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101 Cards in this Set
- Front
- Back
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What is Dawn effect ?
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• Fasting hyperglycemia
– Resulting from early morning (Dawn) release of counter-regulatory hormones: cortisol, Growth Hormone --Glucose increase early in the morning due to increase in cortisol and GH |
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What is Somogyi effect ?
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Rebound effect. When blood sugar gets too low the body has a rebound (glucagon released to bring glycogen stores out of the liver) to increase blood glucose
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Type 2 diabetic pt is alert and talking during hyperglycemia. How do you treat?
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oral med or injection are both ok. ORAL only if pt is alert.
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Why should glucagon injection not be given to alcoholics or people with liver disease?
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because you need to pull glycogen/glucose stores from liver
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Where is/are the best location(s) to administer insulin injections on the body?
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abd best place and rotate around the site (abdomen) and then switch to arm or thigh
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Long acting insulins should not be _____ with other insulins.
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mixed
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What are the 5 classes of oral insulin meds?
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1. Biguanides (insulin sensitizers)
2. Sulfonylureas (insulin secretagogue) 3. Meglitinides (insulin secretagogue) 4. Alpha glucosidase inhibitors 5. Thiazolidinediones (insulin sensitizers) The “glitazones” |
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What does it mean to be a Alpha-glucosidase inhibitors
? What action does it take? |
Alpha-glucosidase inhibitors are oral antihyperglycemic agents—they slow down the absorption of glucose from the SI.
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Which oral meds are insulin secretagogues?
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Sulfonylureas (insulin secretagogue)
Meglitinides (insulin secretagogue) |
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Type 2 diabetic pt is OUT OF IT during hyperglycemia. How do you treat?
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out of it=stick them
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Insulin
Preparations, Onset of Action Peak and Duration of Action : Aspart, glulisine, lispro |
~15 minutes 1–2 hours 4–6 hours
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Insulin
Preparations, Onset of Action Peak and Duration of Action : Human regular |
30–60 minutes 2–4 hours 6–8 hours
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Insulin
Preparations, Onset of Action Peak and Duration of Action : Human NPH |
2–4 hours 4–10 hours 12–20 hours
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Insulin
Preparations, Onset of Action Peak and Duration of Action :Detemir |
2-3 hours Flat ~ 14 hours
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Insulin
Preparations, Onset of Action Peak and Duration of Action :Glargine |
2–4 hours Flat ~24 hours
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How to treat hypoglycemia for pt alert and 50-70 Blood glucose?
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oral glucose (12-15g)
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Why shouldn't glucagon be given to alcoholics of liver disease?
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because you need to pull from liver stores
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Where should you administer injections on the body and how often should you rotate?
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abd best place
then arm then thigh then buttocks. rotate around the site with each injection (i.e. different quadrants of abdomen). Rotate region weekly or so (week one do abdomen, then do arm for one week). |
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Which insulin should you not mix with other insulins?
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long acting should never be mixed
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Name an insulin sensitizer.
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Biguanides and TZDs (Metformin/ Glucophage and Pioglitazone/Actos)
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Name an insulin secretagogues.
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Meglitinides/Glinides (Repaglinide/Prandin) and Sulfonylureas (SFU)
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What is a rare but serious risk of Metformin?
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Lactic acidiosis
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When is Metformin contraindicated?
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should not be used for renal failure, hepatic dysfunc. or heart fail or if being testing with contrast dye
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What are some important teaching points about Symlyn(aka pramlintide), a recently approved agent?
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1. NEVER MIX with insulin, give injection at least 2' away from insulin injection
2. risk for dose error (pen strenth NOT the same as vial stregth) 3. Use new needle for each dose 4. don't use if it has been frozen 5. keep away from light 6. Take medication requiring rapid onset 1 hr before or 2 hrs after pramlintide |
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Pt is taking the Incretin mimetic—Byetta and is having several abd pain what might the pt have?
