Endocrine 2 Flashcards by Hailey Haas

Structure
T4
T3

4- 4 iodines to tyrosine backbone

3- 3 iodines, more active form

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Process of thyroid hormone release

Hypothalamus rel TRH. TRH causes TSH rel from ant pit. TSH acts on thyroid- sec more T4/3

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Thyroid sec more of what, which is converted in periphery

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Graves- what’s affected

TSH receptor activated.

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How antithyroid drugs work

Competes w thyroglobulin for oxidized iodine. Reduced synthesis of thyroid hormones

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Anti thyroid drugs onset, only useful when

1-2 weeks. Overproduction of thyroid hormones

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PTU/methimazole
Can lead to what
Other 2 SE

Goiter- up reg TSH release, stim gland hypertrophy. Pruritic rash and arthralgias

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3 serious complic of antithyroid drugs

Agranulocytosis 1st 90d (WBC monitor if fever/sore throat). Hepatotoxic. Vasculitis (drug ind lupus)

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Which antithyroid drug preferred and why

Methimazole. Longer 1/2 life, take 1 qd, more potent than ptu, less freq serious SE

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PTU
Also inhib what
Dosing
SE

T4 conversion in periphery. TID dosing.

Deplete PT- bleeds.

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PTU
Preferred in
Route

Pregnancy or acute management in thyroid storm due to inhib T4 conversion.
NG for intraop thyroid storm

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3 other tx hyperthyroidism

Thioamines works in 6-12 mos. I 131 ablation. Surgical removal and thyroid replacement

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Use what while waiting for thioamines to work
Does what
Which one for thyroid storm

B blockers. Blocks tachycardia, tremor, conversion t4 to T3.
Esmolol, 9 min 1/2 t

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How corticosteroids work hyperthyroidism

2 ones

Symptomatic tx, blocks t4 conversion, suppressor thyroid receptor Ab and inflammation.
Pred or methylpred

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How lugols solution works

Blocks t4 conversion in hyperthyroid. Dec vascularity of gland. Temporarily blocks thyroid hormone release. Temporary tx

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How hashimotos works

Causes of iatrogenic hypothyroid

Autoimmune antibodies against thyroid gland proteins. Blocks production of thyroid hormone.
Iatrogenic, pit tumor, sx

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Levothyroxine
1/2 life
Monitor what
SE

7 days, once daily dosing
Tsh, free t4, s/s of hyperthyroidism
Allergic rash

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When T3 used

Life threatening hypothyroidism (myxedema coma) where faster onset is useful

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Which 4 drugs increase levothyroxine metab

Phenobarbital, phenytoin, rifampin, carbamazepine

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Which drugs dec t4 to T3 conversion 4 (interact w levothyroxine)

Ptu, BB, amio, glucocorticoids

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Levothyroxine decreases abs of what in gut 5

Cholestyramine, feso4, al(oh)3, sucralfate, kayexalate

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Levothyroxine increases what (hormone interaction)

Thyroid binding globulin (binds T3, t4) in pregnancy, estrogen (OCs or HRT)

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Drugs that alter thyroid status 3

Amio (cont iodine, hypo or hyper)
Lithium (can lead to hypo)
Reglan (inc tsh prod/rel)

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Natural steroids 3

Cortisol, cortisone, aldosterone

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Synthetic steroids 4

Prednisolone, prednisone, methylprednisolone, dexamethasone

Corticosteroid mineralcorticoid effects

Reabs na excretion k in renal distal tubule (aldosterone)

Glucocorticoid fx of steroids

Antiinflammatory, augment sustained sns activity in stress

Corticosteroids all have what in structure. Alterations in it act for what

Same steroid nucleus. Potency, abs, pb, metab

Where mineralcorticoid and glucocorticoid receptors found

Mineral- excretion organs: colon, salivary glands, sweat glands, kidney, hippocampus. Gluc- widespread

MOA steroids

Steroid and receptor enter nucleus, inf dna transcription= more/less protein synthesis/exp of certain genes

Steroid | Metabolic fx due to

Inc in nutrient availability by raising BG, AA, and TG levels

Steroid moa | How inflammatory response inhib

Phospholipase A2 inhib, arachidonic acid formation decreased.

