Endocrine System 1 Flashcards
(154 cards)
1
Q
Cause of hypopituitarism
A
deficiency in any hormones
2
Q
Anterior Pituitary hypopituitarism
A
deficiency in GH = dwarfism
3
Q
Tx for dwarfism
A
replace GH with synthetic form somatropin
4
Q
MOA of somatropin
A
increase bone, skeletal and organ growth, RBC mass, transport of water, electrolytes and fluid
5
Q
AE of somatropin
A
- fluid retention/edema
2. muscle and joint pain
6
Q
Posterior pituitary hypopituitarism
A
decreased ADH = Diabetes Insipidus
7
Q
what is ADH also called?
A
Vasopressin
8
Q
What does ADH normally do?
A
decrease water excretion by increasing urine concentration
9
Q
Tx of Diabetes Insipidus
A
Desmopressin (DDAVP)
10
Q
what is desmopressin?
A
synthetic form of Vasopressin (ADH)
11
Q
administration route for Desmopressin?
A
1) . subcut.
2) . PO
3) . intranasal
12
Q
MOA of desmopressin
A
increase water reabsorption @ kidney by increasing aquaporin 2 channel permeability
13
Q
other indications for Desmopressin?
A
nocturia
14
Q
Desmopressin AE
A
1) . dry mouth
2) . hyponatremia
15
Q
What hormones does the Anterior Pituitary normally secrete?
A
1) . GH
2) . LH and FSH
3) . TSH
4) . ACTH
5) . Pr
16
Q
What hormones do the posterior pituitary normally secrete?
A
1) . oxytocin
2) . ADH
17
Q
Hyperpituitarism
A
excessive production of hormones from pituitary (typically anterior)
18
Q
Hyperpituitarism results in which disease(s)?
A
1) . Gigantism
2) . Acromegaly
19
Q
T/F: Gigantism occurs in children not adults
A
TRUE
20
Q
what is gigantism in adults called?
A
Acromegaly
21
Q
What causes acromegaly?
A
excessive GH
22
Q
physiologic effects of acromegaly
A
1) . affects bone and soft tissue growth
2) . hyperglycemia
3) . cardiomeglia (increase risk for HTN and arrhythmias)
23
Q
T/F: individuals with acromegaly have an increased risk for HTN and arrhythmias?
A
TRUE
24
Q
TX for acromegaly
A
1) . surgery is 1st line - typically remove a tumor that is the cause
2) . medications follow surgery
25
Medications used in Tx of acromegaly
1) . somatostatin analogue
| 2) . GH receptor anatagonist
26
Therapeutic Concerns with Hypopituitarism Tx
1) . easy to over treat
2) . watch for AE of increased hormone levels
3) . communicate with endocrinologist any changes
4) . decreased GH = decreased BMD
27
T/F: there is an increased risk of bone fractures in individuals with dwarfism?
TRUE
28
what is slipped capital femoral epiphyses and who is at greater risk for it?
essentially a hip condition that causes hip dislocations.
| Hypopituitarism has increased risk for it
29
Suffix for synthetic GHs
-trope/tropin
30
Various brand names for synthetic GHs
1) . Humatrope
2) . Genotropin
3) . Norditropin
31
Hyperthyroidism disease
Graves disease
32
S/sx of Graves disease
goiter, expothalmos, increased metabolism, nervousness, weight loss despite increased appetite
33
T/F: graves disease can result in thyroid storm
TRUE
34
what is thyroid storm
fatal symptoms of dehydration, tachycardia, delirium and fever
35
TX for graves disease
1) . anti-thyroid meds
2) . Radioactive Iodine
3) . Thyroidectomy
36
Antithyroid meds
1) . Methimazole
| 2) . Propylthirouracil (PTU)
37
Which antithryoid med is the preferred option?
Methimazole - smaller dose needed and no black box warning
38
PTU black box warning
heptatoxicity
39
MOA of antithyroid meds
blocks formation of T4 to T3 by inhibiting iodine oxidation
40
When are antithyroid meds used?
1) . mild cases
2) . older
3) . avoid radioactive iodine
41
AE of antithyroid meds
1) . rash
2) . GI upset
3) . arthralgia
42
how often is methimazole dosed?
one or 2x daily
43
how often is propylthirouracil dosed?
initially dosed 4x/day
44
T/F: methimazole can cause birth defects in 1st trimester of pregnancy?
