you need to be on these drugs for life
No - you can stop taking them after your thyroid levels off
136
What do we give iodine for
Treatment of thyrotoxicosis (thyroid storm) or preparing the patient for a thyroidectomy
137
Is iodine good for long term
No - it's therapeutic effect decreases over time
138
What are beta blockers good for
They are good to help decrease the systems like high HR, nervousness, irritability and tremors
139
What is the treatment of choice for most nonpregnant adults
Radioactive iodine therapy RAI
140
How does RAI work
RAI destroys the thyroid tissue, which limits the secretion of thyroid hormones. The effectiveness is usually not noticed until 3 months. Can cause a person to end up with hypothyroidism for life.
141
What is important to tell your patient receiving RAI
- To keep their distance from pregnant women and children for 7 days after therapy. - Use a private bathroom - Don't share food or drinks - Separate your laundry
142
What should we watch for post op after a thyroid surgery
- Monitor for hypothyroidism - Hypocalcemia - Hemorrhage - Laryngeal nerve damage - Thyrotoxicosis - Infection - Maintain a patent airway (semi-folwer position so you are not putting any tension on surgical site)
143
What should you monitor for someone with thyroid storm in the ICU
- Dysrhythmias - Ensure adequate oxygen (airway may be obstructed due to the neck surgery) - Fluid and electrolyte replacement - Give tylenol for high temp - Cooling blankets - ROM exercises for eyes to keep things from getting stuck (may need to tape eyelids down) - Wear dark sunglasses
144
How can you treat exophthalmos
Restrict salt to help with the edema
145
What is some good discharge teaching for someone who had a thyroidectomy
- Monitor hormone balance periodically - Decrease caloric intake - Adequate but not excessive amounts of iodine intake (seafood once-twice per week should be enough, or using a normal amount of iodized salt) - Avoid high temp environments
146
What is thyroidits
Swelling or inflammation of the thyroid gland
147
After a thyroid surgery, will the gland regenerate
Yes, it will begin to make hormones again (don't take extra hormones in the meantime, because it will delay or prevent the regeneration of the normal functions)
148
What is hypoparathyroidism
When you have abnormally low PTH levels
149
What can low PTH levels lead to
Low calcium and high phosphorus
150
What does the parathyroid do
It regulates calcium and phosphorous
151
What can cause hypoparathyroidism
- Neck surgery that removed or damaged the parathyroid gland - Autoimmune disorder - Low magnesium (you need magnesium to produce PTH) - Radiation to the neck or face
152
What do the clinical manifestations of hypoparathyroidism look like
Basically what low calcium levels look like - Numbness/tingling around mouth - Stiff extremities - Tonic spasms - Lethargy - Anxiety - Personality changes - Tetany (spasms)
153
How do we treat hypoparathyroidism
- Treat acute complications like tetany, by maintaining normal calcium levels
154
What should we do if a person has acute tetany after surgery
- Give IV calcium (but give it slowly) - Use ECG to monitor heart when giving IV calcium due to risk of hypotension, dysrhythmias or cardiac arrest - Digoxin can make a patient vulnerable to issues
155
What else can you do if a patient is having acute neuromuscular symptoms associated with hypocalcemia
Have them rebreathe CO2 out of a bag (this can lower pH, which causes your body to increase calcium levels)
156
What is hyperparathyroidism
Where you have too much PTH
157
What is happening in primary hyperparathyroidism
There is a benign tumor (adenoma) in the parathyroid gland, which causes an increase in calcium levels.
158
How can we treat primary hyperparathyroidism
Usually treated by surgery
159
What is happening in secondary hyperparathyroidism
From a condition outside of the parathyroid gland that is causing hypocalcemia, which then causes the release of PTH to compensate. It can be from vitamin D deficiencies, malabsorption, kidney disease and hyperphosphatemia
160
How can we treat secondary
By fixing the underlying problem
161
What are the clinical manifestations of hyperparathyroidism
- Osteoporosis (your body is being told by PTH to make more calcium, so it is taking calcium from your bones) - Kidney stones (kidneys cannot reabsorb the excess calcium, so it makes stones) - Polyuria - Abdominal pain - Tiring easily - Weakness - Depression - Forgetfulness - Bone/joint pain - N/v - Anorexia
162
What are the main complications from hyperparathyroidism
- Osteoporosis, which increases your risk of fractures | - Kidney stones
163
What are two indications of hypocalcemia
Positive trousseau's | Chvostek's signs
164
What is a good way to remember hyperparathyroidism
Think Stones, Bones, Moans and Groans (you'll have kidney stones, prone to fractures and bone pain, you'll have abdominal moans (n, v, weight loss, constipation), psychic groans (irritability, confusion))
165
What is hypopituitarism
Decrease in one or more of the pituitary hormones
166
What two hormones are most impacted by hypopituitarism
GH and gonadotropins (LH, FSH)
167
What can cause hypopituitarism
Pituitary tumor or hypothalamus damage
168
What does hypopituitarism cause
Metabolic/sexual dysfunction
169
What are some manifestations of hypopituitarism
- Children with short stature - Issues with reproduction - Decrease in libido - Delayed puberty - ED - Excessive urination and thirst - Issues producing enough breast milk - Decrease in sperm - Decrease in pubic hair - decrease in facial hair - osteoporosis
170
What can be given to treat GH deficiency in adults
Somatropin (Genotropin, humatrope, Omnitrope) (recombinant human GH)
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What will growth hormone do
- Increase energy - Increase lean body mass - Provide a sense of well-being - Improve body image
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What are some side effects to GH
- Fluid retention - Swelling in hands and feet - Myalgia (muscle aches and pain) - Joint pain - Headache
173
What are the treatments for hypopituitarism
Surgery or radiation followed by lifelong hormone therapy
174
How is surgery done on the pituitary gland
They go through your nose hypophysectomy
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What is hyperpituitarism
Where you have too much hormones related to growth, reproduction and metabolism being excreted
176
What is the usual cause of hyperpituitarism
Usually a benign tumor
177
What is acromegaly
Caused by an overproduction of GH (form of hyperpituitarism)
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What are the manifestations of acromegaly
Things on and in your face keep growing (overgrowth of bones in hands, feet, face), tongue enlargement, deepening voice, sleep apnea, thick, leathery, oily skin with acne, vison changes, headaches , diabetes.
179
How can we diagnosis hyperpituitarism
- Look at insulin-like growth factor 1 (IGF-1) levels - Look at GH response to an oral glucose tolerance test (we will see a rise in both of these levels) - We can also look at a CT/MRI
180
What is the treatment of choice for hyperpituitarism
Surgery (hypophysectomy)
181
What happens in a transsphenoidal hypphysectomy
The entire pituitary gland is removed through the nose - patient will need lifelong replacement therapy of the thyroid hormone, sex hormone and glucocorticoids
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What is some good patient teaching for someone who just had a transsphenoidal hypophysectomy
- Rinse mouth with saline water - No tooth brushing until incision heals - Do not blow your nose - Breath through your mouth - Report asap any clear fluid or bright red fluid coming from the nose
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What if clear drainage from the wound tests positive for glucose and proteins
Notify the HCP right away for a possible CSF leak - there could be an open connection from the brain somewhere, which would be bad. Puts the patient at risk for meningitis.
