Endocrine

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Author:
connachtman
ID:
217635
Filename:
Endocrine
Updated:
2013-06-10 20:20:03
Tags:
diabetes thyroid
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Description:
Diabetes, thyroid dz, and other endocrine disorders
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  1. administration of Victoza (liraglutide)?
    SC once daily
  2. ADA recommendations on screening adults for T2DM
    q3yrs
  3. urine collection for microalbumin
    first thing a.m. specimen
  4. concerning microalbumin level in T2DM
    GT 20 mg/L
  5. microalbumin should be checked how often in T2DM
    at diagnosis and then annually
  6. routine monitoring when on TZD
    ALT
  7. TZDs work how?
    increase insulin sensitivity
  8. pts on metformin should receive what monitoring to reduce risk of lactic acidosis
    creatinine
  9. uncommon but serious risk of metformin in pts with renal dz, heart dz, and liver dz
    lactic acidosis
  10. Somogyi effect ; treatment
    high dose of insulin at bedtime induces hypoglycemia that induces increased glucagon and cortisol production that then induces hyperglycemia in a.m. ; tx by reducing dose of long-acting insulin at bedtime
  11. where does 80% of insulin mediated glucose uptake take place
    muscle
  12. 2 hr GTT result that is dx of T2DM
    GT 200
  13. HDL and triglyceride levels that warrant screening for T2DM in children/ados
    HDL LT 35 or triglycerides GT 250
  14. body shape associated with T2DM
    apple-shape because abd fat is associated with insulin resistance
  15. what dz is often associated with T2DM because insulin resistance is associated with decreased renal uric acid clearance?
    gout
  16. what 2 classes of DM drugs are incretin mimetics?
    DPP-4 inhibitors like Januvia (sitagliptin) and GLP-1 agonists like Byetta (exenatide) and Victoza (liraglutide)
  17. administration of exenatide (Byetta) IR and ER
    IR at SC mealtimes ; ER SC once weekly
  18. how do GLP-1 agonists like Byetta and Victoza work?
    incretin mimetics they increase insulin secretion and inhibit glucagon
  19. What non-insulin DM drugs are administered SC?
    the GLP-1 agonists like exenatide (Byetta) and liragluride (Victoza)
  20. DPP-4 inhibitors like Januvia are being investigated for what adverse effect
    pancreatic cancer
  21. DPP-4 inhibitors have what ending on generic name
    -gliptin as Sitagliptin (Januvia) and saxagliptin (Onglyza)
  22. DPP-4 inhibitors, how do they work
    inhibit enzyme that metabolizes incretin, so they are called incretin mimetics.  Makes incretin available longer.  This increases beta cell prod of insulin and decreases glucagon
  23. how do TZDs (-azones) work
    increase insulin sensitivity
  24. if patient has a sulfa allergy is there an alt to sulfonylureas with similar action
    yes meglitinides like repaglinide
  25. meglitinides usually taken when
    at meal time
  26. Meglitinides like repaglinide (Prandin) and nateglinide (Starlix) are like what other DM drugs except they act quickly and are used at mealtimes?
    like sulfonylureas and also oral but onset is quick and can be used for mealtime glycemic control
  27. drugs that can increase metabolism of levothyroxine
    rifampin ; anticonvulsants
  28. normal starting dose of levothyroxine for an adult?
    75-125mcg
  29. dx of subclinical hypothyroidism based on what lab results
    elevated TSH but normal free T4
  30. is there goiter in Hashimoto's?
    yes but may regress over time
  31. hypothyroidism can be caused by what meds
    lithium, amiodarone
  32. hypothyroidism associated with what genetic syndrome
    Down
  33. in pancreatic CA pt may have jaundice but will lack hat sx of liver or gallbladder dz
    RUQ tenderness
  34. radiological study for pancreatitis
    abd CT
  35. labs to test for pancreatitis
    lipase and amylase
  36. pancreatitis associated with what diseases
    gallstones, etoh abuse,  and hypertriglyceridemia
  37. How to take Orlistat
    within 1 hr of a meal
  38. How hyperinsulemia contributes to HTN
    increases renal Na reabsorption and promotes peripheral vasoconstriction
  39. optimal triglyceride level
    LT 150
  40. effect of high-dose thiazides on lipids
    increase
  41. does hypothyroidism result in increase or decrease in lipds
    increase TG and TC
  42. best 2 classes of lipid drugs for lowering triglycerides
    fibrates and niacin
  43. best lipid drugs for lowering LDL
    statins
  44. best lipid drugs for increasing HDL
    niacin
  45. serious sequela of heat stroke d/t the break down of muscle tissue ; this in turn can lead to what?
