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Brandon’s AFN Health Assessment > Metabolic II > Flashcards

Metabolic II Flashcards

1
Q

cushings disease, specifically cushings syndrome is d/t?

A

pituitary secretion of excessive ACTH

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2
Q

s/sx of cushings syndrome

A
  1. Obesity/OSA (moon face and buffalo hump)
  2. HTN with volume overload
  3. electrolyte imbalances
  4. glucose intolerance
  5. GERD
  6. Myopathy/weakness/bruising
  7. infections/poor wound healing
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3
Q

Anesthesia considerations with Cushings

A
  1. will have htn
  2. normalize intravascular volume with diuresis (spirolactone)
  3. correct electrolytes and blood glucose
  4. consider etomidate
  5. Obesity/OSA will have issues with airway, IV access and positioning
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4
Q

why do we consider etomidate with cushings syndrome?

A

it inhibits steroid synthesis

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5
Q

primary adrenal insuffciency

A

destruction of adrenal gland

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6
Q

what is secondary adrenal insufficiency

A

anterior pituitary fails to secrete sufficient ACTH

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7
Q

what are some causes of primary/secondary adrenal insufficiency

A

autoimmune adrenalitis
TB
tumor
surgery
HIV
pituitary radiation

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8
Q

tertiary adrenal insufficiency

A

process that interfere with ACTH release

  1. exogenous high dose glucocorticoid therapy
  2. prednisone > 20 mg/day > 3 weeks
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9
Q

what is the average basal adrenal cortisol secretion per day?

A

30 mg/day

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10
Q

the stress of surgery, trauma, and infection can increase adrenal output of glucocorticoids up to ___________ mg/day

A

300

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11
Q

what are the s/sx of adrenal insufficency

A
  1. fatigue
  2. loss of appetite
  3. weight loss
  4. hypoglycemia
  5. hyponatremia
  6. hyperkalemia
  7. orthostatic hypotension
  8. hyperpigmentation
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12
Q

anesthesia considerations with adrenal insuffiency

A
  1. determine electrolyte levels, and glucose and manage
  2. myopathies –> conservative approach to NMB & respiratory insufficiency postop
  3. refractory to vasopressor and fluid therapy
  4. AVOID etomidate
  5. possible corticosteroid supplementation
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13
Q

when would you consider corticosteroid supplemenation intraoperatively in patient with adrenal insufficiency

A

if pt having major procedure and takes > 20 mg/day of prednisone or its equivalent

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14
Q

T/F: pts with adrenal insufficiency should discontinue glucocorticoid/mineralcorticoid drug therapy day of surgery

A

false; should continue

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15
Q

what is the risk of taking high dose steroid supplementation

A

adrenal insufficiency risk remains up to 1 year after cessation

unable to increase endogenous cortisol to respond to surgical stress

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16
Q

stress dose corticosteroid administration for minor procedures (adrenal insuff)

A

hydrocortisone 25 mg or methylprednisolone 5 mg DOS

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17
Q

stress dose corticosteroid administration for moderate procedures (adrenal insuff)

A

hydrocortisone 50-75 mg or methylprednisolone 10-15 mg DOS then taper over 1-2 days

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18
Q

stress dose corticosteroid administration for major procedure (adrenal insuff)

A

hydrocortisone 100-150 mg or Methylprednisolone 20-30 mg DOS then taper over 1-2 days

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19
Q

patient with pheochromocytoma has surgery scheduled; what should be prescribed to them outpatient and started 10-14 days prior to surgery date?

A

alpha blockade (phenobenzamine)

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20
Q

for patient with pheochromocytoma, once BP is undercontrol with alpha blockade, then you initiate _______________________