184
What is diabetes insipidus
Decrease or absence in ADH
185
What are clinical manifestations of DI
- Polyuria - Nocturia - Polydipsia (excessive thirst) - Tachycardia - Hypernatremia - Hypotension
186
How can we diagnosis DI
- Low urine specific gravity (diluted urine) - Look at electrolytes - MRI of head
187
What are the patients at risk for with DI
Dehydration
188
What can be given to treat DI
- Desmopressin (DDAVP) (for central DI) - Vasopressin (these drugs work like ADH - so they will cause you to retain your fluids)
189
What else can help to treat DI
- Adequate hydration - Maintain fluid/electrolyte balance - Low sodium diet (helps decrease urine output)
190
What is syndrome of inappropriate antidiuretic hormone (SIADH)
Where there is an overproduction or release of ADH when it is not needed (causes you to retain water)
191
What can cause SIADH
Lung cancer
192
What are the manifestations of SIADH
- Low urine output - Increased thirst - Increased weight - Hypertension - Hyponatremia - Tachycardia
193
What are early symptoms of SIADH
- Increased thirst - Dyspnea on exertion - Irritability - Headache - Mild hyponatremia
194
What are late symptoms of SIADH
- Vomiting - Abdominal cramps - Muscle twitching - Cerebral edema - Severe hyponatremia
195
How can we diagnosis SIADH
- Low serum sodium | - High urine specific gravity (means it is very concentrated urine - because you're not peeing)
196
How can we treat SIADH
- Fluid restriction - IV hypertonic saline solution may be given for severe hyponatremia (give slowly) (you can cause permanent damage to nerve cells if given too quickly) - Electrolyte supplements - Seizure precautions - Keep HOB flat or no more than 10 degrees to enhance venous return and reduce the release of ADH - Diuretics may be administered to increase urine output
197
What do both DI and SIADH have in common
Both present as excessive thirst
198
What is cretinism
Severe deficiency in the thyroid hormone in newborns, which causes physical deformities and learning disabilities
199
What is hypoaldosteronism
Body doesn't produce enough aldosterone
200
What does this lead to
- Hyponatremia - Hyperkalemia - Metabolic acidosis
201
What can bromocriptine mesylate do
It can prevent the release of GH, which can help lower levels and treat acromegaly
202
What can prednisone be given for
It's a steroid, so it can be given to treat Addison's, where there are not enough steroids
203
What is a normal glucose range
74-106
204
What type of disorder is type 1
An autoimmune disorder
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What is type 1 known as
Juvenile diabetes or insulin-dependent diabetes mellitus
206
What happens in type 1 diabetes
Your body creates antibodies to destroy insulin and/or the B cells creating the insulin, resulting in not enough production of insulin
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What are the two causes of type 1 diabetes
- Related to human leukocyte antigens (HLAs) (you get a virus and the B cells are destroyed during that process) - Idiopathic diabetes - not related to autoimmunity (both are genetic)
208
When do we usually diagnosis someone with type 1
When they are close or are in actual ketoacidosis
209
What are the 3 classic signs of type 1
- Polydipsia (excessive thirst) - Polyuria - Polyphagia (excessive hunger)
210
Can type 1 be cured
No - you will require insulin for the rest of your life
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What is exogenous insulin
An outside source of insulin
212
What is type 2 known as
Adult-onset diabetes or non-insulin dependent diabetes mellitus (NIDDM)
213
What is endogenous insulin
Self-made insulin
214
What is happening in type 2
- There could be a problem with your insulin receptor, where the insulin receptor is blocked, which makes it difficult for insulin to attach to the receptor (insulin resistance) - The beta cells of your pancreas actually start to die out, because they are so overworked trying to make insulin - Then your glucose is going crazy trying to release insulin to compensate
215
Is there a genetic link with type 2
Yes, if you have a first degree relative, then you are 10x more likely to develop it
216
What are adipokines, and what do they have to do with type 2
Adipokines are secreted by adipose tissue, and are thought to play a role in chronic inflammation, which can cause insulin resistance
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What syndrome also increases your risk for type 2.
Metabolic syndrome (person has 3 of the following: increased glucose levels, abdominal obesity, high BP, high triglycerides, decreased levels of lipoproteins (HDLs)
218
What levels would indicate that someone has prediabetes
- Their impaired glucose tolerance (IGT) levels are 140-199 and their impaired fasting glucose (IFG) is 100-125. (You can have both, but just meeting one of the above will mean that you are prediabetic)
219
Why is prediabetes bad
Because people can go undiagnosed for 6 and a half years without any symptoms, yet there could already be long term damage to heart and blood vessels
220
Explain a little bit about gestational diabetes
- Older women, women who are obese, or they have a family history of GDM are at a higher risk - Sugars will return back to normal after birth, however, the woman is at a higher risk of developing type 2 later on
221
What medical conditions can cause type 2
- Cushing syndrome - Hyperthyroidism - Pancreatitis - Cystic fibrosis - Hemochromatosis - Parenteral nutrition
222
What drugs can cause type 2
- Corticosteroids (prednisone) - Thiazides - Phenytoin (dilantin) - Antipsychotics
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What are the 5 ways that we can diagnosis diabetes
1. An A1C of 6.5% or higher 2. Fasting plasma glucose (FPG) of over 126 3. A 2 hour plasma glucose level of 200 during an OGTT 4. Random glucose level above 200 5. Or by looking at the classic symptoms (polyuria, polydipsia, polyphagia)
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What is A1C looking at
How much glucose is attached to red blood cells (since RBC live for about 3 months, this helps us to determine how high glucose levels have been for the last 3 months)
225
What is a goal for diabetics to have their A1C level at
7%
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What insulin plan mimics our regular production of insulin
The basal-bolus plan
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How does the basal-bolus plan work
You are getting a long-acting insulin (basal) and a rapid or short acting insulin multiple times a day (bolus)
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Why is short-acting scarier than giving rapid
Because short-acting can have a longer duration, which can increase your risk of hypoglycemia
229
What is the only insulin that can be given via IV
Regular insulin
230
When checking glucose before giving insulin, where is our goal
Between 80-130
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What are the rapid acting insulins
lispro (Humalog) aspart (Novolog) glulisine (Apidra)
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What are the times for rapid acting
Onset: 10-30 min Peak 30min-3hr Duration 3-5hrs
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What are the short acting insulins
Regular (Humalin R, Novolin R)
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What are the times for short acting
Onset: 30-60min Peak: 2-5hr Duration: 5-8hr
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What are the intermediate insulins
NPH (Humalin N, Novolin N)
