Endocrine Flashcards

(89 cards)

1
Q

What are the targets of drugs action to treat a hypo endocrine disorder?

A

Replacing an endogenous substance

  • > hypoglycemia - dextrose
  • > hypocalcemia - calcium gluconate

Indirectly helps body to regain normal homeostasis
-> hypocalcemia -> VitD/Calcitrol

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2
Q

What is the usual underlying cause to cause excess of a substance in the body?

A

Lack of response to normal feedback

  • hyperplasia
  • benign neoplasia
  • malignant neoplasia
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3
Q

What are the drug targets to treat hyper endocrine disorders?

A

Destroy abnormal tissue/get ride of the source

Inhibit production of substance

Enhance elimination of substance

Inhibit function of substance

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4
Q

Generally, acute changes should be addressed (slowly/fast) and chronic changes should be reversed (slowly/fast)

A

Fast; slow

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5
Q

What is the function of thyroid?

A

Increase metabolic rate and O2 consumption

Positive inotropic and chronotropic (increase # and affinity of B adrenergic receptors)

Enhance catecholamine response

Catabolic effects on muscle and adipose tissue

Stimulate erythropoiesis

Increase body temp

Regulate cholesterol

Essential for growth and development

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6
Q

Most commonly you will see dogs with ______-thyroidism and cats with ________-thyroidism

A

Hypo; hyper

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7
Q

What is the goal of therapy to treat hypothyroidism in dogs?

A

Replace hormone the body is not producing

Liothyronine (T3) or Levothyroxine (T4)

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8
Q

What thyroid replacement drug requires less dosing and has a lower risk of causing thyrotoxicosis (excess T4)

A

levothyroxine (t4)

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9
Q

In large patients, dosing of levothyroxine is usually done in what measurements?

A

Mg/m^2

Body surface area reflects metabolism

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10
Q

How is hypothyroidism monitored?

A

By measuring T4

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11
Q

What is the only Veterinary approved produce to treatment of hypothyroidism?

A

Thyro-tabs

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12
Q

What is the goal of therapy to treat hyperthyroidism in cats?

A

Stop excessive hormone production

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13
Q

What are non-pharmacological ways of treating hyperthyroidism?

A

Diet -prevent production (iodine uptake)
Surgery
Radioactive iodine

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14
Q

What are the targets for pharmacological therapies for hyperthyroidism?

A

Prevent production/interfere with synthesis
Prevent release of preformed hormone
Prevent conversion of T4 to T3 in tissue

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15
Q

What drugs will inhibit thyroid hormone synthesis

A

Methimazole, carbimazole, propylthiouracil

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16
Q

What drug will inhibit thyroid hormone synthesis and inhibit conversation of T4 to T3?

A

Propylthiouracil

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17
Q

Iodines and iodinated contrast agents have what effect?

A

Inhibit thyroid hormone synthesis
Inhibit release of preformed hormone
Inhibit T4 to T3 conversion (contrast agents)

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18
Q

What do we use in practice to treat hyperthyroidism in cats. Why is it the best choice?

A

Methimazole

Consistently efficacious
Side effects are uncommon and most are manageable

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19
Q

What products contain the active methimazole

A

Tapazole

Felimazole

Transdermal methimazole (not a product -> compounded

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20
Q

What are the side effects of methimazole

A

Mild/common: GI signs (vomiting) and transient hematologist changes on CBC

Severe/uncommon: refractory GI signs, idiosyncratic rxn (facial excoriation, hepatopathy, bone marrow suppression)

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21
Q

Can severe and acute hypocalcemia be life-threatening

A

Yep

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22
Q

What are clinical signs of hypocalcemia?

A
Hyperesthsia/pawing at face 
Tremors -> flaccid paralysis 
Seizures
Hyperthermia 
Bradycardia
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23
Q

What do you call hypocalcemia due to a sudden increased use of calcium, generally associated with birth and lactation

A

Eclampsia

milk fever

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24
Q

What route of administration should be used if our need emergency calcium replacement?

