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Pharmacology > Endocrine 2 > Flashcards

Endocrine 2 Flashcards

1
Q

Structure
T4
T3

A

4- 4 iodines to tyrosine backbone

3- 3 iodines, more active form

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2
Q

Process of thyroid hormone release

A

Hypothalamus rel TRH. TRH causes TSH rel from ant pit. TSH acts on thyroid- sec more T4/3

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3
Q

Thyroid sec more of what, which is converted in periphery

A

T4

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4
Q

Graves- what’s affected

A

TSH receptor activated.

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5
Q

How antithyroid drugs work

A

Competes w thyroglobulin for oxidized iodine. Reduced synthesis of thyroid hormones

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6
Q

Anti thyroid drugs onset, only useful when

A

1-2 weeks. Overproduction of thyroid hormones

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7
Q

PTU/methimazole
Can lead to what
Other 2 SE

A

Goiter- up reg TSH release, stim gland hypertrophy. Pruritic rash and arthralgias

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8
Q

3 serious complic of antithyroid drugs

A

Agranulocytosis 1st 90d (WBC monitor if fever/sore throat). Hepatotoxic. Vasculitis (drug ind lupus)

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9
Q

Which antithyroid drug preferred and why

A

Methimazole. Longer 1/2 life, take 1 qd, more potent than ptu, less freq serious SE

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10
Q

PTU
Also inhib what
Dosing
SE

A

T4 conversion in periphery. TID dosing.

Deplete PT- bleeds.

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11
Q

PTU
Preferred in
Route

A

Pregnancy or acute management in thyroid storm due to inhib T4 conversion.
NG for intraop thyroid storm

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12
Q

3 other tx hyperthyroidism

A

Thioamines works in 6-12 mos. I 131 ablation. Surgical removal and thyroid replacement

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13
Q

Use what while waiting for thioamines to work
Does what
Which one for thyroid storm

A

B blockers. Blocks tachycardia, tremor, conversion t4 to T3.
Esmolol, 9 min 1/2 t

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14
Q

How corticosteroids work hyperthyroidism

2 ones

A

Symptomatic tx, blocks t4 conversion, suppressor thyroid receptor Ab and inflammation.
Pred or methylpred

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15
Q

How lugols solution works

A

Blocks t4 conversion in hyperthyroid. Dec vascularity of gland. Temporarily blocks thyroid hormone release. Temporary tx

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16
Q

How hashimotos works

Causes of iatrogenic hypothyroid

A

Autoimmune antibodies against thyroid gland proteins. Blocks production of thyroid hormone.
Iatrogenic, pit tumor, sx

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17
Q

Levothyroxine
1/2 life
Monitor what
SE

A

7 days, once daily dosing
Tsh, free t4, s/s of hyperthyroidism
Allergic rash

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18
Q

When T3 used

A

Life threatening hypothyroidism (myxedema coma) where faster onset is useful

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19
Q

Which 4 drugs increase levothyroxine metab

A

Phenobarbital, phenytoin, rifampin, carbamazepine

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20
Q

Which drugs dec t4 to T3 conversion 4 (interact w levothyroxine)

A

Ptu, BB, amio, glucocorticoids

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21
Q

Levothyroxine decreases abs of what in gut 5

A

Cholestyramine, feso4, al(oh)3, sucralfate, kayexalate

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22
Q

Levothyroxine increases what (hormone interaction)

A

Thyroid binding globulin (binds T3, t4) in pregnancy, estrogen (OCs or HRT)

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23
Q

Drugs that alter thyroid status 3

A

Amio (cont iodine, hypo or hyper)
Lithium (can lead to hypo)
Reglan (inc tsh prod/rel)

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24
Q

Natural steroids 3

A

Cortisol, cortisone, aldosterone

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25
Q

Synthetic steroids 4

A

Prednisolone, prednisone, methylprednisolone, dexamethasone

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26
Q

Corticosteroid mineralcorticoid effects

A

Reabs na excretion k in renal distal tubule (aldosterone)

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27
Q

Glucocorticoid fx of steroids

A

Antiinflammatory, augment sustained sns activity in stress

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28
Q

Corticosteroids all have what in structure. Alterations in it act for what

A

Same steroid nucleus. Potency, abs, pb, metab

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29
Q

Where mineralcorticoid and glucocorticoid receptors found

A

Mineral- excretion organs: colon, salivary glands, sweat glands, kidney, hippocampus. Gluc- widespread

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30
Q

MOA steroids

A

Steroid and receptor enter nucleus, inf dna transcription= more/less protein synthesis/exp of certain genes

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31
Q

Steroid

Metabolic fx due to

A

Inc in nutrient availability by raising BG, AA, and TG levels

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32
Q

Steroid moa

How inflammatory response inhib

A

Phospholipase A2 inhib, arachidonic acid formation decreased.

