Exam 5: Lpc19 & 34 And Lilley31 (+)

Front 1

Birth asphyxia is AKA *__* and is described as acute brain injury caused by asphyxia when the baby did not get enough oxygen during the birth process

Back 1

-perinatal asphyxia

-asphyxia neonatorum

-hypoxic ischemic encephalopathy

Front 2

Possible causes of asphyxia (which occurs in 4 out of 1000 births in the US) are:

Back 2

-Insufficient O2 to Mom in labor

-Moms BP is too ⬆ / ⬇ during labor

-The placenta separates from the uterus too quickly, = ing loss of O2

-The umbilical cord is wrapped too tightly around the neck or body

-Fetus is anemic & w/out enough RBCs to withstand contractions

-Newborn's airway becomes blocked

-Delivery is too long or too difficult

Front 3

Tissues 1st affected the lack of oxygen in the cells are the:

Back 3

brain, muscles and heart

Front 4

The three hormones that are essential for the proper regulation of metabolism are:

Back 4

thyroxine (T4), triiodothyronine (T3) and calcitonin

Front 5

The parathyroid are two pairs of bean shaped glands just above and behind the thyroid gland. They are responsible for maintaining adequate levels of calcium in the __ __ primarily by mobilizing calcium from bone

Back 5

extracellular fluid

Front 6

T3 & T4 are stored in follicles of the thyroid gland and then released into circulation when triggered by __ (as their levels in the blood become too low)

Back 6

TSH

Front 7

Thyroid hormones are essential for normal growth and development. They control the thermoregulatory center in the brain and have various effects on the __, __ & __ systems

Back 7

cardiovascular, endocrine and neuromuscular

Front 8

__ hypothyroidism is the most common form and stems from an abnormality in the thyroid gland itself, making it unable to __ the thyroid hormones

Back 8

Primary; release

Front 9

Secondary hypothyroidism begins in the __ __ & is d/t reduced secretion of TSH, which we know is needed to trigger the release of __ & __

Back 9

pituitary gland; T3 and T4

Front 10

Tertiary hypothyroidism is due to a reduced level of the __ releasing hormone from the __, which in turn reduces TSH

Back 10

thyrotropin; hypothalamus

Front 11

Symptoms of hypothyroidism include:

Back 11

cold intolerance

unintentional weight gain

depression

dry brittle hair and nails

fatigue

Front 12

Hyposecretion of thyroid hormone during __ may lead to __, which is characterized by low metabolic rate, retarded growth and sexual development and possible mental retardation

Back 12

youth; cretinism

Front 13

Hyposecretion of thyroid hormone as an adult may lead to __, which is. manifested by a ⬇metabolic rate, loss of mental and physical __, weight gain, hair loss, firm edema & yellow dullness of the skin

Back 13

myxedema; stamina

Front 14

Some forms of hypothyroidism result in the formation of a goiter, which is an enlargement of the thyroid gland resulting from its __ by ⬆ levels of TSH secondary to little or no __ __ in circulation.

Back 14

overstimulation; thyroid hormone

Front 15

The most common cause of hyperthyroidism is __ disease

Back 15

Graves'

Front 16

Thyroid storm is a severe and potentially life-threatening exacerbation of the symptoms of hyperthyroidism and is usually induced by __ or __.

Back 16

stress or infection

Front 17

Common symptoms of hyperthyroidism are:

Back 17

diarrhea

flushing

increased appetite

muscle weakness

fatigue

palpitations

irritability

nervousness

Sleep Disorders

heat intolerance

altered menstrual flow

Front 18

The synthetic thyroid preparations are __ (T4), __ (T3) and Liotrix, which contains T4 & T3 in a 4:1 ratio

Back 18

Levothyroxine; Liothyronine

Front 19

__ is the preferred thyroid drug because it's hormonal content is standardized and its effect is predictable

Back 19

Levothyroxine

Front 20

Fetal growth may be retarded if maternal __ remains untreated during pregnancy

Back 20

hypothyroidism

Front 21

Contraindications to thyroid preparations include __ __ & __ __.

