Endocrine Disorders Quiz

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Questions and Answers

What is the acceptable range for normal glucose levels?

  • 90-130
  • 60-100
  • 80-120
  • 70-110 (correct)

Which of the following symptoms is NOT associated with hypoglycemia?

  • Clammy skin
  • Tremors
  • Polyuria (correct)
  • Confusion

What is the best treatment option for a patient experiencing hypoglycemia who is unable to swallow?

  • High-sugar snacks
  • Juice
  • IM glucagon (correct)
  • Crackers

When administering insulin, which of the following is NOT a recommended practice?

<p>Massage the injection area (D)</p> Signup and view all the answers

Which type of insulin can be administered intravenously?

<p>Regular insulin (B)</p> Signup and view all the answers

Which of the following is a primary cause of hyperthyroidism?

<p>Thyroid adenoma (C)</p> Signup and view all the answers

What is a common symptom of hyperthyroidism?

<p>Increased heart rate (A)</p> Signup and view all the answers

Which treatment is used to suppress thyroid activity in hyperthyroidism?

<p>I-131 (Radioactive potassium iodide) (D)</p> Signup and view all the answers

What is a significant adverse effect of Propylthiouracil (PTU)?

<p>Agranulocytosis (B)</p> Signup and view all the answers

Which symptom is least likely to be associated with hyperthyroidism?

<p>Severe depression (D)</p> Signup and view all the answers

What laboratory tests are important to evaluate the effectiveness of Methimazole?

<p>LFTs, CBC, and TSH (A)</p> Signup and view all the answers

What is the therapeutic use of Lugol's solution?

<p>To shrink the thyroid gland prior to surgery (C)</p> Signup and view all the answers

Which of the following indicates a potential side effect of PTU?

<p>Bradycardia (A)</p> Signup and view all the answers

Which side effect is commonly associated with long-term steroid use?

<p>Osteoporosis (A)</p> Signup and view all the answers

What condition is treated with ketoconazole?

<p>Cushing's disease (B)</p> Signup and view all the answers

What is a primary therapeutic use of Desmopressin (DDAVP)?

<p>Diabetes insipidus treatment (B)</p> Signup and view all the answers

Which of the following symptoms is a manifestation of diabetes insipidus?

<p>Polyuria (A)</p> Signup and view all the answers

What mechanism allows the body to indicate it no longer needs a specific stimulus?

<p>Negative feedback (D)</p> Signup and view all the answers

What is the most common cause of Addison's disease?

<p>Sudden cessation of corticosteroids (C)</p> Signup and view all the answers

Which hormone acts to decrease blood glucose levels?

<p>Insulin (C)</p> Signup and view all the answers

Which of the following is a potential adverse effect of desmopressin treatment?

<p>Water intoxication (A)</p> Signup and view all the answers

What is the therapeutic use of rapid insulin such as Aspart or Lispro?

<p>To correct spikes associated with meals (C)</p> Signup and view all the answers

What is the onset time for Regular insulin?

<p>30-60 minutes (D)</p> Signup and view all the answers

Which adverse effect is NOT associated with Metformin?

<p>Hypokalemia (D)</p> Signup and view all the answers

Which type of insulin cannot be mixed with any other insulins?

<p>Glargine (B)</p> Signup and view all the answers

What is the peak time for insulin Lispro?

<p>0.5-1 hour (C)</p> Signup and view all the answers

What is a common adverse effect when Metformin is taken with garlic and ginseng?

<p>Hypoglycemia (B)</p> Signup and view all the answers

Which of the following describes the duration of action for NPH insulin?

<p>18-24 hours (D)</p> Signup and view all the answers

What should be done first when mixing Regular and NPH insulin?

<p>Disinfect the tops of both vials (A)</p> Signup and view all the answers

What is the primary mechanism of action of Filgrastim?

<p>Binds to and stimulates immature neutrophils (B)</p> Signup and view all the answers

Which of the following is a serious adverse effect of Doxorubicin?

<p>Irreversible cardiomyopathy (A)</p> Signup and view all the answers

What serious condition can Methotrexate cause when combined with NSAIDs?

<p>Severe myelosuppression (A)</p> Signup and view all the answers

What is a therapeutic use of Tamoxifen?