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What are the times for intermediate insulin
Onset: 1.5-4hr Peak: 4-12hr Duration 12-18hr
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What are the long acting insulins
glargine (Lantus) | detemir (Levemir)
238
What are the times for long acting insulin
Onset: 0.8-4hr Peak: none Duration 24hours
239
How long can pens and vials be left at room temperature
Up to 4 weeks
240
Can you put insulin in the freezer
NO
241
Is insulin given IM
No - it is given SQ
242
What should you do before injecting insulin
Gently roll the prefilled syringe between your palms 10-20 times to warm the insulin and resuspend the particles
243
Should you inject insulin in an area that you are going to exercise
No - this can be bad and lead to increased absorption
244
What insulin vial should you roll between your palms to mix the insulin
NPH - clear insulins do not need to be mixed
245
How far apart should you be from your last insulin injection
At least a half to one inch apart
246
How is insulin available
U100
247
What angle are insulin injections given
At a 90 degree angle, thin or muscular patients are at 45 degrees so you don't get into the muscle
248
Why are insulin pumps good
They can help keep better control on your glucose levels
249
Why are insulin pumps bad
- Infection at the insertion site - Increased risk for DKA if the insulin infusion is accidently disrupted - Cost
250
What is lipodystrophy and why does it happen
It is loss of subcutaneous fatty tissue - it is when you use the same injection site frequently
251
Could a person have an allergy to insulin
Yes
252
What is the Somogyi effect
A high dose of insulin is given at night, which causes a decline in blood glucose levels, which stimulates lipolysis, gluconeogenesis and glycogenolysis, which then causes rebound hyperglycemia
253
What are the counterregulatory hormones
- Glucagon - Epinephrine - GH - Cortisol (they respond when there is a low BS)
254
What is the dawn phenomenon
When two counterregulatory hormones (GH and cortisol) are excreted in increased amounts early in the morning, which can cause hyperglycemia
255
What is a good way to tell the Somogyi effect and the Dawn phenomenon apart
The dawn phenomenon happens naturally, where the Somogyi effect is from insulin dosage
256
How can we treat the Somogyi effect
Give a bedtime snack or reduce the amount of bedtime insulin given
257
How can we treat Dawn phenomenon
Change the insulin time or the amount given
258
What is Afrezza
An inhaled rapid acting insulin
259
What should I remember about inhaled insulin
- Usually used for type 1 | - Given with a long acting insulin
260
What are biguanides
Group of type 2 diabetic drugs that work by preventing the production of glucose in the liver, improving the body's sensitivity towards insulin and reducing the amount of sugar absorbed by the intestines
261
What is an example of a biguanide
Metformin
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How does Metformin work
It reduces the production of glucose by the liver and makes tissue more sensitive to insulin
263
What is our first line to treatment for type 2
Metformin
264
What drug can help prevent diabetes
Metformin
265
What is the biggest risk on Metformin
If Metformin is not discontinued prior to a scan, then the patient can be at risk for contrast-induced kidney injury
266
When can Metformin be continued
After 48 hours
267
How do sulfonylureas and meglitinides work
They increase insulin production
268
Can you take meglitinides if you are skipping a meal
No - you can cause hypoglycemia
269
How do alpha glucosidase inhibitors work
They decrease carbohydrate absorption "starch blockers"
270
What is important to remember about alpha glucosidase inhibitors
Should be taken with your first bite of a meal
271
How do Thiazolidinediones work
Improve insulin sensitivity "insulin sensitizers"
272
What are examples of Thiazolidinediones
Pioglitazone (Actos) and rosiglitazone (Avandia)
273
Why are Thiazolidinediones rarely used
Because they can have some pretty adverse effects like MIs and worsening HF.
274
What are examples of sulfonylureas
- Glimepiride (Amaryl) - Glipizide (Glucotrol) - Glyburide (DiaBeta, Glynase)
275
How do Dipeptidyl Peptidase-4 Inhibitors work
Increase insulin release, decrease glucagon secretion and decrease hepatic glucose production
276
What is scary about beta blockers
They can mask symptoms of hypoglycemia
277
What is scary about Thiazide and loop diuretics
They can worsen hyperglycemia by inducing potassium loss
278
How can weight loss help for type 2
It can make your body sensitive to insulin again (even losing 5-7% of body weight can improve sensitivity)
279
What is the carb goal
45-60 g of carbs per meal
280
What is important to remember about alcohol
Alcohol can actually stop the release of glucose from the liver, which can cause you to become hypoglycemic if you are not eating anything else (so eat some carbs with your alcohol if you are drinking)
281
How does carb counting work
One serving size of a carb is 15g.
282
How could I calculate my insulin based on how many carbs I ate
I U =15g | 2U = 25g
283
What is the diabetic exchange list
You can choose what foods you want to eat based on a prescribed list, and then see how much insulin you will need based off your selctions
284
What is the myplate portion recommendation
Using a 9inch plate, fill 1/2 your pate with nonstarchy veggies, 1/4 with startch, 1/4th with protein, 8oz glass of nonfat milk and small piece of fresh fruit
285
What do high glycemic index foods do
They increase increase glucose levels faster
286
How much exercise should you get a week
150 minutes (which is 30 minutes, 5 days a week)
287
How much resistance training should you be getting if you're type 2
Resistance training 3 times a week
288
What does exercise do
It decreases insulin resistance
289
For patients who use a drug that may cause hypoglycemia, what should they do
- Wait one hour after a meal to exercise OR - Have a 1-15g carb snack prior to exercising
290
When do you absolutely not want to exercise
If you are a type 1 and your glucose levels are over 250 and ketones are present (if no ketones, then you can exercise)
291
Exercise is good, but it can also be bad, explain
Exercise does cause stress, so it can also elevate your blood sugar and cause the release of counter regulatory hormones
292
For those who have multiple insulin injections or use pumps, how often should they be monitoring their glucose
4-8 times per day
293
How does continuous glucose monitoring (CGM) work
Sensor checks your glucose every 1-5 minutes, but it assess interstitial glucose, so it can lag about 5-10 minutes behind from blood glucose
294
What is the goal of a CGM
To increase the "time in range" which is 70-180
295
What are some other treatment options to treat diabetes
- Bariatric surgery (for type 2) - Pancreas transplant (type 1 - usually done in patients with end stage renal disease and they are going to have a kidney transplant) 3. Pancreatic islet cell transplant - extremely experimental
296
Why is it better to use the sides of your fingers to test than the pads
Fewer nerve endings on the side
297
Why should you inspect your feet every day?
Because diabetes can cause neuropathy, which can lead to nerve damage . Due to this loss of sensation diabetics are unable to feel if they have a foot injury (blister, cut), which can leave them susceptible to an infection, which can then cause osteomyelitis, and result in an amputation to keep the infection from spreading
298
When should you follow the rule of 15
When a patient's blood sugar drops below 70.