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Pancreatitis
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Physiology of Diabetes:
How do you distinguish between type 1 and type 2? |
type 1 beta cells are destroyed and no longer produce an insulin and amylin. type 2: beta cells have impaired production of insulin and amylin AND insulin resistance.
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How often do you check the A1C for T2DM pts?
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—test q 3-4 months until regulated, then q 6 months
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What is the point of checking the A1C?
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—shows how well person is controlling diabetes
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Which populations are at risk for type 2 diabetes?
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> 40 years old, obese, non-white
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WHAT ARE complications of hypoglycemia?
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DKA RESULTING IN :
1. METABOLIC ACIDOSIS 2. COMA/DEATH 3. FRUITY BREATH 4. KUSSMAUL BREATHING |
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The story of two polys are it relates to clincal manifestations just means that the more you pee, the more you crave ______.
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The story of two polys are it relates to clincal manifestations just means that the more you pee, the more you crave WATER (THIRSTY). (POLYURIA RESULTS IN POLYDIPSIA)
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Glucose is stored in the ______ and _______ ______ . Glucose is NOT stored in the b_____.
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Glucose is stored in the LIVER and SKELETAL MUSCLE . Glucose is NOT stored in the BRAIN.
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How do alpha cells regulate glucose? How do beta cells regulate glucose? How are beta cells effected in type 1 diabetes?
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Alpha cells release glucagon which releases glucose into the bloodstream. Beta cells release insulin and amylin which stores glucose in liver and muscle cells as glycogen or fat.
The beta cells are destroyed in type 1 diabetes. Type 2 beta cells are impaired AND there is INSULIN RESISTANCE at insulin receptor. |
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ketoacidosis happens in WHICH TYPE OF DIABETES?
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type 1 diabetes
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Blood glucose goals for diabetics (fill in the blanks):
Pre-prandial level: 70 - ____ mg/dL Peak postprandial level < ____ mg/dL Hemoglobin A1C no higher than __% |
Pre-prandial level: 70 - 130 mg/dL
Peak postprandial level < 180 mg/dL Hemoglobin A1C no higher than 7% |
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ENDOCRINE
Primary, secondary, tertiary |
gland=1, pituitary=2, hypothal=3
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Hypothalamus releases which sort of hormones? (releasing, actual, stimulating)
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releasing Hormones.
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Pituitary release releasing hormones.
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Gland releases actual hormone that performs the action
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Diabetes insipidous(DI) similarities and differences with DM
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Where is oxytocin made/stored?
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Posterior pituitary
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Where is the Antidiuretic hormone stored?
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Posterior pituitary
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Where are Thyrotrophs—TSH made?
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Anterior Pituitary
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Examples of Where are Corticotrophs—
corticotrophin (ACTH) made/stored? |
Anterior Pituitary
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Where are •Lactotrophs—
prolactin made/stored? |
Anterior Pituitary
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Where are •Gonadotrophs—LH
and FSH made/stored? |
Anterior Pituitary
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Where are •Somatotrophs—GH made/stored?