<p>Blocking estrogen receptors on breast cancer cells (D)</p> Signup and view all the answers

What is the primary mechanism of action of dulaglutide and semaglutide?

<p>Stimulates insulin release and blocks glucagon release (D)</p> Signup and view all the answers

What is a common adverse effect associated with Vincristine?

<p>Nerve injury (D)</p> Signup and view all the answers

What should be done before and after a procedure involving dye for a patient taking certain medications?

<p>Stop medication 72 hours before and after the procedure (C)</p> Signup and view all the answers

What is the black box warning associated with Methotrexate?

<p>Severe myelosuppression (C)</p> Signup and view all the answers

Which of the following conditions is a therapeutic use of Filgrastim?

<p>Neutropenia secondary to chemotherapy (B)</p> Signup and view all the answers

Which of the following is a contraindication for dulaglutide and semaglutide?

<p>Chronic kidney disease (CKD) (B)</p> Signup and view all the answers

What does the term 'black box warning' indicate?

<p>A drug carries significant risk and requires careful monitoring (C)</p> Signup and view all the answers

What is a major side effect associated with the use of dapagliflozin?

<p>Frequent urination (A)</p> Signup and view all the answers

What is the recommended route of administration for ferrous sulfate?

<p>Oral (B)</p> Signup and view all the answers

Which of the following precautions should be taken in a patient with thrombocytopenia?

<p>Monitor for signs of bleeding (B)</p> Signup and view all the answers

What electrolyte imbalance can occur with the use of epoetin?

<p>Hypertension (D)</p> Signup and view all the answers

Which route is NOT used for administering cyanocobalamin (B12)?

<p>Sublingual (C)</p> Signup and view all the answers

What is a common cue associated with hyperthyroidism?

<p>Increased heart rate (B)</p> Signup and view all the answers

Which treatment option selectively suppresses thyroid activity?

<p>I-131 (Radioactive potassium iodide) (C)</p> Signup and view all the answers

Which of the following symptoms is characteristic of hyperthyroidism?

<p>Exophthalmos (A)</p> Signup and view all the answers

What potential adverse effect should be monitored when a patient is on Propylthiouracil (PTU)?

<p>Agranulocytosis (A)</p> Signup and view all the answers

When should a patient report signs of infection while taking Propylthiouracil (PTU)?

<p>Regularly as a precaution (B)</p> Signup and view all the answers

Which symptom is commonly associated with hypothyroidism?

<p>Weight gain (A)</p> Signup and view all the answers

What is the primary medication used in the treatment of hypothyroidism?

<p>Levothyroxine (A)</p> Signup and view all the answers

Which of the following indicates a severe form of hypothyroidism?

<p>Myxedema (C)</p> Signup and view all the answers

What condition is characterized by high TSH levels and low T3 and T4 levels?

<p>Hypothyroidism (B)</p> Signup and view all the answers

What is an expected outcome of effective levothyroxine treatment?

<p>Weight loss (D)</p> Signup and view all the answers

Which of the following is a common cue of thyroid storm?

<p>Restlessness (A)</p> Signup and view all the answers

Why should levothyroxine not be taken for weight loss?

<p>It can lead to hyperthyroidism. (D)</p> Signup and view all the answers

What must always be done with corticosteroid therapy?

<p>Taper the dosage before discontinuing. (B)</p> Signup and view all the answers

What is the main therapeutic use of Metformin?

<p>Type 2 Diabetes Mellitus (A)</p> Signup and view all the answers

What is the onset time for rapid insulin such as Aspart or Lispro?

<p>10-30 minutes (A)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect of Metformin?

<p>Weight gain (D)</p> Signup and view all the answers

In what situation can NPH be mixed with regular insulin?

<p>For correction of hyperglycemia (D)</p> Signup and view all the answers

What is the duration of action for NPH insulin?

<p>18-24 hours (B)</p> Signup and view all the answers

Which insulin type cannot be mixed with other insulins?

<p>Lantus (C)</p> Signup and view all the answers

Which of the following actions is performed last when mixing regular and NPH insulin?

<p>Withdraw regular insulin into syringe (C)</p> Signup and view all the answers

What is an important teaching point for a patient taking corticosteroids?

