7341 Endocrine Test 1 Flashcards
(142 cards)
1
Q
Clinical presentation of short stature?
A
> 2 std deviations below population mean for a given age and sex
growth hormone deficiency
2
Q
GH excess laboratory value following OGTT?
A
GH > 1 mcg/L and elevated IGF1
3
Q
GH deficiency value?
A
peak GH conc. > 10 mcg/L during 2 hr period following GH provocation test
4
Q
New GH deficiency test value?
A
GH < 2.8 ng/mL
measure GH at 30, 45, 60, and 90 minutes
5
Q
Microadenoma classification?
A
< 10mm
do not increase in size
hyperprolactinemia
6
Q
Macroadenoma classification?
A
> 10mm
continue to grow and may invade other tissues
hyperprolactinemia
7
Q
Hyperprolactinemia fasting prolactin level?
A
> 25mcg/L
diagnostic for hyperprolactinemia; observed on multiple occasions
8
Q
Normal male prolactin level?
A
< 15 mcg/L
9
Q
Normal non-pregnant female prolactin level?
A
< 25mcg/L
10
Q
What prolactin level causes menstrual irregularities?
A
> 60 mcg/L
11
Q
Normal pregnant female prolactin level?
A
34-386 mcg/L
12
Q
Prolactin levels do not usually rise to ___ in drug -induced disease.
A
> 150 mcg/L
13
Q
GH dose?
A
25-50 mcg/kg
qd SubQ; often at bedtime
14
Q
GH bioavailability?
A
70%
15
Q
GH half life?
A
20 mins
16
Q
Half life of somatostatin (srif)?
A
3 mins or less
17
Q
Half life of bromocriptine (Parlodel)?
A
5 hours
dopamine agonist used to treat hyperprolactinemia
18
Q
Half life of cabergoline (Dostinex)?
A
64 hours
dopamine agonist used to treat hyperprolactinemia
19
Q
ketoconazole
Drug class?
disease state/condition?
A
steroidogenesis inhibitor
Cushing’s syndrome
20
Q
metyrapone
drug class?
disease state/condition?
A
steroidogenesis inhibitor
Cushing’s syndrome
21
Q
etomidate
drug class?
disease state/condition?
A
steroidogenesis inhibitor
Cushing’s syndrome
22
Q
pasireotide
drug class?
disease state/condition?
A
pituitary directed agent
Cushing’s syndrome
23
Q
cabergoline
drug class?
disease state/condition?
A
Dopamine agonist
Cushing’s syndrome, GH excess, hyperprolactinemia
24
Q
mitotane
drug class?
disease state/condition?
A
adrenolytic
Cushing’s syndrome
25
mifepristone
drug class?
disease state/condition?
glucocorticoid receptor antagonist
| Cushing's syndrome
26
spironolactone
drug class?
disease state/condition?
aldosterone antagonist
| primary hyperaldosteronism
27
amiloride
drug class?
disease state?
potassium sparing diuretic
| primary hyperaldosteronism
28
epleretone
drug class?
disease state?
aldosterone antagonist
| primary hyperaldosteronism
29
hydrocortisone
drug class?
disease state?
glucocorticoid/mineralocorticoid
| Addison's disease, adrenal crisis
30
prednisolone
drug class?
disease state?
glucocorticoid
| Addison's disease, adrenal crisis
31
prednisone
drug class?
disease state?
glucocorticoid
| Addison's disease, adrenal crisis
32
methylprednisolone
drug class?
disease state?
glucocorticoid
| Addison's disease, adrenal crisis
33
fludrocortisone
drug class?
disease state?
mineralocorticoid
| Addison's disease, adrenal crisis
34
bromocriptine
drug class?
disease state?
dopamine agonist
| GH excess, hyperprolactinemia
35
ocreotide
drug class?
disease state?
somatostatin analogs
| GH excess
36
lanreotide
drug class?
disease state?
somatostatin analog
| GH excess
37
pasireotide
drug class?
disease state?
somatostatin analog
| GH excess
38
pegvisomant
drug class?
disease state?