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Anterior Pituitary
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Where are •Pars Intermedia—
melanocyte stimulatinghormone made/stored? |
Anterior pituitary
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Examples of hormones released from glands: testosterone
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Examples of hormones released from glands: testosterone
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What do you use to treat diabetes insipidous? Desmopressin (replaces ADH)
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DI—deficiency in ADH
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Know about SIADH—syndrome of inappropriate ADH—too much ADH…fluid retention
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Facts about desmopressin
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What is acromegaly –excess growth hormone
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Know manifestations of acromegaly
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Know the opposite (insuff of GH) and the manifestations (short stature)
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What treats acromegaly? Octreotide
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Know when your TSH is elevated if the T3 or T4 will be high or low. TSH is high then t3 and t4 will be low.Study slide: “test of thyroid function”
T3 and T4 are low in the primary (gland) disfunction: TSH elevated |
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Know about Graves disease= know characteristics, symptoms, drugs and efficacy of drug therapy
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Hypothyroidism=know characteristics, symptoms, drugs and efficacy of drug therapy
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What is thyroid storm?just know what it is—not too much detail
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Readings in F&E lecture about calcium balance and ADH
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Know glulcocorticoids (other uses:endocrin and non-endocrin uses)
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Chapter about men’s health (replacing testosterone in males and females and performance enhancing drugs)
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Look at 64 in Lehne
Know Addison’s disease |
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Know small details about Cushings (signs and symptoms)
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Hypo and hypercalemia and hypo/hypernatremia→related to Addison’s and Cushings (and know other symptoms too)
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Know which hormones come from inner, middle, outer cortex (maybe not be on exam)
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DIGESTIVE
Know anatomy and physiology Innervations, motility, secretion of enzymes and juices helping with digestion |
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H2 blockers for treatment of nausea and vomiting (not just allergies)
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Know about proton pump inhibitors and nausea meds
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Know chron’s disease
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Know meds for constipation, diarrhea and ulcers
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Know h pylori drug regimens—treat with multiple drugs (multiple antibiotics, h2 blocker, proton pump inhibitors and stomach lining protector….)chart 77-2 in Lehne
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Know endings of the drugs
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Know where lipids, carbs and proteins are digested
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Which cells secrete the enzymes digesting carbs, proteins and lipids?
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Know gastric secretions. “HCl secretions by parital cells”
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Reglan facilitates motility
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GERD
Know GI bleeding in general—ulcers, colon cancer GERD can lead to Barret’s esophagus later (precancer to esophageal cancer) |
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Hiatal hernia
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Know about antiemetics
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Laxatives and bulk forming—know classifications of the laxatives (5)
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and the three groups (groups =type of stool the produce and how much time—group 1=2-6 hours, group 2=…)
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Antiulcer drugs—know classifications
H2 blocker drugs-tx of n/v and also used for antiulcer |
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Know sucralfate—protects mucosal barrier
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??
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Cytotech (slide by sucralfate)—know about this drug
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Tables 77-3, 4 and 5 are about mucosal protective agents (in notes)
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Celiac disease—know about diease (gluten allergy)
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Study obstructions. Obstruction causes distention and draws water and electolytes
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Look up bowel obstruction
Fluid and electrolyes imbalances and dehydration quickly developed from obstruction |
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High obstruction may develop met.
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Alkalosis and LOW obstruction may develop met. Acidosis
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You are at risk for hypokalemia if you have diarrhea
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List complications of hyperglycemia
(7 items listed) |
1. nephropathy
2. neuropathy, 3. retinopathy(microvascular disorder), 4. cardiovascular disorders (macrovascular disorders), 5. infections 6. cataracts 7. connective tissue disorders |
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What is the range for an impaired fasting glucose?
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FPG= 100-126
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What is the range for impaired glucose tolerance (IGT)?
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2 hours post challenge glucose= 140-200
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What is the function of the Impaired Fasting Glucose (IFT) and Glucose Tolerance (IGT) tests?
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To predict increased risk of diabetes and macrovascular complications
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The diagnositc criteria for diabetes (nonpregnant) include:
1. A random plasma glucose of >_____mg/dL with symptoms of hyperglycemia 2. Fasting plasma glucoses >/=____ on two occasions 3. Elevated glucose on ________ on 2 occations 4. An A1C of > _____% |
The diagnositc criteria for diabetes (nonpregnant) include:
1. A random plasma glucose of >_____mg/dL with symptoms of hyperglycemia 2. Fasting plasma glucoses >126 on two occasions 3. Elevated glucose on the ORAL GLUCOSE TOLERANCE TEST on 2 occations 4. An A1C of > 6.5% |
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Normal BG (non-diabetic) should be in this range
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60-100
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