Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
130 Cards in this Set
- Front
- Back
|
Where is thyroxine produced?
|
Thyroid gland - regualtes metabolism
|
|
|
Where is epi produced?
|
adrenal medulla - triggers fight or flight
|
|
|
Where are androgens produced?
|
testes - promotes male traits
|
|
|
Where is insulin produced?
|
pancreas - lowers blood glucose
|
|
|
Wehre is melatonin produced?
|
pineal gland - related to daily rhythmn
|
|
|
Whre is FSH produced?
|
anterior pitutary - stimulates ovaries
|
|
|
Where is PTH produced?
|
parathyroid - raises bld calcium levels
|
|
|
Where is ADH produced?
|
hypothalmus - boost water retention
|
|
|
uncontrollled Diabetes is 6th cause of death, leadign cause of blindness, adn end stage renal disease,
|
True
|
|
|
What is leading cause of diabetes related death?
|
Heart disese 2-4 times greater risk of MI or stroke if have diabetes
|
|
|
What is percentge of type 2 Diabetes?
|
90% - can be seen in children r/t obesity, poor nutrition
|
|
|
Risk factors for type 2 diabetes
|
fam hx, inactivity, overwieght, HTN, dislipedemia, GDM, race - black indians
|
|
|
How is Type 2 diabetes different than Type 1?
|
do not always need insulin injections to live, high risk for microvascular nad macrovascular complications. can be present for years before diagnosis made, disease progresses regardless of treatment
|
|
|
What cuases with Type 2 diabetes?
|
pt become insulin resistant
|
|
|
What can high sugars complications cause?
|
tissue lesions, Microvascular: Retinopathies nephropathy, neuropathy & Macrovascular, MI, PVD, Stoke
|
|
|
If control glucose and keep near normal how does this help?
|
decreases risk for microvascular risks: & macrovascular (MI, stoke & PVD)
|
|
|
Standards of CARe for diabetes?
|
ABC
A- A1c goal ,7%, test q3-6 montsh Bld pressure , 130/80 Cholesteral: total ,200, LDL < 100, TG: < 150, HDL > 40 males and > 60 females Test microalbuminuria annully, Serum creatinine test annually to estimate GFR, dilated eye exam annually, foot exam q visit, flu vaccine annually, pneunovax once before 65 & once after 65, nutrition therapy by diatician, diabetes self management education |
|
|
How to diagnose diabetes?
|
FBG: > 126, presence of polyuria, polydypsia and unexplained wt loss, fasting levels should < 100, glucose > 200 with 2 hr post prandial glucse
|
|
|
Who to test for diabetes
|
everyone over 45, repeat q 3 years, person with s/s,
|
|
|
What labs to draw for diabetes?
|
, A1c (3-6 months), pasting lipds, serum creatinine, UA (maybe), ECG
|
|
|
How often to communicate w/ patients?
|
daily for initiation of insulin, weekly for oral meds, quartely for those not meeting goals, or 6 months
|
|
|
Therapy options for Diabetes: Lifestyle interventiosn
|
Diet, Physical activity, weight loss
|
|
|
Therapy for diabetes: medications?
|
Sulfonylureas, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, combinatioen, DPP-IV inhibitors, non-insuling injectables, insulins,many need to be on a ACE inhibitor also
|
|
|
Name some sulfonyleurea?
|
Glipizide (glucotorl) Blyburide (diabeata) glimepiride & glipizide
|
|
|
What to know about sulfonylurea?
|
MOA: stimulates insulin seretion from pancreas, most common reaction hypoglycemia esp elderly, weight gain from insulin release
|
|
|
What to know abut biguanides (metformin)?
|
decreases gluconeogenesis (reduces glucose that comes out of liver), improves peripheral sensitiy to insulin, does not stimulate relase of insulin: Drugs: metformin (glucophage) - only give with food can cause GI upset, & lactic acidosis (rare), vit B12 decreases, monitoer hepatic fx and renal fx
|
|
|
Who shoudl not take Metformin?
|
renal impairment, CHF, hold meds if have contrast dyes d/t dye and metformin both excreted in kidney and can increase lactic acidosis,
|
|
|
How to thiazolidinediones (glitazones) work?
|
insulin sensitizers - decrease insulin resistance in muscle and liver which enhances glucose utilization & decreases hepatic glucose outpt. Risk of liver disease and heart failure
|
|
|
Name 2 thiazolinediones (TZDS)?
|
Rosiglitazone (Avandia) & Pioglitazone (Actos)
|
|
|
What are adverse affects of TZD?