299
What is the rule of 15
Give them 15g of a simple (fast acting) carb, like 4-6 oz of juice or soda. Then recheck the sugar in 15 minutes. Try again up to 3 times. If the sugar is not rising than call the HCP, something else is wrong
300
What is good to remember about the rule of 15
Don't give a carb that contains fat, like candy bars, cookies, whole milk or ice cream. The fat in the foods will slow the absorption of the glucose and delay the response of the treatment.
301
What does hyperglycemia look like
- Polyuria - Polydipsia - Polyphagia - Hot, dry skin - Dry mouth (dehydration) - Fruity breath - Vison changes
302
What does hypoglycemia look like
- Cool, clammy skin - Sweating - Hangry - Palpitations - Fatigue - Confusion - Shaky
303
What can is a high blood glucose amount that can lead to diabetic ketoacidosis
180
304
What if blood glucose is over 240
Then check ketones, if they have ketones, then they are at risk for DKA
305
What is angiopathy
When hyperglycemia has damaged the blood vessels, which can lead to a risk of CVD and stroke (angiopathy is the leading cause of death related to diabetes)
306
What is macrovascular complications
Diseases of the medium-large size blood vessels in people with diabetes
307
What are microvascular complications
Thickening of the vessel membranes in the capillaries and arterioles in response to hyperglycemia
308
What can microvascular complications lead to
- Retinopathy - Neuropathy - Nephropathy
309
What is diabetes related retinopathy
Where microvascular damage occurs in the retina, the little blood vessels in the eyes become occluded and fluid can leak out and there can be swelling, this can lead to blind spots, and then eventually blindness
310
Basically, what is happening in neuropathy
Hyperglycemia has caused damage to the blood vessels and nerve, which can cause a person to lose sensation
311
What is nephropathy
A microvascular complication, where the small blood vessels leading to the glomeruli of the kidney become damaged. This is the leading cause of end stage renal disease.
312
What is acanthosis nigricans
A skin condition caused by insulin resistance, where there are darker patches of skin in the folds of your skin (back of neck, armpits, groin)
313
What is diabetes-related dermopathy
reddish brown, round skin lesions
314
What is DKA
Profound deficiency in insulin, most common in type 1, but can been seen in type 2
315
What is the blood sugar in DKA
Over 250
316
How would you characterize DKA
- Hyperglycemia - Ketosis - Acidosis - Dehydration
317
What can trigger DKA
- Illness - Infection - Inadequate insulin dosage - Undiagnosed type 1 - Neglect
318
What is happening in DKA
Since there is not enough glucose circulating in the body, the body compensates by breaking down fat , and ketones are an acidic by-product of fat metabolism , that can cause problems when there is an excessive amount in our blood
319
What is happening to the positive electrolytes
They are being excreted out to try to maintain electrical neutrality
320
What electrolytes become depleted
- Potassium, sodium, chloride, magnesium and phosphate
321
Due to the electrolyte excretion, what is now happening
You enter hypovolemia , which can lead to shock, renal failure, and eventually death
322
What will dehydration in DKA look like
- Dry mucous membranes - Tachycardia - Orthostatic hypotension
323
What will your breath be like
You will have Kussmaul breathing (rapid, deep breathing that smells sweet, or fruity due to the ketones) (your body is trying to blow off CO2)
324
What will your blood pH be at
Less than 7.2
325
How is DKA treated
Give IV electrolytes and insulin to correct changes
326
What is hyperosmolar hyperglycemic syndrome (HHS)
Your body is able to make enough insulin to keep you from going DKA, but it is not able to make enough to prevent severe hyperglycemia
327
What can cause HHS
- Infection
328
Who do we usually see with HHS
Older adults (over 60) with type 2
329
What is the BS in HHS
Over 600
330
Will there be any ketones
No - because your body is not needing to break down fat for energy, because some insulin is still being produced.
331
What are manifestations of HHS
Neurological (stupor, coma, seizures) - can often look like a stroke, so check sugars if you think someone is having a stroke
332
With someone who has HHS, should you decrease their sugars slow or fast
Slow - you don't want them to drop suddenly (if you drop too quickly you can cause cerebral edema)
333
Besides hyperglycemia, what do we see in both
Osmotic diuresis (HHS is more extreme) this means you're peeing a lot (additional water is coming into the urine)
334
Basically, how can we treat both DKA and HHS
- Restore fluid volume - Correct electrolyte imbalances - Correct ketones and acidosis - Correct glucose
335
What is a huge risk for all diabetics
Depression
336
What is latent autoimmune diabetes in adults (LADA)
Slowly progressing autoimmune form of type 1. It can often be mistaken for type 2.
337
What are some causes of type 2
- Excess calories from saturated fat - Excess weight, especially around the abdomen - Decreased activity level - Chronic stress and pain
338
What might indicate that you have prediabetes
- Fasting glucose between 100-125 | - A1C between 5.7-6.4
339
What is PCOS and what does it have to do with diabetes
PCOS is Polycystic Ovarian Syndrome - it can cause hormone imbalances and lead to insulin resistance
340
Why do we not like adipose tissue
Adipose tissue is not very responsive to insulin, and it can block insulin from doing its job. Adipose can even get inside and around your tissues, which can increase pressure on your organs, which then causes inflammation, which also leads to insulin resistance
341
Can you grow your beta cells back
No, with type 2, people lose about 50-80% of their beta cells, but they can go into remission with the ones they have left
342
What is the difference between type 1 and type 2
Type 2 is driven by insulin resistance, where type 1 is an autoimmune disease, where the body kills all of the beta cells, so there is just no insulin being made
343
What is one big symptom of type 1
We will see a lot of people lose weight, because their body starts to break down fat and muscle for energy, since it can't use glucose as an energy source
344
What 3 tests could you perform to diagnosis type 1
- Blood test - C-peptide test (measures how much insulin the body is making for you) - Antibody screening
345
How does gestational diabetes occur
Due to all of the crazy hormones a woman is producing during pregnancy, these extra hormones can knock insulin out of the way, which creates insulin resistance where the pancreas can't keep up
346
What risks can go up for gestational diabetes
- Increase the risk of high baby birth weight (uses mom's extra sugar to grow) - Increase the risk of the baby being born with low blood sugar (blood sugar can drop because they are use to being in mom's high sugar womb) - Increase the risk of the mom developing type 2 later on
347
Where should we store our test strips
In a cool, dry place
348
What should our fasting glucose be
80-130
349
What should our glocose be 2 hours after a meal
180
350
How often should we try to hit these goals
70% of the time
351
What are our startchy veggies
- Beans - Potatoes - Peas - Corn - Winter squash
352
What are some non-startchy veggies
- Broccoli - Onion - Lettuce - Carrots - Green beans - Mushrooms - Peppers - Zucchini - Tomatoes
353
How much does 10 minutes of exercise equal to insulin
10 minutes of exercise equals about 1 unit of insulin (so if you work out for 10 minutes, you can drop the amount of insulin you need by 1 unit)
354
If you have diabetes how likely are you to have a heart attack or stroke
2-4 times more likely to have a heart attack or stroke
355
Read this
Endothelia cells in arteries, will take in glucose, which will then also bring water into the area and cause swelling. This can cause damage to the endothelin . So then cholesterol sticks to areas of damage in those arteries, the damage was originally caused by the high glucose. This causes plaques to build up. Some of this plaque can build up and lead to clots. This can cause a heart attack or stroke.