A

beta blocker

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21
Q

T/F: pts with pheochromocytoma should take all BP meds day of surgery

A

true

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22
Q

What should you expect intraoperatively for pt with pheochromocytoma

A
  1. aggressive hydration for euvolemia
  2. major hemodynamic changes: need Aline, vasoactive meds, and plan for postop care
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23
Q

what hormones come from posterior pituitary gland

A

oxytocin, ADH

24
Q

what hormones come from anterior pituitary gland

A

TSH
ACTH
FSH
LH
prolactin
GH
endorphins

25
abnormal fx of the _____________ may render the inability to appropriately respond in periods of stress (surgery) and/or critical illness
adrenal cortex
26
_________________ results from excess growth hormone, resulting in overgrowth of skin, connective tissue, cartilage, bone, and viscera
acromegaly
27
s/sx of acromegaly
1. airway abnorm d/t overgrowth of pharyngeal, laryngeal, epiglottic tissues 2. OSA 3. V/Q mismatch d/t visceromeg 4. HTN, CAD, valvular disease, HF 5. DM 6. arthralgia 7. fractures common
28
pt presents with acromegaly, you should anticipate you will need a ____________ ETT
smaller; d/t overgrowth of airway tissues
29
SIADH dx
elevated ADH with hyponatremia, and hypo-osmolality with concentrated urine in euvolemic state
30
s/sx SIADH
headache lethargy disorientation hallucinations N/V Seizures coma
31
perianesthesia management of SIADH - due to chronic asymptomatic hyponatremia
water restriction and diuresis
32
how would you correct acute severe hyponatremia (<120) in someone with SIADH
3% NS + lasix slow IV correction Vasopressin-3-receptor antagonist (Tolvaptan)
33
why does hyponatremia (W/ SIADH) complicat anesthesia management?
potentials NMB delays emergence increases delirium fluid shifts
34
Neurogenic DI
insufficent production of ADH
35
nephrogenic DI
inadequate response to ADH by target cells in the kidney
36
s/sx of DI
polyuria polydipsia alteration in mental status arrhythmias (Na > 160) higher serum osm with low urine osm
37
perianesthesia management of DI
correct free water deficit: 1. drink water if thirst mech intact 2. IV hypotonic saline (D5W) 3. DDAVP 4. off label meds 5. monitor Na and volume status
38
what are some off label medications for DI tx
carbamazepine thiazide diuretics NSAIDs
39
_____________ can occur with rapid Na correction in patients with chronic hypernatremia
cerebral edema
40
T/F: elective procedures should be postponed in pt with DI d/t hypernatremia
true
41
carcinoid tumors secrete
serotinin histamine kinins substance B prostaglandins kallikrein
42
s/sx of carcinoid tumor
1. episodes of flushing 2. diarrhea 3. tachycardia 4. bronchospaz 5. increased serotonin --> +inotropy/chronotropy d/t release of NE --> CAD and HF
43
anesthesia implications with carcinoid tumor
avoid carcinoid crisis through: 1. manipulation of tumor 2. chemical stimulation 3. tumor necrosis d/t induction of anesthesia and surgical stress
44
how do you manage pt with carcinoid tumor intraop?
octreodtide 100 mcg to suppress release of mediators
45
normal weight BMI
20-24.9
46
overweight BMI
25-29.9
47
obese BMI
30-34.9
48
severely obese BMI
35-39.9
49
morbidly obese BMI
>/= 40
50
super (morbidly) obese BMI
>/= 50
51
what are the pulmonary/airway anesthesia implications with obese pt
1. reduced compliance of lungs and chest wall 2. increased incidence of OSA 3. obesity hypoventilation syndrome 4. high risk of difficult airway, difficult mask ventilation
52
obesity hypoventilation syndrome: daytime hypercapnea + OSA --> ___________ and _____________
HTN; R-sided HF
53
Cardiac anesthesia implications with obese pt
1. s/sx of cardiac disease 2. HTN + LVH + HF 3. dysrrhythmias are common
54
GI/metabolic/endocrine anesthesia implications with obese pt
1. increased gastric residual volume, abdominal pressure, Hiatial hernia 2. increased risk of fatty liver dz 3. metabolic syndrome + DM 4. increased subclinicl hypothyroidism
55
in an obese pt what can you use to stratify risk for that patient
obesity surgery mortality risk
56
perianesthesia management with obese pt
1. consider BP cuff size/ABP 2. OR table weight limitations 3. IV access may be difficult 4. planning for difficult intubation and extubation 4. potential for aspiration 5. postoperative SpO2 and CPAP 6. possibly post op ICU

Brandon’s AFN Health Assessment (17 decks)

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