TRUE
45
When is PTU preferred over methimazole
1) . during 1st trimester of pregnancy
| 2) . while breastfeeding
46
Rare AE of antithyroid meds
1) . agrunulocytosis
| 2) . heptotoxicity
47
s/sxs of agrunlocytosis
1) . fever
2) . sore throat
3) . mouth ulcers
48
what is radioactive iodine?
radioactive destruction of thyroid
49
AE for radioactive iodine?
hypothyroidism (will require life long treatment)
50
What other med can be used in trx of hyperthyroidism?
Propanolol >> used to trx symptoms
51
Types of Hypothyroidism
1) . primary
| 2) . secondary
52
What is primary hypothryoidism?
autoimmune destruction of thyroid gland
53
What is secondary hypothryoidism?
1) . reduced secretion of TRH (hypothalamus)
| 2) . reduced secretion of TSH (pituitary)
54
S/Sxs of hypothyroidism (8)
1) . bradycardia
2) . anemia
3) . lethargy
4) . wt gain
5) . cold intolerance
6) . menstrual irregularities
7) . general muscle weakness
8) . Goiter is possible
55
Tx for hypothyroidism
Levothyroxine (Synthroid)
56
What is levothyroxine
synthetic T4 > it is the DOC for hypothyroidism b/c it is cheap
57
MOA of Levothyroxine
synthetic T4 is converted to T3
58
T/F: Levothyroxine is an NTI drug?
TRUE >> requires monitoring and dose adjustments
59
AE of Levothyroxine (Synthroid)?
overall well tolerated unless overtreated:
1) . sweating
2) . heat intolerance
3) . tachycardia
4) . diarrhea
5) . nervousness
6) . menstrual irregularities
7) . increased BMR
60
Special considerations for Levothyroxine (2)
1) . take on empty stomach
| 2) . don't take along with Fe, Ca, Mg, Al containing products
61
T/F: chronic hypothyroidism can increase your risk of CV disease?
TRUE
62
Types of hyperparathyroidism
1) . primary
| 2) . seconday
63
Cause of primary hyperparathyroidism
1) . parathyroid adenoma
| 2) . hyperplasia or carcinoma
64
Causes of secondary hyperparathyroidism
underlying conditions such as chronic kidney disease > Ca lvls become low triggering release of PTH
65
TX options of primary hyperparathyroidism
1) . surgery
| 2) . medications
66
Medications used to trx hyperparathyroidism
1) . Calcimimetics
| 2) . Bisphosphonates
67
MOA of calcimimetics
competitive antagonist of Ca receptors >> decreases PTH secretion
68
AE of calcimimetics
1) . most common: N/V
| 2) . monitor for hypocalcemia
69
TX options for secondary hyperparathyroidism
treat underlying condition
70
Causes of Hypoparathyroidism
All result in hypocalcemia
1) . injury during surgery
2) . autoimmune disease
3) . congenital defect
71
TX for hypoparathyoidism
1) . Calcium 1-3 grams/day
| 2) . Vitamin D
72
Over treatment of hypoparathyroidism can cause _________
1) . hypercalcemia
| 2) . hypercalciuria >> leading to nephrolithiasis
73
The adrenal glands secrete from what regions?
1) . Cortex
| 2) . medulla
74
What is secreted from the medulla of the adrenal glands?
1) . NE
| 2) . epinephrine
75
What is secreted from the cortex of the adrenal glands?
1) . mineralocorticoids
2) . glucorticooids
3) . some sex steroid
76
What is an example of a mineralocorticoid?
Aldosterone
77
What do mineralocorticoids do?
effects electrolyte/water balance
78
What do glucocorticoids do?
effect carb/fat metabolism
79
What are some examples of glucocorticoids?
1) . hydrocortisone
| 2) . cortisol
80
A deficiency of mineralocorticoids is called _____
Hypoaldosteronism
81
What disease is primarily associated with hypoaldosteronism?
Addison's Disease
82
What causes Addison's disease?
1) . general adrenocoticoid insufficiency >> autoimmune system destroys adrenal cortex (main cause)
2) . defective aldosterone producing enzyme (rare)
83
TX for Addison's disease
Fludrocortisone (synthetic aldosterone)
84
What is excessive production of aldosterone called?
hyperaldosteronism
85
causes of Hyperaldosteronism?