|
heptotoxcity (rare), weight gain (report if > 6.6 lbs) mild to mod, caution use in CHF or heart failure, inc risk of MI, makes you fat and not used very much any more
|
|
|
Drug reactrions with TZD
|
Pioglitazone not to use iwth contraceptives or ketoconzolae
|
|
|
What MOA (mechanism of action) of alpha-glucosidease inhibitor?
|
delays carbohydrate absorption, reductioni in post meal hyperglycemia
|
|
|
Name 2 alpha-glucosidase inhibitor agents?
|
Acarbose (precose) & migilitol (glyset)
|
|
|
Side effects of alpha-glucosidase inhibitor agents
|
Flatulence, diarrhea, and abdominal pain - pt find side effects intolerable
|
|
|
How to treat hypoglycemia best?
|
glucose tablets
|
|
|
What is MOA of meglitinides?
|
Stimulate the release of insulin
|
|
|
Name Meglitinide agents
|
Repaglinide (Prandin), Netaglinide (Starlix)
|
|
|
Meglitinde pearls?
|
Can cause hypoglycemia
|
|
|
What is Exenatide (Byetta)
|
similar to incretin - intestinal hormone that increases insulin adn decrases glucose) Enhances glucose dependent insulin secretion, good to take with other diabetic meds who have not achieved glyemic control
|
|
|
side effects of Exenatide (Byetta)
|
N/V, hypoglycemia, does sustain weight loss, only works with meals
|
|
|
Waht is sitagliptin? (Januvia)
|
Lengthens the activity time of GLP-1 and GIP (natural incretin miminic)
|
|
|
What is Pramlintide acetate (symlin)
|
pancreas secretes amylin and insulin - both deficient in diabetic pt. What does amylin do: slows gastric empything, reduces post meal glucagon & increases satiety. symlin slows gastric emptying
|
|
|
What are rapid acting insulins?
|
lispro (humalog), Aspart (Novolog), Glulisine (Apidra) -works within 5-15 min - peak 1-2 hours
|
|
|
What are short acting insulins?
|
Regular (humulin R, Novolin R) works 30-60 min, peak 2-4 hours
|
|
|
What are intermediate insulins?
|
NPH (Humulin N, Novolin N) works 2-4 hours, peak 4-10
|
|
|
What are long-acting insulins?
|
Insulin glargine (Lantus)
onset 1-2 peak: 2-20 hours |
|
|
What is a dawn effect?
|
abnormal early morning increase in bld sugar
|
|
|
What is somogyi effect?
|
rebound is a rebounding high blood sugar that is a response to low blood sugar during the night - check middle of night BS check before changing insulin
|
|
|
What is most effecive therapy to lower A1c?
|
Insulin - best indicator of diabetes control, if high A1c need insulin usually oral drugs will not work
|
|
|
Weigth gain wtih insulin
|
As glycemic control improves, glucose is
captured by the body instead of being lost in the urine and promotes growth of adipose tissue |
|
|
What are normal A1c levels?
|
4-6% normal goal > 7%, oral agents will reduce 1 - 1 1/2%
|
|
|
How to manage type 2 diabetes?
|
Change interventions at as rapid a pace as
titration of medication allows, if glycemic goals are not achieved or sustained |
|
|
What is Step 1 in type 2 diabetes control?
|
Lifestyle intervention & metformin
|
|
|
What is Step 2 in type 2 diabetes control?
|
Add within 2-3 months of initial therapy or any time
within 2-3 months, A1c goal is not achieved, hoose among insulin, a sulfonylurea, or a TZD |
|
|
What is Step 3 in type 2 diabetes control?
|
Start or intensify insulin or if close add 3rd oral agent
|
|
|
What is comprehensive diabetes care?
|
Blood pressure control
|
|
|
What are s/s of hypoglycemia?
|
Blood glucose < 70 mg/dL
|
|
|
What is relationship with diabetes and HTN?
|
73% adults with diabetes have B/P >130/80, when B/P high inc risk of damaging vessel in eyes or kidneys (retinopahy or nephopathy), diabetics have lipid changes
|
|
|
What should be lipid management for diabetics?
|
With diabetes > 40 years of age with a total
cholesterol >135 mg/dL, statin therapy to achieve an LDL reduction of ~30% regardless of baseline LDL levels may be appropriate |
|
|
Triglycerides are directly r/t bld glucose?
|
true as BG lowers so do triglycerides
|
|
|
What to include in a diabetic foot exam?
|
sensory exam, and pedal pulses
|
|
|
What drugs increase blood glucose levels?
|
Corticosteroids
|
|
|
Shoudl you start a newly diagnosed Type 2 diabetic on insulin?
