Shared Flashcard Set

Details

Clin Med Exam 4
Endocrine
60
Medical
Graduate
04/03/2012

Additional Medical Flashcards

 


 

Cards

Term
what is the most reliable and convenient test for identifying DM in asymptomatic individuals
Definition

fasting glucose

 

(to diagnose, fasting glucose must be > or = to 126 mg/dL on more than one occasion at least two weeks apart)

Term
what is the first line of treatment for type I DM
Definition
insulin
Term
what is the dosage of insulin for type I DM
Definition

0.5 - 1.0 U/kg/day of insulin

 

with ~50% of the inslin given as basal insulin

Term
what is the common ratio used in an effort to match caloric intake with the appropriate amount of insulin
Definition
1.0 - 1.5 units of insulin / 10 g carbs
Term
what medication can be given to a type I diabetic pt along with their insulin that can decrease the amount of short-acting insuline needed before meals and slows gastric emptying and suppresses glucagon response
Definition
amylin (pramlintide)
Term
initial treatment of primary hypothyroidism for pt that is: < 60 years and has no evidence of heart disease
Definition

before therapy need to clinically assess for adrenal insufficiency and angina, if those require treatment as well

 

levothyroxin (synthroid): 25 - 75 mcg qp

Term
initial treatment for primary hypothyroidism in pregnant pt
Definition

efore therapy need to clinically assess for adrenal insufficiency and angina, if those require treatment as well

 

levothyroxin (synthroid):

start with 100 - 150/day

Term
initial treatment of primary hypothyroidism in pt that is > 60 or has known cardiac disease
Definition

efore therapy need to clinically assess for adrenal insufficiency and angina, if those require treatment as well

 

levothyroxin (synthroid):

start with 25 - 50 qd

Term
what is the follow up for primary hypothyroidism
Definition

repeat TSH in 6 weeks

adjust dosage by 25 mcg every 6-8 weeks based on TSH in otherwise healthy pt

adjust every 1-3 weeks in cardiac pts

Term

what is the average daily replacement dose for primary hypothyroidism treatment (after the initial treatment and now just doing maintenance)

 

and once controlled (during maintenance phase) how often must you go to follow up visits

Definition

average daily replacement dose is usually 1.7 mcg/kg of synthroid (usually 100 - 150 mcg)

 

once full replacement is achieved and TSH levels are stable, you can extend f/u visits to 6 months and then yearly (instead of every 6 - 8 weeks in the initial treatment phase)

Term
treatment of myxedema crisis
Definition

*severe hypothyroidism*

 

levothyroxine 400 mcg IV bolus

continue IV at 50 - 100 mcg/day

hydrocortisone - if adrenal insufficiency is suspected

Term
treatment of Grave's disease
Definition

*autoimmune hyperthyroidism*

 

methimazole - oral (preferred to PTU)

OR

radioiodine treatment (RAI) to reduce amount of thyroid tissue

OR

thyroidectomy - if not responding to tx

 

if symptomatic - propranolol

Term
treatment of the symptoms of Grave's disease
Definition

*autoimmune hyperthyroidism*

 

propranolol for symptoms during early treatment with anti-thyroid drugs and radioiodine tx

Term
treatment of Grave's disease if it is NOT responsive to the initial treatment of methimazole or RAI
Definition

*autoimmune hyperthyroidism*

 

thyroidectomy to reduce the amount of thyroid tissue

(also possible tx if the goiter is enlarged in Grave's)

Term
treatment of thyroid storm
Definition

*severe hyperthyroidism*

 

aggressive large dose PTU

THEN

1 hour later, oral/IV ipodate sodium

THEN

1 hour later, iodine

 

propranolol

 

glucocorticoids -> hydrocortisone

Term
definitive treatment of toxic multinodular goiter
Definition

*subclinical hyperthyroidism/mild thyrotoxicosis*

 

surgery = definitive treatment

Term
the possible lines of treatment of toxic multinodular goiter
Definition

anti-thyroid drug (methimazole) + propranolol (but can stimulate goiter growth)

 

RAI to treat areas of autonomy

Term
treatment of hashimoto's thyroiditis
Definition

hypothyroid: thyroxine hormone replacement

 

euthyroid + goiter: thyroxine hormone replacement

Term
treatment of general symptoms of subacute thyroiditis (not specific to which phase)
Definition

*viral URTI, w/ diff thyroid phases: hyper -> hypo -> eu*

 

ASA/NSAIDs sufficient to control symptoms, and propranolol for thyrotoxicosis symptoms

Term
treatment of subacute thyroiditis during thyrotoxicosis phase
Definition

*viral URTI, w/ diff thyroid phases: hyper -> hypo -> eu*

 