1) . Adrenal tumor (Conn's syndrome)
| 2) . Adrenal hyperplasia
86
Tx for Conn's syndrome
Surgery
87
Tx for adrenal hyperplasia
1) . Spironolactone
| 2) . Eplerenone
88
why are diuretics used to treat hyperaldosteronism
they are aldosterone receptor antagonists
89
which diuretic tx for hyperaldosteronism have less AE?
Eplerenon (selective for aldosterone receptors, Spironolactone is nonselective)
90
S/Sxs of Hyperaldosteronism (7)
1) . muscle weakness
2) . fatigue
3) . paresthesias
4) . headache
5) . polydipsia
6) . nocturnal polyuria
7) . HTN
91
What is excessive production of glucocorticoids called?
1). Cushing's syndrome
92
What is Cushing's syndrome due to?
Hypercortisolism
93
what can lead to hypercortisolism?
1) . take too much
2) . make too much
3) . tumor on pancreas/thyroid telling adrenal gland to make too much
94
TX options for Cushing's syndrome?
1) . surgery (1st line)
| 2) . meds surrounding surgery
95
Medications used as adjunct TX in Cushing's syndrome?
1) . Steroidogenesis inhibitors
| 2) . Glucocorticoid-antagonist
96
Glucocortioid deficiency types
1) . primary adrenal insufficiency
| 2) . secondary adrenal insufficiency
97
What is primary adrenal insufficiency?
Addison's Disease >> autoimmune destruction of adrenal cortex
98
Primary adrenal insufficiency results in what ______?
deficiency of both mineralcorticoids and glucocorticoids
99
What causes secondary adrenal insufficiency?
Too much exogenous corticosteroid admin >> suppresses hypothalamic-pituitary-adrenal axis >> decreased ACTH release
100
What does secondary adrenal insufficiency tell us about steroid dosages?
It is important to taper off of steroids
101
TX for primary and secondary adrenal insufficiency
1) . Both = replace glucocorticoids (hydrocortisone, prednisone, cortisone)
2) . primary = fludrocortisone as well (replace aldosterone)
102
Short term AE of primary/secondary adrenal insufficiency TX
1) . increased blood glucose
2) . mood changes
3) . fluid retention
103
Long term AE of primary/secondary adrenal insufficiency TX
1) . osteoporosis (increased fracture risk)
2) . thin skin
3) . muscle wasting
4) . poor wound healing
5) . Adrenal suppresion
6) . Cushing's syndrome
7) . increased risk of infection
104
T/F: exercise and increased stress will require higher med dosing for glucocortioid deficiencies?
TRUE
105
Therapeutic Concerns of Adrenal Steroids
1) . lots of pts w/dif disorder use them (RA, lupus, bursitis, etc.)
2) . catabolic effect on supporting tissue >> fall risk ! do not overload
3) . can cause HTN
4) . immunosupressive = increase infection risk
5) . drug toxicity >> mood changes, psychoses
106
Stimulation cascade for sex hormones
Hypothalamus releases GnRH --> Ant. pituitary gland releases LH and FSH --> stimulates gonads to release sex hormones
107
Effects of testosterone (6)
1) . masculinizing effects
2) . development of male genitals in embryo
3) . increase muscle/bone size
4) . stimulates synthesis of clotting factors in liver
5) . stimulates production of erythropietin in kidneys
6) . regulates LH production from ant pituitary
108
Types of testosterone deficiency
1) . primary
| 2) . secondary
109
what causes primary testosterone deficiency?
testicular failure
110
what cause secondary testosterone deficiency?
decreased GnRh
111
S/Sxs of testosterone deficiency? (8)
1) . delay in puberty
2) . low energy
3) . decreased libido
4) . ED
5) . decreased pubic hair
6) . anemia
7) . osteoporosis
8) . muscle atrophy
112
TX for testosterone deficiency
exogenous admin of testosterone (IM or topical)
113
T/F: perfectly safe to administer testosterone PO?
