Endocine 6/7 Flashcards

1
Q

What can decrease renal perfusion and stimulate renin release?

A

hemorrhage
PEEP
CHF
liver failure
Sepsis

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2
Q

What ABG abnormality does aldosterone cause?

A

metabolic alkalosis- holding on too too much water/ buffer

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3
Q

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

A

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

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4
Q

What is gluconeogenesis

A

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

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5
Q

Cortisol effects

A

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

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6
Q

Most potent glucocorticoids

A

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

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7
Q

Most potent mineralcorticoids

A

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

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8
Q

Which steroids have NO mineralcorticoid effects

A

dexamethasone, betamethasone, triamcinolone

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9
Q

Which drugs have no glucocorticoid effects

A

aldosterone

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10
Q

Which synthetic steroid is best for addisons disease

A

prednisone
most closely resembles cortisol

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11
Q

Primary vs secondary hyperaldosteronism causes and renin level

A

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

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12
Q

Treatment of hyperaldosteronism

A

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

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13
Q

How would hypokalemia affect anesthesia

A

muscle weakness- more sensitive to NDNMB
U wave
Avoid hyperventilation

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14
Q

What causes cushing’s syndrome

A

exogenous administration
pituitary tumor, adrenal tumor

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15
Q

glucocorticoid effects of cushings

A

hyperglycemia
weight gain
increased infection risk
osteoperosis
muscle weakness

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16
Q

mineralcorticoid effects in cushings

A

htn
hypokalemia
met alkalosis

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17
Q

androgen effects in cushings

A

hirsutism, hair thinning, acne, amenorrhea
gyno, impotence

18
Q

Anesthetic considerations for cushings

A

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

19
Q

Patho of why etom is bad for adrenal insufficient sepsis patients

A

Inhibits beta 11 hydroxylase

20
Q

When can addisons turn into addison crisis?

A

infection
surgery
illness
sepsis

21
Q

primary vs secondary addisons causes

A

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

22
Q

clinical features of addisons

A

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

23
Q

addisons crisis symptoms

A

cv collapse
fever
hypoglycemia
AMS

24
Q

Treatment of addisons

A

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

25
Q

Who is suppressed (HPA) and needs prednisone coverage?

A

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

26
Q

Minor, moderate, major surgery examples and required hydrocortisone dose

A

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

27
Q

Things that stimulate insulin

A

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

28
Q

What reduces insulin release

A

volatile anesthetics
beta blockers

29
Q

Insulin effects

A

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

30
Q

What organs dont need insulin for glucose uptake

A

brain and liver

31
Q

What stimulates glucagon release

A

hypoglycemia
stress
trauma
beta blocker
sepsis

32
Q

What inhibits glucagon release

A

anything that increases BG
somatostatin
insulin

33
Q

Other uses for glucagon

A

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

34
Q

side effects of glucagon

A

N/V

35
Q

Somatostatin

A

inhibits insulin and glucagon

36
Q

Pancreatic poly peptide roles

A

gastric motility
gallbladder contraction
gastric acid secretion

37
Q

Role of the pancrease

A

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

38
Q

Criteria for diabetes diagnosis

A

fasting bg 126
random bg 200
HBa1C- 6.5

39
Q
A
40
Q

What is metabolic syndrome

A

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

41
Q

3 treatment options for cushings

A

adrenalectomy
pituitary radiation
pituitary resection