Endocrine Flashcards
(206 cards)
1
Q
Anterior pituitary gland releases
A
Growth Hormone (GH)
Adrenocorticotropic (ACTH)
Thyroid-stimulating (TSH)
2
Q
Posterior pituitary releases
A
Arginine Vasopressin
Oxytocin
3
Q
Growth hormone stimulates
A
All tissues, especially skeletal growth & cell proliferation
4
Q
Growth hormone enhances what metabolic effects?
A
Protein synthesis
Lipolysis
Mobilization
Na+ & H2O retention
Antagonism of insulin & increased glucose availability
5
Q
What stimulates GH?
A
Stress
Sleep
HYPOglycemia
Fasting
6
Q
What inhibits GH?
A
Pregnancy
HYPERglycemia
Cortisol
Obesity
7
Q
Recombinant GH is used to treat
A
GH deficiency
8
Q
What are the side effects of recombinant GH?
A
Edema
Myalgia
Arthalgias
Interacts w/corticosteroids & insulin, decreasing its effectiveness
9
Q
Octreotide is a
A
Somatostatin (inhibitory)
Inhibits GH release
10
Q
Octreotide is the treatment choice for
A
Acromegaly & Acute upper GIB by decreasing sphintic blood flow & gastric acid secretion
11
Q
What are the side effects of Octreotide?
A
Edema
HYPERglycemia
Nausea
QT increased
Bradycardia
12
Q
ACTH regulates
A
The secretion of cortisol & androgens via cAMP
13
Q
ACTH is stimulated by
A
CRH & decreased Cortisol
Stress
Sleep-wake transition
HYPOglycemia
Alpha agonist
Beta antagonist
Emergence/pain
14
Q
ACTH is inhibited by
A
Increased cortisol
Opioids
Etomidate
Suppression of HPA
15
Q
What is the use of Cosyntropin?
A
Synthetic ACTH used to screen for adrenocortical insufficiency & increases cortisol release
16
Q
What are the side effects of Cosyntropin?
A
Hypersensitivity
Anaphylaxis
HYPOkalemic metabolic alkalosis
17
Q
Cosyntropin has what effects?
A
Mineralocorticoid
18
Q
What stimulates the Thyroid hormone?
A
Low T3, T4 & Calcitonin
19
Q
What inhibits TSH?
A
Surgery
Stress
SNS stimulation
Corticosteroids
20
Q
Where is arginine vasopressin reserved? Produced?
A
Pituitary is reservoir
Produced in hypothalamus
21
Q
Arginine vasopressin will cause
A
Vasoconstriction
Water retention
Increase in Corticotropin Secretion
22
Q
What stimulates Arginine vasopressin?
A
Increase in plasma osmolarity
Hypovolemia
HOTN
Pain/Stress
HYPERthermia
N/V
Opioids
23
Q
How is Arginine vasopressin Inhibited?
A
Decrease in osmolarity
Cortisol
HYPOthermia
Ethanol
Alpha agonists
24
Q
Which V receptor treats HOTN related to shock/cardiac arrest?
A
V1
25
Vasopressin concentrations are
Low in sepsis
26
What can reverse refractory HOTN?
Supraphysiologic concentrations
27
Which V receptor treats central DI?
V2
28
Desmopressin (DDAVP) is a selective _____agonist with this dose
V2
0.3mcg/kg over 30 min
29
DDAVP can treat
Central DI
Hemophilia A
vWF
Liver disease
30
MOA of DDAVP
Gs-->adenyl cyclase--> increased cAMP, causing vesicles to release aquaporins
31
Vasopressin works on which receptor?
V1
32
How is vasopressin activated (same for oxytoin)?
Gq-->Phospholipase C--> increased IP3--> increases intracellular Ca+ release
33
Vasopressin can be given to
Patients with pulmonary HTN, due to its effects on SVR
34
What is the dose of Vasopressin?
1-4 units (bolus)
0.01-0.04 units/min infusion
35
Activation of the Gq cascade will lead to
Intense vasoconstriction (SVR> PVR)
Myocardial hypertrophy
PLT aggregation
ACTH release
36
What are the adverse effects of Vasopressin?
Ischemia
Angina
Increased GI peristalsis leading to N/V & ABD pain
Uterine stimulation
Decreased PLT count
Allergic reaction
Antibody formation
37
Dose of Oxytocin
Labor 8-10mU/min IV
Atony 1-5 international units IV bolus (up to 40; over 30 seconds)
38
What are the fetal adverse effects of oxytocin?