356
Why is tobacco bad
It is a vasoconstrictor
357
How does this impact amputation
Plaque can build up in the arteries that supply your legs, so this is what causes slow wound healing
358
What happens in neuropathy
Capillaries supplying your nerves can become damage and die off, this then causes the nerve to die off without any blood supply = thus losing nerves and sensation
359
What is gastroparesis
Where your vagus nerve becomes damaged, so your sphincter won't release the food from your stomach. This can cause poor appetite, n, v.
360
What do sulfonylureas do
They tell your pancreas to make more insulin
361
What are the side effects of sulfonylureas
- Hypoglycemia - Possible weight gain - Sun sensitivity
362
How does Metformin work
- Decreases glucose produced by the liver - Increases the glucose that your muscles use - Decreases insulin resistance
363
What are the side effects of metformin
- GI upset - B12 deficiency - Lactic acidosis
364
How should you take metformin
Take with food to decrease GI upset
365
What might impact someone taking metform
- Kidney disease - Liver disease - Alcoholism - Heart disease
366
What should you never mix with Metformin
Contrast dyes for scans
367
What two things should I not forget when using an insulin pen
- Hold pen in place for 10 seconds when giving the injection - Don't forget to prime the pen
368
How long can insulin last once it has been opened
28 days at room temp
369
If someone has severe hypoglycemia and they are unable to swallow or talk, what are we giving them
Glucagon IM or D50 IV
370
What medications can cause HHNK
Steroids or diuretics
371
What is fascia
It holds muscles, nerves and blood vessels together (it does not have a lot of stretch - hint hint)
372
What are the 6 P's of your neurovascular assessment
1. Pain 2. Pulse 3. Pallor (color) 4. Paresthesia ("can you feel this") 5. Paralysis ("can you move this") 6. Pressure
373
What is the difference between active ROM and passive ROM
In active, you are moving the joint yourself. In passive, someone is moving the joint for you.
374
What is plantar flexion
Pointing the toes down
375
What is dorsi flexion
Pointing the toes up towards your shin
376
What is external rotation
Holding your elbow (for example) at 90 degrees and rotating it from side to side
377
What is eversion
Turning your sold outward away from the midline of your body
378
What is pronation
Turning your palm downward
379
What is supination
Turning your palm upward
380
What is a contracture
Shortening of a muscle
381
What is ankylosis
Stiffness and fixation of a joint
382
What is crepitation (crepitus)
Frequent, crackling sound when someone is moving (from their joints or a fracture)
383
What is kyphosis
Exaggerated thoracic curvature "looks like a hump"
384
What is lordosis (swayback)
Exaggerated lumbar curvature
385
What is the C-reactive protein (CRP) used to detect
Inflammation
386
What is the creatine kinase (CK) used to detect
Increased level means that there is a breakdown of muscle happening (released into blood when there is muscle damage)
387
What is given for bone scans
Radioisotope
388
What is the difference between an x-ray and a CT scan
A CT scan can show you a 3D picture (basically a more powerful x-ray)
389
What is an MRI looking at
Soft tissue using radio waves and a magnetic field
390
What is a dual energy x-ray absorptiometry (DEXA) looking at
Bone density
391
What is a myelogram
Uses contrast dye and injects at nerve roots to look for issues with the spinal cord
392
What is an arthrocentesis
Obtaining synovial fluid from a joint capsule to analyze for inflammation, infection or fractures
393
What is an arthroscopy
Inserting an arthroscope into a joint to look at the cavity
394
When would we see an increase in alkaline phosphate (Alkphos)
It's an enzyme made by osteoblasts, so we see an increase level when there are healing fractures, bone cancers, osteoporosis, osteomalacia and Paget's disease
395
Why do old people shrink
Loss of water from the discs between their vertebrae
396
What is a sprain
Injury to the ligaments surrounding a joint
397
What are the 3 levels of a sprain
1. First degree (mild) few fiber tears, mild swelling and tenderness 2. Second degree (moderate) partial disruption with more swelling and tenderness 3. Third degree (severe) complete tear of the ligament with moderate to severe swelling
398
What is a strain
Excessive stretching of a muscle often involving a tendon (classified as first degree (mild) up to third degree (severe))
399
How can we treat sprains and strains
RICE
400
When should you apply ice and when should you apply warmth
Ice for the first 24-48 hours. No more than 20-30 minutes at a time. Then after 48 hours you can apply warmth to reduce swelling. No more than 20-30 minutes at a time.
401
To prevent edema and encourage fluid return, where should you start wrapping your bandage
Start distally (furthest away from the body) then move up. Leave for 30 and take off for 15 min.
402
What is the difference between a dislocation and a subluxation
A dislocation is a complete displacement or separation, where a subluxation is only partial
403
What is important to remember about subluxations and dislocations
- You need to get the joint back in place asap, because it can cause vascular injury and increase the risk for avascular necrosis (cut off from blood supply)
404
After a joint has been put back in place, should you mobilize the joint right away
NO - keep joint immobile. There will be a rehab treatment to get the joint mobile again.
405
What is RSI
Repetitive strain injuries - injuries from repetitive movements
406
What is carpal tunnel syndrome
Compression of the median nerve, which enters the hand at the wrist through the narrow carpal tunnel
407
What are two signs of carpal tunnel syndrome
1. Tinel's sign - tapping over the median nerve over the wrist, will cause a sensation of tingling over the hand 2. Phalen's sign - Flexing the wrist for 60 seconds and feeling tingling
408
How can we treat carpal tunnel syndrome
1. Wear splints at night 2. PT 3. Corticosteroid injections 4. Carpal tunnel release surgery
409
What is a good way to diagnosis a rotator cuff injury
Drop arm test - arm is abducted at 90 degrees, and you slowly lower your arm to the side, if the arm falls suddenly, then a rotator cuff injury is suspected
410
What will the patient complain of in a meniscus injury
That the knee "clicks, pops, locks or give way"
411
What are the repetitive injuries
1. Repetitive strain injury 2. Carpal tunnel syndrome 3. Rotator cuff injury 4. Meniscus injury 5. ACL injury 6. Bursitis
412
What are the 3 types of tears to an ACL
1. Partial 2. Complete 3. Avulsion (tearing away from the bone)
413
What test do we do for ACL
Lachman's - Flex the knee, pull the tibia forward, feel soft or indistinct endpoints
414
What is bursitis
Inflammation of the bursa
415
What is usually the only treatment needed for bursitis
Rest
416
What is a transverse fracture
Straight across fracture
417
What is a linear fracture
Straight up and down fracture
418
What is an oblique fracture
A diagonal fracture
419
What is a spiral fracture
Just how it sounds
420
What is a greenstick fracture
An incomplete fracture, one side is splintered and the other side maybe splint (these happen in children because their bones are so pliable)
421
What is a comminuted fracture
A fracture with more than 2 fragments, the smaller fragments appear to be floating
422
Open vs closed fracture
Open - skin is broken and bone is exposed | Closed - Skin is intact
423
What is a complete vs incomplete fracture
Complete - break goes completely through the bone | Incomplete - only partial. Bone is still intact.