Cortisol Daily avg secreted High stress

10-20 mg | 50-150 mg

Cortisol 1/2 t Metab exc

1.5-3 hrs, longer fx | Liver, urine unchanged

Methylprednisone used for

HPA axis depression replacement

Betamethasone lacks

Mineralcorticoid fx

Dexamethasone uses 3

Cerebral edema, antiemetic, airway edema control periop

Triamcinolone | Use

Epidural injections LBP

Prednisolone Fx Which is converted to it

Mineral and glucocorticoid | Prednisone converted to prednisolone after absorption

Adrenal insufficiency Drug & dose for acute What must be eval tx too

Cortisol 100 mg q8 | F&E imbalances

Adrenal ins Chronic drug and dose Needs what also

``` Cortisone 25 mg q am 12.5 in afternoon Mineralcorticoid added (ex fludrocortisone) ```

IV glucocorticoids fx 1 hr 4-6h

Beta adrenergic agonist enhancement | Antiinflammatory

Steroid for allergy and asthma

Glucocorticoids iv

Chronic asthma tx first line bronchospasm prevention

Inhaled glucocorticoids via MDI. Beclomethasone, triamcinolone, flunisolide

SE inhaled glucocorticoids

Dysphagia (laryngeal muscle myopathy) | HPA axis disturbance if daily dose >1500 mcg adults 400 peds

Decadron Dose E 1/2t Given when

8-10 mg 3 hrs, antiemetic for 24h Shortly after induction

Post op __ effect w glucocorticoids how

Inhib cyclooxygenase and lipoxygenase path has analgesic effect

Steroid use in IC tumors

ICP and edema control. Not for CHI

Steroid not strongly effective for

Aspiration pneumonitis

Steroid use in lumbar disc herniation

Epidural injection to reduce edema and inflammation at nerve root

Steroid and dose for lumbar disc hern | HPA axis sup how long after

25-50 triamcinolone 40-80 methylpred 1-3 months

Steroids prevent what in premies

RDS, given to mothers threatening labor <37 weeks

SE steroids

HPA exis sup (CV collapse), FE imb, infec, osteoporosis, PUD, skel musc weak, psych disorders, CBC changes, growth retard in kids, dec anticoag effectiveness

Conditions needing periop steroid coverage

Addisons. Hypotension, hyponatremia, hyperkalemia, eosinophilia. Risk based on therapy.

Steroid dose for minor surgery

Preop plus hydrocortisone 25 mg

Steroid dose for moderate sx

Preop plus hydrocortisone 50-75 mg

Steroid dose for major surgery

Preop, 100-150 every 8hrs for 48-72hrs

Glucagon- hormone for what

Hyperglycemic. Made by alpha cells in pancreas and upper gi in resp to hypoglucemia or inc plasma proteins

Glucagon | Enhances what two things

Formation of camp and release of catecholamines

Glucagon Inc: 6 Dec:1 Relaxes what

Inc contractility, hr, renal bf, insulin sec, gluconeogenesis/glycogenolysis Gastric motility Smooth muscle (sphincters)

Glucagon does what to vessels

Vasodilates, dec SVR

Glucagon dose

1-5 mg iv | 5 mcg/kg/min (20/hr)

Glucagon cv effects

Inc co (w bb), improves low CO (post mi/Cpb), imp CHF symp, enhances AV conduc (dig toxicity)

Glucagon Use in dx of Use in placement of

Pheochromocytoma | Biliary stents- causes dilation

Glucagon SE

High or low bg, low K, NV, abrupt hr inc in afib

Somatostatin is what

Gi regulatory peptide sec by panc delta cells

Ocreotide is what

Somatostatin analogie. Both inhib produc/rel of hormones from GI/pancreas

Ocreotide inhib rel of

GH, insulin sec, glucagon, VIP

Somatostatin ocreotide 1/2t

3 min, 2.5 min

Ocreotide used for

``` Carcinoid crisis (dec rel of serotonin/vasoactives) Hepatorenal syndrome Control of varices bleed ```

What is possible w ocreotide bolus

Bradycardia, 2nd or 3rd degree heart block

ADH Receptor classes/actions Inc rel of

V1- arterial smooth muscle vasoconstriction V2- inc h20 perm reabs collecting ducts V3- inc acth release

ADH e 1/2

10-20 min

Vasopressin uses 4

DI (central) Varicies Hemorrhagic/septic shock Cv arrest resusc

Vaso SE

``` Inc bp (larger doses) Coronary artery vasoconstriction (angina, mi, ischemia, ecg changes, arrhythmias) Gi hyperperistalsis (NV, abd pain) ```

DDAVP | Comparison to vaso

E 1/2 2-4h | More selective for v2/antidiuretic than v1 (vasoconstriction). Better for DI.

DDAVP | Stim release of

Endothelial cells to inc sec of VWF, tpa, and prostaglandins

Synthetic oxytocin | Acts on what to cause contraction

Uterus, induces labor, dec post partum

Oxytocin | In high doses what can happen

SVR dec reducing SBP and DBP. H20 retention.

Oral bc Estrogen prev Progesterone prev

FSH release | LH release

SE from bc

Thromboembolism (plt agg and clotting factors by estrogen), MI and stroke risk, htn

Endocrine 2 Flashcards

(81 cards)