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Anes Pharm 2 > ENDOCRINE, THYROID, HYPOGLYCERMICS, AND STEROIDS > Flashcards

ENDOCRINE, THYROID, HYPOGLYCERMICS, AND STEROIDS Flashcards

1
Q

Body homeostasis is controlled by 2 major systems

A

Nervous System

Endocrine aka Hormonal System

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2
Q

The purpose of the Endocrine system is (4)

A

regulation of behavior
growth
metabolism
fluid and electrolytes

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3
Q

Hormones bind to, what two receptors types to trigger selective and diverse cellular responses.

A

membrane

nuclear

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4
Q

What are the 3 types of hormones

A

Protein/pepide
Tyrosine
Steriod

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5
Q

Examples of Protein/Peptide Hormones (Name 5)

A 
Insulin
GH
ADH (Vasopressin)
Angiotensin
Prolactin
Erythropoietin
Calcitonin
Somatostatin
ACTH
Oxytocin
Glucagon
PTH
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6
Q

Examples of Tyrosine-type Hormones

A 
Thyroid Hormones:
  -Thyroxine
  -Triiodothyronine
Catecholamines (Adrenal Medulla)
  - Dopamine
 - Epi
  - Nor Epi
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7
Q

Examples of Steroid Hormones

A

Adrenal Cortex Hormones:
Cortisol
Aldosterone

Reproductive Hormones
Estrogen
Progesterone
Testosterone

Active Metabolites of Vit D

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8
Q

What are the 7 endocrine glands

A 
Pituitary
Thyroid
Parathyroid
Pancreas
Adrenal
Ovaries/Testes
Placenta
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9
Q

MOA of Hormone Action:

Hormones bind to _______ and ______ receptors to trigger selective and diverse cellular responses.

A

Membrane

Nuclear

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10
Q

Membrane receptor binding (peptides and catecholamines) initiates signal transduction through enzymes such as?

A

Adenylate cyclase
Tyrosine Kinase
Serine Kinase

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11
Q

Steroids and Vit D bind to receptors on the _________ which regulate gene expression causing production of intracellular proteins and enzymes.

A

Nucleus

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12
Q

Another Name for the pituitary gland is?

A

hypophysis

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13
Q

What is the location of the hypothalamus?

A

Below the thalamus, behind the optic chiasm and between the optic tracts

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14
Q

True or False: The pituitary gland and hypothalamus have no BBB?

A

True

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15
Q 
Which is a function of the hypothalamus (Select 4):
Hunger/Satiety
Sleep-Wake
Nausea
Reproduction
Vision
Water balance and Stress
Thermoregulation
A 
Hunger/Satiety
Sleep-Wake
Reproduction
Water balance and Stress
Thermoregulation
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16
Q

True or False: Oxytocin and ADH/Vasopressin are made in the Posterior Pituitary

A

FALSE - Oxytocin and ADH/vasopressin are made in the hypothalamus and are stored in the posterior pituitary

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17
Q

Releasing and Inhibiting hormones are released from the hypothalamus, travel along the ________ ________ via the ________ ________ vessels

A

Pituitary stalk

Hypophyseal Portal

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18
Q

The anterior pituitary makes up approximately what % of the pituitary gland?

A

80%

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19
Q

What are the 6 major peptide hormones secreted by the anterior pituitary?

A

1) GH/Somatotropin
2) ACTH
3) TSH
4) FSH
5) LH
6) Prolactin

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20
Q

Which lipotropin is released by the anterior pituitary

A

Beta Lipoprotein

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21
Q

What is the function of Beta Lipoprotein?

A

Contains AA sequences of the several endorphins that bind to opioid receptors

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22
Q

Acromegaly Is a hypersecretion of what hormones and is typically caused by?

A

GH

Insulin-like Growth Factor 1

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23
Q

In Acromegaly, GH causes

A

Anatomical Changes

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24
Q

In Acromegaly, IGF-1 causes

A

Metabolic Changes

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25
Q

Acromegaly is a disorder of the Anterior or Posterior Pituitary?

A

Anterior

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26
Q

Common Features of Acromegaly are?

A
  • Skeletal overgrowth- enlarged hands and feet, prognathic mandible
  • Soft tissue overgrowth- enlarged lips, tongue, epiglottis distorted facial features
  • Visceromegaly- enlarged liver, spleen, kidney and heart
  • Hypertension
  • Cardiomyopathy
  • Osteoarthritis
  • Glucose intolerance
  • Peripheral neuropathy
  • Skeletal muscle weakness
  • Extrasellar tumor extension- headache, visual field defects
  • Decreased life expectancy- cardiac and respiratory issues
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27
Q

GH hypersecretion prior to _______ (stage of life), will cause the individual to grow up to ____ to ___ feet tall?

A

Puberty

8 to 9

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28
Q

Pharmacological treatment for Acromegaly?

