Pharm Care Endocrine Dm

Front 1

what are hormones?

Back 1

endogenous chemicals that are produced locally and act in different parts of the body

Front 2

how do hormones maintain homeostasis?

Back 2

they stimulate or inhibit biological responses

Front 3

how is hormone concentration controlled?

Back 3

negative feedback

Front 4

an endocrine disorder is an _________ in physiological functions

Back 4

imbalance (deficiency or excess hormones)

Front 5

what are the 4 endocrine tets and what disease is each used to test for?

Back 5

plasma hormone concen (thyroid)
integrity of feedback mechanism (thyroid)
plasma substance concen (DM)
measurement of physiological effect (DI)

Front 6

what does the integrity of feedback mechanism test tell you about the thyroid & anterior pituitary

Back 6

the thyroid is functioning properly but the anterior pituitary is not

Front 7

what are the 3 general locations within the body?

Back 7

intravascular
intracellular
extracellular

Front 8

insulin is produced as a result of?

Back 8

hyperglycemia (insulin is the only substance that brings down blood sugar)

Front 9

what are the 7 roles of insulin in the body?

Back 9

1. stim glucose uptake
2. promote glucose storage (glycogenesis)
3. inhibits glycogenolysis
4. enhances fat storage (lipogenesis)
5. inhibits lipolysis
6. decr ketogenesis
7. inhibits gluconeogenesis

Front 10

glycogenesis

Back 10

storage of glucose as glycogen in muscle & liver

Front 11

gylcogenolysis

Back 11

breakdown of glycogen (inhibits production of glucose from liver & muscle)

Front 12

lipogenesis

Back 12

fat storage

Front 13

lipolysis

Back 13

break down / mobilization of fat for energy

Front 14

ketogenesis

Back 14

breakdown of fatty acids to ketone bodies

Front 15

gluconeogenesis

Back 15

formation of glucose from non carb sources (amino acids)

Front 16

what are the 4 counteregulatory hormones that control glucose levels

Back 16

glucagon
epinephrine
cortisol
growth hormone

Front 17

where is glucagon produced?

Back 17

alpha cells of the pancreas

Front 18

what effect does glucagon have on glucose homeostasis?

Back 18

glycogenolysis
glucose synthesis

Front 19

what efect does epi have on glucose homeostasis

Back 19

glycogenolysis
glucose synthesis

Front 20

what effect does cortisol have on glucose homeostasis

Back 20

gluconeogenesis

Front 21

what effect does growth hormone have on glucose homeostasis?

Back 21

inhibits uptake of glucose

Front 22

what are the physiological effects of insuline defiency?

Back 22

impaired glucose uptake (muscle)
impaired glycogenesis (liver)
impaired insulin induced supression of gluconeogenesis & glycogenolysis

Front 23

what are the 9 effects of a total lack of insulin in the body (type I DM)

Back 23

1. incr blood glucose concen
2. incr osmolarity (polyuria & polydipsia)
3. dehydration & electrolyte abnormalities
4. incr lipolysis
5. glycerol incr blood glucose even further
6. ketogenesis
7. ketonemia, acidosis, ketonuria
8. kussmaul breathing
9. ketoacidosis can lead to coma & death

Front 24

what is kussmal breathing

Back 24

rapid, deep, labored breathing
trying to compensate for acidosis

Front 25

8 s/s of type I diabetes

Back 25

hyperglycemia
polyuria
polydyspia
polyphagia
dehydration
acidosis
kassmaul breathing
hypokalemia

Front 26

what is type II diabetes?

Back 26

a relative lack of insulin & insulin resistance

Front 27

what are the 4 s/s of type II diabetes?

Back 27

hyperglycemia
polyuria
polydypsia
dehydration

Front 28

what may be a cause of hypogylcemia?

Back 28

over-treatment with antidiabetic drugs

Front 29

what are the 7 s/s of hypoglycemia

Back 29

hunger
sweat
nervous
sleepy
anxious
clumsy
bg < 70mg/dL

Front 30

what are the microvascular long term complications of DM?

Back 30

retinopathy
neuropathy
nephropathy (renal)

Front 31

what are the macrovascular long term complications of DM?