ASA/NSAIS for symptoms

propranolol for the thyrotox symptoms

RAI to cause fall in T3

 

monitor thyroid function every 2 - 3 weeks using TSH and FT4

Term
treatment of subacute thyroiditis during hypothyroid phase
Definition

*viral URTI, w/ diff thyroid phases: hyper -> hypo -> eu*

 

ASA/NSAIDs for symptoms

thyroid hormone during hypothyroid stage may be needed

 

monitor thyroid function every 2 - 4 weeks using TSH and FT4

Term
treatment of painless thyroiditis
Definition

*sporadic or postpartum, nontender goiter*

 

hyperthyroid phase (1st stage) - propranolol for symptoms, but initial stage usually mild

 

hypothyroidism (2nd stage) - thyroxine replacement for only 6 - 9 months as recovery is the rule

Term
treatment of reidel thyroiditis
Definition

*multifocal systemic fibrosis syndrome*

 

tamoxifen provides remission in 3 - 6 months

short term corticosteroids (help with compression symptoms)

surgical decompression may be needed

Term
treatment of acute/suppurative thyroiditis
Definition
antibiotics guided by culture
Term
treatment of thyroid cancer - what is the one main exception to this line of treatment
Definition

surgical excision with near-total thyroidectomy with post-surgical ablation of the remnant thyroid tissue

 

except: papillary <1cm, < 45 yrs, no local mets

Term
treatment of acute tetany in emergency hypoPTH
Definition

ensure adequate airway

 

calcium gluconate in IV solution, slowly, until tetany ceases

 

calcium gluconate in 1L D5W or NS, slow IV drip

 

aim: calium to = 8- 9 mg/dL

 

oral calcium (1 - 2g/day) as soon as pt is able

 

Vit D derivative

 

hypoMg2+: magnesium sulfate, q 6hr, immediately

 

F/U with PCP - NEXT DAY

Term
treatment/maintenance of hypoPTH
Definition

oral calcium (1 - 2 g/day)

 

calcitriol (rocaltrol), start 0.25 PO q AM and titrate to 0.50 - 2.0 PO q AM

 

(may need to correct constipation caused by the Ca)

Term
what drugs should be avoided when treating hypoPTH
Definition

phenothiazines (compazine and thorazine) - may precipitate extrapyramidal symptoms

 

furosemide (lasix) - can worsen hypocalcemia

Term
follow up for hypoPTH
Definition

serum Ca - every 3 months

spot urine - want < 30 mg/dL

Term
medications for the treatment hyperPTH
Definition

bisphosphanates - to inhibit bone resorption

 

calcimimetics - increase PTH gland affinity for Ca (lowering PTH)

 

Vit D analogs - lowers PTH levels

 

calcitriol (for 2ndary/tertiary) - lowers PTH levels

 

(others: estrogen replacement, raloxifene, propranolol, phosphate binding meds for renal osteodystrophy)

Term
criteria for parathyroidectomy in asymptomatic hyperPTH pts:
Definition

serum Ca 1 mg/dL above normal w/ urine Ca excretion > 50 mg/24hr

 

urine Ca > 400 mg/24hr

 

cortical bone density > 2 SD BELOW normal

 

< 50 - 60 years of age

 

difficulty ensuring medical f/u

 

2nd trimester pregnancy

Term
treatment for symptomatic hyperPTH pts that have kidney stones or bone disease
Definition

parathyroidectomy

 

minially invase PTHectomy surgery usually sufficient if adenoma identified preoperatively by sestamibi and US

Term
treatment for pt with resistant PTH hyperplasia (think 2ndary hypherPTH)
Definition
subtotal parathyroidectomy (3 1/2 glands removed)
Term
treatment of pt with mild, asymptomatic hyperPTH
Definition

keep active

drink plenty of fluids

avoid immobilization

avoid thiazides, large doses of Vits D and A, Ca-containing antacids or supplements, and digitalis

Term
treatment of hyperPTH pt postoperatively to help prevent tetany
Definition
oral Ca and calcitriol 0.25 mg/dL for 2 weeks to prevent tetany
Term
F/U for hyperPTH pts
Definition

serum Ca and albumin - twice a year

 

renal function and urine Ca - yearly

 

bone density (hip, spine, distal radius) - every 2 yeras

Term
treatment and prevention of osteomalacia
Definition

sun exposure - 15 minutes, 2X week W/O sunscreen

 

vit D replacement (prevention), if sundeprived pt - 1000 - 2000 IU/day

 

frank Vit D deficiency - vit D2 (ergocaliferol) 50,000 units oreally 1x or 2x weekly for 6 - 12 months, then 1000 - 2000 IU per day long term

 

calcium replacement - not needed if malabsorption or poor nutrition is NOT susprected - Ca citrate or carbonate with  meals

Term
what treatment is added to the regiman for osteomalacia if malabsorption/poor nutrition is suspected
Definition

calcium replacement:

 

