Endocrine

Question 1

What is the preferred method of thyroid replacement therapy?

Answer 1

Levothyroxine (T4) Don’t forget, T4 is a prohormone. T3 is the active hormone.

Question 2

Liothyronine is what?

Answer 2

T3 replacement

Question 3

Liotrix is what?

Answer 3

Combination treatment of thyroid replacement.

Question 4

Primary hypothyroidism is a result of what?

Answer 4

Problem with the thyroid gland itself

Question 5

In primary hypothyroidism, what are the levels of TSH and T3, T4 like?

Answer 5

High TSH levels, low T3 and T4

Question 6

Secondary hypothyroidism is a result of what?

Answer 6

Problem with the pituitary gland – decreased levels of TSH as a result.

Question 7

What is the third way one can have hypothyroidism?

Answer 7

Hypothalamus doesn’t secrete enough TRH.

Question 8

When do pts treated with T4 usually improve?

Answer 8

2 weeks (complete recovery can take months for severe cases)

Question 9

When are steady state TSH concentrations achieved in thyroid replacement therapy?

Answer 9

at least 6 weeks

Question 10

Thyroid preparations increase the metabolism of _______.

Answer 10

VItamin K-dependent clotting factors.

Question 11

True or false: mineral supplements can bind with thyroid replacement therapy agents and hinder absorption.

Answer 11

True.

Question 12

True or False: Thyroid preparations require an alkaline gastirc pH for optimal absorption.

Answer 12

False. They require normal gastric acid secretion, so PPIs affect absorption.

Question 13

True or false: oral hypoglycemic agents may need adjustment when taking thyroid preparations.

Answer 13

True

Question 14

What is the most common presentation of hyperthyroidism? What are the levels of TSH, T3, and T4 like?

Answer 14

Grave’s disease. Low TSH, high T3, T4

Question 15

Diarrhea, flushing, increased appetite, muscle weakness, fatigue, irritability, heart palpitations… clinical manifestations of what??

Answer 15

Hyperthyroidism

Question 16

Popythiouracil (PTU) and Methimazole are agents for the treatment of what?

Answer 16

They are anti-thyroid drugs for the treatment of hyperthyroidism. They work by inhibiting the incorporation of iodine into the thyroid hormones.

Question 17

PTU has the added ability to do what?

Answer 17

Inhibit the conversion of T4 into T3 in peripheral circulation.

Question 18

Warfarin, beta blockers, digoxin, and theophylline are the drug-drug interactions for what?

Answer 18

Anti-thyroid drugs

Question 19

Parathyroid glands maintain adequate levels of what two things?

Answer 19

Calcium and phosphorus

Question 20

Elevated levels of PTH cause changes in the function of renal cells, bone cells, and GI tract mucosa. This leads to what electrolyte abnormality and results in what disease?

Answer 20

Hypercalcemia. Also, bone breakdown is increased. This is from HYPERPARATHYROIDISM.

Question 21

Secondary hyperparathyroidism is associated with what?

Answer 21

Low calcium; calcium or vitamin D deficiency, chronic kidney disease.

Question 22

True or false: Vitamin D is a prohormone.

Answer 22

True (1,25 dihydroxy vitamin D is the active form)

Question 23

What is an analog of fat-soluble vitamin D?

Answer 23

1,25 dihydroxy vitamin D (the active form, also known as calcitrol)

Question 24

What is the preferred vitamin D analog for daily supplementation?

Answer 24

Cholecalciferol (vitamin D3). Considered 2-3x more potent than ergocalciferol (vitamin D2).

Question 25

What other drug may be used to supplement vitamin D therapies?

Answer 25

Thiazide diuretics (work on DCT to decrease calcium excretion in urine)

Question 26

What hormones are secreted by the posterior pituitary?

Answer 26

Vasopressin and Oxytocin.

Question 27

Insufficient secretion of vasopressin leads to _______, while oversecretion leads to ________.

Answer 27

diabetes insipidus, SIADH.

Question 28

What hormone can only be given in parenteral formulations?

Answer 28

Vasopressin

Question 29

What drug increases plasma levels of von Willebrand factor, factor VIII, and tPA, contributing to a shortened bleeding time and aPTT? (good news for hemophiliacs!)

Answer 29

Desmopressin

Question 30

Primary nocturnal enuresis and diabetes insipidus (as well as hemophilia) are treated with what?

Answer 30

Desmopressin

Question 31

What does the adrenal cortex secrete?

Answer 31

Aldosterone and cortisol

Question 32

What does the adrenal medulla secrete?

Answer 32

epinephrine and norepinephrine

Question 33

Glucose metabolism (stimulating gluconeogensis), lipolysis, and fetal development, as well as potent inflammatory and immunosuppressive properties, are a result of what?

Answer 33

Glucocorticoids.

Question 34

Increased appetite, insomnia, mood alterations, stress ulcers, acne, hypertension, and hyperglycemia

Answer 34

Short term adverse effects from systemic corticosteroid use

Question 35

Cushing's syndrome, immunosuppression, adrenal suppression, delayed wound healing, growth suppression, osteoporosis

Answer 35

Long Term adverse effects from systemic corticosteroid use

Question 36

True or false: Corticosteroids should be taken in the morning without food.

Answer 36

False: morning WITH food.

Question 37

Pts at high risk for infection, hypertension, heart failure, and renal failure should avoid what drug?

Answer 37

Corticosteroids.

Question 38

When is adrenal suppression (suppression of HPA axis) with corticosteroids a threat?

Answer 38

When they are administered longer than 2 weeks.

Question 39

What drug has an adverse effect of hypokalemia and is used to replace aldosterone?

Answer 39

Fludrocortisone

Question 40

What drug competitively inhibits aldosterone leading to less potassium loss in the urine?

Answer 40

Aldosterone antagonists

Question 41

What does aldosterone do?

Answer 41

Acts in collecting ducts and induces expression of Na/K exchangers. Na enters tubular cells, K is lost in the urine.