|
Yes if A1c is over 9%
|
|
|
What do yo uneed to have present to diagnose with metabolic syndrome?
|
3 out of 5
•Central obesity (waist circumference >39 inches for men, >35 inches for women) •Elevated fasting glucose >100 mg/dl, or drug treatment for elevated glucose •Elevated triglycerides: >150mg/dl, or on drug treatment for elevated triglycerides •Reduced HDL-C: < 40mg/dl in men; < 50mg/dl in women, or tx for reduced HDL-C •Elevated blood pressure: >130mm Hg systolic or > 85mm Hg diastolic or tx for elevated blood pressure |
|
|
What is microvascular disease?
|
caused by the long-standing hyperglycemia of diabetes and results in nephropathy, neuropathy, and retinopathy - not a part of metabolic syndrome
|
|
|
What are some s/s of hypothyroidism? Slowing of metabolic processes
|
Fatigue and weakness
Cold intolerance SOA Weight gain Cognitive dysfunction Constipation Slow movement and slow speech Delayed relaxation of tendon reflexes Bradycardia Carotenemia |
|
|
What are some s/s of hypothyroidism? Accumulation of matrix substances
|
Dry skin
Hoarseness Edema Coarse skin Puffy face and loss of eyebrows Periorbital edema Enlargement of the tongue brittle nails |
|
|
What are some s/s of hypothyroidism? Other
|
Decreased hearing
Myalgias and paresthesia Depression Menorrhagia Arthalgia Pubertal delay Diastolic hypertension Pleural and pericardial effusions Ascites galactorrhea fatigue forgetfulness, heavy periods arthritis |
|
|
What are s/s of hyperthyroidism? Acceleration of metabolic processes
|
Anxiety
Unexplained weight loss Menstrual changes scant periods Increased perspiration Weakness Hair loss Heart racing Tachycardia Atrial fibrillation Hair thin and fine Tremor Proximal muscle weakness Hyperreflexia |
|
|
What are s/s of hyperthyroidism? Other
|
Swelling
SOA Perioribital edema Systolic hypertension Infiltrative dermopathy Enlarged thyroid Gynecomastia Lid lag Stare diff sleeping, moist sweatly palms, frequent bowel movements, tremors of hands, soft nails. |
|
|
What tests to order if suspect hypothyroidism?
|
TSH, Free T4, T4,
|
|
|
How does thyroid hormone work?
|
affects most cells in body, increases triglycerdies and lipids, regulates metabolism, stimultes insulin dependdnet entry of glucos to cells, increase TH increases prodution of glucose, TH related to growth hormone, increase TH increases HR, acn output. change sin TH can change mental state: fatigue and depression, infertility with high or low
|
|
|
Hypothalmus produces TRH which stimulates Ant pitutary TSH which then stimulates thyroid hormones
|
True
|
|
|
What is function of Thryoiud gland?
|
produce iodine which is convereted to thyroid hormones, produces 80% T4 & 20% T3
|
|
|
What is subclinical hypothyroid disease?
|
TSH high or upper normals Free T4 normal, may have mild anemia, may have high cholesterol, may be depressed
|
|
|
How to treat subclinical hypothyroid disease?
|
Not agreed upon. Will treatment improve survival or decrease CVD? Lab normals are different. If TSH 3-5 no treatment (recheck TSh 6-12 months), if 5-10 and s/s then treat if no s/s then no treatment, if TSH > 10 treat
|
|
|
Hypothyroid treatment
|
levothyroxine 25-50 mcg (start low in older people, can start 75-100 mcg/day in younger pts) and recheck 6-8 weeks,once normal then recheck 6 months then yearly
|
|
|
Where shoudl TSh level be?
|
TSH at lower end of normal 0.3-3
|
|
|
What is overt hypothyroidism?
|
TSH over 10 and T4 low (first abnormal TSh recheck to make sure it was not a lab error)
|
|
|
When to refer for thyroid levels?
|
If TSh high and T4 is normal or if TSH high and T4 high (never need to order t3 this always stays the same)
|
|
|
What is hashimoto's thyroiditis?
|
Chronic autoimmune thyroiditis. most common cuase of primary hypothyroidism, often has goiter, can see transient hyperthyroidism d/t swelling of thyroid and leaking of T4 & T3, do not need to order thyroid antibioties as treatment the same
|
|
|
When to order a iodine uptake scan?
|
with nodules ot find out if nodule is hot or not (hot lower risk for being malignant, cold nodules riskier than hot ones) US ordered if want to determine size or possible nodules, but not routine)
|
|
|
Primary Hyperthyroidism is caused from thryoid gland dysfunction
|
True
|
|
|
Suspect seconday hyperthyroidism?