424
Displaced vs.nondisplaced
Displaced - the broken bones are separated and out of alignment from each other. Non-displaced - Bone fragments stay in alignment
425
What are the 6 stages of healing in fractures
1. Hematoma (blood to form clot) 2. Granulation tissue 3. Callus formation (building new bone) 4. Ossification 5. Consolidation 6. Remodeling
426
What is the difference between closed and open reduction
Closed reduction, nonsurgical manual realignment of the bone using traction. Open reduction - making a surgical incision and adding wires, screws, pins etc, to hold the bones in place.
427
What is traction used for
To maintain alignment (use weights)
428
Should weights ever be on the floor
No
429
What is Buck's traction
Keeps the leg in an extended position so you don't have hip flexion
430
When someone is in traction what do you want to do
- Check pressure points every 2-4 hours - Do your neuro checks - Assess pain - Look for denting or flatening of casts, because this can lead to skin breakdown
431
After a cast has been placed on a lower extremetiy, what do you want to do
Elevate above the heart for 24 hours
432
What are we always checking for after cast placement
Pressure to see if compartment syndrome is happening
433
What is a person at risk for if they have a body jacket brace
Superior mesenteric artery syndrome (cast syndrome) where if the brace is too tight, it may be compressing the superior mesenteric artery against the duodenum. If this is happening, the pt will complain of abdominal pain, pressure, n, v. Treat with gastric decompression
434
What can be used to help manage post op pain
Nerve catheters - they can go right to the site and provide local anesthesia for up to 3 days
435
Could you also use traction to expand space
Yes, you can use it to make space
436
Can traction help with muscle spasm
Yes - your muscles spasms because they're trying to hold things in place. You can reduce spasm if you have traction hold the bones in place instead
437
Can you bear weight on a cast right away
No - you need to wait 48 hours
438
What is happening in compartment syndrome
Swelling inside the fascia, which can put pressure on the nerves and blood vessels
439
What is one of the first signs of compartment syndrome
Drugs do not relieve the pain, and the pain is horrible
440
What are late signs of compartment syndrome
Pulseness and paralysis
441
Should you elevate an extremity when you suspect compartment syndrome
NO - this could cause further vasoconstriction
442
How might they treat compartment syndrome
A fasciotomy (surgical incission) or amputation
443
Since orthopedic patients are at high risk for VTE, what are they given
Prophylactic anticoagulats for 10-14 days. (warfarin, heparin)
444
What can also help prevent VTE
- Compression socks - SCDs - ROM
445
How do fat embolisms work
We see the in long bone fractures, where the fat globulus are released into the blood stream and work like a clot
446
What are signs of a fat embolism
Looks like respiratory distress - Low o2 - chest pain - cyanosis - tachypnea (rapid breathing)
447
How can we prevent fat embolism
Be super careful handling a fracture, you don't want to be rough and cause a fat globule to break off and head into the blood stream
448
How can we treat fat embolism
With oxygen and fluids
449
What is Rhabdomyolysis
Where muscle breaks down, which causes myoglobin to be realesed into the bloodstream. They can travel and obstruct your renal tubules
450
What do we look for Rhabdomyolysis
Reddish-brown urine
451
What two assessments should we do for someone with a fracture
- Peripheral vascular assessment (color, temp, cap refill, pulses, edema) - Peripheral neurologic assessment (sensation, motor function, pain)
452
What can we help give to reduce muscle spasms
Muscle relaxants
453
What is electrical bone growth stimulation
Provides low electrical current, which can help unify bones together
454
What is a Colle's fracture
Fracture in the distal radius
455
Why can pelvic fractures be life threatening
There is a big risk for hemorrhage (check for blood in the urine or stool), compartment syndrome, paralytic ileus, sepsis, VTE.
456
How long do fractures usually take to heal
- 6 weeks in adults - 4-5 weeks in kids - Up to 3 months in elderly
457
What if the patient has a hip fracture, but they are not stable enough yet for surgery, but they're having muscle spasms because of the injury
You can use Buck's traction for 24-48 hours to relieve the painful muscle spasms
458
What are the hip surgery percautions
- Do not flex more than 90 degrees, do not adduct across the midline (crossing ankles, knees), Do not internally rotate hip
459
How should a patient be placed after a mandibular fracture
On their side, with the head of the bed slightly elevated
460
What should be with the patient at all times after a mandibular fracture
WIRE CUTTERS (they should go everywhere with the patient)
461
What can help with phantom limb pain
Mirror therapy - looking in a mirror at the remaining limb can help trick your brain and relieve symptoms
462
What can we use to help diagnosis the need for an amputation
- WBC, wear we see an infection | - Doppler, arteriography, venography - where we can see poor circulation
463
Does phantom limb sensation happen right away
Yes usually, but then it will hopefully go away
464
What should you keep by you for emergencies, when a patient is trying on their new prosthesis
A tourniquet, incase excess bleeding occurs
465
When will the amputee wear the bandage
Aft first all of the time (except during PT and bathing), but as the limb heals, the bandage is only needed with the patient is not wearing the prosthesis.
