Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APEX > Unit 12 > Flashcards

Unit 12 Flashcards

1
Q

Posterior pituitary hormones

A

ADH- produced in supraoptic nuclei
Oxytocin- produced in paraventricular nuclei, positive feedback loop

Both are produced in thalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anterior pituitary hormones

A 
FLAT PiG
Follicle stimulating hormone
Luteinizing hormone
Adrenocorticotropin
Thyroid Stimulating hormone
Prolactin- neural control, increased dopamine decreases prolactin release
(Ignore)
Growth hormone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hormones stored and secreted by thyroid gland

A

Thyroxine=T4 (prohormone from tyrosine), high concentration in blood, more protein binding, less potent, 7 day half life
Triiodothyronine=T3 (Active), high concentration in target cell, less protein binding, more potent, 1 day half life, mostly converted from T4

Calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Goiter formation

A

Chronic high TSH
TSH stimulates follicles to make thyroglobulin colloid and iodine isn’t required
Thyroglobulin continued to be produced and causes gland to increase in size

Goiter=awake intubation
Next best = spontaneous ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Beta blockers for hyperthyroid

A

Propranolol and esmolol

Also inhibit peripheral conversion of T4 to T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treating thyroid storm

A

4 B’s
Block synthesis (methimazole, PTU)
Block release (radioactive iodine, K iodide)
Block T4 to T3 conversion (PTU, propranolol)
Beta blocker (propranolol, esmolol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RLN injury

A

Innervates all intrinsic laryngeal muscles
Unilateral- ipsilateral paralysis, hoarseness
Bilateral- both cords midline on inspiration=obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Resection of parathyroid gland

A

Hypocalcemia at least 6-12 hours after surgery
Increased nerve and muscle irritability
Hypotension
Prolonged QT
Chvosteks- tapping angle of jaw=facial contraction on ipsilateral side
Trousseaus- upper extremity cuff inflated for 3 min, decreased BF=irritability and causes muscle spasm of hand/FA
IV Ca- Ca gluc is less Ca but lower risk of necrosis than Ca Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mineralacorticoids

A 
(Aldosterone)
Zona glomerulosa (outer layer)- cortex
Sodium retaining potency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Glucocorticoids

A

(Cortisol)
Zona fasciculata
Anti inflammatory potency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Androgens

A

(Dehydroepiandrosterone)

Zona reticularis- inner most layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adrenal medulla

A

(Middle)

Catecholamines (epi 80% and norepi 20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adrenal context

A

GFR from outside to inside

Salt, sugar, and sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Decreased ACTH

A

Minor influence on aldosterone release

Decreased does not cause hypoaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Aldosterone

A

Regulates intravascular volume- NOT osmolality
Causes fluid retention and expansion of extracellular space- stimulates Na K ATPase in distal tubule and collecting duct
With reduction in serum K and metabolic alkalosis
Stimulated by- RAAS stimulation, increased K, decreased Na
1-2 hour delay before effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ADH

A

Increases absorption of water and NOT Na
Diluted plasma sodium
Half life 5-15 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cortisol

A

Diffuses into cell to bind with intracellular receptors= slow onset of steroids
CRH from HT and stimulates anterior pituitary
ACTH from anterior pituitary and stimulates cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cortisol production

A

15-30 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Serum cortisol level

A

12 mcg/dL

Up to 30-50 mcg/dL during and after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cortisol effects

A

Energy mobilization
Anti inflammatory- doesn’t decrease histamine release
Increases number and sensitivity of beta receptor in myocardium
Vasoconstrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cortisol

A

Equal GC and MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cortisone

A

Equal GC and MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Prednisone and prednisolone

A

4 GC: 0.8 MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Methylprednisolone

A

5 GC: 0.5 MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dexamethasone and betamethasone

A

25 GC: 0 MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Triamcinolone

A

5 GC: 0 MC

Given in epidural space
Incidence of muscle weakness
Causes sedation and anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Conns syndrome

A

Hyperaldosteronism
Primary- normal renin, increased from adrenal gland
Secondary- increased renin activity
Long term Licorice- glycyrrhizic acid causes resembling syndrome

Htn
Decreased K
Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cushing’s syndrome

A

Excess cortisol from overproduction or exogenous
Causes GC, MC, and androgenic effects

Increase glucose
Htn
Low K
Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Adrenal insufficiency

A

Primary (Addison’s)

Hotn 
Low gluc
Low Na
High K
Metabolic acidosis

Treat with 15-30mg cortisol day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stress dosing

A

Yes- greater than 20mg for greater than 3 weeks
Yes 5-20mg for greater than 3 weeks
No- less than 5 mg for less than 3 weeks

5mg prednisone=20mg hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Surgeries

A

Superficial-dental, biopsy

Minor- inguinal hernia, colonoscopy
25mg IV (hydrocortisone)

Moderate- colon resection, total joint, hysterectomy
50-75 mg, taper

Major- CV, thoracic, liver, whipple
100-150mg, taper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Glucagon