|
elevated TSH and high T4
|
|
|
Labs with primary hyperthyroidism
|
TSH -low, free T4 high then can diagnose Graves disease. if free T4 level normal then test free t3 level
|
|
|
What does elevation of T3 show? high level t3, normal t4 and low TSh
|
t3 toxicosis - Graves disease, 85% of hyperthyriodism is Graves disease
|
|
|
When do radioiodine thyroid uptake?
|
after diagnose primary hyperthyroidism, get thyroid uptake, if high and diffuse probably graves disease, can differntiate between graves disease and thyroiditis (low radioactive uptake)
|
|
|
What is subclinical hyperthyroidism?
|
low TSH and normal T4 & T3
|
|
|
When to treat hyperthyroid disease?
|
depends on age, size of goiter other medical conditions, severity of s/s and wishes of pt
|
|
|
What is radioactive iodine ablation?
|
radioactive iodine taken up by hyperactive cells of cells of goiter and tissue is destroyed. Gland ceases to fx w/i 2-3 months resulting in hypothyroid state need to take T4 for life
|
|
|
How can treat symptoms of hyperthyroidism?
|
with propranolol prevents conversion of T4 to T3, decrease arrhythmias & psychomotoer s/s of hyperthyroid state rapidly
|
|
|
If s/s of hyperthyroidism not controlled with beta blockers need to refer to endocrinologist
|
iodides can be initiated by endocrinologist
|
|
|
What anitthyroid drugs can be used to treat hyperthyroidism?
|
Propylthiouracil (PTU) and methimazole (MMI - cannot be use in pregnancy, but drug of choice) remission rate about 60% after 2 years, but relapes is high. probably need ablation or surgery
|
|
|
What is a thyroid nodule?
|
If TSH normal then aspirite nodule with fine needle aspiration if solid can be malignancy, If TSH low considerea hyperthyroidism, if TSH high consider hypothyroidism (hashimoto's thryoiditis)
|
|
|
Waht tests to order with nodule?
|
US to deterine size, location and character, thyroid scan and radioiodine scan, cold nodlue - low uptake of iodine,hot nodule reveals incrased uptake of iodine compared to tissue around it
|
|
|
Most subclinical hyperthyroidism is due to autonomouse functioning nodules?
|
true - nodules work independently secreting thyroid hormones
|
|
|
When to treat subclinical hyperthyroid disease?
|
moniter if TSH bewteen 0.1 and 0.5, consider if TSh < 0.1, or over 60 yo, or those increased risk of osteoporosis, or HD
|
|
|
When to use Metformin?
|
use early in diabetes - 2gm/day dose needed, use in metabolic syndrome, do not get hypoglycemic, helps utilization of insulin and helps liver not make suger
|
|
|
Lipids goals with diabetics
|
LDL less than 100, goal at 70 best
|
|
|
Do diabetics need to be on ASA?
|
yes
|
|
|
Why should you start someone with hyperthyroidism on a beta blocker?
|
Beta blocker had an inotropic effects and will reduce HR
|
|
|
Why start older adult slowly on thyroid repalcement?
|
thryoid replacements can be cardio toxic and need to monitor older adults closely
|
|
|
Define Type 2 Diabetes
|
progressive insulin secretory defect
|
|
|
How to diagnose type 2 diabetes?
|
A1c > 6.5% or FBG > 126, or 2 h postprandial glucose > 200, keep A1c under 7% reduces microvascular damage
|
|
|
Who is at high risk for diabetes?
|
A1c 5.7-6.4% or FBG 100-125 or 2 h post pranial glucose 140-199
|
|
|
What lifestyle changes should be made to help a pre-idabetic or diabetic?
|
lose weight (reduces insulin resistance), moderate exercise at least 150 min/week,
|
|
|
When is it OK to have A1c higher than 7%?
|
Elderly patients at high risk for hypoglycemia or have life expectancy less than 5 years
|
|
|
What is diagnositic criterea for metabolic syndrome?
|
elevated waist circumferance, elevated TG > 150, reduced HDL < 40 men < 50 women, elevated B/P 130/85, elevated FBG >100
|
|
|
What are the risks of having metabolic syndrome?
|
high CVD risk ad risk for diabetes, underlying risk factor abdominal obesity and insulin resistance
|
|
|
What are s/s of hypothyroidism?
|
lack of initiative, fatigue and somnolence, memory problems, slow motor functions and speech, coarse voice, feeling cold, decreased perspiration, constipation, weight gain, and generalized edema. The skin symptoms include a dry, rough, cold or pale skin. Periorbital oedema may occur. Hair may become rough, and there is hair loss. Pulse rate becomes slower.