466
What should you not do with your limb
Dangle over the edge of the bed - this can cause edema
467
What is an osteotomy
When you remove a wedge or slice of a bone to restore alignment and to shift weight bearing, which helps relieve pain
468
What is an arthroplasty
Reconstruction or replacement of a joint to relieve pain, improve or maintain ROM and correct deformity
469
What is a hip arthroplasty
A hip replacement
470
Can you put your own socks on after a hip replacement
NO
471
After a knee arthroplasty, how will the knee need to be
In extension, it the patient cannot maintain this extension, then they can use a knee immobilizer to maintain extension when ambulating and resting for 4 weeks
472
What is osteomyelitis
Severe infection of the bone, bone marrow and surrounding soft tissue
473
How can one get osteomyelitis
Indirect entry - coming from the blood into the bone (usually from one organism) Direct - coming from an open wound or implant (can be multiple organisms)
474
What is the area called when the dead bone separates from the live bone
A sequestra (this area can be difficult to treat and becomes a reservoir)
475
How long is acute osteomyelitis
1 month, and then it is considered chronic
476
What are local symptoms of osteomyelitis
- Constant bone pain unrelieved by rest - Worsens with activity - Swelling - Tenderness - Warmth - Restricted movement
477
What are systemic symptoms of osteomyelitis
- Fever - Night sweats - Chills - Restlessness - Nausea - Malaise - Drainage
478
Once is progresses to chronic osteomyelitis, what happens
It forms into scar tissues, which makes it even harder to treat with abx
479
How can we diagnosis osteomyelitis
- Bone or soft tissue biopsy is the definitive way
480
Can we see osteomyelitis on an x-ray in the first two weeks
NO
481
What is something cool with WBC and osteomyelitis
We can tag the WBC to see where they are going in to body, and they should lead us right to the source of the infection
482
What else will be elevated in osteomyelitis
ESR and CRP
483
If bone ischemia has not yet occurred in osteomyelitis, how can we treat
With long-term abx
484
What is a big thing to teach your patients with abx and osteomyelitis
To notify HCP of any adverse effects, like hearing deficit, impaired renal function, and neurotoxicity
485
What is referred pain
When you have pain that is not at the site of the injury
486
What are we watching for with scoliosis
Cardiopulmonary compromise (tachypnea, tachycardia, SOB, decrease O2)
487
What are the 3 categories of scoliosis
1. Neuromuscular (muscles can't support the spine - usually due to another disease) 2. Congenital 3. Idiopathic
488
When would we perform surgery for someone with scoliosis
When the Cobb's angle is greater than 50%
489
What is osteochondroma
Most common primary benign bone tumor
490
What is a sarcoma
A malignant tumor in the bone, muscle, fat, nerve or cartilage
491
What are malignant bone tumors called
Osteosarcoma
492
What do we see a lot of with osteosarcoma
Pathological fractures, where you bone just randomly breaks
493
What will we see a lot of released in the blood
Calcium due to the damaged bones releasing calcium
494
So what is one thing we need to treat with osteosarcoma
Hypercalcemia
495
What type of bone scan and detect metastatic lesions before an x-ray
Radionuclide
496
What is isometric contraction
Where your muscle is contracting, but your joint is not moving "like holding a weight at 90 degrees"
497
What is an isotonic contraction
Where your muscle is contracting and your joint is moving "like curls"
498
How can we diagnose MD
- Genetic testing (it is a genetic disease) - Muscle serum enzymes (creatine kinase - Eclectroymyogram - Muscle fiber biopsy
499
How can we treat MD
We can't stop it, but we can slow it down with corticosteroids
500
What is the goal of MD
Try to keep the patient as active as possible, because immobility can lead to further muscle breakdown
501
How can we treat low back pain
- Muscle relaxants - NSAIDs - Massage - Acupuncture - Hot/cold
502
How long is chronic back pain
Greater than 3 months
503
What are the types of pain associated with low back pain
1. Localized - patient feels the pain in a specific spot 2. Diffuse pain - goes over a larger area and comes from deeper tissue 3. Radicular - pain caused by irritation of a nerve root (radiates and moves) 4. Referred pain - pain is coming from a different source
504
Will we see acute low back pain right after injury
No, it usually takes 24 hours before symptoms to appear
505
What can cause chronic back pain
1. Degenerative conditions (arthritis, disc disease) 2. Osteoporosis or other bone disease 3. Weakness from the scar tissue of a prior injury 4. Chronic strain 5. Congenital spine problems
506
What is intervertebral disc disease
Deterioration, herniation or other dysfunction of the intervertebral discs.
507
What are some s+s of intervertebral disc disease
1. Low back pain 2. Radicular pain (pain that radiates from your back to your hip, then down your leg) 3. Depressed/absent reflexes 4. Numbness/tingling 5. Muscle weakness
508
With intervertebral disc diseases, what requires immediate medical attention
Cauda equina syndrome
509
What is Cauda equina syndrome
Where there is lumbar nerve root compression from a herniated disc, tumor or abscess in the lower back
510
What are the s+s of cauda equina syndrome
1. Severe lower back pain 2. Progressive weakness 3. Increased pain 4. Bowel and bladder incontinence or retention
511
Why is Cauda equina syndrome a medical emergency
People the pressure on the roots can cause permanent paralysis
512
What is degenerative disc disease (DDD)
Loss of fluid in the intervertebral discs with aging
513
What is a herniated disc
Slipped disc where the spinal disc bulges outward between the vertebrae
514
What is a diskogram
Imaging test to look at the discs of your back
515
How might you diagnosis an intervertebral disc disease
- X-ray - CT - MRI - Myelogram - Diskogram - EMG
516
What is osteomalacia caused by, and what is it
By a vitamin D deficiency, which causes your bones to lose calcium and become soft
517
What disease is just like osteomalacia, but for children
Ricketts - except the epiphyseal growth plate is still open in children
518
Is osteomalacia pretty common in the US
No - we provide foods with the added vitamin D
519
What would lab findings show for osteomalacia
- Decreased calcium or phosphorus - Decreased Vit D - Increased alkaline phosphate
520
What is important to remember about alkaline phosphate
We see an increased amount in bone disorders
521
What two types of x-rays can help us determine osteomalacia
- X-ray showing demineralization | - X-ray showing Looser's transformation zones where we can see ribbons of decalcification in the bone
522
How can we treat osteomalacia
Correct the Vitamin D deficiency, eat foods high in vitamin D (eggs, milk, cereal), get some sunlight
523
What are the 5 reasons that osteoporosis occurs in more women
1. Women tend to have a lower calcium intake than men 2. Women have less bone mass due to their smaller frames 3. Bone reabsorption begins at an earlier age and then really gets going at menopause 4. Pregnancy and breastfeeding depletes skeletal reserve of calcium 5. Women live longer
524
What can be a big cause of osteoporosis
Cigarette smoking
525
After having multiple vertebral fractures due to osteoporosis, what might we see
A loss of heing and a humped thoracic spine called kyphosis or "dowager's hump"
526
What is the gold standard for diagnosing osteoporosis
DEXA - Measures bone density
527
What is ossteopenia
Abnormal bone loss, but not as bad as osteoporosis
528
At what age should all women have a bone density test
65
529
What drugs can we use to treat osteoporosis
Bisphosphonates - Alendronate - Risedronate - Zoledronic acid - Denosumab
