treatments and gold standards clin med

Diabetes diagnostic tests

A12 test, fasting plasma glucose, oral glucose tolerance test, random plasma glucose

A12 test

Greater then 6.5%

Fasting plasma glucose

Greater than 126 mg/dl

• Oral Glucose Tolerance Test (OGTT)

Greater then 200 mg/dl

Random plasma glucose

Greater then 200 mg/dl plus symptoms

Continuous glucose monitoring (subcutaneous sensor)

Gives patients alerts about high or low BG levels

Prediabetes tx

Lifestyle modifications (nutrition, physical activity, sleep hygiene, healthy habits, smoking cessation)

Tx for all types of diabetes for diet

Refer all pts to a dietician and diabetes educator

Diabetes plate method

¼ lean meat ¼ starch ½ vegetables + 1 serving fruit

Tx for all types of diabetes

Modest weight loss, regular physical, activity, metabolic surgery

Mainstay tx for type 1 diabetes

Insulin

Insulin

Used in type 1 type 2 and during pregnancy or illness

Insulin delivery systems

Pens, inhaled, pancreas transplant, insulin pump

Insulin inhaler

Afrezza

Insulin pumps

Traditional (tubed) pumps, patch (tubeless) pumps, automated insulin delivery systems

Type 1 tx

Need continuous subcutaneous insulin infusion pump

Continuous glucose monitoring

Tx for hypoglycemia

Give glucose below 70 and give glucagon less than 54

type 2 med for heart disease

Sglt2i

Type 2 med for obesity

Glp1 RA

Tx for unregulated glycemic targets

Start metformin

If alc is greater than 8.5% or polyuria polydipsia or polyphagia

Glp1 RA or basal insulin

Avoid sglt2i

Tx for hypoglycemia

Glp1 RA or sglt2i

Glycemic control in diabetes

Aim for an A12 of 7%

Metformin side effects

Diarrhea

Lactic acidosis

SGLT2 side effects

Genitourinary infections

Hypotension

Euglycemis DKA

GLP1 agonists

Nausea and vomiting

Pancreatitis

Weight loss

Sulfonylureas side effects

Hypoglycemia

Thiazolidinediones bbw and side effect

May cause or exacerbate congestive heart failure

Weight gain

Acute Tx for DKA

Fluid replacement

Add regular insulin

Potassium replacement

Hyperthyroidism labs

Low TSH with high T3 and T4

Graves’ disease diagnosis

Thyroid stimulating immunoglobulin is elevated

Radioactive iodine uptake scan show ___ uptake in graves

Diffuse

RAIU contradictions

Pregnancy and breastfeeding

Hyperthyroidism specific test

TSH receptor antibody

Thyroid radioactive iodine uptake scan

1st line medical tx for graves

Beta blockers

Thionamides

Beta blockers

Atenolol and propranolol

Thionamides

Methimazole preferred medication

Methimazole side effects

Agranulocytosis, hepatic necrosis/cholestatic jaundice

Adiidtional Graves’ disease tx

Radioactive iodine ablation

Thyroidectomy

Blood work for hypothyroidism

TSH is high and thyroid hormone is low

1st line tx for hashimotos

Levothyroxine T4

Anterior hypopituitarism tx

Replace hormones

Imaging for pituitary adenoma

MRI

Pituitary adenoma tx

First line is surgery except for prolactinomas

Prolactinoma first line

Medical therapy

Acromegaly/gigantism labs

IGF-1

Acromegaly/gigantism imaging

MRI

Acromegaly/gigantism tx

Surgery

Resection of pituitary tumor via endoscopic trans nasal transsphenoidal

Acromegaly p/gigantism other tx

Medical tx

XRT or stereotactic radio surgery

GH Deficiency tx

Expert referral needed

Hyperprolactinnemia labs

Serum prolactin levels

Pregnancy testing in women (HCG)