A

Parenteral

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25
What are the parenteral calcium options?
Ca Gluconate | Ca Chloride
26
Can you give Ca Chloride SQ or IM?
Caustic | Irritating to tissue
27
What can occur if your give Ca too rapidly?
Arrhythmia -Monitor ECG
28
What are the oral Ca options
Ca Carbonate (small animal) Ca Propionate (large animal)
29
Hypoparathyroidism results in inability of the body to covert vitamin D to ___________
Calcitriol
30
What is the biggest potential side effect of calcitriol?
Hypercalcemia
31
How do you treat acute/transient hypoglycemia
Diet Dextrose 50% solution Glucagon
32
How would you treat hypoglycemia with diet?
Frequent small meals with complex carbohydrates
33
How do you administer glucagon?
IV (dosed in nanograms)
34
How is dextrose administered?
``` Mucosal absorption IV bolus (emergency) ```
35
An IV dextrose should not be more than ______ concentration.
5%
36
You need to make a 5% dextrose solution using a 1000mL fluid bag. How much 50% dextrose stock do you need to add?
V1 x C1 = V2 x C2 1000ml x 5% = ? X 50% ?= 1000mL x 5% / 50% 100mL
37
You have a patient on IV LRS with 600ml left in their bag and you want to make it 2.5% dextrose solution. How much 50% dextrose should you add?
600ml x 2.5% = ? X 50% ?= (600ml x 2.5%) / 50% 30ml
38
What is usually the cause of hyperglycemia?
Stress, exercise, or steroids (does not require therapy) Diabetes mellitus (DM)
39
What is the primary goal of therapy in treating diabetes mellitus?
To address the insulin deficiency | -> secondarily brings down glucose
40
Insulin is produced by ?
B cells of the islets of Langerhans
41
Insulin binds to ___________ receptors to up regulate GLU4 allowing glucose to enter the cell
Tyrosine kinase
42
In the absence of insulin, tyrosine kinase receptors are not activated, and _________ receptors remain in the cell
GLUT4 (Insulin dependent expression) Insulin is not taken up into the cell--> hyperglycemia
43
All exogenous insulin formulations are administered how?
injectable (IV, SQ or IM)
44
What differs between human and vet formulations of insulin
Concentration Human 100IU/mL Vet 40IU/mL
45
What is the duration of action of insulin
Depending of formation can be short, intermediate, or long-acting
46
What is the difference between potency and concentration of a drug?
Potency is the amount required to produce an effect of given intensity Concentration is the amount of drug per amount of volume
47
What is the most important short acting insulin type?
Regular insulin
48
How do you administer regular insulin?
IV, IM, or SC (only one that can be IV)
49
How does the onset and duration of IV regular insulin compare to IM/SC regular insulin?
IV- immediate onset and duration 1-4hrs IM/SC- 10-30mins and duration 3-10hrs Usually only used in hospitalized patients (CRI)
50
What are the intermediate acting insulin types?
NPH, Lente, Vetsulin/Caninsulin
51
How are the intermediate acting insulin administered?
SC only
52
protamine in ________ or zinc in _________ are added to delay absorption and extended clinical effect
NPH; Lente
53
_____________ is a porcine lente insulin and is a veterinary formulation, therefore the concentration is _________
Vestsulin/Caninsulin | 40IU/mL
54
What is the onset and duration of intermediate acting insulin
Onset 30min-2hrs | Duration 4-24hrs
55
What are the long acting insulins?
Protamine zinc/ PZI Glargine Determined
56
_________ forms miroprecipetates in physiological pH which results in gradual absorption
Glargine (long acting insulin)
57
____________ has a much higher protect in dogs (4x) and requires special dosing
Detemir Dosing may be difficult to dose for small dogs The only insulin with a different potency
58
What is the duration and action of the long-acting insulin types?
Onset 1-4hrs | Duration 6-28hrs
