Nurs 5334 Test 3 Quiz: Essential Diabetes and Men's Health Notes with Complete Solutions | UTA

lOMoAR cPSD| 6861666




Nurs 5334 Test 3 Quiz: Essential Diabetes and Men's
Health Notes with Complete Solutions | UTA

DIABETES

- Know diagnostic criteria for DB o Fasting glucose of 126 o Casual glucose of
200 or higher o A1c of 6.5 or greater
o NO NEED TO DO ANY OTHER TESTS – THIS IS DEFINITIVE
- BP of 140/90 or higher (HTN) per JNC8
- BP of 130/90 or higher (HTN) per ACE/ACCE o Treat these pt’s for HTN
- Review Rip’s pearls for insulin (not expected to memorize all the insulins) -
KNOW ABOUT THE BASAL INSULINS!!!
o When to prescribe o How to figure dosages on long-acting
insulins etc.
o Basal is always the first insulin for DM2 if orals are not working
- Metformin is always first med to be given
- Lifestyle changes and metformin: Step 1
- Step one plus adding a second drug such as sulfonylurea, TZD, DPP-4 inhibitor,
SLG2 inhibitor, GLP1 receptor agonist, or basal insulin: Step 2
- Same as step two, with a three drug combo (including metformin): Step 3
- If 3 drug combo does work, as basal insulin: Step 4
- Know percentages of A1C reductions; weight gain, weight neutral, weight loss
of medications (TABLE IN PRESCRIBERS LETTER ABOUT THIS)
- Metformin side effects most common – GI effects o Need to titrate this med up
o Lactic acidosis is only an issue in patients with CKD typically – but does not make
kidney function worse
o Inhibits glucose production in the liver; reduces glucose absorption in the gut,
sensitizes insulin receptors in the target tissue and increases glucose reuptake to
whatever insulin is available
o 1-2% A1C reduction!!!!! o Can cause weight loss
o Used in PCOS because it helps with weight loss and insulin resistance
- Sulfonylureas: glipizide (liver toxicity), glyburide (renal toxicity), glimepiride
(renal and liver toxicity)
o Cause hypoglycemia and weight gain (KNOW THESE) o
1.5%-2% A1C reduction!!!!!
o Very inexpensive
- Meglitinides – repaglinide, nateglinide o Cause hypoglycemia and weight gain o
0.5%-1.5% A1C reduction!!!!!!

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- TZD’s – rosiglitazone, poglitazone o Reduces insulin resistance and decreased
glucose production
o Weight gain o 0.5%-1.4% A1C reduction!!!!!

- Alpha glucosidase inhibitors – miglitol, acarbose o Act in the intestine to delay
glucose absorption o Can cause explosive diarrhea – not always a good choice
o Does not cause weight gain or weight loss – weight neutral o 0.5%-0.8% A1C
reduction!!!!!
- DPP4 inhibitors – gliptins o Side effects are UTI’s o Weight loss
o 0.6%-0.8% A1C reduction
- SLG2 inhibitors – flozins o Have been shown to block the reabsorption of
filtered glucose, leading to glucosuria which can lead to yeast infections and
UTI’s
o Do not work well with pt’s who have a GFR of less than 45,
so these should not be initiated in them unless they are
already taking – then you can give until they have a GFR of
30 or less
o Come in combo forms with metformin o Can cause weight
loss o 0.7%-0.99% A1C reduction!!!!
- Colesevelam and Bromocriptine – not often given in DM
- Injectables o GLP1 receptor agonists (incretin mimetics) – exanatide byetta,
liraglutide, dulaglutide, lixisenatide, semaglutide (comes in PO also)
 Slows gastric emptying, stimulates glucose dependent release of insulin,
inhibits post-prandial release of glucagon, and suppresses appetite
 INCREASES RISK FOR MEDULLARY THYROID CANCER SO AVOID IN PT’S WHO
ARE AT RISK FOR THIS - Amylin mimetics – pramlinitide
THYROID

Hypothalamus produces thyrotropin releasing hormone, which stimulates the pituitary to
release thyroid stimulating hormone, which stimulates the thyroid to produce T4 and then
converts to T3 in the periphery
- T3 is highly protein bound (99% protein bound) and 1% of freely circulating which is
where we get our function from
- Any break in this cycle will cause hypo or hyperthyroidism
- If this occurs at the hypothalamus level – tertiary hypo or hyper
- If it occurs at the pituitary – secondary hypo or hyper
- We will focus on the primary hypo and hyperthyroidism
- Check females older than 40 yearly for thyroid issues
- Hardly every refer these patients out unless they have hyperthyroidism or uncontrolled
hypothyroidism

