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APEX > Unit 12 > Flashcards

Unit 12 Flashcards

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1
Q

Posterior pituitary hormones

A

ADH- produced in supraoptic nuclei
Oxytocin- produced in paraventricular nuclei, positive feedback loop

Both are produced in thalamus

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2
Q

Anterior pituitary hormones

A 
FLAT PiG
Follicle stimulating hormone
Luteinizing hormone
Adrenocorticotropin
Thyroid Stimulating hormone
Prolactin- neural control, increased dopamine decreases prolactin release
(Ignore)
Growth hormone
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3
Q

Hormones stored and secreted by thyroid gland

A

Thyroxine=T4 (prohormone from tyrosine), high concentration in blood, more protein binding, less potent, 7 day half life
Triiodothyronine=T3 (Active), high concentration in target cell, less protein binding, more potent, 1 day half life, mostly converted from T4

Calcitonin

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4
Q

Goiter formation

A

Chronic high TSH
TSH stimulates follicles to make thyroglobulin colloid and iodine isn’t required
Thyroglobulin continued to be produced and causes gland to increase in size

Goiter=awake intubation
Next best = spontaneous ventilation

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5
Q

Beta blockers for hyperthyroid

A

Propranolol and esmolol

Also inhibit peripheral conversion of T4 to T3

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6
Q

Treating thyroid storm

A

4 B’s
Block synthesis (methimazole, PTU)
Block release (radioactive iodine, K iodide)
Block T4 to T3 conversion (PTU, propranolol)
Beta blocker (propranolol, esmolol)

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7
Q

RLN injury

A

Innervates all intrinsic laryngeal muscles
Unilateral- ipsilateral paralysis, hoarseness
Bilateral- both cords midline on inspiration=obstruction

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8
Q

Resection of parathyroid gland

A

Hypocalcemia at least 6-12 hours after surgery
Increased nerve and muscle irritability
Hypotension
Prolonged QT
Chvosteks- tapping angle of jaw=facial contraction on ipsilateral side
Trousseaus- upper extremity cuff inflated for 3 min, decreased BF=irritability and causes muscle spasm of hand/FA
IV Ca- Ca gluc is less Ca but lower risk of necrosis than Ca Cl

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9
Q

Mineralacorticoids

A 
(Aldosterone)
Zona glomerulosa (outer layer)- cortex
Sodium retaining potency
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10
Q

Glucocorticoids

A

(Cortisol)
Zona fasciculata
Anti inflammatory potency

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11
Q

Androgens

A

(Dehydroepiandrosterone)

Zona reticularis- inner most layer

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12
Q

Adrenal medulla

A

(Middle)

Catecholamines (epi 80% and norepi 20%)

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13
Q

Adrenal context

A

GFR from outside to inside

Salt, sugar, and sex

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14
Q

Decreased ACTH

A

Minor influence on aldosterone release

Decreased does not cause hypoaldosteronism

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15
Q

Aldosterone

A

Regulates intravascular volume- NOT osmolality
Causes fluid retention and expansion of extracellular space- stimulates Na K ATPase in distal tubule and collecting duct
With reduction in serum K and metabolic alkalosis
Stimulated by- RAAS stimulation, increased K, decreased Na
1-2 hour delay before effect

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16
Q

ADH

A

Increases absorption of water and NOT Na
Diluted plasma sodium
Half life 5-15 min

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17
Q

Cortisol

A

Diffuses into cell to bind with intracellular receptors= slow onset of steroids
CRH from HT and stimulates anterior pituitary
ACTH from anterior pituitary and stimulates cortex

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18
Q

Cortisol production

A

15-30 mg/day

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19
Q

Serum cortisol level

A

12 mcg/dL

Up to 30-50 mcg/dL during and after surgery

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20
Q

Cortisol effects

A

Energy mobilization
Anti inflammatory- doesn’t decrease histamine release
Increases number and sensitivity of beta receptor in myocardium
Vasoconstrictive

