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NURP FNP III > Renal Week III > Flashcards

Renal Week III Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Define Proteinuria

A

urinary protein excretion of more than 150 mg/day

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2
Q

Persistent proteinuria

A

as 1+ protein on a standard dipstick, two or more times during a 3-month period. This has to be investigated.

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3
Q

The most accurate way to measure proteinuria

A

24 hour urine

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4
Q

Most common symptom of bladder CA

A

Hematuria

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5
Q

When to screen for proteinuria in pregnant women

A

after 24 weeks- needs to be referred, sent to OBGYN, this due to risk of pre eclampsia

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6
Q

What tests to run when you find proteinuria > 150 mg/day

A

Test urine for :
Urine Dipstick
Urine analysis ( C&S)
24-hour urine collection (or spot protein/creatinine)
urinary sediment
Test Blood for:
CBC w diff, Lipids
renal function tests
fasting glucose and HgA1C

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7
Q

What can cause proteinuria > 150 mg/day

A

Glomerulonephritis
Hepatitis induced vasculitisis
Urate-related renal disease
Diabetes

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8
Q

drugs used to treat proteinuria

A

ACE/ARBS- reduces interglomerular pressure

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9
Q

Lifestyle changes to reduce proteinuria

A

sodium and protein-restricted diets

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10
Q

What can cause Hematuria DD

A

Drugs (anticoagulants) , Diet, Physical Activity, UTIs, Malignancies, Nephropathies

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11
Q

RBC casts seen via Urinalysis indicate what?

A

injury to the nephron

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12
Q

Colicky flank/ABD pain with hematuria, NV, increased urinary frequency

A

Renal stones

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13
Q

Gross hematuria

A

CA, cystitis, urethritis

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14
Q

Workup for hematuria

A

Pelvic/Prostate exam
Urine specimen (via cath) for UA, C&S, Cytology
sediment analysis
Imaging:
IVU, US, CT scan, Cystoscopy
Blood draw for:
CBC diff, PTT/INR
Kidney function tests: BUN, Creatinine

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15
Q

Hematuria management

A

Identify the problem, urological referral, surgery

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16
Q

Risk for renal stones

A

Diet (high salt, calcium) dehydration, sedentary lifestyle, family hx, gout, hyperparathyroidism

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17
Q

Conservative acute management of stones

A

Oral hydration, pain management, expectant stone passage

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18
Q

Lab testing for kidney stones

A

UA, C&S, Urinary PH, 24 hour urine collection, CBC, Serum calcium, Vit D levels

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19
Q

Imaging for kidney stones

A

KUB x ray, IVP US, CT

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20
Q

Size of stones to refer

A

> 6-8mm

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21
Q

Criteria for nephrotic syndrome

A

3-3.5 g of protein in urine/day- refer

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22
Q

What are the elements of a urinary analysis

A

Dipstick, Microscopy

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23
Q

Proteinuria after prolonged standing

A

orthostatic proteinuria - repeat test 24/r urine

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24
Q

DX for orthostatic proteinuria

A

3x negative results of early morning proteinuria- benign conditoon

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25
Q

Why do we check lipids for proteinuria?

A

client with proteinuria and hyperlipidemia should be aggressively managed to limit ESRD

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26
Q

the goal for tx of proteinuria

A

1 gram per day or less

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27
Q

When to refer for hematuria

A

gross frank blood, severe flank pain, unstable vitals, ss of urological obstruction

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28
Q

Glomerular causes of hematuria

A

Glomerulonephritis
Lupus Nephritis
Interstitial nephritis
pyelonephritis
vascultitis

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29
Q

non glomerular causes of hematuria

A

infection, cancer, renal stones, polycystic kidney disease, sickle cell, trauma, increased bleeding time, hemorrhagic cystitis