GH receptor antagonist
| GH excess
39
mecasermin
drug class?
disease state?
recombinant IGF-1
| GH deficiency
40
methimazole
drug class?
disease state?
antithyroid drug
| hyperthyroidism
41
propylthiouracil
drug class?
disease state?
antithyroid drug
| hyperthyroidism
42
radioactive iodine (131I)
drug class?
disease state?
iodide
| hyperthyroidism
43
potassium iodide
drug class?
disease state?
iodide
| hyperthyroidism
44
propranolol
drug class?
disease state?
beta adrenergic blocker
| hyperthyroidism
45
nadolol
drug class?
disease state?
beta adrenergic blocker
| hyperthyroidism
46
metoprolol
drug class?
disease state?
beta adrenergic blocker
| hyperthyroidism
47
levothyroxine
drug class?
disease state?
L-thyroxine T4
| hypothyroidism
48
liothyronine
drug class?
disease state?
L-thyroxine T4
| hypothyroidism
49
liothyronine
drug class?
disease state?
liothyronine, T3
| hypothyroidism
50
alfuzosin
drug class?
disease state?
alpha adrenergic antagonist
| BPH
51
doxazosin
drug class?
disease state?
alpha adrenergic antagonist
| BPH
52
prazosin
drug class?
disease state?
alpha adrenergic antagonist
| BPH
53
terazosin
drug class?
disease state?
alpha adrenergic antagonist
| BPH
54
silodosin
drug class?
disease state?
alpha 1A adrenergic antagonist
| BPH
55
tamsulosin
drug class?
disease state?
alpha 1A adrenergic antagonist
| BPH
56
finasteride
drug class?
disease state?
5 alpha reductase inhibitor
| BPH
57
dutasteride
drug class?
disease state?
5 alpha reductase inhibitor
| BPH
58
tadalafil
drug class?
disease state?
phosphodiesterase inhibitor
| BPH, ED
59
sildenafil
drug class?
disease state?
phosphodiesterase inhibitor
| BPH, ED
60
vardenafil
drug class?
disease state?
phosphodiesterase inhibitor
| BPH, ED
61
avanafil
drug class?
disease state?
phosphodiesterase inhibitor
| BPH, ED
62
darifenacin
drug class?
disease state?
anticholinergic agent
| BPH
63
solifenacin
drug class?
disease state?
anticholinergic agent
| BPH
64
oxybutynin
drug class?
disease state?
anticholinergic agent
| BPH
65
tolterodine
drug class?
disease state?
anticholinergic agent
| BPH
66
mirabegron
drug class?
disease state?
Beta 3 adrenergic agonist
| BPH
67
depo-testosterone
drug class?
disease state?
testosterone replacement
| ED
68
delatestryl
drug class?
disease state?
testosterone replacement
| ED
69
testopel
drug class?
disease state?
testosterone replacement
| erectile dysfunction
70
androderm
drug class?
disease state?
testosterone replacement
| erectile dysfunction
71
androgen
drug class?
disease state?
testosterone replacement
| ED
72
alprostadil
drug class?
disease state?
prostaglandin
| ED
73
flibanserin
drug class?
disease state?
serotonin agonist/antagonist
| hypoactive sexual desire disorder
74
Half life of cortisol?
70-120 mins
95% protein bound
75
Dexamethasone suppression test:
Cortisol value indicating normal?
< 1.8 mcg/dL
Diagnostic test for Cushing's syndrome
76
Dexamethasone suppression test:
Cortisol value indicating likely abnormal?
1.8-5 mcg/dL
Diagnostic test for Cushing's syndrome
77
Dexamethasone suppression test:
Cortisol value indicating abnormal?
5 mcg/dL or more
Diagnostic test for Cushing's syndrome
78
ACTH stimulation testing normal cortisol level?
> 18 mcg/L
if no change in cortisol, indicative of Addison's disease
79
Ocreotide reduces GH to what level?
< 5 mcg/L
normalization of IGF-1 levels in 50-60% of pts after 1 year
80
pasireotide can reduce GH levels too?