<p>Maintain adequate calcium intake. (C)</p> Signup and view all the answers

Which of the following represents a common adverse effect of corticosteroid use?

<p>Increased risk of fractures (C)</p> Signup and view all the answers

What is the primary therapeutic use of octreotide?

<p>Control of acromegaly (C)</p> Signup and view all the answers

In the case of adrenocortical insufficiency, what does cosyntropin resemble?

<p>ACTH (A)</p> Signup and view all the answers

Which manifestation is characteristic of diabetes insipidus?

<p>Polyuria (A)</p> Signup and view all the answers

What should be monitored to evaluate the effectiveness of desmopressin treatment?

<p>Fluid intake status (C)</p> Signup and view all the answers

What is the role of glucagon in the body?

<p>To increase blood glucose levels (D)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect associated with desmopressin?

<p>Visual disturbances (D)</p> Signup and view all the answers

What is the main action of Filgrastim in treating neutropenia?

<p>Stimulates immature neutrophils to divide and differentiate (D)</p> Signup and view all the answers

Which of the following is considered a serious adverse effect of Doxorubicin?

<p>Irreversible cardiomyopathy (B)</p> Signup and view all the answers

What potential adverse effect should be monitored for in patients receiving Methotrexate?

<p>Liver cirrhosis (B)</p> Signup and view all the answers

Which cancer types are treated with Methotrexate?

<p>Osteogenic sarcoma and leukemias (D)</p> Signup and view all the answers

What is a common adverse effect of Vincristine?

<p>Nerve injury, resulting in numbness and tingling (D)</p> Signup and view all the answers

What is the primary therapeutic use of Tamoxifen?

<p>Blocking estrogen receptors on breast cancer cells (C)</p> Signup and view all the answers

What condition can result from combining Methotrexate with NSAIDs?

<p>Severe myelosuppression (C)</p> Signup and view all the answers

What is the black box warning associated with Vincristine?

<p>Irreversible nerve damage (B)</p> Signup and view all the answers

What is the mechanism of action of dulaglutide and semaglutide?

<p>Stimulates release of incretin (B)</p> Signup and view all the answers

Which condition is a contraindication for the use of incretin enhancers like dulaglutide and semaglutide?

<p>Chronic kidney disease (C)</p> Signup and view all the answers

Which of the following is a significant risk associated with the use of medications that affect Hb A1C levels?

<p>Lactic acidosis (C)</p> Signup and view all the answers

What is the primary therapeutic use of sitagliptin?

<p>To manage blood glucose levels without causing hypoglycemia (C)</p> Signup and view all the answers

What is the recommended route of administration for epoetin?

<p>Subcutaneous 1-3 times a week (A)</p> Signup and view all the answers

What monitoring is essential when administering epoetin?

<p>Complete blood count (CBC) (C)</p> Signup and view all the answers

Which of the following is a common side effect of dapagliflozin?

<p>Increased urination (B)</p> Signup and view all the answers

What patient education should be provided regarding ferrous sulfate administration?

<p>Take it with vitamin C for better absorption (C)</p> Signup and view all the answers

Flashcards

Hyperthyroidism Cause

Conditions like thyroid adenoma, iodine intake, or Grave's disease.

Hyperthyroidism Symptoms

Increased heart rate, appetite, GI issues, weight loss, hair loss, insomnia, heat intolerance, menstrual irregularity, exophthalmos, goiter.

I-131 Treatment

Radioactive iodine, used to reduce thyroid activity for hyperthyroidism.

PTU Side Effects

Hepatotoxicity, agranulocytosis, bradycardia, nausea, hypothyroidism.

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Methimazole Adverse Effects

Hepatotoxicity, agranulocytosis (monitor for infections).

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Lugol's Solution Use

Non-radioactive iodine used to shrink the thyroid before surgery.

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PTU 1st trimester use

PTU is acceptable for thyroid storm during the first trimester of pregnancy.

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Hyperthyroidism Treatment Evaluation

Monitor TSH and T4 levels to check treatment effectiveness.

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Steroid adverse effects

Steroid use can cause immunosuppression, hyperglycemia, osteoporosis, fractures, peptic ulcers, clots, and hypertension (HTN). Long-term use can lead to moon face and weight gain.