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30
Q

Hematuria and proteinuria with edema, HTN, HX of sore throat or skin infection

A

Post-infection glomerulonephritis

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31
Q

GFR criteria for kidney damage

A

GFR< 60mL

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32
Q

Normal kidney function GFR

A

GFR > 90

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33
Q

GFR Criteria for Kidney failure

A

GFR <15

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34
Q

the hallmark clinical signs of CKD and AKI

A

DEcreased GFR<90
Increased serum creatinine

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35
Q

Normal serum creatinine levels

A

Men 0.74-1.35
Women 0.59-1.04

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36
Q

Volume overload from kidney damage can cause…

A

irregular lung sounds, jugular vein distension, peripheral and central edema (ascities), extra heart sounds, increased fluid around heart AKA pericarditis

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37
Q

What stage of CKD do we refer to a nephrologist

A

Stage 4 CKD
GFR< 30
ACR >300 (albumin to creatinine ratio)

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38
Q

When do we refer to nepro when HTN is r/t kidney damage

A

HTN refractory to tx with 4 or more meds

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39
Q

Risk of starting ACE/ARBS for renal protection

A

Hyperkalemia ( high K+)

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40
Q

Metformin is contradicted with a GFR …

A

<30

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41
Q

Hematuria + Proteinuria, peripheral and central edema, tea-colored urine s/p infection

A

Post streptococcal glomerulonephritis

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42
Q

red/brow-colored urine 2+ heme but no RBC

A

hemoglobinuria or myoglobinuria

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43
Q

Most common cause of proteinuria in adolescent males

A

Orthostatic Proteinuria- benign, follow up 1 year

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44
Q

Edema, foamy urine, weight gain, fatigue, anorexia, tired

A

symptoms of nephrotic syndrome

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45
Q

treatment of nephrotic syndrome in children

A

oral steroids 2.5-3 months, diet (salt restriction), calcium & Vit D until urine is negative for protein

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46
Q

Treatment of nephrotic syndrome in adults

A

ACE, a statin for hyperlipidemia, anticoagulants, immunosuppression therapy

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47
Q

proteinuria, peripheral edema, and low serum albumin may indicate

A

nephrotic syndrome

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48
Q

Diagnosis of CKD

A

GFR <60 for 3 mths

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49
Q

Screening tests for CKD- done annually if at risk

A

Spot urine for albumin to creatinine ratio (ACR)
Serum creatinine to estimate GFR
UA
Serum cystatin C

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50
Q

risk factors for renal stones

A

obesity, family HX, dehydration, warm climates, animal products, high salt, high calcium

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51
Q

work up for kidney stones

A

constant pain may indicate obstruction, versus colicky, UA, C&S, CBC diff, PTH, CT scan US for prego or kids

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52
Q

What test should be monitored regularly in CKD

A

Parathyroid hormones= can cause hyper parathyroid
Serum lipids= can cause hyperlipidemia
Vit D, calcium, and phosphorus metabolism are all altered

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53
Q

Your patient has a butterfly rash and periorbital edema, what is in your differential

A

Lupus induced nephritis

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54
Q

What is a normal specific gravity

A

1.005-1.030

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55
Q

What is normal urine PH

A

4.6-8.0

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56
Q

Causes of kidney failure

A

NSAID use, DM, HTN, Family hx, 60+, race, hx AKD

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57
Q

most common cause of acute nephritis in children globally

A

Poststreptococcal glomerulonephritis

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58
Q

Testing for Poststreptococcal glomerulonephritis

A

Antistreptolysin O (ASO) titer
C3- will go down in 8 week

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59
Q

Poststreptococcal glomerulonephritis course of disease with labs

A

edema - 2 weeks
creatinine - 4 weeks
compliment 8 weeks
hematuria months
proteinuria 1 year

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60
Q

4 weeks s/p PSGN what would we see in labs?

A

Low c3, elevated ASO titer

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61
Q

Stages of kidney disease

A

Stage 1 normal GFR >90- with 1 other sign of kidney disease like proteinuria
Stage 2 GFR <60-89 with other signs
Stage 3a GFR 45-59
Stage 3b GFR 30-44
Stage 4 GFR 15-29- refer
Stage 5 GFR <15- refer

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62
Q

What is the definition of microscopic hematuria according to the American Urological
Association (AUA)?