< 2.5 mcg/L and normalize IGF-1 levels in 35% of drug naive and somatostatin analog treatment failure pts
81
1 mg of recombinant GH contains ___ IU of GH?
2.6
recombinant GH potency expressed in international units (IU)
all contain somatropin
82
How much growth expected with recombinant GH use?
5 cm/year
final height will still be 0.5-1.7 SD below normal
dose is weight based
83
When to double recombinant GH dose in children?
if growth rate is 2-2.5 cm/1year or less
double dose for 6 months
84
Starting recombinant GH dose in adults?
0.2mg/day
increase every 2-3 months on basis of response and serum IGF-1 values
administer in evening
85
Initial bromocriptine dose for hyperprolactinemia?
1.25-2.5mg QD
titrate by 1.25mg increments
usually ranges from 2.5-15mg QD to TID; some require up to 40mg/day
86
Initial cabergoline dose for hyperprolactinemia?
0.25-0.5mg once weekly or in divided doses twice weekly
dose may be titrated by 0.5 mg increments at 4 week intervals
usual dose is 1mg weekly; up to 12 mg/week have been used safely
87
Ketoconazole inhibits what CYP at normal doses?
CYP17
also CYP3A4
88
Ketoconazole inhibits CYP17 and what other CYP at high doses?
CYP11A1
also CYP3A4
89
Metyrapone inhibits what CYP?
CYP11B1
90
Etomidate inhibits what CYP?
CYP11B1
91
Etomidate has no hypnotic effect at what dose?
0.3 mg/kg/hr
steroidogenesis inhibitor for Cushing's syndrome
92
How does pasireotide work?
somatostatin analog
approved for Cushing's; pituitary targeted therapy
93
How does cabergoline work?
dopamine D2 agonist
off-label use for Cushing's; pituitary targeted therapy
94
Pasireotide dose?
0.6mg SQ BID
approved pituitary targeted therapy for Cushing's
95
Cabergoline dose?
1-7 mg/week PO
off label for Cushing's; dopamine D2 agonist; pituitary targeted therapy
96
mifepristone drug class?
glucocorticoid receptor antagonist
progesterone antagonist; terminates early pregnancy; glucocorticoid receptor antagonist at higher doses
97
Where are mineralocorticoids made?
zona glomerulosa of adrenal cortex
aldosterone
98
Where are glucocorticoids made?
zona fasciculata of adrenal cortex
cortisol
99
Where are gonadocorticoids made?
zona reticular of adrenal cortex
sex hormones
100
Continue ACTH replacement until cortisol is at what level?
> 20 mcg/dL
6-12 months for adrenal adenoma
101
ketoconazole dose?
200-1200 mg/day; divide BID/TID
steroidogenesis inhibitor for Cushing's
102
metyrapone dose?
750-6000 mg/day; divided BID/TID/QID
steroidogenesis inhibitor for Cushing's
103
etomidate dose?
0.3mg/kg/hr x 11-24 hrs
steroidogenesis inhibitor for Cushing's
104
mitotane dose?
1-3 g/day PO
start at 0.5 mg qhs
up to 12 g/day for carcinomas
adrenolytic for Cushing's
105
pasireotide can increase HbA1c by?
about 1.4%
pituitary targeted pharmacotherapy for Cushing's
106
mifepristone dose?
300mg PO daily
glucocorticoid receptor antagonist for Cushing's
107
Normal serum cortisol level?
7-20 mcg/dL
108
Cushing's caused by adrenal adenoma pharmacological Tx?
steroidogenesis inhibitors
block and replace or normalization strategy
109
Cushing's caused by adrenal carcinoma pharmacological Tx?
adrenolytics
normalization strategy
110
Eplerenone is contraindicated for primary aldosteronism at what CrCL?
< 30 ml/min
111
Spironolactone is contraindicated for primary aldosteronism at what CrCl?
< 50 ml/min
112
spironolactone dose for primary aldosteronism?
12.5-25mg PO with food
titrate every 4 weeks
max dose 400 mg/day
113
epleretone dose for primary aldosteronism?