Fetal hypoxia/hypercapnia
Neonatal jaundice & seizure
Low APGAR
variable decelerations of fetal HR
39
Adverse effects of Oxytocin?
Direct Vascular smooth muscle relaxation, leading to transient decrease in BP, venous return & CO
Reflex tachycardia
Arrhythmia
Higher risk w/general & hypovolemic patient
40
Which glucocorticoids are often given for pituitary adenoma?
Hydrocortisone
Methylprednisolone
41
Glucagon is
Catabolic, meaning it breaks down complex molecules for energy
42
Glucagon stimulates
Gluconeogenesis
Glucogenolysis
43
Glucagon helps
Mobilize glucose, fatty acids & amino acids
44
Glucagon's release is stimulated by
HYPOglycemia
Stress/trauma
Beta Agonists
ACh
Cortisol
45
Glucagon's release is inhibited by
HYPERglycemia
free fatty acids
Insulin & somatostatin
Alpha agonists
46
Glucagon binds glucagon & GLP-1 receptors which
Activates adenyl cyclase, increases cAMP & modulates insulin release
47
Insulin is
Anabolic, meaning it builds up & promotes storage
48
Insulin's release is stimulated by
HYPERglycemia
Beta Agonists
ACh
Glucagon
49
Insulin's release is inhibited by
HYPOglycemia
Beta Antagonists
Alpha Agonists
Insulin & somatostatin
Volatile Anesthetics
Thiazide diuretics
50
Anesthetics inhibit
K+ channels on Beta cells, causing a decrease release of insulin
51
Insulin increases the activity of
Na/K pump, causing hypokalemia (K+ moves from blood stream to inside the cell)
52
Insulin can treat
Hyperkalemia
53
Insulin increases the activity of
Glucokinase, which helps promote glucose storage
54
Insulin inhibits
Lipase (Lipolysis)
Gluconeogenesis/lysis
55
Insulin decreases
Protein degradation
56
Insulin increases
Permeability of Skeletal muscle
Uptake of protein & conversion of amino acids
57
Insulin's effects are prolonged in
Renal disease
58
GLUT4=
Translocation
59
Insulin is increased by _____adrenergic
Decreased by _______ adrenergic
Beta adrenergic (PSNS stimulation)
Alpha adrenergic stimulation
60
Insulin is absent in
Type 1
61
Absent insulin will cause
Lipolysis
Increase in free fatty acids
Excess Ketones
Acidosis
62
Low or insulin resistance can cause
Pro-inflammation
Pro-thrombotic
Pro-atherogenic
Impaired vasodilation
63
In type 1 DM, there is an increase risk of
Breaking down fat & increased fatty acids
Excess Ketones
64
Type 1 DM is classified as being
Autoimmune
Pancreatic cell destruction
Normal insulin sensitivity
Little insulin production
65
Type 2 DM is characterized as having
Pancreatic cell dysfunction
failure to secrete insulin & has insulin resistance
Problem with Translocation
66
The surgical stress response will cause an increase release of
Epi
Glucagon
Cortisol
GH
Inflammatory Cytokines
67
The surgical stress response will place the patient at a higher risk of
Acute insulin resistance
Impaired secretion
Decrease peripheral glucose utilization
Lipolysis
Protein Catabolism
Hyperglycemia
68
Neuropathy will cause
CV instability (resting tachy; post-induction HOTN; lability)
Delayed gastric emptying
Increased sensitivity to LA (prolonged duration)
OSA
69
Insulin receptors are ___________ at ___________ leading to a tight bond
Fully saturated
Low concentration
70
What are the slow & long acting insulin?
NPH (intermit acting)
Glargine
Insulin Detemir
71
What are the rapid & short acting insulin?
Insulin Aspart
Lispro
Glulisine
72
Rapid & short acting insulin have the duration of
3-5hrs
73
What is special about NPH?
There is a delay in SUBQ absorption d/t conjugation with protamine (which is used for heparin reversal)
74
What is the IV onset of regular insulin?
10-15 min
75
What is the SQ onset of regular insulin?
30-60min
76
What is the duration of regular insulin?
2-8 hrs
77
Regular insulin can
Bind to IV tubing
78
Administration should be reduced in what populations?
>70
Renal insufficiency
No hx of DM
79
In a major surgery, what should be monitored?