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- Only check TSH – then if that is abnormal, you can order the other labs o
Hypothyroidism: TSH elevated and free T4 low (because free T4 is the circulating one)
o Hyperthyroidism: TSH low and free T3 and T4 are elevated o
Subclinical: TSH low or high with normal free T4
 Only treat IF it is 10 or higher
 These patients will convert to either hypo or hyper at some point, or they
may never
- To get your pt to a euthroid state with medication o 1.6-1.8 mcg/kg/day for adults that
are healthy under 50 years old o Patients who are over 50, start them on 50 mcg/day
o Older patients who have CAD should be on 12.5-25 mcg/day – remember to start
low and go slow
o DO NOT HAVE TO KNOW THE YOUNGER DOSAGES
 Patients younger than 3 months, give 10-15 mcg/kg/day
 Patients aged 3 months to 5 months, give 8-10 mcg/kg/day 
Patients aged 6 months to 11 months, give 6-8 mcg/kg/day
 Patients after 1 year to 5 years, give 6 mcg/kg/day
 Patients aged 6 years to 12 years, give 4-5 mcg/kg/day o WILL
HAVE A DOSAGE CALCULATION OVER THIS!!!!! NEED TO KNOW THE 1.6-1.8
MCG/KG/DAY EXCEPT FOR PATIENTS 50 OR OLDER (50 MCG DAILY)
- Medications o Thyroid hormone preparations
 Levothyroxine
• Synthetic preparation of T4 and drug choice for hypothyroidism
• Conversion to T3
• Half life is 7 days
• Used for ALL forms of hypothyroidism
• Extremely inexpensive
• Have these patients back in 6-8 weeks after starting (only do a TSH
lab)
• If TSH is still high, increase the dosage (typically by 12.5-25 mcg)
and have them come back in another 6-8 weeks
• If it is good, come back in 6 months, and then if it is normal come
back in a year
 Liothyroxine (Cytomel)
 Synthetic T3
 Liotrix (Thyrolar)
• Mixture of synthetic T4 plus synthetic T3 in a 4:1 fixed ratio
• Because levothyroxine alone produces the same ration of T4 to T3,
this offer no advantage over levothyroxine for most indications
 Thyroid (Armour Thyroid, others)
• Consists of desiccated animal thyroid glands

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• Standardization is based on content of iodine, levothyroxine, and
liothyronine
• The ratio of levothyroxine to liothyronine is not less than 5:1
• Thyroid is available in tablets (15-300 mg)
o Drug interactions
 DRUGS THAT REDUCE LEVOTHYROXINE ABSORPTION
• H2 receptor blockers, PPI, sucralfate, cholestyramine, colestipol,
Maalox, Mylanta, calcium supplement, iron, magnesium, orlistat
• Take these 4 hours apart from levothyroxine (take levothyroxine
an hour before eating and 4 hours prior to these drugs)
 DRUGS THAT ACCELERATE LEVOTHYROXINE METABOLISM
• Phenytoin (Dilantin), carbamazepine (Tegretol, Caarbatrol),
rifampin (Rifadin), sertraline (Zoloft), and phenobarbital
• To maintain adequate levothyroxine levels, patients on these
drugs may need to INCREASE their levothyroxine dosage
 Warfarin
• Levothyroxine accelerates the degradation of vitamin K
dependent clotting factors
• As a result, effects of warfarin are ENHANCED
• If thyroid hormone replacement therapy is started, the dosage of
the warfarin may need to be reduced
 Catecholamines
• Thyroid hormones increase cardiac responsiveness to these,
thereby increasing the risk for catecholamine-induced
arrhythmias
• Caution must be exercised when administering catecholamines to
patients taking levothyroxine and other thyroid preparations

 Insulin and digoxin
 Levothyroxine can INCREASE requirements for these

- Hyperthyroidism o Usually Grave’s disease seen in patients 40 or younger
and females o Typically referred out to an endocrinologist
o Can give propranolol until getting them into an endocrinologist o Two
meds for tx
 PTU
 Methimazole
• PTU can cause sever liver injury (BBW), where methimazole does
not
• Methimazole cannot be given in 1st trimester of pregnancy – PTU
for this time and then swap to methimazole