Back 21

recent MI & adrenal insufficiency

Front 22

The most significant AE of thyroid medication overdose is:

Back 22

cardiac dysrhythmia/ fatal irregularities

Front 23

Interactions:

Thyroid meds may enhance the activity of oral __.

__ binds to thyroid hormone in the GI which ⬇ the absorption of both.

Back 23

Anticoagulants

Cholestyramine

Front 24

Common AE of Thyroid meds by body system:

Back 24

Cardiovascular- Tachycardia, angina, dysrhythmia, HTN

CNS- Insomnia, tremors, HA, anxiety

GI- Nausea, diarrhea, cramps

Other- Menstrual irregularities, weight loss, sweating, heat intolerance, fever

Front 25

⬇ levothyroxine effectiveness when given with:

Back 25

Phentoin & fosphentoin

Cholystyramine, antacids, Calcium salts, iron, & estrogen

Front 26

⬆ __ effect when given with thyroid drugs

Back 26

Warfarin

Front 27

When giving IV Levothyroxine, the vial Must be __ 1ST & then the dose is calculated upon the concentration of the __ med, NOT the size of the vial.

Back 27

diluted; reconstituted

Front 28

Antithyroid drugs, iodides, ionic inhibitors, surgery, & radioactive isotopes of iodine are used as tx of __ __ __ of hyperthyroidism

Back 28

the underlying cause

Front 29

__ __ are used to treat the symptoms of hyperthyroidism.

Back 29

Beta blockers

Front 30

Radioactive iodine works by __ the thyroid gland in a process known as __, which is commonly used as tx of both hyperthyroidism & thyroid cancer

Back 30

Destroying; ablation

Front 31

Methimazole & Propylthiouracil ⬇the thyroid hormone level in the body by __ __ __ of the components needed for its synthesis.

Back 31

inhibiting the conversion

Front 32

Surgical resection of the thyroid gland is used in those __ of Antithyroid drug therapy & in __ (d/t it typically being contraindicated during this time)

Back 32

intolerant; pregnancies

Front 33

Propylthiouracil is only to be used during the __ __ & then methimazole is used for the remainder of the pregnancy (if imperative) though both drugs are __

Back 33

1st trimester; category D

Front 34

The most serious SE of Antithyroid drug therapy is __ & __ __ toxicity.

Back 34

Liver & bone marrow

Front 35

There are additive __ effects when Antithyroid drugs are given with bone marrow suppressants as well as an increase in the activity of __ __.

Back 35

leukopenic; oral anticoagulants

Front 36

Approximately __ __ of therapy with Propylthiouracil may be needed before symptoms improve

Back 36

two weeks

Front 37

Common AE of Antithyroid drugs by body system:

Back 37

Front 38

Watch for s/s of thyroid crisis aka __ __, which is manifested by exacerbation of hyperthyroidism, r/t precipitating causes such as __ or __, & is potentially life threatening.

Back 38

thyroid storm; stress or infection

Front 39

Thyroid hormone replacement requirements are approx. __ __ in patients 60 & older (than in younger patients). Patients must call the MD immediately if they experience palpitations, angina, stumbling, depression, incontinence, sweating, SOB, aggravated heart disease, cold intolerance or weight gain

Back 39

25% lower

Front 40

Thyroid meds should be taken @ the same time every day:

Back 40

30 minutes before breakfast (on an empty stomach)

Front 41

Vitamins, supplements containing __ or __, antacids & OTC preparations with __ should also be avoided within a 4-Hour time frame when taking thyroid medications

Back 41

iron or calcium; iodine

Front 42

While taking thyroid replacement drugs, iodized salt and iodine rich foods such as **__** must be avoided, as must changing brands of the medication

Back 42

soy beans, tofu, turnips, Seafood and some breads

Front 43

If the patient is scheduled to undergo radioactive iodine isotope studies, the thyroid replacement drug is discontinued about __ __ before the test

Back 43

4 weeks

Front 44

PTU must be taken with meals to help decrease stomach upset. Any fever, sore throat, mouth ulcers, skin eruptions, odd bleeding or bruising needs to be reported immediately as they may be signs of :

Back 44

liver or bone marrow toxicity with possible leukopenia

Front 45

Sleeplessness can be prevented by taking thyroid replacement drugs in the morning. These meds are not to be abruptly discontinued, & __ therapy is usually the norm.