A

Three or more red blood cells in a noncontaminated urinalysis without evidence of infection

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63
Q

dx of hematuria

A

3 RBCs or more per high-power field

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64
Q

child has failed to growth, increased thirst, and urination, muscle weakness irritability, acidic urine

A

renal tubular acidosis

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65
Q

HTN crisis refer to er with BP >

A

180/120 with ss of end-organ damage

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66
Q

Normal blood pressure

A

<120/80

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67
Q

elevated BP

A

120-129 and <80

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68
Q

Stage 1 HTN

A

130-139 and 80-89

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69
Q

Stage II HTN

A

140+ and 90+

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70
Q

How do we dx BP

A

2 separate office visit, at least 2 weeks apart

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71
Q

JNC 8 recommendations are to start Black patients on _____for HTN

A

dyhydropine CCB (e.g., amlodipine) and/or a thiazide diuretic.

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72
Q

Asian patients often do better when prescribed ______ for HTN

A

Calcium channel blocker or ARB

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73
Q

Non-Black patients should be started on _____ for HTN

A

thiazide diuretic, ACE inhibitor, angiotensin blocker, CCB, or combination

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74
Q

These HTN medications are recommended for any client with DM

A

Ace/ARBS are renal protectives (reduce blood flow through kidney)

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75
Q

The JNC 8 blood pressure goal recommendation for adults less than age 60

A

< 140/90;

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76
Q

BP goal for adults with confirmed HTN AND known CVD or 10-year ASCVS of 10% or higher

A

<130/80

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77
Q

The JNC 8 blood pressure goal recommendation for adults older than age 60

A

<150/90

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78
Q

The JNC 8 blood pressure goal recommendation for any adults with DM or CKD

A

<140/90

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79
Q

initial workup for HTN

A

H&P, CBC,UA, Glucose, BUN, Creatinine, Electrolytes, ECG, lipids

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80
Q

When to initiate drug therapy for obesity

A

BMI 30 or over with failed lifestyle changes - Orlistat

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81
Q

Obesity is a BMI greater than …

A

30

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82
Q

what age should patients be assessed for
cardiovascular risk factors and calculate
10-year risk of ASCVD

A

40-75

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83
Q

ACC/AHA guideline recommends moderate-to-high-intensity statin therapy starting at a 10-year ASCVD risk score of 7.5%

A

10% or greater

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84
Q

Risk factors for CAD coronary artery disease

A

Age, Gender, race, total cholesterol, hdl, ldl, BP, diabetes, smoking, tx for htn

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85
Q

When to start statins

A

40-75 with elevated lipids, LDL>130, HDL <40 and one other risk factor like DM, HTN Smoking, or >10% risk factor

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86
Q

Total cholesterol goal

A

<200

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87
Q

LDL

A

<100

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88
Q

HDL

A

> 60

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89
Q

Severe hypertriglyceridemia, elevated liver enzymes, chest pain, resp issue, rhabdomyolysis

A

Immediate ER

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90
Q

Who needs a fasting lipid panel and how often

A

adults older than 20 years, repeat every 5 years

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91
Q

Triglyceride goal

A

<150

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92
Q

Diseases that cause hyperlipidemia

A

hypothyroidism
diabetes

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93
Q

diseases that must be treated before starting statins

A

must get to euthyroid and control bs

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94
Q

labs to take before starting statins

A

liver enzymes- can cause liver damage

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95
Q

patient new on statin develops muscle pain, what lab should be drawn

A

CK to r/o rhabdo
discontinue statin if this is suspected

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96
Q

drug of choice for hyperlipidemia with liver disease

A

bile acid sequestrants

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97
Q

DX of metabolic syndrome

A

Waist >35-40
Triglycerides >150
HDL <40
BP> 130/85
Fasting glucose >100

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98
Q

A physical sign that is suggestive of moderate to severe insulin resistance is the hyperkeratotic condition

A

acanthosis nigricans.