FALSE >> risk of heptatoxicity
114
IM admin of testosterone considerations
1) . variable symptom relief (cycle between high to low)
2) . mood changes
3) . can cause hepatic adenomas
115
topical admin of testosterone considerations
keep it covered so no contact
116
Risks/AE with testosterone administration
1) . increased risk of MI, stroke, CV death
2) . hepatotoxicity (long-term)
3) . large doses may cause infertility
117
AE of testosterone in Athletic populations (11)
1) . acne
2) . MI, CV death, VTE
3) . PE
4) . Cancer (testicular or prostate)
5) . injection site infections
6) . feminization
7) . menstrual irregularities (in women)
8) . tendon/ligament rupture
9) . insomnia
10) mood disorder
11) . aggressiveness
118
Therapeutic concerns with testosterone TX
1) . monitor BP
| 2) . athletic use of androgens
119
Role of estrogen (4)
1) . develops female genitals in embryo
2) . causes puberty and female specific changes
3) . deposition of subcutaneous fat stores
4) . widens pelvic girdle
120
What is the menstrual cycle?
28 day cycle. regulated by interaction between pituitary and ovarian hormones
121
Positive feedback loop in Menstrual cycle
1) . low estrogen levels increase LH release
| 2) . LH release further increases estrogen
122
Negative feedback loop in Menstrual cycle
LH and FSH are inhibited during second half of cycle from high estrogen and progesterone levels
123
What does the altering normal control between pituitary and ovarian hormones provide?
contraceptive control
124
Estrogen and Progesterone Medical uses
1) . Contraceptives
| 2) . Post-menopausal hormone replacement therapy (HRT)
125
Types of Contraceptives
1) . Combination Oral contraceptive (COC)
| 2) . Long-acting intrauterine device (IUD)
126
common COC AEs (6)
1) . increased BO
2) . N/V
3) . weight gain
4) . acne
5) . depression
6) . topical rxn
127
Rare COC AEs (3)
1) . DVT/PE
2) . Stroke
3) . MI
128
T/F: the risk for MI from contraceptive use increases after 35 years of age?
TRUE, also if uncontrolled smoker and diabetic
129
T/F: AE of N/V from COC generally improve after 2-3 cycles?
TRUE
130
Complications from IUDs?
pelvic inflammatory disease
131
Goals of HRT?
1) . decrease menopausal symptoms
2) . increase BMD
3) . decrease fracture risk
132
TX for HRT
1) . estrogen only (if no uterus)
| 2) . estrogen + progestogens
133
Route of admin for estrogen (4)
1) . PO
2) . transdermal patch/spray
3) . topical gel/solution
4) . vaginal ring/cream
134
Estrogen AE (4)
1) . nausea
2) . HA
3) . breast tenderness
4) . vaginal bleeding
135
Progestogens admin
1) . PO
| 2) . patch
136
Progestogens AE (4)
1) . bloating
2) . headache
3) . weight gain
4) . irritability
137
Known risks with HRT TXs
1) . DVT
2) . PE
3) . gallbladder disease
4) . breast cancer (with combo)
5) . endometrial cancer (with estrogen alone)
138
General Men's health disorder
Benign prostatic hypertrophy (BPH)
139
TX options for BPH
1) . Alpha-adrenergic antagonists
2) . 5a-reductase inhibitors
3) . anticholinergic agents
4) . B3-adrenergic agonsit
140
Alpha-adrenergic antagonist used for BPH
Tamsulosin
141
MOA of tamsulosin
relax smooth muscle in prostate and bladder neck
142
5a-reductase inhibitor used for BPH
finasteride
143
MOA of finasteride
interfere with stimulatory effects of testosterone
144
AE of tamsulosin and finasteride
Hypotension
145
Anticholinergic agents used to treat BPH
oxybutynin
146
MOA of oxybutynin
antispasmodic effect on smooth muscle >> blocks acetylcholine on smooth muscle
147
AE of oxybutynin
ABCDs
148
B3-adrenergic agonist used to treat BPH
mirabegron (Myrbetriq)
149
MOA of mirabegron (Myrbetriq)
relaxes detrusor muscle to decrease voiding symptoms
150
AE of mirabegron (Myrbetriq)
may increase BP
151
Other indication for mirabegron (Myrbetriq)
OAB
152
Male to Female gender transition meds
1) . Estrogen and Progesterone
2) . Spironolactone (testosterone blocker)
3) . Finasteride (testosterone blocker)
153
Female to Male gender transition meds
testosterone
154
T/F: sex at birth still defines some risks for individuals undergoing gender transition?
TRUE