Back 45

lifelong

Front 46

All thyroid tablets must be protected from __.

Back 46

light

Front 47

Antithyroid meds are better tolerated when __ __ __, should be taken the same time everyday, and never __ __.

Back 47

taken with meals; withdrawn abruptly

Front 48

When monitoring lab values for a patient taking anti thyroid drugs, the nurse knows to watch for:

Back 48

Increased blood urea nitrogen level

Front 49

Diabetes mellitus is a complex d/o of carb, fat & protein metabolism, d/t lack of insulin secretion by the __ __ of the __, or from defects of the __ .

Back 49

beta cells of the pancreas; insulin receptors

Front 50

Diabetic ketoacidosis (DKA)is a severe __ complication of uncontrolled diabetes that, if left untreated, leads to __ __ & __.

Back 50

metabolic; diabetic coma and death

Front 51

Glucagon: a hormone produced by the __ cells in the islets of langerhans that stimulates the conversion of __ to __ in the liver.

Back 51

alpha; glycogen to glucose

Front 52

__: simple sugar that serves as a major source of energy and is the final breakdown product of complex carbohydrate metabolism in the body. Often referred to as __

Back 52

Glucose; dextrose

Front 53

Glycogen: a __ that is the major carbohydrate stored in __ cells.

Back 53

polysaccharide; animal

Front 54

__: the breakdown of glycogen to glucose

Back 54

Glycogenolysis

Front 55

Hemoglobin A1C is aka __ __.

Back 55

glycosylated hemoglobin

Front 56

Hyperglycemia= fasting blood glucose level of __ or higher, or a non- fasting level of __ or higher.

Back 56

126; 200

Front 57

__ __ __ (HHS): a metabolic compli-cation of uncontrolled DM II similar in severity to DKA but without __ & __

Back 57

Hyperosmolar hyperglycemic syndrome; ketosis and acidosis

Front 58

Hypoglycemia: blood glucose level less than __ or above 50 mg/dL with __ __ __.

Back 58

70; s/s of hypoglycemia

Front 59

Insulin: naturally occurring hormone secreted by the __ cells of the islets of langerhans in the __ in response to ⬆ levels of glucose in the blood.

Back 59

beta; pancreas

Front 60

__: organic chemical compounds produced through the oxidation of secondary alcohols (eg- fat molecules) including dietary carbohydrates

Back 60

Ketones

Front 61

__: chronic excessive intake of water; a common symptom of uncontrolled diabetes

Back 61

Polydipsia

Front 62

__: excessive eating; common symptom of uncontrolled diabetes

Back 62

Polyphagia

Front 63

DM 1: genetically determined __ d/o characterized by complete or nearly complete lack of insulin production; most commonly arises in __ or __.

Back 63

autoimmune; children or adolescents

Front 64

DM 2: commonly presents in adults; becoming more common in kids and adolescents d/t __ & __ __; may be controlled by lifestyle modifications, oral drug therapy &/or insulin

Back 64

inactivity and weight gain

Front 65

When more circulating glucose is needed, glycogen (stored in the __, __, & __) is converted back to glucose through glycogenolysis, which is initiated by glucagon. Glucagon has __ __ on muscle glycogen & adipose tissue triglycerides stores

Back 65

liver, muscles & adipose tissue; minimal effects

Front 66

Because of the critical role of the pancreas, __ or __ __ transplants are sometimes undertaken to treat DM 1 that has not been controlled by other means

Back 66

pancreatic or islet cell

Front 67

Kidneys unable to reabsorb excess glucose excrete it in large amounts along with ketones & other solutes into the urine. This loss of nutrient energy leads to __, __ __ & __.

Back 67

polyphagia, weight loss and malnutrition

Front 68

The presence of ⬆ solutes in the distal renal tubules and collecting ducts draws large volumes of water through osmotic diuresis, which leads to __, __, & __.