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99
Q

impaired fasting glucose

A

100-126

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100
Q

When do we screen kids for hyperlipidemia

A

2+ with any risk factors like family hx and 9-11 routinely

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101
Q

tx of hyperlipidemia in children

A

lifestyle changes 1st then meds after 9 y/o - refer for med tx

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102
Q

PCP tx of HTN in kids

A

start checking 3 y/o start with lifestyle changes and refer if meds needed

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103
Q

Normal BP in kids

A

<90th percentile

104
Q

stage 1 HTN in kids

A

> 95th - 99 percentile repeat 1-2 wks, take average over 3 visits

105
Q

stage II HTN in kids

A

> 99 percentile- refer within 1 week

106
Q

Dx secondary HTN ABCD

A

A-Accuracy, Apnea, Aldosterone
B-Bruits (renal artery), Bad Kidneys
C-Catecholamines (strees0, Coarctation or Aorta, Cushings syndrome
D-Drugs, Diet
E-Erythropoietin, Endocrine disorders

107
Q

The client has elevated BP or stage 1 with an estimated 10 year ASCVD risk of <10% what do you recommend?

A

Lifestyle changes and come back in 3-6 months to see if its has worked

108
Q

The client has stage 1 HTN and an estimated 10-year ASCVD risk greater than or equal o 10% when do you recommend?

A

in addition to lifestyle changes, 1 drug tx is recommended with a follow up in 1 month

109
Q

The client has stage II HTN, in addition to lifestyle changes what do you recommend?

A

2 drygs from different classes with recheck in 1 months

110
Q

The client has BP of 180/110

A

Give med in office and start woth 2 routine BP meds of different classes

111
Q

work up for HTN

A

UA- check for hematuria/protienuria
(CMP)BUN, Creatinine, electrolytes - check kidney function
CBC- anemia erythropoietin kidney damage
Uric Acid - kidneys
Glucose- DM
Lipid Panel- Hyperlipidemia needs to treat more aggressively
ECG- LVH with wcs, ischemic heart disease

112
Q

Moderate intensity statins

A
  • Lovastatin 40-80
  • Pravastatin 40-80
  • Simvastatin 20-50
  • Atorvastatin 10-20
  • Rosuvastatin 5-10
113
Q

high intensity statins

A
  • Atorvastatin 40-80
  • Rosuvastatin 20-40
114
Q

Statin dosage for patients with clinical atherosclerotic cardiovascular disease

A

Atorvastatin 40-80
Rosuvastatin 20-40

115
Q

Patients with severe high cholesterol LDL >190 regardless of other factors will get what kind of statin

A

high dose
atorvastatin 40-80
Rosuvastatin 20-40

116
Q

Patients with DM and a LDL>70

A

Moderate
Pravastatin 40-80
Atorvastatin 10-20
Lovastatin 40-80
Simvastatin 20-50
Rosuvastatin 5-10

117
Q

Patients 40-75 with and estimated risk of >7.5

A

Moderate
Pravastatin 40-80
Atorvastatin 10-20
Lovastatin 40-80
Simvastatin 20-50
Rosuvastatin 5-10

118
Q

Avoid ace inhibitors in what population?

A

pregnant women

119
Q

When does an ACE cough begin

A

Within 2 weeks of starting therapy

120
Q

People taking an ACE inhibitor should avoid what?

A

Potassium - bc it already raises potassium risk of hyperkalemia

121
Q

What is the 1st thing you should do if a client develops rhabdo with atorvastatin

A

stop the rhabdo 1st and then draw a CPK

122
Q

What happens to SBP as you age

A

it gets higer

123
Q

ASCVD risk is greater than or equal to 10% what is the blood pressure goal

A

<130/80

124
Q

*What can a patient expect from adoption of the DASH diet?