A

Octreotide or Ianreotide
Cabergoline
Pegvisomant
Stress dose glucocorticoid therapy

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29
Q

What is the MOA of Otreotide?

A

Inhibits the release of GH; Growth Hormone blocker

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30
Q

A major side effects of long-term use of octreotide are?

Name 3

A

Gall stones
Hyperglycemia
Decrease Glucose tolerance

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31
Q

What is the MOA of Cabergoline?

A

Dopamine Antagonist

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32
Q

What is the MOA of Pegvisomant?

A

GH Receptor Antagonist

33
Q

With Acromegaly, what is the side effect of stress dose glucocorticoid therapy?

A

Decreased synthesis of 1,25 dihydroxyvitamin D which causes DECREASED intestinal reabsorption of CALCIUM and INCREASED excretion of CALCIUM

34
Q

What are the functions of AVP/ADH?

A

Vasoconstriction V1
Water retention V2
Corticotropin secretion V3

35
Q

What stimulates the release of AVP/ADH?

A
  • Decrease blood volume
  • Increase plasma osmolality
  • Decreased arterial pressure
36
Q

What does Oxytocin do?

A

Stimulates uterine smooth muscle contraction during labor and decreases post partum bleeding

High boluses decrease SBP & DBP via direct effect on vascular smooth muscles (us giving it)

37
Q

Oxytocin causes what to happen to the heart rate?

A
  • Reflex tachycardia

- increased CO

38
Q

what happens with high doses of oxytocin

A

water intoxication
hyponatremia
neurologic dysfunction if excessive volume of fluid administered

39
Q

What are the posterior pituitary drugs?

A

Desomopressin DDAVP synthetic AVP- ( Nasal dose: Lypressin)

40
Q

What is the recommended infusion rate for Tx of shock in adults with Vasopressin?

A

The recommended infusion rate in the Tx of shock in adults is 0.01-0.04 units/min

41
Q

Vasopressin is not recommended for what disorder?

A

Not recommended for nephrogenic DI

42
Q

What is Vasopressin used to treat?

A

Tx AVP DI

  • Refractory hypotension
  • Uncontrolled hemorrhage esophageal varices- hepatic blood flow
  • Septic shock
43
Q

Desomopressin DDAVP synthetic AVP- ( Nasal dose: Lypressin) is used in the treatment of?

A

1) AVP/ADH deficiency

2) Central DI NOT recommended for nephrogenic DI

44
Q

Desomopressin DDAVP synthetic AVP

Increases levels of which clotting factors?

A

Increases levels of von Willebrand factor & factor VIII

Reverses coagulopathy associated with platelet adhesion defects including coagulopathy of renal failure

45
Q

Diabetes insipidus inadequate secretion of???

A

ADH/AVP

46
Q

Destruction of neurons in or near the, what two structures, of the hypothalamus may decrease vasopressin release to cause central diabetes insipidus.

A

Destruction of neurons in or near the “supraoptic and paraventricular nuclei” of the hypothalamus from pituitary surgery, trauma, cerebral ischemia, or malignancy may decrease vasopressin release to cause central diabetes insipidus.

47
Q

What can cause damage to the neurons of the hypothalamus that may decrease vasopressin levels to cause ventral DI

A

Pituitary surgery, trauma, cerebral ischemia, or malignancy

48
Q

If the posterior pituitary alone is damaged, however, the transected fibers of the pituitary stalk can still continue to secrete

A

AVP

49
Q

Diabetes insipidus from lack of vasopressin release during pituitary surgery is permanent or transient?

A

transient

50
Q

What are the hallmark signs of Diabetes Insipidus?

A
  • Polyuria which results in dehydration and HYPERnatremia ( Na > 145 mEq/L).
  • Serum osmolarity ( >290 mOsm/L)
  • Urine output greater than 2 mL/kg per hour
  • Urine osmolarity HYPOtonic relative to plasma**
51
Q

What is the treatment for Diabetes insipidus?

A
  • DDAVP or Vasopressin V2
  • Chlorpropamide (sulfonylurea hypoglycemic agent)
  • Carbmazepine (anticonvulsant)
  • Thiazide diuretics
52
Q

What is syndrome of antidiuretic hormone?

A

Disorder characterized by high circulating vasopressin levels relative to plasma osmolarity & serum sodium concentration

53
Q

What are the clinical features of syndrome of antidiuretic hormone?

A
  • Water intoxication
  • Dilutional hyponatremia
  • Brain edema
  • Lethargy
  • Headache
  • Nausea
  • Mental confusion
  • Seizures
  • Coma
54
Q

What are the hallmark signs of syndrome of antidiuretic hormone?