59
What is the effect of glipizide? And when is it used?
Oral hypoglycemic agent -> CAUSE hypoglycemia, they don't treat it Only useful in type II diabetes (only in cats)
60
What is the MOA of glipizide?
Simulate insulin secretion by pancreatic B cells (blocking K+ channels) Also increase tissue sensitive to insulin
61
What are the adverse effects of glipizide?
Can accelerate beta cell loss | Only effective in 20-30% cats
62
Glucocorticoids are produced by the ______________
Zone fasciculata
63
What is the endogenous hormone produced by the zona fasiculata?
Cortisol (glucocorticoids )
64
How is cortisol release regulated in the body?
Hypothalamus/pituitary -> released of CRH (corticotropin releaseing hormone) and ACTH (adrenocorticotropic homone)
65
What is the MOA of glucocorticoids ?
Receptors in the membrane (cell cascade) or in the cytoplasm (gene expression)
66
What are the glucocorticoids drugs and what are their main use?
Prednisone, prednisolone, dexamethasone, triamcinolone, methylprednisolone Anti-inflammatory effects
67
What are the effects of glucocorticoids ?
Suppress immune response Increase Ca excretion (treat chronic hypercalcemia) Reduce fever Lymphotoxic
68
Can you used glucocorticoids in a diabetic patient?
Nope | Glucocorticoids antagonize insulin
69
What are the adverse effects of glucocorticoids ?
Alter water metabolism (PU/PD) Catabolic Antagonize insulin Stress Impair healing Chronic use can cause calcinosis cutis, osteoporosis, thin skin, and alopecia Increase GI acid and decrease mucus (dont use with NSAID!) Increase fat absorption/deposition
70
Topical glucocorticoids are used to treat what opthalamic conditions
Non-infectious keratitis, uveitis
71
When is opthalamic topical glucocorticoids contraindicated?
Corneal ulcer, infection, or diabetes
72
What re the topical glucocorticoids ?
Dexamethasone, and prednisolone
73
What are the clinical uses of glucocorticoids ?
Diagnostic testing Physiological replacement therapy Anti-inflammatory Immunosuppressive -these effects are dose dependent, low to high
74
What are some examples of glucocorticoid drugs that must be hyrdolyzed to their active form?
Prednisone -> prednisolone Cortisone -> cortisol Methylprednisone ->methylprednisolone
75
How are glucocorticoids transported in the body
Protein bound Transcoriton Albumin (secondary)
76
What are the glucocorticoids relative to their potency (low to high)
Cortisol (1) Prednisolone (4) Triamcinolone (5) Dexamethasone (30)
77
What excipients may be added to injectable glucocorticoids?
``` Salt esters (Na succinate/ Na phosphate) Insoluble esters (pivalate, acetate, acetonide) ```
78
What effect with a soluble ester have on glucocorticoids ?
Make steroid soluble IV administration Onset after but duration unchanged
79
What effect with insoluble esters have on glucocorticoids ?
Less soluble Not for IV use Delay onset and longer duration
80
What are the short term side effects of glucocorticoids ?
Lab changes PU/PD/PP Fetal abnormalities/abortion
81
What are the long term side effects of glucocorticoids ?
``` Increase susceptibility to infection Skin changes Collagen disease Hypertension, thromboembolic disease Panting Additions signs ``` Less common: myopathy, calcinosis cutis, osteoporosis
82
What are the two mineralcorticoids you should know
Fludrocortisone | DOCP
83
Mineralcorticoids are produced by the ___________
Zona glomerulosa
84
What in the endogenous mineralcorticoids
Aldosterone
85
What is the purpose of aldosterone
Regulate Na and K excretion in the kidney
86
What is the effect of Fludrocortisone and DOCP?
Na retention -> mineralcorticoid effects
87
How is Fludrocortisone administered
Oral BID
88
How is DOCP administered?
Parenteral (IM or SC)
89
T/F: fludrocortisone has a small amount of glucocorticoids activity
Truth