Back 31

cerebral vascular
coronary artery
peripheral vascular disease

Front 32

what are the 4 tests to assess glucose control?

Back 32

fasting plasma glucose
oral glucose tolerance test
gycosylated hemoglobin
fructosamine

Front 33

which test is the best indicator of glucose homeostasis?

Back 33

fasting plasma glucose

Front 34

what does the fasting plasma glucose test measure?

Back 34

the ability of endogenous or exogenous insulin to prevent fasting hyperglycemia (trough levels more reproducible)

Front 35

is FPG used to screen or diagnose?

Back 35

screen

Front 36

how is the FPG test conducted

Back 36

must fast for 8 hours
venipuncture
use seperator tube, add sodium floride, or refrigerate

Front 37

FPG normal range, prediabetes range, & diagnosis range

Back 37

normal < 110mg/dL
pre > 100 to <126mg/dL
diagnose >126mg/dL (on 2 occasions)

Front 38

in an FPG test, the first reading is considered a _________ while the second is a __________

Back 38

screening
diagnosis

Front 39

what are some causes of abnormal lab results in the FPG test

Back 39

improper collection
improper storage

Front 40

the american diabetic association recommends sreenings for:

Back 40

those >45 yo (every 3 yrs)
>25kg/m2 + dyslipedemia, vascular disease, polysystic ovarian disease

Front 41

what are the 5 possible results of a diagnostic test

Back 41

confirm suspected diagnosis
differentiate among possible diagnoses
determine severity of disease
detect recurrence of disease
monitor therapy

Front 42

when is the OGT test used?

Back 42

when a patient has s/s
when FPG suggests prediabetes

Front 43

what does the OGT test tell you?

Back 43

the body's ability to secret insulin
body's response to insulin action

Front 44

OGT test normal range, prediabetes range, provisional dx range, & confirm dx range

Back 44

nl <140mg/dL
pre >140-200mg/dL
pro >200mg/dL
confirm + raised FPG

Front 45

how is OGT test conducted

Back 45

overnight fast
75g oral glucose dose
taken over 5 min
samples taken between 0-2hr
sodium floride tube or assay immedietly

Front 46

what can cause an abnormal OGT test result?

Back 46

improper collection
improper storage
malnourished
consume inadequate carbs
bedridden
alcohol
medication that causes hypergylcemia
coffee
smoking

Front 47

does the gycosylated hemoglobin test monitor short or long term control of glucose?

Back 47

long term (2-3months)

Front 48

which subfraction of Hb is used in the gycosylated hemoglobin test?

Back 48

A1C

Front 49

calculation for mean daily plasma glucose

Back 49

10*(A1C + 4)

Front 50

what is the reference range for the gycosylated hemoglobin test?

Back 50

>7% suggets poor glucose control
up to 20% for persistent hyperglycemia

Front 51

what is the specimen for the GH test?

Back 51

RBC (Hb) not plasma or serum

Front 52

what can cause abnormal gycosylated hemoglobin test results?

Back 52

false elevation (uremia, chronic alcohol intake, hypertriglyceridemia, pregnancy)
falsely lowered (pregnancy, hemolysis)

Front 53

what can't the GH test be used to screen for gestational diabetes?

Back 53

pregnancy can cause false elevations & depressions

Front 54

what is the reference range for the GH test?

Back 54

varies with assay method

Front 55

how often shouild a patient with good glycemic control get a GH test? a person with poor control?

Back 55

1-2 times a year
4 times a year

Front 56

when is the fructosamine test used?

Back 56

for acute cases - to see how a patient is doing

Front 57

reference range for the fructosamine test?

Back 57

<285 umol/L (can vary)

Front 58

where does the specimen come from for the fructosamine test?

Back 58

serum or plasma b/c using glycosylated proteins

Front 59

what can cause an abnormal lab result in the fructosamine test?

Back 59

falsely elevated (serum Hb concen >100mg/dL, serum bilirubin >4mg/dL, serum ascorbic acid >5mg/dL, methyl dopa & Ca dobesilate)
falsely lower (obesity)