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Pharmacology > Week 13: endocrine > Flashcards

Week 13: endocrine Flashcards

1
Q

what are the two control centres of the brain

A

Hypothalamus and pituitary gland

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2
Q

which hormones are considered “master key” (can be used on all body tissues)

A

Thyroid hormones and corticosteroids

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3
Q

why is it difficult to assess an endocrine issue?

A

changes are usually non-specific and clinical manifestations are unclear and system wide.

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4
Q

what should you be doing to assess a patient with broad, system wide, and unclear clinical manifestations?

A

A very detailed health history

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5
Q

which hormones does the thyroid secrete?

A

T3 and T4 hormones

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6
Q

how does the hypothalamus send signals to the thyroid gland? (through hormones)

A
  • TRH secreted from hypothalamus
  • Stimulates release of TSH from anterior pituitary
  • this stimulates release of thyroid hormones from thyroid gland
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7
Q

which gland releases Thyroid Stimulating Hormone?

A

The anterior pituitary

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8
Q

which Gland secretes Thyroid Releasing Hormone (TRH)

A

Hypothalamus

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9
Q

which three hormones does the thyroid secrete?

A

Thyroxine (T4) , Triiodothyronine (T3), calcitonin

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10
Q

what does iodine do for the thyroid?

A

Iodine is needed for the synthesis of thyroid hormones

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11
Q

what is a thyroid storm

A

It is a thyroid disorder where everything is moving too fast

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12
Q

what is a myxoedema coma?

A

severe hypothyroidism

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13
Q

what are characteristics of hyperthyroidism clinical manifestations?

A

think fast
- increased metabolism and sensitivity to stimulation from the SNS
- rapid heart beat, nervousness, insomnia, weak, increased temp, weight loss, menstrual irregularities

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14
Q

what is exophthalmos?

A

a bulging or protruding eye, often caused by hyperthyroid disease

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15
Q

what causes exophthalmos?

A

impaired drainage from orbit, increasing fat and edema from retro-orbital tissues
- increases pressure and forces eye outward

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16
Q

how is hyperthyroidism diagnosed?

A

swallow iodine and see if it shows up on CT scan,shows how much iodine is taken up by your thyroid gland (if its a lot the you have hyperthyroidism)

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17
Q

what would lab values look like to determine graves disease?

A
  • Elevated T4 and T3
  • TSH levels go down because she’s not needed
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18
Q

What is the active form of T4?

A

T3

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19
Q

what does methimazole do?

A

stops iodine from helping to make thydoid hormones

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20
Q

what does Propranolol do?

A

Its a beta blocker that brings down heart rate and treats clinical manifestations from hyperthyroidism

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21
Q

how does Iodine work to relieve symptoms form Hyperthyroidism?

A

We need iodine to create TH, but in crisis we give fat dose which stops the release
- basically overloads it so it stops working

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22
Q

How does radioactive iodine treat hyperthyroidism?

A

Destroys thyroid tissue so the cells in the thyroid gland die (don’t take while pregnant)

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23
Q

What is the worst case scenario treatment for hyperthyroidism?

A

total thyroidectomy, removing significant part of the thyroid gland

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24
Q

what is a sign in someone taking MEthimazole that shows that they need to stop taking it immediately?

A

Sore throat
- it indicates agranulocytosis which is a severe auroimunofecigienty, resulting in immune attack

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25
Q

what are some nutritional changes a person with hyperthyroidism should consider?

A
  • eat high calorie food to prevent tissue breakdown
  • eat one gram of protein for ideal body weight
  • avoid caffeine, and any foods that could increase GI motility
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26
Q

what are the symptoms of hypothyroidism?

A

Think slow
- symptoms related to decreased metabolism
-

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27
Q

what is goitre

A

a lump or swelling on the neck from swollen thyroid, caused by hypothyroidism

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28
Q

what is Myxedema

A

fluid accumulates inside cells, without presence of TH, cells don’t use their energy
- glucose overload, pulls fluid in
- caused by hypothyroidism

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29
Q

What are some symptoms of Myxedema?

A
  • thickened, non-pitting oedematous changes to soft tissues
  • causes puffiness, periorbital edema, mask like effect
30
Q

how is hypothyroidism diagnosed?

A

-History and physical exam
- Blood test for Increased TSH and decreased T4
- TPO antibodies that destroy the thyroid gland may also be high
- may have high cholesterol and triglycerides, anaemia, increased creatine kinase

31
Q

what is the brand name for levothyroxine?

A

synthriod

32
Q

what is levothyroxine MOA?

A

a synthetic form of T4, non potent and long acting

33
Q

what time a day should someone take levothyroxine

A

take 30-60 minutes before a meal on an empty stomach or else it may severely alter the absorption

34
Q

what are some drugs that reduce levothyroxine absorbtion?