A

Can lower your BP between 8-14mmh, like being on (1) med

125
Q

Per 20 pound loss how much does BP drop

A

5-20 mmHg

126
Q

Restricting sodium will drop BP how much

A

2-8mmhg

127
Q

thiazide diuretic side effects

A

hypokalemia, low sodium, and hypercalciuria, make gout worse from dehydration, increased urination

128
Q

Calcium Channel blockers side effects

A

flushing headaches, tachycardia, palpitations, dizziness, peripheral edema, gingival hyperplasia

129
Q

ACE side effects

A

Dry cough, angioedema (can happen any time), do not take for child bearing age

130
Q

ARB side effects

A

rashes, angioedema,

131
Q

What anti hypertensive meds should be avoided with gout

A

hydrochorathiazide

132
Q

What meds do we avoid with anyone with respiratory issues?

A

Beta-blockers- can cause bronchicontriction

133
Q

Which of the following medications should be discontinued in a woman with essential hypertension who
is trying to get pregnant?

A

ACE/ARB- Losartan

134
Q

What part of the lipid profile is most affected by not fasting

A

triglycerides, LDL

135
Q

What test can we order if client does not want to fast for the test

A

Direct LDL

136
Q

what is likely paired with a statin

A

bile acid sequestration- Ezetimibe

137
Q

contraindication to statin

A

pregnancy, active liver disease

138
Q

What is the mechanism of action of ezetimibe

A

Inhibits cholesterol absorption at the brush border of the small intestine

139
Q

High TSH and Low T4

A

Hypothyroidism

140
Q

Constipation, fatigue, weight gain, everything slows in body
Puffy/pale face/hair loss/weight gain/ diastolic hypertension / goiter

A

hypothyroid

141
Q

Goiter with autoimmune hypothyroid

A

hashimotos

142
Q

Diagnostic tests for thyroid

A

TSH- thyroid stimulating hormone - if abnormal order reflex..
Free T4
TPO Thyroid peroxidase antibodies- autoimmune
Antithyroglobulin antibodies

143
Q

what thyroid test do you run to dx autoimmune thyroditis

A

TP0 Thyroid peroxidase antibodies

144
Q

subclinical hypothyroidism

A

high TSH, normal T4

145
Q

secondary hypothyroidism

A

normal TSH , low T4

146
Q

The average dose of levothyroxine

A

1.6 mcg/kg/day

147
Q

Levothyroxine teaching

A

take 1st thing in Am on an empty stomach, space out with other vitamins by 4 hours

148
Q

levothyroxine requirements during pregnancy

A

dose should be increased by 20-30%

149
Q

Subacute thyroiditis

A

thyroid is tender, hyper to hypothyroid - TX is NSAIDs

150
Q

postpartum thyroiditis

A

3 mths after delivery - 40% develop hypothyroidism

151
Q

most common cause of hyperthyroidism

A

graves disease- autoimmune

152
Q

toxic multinodular goiter

A

palpate multiple nodules, excess tissue produces excess thyroid hormone, refer

153
Q

Weight loss, fatigue, heat intolerance, tremors, anxiety

A

hyperthyroidism

154
Q

exophthalmos, pre-tibial edema, clubbing of fingers and toes, vitiligo on the skin, thyroid bruit

A

graves disease

155
Q

Graves disease dx

A

TSH suppressed, free T4, T3 elevated, Thyrotropin receptor antibodies +, ESR, CBC, LFT

156
Q

graves, refer for tx including …

A

Methimazole, propylthiouracil, radioactive iodine, thyroidectomy, betablockers

157
Q

Hyperthyroidism in 1st trimester

A

Propylthiouracil

158
Q

Hyperthyroidism in 2nd trimester

A

methimazole

159
Q

Thyroid storm - got to ER

A

fever, tachycardia, arrhythmias, CNS symptoms and GI symptoms

160
Q

What do you order when you feel a thyroid nodule

A

order thyroid tests (TSH) and refer for a thyroid ultrasound

161
Q

What is the management of Benign Nodules

A

repeat exam, US, TSH in 12 mths, if getting larger then fine needle aspiration, Surgery >4cm or symptomatic

162
Q

A 20-year-old female patient with tachycardia and weight loss but no optic symptoms presents with the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?