|
|
|
How to prescribe thyroxine?
|
young pts start 50-100/day assess TSH 6-8 wks, older elderly and in patients with ischaemic heart disease the initial dose is 12.5–25 µg/day, and the dose should be increased slowly and carefully monitoring heart rate. If necessary, beta-blockers should be used. Cardiac patients may not be given too high doses of thyroxine.
|
|
|
What is autoimmune thyroiditis?
|
Hypothyroidism and increase concentraiton of thryoid perosxidase antibodies, increased susceptibiity to other autoimmune disorders
|
|
|
How to treat hyperthyroidism?
|
•Long-term treatment (18 months) with an antithyroid drug ( carbimazole 15–40 (–60 mg)) often provides a permanent cure for Basedow’s (Graves') disease.
•Start a beta-blocker and also antithyroid medication already at referral to a specialist when the diagnosis of hyperthyroidism is clear. radioiodine or surgical treatment - must treat as hypothryoidism afterwards |
|
|
Who gets Graves disease most?
|
Women 30-40 - self limiting disease that will often end with hypothyroidism
|
|
|
What are symptoms of hyperthyroidism?
|
•General symptoms
◦Hypersensitivity to heat and sweating ◦Fatigue, muscular weakness, deterioration of general condition ◦Increased appetite, weight loss ◦Thirst, polyuria ◦Headache may be the only cause that brings the patient to a doctor. •Thyroid gland is often enlarged •Skin symptoms ◦Warm and moist skin •Psychological symptoms ◦Lability, nervousness, irritability, sleeplessness •Cardiac symptoms ◦Tachycardia and arrhythmias, particularly atrial fibrillation, systolic hypertension •GIT symptoms ◦diarrhoea and abdominal discomfort •Ophthalmopathy in Basedow's disease only ◦Other types of ocular symptoms occur in many other patients with hyperthyroidism |
|
|
What labs diagnose hyperthyroidism?
|
•TSH below and free T4 above the normal range.
•If TSH is < 0.1 and the level of free T4 is normal, test free T3 to identify T3 hyperthyroidism. |
|
|
When should operate on thyroid nodule?
|
greater than 4cm, risk for malignancy if < 20 or > 70, male gender, solid nodules, need to US to asses nodule and do needle biopsy
|
|
|
What are ADA guideliens for treatment of type 2 diabetes?
|
first line - lifestyle intervention and metformin if A1c goal not met then add insulin, sulfonylurea or TZD
|
|
|
What to teach a diabetic patient?
|
What is diabeties and long term risk of high BS, how diet and exercise help, importance of monitoring BS, how meds work
|
|
|
What is Addison's Disease?
|
autoimmunie disorder or caused fromk TB - distruction of adrenal glands
|
|
|
Waht is Cushing Syndrome?
|
depression adn obesity caused by abnormal cortisol secretion - too much cortisol
|
|
|
What causes hyperglycemia in type 2 diabetes?
|
insulin resistance adn impaired beta cell fx. increased hepatic glucose production, impaired insulin secretion & decreased glycogen uptake
|
|
|
What are s/s of diabetes?
|
polyurina, poly dispsia, pholy phagia, weight loss, blurred vision, also candida infections, parethesis of feet, recurrent infections
|
|
|
What does A1c measure?
|
percentage of saturated glucose to hemoglobin, reflects glucose control in past 12 weeks.
|
|
|
What is insulin resistance associated with?
|
metabolic syndrome, nonalcoholic fatty liver disease, sleep apnea, diabetes type 2, prediabetes, cardiovascular disease and acanthosis nigricans (is a brown to black, poorly defined, velvety hyperpigmentation of the skin.)
|
|
|
What are s/s of diabetic neuropathy?
|
May be painless or cause painful burning, tingling sensation in periphery.
affects the patient’s sense of touch, temperature, and proprioception in the affected extremities. Feet most common site, painful at night, interrupts sleep. Autonomic neuropathy may affect the GU system causing impotence, retrograde ejaculation, urinary hesitancy, and overflow incontinence or the GI system causing N/V, abd distention, dysphagia, and diarrhea. |
|
|
What to labs measure annually in a type 2 diabetic?
|
serum creatinine and urine albumin
|
|
|
What is the first line B/P med for a diabetic?
|
ACE or ARB
|
|
|
What are s/s of hyperglycemia?
|
fatigue, increased urination, and thirst
|
|
|
What does the A1C represent?
|
to reflect average glycemia over several months
|
