Flashcards in Exam IV: Endocrine Deck (16):
Where is TSH secreted from?
Types of Insulin: Rapid, Short, and Long Acting
Rapid acting: insulin aspart, lispro, glulidine
onset ranges from 10-30 minutes
peak ranges from 30-90 minutes
duration ranges from 1-5 hours
Short acting: regular/endogenous, intermediate, and NPH (1st type available)
onset ranges from 30 min. - 2 hours
peak ranges from 2-12 hours
duration ranges from 5-24 hours
Long acting: glargine, detemir, degludec, inhaled, and human insulin liquid
onset ranges from 5 min-2 hours
peak ranges from none to 8 hours
duration ranges from 5-24 hours
Insulin Dosage Regimen: Long, Rapid, and NPH
Long-acting insulin (glargine/detemir) once or twice a day
Rapid acting insulin (Aspart, glulisine, lispro) before meals and as need to correct high blood sugars delivered via an insulin pump.
Three small doses of NPH before meals, and a larger dose of NPH at night, with rapid acting insulin (aspart, glulisine, lispro) before meals and, as needed, for snacks and to correct high blood sugars
Regulation of Aldosterone
Ang II to Aldosterone via ARBs (Ang II Receptor Blocker)
Ang II not blocked, but aldosterone levels lowered causing vasoconstriction
Products Used for Thyroid Treatments: Hypothyroidism
T4 only (synthetic): levothryroid, levoxyl, synthroid, unithroid
T3 only (synthetic): liothyronine, cytomel
T4/T3 combo (synthetic): liotrix, euthroid, thyrolar
T4/T3 (bioidentical/natural): armour, nature-thyroid, westhroid, desiccated thyroid
Treatment of Hyperthyroidism
Antithyroid agents, surgery, and RAI (radioactive iodine) low dose treatment
The goal to eliminate excessive thyroid hormone production and to control the symptoms
Antithyroid agents are used short-term either to induce remission of Graves disease or to control the symptoms of hyperthyroidism before thyroid surgery or RAI (high doses)
Either surgery or RAI result in hypothyroidism which necessitates life long thyroid hormone replacement therapy
Thioamide drugs (methimazole and propylthiouracil (PTU)), beta adrenoceptor antagonists, iodide salts, and RAI
Where is TRH secreted from?
What is long acting insulin attached to?
Long acting insulin attached to albumin
Which medication can cause lactic acidosis?
Anti-diabetic med that increases renal excretion of glucose
Selective SGLT2 inhibitors have a novel & unique mechanism of action reducing blood glucose levels by increasing renal excretion of glucose
What is gluconeogenesis?
Glucagon raises blood glucose by increasing the rates of glycogen breakdown (glycogenolysis) and glucose manufacture by the liver (gluconeogenesis)
What is the main characteristic of Type I diabetes?
Type 1 characterized by destruction of beta cells in the pancreas
Acute Addison’s disease treatment
Caused by abrupt stopping of corticosteroid medication
IV administration of hydrocortisone for 48 hours
Signs and Symptoms of Cushing's Disease
General: central obesity, proximal muscle weakness, HTN, headaches
Dermatologic: wide purple striae, spontaneous ecchymoses, facial plethora (moon face), hyperpigmentation, acne, hirsutism, fungal skin infections
Endocrine/Metabolic: hypokalemic alkalosis, hypokalemia, osteopenia, hypogonadism, glucose intolerance, hyperlipidemia, hyperhomocysteinemia, kidney stones, polyuria, hypercoagulability
Neuropsychiatric: insomnia, depression, frank psychosis, impaired cognition and short-term memory
Test to Confirm Cushing's Disease
Low dose dexamethasone suppression test
Free cortisol urine level
A single dose of dexamethasone is given orally at 11pm
Cortisol plasma level is done at 8am the following morning
Dexamthasone will suppress corticotropin secretion by the pituitary and cortisol plasma levels will be under 5mcg/dl
In Cushing syndrome dexamethsone will not suppress corticotropin and the cortisol level will be greater than 10mcg/dl