Endocine 6/7

Question 1

What can decrease renal perfusion and stimulate renin release?

Answer 1

hemorrhage
PEEP
CHF
liver failure
Sepsis

Question 2

What ABG abnormality does aldosterone cause?

Answer 2

metabolic alkalosis- holding on too too much water/ buffer

Question 3

Cortisol production per day, normal serum level, max production, and level during major surgery

Answer 3

15-30mg per day
12mcg/dl normal level
100mg/day max production
50mcg/dl during surgery

Question 4

What is gluconeogenesis

Answer 4

glucose- new-make
make new glucose
Amino acids are converted to glucose by the liver
increases blood glucose

Question 5

Cortisol effects

Answer 5

gluconeogenesis
protein catabolism for gluconeogenesis
Fatty acid mobilzation- use fat for energy
Anti inflammatory- stabilize lysosomal membranes, reduce cytokine release, decrease eosiniphils/ lymphocytes
Improve hemodynamics (inotropy) by increasing number and sensitivity to beta receptors in the myocardium
Improves vasoconstriction of catecholamines

Question 6

Most potent glucocorticoids

Answer 6

1- decadron/ betamethasone- 25x (synthetic)
2- fludro- 10x
3-… (many)
4- cortisol- 1x (first endogenous)

Question 7

Most potent mineralcorticoids

Answer 7

1- Aldosterone 300x
2- fludrocortisone 250x
3- cortisol 1x

Question 8

Which steroids have NO mineralcorticoid effects

Answer 8

dexamethasone, betamethasone, triamcinolone

Question 9

Which drugs have no glucocorticoid effects

Answer 9

aldosterone

Question 10

Which synthetic steroid is best for addisons disease

Answer 10

prednisone
most closely resembles cortisol

Question 11

Primary vs secondary hyperaldosteronism causes and renin level

Answer 11

primary- conns syndrome- aldosteronoma, pheo, primary hyperthyroid, aldosterone release from adrenal gland, normal renin
secondary- renovascular htn, aldosterone release from extra renal location, (chf, cirrhosis, nephritis) high renin

Question 12

Treatment of hyperaldosteronism

Answer 12

removal of tumor
aldosterone blocker- spironalactone/ eplerenone
k supplementation
na restriction

Question 13

How would hypokalemia affect anesthesia

Answer 13

muscle weakness- more sensitive to NDNMB
U wave
Avoid hyperventilation

Question 14

What causes cushing’s syndrome

Answer 14

exogenous administration
pituitary tumor, adrenal tumor

Question 15

glucocorticoid effects of cushings

Answer 15

hyperglycemia
weight gain
increased infection risk
osteoperosis
muscle weakness

Question 16

mineralcorticoid effects in cushings

Answer 16

htn
hypokalemia
met alkalosis

Question 17

androgen effects in cushings

Answer 17

hirsutism, hair thinning, acne, amenorrhea
gyno, impotence

Question 18

Anesthetic considerations for cushings

Answer 18

aseptic technique
skin and bone injury- careful positioning
post op steroids
DI following pituitary resection

Question 19

Patho of why etom is bad for adrenal insufficient sepsis patients

Answer 19

Inhibits beta 11 hydroxylase

Question 20

When can addisons turn into addison crisis?

Answer 20

infection
surgery
illness
sepsis

Question 21

primary vs secondary addisons causes

Answer 21

primary- autoimmune, hiv, tb
secondary- chronic exposure, removal

Question 22

clinical features of addisons

Answer 22

fatigue
hotn
inability to handle stress
hypoglycemia
weakness
hyponatremia, hyperkalemia
hyperpigmentation

Question 23

addisons crisis symptoms

Answer 23

cv collapse
fever
hypoglycemia
AMS

Question 24

Treatment of addisons

Answer 24

30mg cortisol/day
crisis- hydrocortisone >200mg, d5ns, hemodynamic support

Question 25

Who is suppressed (HPA) and needs prednisone coverage?

Answer 25

>20mg day for >3 weeks 5-20mg >3 weeks

Question 26

Minor, moderate, major surgery examples and required hydrocortisone dose

Answer 26

minor- colonoscopy - 25mg iv moderate- colon resection, total joint- 50mg major- cardio, thoracic, liver, whipple- 100mg

Question 27

Things that stimulate insulin

Answer 27

pns stimulation- after eating sns stimulation- more bg and more insulin glucagon raises bg catecholamines cortisol, GH Beta agonists

Question 28

What reduces insulin release

Answer 28

volatile anesthetics beta blockers

Question 29

Insulin effects

Answer 29

increase glucose permeability in skeletal muscle, liver, fat converts carbs to glycogen converts excess carbs to fats, which can later be used as energy promoting uptake of amino acids, mag, phos encourage protein synthesis, discourage protein breakdown

Question 30

What organs dont need insulin for glucose uptake

Answer 30

brain and liver

Question 31

What stimulates glucagon release

Answer 31

hypoglycemia stress trauma beta blocker sepsis

Question 32

What inhibits glucagon release

Answer 32

anything that increases BG somatostatin insulin

Question 33

Other uses for glucagon

Answer 33

bb od chf bypass ERCP to relax biliary sphincter increases cAMP/ inotropy

Question 34

side effects of glucagon

Answer 34

N/V

Question 35

Somatostatin

Answer 35

inhibits insulin and glucagon

Question 36

Pancreatic poly peptide roles

Answer 36

gastric motility gallbladder contraction gastric acid secretion

Question 37

Role of the pancrease

Answer 37

endocrine- metabolism, islets of langerhan exocrine- into duodenum for digestion from acini

Question 38

Criteria for diabetes diagnosis

Answer 38

fasting bg 126 random bg 200 HBa1C- 6.5

Question 40

What is metabolic syndrome

Answer 40

Higher risk for developing DM fasting glucose >100 Abdominal obesity >40 in men 35> women triglyceride >150 HDL <40 BP 130/85

Question 41

3 treatment options for cushings

Answer 41

adrenalectomy pituitary radiation pituitary resection