BS Q1hr
K
HCO3
Ca
80
When should SUBQ insulin be avoided?
Hemodynamic instability
Hypothermia
Vasoconstriction
81
What are the s/s of hypoglycemia?
Tachycardia
Diaphoretic
HTN
Confusion
Seizure
82
Administration of insulin can cause an
Allergic reaction
Acute insulin resistance
83
What can go unrecognized?
Hypoglycemia when a patient is under general
84
What is the solution & gram for IV dextrose?
2.5-70%
5-25g
85
What is the onset of IV dextrose
<10min
86
IV glucagon is an insulin
Antagonist
87
What is the dose of IV Glucagon?
0.5-1mg
Dilute w/sterile water
88
IV glucagon also
Relaxes GI muscle
89
Insulin will decrease K by
1mEq/L
90
Which drug is the first line treatment for DM2?
Metformin (rare to cause hypoglycemia)
91
Metformin can improve
Lipid profile
92
What is the MOA of Metformin?
Suppression of hepatic glucose production
Decreases GI glucose absorption
Increases insulin sensitivity & GLP-1 synthesis
93
What are the adverse effects of Metformin?
Gi disturbances
Vit B12 deficiency
LACTIC ACIDOSIS (due to inhibition of converting lactate to pyruvate)
94
When should MEtformin be held?
Contrast
Renal dysfunction
NSAIDs
ACEI
ARBs
95
What are examples of Sulfonylureas?
Glyburide
Glipizide
Glimepiride
Chlorpropamide
96
Sulfonylureas drastically
Lower BS
Decrease insulin resistance
97
Sulfonylureas require
Beta Cell function, so they are ineffective in Type 1 Dm
98
What are the adverse effects of Sulfonylureas?
Therapy failure CV risks
GI
Abnormal liver function
99
What should receive special attention with
Sulfonylureas?
HYPOGLYCEMIA, which is more severe than insulin induced hypoglycemia
100
With a patient taking Sulfonylureas, the risk of hypoglycemia is elevated by
Malnutrition
>60
Impaired renal function
ETOH
Warfarin
Sulfonamide ABX
101
What is the MOA of Sulfonylureas?
Inhibits K ATP on beta cells
Ca+ enters cell
Insulin leaves the cell
102
Sulfonylureas should be held
Morning of
103
What are examples of Thiazolidinediones (TZDs)?
Rosiglitazone
Pioglitazone
104
What is the MOA of Thiazolidinediones (TZDs)?
Increases insulin sensitivity & glucose use
Decreases insulin resistance & hepatic glucose production
105
TZDs also increase__________ & decreases_______
HDL & ECF
Triglycerides
106
TZDs should be continued
In peri-op
107
TZDs can cause
Liver dysfunction
108
What are examples of GLP-1 receptor agonists?
Liraglutide
Semaglutide
Dulaglutide
Tirzepatide
Exenatide
109
What is the MOA of GLP-1 receptor agonists?
Increases beta cell insulin secretion & satiety
Decreases alpha cell glucagon production and appetite
110
GLP-1 receptor agonists can cause
Wt loss
Slowed gastric emptying
111
What are the adverse effects of GLP-1 receptor agonists?
Gi disturbances
Hypoglycemia (when combined w/sulfonylureas & insulin)
Acute pancreatitis & renal insufficiency
Gallbladder & biliary disease risk
Injection site reaction
112
What are examples of sodium glucose cotransporter inhibitors? (SGLT2)?
Canagliflozin
Dapagliglozin
Empagliflozin
113
What is the MOA of sodium glucose cotransporter inhibitors (SGLT2)?
Inhibits SGLT2 in the proximal tubule
114
Sodium glucose cotransporter inhibitors (SGLT2) require
Normal renal function
115
Sodium glucose cotransporter inhibitors (SGLT2) can cause
Wt loss
Decreased BP & CV events
116
What are the adverse effects of Sodium glucose cotransporter inhibitors (SGLT2)?
Osmotic diuresis due to glucose trapping (hypovolemia, HOTN, AKI; higher risk with ACEI & ARBs)
Euglycemic ketoacidosis
UTI & genital infections
Decreased bone density
117
What is the anesthetic consideration with Sodium glucose cotransporter inhibitors (SGLT2)?
Risk for ketoacidosis & dehydration
118
What are examples of Dipeptidyl- peptidase 4 inhibitors?