A

Serum osmolarity less than 270 mOm/L
Serum sodium less than 130 mEq/L
Urine volume LOW
Urine osmolarity HYPERtonic relative to plasma*

55
Q

What is the treatment for syndrome of antidiuretic hormone?

A
  • Fluid restriction 0.9% normal saline 800-1000 ml per day

- If patient symptomatic of Na 115-120 mEq/L consider hypertonic saline

56
Q

What are the hormones secreted from the thyroid?

A
  • T4 Thyroxine- 80% of body’s hormone production- prohormone synthesized from tyrosine
  • T3 Triiodothyronine 5x more active than T4 produced from tyrosine production
57
Q

What does the Thyroid do?

A
  • Maintains optimal metabolism for normal tissue function
  • Increases O2 consumption in nearly all tissues except the brain
  • Secretes calcitonin which is important for calcium ion use
58
Q

Hypothyroid has a decrease concentrations of what? and increased levels of?

A

Hypo-function with decreased circulating concentrations of T3 and T4 hormones
Increased levels of TSH

59
Q

What is the most common thyroid disorder?

A

HYPOThyroidism

60
Q

What is Hashimoto thyroiditis?

A

Autoimmune mediated hypothroidism

61
Q

What are some Iatrogenic causes of Hypothroidism?

A

Surgery
neck irradiation
radioiodine therapy

62
Q

What two things are seen with hypothyroidism?

A

Iodine deficiency

Colloid goiter

63
Q

What is the treatment for hypothroidism?

A
  • Primary Tx is hormone replacement
  • TSH is monitored in PRIMARY hypothyroidism
  • T4 is monitored in SECONDARY hypothyroidism TSH released is impaired
64
Q

What can you use for thyroid hormone replacement for Hypothyroid?

A

Synthetic Thyroxine Levothyroxine Sodium T4 (Tx of choice)*

Synthroid, Levoxyl*

  • Long ½ life 7- 10 days
  • Once a day dosing
  • Maintains physiologic levels of T3- active hormone
65
Q

What are some side effects of hypothyroid hormone replacement?

A
  • Patients with existing angina pectoris or underlying CAD requires careful monitoring
  • Myocardial O2 consumption is augmented by thyroid hormone
  • Patients with deficient coronary artery circulation may not tolerate full replacement dose
66
Q

What is a LONGterm treatment for Hypothyroid?

A

T3 formulations*

Liothyronine isomer of T3*

  • 2-3 times as potent as Levothyroxine
  • Rapid onset & short duration
67
Q

What are the goals of therapy for Hypothyroid?

A
  • Correction of hypothyroidism to euthyroid
  • Reduction in goiter
  • Prevention of Thyroid Ca recurrence
68
Q

What is thyrotoxicosis?

What is the most common cause?

A

Defined as thyroid hormone excess

Most common cause of thyrotoxicosis is Graves Disease

69
Q

What is Graves disease?

A

Autoimmune disease which TSH receptor antibodies bind & stimulate thyroid gland resulting in gland enlargement and excessive production of T3 and T4

70
Q

Graves disease occurs most commonly in what population?

A

More common in women 40-60 years of age

3 fold increase incidence in POSTPARTUM period

71
Q

What are the potential risk associated with graves disease?

A

Potential risk cigarette smoking and stress

72
Q

Other causes of Thyrotoxicosis, besides Graves disease?

A

Toxic Nodular Hyperthyroidism

  • Thyroiditis causes increased released hormones
  • Thyroid Cancer associated with euthyroid may cause hyper or hypo thyroidism
  • Iodine containing radiocontrast or angiography dyes
  • Amiodarone is iodine rich and may cause hyper or hypothyroid
73
Q

How do you determine Hyperthroid/thyrotoxicosis?

A

Diagnosis TSH levels and measurement of free T3 and T4.

Once steady state maintained you can measure TSH

74
Q

What are the treatments for Hyperthyroid/thyrotoxicosis?

A
  • Radioactive gland ablation
  • Surgery
  • Antithyroid medications
75
Q

What is Methimazole?

A

THIONAMIDES- Anti-thyroid medication

METHIMAZOLE ½ life 4-6 hours QD dosing

Crosses the placenta appears in breast milk*

76
Q

What is Propylthiouracil (PTU)

A

THIONAMIDES- Anti-thyroid medication

PROPYLTHIOURACIL (PTU) ½ life 75 min dosed several times per day

Hepatic toxicity*
Preferred drug for parturient

77
Q

What are three Thionamides?

A

METHIMAZOLE
CARBIMAZOLE
PROPYLTHIOURACIL (PTU)

78
Q

What is the MOA of Thionamides?

A
  • Inhibit thyroid hormone synthesis by interfering with in the incorporation of iodine to tyrosine residues of thyroglobulin
  • Euthyroid is obtained in 6-7 weeks
  • Agranulocytosis serious side effect of all drugs

Anes Pharm 2 (2 decks)

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