Ca citrate - 0.4 - 0.6 g/day

OR

Ca carbonate (tums) 1 - 1.5 g/day

 

with meals

Term
what is the initial treatment of conn's syndrome
Definition

*primary hyperaldosteronism (adenoma)*

 

initial treatment: low sodium diet and potassium supplement; refer to endocrinologist for initial work up

Term
treatment for aldosterone producing adenoma causing conn's syndrome
Definition

*primary hyperaldosteronism*

 

surgical removal

 

spironolactone while awaiting surgery

Term
treatment for bilateral hyperplasia of of the adrenal glands causing conn's syndrome
Definition

*primary hyperaldolsteronism*

 

spironolactone - blocks the effect of aldosterone on the renal tubules (life long treatment)

Term
treatment of addison's disease
Definition

*adrenal insufficiency*

 

hydrocortisone = drug of choice; 2/3 in AM, 1/3 in PM (mimicing cortisol levels throughout a day)

 

prednisone = alternative to hydrocortizone

 

these are increased in case of: infection, trauna, surgery, diagnostic procedures

 

can add fludrocortisone to hydrocortizone (or prednisone) - if symptom resolution isn't complete via monotherapy

 

Term

when would you need to incraese the levels of fludrocortisone during the treatment of addison's disease

 

when is it decreased

Definition

*adrenal insufficiency*

 

increased for:

postural hypotension

hypoNA+

hyperK+

fatigue

elevated plasma renin activity

 

decreased for:

edema

hypoK+

HTN

Term
treatment of adrenal crisis
Definition

*emergent insufficient cortisol levels*

 

immediate IV hydrocortizone 100 - 300 mg in NS

for rest of day, continue hydrocortisone 50 - 100 mg IV q 6hrs; next day q 8 hrs; then taper and change to oral

 

empiric antibiotics

 

D5W to treat hypoglycemia

Term
treatment of choice for cushing's disease
Definition

selective transsphenoidal resection of pituitary adenoma = surgery of choice

 

hydrocortisone needed temporarily after resection of pit adenoma or adrenal adenoma

Term
treatment for a pt with cushing's disease who is NOT a surgical candidate
Definition

ketoconazole, 200 mg PO q 6hrs (to suppress the high cortisol levels)

 

monitor liver enzymes

Term
what is the next line of treatment for a pt with cushing's disease who underwent a pituitary resection with no remission (had recurrence)
Definition
bilateral laparoscopic adrenalectomy
Term
treatment of cushing's syndrome caused by an adrenal neoplasm; an ectopic ACTH-secreting tumor
Definition

adrenal neoplasm: laparoscopic resection of adrenal neoplasm

 

ectopic: surgical rections

Term
treatment of choice for acromegaly/gigantism
Definition
endoscopic transnasal, transsphenoidal resection of the pituitary adenoma, where the normal pituitary is preserved
Term
possible drugs for acromegaly/gigantism if no remission occurs after pituitary adenoma resection
Definition

dopamine agonist - if no remission or normalization of GH

 

somatostatin analogs if acromegaly presists despite pituitary surgery

 

GH receptor antagonist

Term
treatment of acromegaly/gigantism if not cured by surgical and medical therapy
Definition
pituitary iradiation - stereostatic radiosurgery (cyber or gamma knife) preferred
Term
treatment of GH deficiency
Definition

support

 

GH injections

Term
treatment of mild case of (central) diabetes insipidus
Definition
requires only adequate fluid intake
Term
treatment of choice for (central) diabetes insipidus
Definition

desmopressin

 

intranasal - most common administration

start 0.05 - 0.1 ml (100 mcg/mL sol) every 12 - 24 hrs

 

oral

start 0.05 mg BID, increased to max of 0.4 mg q 8 hrs if needed

Term
possible treatment of a pituitary adenoma
Definition

goal: normalize pituitary hormones and shrink or ablate larger tumor masses

 

transshenoidal surgical resection of tumor

 

gamma knife radiation

Term
treatment of type II DM when FPG is < 200 - 250
Definition
pts often respond to a single oral agent - metformin
Term
treatment of type II DM when FPG > 250 mg/dL
Definition
pts often need > 1 agent to reach goal, however start one at a time
Term
when would you consider adding insulin to the medication regimen for type II DM
Definition
consider insulin if FPG > 250 - 300 mg/dL or in those who are symptomatic from hyperglycemia
Term
how do you treat diabetic nephropathy
Definition

to slow progression: good glycemic control

 

strict control of BP

 

Start ACEI or ARB

 

restrict protein intake to 0.8g/kg/day

 

consultation when GFR < 60 ml/min

Term
treatment of diabetic neuropathy
Definition

pt should be checking feet daily and taking precautions (diabetic footwear)

 

prescribe: TCAs, anticonvulsants, duloxetine (cymbalta), pregabalin (lyrica), gabapentin (neurontin)

Supporting users have an ad free experience!