Saxagliptin
Sitagliptin
Linagliptin
Alogliptin
119
What is the MOA of Dipeptidyl- peptidase 4 inhibitors?
Inhibits DPP4 enxyme, which breaks down incretin hormones
Increases insulin secretion
Decreases glucagon secretion
120
DDP4 inhibitors have a very low risk of
Hypoglycemia
121
DPP4 inhibitors have a risk of
Musculoskeletal pain
122
Metformin
Decreases endogenous glucose production
123
TZDs
Increase glucose uptake
124
DPP4 inhibitors
Increase incretins
125
Sulfonylureas
Increase insulin
Decrease glucagon
126
SGLT2 inhibitors
Decrease tubular glucose reabsorption
127
The thyroid maintains
Optimal metabolism for tissue function
128
T3 is also known as
Triiodothyronine
Active form
129
T3 comes from
T4 synthesis
130
T3 increases
O2 consumption & metabolism
131
T3 is involved in
Protein catabolism
132
T4 is known as
Thyroxine & is synthesized from tyrosine
133
Calcitonin will decrease
Concentration of Ca in the plasma
134
Calcitonin on osteocytes
Weakens osteoclasts
Strengthens osteoblasts
135
Calcitonin will cause a decrease in
Renal reabsorption of Ca+ & phosphates
136
What causes Hypothyroidism?
Deficient thyroid production
Iodine Deficiency
Autoimmune disease
137
Which 2 drugs are used for hypothyroidism?
Levothyroxine (synthroid)
Liothyronine (T3)
138
Levothyroxine is synthetic
T4
139
Synthroid will increase
metabolism
SNS activity
Growth & development
(DNA transcription)
140
Levothyroxine affects
Protein synthesis
141
T3 binds
Thyroid hormone receptors
142
Liothyronine is
More potent but less effective & has no effect on hypothyroid symptoms
143
Does hypothyroidism affect MAC?
NO
144
Levothyroxine may cause
Synergism with anticoagulants & epi
(lead to bleeding & exaggerated effect with epi)
145
Non-euthyroid patients may experience
Sedation
Delayed emergence
Respiratory depression
Respiratory muscle weakness
Vasopressor resistant HOTN
Bradycardia
Diastolic dysfunction
Diminished response to alpha & beta adrenergic
Decreases BS
Anemia
Hypothermia
146
What disease is characterized as hyperthyroidism?
Grave's (autoimmune disorder of TSH receptor antibodies)
147
What are risk factors of thyroid storm?
Surgery
trauma
Acute illness
Pregnancy
148
What are s/s of thyroid storm?
Hyperthermia
Agitation
Delirium
Seizures
tachycardia
Afib
HF
Diarrhea
Jaundice
149
What are examples of Thionamides?
Methimazole
Propylthiouracil (PTU)
Carbimazole
150
What is the MOA of Thionamides?
Inhibits thyroid peroxidase & formation of TH
Decreases concentration of antithyrotropin receptor antibodies
PTU inhibits deiodination of T4-->T3
151
What are the adverse effects of Thionamides?
Urticaria
Skin rash
Arthralgia
GI discomfort
Agranulocytosis & granulocytopenia (monitor WBC)
Hepatic toxicity
152
What are examples of Potassium Iodides?
Potassium Iodide
Potassium Iodid-iodine (Lugol's)
153
What is the MOA of Potassium Iodides?
Decreases iodine uptake by thyroid, TH synthesis & release, thyroid size & thyroid vascularity
154
What are the adverse effects of Potassium Iodides?
Allergic reaction (rare)
Angioedema
Laryngeal edema
Bleeding disorders
155
What is the definitive treatment for Graves?
Radioactive Iodine
156
What is the MOA of radioactive iodine?
Uptake by thyroid cells
Iodine isotopes trapped in thyroid
Beta rays destroy cells with minimal to no damage to surrounding tissues
157
What are the risks of radioactive iodine?
Hypothyroidism risks
Contraindicated in pregnancy
Radiation toxicity
Infertility
158
What should be considered when taking radiation iodine?