Back 68

polyuria, dehydration and polydipsia

Front 69

Criteria for dx of diabetes: Fasting plasma glucose level of 126+ mg/dL or A1C greater than __%

Fasting is defined as no caloric intake for at least __ __.

Back 69

6.5%; 6 hours

Front 70

Further criteria for dx of diabetes:

s/s of DM (ie, polydipsia, polyuria and unexplained weight loss) plus casual plasma glucose level of __ (+) mg/dL. "Casual" means measured at any time of the day, without regard to:

Back 70

200; time since last meal

Front 71

Further criteria for dx of diabetes:

2-hour plasma glucose level of 200 + during an __ __ __ __ (OGTT). The glucose load should contain the equivalent of 75gm of glucose dissolved in water, & isnt recom-mended for routine clinical use. A positive finding for any of the criteria listed should be confirmed by:

Back 71

oral glucose tolerance test; repeat testing on a different day

Front 72

Uncontrolled type 1 diabetes is often referred to as __ __ & these patients have large fluctuations in their blood glucose levels

Back 72

brittle diabetes

Front 73

When blood glucose levels are ⬆, but no insulin is present to allow glucose to be used for energy, the body may break down fatty acids for fuel, producing __ as a metabolic byproduct. If this occurs to a sufficient degree, __ may result.

Back 73

ketones; DKA

Front 74

Approximately __-__% of patients with newly diagnosed type 1 DM present with DKA.

Back 74

25 to 30

Front 75

It was formerly believed that DKA occurred only in DM1 and HHS only in DM2. However, both d/o can occur with DM of either type, & this overlap is increasingly common with the rapidly __ __ of patients with DM2.

Back 75

decreasing age

Front 76

Relatively uncommon gestational diabetes occurs in about __ - __% of pregnancies

Back 76

2 to 10

Front 77

As many as 30% of patients who experience gestational diabetes are estimated to develop DM2 within __-__.

Back 77

10 to 15 years

Front 78

Women who develop gestational DM need to be screened for lingering diabetes __-__ postpartum & advised of their increased risk and of the importance of regular check-ups and weight control

Back 78

6-8 weeks

Front 79

Lispro (Humalog) = __ acting

Regular(Humulin, Novolin) = __ acting

glargine (Lantus) = __ acting

Back 79

-rapid

-short

-long

Front 80

__, __, __, & __ __ interfere with insulin, resulting in ⬆ blood glucose levels

Back 80

Corticosteroids, diuretics, estrogen, & thyroid drugs

Front 81

Nonselective beta-blockers mask the __ from __.

Back 81

tachycardia from hypoglycemia

Front 82

Hypoglycemic drugs, diuretics and corticosteroids all interact with __, resulting in additive effects of hypoglycemia.

Back 82

Metformin

Front 83

When metformin is given with __, it inhibits metabolism, which ⬆ metformins effects.

When it is given with contrast media, there is ⬇excretion, resulting in __ __

Back 83

cimetidine

lactic acidosis

Front 84

When glipizide is given with: ***

there is an ⬆ in metabolism & a

⬇ in effectiveness of the glipizide

Back 84

-Beta blockers

-Carbamazepine

-Cimetidine

-DPP-4 Inhibitors

-Erythromycin

-Fluconazole

-Garlic

-Ginger

-Ginseng

-Phenobarbital

-Phenytoin

-Rifampin

-Sulfonamide antibiotics

Front 85

Effective glycemic control during pregnancy is essential, cuz infants born to women w/ gestational DM have a __-__ greater risk of congenital anomalies. In addition, the incidence of __ is directly related to the degree of maternal hyperglycemia

Back 85

2-3x; stillbirth

Front 86

Women with gestational diabetes tend to have babies that weigh more and have trouble with __ __ __ in the postnatal period.