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33
Q

Cortisol
Daily avg secreted
High stress

A

10-20 mg

50-150 mg

34
Q

Cortisol
1/2 t
Metab exc

A

1.5-3 hrs, longer fx

Liver, urine unchanged

35
Q

Methylprednisone used for

A

HPA axis depression replacement

36
Q

Betamethasone lacks

A

Mineralcorticoid fx

37
Q

Dexamethasone uses 3

A

Cerebral edema, antiemetic, airway edema control periop

38
Q

Triamcinolone

Use

A

Epidural injections LBP

39
Q

Prednisolone
Fx
Which is converted to it

A

Mineral and glucocorticoid

Prednisone converted to prednisolone after absorption

40
Q

Adrenal insufficiency
Drug & dose for acute
What must be eval tx too

A

Cortisol 100 mg q8

F&E imbalances

41
Q

Adrenal ins
Chronic drug and dose
Needs what also

A 
Cortisone 25 mg q am 12.5 in afternoon 
Mineralcorticoid added (ex fludrocortisone)
42
Q

IV glucocorticoids fx
1 hr
4-6h

A

Beta adrenergic agonist enhancement

Antiinflammatory

43
Q

Steroid for allergy and asthma

A

Glucocorticoids iv

44
Q

Chronic asthma tx first line bronchospasm prevention

A

Inhaled glucocorticoids via MDI. Beclomethasone, triamcinolone, flunisolide

45
Q

SE inhaled glucocorticoids

A

Dysphagia (laryngeal muscle myopathy)

HPA axis disturbance if daily dose >1500 mcg adults 400 peds

46
Q

Decadron
Dose
E 1/2t
Given when

A

8-10 mg
3 hrs, antiemetic for 24h
Shortly after induction

47
Q

Post op __ effect w glucocorticoids how

A

Inhib cyclooxygenase and lipoxygenase path has analgesic effect

48
Q

Steroid use in IC tumors

A

ICP and edema control. Not for CHI

49
Q

Steroid not strongly effective for

A

Aspiration pneumonitis

50
Q

Steroid use in lumbar disc herniation

A

Epidural injection to reduce edema and inflammation at nerve root

51
Q

Steroid and dose for lumbar disc hern

HPA axis sup how long after

A

25-50 triamcinolone
40-80 methylpred
1-3 months

52
Q

Steroids prevent what in premies

A

RDS, given to mothers threatening labor <37 weeks

53
Q

SE steroids

A

HPA exis sup (CV collapse), FE imb, infec, osteoporosis, PUD, skel musc weak, psych disorders, CBC changes, growth retard in kids, dec anticoag effectiveness

54
Q

Conditions needing periop steroid coverage

A

Addisons. Hypotension, hyponatremia, hyperkalemia, eosinophilia. Risk based on therapy.

55
Q

Steroid dose for minor surgery

A

Preop plus hydrocortisone 25 mg

56
Q

Steroid dose for moderate sx

A

Preop plus hydrocortisone 50-75 mg

57
Q

Steroid dose for major surgery

A

Preop, 100-150 every 8hrs for 48-72hrs

58
Q

Glucagon- hormone for what

A

Hyperglycemic. Made by alpha cells in pancreas and upper gi in resp to hypoglucemia or inc plasma proteins

59
Q

Glucagon

Enhances what two things

A

Formation of camp and release of catecholamines

60
Q

Glucagon
Inc: 6
Dec:1
Relaxes what

A

Inc contractility, hr, renal bf, insulin sec, gluconeogenesis/glycogenolysis
Gastric motility
Smooth muscle (sphincters)

61
Q

Glucagon does what to vessels

A

Vasodilates, dec SVR

62
Q

Glucagon dose

A

1-5 mg iv

5 mcg/kg/min (20/hr)

63
Q

Glucagon cv effects

A

Inc co (w bb), improves low CO (post mi/Cpb), imp CHF symp, enhances AV conduc (dig toxicity)

64
Q

Glucagon
Use in dx of
Use in placement of

A

Pheochromocytoma

Biliary stents- causes dilation

65
Q

Glucagon SE

A

High or low bg, low K, NV, abrupt hr inc in afib

66
Q

Somatostatin is what

A

Gi regulatory peptide sec by panc delta cells

67
Q

Ocreotide is what

A

Somatostatin analogie. Both inhib produc/rel of hormones from GI/pancreas

68
Q

Ocreotide inhib rel of

A

GH, insulin sec, glucagon, VIP

69
Q

Somatostatin ocreotide 1/2t

A

3 min, 2.5 min

70
Q

Ocreotide used for

A 
Carcinoid crisis (dec rel of serotonin/vasoactives) 
Hepatorenal syndrome 
Control of varices bleed
71
Q

What is possible w ocreotide bolus

A

Bradycardia, 2nd or 3rd degree heart block

72
Q

ADH
Receptor classes/actions
Inc rel of

A

V1- arterial smooth muscle vasoconstriction
V2- inc h20 perm reabs collecting ducts
V3- inc acth release

73
Q

ADH e 1/2

A

10-20 min

74
Q

Vasopressin uses 4

A

DI (central)
Varicies
Hemorrhagic/septic shock
Cv arrest resusc

75
Q

Vaso SE

A 
Inc bp (larger doses) 
Coronary artery vasoconstriction (angina, mi, ischemia, ecg changes, arrhythmias)
Gi hyperperistalsis (NV, abd pain)
76
Q

DDAVP

Comparison to vaso

A

E 1/2 2-4h

More selective for v2/antidiuretic than v1 (vasoconstriction). Better for DI.

77
Q

DDAVP

Stim release of

A

Endothelial cells to inc sec of VWF, tpa, and prostaglandins

78
Q

Synthetic oxytocin

Acts on what to cause contraction

A

Uterus, induces labor, dec post partum

79
Q

Oxytocin

In high doses what can happen

A

SVR dec reducing SBP and DBP. H20 retention.

80
Q

Oral bc
Estrogen prev
Progesterone prev

A

FSH release

LH release

81
Q

SE from bc

A

Thromboembolism (plt agg and clotting factors by estrogen), MI and stroke risk, htn

Pharmacology (19 decks)

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