It can cause arrhythmias, ischemia & HF, so it is best to treat with a long acting beta blocker like PROPRANOLOL, which inhibits T4-->T3 conversion
This will control HR, HTN & fever
Dose 0.5-1mg over 10min
159
The main mineralocorticoid is
Aldosterone
160
Aldosterone will cause a
Increase in Na reabsorption
Ca, K & Mg excretion
161
Aldosterone will increase
Na/K ATPase activity
162
Aldosterone will cause
Muscle weakness due to a K+ & Ca+ excretion
163
The main glucocorticoid is
Cortisol
164
Cortisol can cause
Diuresis
Increases HGB & RBCs
Muscle wasting
Bone loss
Decreased bone remodeling
Increase IOP
165
How is cortisol released?
Stress
166
Cortisol influence with surgery
Minor- x2
Mod-3-4x
Major-5-10x
167
Primary adrenal insufficiency is due to
A local problem
Autoimmune
Carcinoma
TB
168
What is chronic AI called?
Addisons
169
What is secondary adrenal insufficiency?
Pituitary gland not stimulated enough
170
What is the MOA of corticosteroid?
Bind cytoplasmic receptors
DNA transcription
Regulates protein synthesis
Glucocorticoids are widely distributed
171
Which glucocorticoids have mineralocorticoid activity?
Fludrocortisone
Aldosterone
172
Which glucocorticoids have no mineralcorticoid activity?
Betameth
Triaminolone
173
Adrenal insufficiency has what effect on blood vessels?
Vasodilation
174
Glucocorticoids effect on SVR
Can increase it
175
When should dexamethasone be avoided?
In severe head injury/hemorrhage
176
Dexamethasone is often given with
Zofran & Droperidol for nausea
177
What is the action of glucocorticoid use for analgesia?
peripheral inhibition along COX & lipoxygenase
(dex & Betameth)
178
Long term use of glucocorticoids can cause
HPA suppression
Decrease in cortisol stress response
Risk of acute adrenal crisis
179
Glucocorticoids can have these effects
Fluid resistant HOTN
Change in consciousness & cognitive decline
N/V?ABD pain
Hypoglycemia
Decrease Na
Increase K
Persistent fever
180
Replace cortisol therapy is
>20mg/day or >3 weeks of therapy
or
S/s of Cushing (cortisol excess)
181
Unknown HPA suppression?
5-20/day or prolonged therapy
Variable suppression
182
How can you assess cortisol levels
Serum cortisol
>10mcg/dL-no suppression
5-10=some suppression
183
Why is a stress dose steroid given?
Enhances vascular reactivity
Inhibits Prostacyclin PGI1
184
Cortisol is involved in
Catecholamine synthesis
185
Hydrocortisone (solu-cortef) has
Both glucocorticoid & mineralocorticoid activity
186
What is the treatment choice of HPA suppression?
Hydrocortisone (Solu-cortef) or methylpred
187
Which medication is first line for stress dose?
Hydrocortisone (solu-cortef)
188
Hydrocortisone (Solu-cortef) can treat
Acute adrenal crisis
Chronic AI
Inflammation
Status Asthmatics
189
What is the dose of Hydrocortisone for surgery types?
Min- 25mg
Mod-50-75mg
Major-100mg
190
What is the duration of Hydrocortisone?
8-12 hours (short-acting)
191
When should hydrocortisone be administered?
Prior to incision
Give every 8 hours
192
For normal mineralocorticoid activity, consider using
Methylprednisolone
193
Duration of dexamethasone (decadron)
Long acting
3-5 days
194
Decadron is not compatible with
Benadryl
195
Dose of Decadron as an antiemetic, analgesia, post intubation & for neuro cases
Antiemetic- 4-12
Analgesia-4-10
Post-intubation-10-16
Neuro-10
196
Decadron is a potent
Glucocorticoid with minimal to no mineralocorticoid activity
197
Decadron can help prolong
Regional anesthesia
198
What are the adverse effects of corticosteroids?
HPA suppression
Decrease K+ (skeletal muscle myopathy)
Alkalosis
Edema/wt gain
Increased BS
CNS effects
Increased HCT
Osteoporosis
Inhibits growth
199
Large doses of opioids can
Alter cortisol
200
Etomidate can
Inhibit cortisol synthesis, leading to adrenal insufficiency
201
Volatile anesthetics have
Minimal suppression
202
Regional anesthesia decreases
Cortisol release
203
What is the standard tx for COPD?
Asthma?
Inhaled anticholinergics
204
What effects PAP?
CO
FiO2
Positive pressure ventilation
Left arterial pressure
CO2
205
Nitrous Oxide can cause
Pulmonary vasoconstriction
206
Epidural can cause
HOTN & RV dysfunction