A

Alpha cells
Catabolic- promotes energy release from adipose and liver
Stimulate pancreas to release insulin
Glucose antagonist
Increases contractility, HR, and AV conduction- increases cAMP
Releases biliary sphincter in ERCP
N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Insulin

A 
Beta cells
Anabolic- promotes energy storage
Stimulates Na/K ATPase to decrease serum K 
Glucose=primary stimulator of release
Beta agonists=increased serum glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Somatostatin

A

Delta cells
Growth hormone inhibitions hormone
Inhibits insulin and glucagon
Inhibits splanchnic blood flow, gastric motility, and gall bladder contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pancreatic polypeptide

A

PP cells

Inhibits pancreatic exocrine secretion, gallbladder contraction, gastric acid and motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Insulin receptor

A

2 alpha and 2 beta subunits- insulin binds to beta
Activate tyrosine kinase and activate substrates
Turns on GLUT 4 transporter to increase glucose uptake into muscle and fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Organs that dont need insulin for glucose uptake

A

Brain- needs steady glucose supply to function

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Diabetes triad

A

Polyuria
Dehyrdation
Polydipsia

39
Q

DKA

A

Cause=infection
Ketoacidosis, hyperosmolarity, dehydration
Hyperglycemia but cells starved for fuel
Metabolic acidosis= kussmaul respirations
Acetone= fruity breath
Tx= volume, inclusion, K after acidosis

40
Q

HHS

A

Enough produced to prevent ketones, but not hyperglycemia (greater than 600)
Increases osmolarity
Dehydration and hypovolemia
Mild metabolic acidosis (no gap)
Tx= volume, insulin, correct electrolytes

41
Q

prayer sign

A

Joint glycosylation

Increased risk of difficult intubation

42
Q

Biguanides

A 
Metformin
MOA- inhibits gluconeogensis and glycogenolysis in liver, decreased peripheral insulin resistance
NO hypoglycemia
Lactic acidosis
Vit B12 deficiency
used in PCS
Discontinue 48 hours before surgery
43
Q

Sulfonylureas

A 
Glyburide, glipizide, glimepiride, gliclazide, tolbutamide, chlorpromazine, acetohexamide
MOA- stimulates insulin secretion 
CAN cause hypoglycemia
Avoid in sulfa allergy
Discontinue 24-48 hours before surgery
44
Q

Meglitinides

A

Repaglinide, nateglinide
MOA- stimulates insulin secretion
CAN cause hypoglycemia

45
Q

Thiazolidinediones

A

Rosiglitazone, pioglitazone
MOA- decrease insulin resistance, increase hepatic glucose utilization
NO hypoglycemia
Black block warning- increased risk of CHF

46
Q

A Glucosidase inhibitors

A

Acarbose, miglitol
Slows digestion and absorption of carbs
NO hypoglycemia

47
Q

Glucagon like peptide 1 receptor agonists

A

Exenatide, liraglutide
Increase insulin release, decrease glucagon release, prolong gastric emptying
Risk of hypoglycemia

48
Q

Dipeptidyl peptidase 4 inhibitors

A

:liptin
Increase insulin release, decrease glucagon release
Risk of hypoglycemia

49
Q

Myelin agonists

A

Pramlintide
Inhibit glucagon release, reduce gastric emptying
Risk of hypoglycemic with insulin
N/V

50
Q

Goals of insulin therapy

A

HbA1c less than 7
Glucose 70-130 (before meal)
Glucose less than 180 (after meal)

51
Q

Carcinoid syndrome

A

Secretion of vasoactive substances from enterochromaffin cels
Usually GI tumors
Cleared by liver- in liver dysfunction have mimicked symptoms
Flushing and diarrhea
Concurrent cardiac disease= pulmonic stenosis and tricuspid regurg

52
Q

Carcinoid syndrome and drugs

A

Give- somatostatin, antihistamines, serotonin antagonis, steroids
Don’t give- histamine releasing, succ, exogenous catecholamine, sympathomimetic

53
Q

When does glycosuria occur

A

Serum glucose greater than 180 mg/dL

54
Q

Renal hormone production

A

Erythropoietin
Calcitrol
Prostaglandins

55
Q

Calcitrol

A

Synthesize from Vit D
Converted to inactive rom in liver
Active form (1.25 Oh 2- Active Vit D3)

Stimulates absorption from Ca2 from food
Stimulates bone to store
Stimulates kidneys to reabsorb

56
Q

Cardiac output to kidneys

A

20-25%

57
Q

Blood filtered through glomerulus

A

20% of kidneys blood

58
Q

amount of ultrafiltrate reabsorbed

A

99%

59
Q

Amount of urine produced daily

A

1-1.5L/day

60
Q

Renal blood flow

A

(MAP - renal venous pressure)/ renal vascular pressure

61
Q

Renal autoregulation

A

50-180 mmHg

62
Q

Conditions that increase renin release

A

Decreased renal perfusion pressure
SNS activation (B1)
TGF- decreased Na and CL in distal tubule