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Steroid teaching points

Patients taking steroids should maintain calcium intake, report any signs of infection (e.g., low-grade fever), and not stop the medication abruptly.

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Ketoconazole use

Ketoconazole is an antifungal medication used to decrease steroid levels in the body.

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Cushing's disease

Cushing's disease is a condition characterized by elevated blood pressure, due to high ACTH.

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Octreotide treatment

Octreotide is used to treat Acromegaly, a condition resulting from overproduction of growth hormone (GH).

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Cosyntropin Therapeutic Use

Cosyntropin treats adrenocortical insufficiency, like Addison's Disease (too little ACTH). It is also used to diagnose the cause of the insufficiency, mimicking ACTH function.

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Diabetes Insipidus Treatment

Diabetes Insipidus (DI) is treated with Desmopressin (DDAVP) to help to regulate water balance in the body.

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Diabetes Mellitus Type 1/2

Type 1 Diabetes Mellitus is insulin-dependent. Type 2 Diabetes Mellitus is characterized by insulin resistance. Both conditions disrupt blood glucose regulation.

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Normal blood glucose range

The blood glucose level considered healthy is between 70-110 mg/dL. Levels outside this range may indicate issues like diabetes.

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Hemoglobin A1c

Hemoglobin A1c reflects your average blood glucose level over the past 2-3 months. A level above 6.5% is indicative of diabetes.

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Hypoglycemia symptoms

Hypoglycemia is characterized by low blood sugar. Symptoms include tremors, clammy skin, confusion, and slurred speech. It is dangerous and can be life-threatening if left untreated.

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Insulin dosing schedule

Diabetic patients taking insulin require precise dosing based on blood glucose levels. A sliding scale helps determine the amount of insulin needed depending on the blood sugar reading.

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Rotating injection sites

Rotate insulin injection sites regularly to minimize lipohypertrophy (fat build-up). This ensures better absorption and prevents complications.

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Hb A1C Levels

A blood test that measures average blood sugar levels over the past 2-3 months.

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Lactic Acidosis

A dangerous condition where lactic acid builds up in the blood, often caused by medications like metformin.

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Dulaglutide/Semaglutide

Injectable medications that help control blood sugar by mimicking a body's natural hormone.

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Incretin Enhancers

Medications that stimulate the release of insulin and suppress the release of glucagon.

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Dapagliflozin

A medication that helps lower blood sugar by excreting it in the urine.

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Glimepiride/Glipizide

Medications that stimulate the release of insulin from the pancreas.

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Ferrous Sulfate

An iron supplement used to treat iron deficiency anemia.

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Epoetin

A drug that helps the body make more red blood cells.

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Insulin Mixing: When to Inject Air

When mixing regular and NPH insulin, inject air into the NPH (isophane) vial first, then the regular insulin vial. Always withdraw regular insulin into the syringe last.

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Insulin Onset: Fastest to Slowest

Insulin types are categorized by their onset of action. Fastest is Lispro, followed by regular, then NPH, and slowest is Glargine.

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Rapid Insulin: Aspart/Lispro

Rapid-acting insulins like aspart and lispro are used to correct blood sugar spikes after meals. They have a fast onset, peak in 1-3 hours, and last for 3-5 hours.

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Short-Acting (Regular) Insulin: Timing

Regular insulin is given 30-60 minutes before meals to help control blood sugar during meals.

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NPH (Isophane) Insulin: Therapeutic Use

NPH is an intermediate-acting insulin that provides longer-acting glucose control for type 2 diabetes.

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Metformin: Mechanism of Action

Metformin decreases the production of glucose in the liver and improves insulin sensitivity, helping to control blood sugar in individuals with type 2 diabetes.

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Metformin: Adverse Effects

Common side effects of metformin include gastrointestinal upset, poor appetite, and a metallic taste. It can also interfere with B12 and folic acid absorption.

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Metformin: Evaluation of Effectiveness

Monitor blood sugar levels after starting metformin to evaluate its effectiveness in controlling type 2 diabetes.

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Filgrastim MOA

Filgrastim binds to and stimulates immature neutrophils to divide and differentiate, increasing their production.

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Filgrastim Therapeutic Use

Filgrastim is used to treat neutropenia caused by chemotherapy, organ transplant, AIDS, stem cell transplants, and malignancies.