    rhabdomyolysis ; acute renal failure
  46. transient electrolyte imbalance in heat stroke
    hyponatremia
  47. transient hematologic condition in heat stroke
    polycythemia d/t vol depletion
  48. why should cooling be controlled and gradual in pt with heat stroke
    to avoid vasoconstriction that will inhibit cooling
  49. What DM meds promote weight loss?
    TZDs and GLP-1 agonists like Byetta (exenatide) and Victoza (liraglutide)
  50. Total cholesterol target of tx
    LT 200
  51. HDL target of tx
    GT 40
  52. LDL target of tx
    LT 100
  53. BMI for morbid obesity.  Morbid obesity is what class obesity
    40+ ; class 3 obesity
  54. which form of thyroid hormone is converted in peripheral tissues to other form
    t4 is converted to t3
  55. ADA A1c tx goals for those with T2DM
    LT 7% for most.  6.5% for those with more risk factors.  8% for elderly and those with risk factors for hypoglycemia.
  56. 2 hr OGTT result that is dx of diabetes
    GT=200
  57. random plasma BG that is diagnostic of diabetes in pt with sx of diabetes
    GT/=200
  58. A1c dx of diabetes
    6.5 or higher
  59. criteria for screening for diabetes in children and ados
    start at 10 yo (or at puberty if earlier) and q3yrs if has 2 or more risk factors:  obese, ethncity, fh of T2DM, maternal hx of DM
  60. urination and activity restrictions in pheochromocytoma
    void in small amts and avoid full bladder ; avoid bending and compressing abd
  61. Troussea sign
    sing of latent tetany ; bp cuff inflated to GT SBP and left for 3 min.  positive if hand contracts ; used to diagnose hypoPTH
  62. dawn effect
    early morning hyperglycemia perhaps resulting from release of cortisol and glucagon
  63. Somogyi effect
    too much insulin taken at night results in rebound hyperglycemia in a.m. as a result of cortisol and glucagon release
  64. Labs that should be performed before stating anti-thyroid meds
    WBC and LFT because of risk of liver damage and agranulocytosis
  65. How often should a pt with an insulin pump monitor BG
    at least qid
  66. why are DPP-4 inhibitors (e.g. Januvia) and incretin mimetics (Byetta and Victoza) ganing favor over sulfonulureas?
    less risk of hypoglycemia
  67. dietary mods that slow progression of diabetic nephropathy
    reduce protein intake
  68. labs that are indicative of hypoPTH
    increased serum and urine phosphates and decreased serum and urine calcium
  69. why is jogging not recommended exercise for pts with DM
    potential nerve damage to feet
  70. criteria for snacks in T1DM
    most anything as long as it aids in maintaining healthy wt
  71. What med or supp does NOT effect OGTT results
    Ca
  72. ear problem in older pts with DM
    malignant otitis externa and risk of progression to meningitis
  73. what is trismus and what might it be a sign of
    tonic contracture of muscles of mastication ; might be a sign of malignant otitis ext
  74. Which oral DM drugs are safe in prg?
    metformin and insulin
  75. what is the Ferriman-Galwey Scale?
    a measure of hirsutism.  a score of 8 indicates hirsutism
  76. after thyroidectomy and euthyroidism is established how often should TSH be checked?
    annually
  77. lifestyle factor that aggravates exophthalmia in Graves Dz
    smoking
  78. Gynecomastia might be a sx of what CA
    testicular
  79. Dermatological sequelae of Cushings Syndrome?
    fungal infections
  80. How do PTU and methimazole tx hyperthyroidism?
    inhibit synthesis of thyroid hormone
  81. what anti-thyroid med blocks secretion and release of thyroid hormone
    saturated potassium iodide

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