TSH

CMP

Hyperprolactinemia imaging

Mri

Hyperprolactinemia first line drug tx

Cabergoline

Bromocriptine

Diabetes insipidus labs

Increased serum osmolartiy

Decreased urine osmolality

Diabetes insipidus special tests

Fluid depravation test

Desmopressin (adh) stimulation test

Diabetes insipidus imaging

MRI brain

Diabetes insipidus tx central

Desmopressin acetate

Diabetes insipidus tx nephrohemic

Complex treat underlying cause

Salt restriction, hydration, diuretic

SIADH labs

Hyponatremia <130mEq/L

Serum osmalality decreased

Urine sodium osmolality increased

SIADH diagnosis

Diagnosis of exclusion

SIADH TX

treats underlying cause

Fluid restriction

Loop diuretics

SIADH pharmacotherapy

Demeclocycline

ADH receptor antagonists

Corticoadrenal insufficiency primary diagnosis

High ACTh and low cortisol

Corticoadrenal insufficiency Secondary cause diagnosis

Lopes acth and low cortisol

Corticoadrenal insufficiency non pharmacological tx

Perform periodic monitoring

Aggressive tx of all infections

Corticoadrenal insufficiency chronic tx

Replace glucocorticoids/mineralcorticoids (hydrocortisone, fludrocortisone)

Instruct pts to increase glucocorticoids replacement in times of stress

Corticoadrenal insufficiency acute tx

Aggressive if saline/glucose tx

Administer glucocorticoids

Identify and correct any precipitating factor

Cushings syndrome labs diagnosis

Screening (24 hr urinary free cortisol) best one

Differentiation (plasma corticotropin acth)

Once hypercortisolism confirmed

Measure plasma acth

Overnight dexamtheasome suppression test

Cushing’s syndrome tx

Surgery

Medical tx

Cushing’s syndrome tx pituitary adenoma

Transsphenoidal surgery

Primary hyoeraldosteronism labs

Elevated palms and urine aldosterone levels

Metabolic alkalosis

Low plasma renins levels

Primary hyperadosteronism tx

Chronic medical therapy (spironolactone)

Surgery

Thyroid nodules imaging

Ultrasound

Ct/mri

Thyroid scan

Obesity diagnostic testing

BMI

Waist circumference + waist:hip ratio

Body fat percentage

Obesity tx first line

Lifestyle modifications (behavioral modification CBT, diet, physical activity)

Obesity tx pharmacological

GLP-1 receptor agonists

Sympathomimetics

Opioid receptor antagonist/antidepressant

Lipase inhibitor

Glp-1s

Semaglutide (wegovy) weekly injection daily oral

Trizepatide (zebound) weekly injection

Others ( liraglutide, orforglipron)

Opioid receptor antagonist/antidepressant

Naltrexone/bupropion (contrave)

Lipase inhibitor

Orlistat (xenical or ALLI)

Sympathomimetics

Phentermine (adipex-p)

Qysmia (phentermine and topiramate)

Obesity tx weight loss devices

Intragastric balloon (orbera, allurion, Spatz)

Obesity bariatric surgery tx

Endoscopic sleeve gastroplasty

Roux en y bypass

One anastomosis gastric bypass

Biliopancreatic diversion duodenal switch

Single anastomosis duodenal ideal bypass with sleeve gastrectomy

Laparoscopic adjustable gastric band

Transpyloric shuttle

Primary hyperparathyroidism labs after diagnosis

25-hydroxyvitamin D

24-hour urine calcium

Serum creatinine

Dual energy x ray absorptiometry

Tx for hyperparathyrpidism

Parathyroidectomy is definitive tx for all symptomatic pts

Imaging for parathyroidectomy

Tc-99m sestamibli scanning

Secondary hyperparathyroidism labs and findings

Intact PTH (elevated)

Calcium level (normal to midline decreased)

Secondary hyperparathyroidism tx

Optimize medical management of the underlying condition

CKD tx

Tx underlying causes

Tx vitamin D deficiency

Hypoparathyroidism labs

Calcium-low

PTH- normal or low

Phosphorus-high

Hypoparathyroidism tx

Slow intravenous calcium for life threatening or severe

Maintenance regime of oral calcium, vitamin D, and or magnesium for mild to moderate