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Pharmacology II for Anesthesia > 06 - Endocrine II > Flashcards

06 - Endocrine II Flashcards

1
Q

Corticosteroids are ___ with receptors ____ throughtout the body. Example?

A

anti-inflammatory
widely distributed

glucocorticoids (cortisol)

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2
Q

Secretion of endogenous cortisol increases in response to ___. What is baseline episodic secretion?

A

stress

~20 mg/day

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3
Q

What are the anti-insulin effects of corticosteroids?

A

gluconeogenesis
inhibition of glucose utilization
hyperglycemia

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4
Q

Corticosteroid interaction with catecholamines?

A

vascular smooth muscle response

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5
Q

Corticosteroids have some sodium ___ and potassium

A

retention

excretion (mineral corticoid effect)

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6
Q

Exogenous glucocorticoids are primarily used to replace

A

glucocorticoid deficiency (Addison’s disease)

25-37.5 mg daily replacement

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7
Q

Inhaled exogenous glucocorticoids are used for

A

asthma

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8
Q

Inhaled steroids have a ___ effect and little

A

local effect

systemic absorption

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9
Q

Examples of inhaled steroids?

A 
Azmacort - triamcinolone
Beclovet - beclomethasone
Flovent - fluticasone
Pulmicort - budesonide
Advair - flutocasone + salmetrol
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10
Q

Inhaled steroids can cause significant ____ deposition leading to

A

pharyngeal

dysphonia, candidiasis

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11
Q

Exogenous systemic steroids are typically used for ___ of asthma given ___ hours before anesthesia

A

acute exacerbations

1-2 hours

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12
Q

Exogenous glucocorticoid given as an antiemetic? It has similar efficacy to ____. Is there data to support giving more?

A

4 mg IV dexamethasone
odansetron or droperidol
no

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13
Q

Dexamethasone is best if given near the

A

beginning of surgery

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14
Q

Dexamethasone prevents surgery-induced ____ and increases release of

A

inflammation

endorphins?

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15
Q

Why is dexamethasone used in caution with diabetics?

A

consider the risks of hyperglycemia vs benefits of therapy

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16
Q

Given for cerebral edema?

A

dexamethasone

larger doses required (10-20 mg)

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17
Q

Dexamethasone is effective for ____ due to global ischemic injury by decreasing ____ for intracranial surgery

A

elevated ICP

cerebral volume

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18
Q

What are the other uses of exogenous glucocorticoids?

A

anti-inflammatory - postop pain, lumbar disc disease, collagen diseases, arthritis, skin disorders, ulcerative colitis, acute spinal cord injury
immunosuppressiob (transplant) - respiratory distress syndrome, leukemia, myasthenia gravis

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19
Q

All patients you want to administer exogenous glucocorticoids to should be evaluated for

A

past/current steroid use

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20
Q

Many people give ____ for post-intubation laryngeal edema but there is no evidence of efficacy

A

dexamethasone

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21
Q

Side effects of glucocorticoid therapy

A

suppression of hypothalamic-putitary-adrenal (HPA) axis
electrolyte/metabolic changes
osteoporosis
peptic ulcer disease
CNS: psychosis (steroid rage), depression; cataracts
immunosupression: bacterial/fungal infection

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22
Q

Suppression of the HPA axis can occur only ___ after taking 20 mg/day ___ and take ___ to fully recover

A

5 days
prednisone
9-12 months

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23
Q

When corticosteroid therapy suppresses the HPA axis, the ____ no longer secrets ____ in response to stress (illness, injury) which causes risk of ____ with stress

A

adrenal gland, cortisol

acute adrenal insufficiency (cardiovascular collapse)

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24
Q

Risk of HPA axis suppression increases with

A

dose and duration of therapy
every other day therapy is better than daily
topical/inhaled/local treatment is better than systemic

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25
Q

How is “stress-dose” corticosteroid administered?

A
  1. Continue daily basal maintenance dosing
  2. Supplementation with hydrocortisone

It is a subject of much debate

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26
Q

What is the low and high dose for stress-dose corticosteroid?

A

25 mg Q12h

100 mgQ6h

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27
Q

Stress doses vary based on ____ of the surgical procedure as well as the perceived rush of this patient developing

A

magnitude

acute renal insufficiency

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28
Q

Is tapering needed when giving a steroid for colonoscopy?

A

No, 25 mg bolus

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29
Q

What is the dosing of steroids for a moderate surgery such as hysterectomy?

A

50-75 mg

25 mg q8h x3 doses

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30
Q

Dose of steroids for a major surgery (cardiac)?

A

100-150 mg

50 mg q8h x3, 50 mg q12h x2, 25 mg q12h x 2

31
Q

Glucocorticoid therapy can cause a ____ effect that leads to hypokalemic metabolic acidosis (think ____)

A

mineralcorticoid
aldosterone

binds at renal tubules “save sodium, pee potassium”
edema, weight gain, HTN

32
Q

Electrolyte/metabolic changes associated with glucocorticoid therapy?

