Endocrine Agents Flashcards
(145 cards)
1
Q
What is the corticosteroid treatment for minimal surgical stress?
A
25mg hydrocortisone x1
2
Q
What are some side effects of corticosteroids that we should be aware of in the OR?
A
electrolyte and metabolic changes (hyperkalemia)
decreased effectiveness of anticoagulants
3
Q
What is the pathway for the synthesis of cortisol?
A
Corticotropic-releasing hormone and vasopressin from hypothalamus→ACTH (anterior pituitary)→synthesis of cortisol
4
Q
What hormones counter the hypoglycemic effects of insulin?
A
ACTH, estrogens, glucagon
5
Q
stimulation of ACTH in the perioperative period is caused by what three things?
A
incision, pain, reversal of anesthesia
6
Q
Why does the surgeon ask you for Glucagon while doing a ERCP?
A
relaxes the sphincter of Oddi
7
Q
What are the intermediate acting insulins?
A
NPH
8
Q
What is the dose of dexamethasone for PONV?
A
2.5-5mg
9
Q
Which thionamide has a black box warning? What’s the warning for?
A
Propylthiouracil - cause hepatic toxicity
10
Q
What is the dose of dexamethasone for post-op pain?
A
0.1mg/kg
11
Q
Which synthetic corticosteroid has Na retaining activity?
A
Fludrocortisone
12
Q
What can a bolus dose or high infusion rate of oxytocin lead to?
A
hypotension
13
Q
What is the onset, peak and DOA of very rapid acting insulins?
A
onset 15 minutes
peak 45-75 minutes
DOA 2-4 hours
14
Q
What is the corticosteroid treatment for a patient taking <5mg prednisone with no HPA axis suppression?
A
No treatment
15
Q
What inhibits insulin release?
A
alpha receptor stimulation or beta antagonism
16
Q
How do the thionamides work?
A
prevents hormone synthesis by inhibiting the peroxidase catalyzed reactions and blocking iodine organification
17
Q
How does metformin work?
A
decreases glucose production, decreases absorption, and increases sensitivity
18
Q
What medication is used to treat hypothyroidism? Is it synthetic T3 or T4?
A
Levothyroxine. T4
19
Q
Which side effect of iodine should we be aware of when intubating?
A
mucus membrane ulcers
20
Q
What drugs are the thionamides?
A
methimazole and propylthiouracil
21
Q
Which form of insulin is the best choice to treat hyperglycemia and ketoacidosis?
A
regular insulin
22
Q
What is the most commonly used preparation of insulin?
A
U-100, 100 U/mL
23
Q
What is the glucocorticoid affect of the corticosteroids?
A
anti-inflammatory
24
Q
Which medication is used to block sympathetic stimulation seen with thyrotoxicosis?
A
Propranolol- adrenoreceptor blocker
25
What are side effects of metformin?
B12 deficiency, lactic acidosis
26
Inadequate secretion of what leads to DI?
vasopressin
27
what are the clinical symptoms of diabetic ketoacidosis?
N/V, abdominal pain, kussmal respirations, mental status changes, elevated ketones and glucose.
28
How do we treat thyroid storm in the OR?
Propranolol 1-2mg slowly, up to 10mg
Esmolol 50-100 mg/kg
Propylthiouracil 500-1000 mg
Hydrocortisone 50mg Q6h
29
*Which sulfonylurea causes severe hyponatremia?*
chloropropamide
30
What inhibits thyroid peroxidase to prevent incorporation of iodine into tyrosine and inhibits formation of thyroid hormone?
Iodides and thioamides
31
What drugs are the alpha-glucosidase inhibitors?
acarbose and miglitol
32
How do sulfonylureas work?
inhibits ATP-K channels on beta cells, increasing insulin release
33
What are the ultra rapid acting insulins?
Lispro, glulisine, aspart
34
What are the symptoms of hypoglycemia we will notice as anesthetists? Which is he most specific?
tachycardia, HTN *Diaphoresis*
35
What increases cortisol release?
increased ACTH, tissue damage, inflammatory mediators
36
What class of drugs is Metformin?
Biguanides
37
How does iodine work for the treatment of hyperthyroidism?
antagonizes TSH release
38
How is aldosterone stimulated?
Hyperkalemia and RAAS.
39
Which brain structure releases thyrotropin releasing hormone, dopamine, GHRH, somatostatin, GTRH, CTRH, oxytocin, vasopressin
hypothalamus
40
Corticosteroid binding globulin is increased in which situations?
pregnancy, estrogen administration, hyperthyroidism
41
What is the onset, peak and duration of regular insulin?
30 min onset
2-4h peak
6-8h duration
42
What is the dose of insulin is used to treat diabetic ketoacidosis?
0.1 units/kg/h
43
Do the hypothalamus and pituitary gland lay inside or outside the BBB?
outside
44
Thiaolidinediones should be used cautiously with CHF patients due to?
increase in ECV -> weight gain and edema
45
What degrades the protamine in NPH for insulin absorption?
