314 Final Flashcards by Stephen Nicewarner

Corticotropin Releasing Hormone –> (4)

Anterior pituitary –> ACTH –> adrenal cortex –> glucocorticoids/steroid hormones

How well did you know this?

Not at all

Perfectly

Describe negative feedback loop

The hormone released by the target organ stops the hypothalamus and pituitary from releasing hormones that stimulate target organ

How well did you know this?

Not at all

Perfectly

What is an example of a glucocorticoids?

Cortisol

How well did you know this?

Not at all

Perfectly

Adrenal glands produce glucocorticoids but do not

Store them

How well did you know this?

Not at all

Perfectly

4 key times in the cortisol circadian rhythm

Peak at awakening, 8:30AM

Decrease during the day

Lowest at midnight

Start rising around 2-3AM

How well did you know this?

Not at all

Perfectly

What is the hypothalamus stimulated by? (2)

Stress

CNS stimuli

How well did you know this?

Not at all

Perfectly

Physiological effects of glucocorticoids in terms of metabolism (6)

Increased gluconeogenesis

Increased glucose storage as glycogen

Increased lypolysis and fat redistribution

Decreased protein synthesis

Decreased glucose uptake into fat and muscle

Decreased peripheral to glucose use

How well did you know this?

Not at all

Perfectly

Thyrotropin releasing hormone (TRH) –> (4)

Anterior Pituitary –> releases TSH –> Thyroid –> releases thyroid hormones

How well did you know this?

Not at all

Perfectly

Physiological effects of glucocorticoids in CV system

Maintains vasculature integrity

Increased RBC

Decreased LEBM

How well did you know this?

Not at all

Perfectly

Low dose glucocorticoids for endocrine treatment

Physiological

How well did you know this?

Not at all

Perfectly

High dose glucocorticoids for non-endocrine treatment

Pharmacological

How well did you know this?

Not at all

Perfectly

All glucocorticoids produce the same therapeutic effect but differ in three areas

Half life

Mineralocorticoid potency

Anti-inflammatory potency

How well did you know this?

Not at all

Perfectly

Low dose glucocorticoids for endocrine treatment

Physiological

How well did you know this?

Not at all

Perfectly

High dose glucocorticoids for non-endocrine treatment

Pharmacological

How well did you know this?

Not at all

Perfectly

All glucocorticoids produce the same therapeutic effect but differ in three areas

Half life

Mineralocorticoid potency

Anti-inflammatory potency

How well did you know this?

Not at all

Perfectly

Effects of pharmacological doses of glucocorticoids (4)

Decrease synthesis of chemical mediators

Decrease infiltration of phagocytes

Decrease proliferation of lymphocytes

How well did you know this?

Not at all

Perfectly

Glucocorticoids inhibit chemical mediators such as (3)

Prostaglandins

Leukotrienes

Histamines

How well did you know this?

Not at all

Perfectly

Inhibition of chemical mediators means decreased (4)

Pain

Edema

Erythema

Warmth

How well did you know this?

Not at all

Perfectly

Why do glucocorticoids have greater anti-inflammatory effects than NSAIDs?

More diverse mechanisms

How well did you know this?

Not at all

Perfectly

One side effect of pharmacologic doses of glucocorticoids is that

Physiologic effects are magnified

How well did you know this?

Not at all

Perfectly

Therapeutic uses of pharmacologic glucocorticoids (10)

Rheumatoid arthritis 
Lupus 
Inflammatory bowel disease 
Osteoarthritis 
Allergies 
Dermatology
Asthma
Neoplasms 
Immunosuppression for skin graft
Prevention of respiratory distress syndrome

How well did you know this?

Not at all

Perfectly

4 systemic routes of glucocorticoid administration

Oral

How well did you know this?

Not at all

Perfectly

Local administration routes (4)

Topical

Inhalation

Intranasal

Intra-articular

How well did you know this?

Not at all

Perfectly

High lipid solubility increases the risk for

Systemic effects

How well did you know this?

Not at all

Perfectly

Multiple small doses of glucocorticoids means better maintenance of blood levels within therapeutic range, but increases the risk of

Adrenal suppression

Large doses of intermediate acting glucocorticoids every other day

Alternate dosing

Alternate dosing decreases (3)

Adrenal suppression Growth retardation Toxicity

May fall to sub therapeutic levels

Alternate dosing

Normal body temperature range

36-37.5

When is the temperature highest?