A

Beta blocker medications

163
Q

A female patient with hypothyroidism for the past 5 years presents for a positive home pregnancy test. She is taking levothyroxine 75 mcg daily and her TSH was 2.5 mIU/L six months ago at her routine physical. The nurse practitioner understands which of the following?

A

Thyroid requirements increase by 20-30% in pregnancy so she should have a TSH checked today

164
Q

A patient has a thyroid nodule and the nurse practitioner suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?
Responses

A

Thyroid ultrasound

165
Q

A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the nurse practitioner tell this patient?
Responses

A

This condition may be transient.

166
Q

hyperparathyroidism will increase_______ in the body?

A

Calcium

167
Q

Cushing’s syndrome is caused by what

A

increased production of ACTH from the anterior pituitary, stimulating the adrenal cortex to produce more cortisol - long-term use of steroids

168
Q

How to dx Cushing’s syndrome

A

24-hour free urine cortisol 2x
late night salivary cortisol 2x
low dose dexamethasone impression test

if positive refer to endocrinology - tx is surgery

169
Q

A 25-year-old female patient presents with bilateral galactorrhea and irregular menses. She has a normal breast exam. In addition to checking a prolactin level, which of the following should be included in the initial work up?
Responses

A

Human chorionic gonadotropin (HCG)

170
Q

Symptoms of hyperparathyroidism

A

cognitive impairment, Left ventricular hypertrophy, renal stones (from increased calcium)

171
Q

A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient?
Responses

A

Annual monitoring of calcium, creatinine, and bone density

172
Q

Which of the following is true regarding Cushing disease?

A

Increased production of ACTH stimulates increased production of cortisol by the adrenal glands

173
Q

Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?

A

Inappropriate secretion of PTH along with hypercalcemia

174
Q

Diabetic keto acidosis

A

Type I- ketones in urine, glucose 250-350, acidosis, admission to ER, PH < 7.3, Bicarb <15

175
Q

HHS hyperglycemic, hyper osmolar syndrome

A

Type II- hyperosmolality (blood-like motor oil with sugar), dehydration, AMS, glucose 600+, PH > 7.3, Bicarb >15 HHS

176
Q

New client with an A1C of 7.5, does he have DM?

A

Yes

177
Q

The pathologic factors involved in type 2 diabetes in adults include:

A

Resistance to the effects of insulin at peripheral tissues and a relative insulin deficiency that is progressive over time

178
Q

After Metformin if target A1C is still not met AND client has ASCVD (atherosclerosis)

A

GLP-1 end in “tide”
SGLT-2 end in “flozin”

“keep veins open with tide flozin”

179
Q

Diabetic meds that lower weight

A

GLP-1 - end in tide
SGLT2 end in Flozin

180
Q

Diagnostic criteria for DM

A

Random plasma glucose >200 With symptoms (1x)
A1C >6.5 (1X)
Fasting plasma glucose > 126 (2+x)

181
Q

A1C to diagnose DM

A

A1C >6.5 (1x is ok)

182
Q

Random fasting glucose to DX Diabetes

A

> 200 with symptoms (1x is ok)

183
Q

What is the 1st thing your prescribe a client with new DM with a A1c of 6.5-7.5

A

Monotherapy- Metformin, GLP-1 - “Tide”
SGL T2 -“ Flozin”

184
Q

What would you start a newly dx diabetic on with an A1C of >7.5

A

Duel therapy
oral med or insulin as second med

185
Q

What do you start a new Dm client on that comes in with a A1C at 9 or higher WITH symptoms

A

Have to start right away with insulin, triple therapy

186
Q

What do you start a new Dm client on that comes in with a A1C at 9 or higher WITH OUT symptoms

A

Can start with insulin, duel therapy

187
Q

What is our Go TO for diabetic meds for CHF and CKD clients

A

SGLT 2- end with “flozin”

188
Q

1st line- Basal Insulin dosing

A

Start with basal insulin, start low, go slow, increase units by 2 units every 3 days , lower dose by 10-20% of hypoglycemic

189
Q

After Basal insulin what do we add if still not at goal?