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Doxorubicin Adverse Effects

Doxorubicin can cause severe adverse effects including cardiotoxicity (irreversible cardiomyopathy and dysrhythmias), nausea and vomiting, hair loss, bone marrow suppression, and secondary malignancies.

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Doxorubicin Black Box Warning

Doxorubicin carries black box warnings for severe myelosuppression (thrombocytopenia, leukopenia, anemia), cardiotoxicity, severe local necrosis if extravasation occurs, and secondary malignancies.

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Methotrexate Therapeutic Uses

Methotrexate is used to treat various cancers including choriocarcinoma, osteogenic sarcoma, leukemias, head/neck cancer, breast cancer, lung cancer, non-Hodgkin's lymphoma, and T-cell lymphoma. It is also used for autoimmune diseases like rheumatoid arthritis, Crohn's disease, and psoriasis.

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Methotrexate Black Box Warning

Methotrexate carries black box warnings for severe myelosuppression when combined with NSAIDs, hepatotoxicity leading to liver cirrhosis, ulcerative stomatitis and diarrhea, pneumocystis pneumonia, pulmonary toxicity, Stevens-Johnson syndrome, malignant lymphomas, and AKI.

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Vincristine Adverse Effects

Vincristine can cause nerve injury, numbness and tingling, paralytic ileus and severe constipation, muscular weakness, and loss of reflexes, as well as reversible alopecia.

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Tamoxifen Therapeutic Use

Tamoxifen blocks estrogen receptors on breast cancer cells preventing the growth of tumors. It is non-cytotoxic.

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Radioactive Iodine (I-131)

A radioactive isotope of iodine used to treat hyperthyroidism by suppressing thyroid activity.

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Propylthiouracil (PTU)

A medication used to treat hyperthyroidism, Grave's disease, and prevent thyroid storm during pregnancy.

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Methimazole

A medication used to treat hyperthyroidism and Grave's disease. It works by blocking the production of thyroid hormones.

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Lugol's Solution

A non-radioactive iodine solution used to shrink the thyroid gland before surgery.

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Thyroid storm

A life-threatening condition caused by a sudden surge of thyroid hormones, leading to high fever, rapid heart rate, and extreme agitation.

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Hypothyroidism: TSH level

In hypothyroidism, the thyroid gland is underactive, causing low levels of T3 and T4 hormones, which leads to a high TSH level as the body tries to compensate.

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Causes of Hypothyroidism

Common causes include Hashimoto's disease (autoimmune disorder), radioactive iodine therapy, surgery for hyperthyroidism, iodine deficiency, and medications.

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Levothyroxine

A synthetic thyroid hormone medication used to treat hypothyroidism.

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Levothyroxine: Morning dose

Levothyroxine should be taken in the morning on an empty stomach, before breakfast.

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Corticosteroids

Powerful medications that suppress inflammation and immune responses.

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Steroid Tapering

Corticosteroids must be gradually reduced in dose, usually over two weeks, to avoid withdrawal symptoms.

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Steroid Side Effects

Steroids can suppress your immune system, causing increased infection risk. They can also lead to high blood sugar, weak bones, stomach ulcers, blood clots, high blood pressure, and even a round face and weight gain over time.

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Stopping Steroids Safely

Never stop taking steroids abruptly. Tapering off the medication gradually helps your body adjust and prevents serious side effects, like Addison's disease.

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Ketoconazole Function

Ketoconazole is an antifungal medication that helps reduce the levels of steroids in the body.

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Diabetes Insipidus: What is it?

Diabetes Insipidus is a disorder where your body can't concentrate urine properly, leading to excessive thirst and urination.

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Diabetes Mellitus: Insulin's Role

Insulin, produced by the pancreas, helps regulate blood glucose levels by letting sugar enter cells for energy.

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Diabetes Type 1 vs. Type 2

Type 1 diabetes occurs when the pancreas doesn't produce enough insulin, while Type 2 diabetes happens when the body doesn't respond properly to insulin.

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Mixing Regular and NPH Insulin

When mixing regular and NPH insulin, always inject air into the NPH (isophane) vial first, then the regular insulin vial. Always withdraw regular insulin into the syringe last.