Late afternoon/early evening

Temperature drops between

8-2AM

Heat producing behaviors (5)

Superficial vasoconstriction Contraction of pilomotor muscles Huddle position Shivering Increased epinephrine and thyroid hormones

Heat dissipation (2)

Superficial vasodilation Diaphoresis

Superficial vasoconstriction allows heat loss through

Convection or radiation

Diaphoresis allows heat loss via

Evaporation

What substance increases thermoregulatory center set point?

Prostaglandin E2

Purpose of pyrexia (3)

Increased WBC activity Increased interferon production Activation if T cells

If the body temperature increases by 1°C, how much will the heart rate increase?

15 bpm

If the body temperature increases by 1°F, how much will the heart rate increase?

10 bpm

Determining the underlying cause is important when treating

Fever

Fever treatments (5)

Cool sponge bath Cooling blanket Fluids Carbohydrates Antipyretics

Groups that may have blunted fever responses (3)

Infants Immunocompromised Eldery

Examples of immunocompromised individuals (3)

HIV Chemotherapy Organ transplant

Core temperature between 37.8°C and 40°C

Heat exhaustion

Core temperature above 40°C/104°F

Heat stroke

Hypothermia range

Below 93°F or 35°C

Most sensitive method for screening diagnosing and monitoring treatment of thyroid issues

Serum TSH

Which serum test can monitor thyroid hormone replacement therapy?

Serum T4

Used for the diagnosis of hyperthyroidism

Serum T3

Both tests for T3 and T4 are obtained after

Serum TSH

Lifelong levothyroxin (T4)

Hypothyroidism

A severe form if hypothyroidism

Myxedema

What is myxedema called in infants?

Cretinism

Does myxedema cause pitting edema?

Causes mucus type of edema

Myxedema

Drug for hypothyroidism (trade) (3)

Synthroid Levoxyl Levothroid

Generic name for hypothyroidism drug

Levothyroxine

Hypothyroidism during pregnancy can cause (3)

Retardation/low IQ Impair development of muscle, bones and nerves Permanent neuropsychological changes

When is the baby most affected by the mother's hypothyroidism?

1st Trimester

Hyperthyroidism is important to diagnose early in mothers, but the symptoms are very nonspecific such as (3)

Tiredness Irritability Poor concentration

Pregnant women required ___% more replacement therapy

50%

Causes of hyperthyroidism (6)

``` Graves Disease Diffuse goiter Multinodular goiter Adenoma of thyroid Thyroiditis Iodine containing agents ```

Hyperthyroidism symptoms (5)

Strong and rapid heartbeat CNS stimulation Skeletal muscle atrophy Increased appetite Weight loss

Examples of CNS stimulation (3)

Nervousness Insomnia Rapid speech/thought

Hyperthyroidism treatment (3)

Surgical ablation Radioactive iodine Anti-thyroid drugs

Drugs to relieve symptoms of surgical ablation (2)

Calcium channel blockers Beta blockers

How long does the full effect radioactive iodine take?

2-3 months

Anti-thyroid drug (2)

Propylthiouracil (PTU) Methimazole

Propylthiouracil blocks (2)

TH synthesis Conversion of T4-T3

Methimazole blocks only

Conversion of T4-T3

What is the trade name of methimazole?

Tapazole

Thyrotoxic crisis/thyroid storm is the increased release of thyroid hormones precipitated by (2)

Surgery Severe illness

Thyroid crisis/storm symptoms

Profound hyperthermia Severe tachycardia and other heart issues Restlessness/tremors Coma

Large myelinated fibers for "fast" pain

A-Delta fibers

Small Un myelinated Slow

C fibers

Release glutamate at the synapse with spinal neurons

A-delta

Release both glutamate and substance P

C fibers

Barriers to pain management (7)

``` Inadequate assessment Fear of side effects Fear of addiction/tolerance Fear of respiratory depression Fear of hastening death Healthcare systems Cost and reimbursement ```

The goal is to eliminate pain by treating underlying cause. What kind of pain?

Acute

What is the goal for chronic pain?