Proteolytic enzymes
46
Which sulfonylureas have a diuretic effect?
glyburide, and glipizide
47
What is the most abundant hormone in the anterior pituitary?
growth hormone
48
Which patients should we avoid metformin use?
lactic acidosis, kidney injury, hepatic disease
49
If you are doing a thyroidectomy, what drugs will you likely see on the home med list?
Thionamides – methimazole and propylthiouracil
50
Why do we give dexamethasone to patients after they are asleep?
causes perianal burning
51
When catecholamines are released, what does the thyroid hormone do to beta receptors?
increase the number of beta receptors
52
What is the onset, peak and duration of long acting insulin?
1.5-2h onset
3-9h peak
6-12h duration
53
Which drugs prolong the duration of insulin?
Antibiotics (tetracyclines, chloramphenicol), salicylates, phenylbutazone
54
What do glucocorticoid target cells contain that converts cortisol to cortisone?
11-beta hydroxysteroid dehydrogenase
55
Which thionamide is the preferred treatment for hyperthyroid?
methimazole, 10x more potent than propylthiouracil
56
What is the corticosteroid treatment for a patient taking 5-20 mg prednisone for more than 3 weeks in the last year?
further analysis needed...
57
What is the corticosteroid treatment for moderate surgical stress?
50-75 mg hydrocortisone, 1-2 days
58
What medication is used for Graves disease?
radioactive iodine
59
Where are sulfonylureas metabolized and excreted?
metabolized in the liver, excreted in the kidneys
60
What is the risk in giving sulfonylureas to a patient that with a history of MI?
It inhibits a cardio protective mechanism, increased risk of mortality
61
What does cortisol do in the body?
gluconeogenesis, decrease immune function, anti-inflammatory, breaks down protein, mobilizes fatty acid
62
What medications are synthetic corticosteroids?
Prednisolone, predinisone, methylprednisolone, betamethasone, dexamethasone, triamcinolone
63
What is desmopressin?
intense antidiuretic
64
Which class of drugs is used to treat Graves Disease?
Thioamides. Methimazole > propylthiaouracil
65
What is the cascade of events starting with TRH and ending with the release of T4 and T3?
TRH released from the hypothalamus, stimulates TSH, TSH stimulates release of T4 and T3
66
What class of medications do corticosteroids potentiate?
beta adrenergic agonists
67
What is Cushings syndrome?
ACTH secreting pituitary adenoma - excess of cortisol
68
What is the corticosteroid treatment for major surgical stress?
100-150mg hydrocortisone, 2-3 days
69
What is the only sulfonylurea that excretes uric acid in the urine?
acetohexamide
70
Is graves disease hypothyroid or hyperthyroid?
hyperthyroid
71
What is the preferred drug in anesthesia for PONV?
dexamethasone
72
What is the dose of hydrocortisone for Addisons Disease?
20-30mg
73
Cortisol is stimulated by the release of what hormone?
ACTH
74
What can high concentration of oxytocin cause?
fluid retention, hyponatremia, heart failure, seizures, death
75
what type of drugs affect insulin production and release?
beta adrenergic
76
What class of drugs is used to treat hyperthyroidism?
Thionamides
77
In what instances do we use corticosteroids in the OR?
anti-inflammatory for difficult intubation
| PONV prevention
78
What is a side effect of inhaled glucocorticoids that can be exacerbated by extubation?
hoarse voice, dysphonia
79
What is the bolus dose for rapid acting insulin?
1-5 units
80
Where is metformin eliminated?
kidneys
81
How do we treat the patient taking Metformins lactic acidosis?
Bicarb
82
What causes intermediate acting insulins to have a delayed onset?
addition of protamine
83
Exhaustion of beta cells can occur due to prolonged use of (3)?
glucagon, GH, corticosteroids
84
How do thiaolidinediones work?
decrease insulin resistance and glucose production
85
Which diabetic agent should you avoid in pheochromocytoma?
Glucagon, its causes release of catecholamines and increases BP
86
What is the treatment for hyperkalemia?
dextrose and insulin
87
What is the mineralocorticoid affect of the corticosteroids?
Distal convoluted tubule reabsorption of Na in exchange for K
88
What are adjunct medications used to treat hyperthyroidism?
B blockers, CCBs, barbiturates, cholestyramine
89
What are parenteral glucocorticoids used for?
prep treatment of RAD
| Intraop bronchospasm
90
If a patient is taking NPH insulin and we give protamine intraop, what is a risk?
allergic reaction
91
How do we treat DI?
Desmopressin (DDAVP)
92
How does propylthiouracil work?
inhibits deiodination of T4 and T3
93
What type of drugs decreases thyroxine levels? (bad thing)
metabolic inducers. rifampin, phenobarb, carbamazepine, phenytoin, tyrosine kinase inhibitors, HIV protease inhibitors
94
What links the CNS to the endocrine system?