25mg PO BID
titrate every 4 weeks
FDA max dose 100mg/day
off label max dose 300 mg/day
114
amiloride dose for primary aldosteronism?
5mg PO BID
115
cortisone for adrenal insufficiency:
equivalent dose?
duration of action?
mineralocorticoid activity?
equivalent dose: 25mg
duration: short
MC activity: ++
116
Hydrocortisone for adrenal insufficiency:
equivalent dose?
duration of action?
MC activity?
equivalent dose: 20mg
duration: short
MC activity: ++
117
prednisolone for adrenal insufficiency:
equivalent dose?
duration of action?
MC activity?
equivalent dose: 5mg
duration: intermediate
MC activity: +
118
prednisone for adrenal insufficiency:
equivalent dose?
duration of action?
MC activity?
equivalent dose? 5mg
duration: intermediate
MC activity: +
119
methylprednisolone for adrenal insufficiency:
equivalent dose?
duration of action?
MC activity?
equivalent dose: 4mg
duration: intermediate
MC activity: 0
120
dexamethasone for adrenal insufficiency:
equivalent dose?
duration of action?
MC activity?
equivalent dose: 0.75mg
duration: long
MC activity: 0
121
fludrocortisone for adrenal insufficiency:
equivalent dose?
duration of action?
MC activity?
equivalent dose: n/a
duration of action: n/a
MC activity: ++++ 100%
purely mineralocorticoid effects!!
122
Glucocorticoid replacement:
hydrocortisone dose?
15-25 mg/day divided BID/TID
TID regimen: 10mg at 0800, 5mg at 1200, 5mg at 1600
123
Glucocorticoid replacement:
prednisolone dose?
3-5mg daily
124
mineralocorticoid replacement:
fludrocortisone dose?
initial 0.05-0.1mg Qam
pts on long acting glucocorticoids may require 0.2mg/day
125
androgen replacement:
DHEA dose?
25-50mg Qam
d/c after 6 month is no benefit observed
126
Hydrocortisone dose for severe sickness/adrenal crisis?
100mg IM or IV immediately; then 50mg IV or IM every 6 hrs
then 1-3 liters D4NS or NSIV (do not use 1/2 NS)!!
127
Low probability of HPA suppression:
any dose less than 3 weeks
prednisone alternating day regimen 10mg or less QOD
128
Intermediate probability of HPA suppression:
prednisone 10-20mg for 3+ weeks
prednisone < 10mg/day
129
High probability of HPA suppression:
prednisone > 20mg/day for 3+ weeks
bedtime prednisone 5mg/day for 2+ weeks
cushingoid appearance
130
Glucocorticoid behavior/cognitive changes/sleep disturbances occur when?
immediate (within 1 week)
131
Glucocorticoid CV disease occurs when?
higher dose (>7.5mg of prednisone equivalent)
132
Glucocorticoid glaucoma occurs with what dose?
> 10 mg/day of prednisone or equivalent for > 1 year
133
Glucocorticoid HPA suppression occurs with what dose?
> 15 mg/day of prednisone or equivalent for > 3 weeks
134
thyrotropin (TSH) range:
0.5-4.7 mIU/L
135
free thyroxine (FT4) range:
0.8-2.7 ng/dL
136
total thyroxine (TT4) range:
4.5-10.9 mcg/dL
137
total triiodothyronine (TT3) range:
60-181 ng/dL
138
PTU initial dosing?
300-600 mg/day in three to four divided doses
maintenance: 50-300mg/day
139
Methimazole (MMI) dosing?
15-60mg in three divided doses or single daily dose for doses > 30 mg/day
maintenance: 5-30mg/day
140
Levothyroxine dose?
1.6-1.7 mcg/kg
141
Levothyroxine dose in cardiac disease?
initiate low: 12.5 mcg
slowly titrate 12.5-25 mcg increments every 6-8 weeks
142
Levothyroxine dose in elderly?
start low: 50 mcg
slowly titrate 12.5-25 mcg increments every 6-8 weeks