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21
Q

Cortisol

A

Equal GC and MC

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22
Q

Cortisone

A

Equal GC and MC

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23
Q

Prednisone and prednisolone

A

4 GC: 0.8 MC

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24
Q

Methylprednisolone

A

5 GC: 0.5 MC

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25
Dexamethasone and betamethasone
25 GC: 0 MC
26
Triamcinolone
5 GC: 0 MC Given in epidural space Incidence of muscle weakness Causes sedation and anorexia
27
Conns syndrome
Hyperaldosteronism Primary- normal renin, increased from adrenal gland Secondary- increased renin activity Long term Licorice- glycyrrhizic acid causes resembling syndrome Htn Decreased K Metabolic alkalosis
28
Cushing’s syndrome
Excess cortisol from overproduction or exogenous Causes GC, MC, and androgenic effects Increase glucose Htn Low K Metabolic alkalosis
29
Adrenal insufficiency
Primary (Addison’s) ``` Hotn Low gluc Low Na High K Metabolic acidosis ``` Treat with 15-30mg cortisol day
30
Stress dosing
Yes- greater than 20mg for greater than 3 weeks Yes 5-20mg for greater than 3 weeks No- less than 5 mg for less than 3 weeks 5mg prednisone=20mg hydrocortisone
31
Surgeries
Superficial-dental, biopsy ``` Minor- inguinal hernia, colonoscopy 25mg IV (hydrocortisone) ``` Moderate- colon resection, total joint, hysterectomy 50-75 mg, taper Major- CV, thoracic, liver, whipple 100-150mg, taper
32
Glucagon
Alpha cells Catabolic- promotes energy release from adipose and liver Stimulate pancreas to release insulin Glucose antagonist Increases contractility, HR, and AV conduction- increases cAMP Releases biliary sphincter in ERCP N/V
33
Insulin
``` Beta cells Anabolic- promotes energy storage Stimulates Na/K ATPase to decrease serum K Glucose=primary stimulator of release Beta agonists=increased serum glucose ```
34
Somatostatin
Delta cells Growth hormone inhibitions hormone Inhibits insulin and glucagon Inhibits splanchnic blood flow, gastric motility, and gall bladder contraction
35
Pancreatic polypeptide
PP cells | Inhibits pancreatic exocrine secretion, gallbladder contraction, gastric acid and motility
36
Insulin receptor
2 alpha and 2 beta subunits- insulin binds to beta Activate tyrosine kinase and activate substrates Turns on GLUT 4 transporter to increase glucose uptake into muscle and fat
37
Organs that dont need insulin for glucose uptake
Brain- needs steady glucose supply to function | Liver
38
Diabetes triad
Polyuria Dehyrdation Polydipsia
39
DKA
Cause=infection Ketoacidosis, hyperosmolarity, dehydration Hyperglycemia but cells starved for fuel Metabolic acidosis= kussmaul respirations Acetone= fruity breath Tx= volume, inclusion, K after acidosis
40
HHS
Enough produced to prevent ketones, but not hyperglycemia (greater than 600) Increases osmolarity Dehydration and hypovolemia Mild metabolic acidosis (no gap) Tx= volume, insulin, correct electrolytes
41
prayer sign
Joint glycosylation | Increased risk of difficult intubation
42
Biguanides
``` Metformin MOA- inhibits gluconeogensis and glycogenolysis in liver, decreased peripheral insulin resistance NO hypoglycemia Lactic acidosis Vit B12 deficiency used in PCS Discontinue 48 hours before surgery ```
43
Sulfonylureas
``` Glyburide, glipizide, glimepiride, gliclazide, tolbutamide, chlorpromazine, acetohexamide MOA- stimulates insulin secretion CAN cause hypoglycemia Avoid in sulfa allergy Discontinue 24-48 hours before surgery ```
44
Meglitinides
Repaglinide, nateglinide MOA- stimulates insulin secretion CAN cause hypoglycemia
45
Thiazolidinediones
Rosiglitazone, pioglitazone MOA- decrease insulin resistance, increase hepatic glucose utilization NO hypoglycemia Black block warning- increased risk of CHF
46
A Glucosidase inhibitors
Acarbose, miglitol Slows digestion and absorption of carbs NO hypoglycemia
47
Glucagon like peptide 1 receptor agonists
Exenatide, liraglutide Increase insulin release, decrease glucagon release, prolong gastric emptying Risk of hypoglycemia
48
Dipeptidyl peptidase 4 inhibitors
:liptin Increase insulin release, decrease glucagon release Risk of hypoglycemia
49
Myelin agonists
Pramlintide Inhibit glucagon release, reduce gastric emptying Risk of hypoglycemic with insulin N/V
50
Goals of insulin therapy
HbA1c less than 7 Glucose 70-130 (before meal) Glucose less than 180 (after meal)
51
Carcinoid syndrome
Secretion of vasoactive substances from enterochromaffin cels Usually GI tumors Cleared by liver- in liver dysfunction have mimicked symptoms Flushing and diarrhea Concurrent cardiac disease= pulmonic stenosis and tricuspid regurg
52
Carcinoid syndrome and drugs