A

over the counter GI medications

35
Q

how does levothyroxine affect warfarin?

A

it enhances the effects of warfarin

36
Q

how should someones nutrition change if they have hypothyroidism?

A

they should go on a low calorie diet to promote weight loss

37
Q

Everything we need to cover when taking a history to assess for a thyroid disorder

A
  • OPQRSTUV
  • Review of systems
  • Past medical history and family Hx
  • meds
  • allergies
  • immigration from iodine deficient area (because iodine deficiency can cause hypothyroidism)
38
Q

what does the medulla secrete

A

catecholamines/epinephrine

39
Q

what does the cortex secrete?

A

over 50 steroid hormones (corticosteroids)

40
Q

how does the hypothalamus lead to cortisol being released?

A

-Hypothalamus releases CRH
-Stimulates the anterior pituitary
-anterior pituitary releases ACTH
- Stimulates adrenals which produce corticosteroids

41
Q

how would the body lower cortisol?

A

hypothalamus stops secreting CRH, lack of CRH prevents secretion of ACTH, lack of ACTH prevents secretion of cortisol

42
Q

what is the main glucocorticoid?

A

Cortisol

43
Q

what does cortisol do?

A
  • It helps maintain blood glucose
    -it has anti-inflammatory action by suppressing immune system and supportive action to respond to stress
44
Q

what is the main mineralocorticoid?

A

Aldosterone

45
Q

how does aldosterone maintain fluid and electrolyte balance?

A

regulates the salt and water balance of the body by increasing the retention of sodium and water and the excretion of potassium by the kidneys

46
Q

what do androgens to?

A

they stimulate pubic and axillary hair growth and sex drive in females

47
Q

what is the most dominant feature of Cushings syndrome?

A

swollen and puffed up

48
Q

how is cushings diagnosed?

A

24 hour urine samples for free cortisol (do it over 24 hours because cortisol levels are higher in the morning)

49
Q

what syndromes make you more at risk to develop cushings?

A

cystic fibrosis and rheumatoid arthritis

50
Q

what is the treatment for cushings?

A
  • if due to corticosteroid use: gradually taper off or switch to alternate day regimen
  • if its a tumour causing the issue, surgically remove the tumour
51
Q

what is a random thing that could be caused by cushings?

A

Thromboembolic pneumonia

52
Q

what is the etiologic behind Addisons disease

A

-Lack of endogenous corticosteroids
-opposite of Cushings
-autoimmune

53
Q

which corticosteroids are reduced with Addisons disease?

A

all mineralocorticoids, corticosteroids and adrogens

54
Q

what are the main clinical manifestations with Addisons disease

A
  • weakness
  • fatigue
    -weight loss
  • ## anorexia
55
Q

what is the big complication with Addisons disease?

A

Addisonian crisis (acute adrenal insufficiency)

56
Q

what can trigger addisonian crisis

A

triggered by stress, sudden corticosteroid withdrawal, adrenal surgery, sudden pituitary gland destruction

57
Q

what are some GI manifestation for addisonian crisis

A

Nausea and vomiting, diarrhoea, abdominal pain

58
Q

how do you treat addisonian crisis

A

shock management and aggressive hydrocortisone replacement (in high doses), and increased salt diet

59
Q

what should a nurse do in response to Addisons?

A
  • frequent assessments
  • medications: glucocorticoids, mineral corticoids
60
Q

how is Addisons disease diagnosed? (lab results)

A
  • hyperkalemia
  • hyponatremia
  • hypoglycemias
  • anemia
  • low urine cortisol and aldosterone
61
Q

if T3 and T4 levels are high, what will TSH levels look like?

A

Low

62
Q

what does calcitonin do?

A

take calcium from blood to bone

63
Q

which antibodies destroy thyroid gland causing hypothyroidism?

A

TPO

64
Q

what happens during graves disease?

A

B cells produce too much TH, this causes hyperthyroidism

65
Q

what would happen to the thyroid if there was a tumour in the anterior pituitary?

A

it would stop the release of TSH which would cause hypothyroidism

66
Q

what are the four “nos” when taking levothyroxine?

A
  • no food 1 hr before breakfast
  • no cure
  • no doubling doses
  • no abrupt discontinuation
67
Q

what is the most aggressive treatment for hyperthyroidism?

A

Radioactive iodine

68
Q

what are the only 2 things that are high in Addisons disease?

A
  • pigmentation and potassium (causing muscle spasms)
69
Q

how does propranolol reduce symptoms of hyperthyroidism

A

its a beta blocker so it reduces SNS symptoms

70
Q

what does prednisone do

A

reduces inflammation

71
Q

which antibodies may destroy the thyroid gland

A

APO

Pharmacology (8 decks)

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