Hypothalamus
95
which type of diabetes s caused by beta cell dysfunction and tissue resistance to insulin?
DM2
96
What drugs are in the class of sulfonylureas?
End in -ide
| Tolbutamide, Glyburide, Glipizide, acetohexaide, chloropropamide
97
What drugs potentiate the effects of sulfonylureas?
sulfonamide antibiotics, alcohol, salicylates, and warfarin
98
What is the dose of insulin for DM1?
0.5-1 units/kg/day
99
Where do meglitinides work?
pancreatic beta cells
| can lower A1C by 1%
100
What is the dose of cortisol for RAD and bronchospasm?
1-2mg
101
What class of drugs potentiates hypoglycemia?
MAOIs
102
Where is cortisol released from?
adrenal cortex
103
What drugs are the thiaolidinediones?
end in -glitazone
| rosiglitazone, pioglitazone
104
Cortisol is regulated by negative feedback from which two organs?
hypothalamus and anterior pituitary gland
105
which type of diabetes is caused by autoimmune destruction of beta cells?
DM1
106
which organ releases thyroxine, and triiodothyronine
Thyroid
107
What endocrine organ regulates serum calcium
parathyroid glands
108
What is the loading dose of T3 used to treat myxedema coma?
5-20 mcg IV
109
What are the rapid acting insulins?
Regular insulin
110
What are the adverse effects of triamcinolone?
weakness, anorexia, sedation
111
Whats the treatment for hypoglycemia?
D50, 50-100mL
| Glucagon 0.5-1 mg
112
How is amiodarone induced hypothyroidism treated?
Levothyroxine
113
What does glucagon do?
stimulates glycogenolysis
| increases gluconeogenesis
114
What is the dose of oxytocin to stimulate uterine contractions?
0.5-2 mU/min, max 20mU/min
115
If you are unable to treat thyroid storm with B blockers, what medication do you use?
Diltiazem 5-10mg
116
What is the epidural steroid injection dose of triamcinolone?
25-50 mg with lidocaine
117
What causes Hashimoto Thyroiditis?
inhibited thyroid hormone synthesis - Hypothyroidism
118
What is the onset, peak and duration of rapid acting insulin?
30 min onset
2-4 peak
6-8 duration
119
What are the ultra long acting insulins?
Degludec
120
Which synthetic corticosteroid is used for replacement therapy in adrenocortical deficiency?
Prednisolone
121
What is the onset, peak and duration of intermediate insulin?
2h onset
4-14h peak
18-28h duration
122
What is the dose of oxytocin to control post-op uterine bleeding?
10-40 units added to a 1L bag of fluids
| 10 units IM
123
What hormone released by the thyroid decreases serum calcium?
calcitonin
124
What drugs are the meglitinides?
end in -glinide
| Repaglinide and nateglinide
125
Which drugs are best used for short term TSH suppression?
T3 drugs
| Liothyronine
126
How does myxedema coma present?
weakness, stupor, hypothermic, hyperventilate, hypoglycemia, hyponatremia, shock, death
127
Corticosteroid binding globulin is decreased in which situations?
hypothyroid, genetic defects, protein deficiency
128
What is the onset and duration of ultra long acting insulin?
2h onset
| >40h duration
129
What hormone is highly bound in plasma corticosteroid binding globulin?
Cortisol
130
What releases oxytocin, vasopressin,, stored ADH?
Posterior Pituitary
131
How does aldosterone affect BP and fluid status?
increases blood pressure and CVP.
132
How do the alpha-glucosidase inhibitors work?
interfere with intestinal glucosidase activity, decreasing carb digestion and absorption
133
60% of islet cells from the pancreas are what type of cells?
beta cells
134
what is the dose of DDAVP?
1-4 mcg/day
135
Why can glucagon be given for beta blocker overdose?
Potent inotrope and chronotrope, increasing cAMP production
136
Where is glucagon degraded?
liver, kidney, and plasma at tissue receptor sites
137
Does cortisol inhibit or potentiate beta agonists?
potentiate
138
What is the loading dose of levothyroxine used to treat myxedema coma?
300-400 mcg IV
139
What releases GH, TSH, Adrenocorticotropic hormone, FSH, LH, and prolactin?
anterior pituitary
140
Which form of thyroid hormone is the active form
T3 is active
| T4 is the prohormone
141
What is the corticosteroid treatment for a patient taking >20mg prednisone for more than 3 weeks with HPA axis suppression?
Treat
142
What are the long acting insulins?
Detemir and glargine
143
Which diabetic agent should you avoid with sulfa allergies?
sulfonylureas
144
What stimulates insulin release?
beta receptor stimulation and acetylcholine
145
What does perioperative stress do to pituitary hormone secretion?
stress increases SNS activation, increasing pituitary hormone secretion