Give- somatostatin, antihistamines, serotonin antagonis, steroids Don’t give- histamine releasing, succ, exogenous catecholamine, sympathomimetic
53
When does glycosuria occur
Serum glucose greater than 180 mg/dL
54
Renal hormone production
Erythropoietin Calcitrol Prostaglandins
55
Calcitrol
Synthesize from Vit D Converted to inactive rom in liver Active form (1.25 Oh 2- Active Vit D3) Stimulates absorption from Ca2 from food Stimulates bone to store Stimulates kidneys to reabsorb
56
Cardiac output to kidneys
20-25%
57
Blood filtered through glomerulus
20% of kidneys blood
58
amount of ultrafiltrate reabsorbed
99%
59
Amount of urine produced daily
1-1.5L/day
60
Renal blood flow
(MAP - renal venous pressure)/ renal vascular pressure
61
Renal autoregulation
50-180 mmHg
62
Conditions that increase renin release
Decreased renal perfusion pressure SNS activation (B1) TGF- decreased Na and CL in distal tubule
63
Renin
From JG cells in kidney
64
ACE
From lung
65
Serum osmolarity
2 Na + (glucose/18) + (BUN/28) Na=primary determinant
66
Normal serum osmolarity
280-290 mOsm/L
67
Stimulation of ADH
Increased osmolarity of ECF | Decreased blood volume- baroreceptors in carotid bodies, transverse aortic arch, great veins, and RA
68
Anesthetic considerations that increase ADH
PEEP Positive pressure ventilation Decreased BP Hemorrhage
69
Da 1
Increases cAMp | Vasodilation, increased RBF and GFR
70
Da 2
Decreased cAMP | Decreased NE release
71
GFR
125 mL/min | 180 mL/day
72
Filtration fraction
20%
73
Net filtration
Glomerular hydrostatic pressure- Bowman’s capsule hydrostatic pressure- glomerular oncotic pressure
74
urinary excretion rate
Filtration-reabsorption+ secretion
75
Carbonic anhydrase inhibitors
Acetazolamide Noncompetitively inhibit Ca in proximate tubule Leads to reabsorption HCO3, Na, and H2O Alkaline urine and hyperchloremic metabolic acidosis Decreases K
76
Osmotic diuretics
Mannitol, glycerin, isosorbide Sugars that get filtered and not reabsorbed- inhibit water reabsorption in proximal tubule and LOH CHF, pulm edema, enters brain in disrupted BBB
77
Loop diuretics
Furosemide, bumetanide, ethacrynic acid Disturbs Na K 2 CL transporter in thick ascending LOH Large vol of dilute urine- with K, Ca, Cl Decreased K, hypochloremic metabolic alkalosis Ototoxicity Decreased lithium clearance
78
Thiazides diuretics
Hydrochlorothiazide, chorthalidone, metolazone, indapamide Inhibit NaCl cotrasnporter in distal tubule Activates NaCa antiporter in distal tubule=increased Ca Increase glucose Increased Uric acid Decreased K, hypochloremic metabolic alkalosis
79
Potassium sparing diuretics
Amiloride, traimterine- inhibit K secretion and Na reabsorption in collecting duct Spironolactone- aldosterone antagonist at MC receptor in collecting duct Metabolic acidosis Libido changes and gynecomastia
80
BUN
10-20 mg/dL ``` <8= overhydration or decreased production 20-40= dehydration, increased protein, decreased GFR, catabolism >50= decreased GFR ```
81
Serum creatinine
``` 0.7-1.5 mg/dL By product of creatine breakdown Proportional to muscle mass Filtered by NOT reabsorbed 100% increased= 50% GFR decrease ```
82
BUN: creatine ratio
10:1 | > 20:1 suggest prerenal azotemia
83
Creatine clearance
110-150 mL/min | Most useful indicator of GFR
84
GFR calculation
((140-age) x weight in kg))/(72 x serum creat) Multiply by 0.85 in women
85
Fractional excretion of sodium
1-3% Relationship of Na clearance to creatinine clearance <1%- increased Na conserved compared to creatinine cleared= prerenal azotemia >3%- increased Na excreted compared to creatinine cleared= impaired tubular function
86
Urinary sodium
130-260 mEq/day | Failing kidneys waste Na
87
Urine protein
Large amount indicates glomerular injury > 750 mg per day +3 on urinalysis
88
Specific gravity
1.003-1.030 Weight of urine compared to sterile O2 Increase= more concentrated urine
89
Urine osmolality
65-1400 mOsm/L | Better test of tubular function than specific gravity
90
Risk factors for AKI
``` Prexisitng kidney condition Prolonged decreased perfusion CHF Increased age Sepsis Jaundice High risk surgery (cross clamp or liver transplant) ```
91
Hyperventilation and PaCO2 impact on K
10 mmHg decreased in PaCO2 leads to 0.5 mEq/L K decrease
92
Increases production of Comp A
High concentration of sevo Decreased FGF Increased temp of absorbent Increased CO2
93
TURP fluid
Distilled water- increased TURP risk Glycine- post op visual problems Sorbitol- osmotic diuresis, increased sugar, lactic acidosis Mannitol- osmotic diuresis, transient plasma volume increase Na Cl 0.9%- fire risk with mono polar cautery
94
TURP syndrome
Htn Bradycardia Mental status change Decreased serum sodium

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