A

Post prandial (AKA rapid acting insulin) start by giving dose with largest meal, about 4 units per day, Titrate dose by 1-2 units 2x per week, If still not at goal add for other meals

190
Q

When do we screen for renal disease in type 2 dm

A

When they are 1st diagnosed

191
Q

How do we screen for renal disease in DM?

A

ACR <30- have to do 3x. 2/3 are abnormal , that indicates kidney disease

192
Q

What are thyroid drugs based on?

A

body weight

193
Q

How to start thyroid meds

A

Start low, go slow, DO not start with max dose or can go into A fib

194
Q

What is the best screen for diabetic nephropathy

A

ACR and GFR

195
Q

How often do we screen for Nephropathy in a diabetic ?

A

Annually

196
Q

How often to diabetics see the eye doctor

A

Annually

197
Q

How quick does ACE work to protect kidneys ?

A

6-8 weeks

198
Q

Hyperthyroid does what to bp?

A

Increases systolic and diastolic BP

199
Q

Symptoms of type II DM may include..

A

Fungal and bacterial infections, new onset fatigue

200
Q

When free T4 falls- what else happens?

A

TSH increases

201
Q

What is the earliest glycemic abnormality in a patient with type II DM

A

post prandial hyperglycemia - glucose from food takes longer to go back to normal (Insulin not working) until it just remains elevated (insulin never works)

202
Q

dark, velvety skin, looks dirty, does not itch or hurt

A

acanthosis nigricans- from constant high blood sugar

203
Q

Asian BMI

A

> 23 is overweight

(25 everyone else)

204
Q

Gestational DM is a risk factor for full blown DM (T/F)

A

True. 20% of women who have gestational DM develop type II DM.

205
Q

Large baby is a risk factor for DM (T/F)

A

True

206
Q

Triglycerides normal range

A

<250

207
Q

What would make an hemoglobin A1C not accurate?

A

anemia
pregnancy
sickle cell
blood transfusions or blood loss

208
Q

When do we start testing people for DM?

A

45 y/0
OR
Any age that are overweight with risk factors
OR
any high risk race

209
Q

Anyone with a HX of giving birth to a baby over 9 pounds should be screened for DM (T/F)

A

True

210
Q

What are criteria to test kids for DM?

A

Any BMI greater than 85th %
any kid that is overweight OR mom had gestational DM OR family HX of DM in 1st , 2nd relative, Symptoms of DM, Ethnicity is high risk

211
Q

2 hour glucose tolerance test

A

> 200 without symptoms - has to come back and do it again
200 with symptoms, can dx with DM

212
Q

How would you check between type I or type II DM?

A

DM I - you would see auto antibodies because its auto immune

213
Q

Name (2) other autoimmune d/o you should check for with a dx of type I dm?

A

Hashimotos
Celiac
Type 1 DM

The presence of any one of these disorders should prompt testing of the other

214
Q

When is metformin contraindicated?

A

GFR <30

215
Q

What % of body weight should we ask to lose for lifestyle changes?

A

5%

(PA 30 minutes a day for 5 days a week)

216
Q

How often do we check A1C in DM patients?

A

Every 3 mth until we meet goal then every 6 mths

217
Q

All people over 26 y/o who are diabetics should be put on a statin (T/F)

A
218
Q

Injectable DM meds

A

GLP-1
Insulins

219
Q

Contraindications for metformin

A

GFR <30
Heavy alcohol use
Liver failure
Decompensated HF
Anyone who needs IV contrast - can not start metformin in 48 hours after IV contrast

220
Q

How much of a reduction in A1c can you expect from Metformin

A

1-1.5%

221
Q

Side effects of metformin

A

B12 deficiency

222
Q

What organ does metformin work in?