Back 86

low blood sugar

Front 87

__ (ie, Glipizide) bind to receptors on beta cells in the pancreas to:

⬆ the release of insulin &

⬇ the secretion of glucagon

Back 87

Sulfonylureas

Front 88

For sulfonylureas to be effective, the patient must have functioning __ __, thus these drugs work best during the early stages of DM2 and are not used in DM1

Back 88

beta cells

Front 89

Contraindications for sulfonylureas include a potential for cross-allergy in patients who are allergic to __ __

Back 89

sulfonamide antibiotics

Front 90

__ (Prandin & Starlix) have a similar MOA to sulfonylureas, so they must not be given together, as they both ⬆ insulin secretion.

Back 90

Glinides

Front 91

Glinides have a short duration of action & must be given w/ each meal. Thus, they may be particularly useful for patients with ⬆ __ glucose levels but low levels of circulating insulin

Back 91

postprandial

Front 92

Glitazones are referred to as __ __ __, as they work to ⬇ insulin resistance by enhancing the sensitivity of insulin receptors

Back 92

insulin sensitizing drugs

Front 93

Because glitazones affect __ __, they have a slow onset of activity over several weeks, & maximal activity may not be evident for many months

Back 93

gene regulation

Front 94

Glitazones may be combined w/ __ or a __ for a synergistic effect.

Black box warning for ❤ failure, liver or kidney disease, as well as ⬇ bone mineral density &⬆ risk of fractures

Back 94

metformin; sulfonylurea

Front 95

__-__ inhibitors (aka gliptins) delay breakdown of incretin hormones & ⬇ fasting and postprandial glucose concentrations.

Back 95

DPP-IV

Front 96

Common AE of DPP-IV inhibitors include:

Back 96

Upper respiratory tract infection

HA

Diarrhea

May increase digoxin levels

Front 97

Glipizide is contraindicated in DM1 & brittle DM2.

OK in patients w/ __ __ __.

Given 30 minutes before breakfast

Back 97

severe renal failure

Front 98

__ (glucophage) is the only biguanide oral drug. It inhibits hepatic glucose production & ⬆ the __ of tissue to insulin.

Back 98

Metformin; sensitivity

Front 99

Metformin may be given w/ sulfonyl-ureas.

It can not be given to patients with:

Back 99

hepatic, renal, or cardiopulmonary disease or alcoholism

Front 100

Amlyn Agonists mimic the action of the hormone amlyn, (secreted by the beta cells along with insulin) to ⬇ postprandial glucose levels by:

Back 100

-Slowing gastric emptying

-Suppressing glucagon secretion and hepatic glucose production

-Increasing satiety

Front 101

__ memetics (released by the GI tract in response to food) stimulate insulin secretion, ⬇ postprandial glucose production, slow gastric emptying and increase satiety.

Back 101

Incretin

Front 102

Incretin memetics are rapidly deactivated by the enzyme ___-__.

Back 102

dpp-iv

Front 103

Incretin mimetics (think "-tide", ie exenatide, dulaglutide, Albiglutide, liraglutide) are available only as __ __ & only for patients with DM2 who've been unable to achieve glucose control with metformin sulfonylureas and/or a glitazone

Back 103

Sub-Q injections

Front 104

Incretin mimetics are best given 60 minutes before a meal and all share black box warnings for __ __ __, along with N/V/D & a 5 to 10 lb weight loss

Back 104

thyroid c-cell tumors

Front 105

(SGLTs) __ __ __ __ (work indepen-dently of insulin to) inhibit glucose reabsorption in the __ renal tubules, which leads to a ⬇in blood glucose and an ⬆ in renal glucose excretion.

Back 105

Sodium glucose-linked cotransporters; proximal

Front 106

SGLT2s (think "-liflozin", ipragliflozin, tofogliflozin, canagliflozin, dapagliflozin [Farxiga], empagliflozin) may also ⬆ insulin sensitivity and glucose uptake in the __ cells & ⬇ __.