Maintain quality of life and function

Pain is relayed from tissues by nerves

Nociceptive pain

Pain is from the nerve itself

Neuropathic pain

Character of nociceptive pain (4)

Dull Aching Pressure Tender

Character of neuropathic pain (4)

Shooting Burning Electric shock Tingling

Why is it important to identify whether the pain is nociceptive or neuropathic?

Because they require different treatments

Which kind of pain responds to traditional pain medications and therapies?

Nociceptive pain

4 other types of pain

Cutaneous Deep somatic Visceral Referred

This kind of pain is superficial. Can be localized or distributed along the dermatomes.

Cutaneous

This pain is deep, difuse, and sometimes radiating

Deep somatic

This pain has small unmyelinated afferent nerve fibers

Visceral

Most common pain in elderly (5)

Back pain Osteoarthritis Diabetic neuropathy Post-herpetic neuralgia Cancer

Veteran common pain (5)

Headache Joint pain Back pain Muscle pain Abdominal pain

Patient report of pain is #1 priority. What is #2 priority?

Prior pain history

#3 priority in gauging pain is painful diagnoses. For example (5)

``` Degenerative joint/disc disease Spinal stenosis Osteoporosis/compression fracture Cancer Herpes zoster ```

Pain assessment tools (4)

CNPI NOPAIN PAIN-AD Wong-Baker FACES

Causes of pain in dementia patients (5)

Constipation/diarrhea Lodged food Contracture Pressure ulcer UTI

Empirical trials, lowest on the hierarchy, are useful in patients that are

Nonverbal

Non-opioids are (1)

COX inhibitors

Two categories of COX inhibitors

Anti-inflammatory (NSAIDs) Not anti-inflammatory

Anti-inflammatory (NSAIDs) (2)

COX1 inhibitors COX2 inhibitors

COX1 inhibitors (3)

Ibuprofen Aspirin Naproxen

COX2 inhibitors (1)

Celecoxib

Which cyclooxygenase inhibitor lacks anti-inflammatory properties?

Acetaminophen

Opioid side effects (7)

``` Constipation Sedation Nausea Myoclonus Respiratory distress Urinary retention Pruritus ```

Examples of adjuvants (5)

``` Antidepressants Anticonvulsants Corticosteroids Local anesthetics Biphosphonates ```

Pain 1-3

Non-opioid with potential adjuvant

Pain 4-6

Weak opioid AND potential adjuvant or NSAID

7-10

Strong opioid Potential adjuvant Potential NSAID

3 times to avoid NSAIDs

Avoid in Renal disease Avoid in Bleeding risk Avoid with steroids

Do not use acetaminophen if the patient has

Liver disease

What % is an IR break through dose?

10-20% of 24 hour dose

After initial IR is given, how long until calculating 24 hour dose?

25-48 hours

Other pain therapies (3)

Neurolytic block Neuroablative procedures Vertebroplasty/kyphoplasty

During REM sleep, acetylcholine and dopamine

Increase

Secretes melatonin in darkness

Pineal gland

During REM sleep brain metabolism

Increases

Most dreaming occurs during

REM sleep

RAS is inhibited during

NREM sleep

Lightest stage of sleep in which eyes roll from side to side

Stage 1

Light sleep, but eyes are still

Stage 2

Deepest stages of sleep

Stage 3 and 4

Delta sleep occurs during

Stage 3 and 4

When does snoring occur?

Stage 3 and 4

Which stage is essential for restoring energy and releasing GH

Stage 3 and 4

HR and respiration drop 20-30% during

Stage 3 and 4

Sleep is important for synthesis of

Protein

How many hours a day do newborns sleep?

16-18

Newborns instantly enter

REM sleep

How long is a newborn sleep cycle?

50 minutes

Do newborns have rapid eye movement?

Yes

Awaken every 3-4 hours, eat, and then go back to sleep

Infants

Sleep 14-15 hours a day

Infants

Sleep 12-14 hours

Toddlers

Afternoon naps still advised for

Toddlers

Nighttime fears and nightmares begin with

Toddlers

Enuresis with

Preschoolers

Establishing a routine is key for

Preschoolers

Who needs 11-13 hours

Preschoolers

Who needs 10-11 hours

School aged

7-9 hours for

Adults and elders

Caused by lack of hypocretin

Narcolepsy

CAGE screening for

Alcoholism

What score is significant for the CAGE?

2 or more

PHQ-9 screens for

Depression

314 Final Flashcards

(144 cards)