A

Liver
(this is why its contradicted in liver disease)

223
Q

What A1C % would you start duel therapy?

A

7.5 or greater

224
Q

GLP-1 MOA

A

They kick the pancreas to stimulate insulin secretion

225
Q

sulfonylureas MOA

A

They kick the pancreas to stimulate insulin secretion

226
Q

TZD MOA

A

increase insulin sensitivity of muscle adipose tissue in LIVER

227
Q

SGLT-2
(Jardiance)

A

Cause lots of UTI because they decrease kidney reabsorption and make you pee out glucose

228
Q

DPP-4
(Januvia)

A

Slow down breakdown of GLP-1s that we already have

229
Q

Metformin adverse affects

A

Diarreah for 2 weeks
can worsen heart failure

230
Q

GLP-1 adverse effects
(Victoza)

A

Cause Nausea / vomiting

231
Q

sulfonylureas adverse effects
(glipizide)

A

Kidney damage
decrease of GFR
Fractures
Weight gain

232
Q

TZD adverse effects

A

Contradicted in people with intestinal disease, causes flatulence

233
Q

DPP 4
(Januvia)

A

Weight Gain

234
Q

How do we start dosing insulin

A

Start with long acting basal insulin and then add short acting if BS is still not controlled after meals

235
Q

Long acting basal insulin names

A

Lantus
Levemir
glargine
Toujeo

236
Q

What medication must you STOP when you start insulin

A

sulfonylureas
(glipizide)

237
Q

Insulin dosing for A1C <8%

A

0.1-0.2 units per KG/DaY

238
Q

Insulin dosing for A1C >8%

A

0.2-0.3 units per KG/Day

239
Q

What hypoglycemia agency has been associated with weight loss

A
240
Q

Metformin is associated with weight loss T/F

A

True

241
Q

Rapid acting insulin (lispro, aspart) Onset, Peak, Duration

A

Onset 5-15min
Peak 1-2 hours
Duration 4-6 hours

242
Q

Regular/Short acting Insulin
Onset, Peak, Duration

A

Onset 30 min
Peak 2-3 hours
Duration 3-6 hours

243
Q

Intermediate acting Insulin Onset, peak, duration Rapid

A

Onset 2-4 hours
Peak 4-12 hours
Duration 12-18 hours

244
Q

Long acting insulin
Onset, peak, duration

A

Onset 2 hours
Duration 24 hours

245
Q

Nephropathy screening in DM in children

A

Start screening at 10 y/o, then annually spot urine ACR
OR once they had DM for 5 years

246
Q

Eye screening for DM in children

A

Start screening at 10 y/o, then annually spot urine ACR
OR once they had DM for 5 years

247
Q

DM foot screening in children

A

Start screening at 10 y/o, then annually spot urine ACR
OR once they had DM for 5 years

248
Q

Lipid screening in DM children

A

10 y/o

249
Q

when do you check for hashimoto and celiac for DM in children

A

at diagnosis

250
Q

Infant has hypotonia, constipation, dry skin, open posterior fontanel, horse cry- what do you suspect?

A

Neonatal hypothyroidism- every baby gets screened at birth, bc sometimes there are no symptoms

251
Q

Neonatal Synthroid dosing

A

10-15mcg/kg/day

252
Q

Most common finding in a child with hypothyroid

A

a NORMAL exam

253
Q

Lab value associated with subclinical hypothyroid

A

Elevated TSH and Normal T3

254
Q

Lab value associated with hyperthyroid

A

Low TSH and high T4

255
Q

treatment for hyperthyroid

A

thionamides, radioiodine, or surgery

256
Q

in hyperthyroidism what would you see on a 24 hour radio iodine scan?

A

Increased uptake with homogenous pattern

NURP FNP III (1 decks)

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