Back 106

muscle; gluconeogeneisis

Front 107

SGLT2s are contraindicated in __ and moderate to severe __ impairment

Back 107

dka; kidney

Front 108

The AE of SGLT2s include:

Back 108

genital yeast infections

UTIs

⬆ urination

hyperkalemia

an ⬆ in LDL cholesterol

hypotension

hypovolemia

Front 109

Early s/s of hypoglycemia include:

Back 109

confusion

irritability

tremor

sweating

Front 110

Later s/s of hypoglycemia include:

Back 110

hypothermia & seizures; without adequate restoration of glucose levels, coma and death will occur

Front 111

__ tablets and semi-solid __ are designed for rapid mucosal absorp-tion of concentrated glucose in a hypoglycemic event.

Back 111

Buccal; gels

Front 112

If a patient is unconscious, IV __ is used most often, along with Sub-Q __ (which may induce vomiting, so roll an unconscious patient onto their side prior to injection)

Back 112

D50W; glucagon

Front 113

Afrezza is a rapid-acting insulin administered via __ dosage form. Its contraindications include patients who smoke, have chronic asthma or COPD, and carries a black box warning r/t __ __.

Back 113

inhaled; acute bronchospasms

Front 114

Avoid extreme temps & sunlight, cuz insulin's protein structure will be permanently denatured. Never give __ insulin or __ it, but it can be stored for up to one month at room temp or up to three months in the fridge.

Back 114

cold; freeze

Front 115

DM patient education should include info about situations or conditions that may lead to altered serum glucose levels, such as:

Back 115

fever

illness

stress

increased activity or exercise

surgery

emotional distress

Front 116

We must also educate patients about the importance of knowing __-__ serum glucose levels before taking insulin, and the importance of __ meals r/t the type of insulin

Back 116

pre-meal; timing

Front 117

Rapid acting afrezza peaks in 15- 20 minutes, and has a 2 to 3-hour duration of action, so it will not replace the need for:

Back 117

injected long-acting insulin

Front 118

The side effects of afrezza include:

Back 118

hypoglycemia, cough and throat pain or irritation

Front 119

American Heart Association's recommendations, as it relates to exercise for diabetic patients include

Back 119

30 minutes of exercise daily and 150 minutes per week

Front 120

Patients must be educated about the need to monitor blood sugar __ & __ exercise to avoid hypoglycemia, and adjusting insulin as directed

Back 120

before and after

Front 121

Stress the need for strict foot care, including daily assessment- checking for sores or any other changes in __, __, __, or __, and contacting the MD if there is suspicion of any wound or alteration in skin integrity

Back 121

color

temperature

swelling

drainage

Front 122

Some oral anti-diabetic drugs cause __, so patients must wear protective sunscreen and avoid use of tanning beds

Back 122

photosensitivity

Front 123

Little or no __ insulin is produced by people with DM1 (which only = about __% of all DM patients).

Back 123

endogenous; 10

Front 124

Because insulin therapy is required for dm1 patients, those who have the cognitive & financial ability, need to be encouraged to consider adding an __ __ with __ __ __ as part of their therapy

Back 124

insulin pump, continuous glucose monitoring

Front 125

If normal blood glucose levels are not achieved after __-__ __ of Lifestyle Changes in DM2 patients, tx with oral anti-diabetic drugs is often added to the regimen.

Back 125

2-3 months

Front 126

Complications r\t DM include:

Annual retinopathy, urinalysis and renal function screenings are recommended

Back 126

Retinopathy

Neuropathy

Nephropathy

HTN

Cardiovascular disease

CAD

Front 127

All rapid-acting, short-acting and long-acting Insulin preparations are:

All intermediate acting insulins are:

Back 127

Clear Solutions

Cloudy Solutions

Front 128

Insulin vials are to be __ in the __ instead of shaken.

Back 128

rolled in the hands

Front 129

Dm2 patients scheduled for MRIs with contrast dye should expect to:

Back 129

Hold their metformin the day of the test and for 48 hours after the test is performed

Front 130

If a DM2 Patient taking (Prandin) repaglinide keeps misses a meal, they will need to plan to:

Back 130

Skip that next dose of Prandin

Front 131

A patient taking metformin should expect a potential AE which include:

Back 131

abdominal bloating

nausea

diarrhea

metallic taste

Front 132

A patient with DM2 asks about a new insulin that can be inhaled. Which condition, if present in the patient would be a concern?

Back 132

Chronic lung disease