530
What is a rare, but serious side effect of Bisphoshonates
Osteonecrosis of the jaw (bone death)
531
So who should you be visiting regularly before and while on this drug
The dentist
532
How do Bisphosphonates work
They slow down bone reabsorption and remodeling
533
What two procedures can you do for osteoporosis
- Vertebroplasty | - Kyphoplasty
534
What is happening in vertebroplasty
Bone cement is injected into the collapsed vertebra
535
What is happening in kyphoplasty
A small balloon is inserted into the collapsed vertebra
536
What is Paget's disease
Excessive bone reabsorption, but the bone that replaces it is larger, disorganized and weaker
537
Who is more affected in Paget's disease , men or women
Men
538
What are s+s of Paget's disease
- Bone pain that develops gradually - Fatigue - Waddling gait - Loss of stature - Enlarged head (can cause headaches, vision/hearing losses)
539
What can Paget's disease lead to
Pathological fractures or tumors
540
How can we diagnosis Paget's disease
- Increased alkaline phosphatase - X-ray (shows curvature of bones) - Bone scan
541
Is there good tx for Paget's disease
Really just limited to supportive care
542
What is osteoarthritis
Slowly, progressive, non-inflammatory disorder of the synovial joints
543
What is really happening in osteoarthritis
You are losing your articular cartilage and bony outgrowths are forming
544
How early can osteoarthritis occur
It can start from 20-30, but you might not see symptoms until your late 60s
545
What can cause osteoarthritis
Pretty much anything (obesity, menopause, repetitive movements, drugs, trauma, etc)
546
What are the symptoms of osteoarthritis
- Joint pain - Stiffness - Loss of function - Increased symptoms when barometric pressure falls before bad weather
547
Unlike RA, when are the joints for osteoarthritis stiff
You will have stiffness after rest, until the bones get "warmed uup"
548
What is common in patients with knee osteoarthritis
Crepitation - where there is a grating sensation in the joints
549
Are the joints affected usually symmetrical in osteoarthritis
No, they are asymmetrical, where you can have one knee with OA and the other without
550
What are Heberden's and Bouchard's nodes
They are nodes on the fingers that are often swollen, red and tender. "look like big knuckles" - Heberden's are the furthest knuckles away - Bouchard's are the closest knuckles
551
How can we treat osteoarthritis
``` There is no cure, so help manage pain - Hot/cold (hot for stiffness - cold for flare ups) - Wt reduction - Exercise - Muscle strengthening - Ti-Chi - Fish oil - Ginger - Acetaminophen - Capsaicin cream - NSAIDs - TENS - use electricity to provide pain relief (usually surgery isn't better than pain medications) ```
552
What is RA
Chronic, system, autoimmune disease characterized by inflammation in the synovial joints, with periods of remission and exacerbation
553
How many times more likely do women have RA than men
3 times
554
When does incidence peak for RA
30-50
555
So how does RA work
We think it has to do with genetics and the environment. So someone who is genetically susceptible to RA has an immune response to an antigen (could be a virus or bacterium), so the body produces antibodies known as rheumatoid factor (RF) that go in and create an unneeded immune response (cytokines (proinflammatory) drive this immune response)
556
What are the manifestations of RA
- Joint stiffness - Pain - Limited ROM - Inflmmation
557
Are RA symptoms asymmetrical or symmetrical
Symmetrical - what ever is happening in your right hand is going to happen in your left
558
Will the stiffness every go away with RA
It may last 1hr to all day, but it may decrease with use. However, symptoms become worse with rest.
559
What are RA manifestations seen later on in life
Rheumatoid nodules, which are tender masses, and they can grow on your fingers, elbows, base of the spine, back of head, eye, lungs and heart (they can break down like pressure injuries and cause damage)
560
What are good diagnostic test for RA
- Test to see if they have a positive RF, which will occur in 80% of patients with RF. - Test to see if their ESR and CRP are increased showing active inflammation - Test to see if they have anti-CCP (if they have it then they have RA) - Test to see if they have an increased enzyme MMP-3 in the synovial fluid, which would be an indicator of joint damage - Test to see if there is an increase in WBC count in they synovial fluid - Test to see if they have an increase in ANA, which indicates an autoimmune reaction
561
What is the cornerstone tx for RA
Disease-modifying antirheumatic drugs (DMARDs)
562
What do DMARDs do
They help slow the disease progression and decrease risk for joint erosion and deformity
563
What is the preferred DMARD for early treatment of RA
Methotrexate
564
Methotrexate side effects are rare, what are these side effects
- Bone marrow suppression | - Hepatotoxicity
565
What labs are we checking for someone on methotrexate
CBC with diff. AST/ALT.
566
Is an x-ray alone a good diagnostic of RA
No, you need to run other tests as well
567
What are some good pt teachings for someone with RA
- Have rest and activity periods - Use cold/heat (cold from 10-15 minutes) heat up to 20 minutes. - Continue to exercise (PT may develop a plan) - Continue to practice ROM (should be done under supervision)
568
When does gout (hyperuricemia) occur
Has painful flare ups lasting from 2-10, followed by periods without any symptoms
569
What are the two ways we classify gout
- Primary hyperuricemia - genetic - Secondary hyperuricemia - can be cause by conditions that increase/decrease uric acid or inhibit the excretion of uric acid.
570
What two drugs can inhibit the excretion of uric acid
Loop diuretics and beta blockers
571
What are the conditions that can cause gout
- Metabolic syndrome (obesity, insulin resistance, hypertension, hyperlipidemia) - Increased intake of foods containing purines (red meat, shellfish, fructose drinks) - Prolonged fasting - Alcohol abuse
572
What are the manifestations of gout
- Sudden inflammation and pain usually occurring at night . | - Low grade fever
573
How can we diagnosis gout
- Serum uric acid is above 6mg/Dl - 24 hour urine uric acid test - Gold standard is synovial fluid aspiration - the fluid will have monosodium urate crystals "that are needle-like"
574
What is the classic symptom of gout
Inflammation of the great toe (podagra)
575
What do we treat gout with
Colchicine - this is an anti-inflammatory, not an analgesic, add an NSAID for pain management. Pain should be reduced within 12 hours of the attack.
576
What is the number one drug used to prevent gout
Allopurinol, it lowers the production of uric acid
577
What can gout lead to
Kidney stones
578
What is systemic lupus erythematosus (SLE)
Autoimmune disease where the immune system attacks its own tissues causing widespread inflammation and tissue damage
579
What can SLE affect
Your joints, skin, brain, lungs, kidneys and blood vessels (basically your immune system is going around and targeting anything it wants)
580
What is a "classic" symptom of SLE
The butterfly rash that occurs over the bridge of the nose to the cheeks
581
Is there a specific diagnostic test for SLE
No, we really just look for abnormalities like the following: - Having ANA (anti-nuclear antibodies) in the blood - Anti-DNA antibodies - Increased ESR and CRP to indicate inflammation
582
What drugs might we use to treat SLE
- NSAIDs - Anti-malaria (hydroxychloroquine) (watch for retinopathy) - Methotrexate (basically we are trying to suppress the immune system)
583
What is one thing to watch for with SLE
The condition can affect women of child bearing age, so really be careful giving meds to these women

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