A

mineralcorticoid effect
hyperglycemia
buffalo hump, moon facies, abdominal striae, tissue-paper skin

33
Q

Which steroid causes the most sodium retention?

A

Fludrocortisone - 250

34
Q

Which steroid causes the least amount of sodium retention?

A

Dexamethasone - 0

35
Q

Cyclooxygenase (COX) enzymes convert ____ to

A

arachidonic acid

prostaglandins

36
Q

COX-1 activity is constitutive or at a ____ level

A

constant

37
Q

COX-1 is involved in maintenance and protection of

A

gastric mucosa
platelet aggregation (depends on generation of thromboxane A2)
renal blood flow

38
Q

COX-2 activity is ___, expressed at the site of injury

A

inducible

39
Q

COX-2 up regulates sensitivity of peripheral ____ to cause ___ mediated by PGE2

A

nociceptors
pain, inflammation

fever

40
Q

Which COX crosses the BBB to facilitate spinal nociception?

A

COX-2

41
Q

Desirable features of NSAIDs

A

9 features

42
Q

Aspirin is a ____ COX inhibitor that causes anti platelet function due to ____ acetylation of platelet COX-1

A

nonselective

irreversible

43
Q

Used for the prevention of thrombosis in coronary stents?

A

aspirin

44
Q

How long should invasive procedures be avoided for a patient taking aspirin?

A

7-10 days

life of the platelet

45
Q

Which patients are especially sensitive to aspirin?

A

uremic patients

46
Q

Common side effects of aspirin?

A

bleeding

GI irritation/ulceration

47
Q

Aspirin causes ____ in 8-20% of all ____ adults

A

bronchoconstriction/asthma

asthmatic

48
Q

Aspirin is no longer used in children, especially due to

A

Reyes Syndrome

49
Q

Overdose on aspirin causes CNS stimulation (hyperventilation, seizures) leading to

A

respiratory alkalosis + metabolic acidosis

50
Q

When taken orally, ibuprofen has

A

first pass effect

consider IV use - does not accumulate over time, use Q6h

51
Q

Side effects of ibuprofen

A

GI irritation/ulceration

some platelet dysfunction

52
Q

Ibuprofen that is twice daily dosing

A

Naproxen

53
Q

Ketorolac is a ____ analgesic that can be used as a ___ drug or to supplement

A

post-operative

sole, opiates

54
Q

30 mg IM ketolorac =

A

10 mg morphine

55
Q

Ketorolac causes ____ inhibition of platelet aggregation

A

reversible

56
Q

Why should ketorolac be used with caution in renal patients?

A

Decreases renal blood flow on compromised patients (CHF, hypovolemia)

57
Q

NSAIDs are not recommended in

A

pregnancy and children
especially during third trimester, linked the premature birth and miscarriage

OK in children >6 months

58
Q

NSAIDs may cause premature closure of fetal ___ and limit renal blood flow

A

ductus arteriosus

59
Q

COX-2 inhibitor used for pain/inflammation of arthritis, surgery

A

Celecoxib (Celebrex)

60
Q

Celebrex is well absorbed from ___ with little

A

GI tract

first pass effect

61
Q

Safer NSAID for patient with gastritis/gastric ulcers

A

Celebrex

62
Q

NSAID with lack of antiplatelet effects

A

Celebrex

63
Q

NSAID that is better tolerated by patients with asthma

A

Celebrex

64
Q

Rofecoxib (vioxx) and valdecoxib (bextra) are COX-2 inhibitors that seems to cause ____ events and were ____ due to risk of MI and CVA

A

pro-thrombic

withdrawn from market

65
Q

Acetaminophen is not a true NSAID because it is not

A

anti inflammatory

66
Q

The mechanism of acetaminophen is ____ but some COX-2 or ____ inhibition

A

Not completely understood

COX-3?

67
Q

Provides excellent synergy with opioids

A

Acetaminophen

68
Q

T or F. Acetaminophen causes gastric irritation and affects platelets

A

False

69
Q

Hepatic metabolism of acetaminophen produces ___ metabolites that are scavenged by

A

Inactive

Glutathione

70
Q

High doses of acetaminophen leads to the formation of ___ which are nephrotoxic

A

P-aminophenol

N-acetyl-p-benzoquinone

71
Q

Overdose of acetaminophen can cause ____ which is increased in people who are

A

Hepatic necrosis

Chronic alcoholics - increased P450 activity and decreased glutathione stores

72
Q

With large alcohol consumption, a single dose of acetaminophen ___ is probably OK

A

The next day

73
Q

Antioxidant used to prevent hepatic damage if given within 8 hours of acetaminophen overdose

A

Acetylcysteine

74
Q

IV acetaminophen causes a rapid spike in plasma concentration without

A

First pass effect

Use q6h scheduled to maintain plasma concentration

Pharmacology II for Anesthesia (7 decks)

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