63
Q

Renin

A

From JG cells in kidney

64
Q

ACE

A

From lung

65
Q

Serum osmolarity

A

2 Na + (glucose/18) + (BUN/28)

Na=primary determinant

66
Q

Normal serum osmolarity

A

280-290 mOsm/L

67
Q

Stimulation of ADH

A

Increased osmolarity of ECF

Decreased blood volume- baroreceptors in carotid bodies, transverse aortic arch, great veins, and RA

68
Q

Anesthetic considerations that increase ADH

A

PEEP
Positive pressure ventilation
Decreased BP
Hemorrhage

69
Q

Da 1

A

Increases cAMp

Vasodilation, increased RBF and GFR

70
Q

Da 2

A

Decreased cAMP

Decreased NE release

71
Q

GFR

A

125 mL/min

180 mL/day

72
Q

Filtration fraction

A

20%

73
Q

Net filtration

A

Glomerular hydrostatic pressure- Bowman’s capsule hydrostatic pressure- glomerular oncotic pressure

74
Q

urinary excretion rate

A

Filtration-reabsorption+ secretion

75
Q

Carbonic anhydrase inhibitors

A

Acetazolamide
Noncompetitively inhibit Ca in proximate tubule
Leads to reabsorption HCO3, Na, and H2O
Alkaline urine and hyperchloremic metabolic acidosis
Decreases K

76
Q

Osmotic diuretics

A

Mannitol, glycerin, isosorbide
Sugars that get filtered and not reabsorbed- inhibit water reabsorption in proximal tubule and LOH
CHF, pulm edema, enters brain in disrupted BBB

77
Q

Loop diuretics

A

Furosemide, bumetanide, ethacrynic acid
Disturbs Na K 2 CL transporter in thick ascending LOH
Large vol of dilute urine- with K, Ca, Cl
Decreased K, hypochloremic metabolic alkalosis
Ototoxicity
Decreased lithium clearance

78
Q

Thiazides diuretics

A

Hydrochlorothiazide, chorthalidone, metolazone, indapamide
Inhibit NaCl cotrasnporter in distal tubule
Activates NaCa antiporter in distal tubule=increased Ca
Increase glucose
Increased Uric acid
Decreased K, hypochloremic metabolic alkalosis

79
Q

Potassium sparing diuretics

A

Amiloride, traimterine- inhibit K secretion and Na reabsorption in collecting duct
Spironolactone- aldosterone antagonist at MC receptor in collecting duct
Metabolic acidosis
Libido changes and gynecomastia

80
Q

BUN

A

10-20 mg/dL

<8= overhydration or decreased production
20-40= dehydration, increased protein, decreased GFR, catabolism
>50= decreased GFR
81
Q

Serum creatinine

A 
0.7-1.5 mg/dL
By product of creatine breakdown
Proportional to muscle mass
Filtered by NOT reabsorbed
100% increased= 50% GFR decrease
82
Q

BUN: creatine ratio

A

10:1

> 20:1 suggest prerenal azotemia

83
Q

Creatine clearance

A

110-150 mL/min

Most useful indicator of GFR

84
Q

GFR calculation

A

((140-age) x weight in kg))/(72 x serum creat)

Multiply by 0.85 in women

85
Q

Fractional excretion of sodium

A

1-3%
Relationship of Na clearance to creatinine clearance
<1%- increased Na conserved compared to creatinine cleared= prerenal azotemia
>3%- increased Na excreted compared to creatinine cleared= impaired tubular function

86
Q

Urinary sodium

A

130-260 mEq/day

Failing kidneys waste Na

87
Q

Urine protein

A

Large amount indicates glomerular injury
> 750 mg per day
+3 on urinalysis

88
Q

Specific gravity

A

1.003-1.030
Weight of urine compared to sterile O2
Increase= more concentrated urine

89
Q

Urine osmolality

A

65-1400 mOsm/L

Better test of tubular function than specific gravity

90
Q

Risk factors for AKI

A 
Prexisitng kidney condition
Prolonged decreased perfusion
CHF
Increased age
Sepsis
Jaundice
High risk surgery (cross clamp or liver transplant)
91
Q

Hyperventilation and PaCO2 impact on K

A

10 mmHg decreased in PaCO2 leads to 0.5 mEq/L K decrease

92
Q

Increases production of Comp A

A

High concentration of sevo
Decreased FGF
Increased temp of absorbent
Increased CO2

93
Q

TURP fluid

A

Distilled water- increased TURP risk
Glycine- post op visual problems
Sorbitol- osmotic diuresis, increased sugar, lactic acidosis
Mannitol- osmotic diuresis, transient plasma volume increase
Na Cl 0.9%- fire risk with mono polar cautery

94
Q

TURP syndrome

A

Htn
Bradycardia
Mental status change
Decreased serum sodium

APEX (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions