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Pharmacology 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is Addison’s disease?

A

A relatively rare disease occurring in those aged 30-60 (more common in women) that is caused by autoimmune mechanisms that destroy adrenal cortical cells– decrease in glucocorticoids, mineralocorticoids and androgen

Inadequate corticosteroid and mineralocorticoid synthesis and elevated serum ACTH

Before clinical manifestations occur, more than 90% of total adrenocortical tissue must be destroyed

Decreased BG (mostly in kids), fatigue, weight loss, hyponatremia and salt craving, hyperkalemia, hypotension, skin changes and hair loss (women)

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2
Q

What is the emergency treatment for adrenal crisis?

A
  1. establish large bore IV access
  2. draw blood for immediate serum electrolytes and glucose
  3. infuse 2-3L of NS or 5%DNS bolus (depending on BG level) monitor for FVE during tx
  4. hydrocortisone loading dose (bolus) followed by lower dose q6h (or continuous)
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3
Q

Define acromegaly

A

A condition most often caused by a somatotroph (growth hormone secreting) adenoma of the pituitary gland. Prolactin can also be secreted in excess.

manifestations:
-enlarged hands, feet, jaw, nose, protruding forehead, enlarged tongue
-excess prolactin– amenorrhoea (no period), unexpected lactation, erectile dysfunction and loss of libido
-if not treated, can reduce life expectancy as it increases risk for cardiovascular disease, diabetes and some cancers

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4
Q

Where is growth hormone secreted from?

A

pituitary gland

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5
Q

Define giantism

A

acromegaly that occurs in children/adolescents

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6
Q

What happens with hyposecretion of ADH?

A

-diabetes insipidus– think dry inside
-increases urine output (with extreme thirst), loss of fluids result in increased blood osmolality and hypernatremia (hemoconcentration), and there is also a loss of K+ (hypokalemia)

NOTE: psychogenic DI does not lead to these lab imbalances

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7
Q

What happens with hypersecretion of ADH?

A

-syndrome of inappropriate antidiuretic hormone (SIADH)
-think “soggy inside”
-decreased urine output, retention of free water resulting in dilutional hyponatremia and ++concentrated urine

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8
Q

What does SIADH stand for?

A

Syndrome of inappropriate antidiuretic hormone– from hypersecretion of ADH

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9
Q

What is T4

A

Thyroid hormone

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10
Q

What happens when T4 is low?

A

increase in TSH

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11
Q

What happens with high T4?

A

decrease in TSH

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12
Q

What does thyroid effect?

A

metabolism

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13
Q

What are the symptoms of hypothyroidism (Hashimoto’s)?

A

-decreased metabolic processes
-fatigue, bradycardia, constipation, weight gain, dry skin, brittle hair and nails, cold intolerance

can turn into Myxedema crisis

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14
Q

What are the symptoms of hyperthyroidism (Graves)?

A

-increased metabolic processes
-nervousness, tachycardia, diarrhea, weight loss, fine hair, diaphoresis, heat intolerance

Can turn into thyroid storm

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15
Q

What is a thyroid storm?

A

Extreme hyperthyroidism

Sx: tachycardia, HTN, hyperthermia, seizures, delirium, coma

managed with: beta blockers, thioamide (antithyroid), iodine solution, corticosteroids

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16
Q

What is the diagnosis if the serum TSH is normal? high? low?

A

normal– no further testing needed

high– free T4 added to determine the degree of hypothyroidism

low– free T4 and T3 added to determine the degree of hyperthyroidism

REMEMBER: low TSH is hyperthyroidism and high TSH is hypothyroidism

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17
Q

Hyperthyroidism results in ___ TSH

A

low

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18
Q

Hypothyroidism results in ___ TSH

A

high

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19
Q

Describe the radioiodine uptake test

A

-only relevant to hyperthyroidism
-radioactive iodine ingested which will be taken up by the thyroid gland
-images examined to see degree of uptake to determine cause
-high iodine uptake=hyperthyroid
-low uptake-the gland is no longer producing high levels of thyroid hormone

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20
Q

What do Thyrotropin receptor antibodies determine?

A

the etiology of hyperthyroidism

-Graves’ disease is caused by autoantibodies to the TSH receptor
-may be used in pts that cannot take radioactive iodine

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21
Q

What is TSH?

A

Thyroid stimulating hormone

22
Q

What contraindications are there for using radionuclide imaging?

A

pregnancy and breastfeeding

23
Q

What is the biggest misconception about iodine?

A

that being allergic to shellfish means that you are allergic to iodine

24
Q

Describe thyroid ablation

A

radioiodine taken by capsule (or liquid) with the purpose of causing tissue damage
-pt will have to be on levothyroxine for the rest of their life as replacement therapy

25
Q

What is aplastic anemia?

A

all blood cells are low and is commonly a side effect of medications

26
Q

Define hypercalcemia

A

too much calcium in the blood

27
Q

What does the parathyroid effect?

A

regulates calcium and phosphate levels

28
Q

What are the clinical manifestations of hypercalcemia?

A

Stones– calcium-based kidney stones or gallstones
Thrones– polyuria
Bones– osteoporosis
Groans– constipation and muscle weakness
Psychotic overtones– mental status changes

29
Q

Describe the relationship between hyper-PTH and secondary osteoporosis

A

too much Parathyroid hormone causes calcium to be taken out of the bone storage, causing osteoporosis

30
Q

What is Paget’s disease?

A

Chronic, progressive genetic disease that leads to osteolytic and osteoblastic activity– disorganized reformation of bone that is structurally abnormal and prone to fracture
-pts may experience bone pain, arthritis and deformities

31
Q

How should bisphosphonates be taken? NCLEX question

A

taken in the morning before eating with a cup of water and pt should remain sitting up for 30 min post administration

32
Q

Define dyspepsia

A

indigestion– stomach pain, heart burn, burping

33
Q

How often should bone mineral density (BMD) be evaluated?

A

at baseline and every 1-3 years on treatment

34
Q

What is the interaction between Raloxifene and Levothyroxine?

A

Raloxifene lowers absorption of levothyroxine

35
Q

Describe Trousseau’s sign

A

when a BP cuff is inflated it causes a carpal spasm

36
Q

Describe Chvostek’s sign

A

tapping cheek will cause it to twitch

37
Q

What is Cushing’s disease?

A

Pituitary hypersecretion of ACTH– chronic excess corticosteroid levels

DIFFERENT from Cushing’s syndrome which can be caused by administration of too much glucocorticoids or a tumor

38
Q

What is the treatment of primary Cushing’s?

A

-surgical removal of tumor
-pharmacological

39
Q

What is the treatment of iatrogenic Cushing’s?

A

-use minimum dose required and try alternative day dosing to minimize side effects

40
Q

What is the treatment for Addison Disease?

A

Glucocorticoid: hydrocortisone, short acting

Mineralocorticoid: fludrocortisone, salt additives for excess heat and humidity, increased dose of glucocorticoids for stress situations

41
Q

What causes Adrenal crisis?

A

long-term corticosteroid that is suddenly discontinued

corticosteroid needs to be tapered off because adrenal glands slow down/atrophy and need time to start up again

42
Q

What are the symptoms of adrenal crisis?

A

hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion

43
Q

What does Growth hormone do?

A

regulates anabolic processes related to growth and adaptations to stressors
-promotes skeletal and muscle growth (why body builder’s inject it)
-increases protein synthesis
-increase liver glycogenolysis (glycogen in liver is broken down into glucose)
-increases fat metabolization (fat stores are released and used as energy)

44
Q

What are the 3 types of Diabetes Insipidus?

A

central, nephrogenic and psychogenic

45
Q

How is SIADH diagnosed?

A

a diagnosis of exclusion– consider pt history and rule out other causes of hyponatremia AND compare urine and serum osmolality (is serum osmolality is lower than urine osmolality, it supports SIADH)

46
Q

What is the treatment of SIADH?

A

-treat underlying trigger if possible
-only severe hyponatremia (<120mmol/L) is corrected with hypertonic fluid
-primary tx is fluid restriction of about 800-1000mL/day
-oral solutes may be added (extra salt) and a loop diuretic io increase UO

47
Q

What are some acquired causes of thyroid imbalance?

A

-imbalances in iodine intake (low=hypothyroid, excess=hyperthyroid)
-medications (ex. amiodarone can cause both hypo and hyper)

48
Q

What is Myxedema crisis (coma)?

A

Sx: hyponatremia, hypoglycemia, hypothermia, hypotension, hypoventilation and loss of consciousness

Causes: infection, MI, severe cold exposure, trauma, sedating meds and OPIOIDS of severe, longstanding hypothyroidism

Management: supportive to maintain perfusion IV fluid resuscitation, vasopressors, maintain ventilation, dextrose infusion, passive warming, IV levothyroxine loading dose q8h, IV hydrocortisone until adrenal insufficiency ruled out

49
Q

What does the parathyroid do?

A

responsible for the regulation of calcium and phosphate levels

50
Q

What are the clinical manifestations of hypercalcemia?

A

stones– kidney or gallstones
thrones– polyuria
bones–osteoporosis
groans– constipation and muscle weakness
psychiatric overtones– mental status changes

parathyroid gland regulates calcium levels in the body

51
Q

Describe Primary Hyperparathyroidism (H-PTH)

A

A tumor leads to excess PTH release that is not responsive to normal negative feedback signal
-hypercalcemia
-hypophosphatemia

treated by removing tumor
-maintenance of the airway is vital post-op (trach kit at bedside)
-hypocalcemic crisis (tetany, seizures, laryngospasm)

52
Q

What are the signs and symptoms of hypocalcemia?

A

-photophobia
-mental status changes
-tetany (neuromuscular irritability/twitching)
-paresthesia
-bronchospasm
-laryngospasm
-arrhythmias

Pharmacology 2 (12 decks)

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