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Study Notes

Hyperthyroidism

  • Causes: Thyroid adenoma, excessive iodine intake, Grave's disease. Primary hyperthyroidism is characterized by decreased TSH levels.
  • Symptoms: Increased heart rate, increased gastrointestinal motility and appetite, cardiac dysrhythmias, thyroid bruit, decreased weight and hair loss, insomnia, fatigue, nervousness, heat intolerance, irregular or absent menses, exophthalmos, goiter.
  • Treatments: Radioactive iodine (I-131), propylthiouracil (PTU).
  • PTU Teaching: Safe in the first trimester for thyroid storm, report signs of infection (agranulocytosis), monitor for hypothyroidism. Hepatotoxic effects and agranulocytosis are possible adverse effects.
  • Methimazole Teaching: Monitor liver function tests (ALT/AST), and TSH and T4 levels which should be normal to ensure treatment success. Adverse effects include liver toxicity, agranulocytosis, bradycardia and nausea.

Thyroid Storm

  • Symptoms: High fever, tachycardia, agitation, restlessness.
  • Treatment: Lugol's solution, administering IV dextrose, and IM glucagon if needed but not IV.

Hypothyroidism

  • Causes: Hashimoto's disease which is an autoimmune disorder, iodine deficiency, medications.
  • Symptoms: Low T3, T4, high TSH, decreased energy and appetite, fatigue, weight gain, increased sleep, susceptibility to cold
  • Treatment: Levothyroxine.

Diabetic Mellitus

  • Pancreas Function: When blood glucose levels rise, the pancreas releases insulin, regulating glucose levels in the body
  • Type 1: Insulin dependent diabetes
  • Type 2: Insulin resistance.
  • Role of Hormones: Glucagon elevates blood glucose, glucose is the body's primary energy source, and insulin decreases blood glucose levels.
  • Diagnosis: Normal glucose levels are 70-110 mg/dL. Fasting glucose >126 mg/dL, and HbA1c >6.5% indicates diabetes mellitus.

Insulin

  • Types: Rapid-acting (Lispro, Aspart), Short-acting (Regular), Intermediate-acting (NPH), Long-acting (Glargine, Detemir).
  • Administration: Administering insulin involves using only insulin syringes, rotating injection sites to prevent lipohypertrophy (rotating injection sites and avoid massaging the injection site). Clear and cloudy insulins should be mixed accordingly, short-acting first, then intermediate (NPH).
  • Timing of meals: Rapid-acting insulins (Lispro, Aspart) are taken 5-10 minutes before meals. Short-acting (Regular) insulins are administered 30-60 minutes before meals.
  • Monitoring: Checking blood glucose levels before administering medication and monitoring for hypoglycemia are crucial steps.
  • Adverse Effects: Hypoglycemia, severe myelosuppression, injecting the wrong insulin, lipohypertrophy. Mixing insulins incorrectly can lead to inaccurate dosing.

Other Medications

  • Ketoconazole: Antifungal drug used to reduce steroids.
  • Octreotide: Used for acromegaly.
  • Cosyntropin: Used to diagnose and treat adrenocortical insufficiency (Addison's Disease).
  • Metformin: First-line treatment for type 2 diabetes, decreases liver glucose production to help reduce insulin resistance. Black box warning - lactic acidosis with caution in patients with kidney concerns, and 72 hours prior and after procedures with dyes.
  • Dapagliflozin: Excretes glucose in urine which is used to treat type 2 diabetes and for weight loss.
  • B12: Used to treat pernicious anemia, administering nasal or intramuscular injections.
  • Epoetin: Used to treat anemia in CKD, cancer, and HIV patients. Administered SubQ 1-3x/week and should monitor baseline RBC, H/H, and BP.

Neoplasms

  • Doxorubicin: Treats various cancers, but has cardiotoxicity and secondary malignancy risk. Severe myelosuppression
  • Methotrexate: Treats various cancers with toxicities including cardiotoxicity, severe myelosuppression and secondary malignancies.
  • Vincristine: Treats various cancers with toxicities including liver cirrhosis, ulcers, and hemorrhagic enteritis.

Other

  • Tamoxifen: Used in breast cancer treatment, possible increased risk of uterine cancer.

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