3. Endocrine 2 Flashcards by Kira Harms

T4 half life

7-8 days

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T3 half life

1-2 days

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hyperthyroidism drugs

methimazol
PTU
iodide
beta blockers

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methimazol mech

inhibits orgamnification and coupling

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PTU mech

inhibits peripheral T4 to T3 conversion

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iodide mech

block proteolysis
inhibits hormone release
decr thyroid synth release

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iodide indications

surgical prep
thyroid storm
severe hyperthyroid

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beta blocker (propranolol) mech

decr T4 to T3 conversion

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goal for hyperthyroid pre-op

establish euthyroid
antithyroid
beta blocker
glucocorticoids

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how long does it take to establish euthyroid

6-8 weeks

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hyperthyroid induction

slow inhalational

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hyperthyroid vasopressor

phenyleprhine to incr sensitivity to catecholamines

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can you use regional in hyperthyroid

yes - avoid epi

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propranolol hyperthyroid dose

10 mg IV

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propranolol titration to

HR < 90 bpm

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propranolol mech

manage CV effects
decr perip T4 to T3 conversion

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decadron dose

2 mg IV every 6 hrs

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decadron mech

decr periph T4 to T3 conversion

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which pts are at higher risk to anesthetic complications

hypothyorid

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which pts need lower doses due to excessiv eresponse to anesthetics

hypothyroid

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hypothyroid SE

resp depression
bradycardia
hypotension resistant to pressors
longer recovery

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Chronic hypothyroid treatment

levothyroxine (T4)
L-triiodythyronine (T3)
Liotirx (T4:T3)

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severe myxedema is a type of

hypothyrpidism

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severe myxedema SE

T4 < 1.0 mcg/dL
altered mental status
pericardial effusion
HF
coma

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PONV management for thyroid sx

ondansetron opioid sparing TIVA

thyroid storm S+S

hyperthermia cardiac dysfunction altered metnation

thyroid storm treatment

beta blocker (propranolol) dexamethasone hydrocortisone acetaminophen phenylephrine PTU

what can thyroid storm present like

what can you give for thyroid storm if you cannot confirme hyperthyroidism

treat like MH : give dantrolene

hydrocortisone doseing

100-200 mg

PTU dose

200-400 mg

how do you have to admin PTU

pheochromocytoma

catecholamine secreting tumor

pheo diagnosis

urine VMNA

pheo initial treatment

alpha blockers phenoxybenzamine

alpha blocker mech

lower BP incr intravascular volume myocardial-protective

phenoxybenzamine mech

non-competitive alpha 1 antagonist some alpha 2 antagnoism

phenoxybenzamine duration

longer DOA

phenoxy dose

1-2x daily 14 days prior to surgery

phenoxy SE

orthostatic hypotension tachycardia

which do you block first in pheos?

alpha before beta

periope pheo treatment

competative alpha 1 antag beta blocker phenoxy metyrosine CCB ACEi anti arrythmics

alpha 1 antagnoists

prazosin doxazosin

alpha 1 duration

shorter

alpha 1 SE

less tachycardias

BB indication in pheo

pts who are tachycardic with phenoxybenzamine

labetalol mech

alpha 1 beta 1 beta 2

esmolol mech

beta 1 selective antagonist

esmolol indication

EPI secreting tumor

phenoxy before surgery

STOP or Lower dose 24-48 hrs prior

metyrosine pmech

inhibits tyrosine hydroxylase in catecholamine synth

drugs to avoid w/pheo

atracurium ketamine deslurane

why avoid atracurium w/pheo

histamine reaction causing incr catecholamines

why avoid ketamine w/pheo

blocks catecholamine reuptake

why avoid desflurane w/pheo

causes sympa stimulation

drugs to treat periop HTN

nipride phentolamine CCB incr depth add opioid NTG labetalol mag sulfate

nirpide mech

direct vasodilator

nipride onset/duration

fast on short DOA

nipride CI

renal insufficiency

phentolamine mech

competitive alpha blocker direct vasodilator

vasopressin mech

non-adrenergic acting alternative

mag sulfate mech

inhibit catecholamine release direct vasodilator

how to treat hypotension

fluids vasopressin

primary adrenal

addison's adrenal gland unable to provide corticosteroids

secondary adrenal

ioatrogenic xurgery steroid therapy

short acting corticosteroids

hydrocortisone

intd acting corticosteroids

prednisone prednisolone methylprednisolone tramcinalone

long acting corticosteroids

dexamethasone

corticosteroids SE

adrenal supression hyperglycemia HTN acute adrenal isufficiency

adrenal suppression is dependent on

dose and duration

prednisone can cause adrenal suppression after

20 mg for > 3 weeks

acute adrenal insufficiency

fever myalgias arthralgias malaise hTN shock

what causes acute adrenal insufficien cy

abrupt steroid discontinuation

corticosteroid indication

allergic rxn inflammation RA

if pts have suppressed HPT

give periopcorticosteroiud

< 5 mcg/dL

supplement steroids

5-10 mcg/dL

give ACTH test or supplement steroids

> 10 mcg/dL

give usual dose

adrenal dysfunction S+S

hyperglycemia HTN fluid retention incr infection risk

minor srugery

none required

mod surgery

50 mg IV 25 mg ever 8 hrs for 24 hrs

maj surgery

100 mg IV 50 mg every 8 hrs for 24 hrs

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