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Anesthesia Pharm Study Guide > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Metformin

  1. Class
  2. Mechanism of action
  3. Can it cause hypoglycemia?
A
  1. Biguanides
  2. Decreased hepatic glucose absorption → decreased gluconeogensis → decreased serum glucose
    Sensitizes peripheral tissues to effects of insulin
  3. No
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2
Q

Rosiglitazone

  1. Class
  2. Mechanism of action
A
  1. Thiazolidinediones
  2. Act on extra pancreatic sites to increased insulin sensitivity and decrease hepatic glucose production
    * *May increase risk for CV disease
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3
Q

Pioglitazone

  1. Class
  2. Mechanism of action
A
  1. Thiazolidinediones

2. Act on extra pancreatic sites to increased insulin sensitivity and decrease hepatic glucose production

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4
Q

Glipizide

  1. Class
  2. Mechanism of action
  3. Can it cause hypoglycemia?
A
  1. Sulfonylureas
  2. Increased insulin secretion by stimulating pancreatic beta cells → decreases hepatic clearance of insulin
  3. YES
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5
Q

Glyburide

  1. Class
  2. Mechanism of action
  3. Can it cause hypoglycemia?
A
  1. Sulfonylureas
  2. Increased insulin secretion by stimulating pancreatic beta cells → decreases hepatic clearance of insulin
  3. YES
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6
Q

Glimepiride

  1. Class
  2. Mechanism of action
  3. Can it cause hypoglycemia?
A
  1. Sulfonylureas
  2. Increased insulin secretion by stimulating pancreatic beta cells → decreases hepatic clearance of insulin
  3. YES
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7
Q

What are the treatment options for hyperthyroidism?

A
  • Antithyroid meds: propylthiouracil (PTU), Methimazole and Carbimazole → inhibit thyroid hormone synthesis
    • PTU inhibits peripheral conversion of T4→T3
  • Radioiodine therapy
  • Surgery is the definitive treatment
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8
Q

What is hyperthyroidism and what is the most common cause?

A

Excessive thyroid hormone due to an over production or over functioning of thyroid gland that causes increased metabolism and autonomic nervous system disturbances
Graves Disease

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9
Q

What is a myxedema coma?

A

SEVERE hypothyroid

  • May occur in postoperative period → triggers include: cold temp, infection, sedation, analgesia
  • S/Sx: Decreased LOC, hypothermia, bradycardia, hyponatremia, HF, respiratory failure
  • HIGH mortality
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10
Q

What is the hormone of choice for thyroid replacement?

A
  • *T4 (Thyroxine)**
  • Consistent potency and duration of action
  • Absorbed in small intestine
  • Levothyroxine sodium is most common
    • Dose: 75-150 mcg/day.
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11
Q

What is the treatment plan of a patient with myxedema coma?

A
  • Mechanical ventilation
  • Supportive therapy
  • Rewarming
  • Hydration
  • IV administration of levothryoxine and hydrocortisone
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12
Q

What is sick euthyroid syndrome? What can induce it?

A

Patient appears euthyroid clinically → evidence of dysfunction on lab testing

Can be induced by stress, starvation, MI, surgery, and propranolol

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13
Q

What is thyroiditis?

A

Inflammation of thyroid (acute or chronic)

  • Leads to abnormalities of function
  • Acute = rare, infections
  • Chronic = Hashimoto’s thyroiditis ** Most common hypothyroid
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14
Q

Anesthetic Considerations for:

  1. Hypothyroid
  2. Hyperthyroid
  3. Thyroid surgery
A
  1. Patient is MORE sensitive to effects of anesthetics → prolonged recovery
  2. Assess most current thyroid function tests →know symptoms → tachycardia, fib, diarrhea, weight loss
    • Potential for large gland → compression on tissues/structures → difficult airway or obstruction
      - Want smooth wake up → no coughing or bucking to avoid hemorrhage or swelling ex: remifentanil
      - Neck wound may need to be opened to allow drainage
      - Surgical re-exploration maybe necessary
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15
Q

What four hormones are essential in maintaining a normal plasma C++ concentration?

A

PTH, Ca, Vit D, Calcitonin

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16
Q

Primary Hyperparathyroidism

  1. What is it? Risk factors?
  2. Clinical signs?
  3. Treatment
A
  • Excess PTH production most often due to hyperplasia or tumor (risk factors are age 30-50, women > men, increased chance of CV disease without treatment)
  • Increases bone resorption and extracellular Ca++

Clinical signs: hypercalcemia, hypophosphatemia, nephroliathisis, osteoporosis, fatigue, weakness, and cognition difficulties

Treatment: Surgical excision

17
Q
  1. What are the anesthetic considerations of hypercalcemia?

2. What part of the procedure should I focus on for potential concerns?

A
    • Focus on the degree of CV or renal complications of hypercalcemia (the effects)
      - ECG? → maybe! → shortened PR and QT intervals, potential for arrhythmias, hypertension, hypovolemia
  2. EMERGENCE: surgery on thyroid or parathyroid glands can result in damage to recurrent laryngeal nerve, airway swelling and hematoma formation
18
Q

Recurrent Laryngeal Nerve Damage

  1. Causes
  2. What is the difference between unilateral injury vs bilateral injury and their characteristics?
  3. What can be used to watch for nerves are located?
A

1.- Intubation
- Neck surgery
- Stretching of the neck
- Thyroid or cervical spine surgery
2. Unilateral: Cord injured on one side → cord on injured side assumes midline position ⇒ hoarseness
Bilateral:Cord injured on both sides → both cords close to midline (ADDUCTION) ⇒ aphonia and airway obstruction = AIRWAY EMERGENCY
3. NIMS tube: helps identify where nerves are → used with ENT, thyroid, and parathyroid cases
Blue section of the tube goes between cords so USE CMAC so everyone can verify placement

19
Q

What is the major concern with inadvertent removal of parathyroid glands?

A
  • HYPOcalcemia → Tetany of facial muscles and extremities - Tetany can cause laryngeal muscle spasm and upper airway obstruction are possible
  • Other Concerns: prolonged QT and possible heart block
20
Q

Pheochromocytoma

  1. What is the classic diagnostic test?
  2. What are first line agents
  3. When should they be started?
A
  1. High metanephrine levels on blood tests
  2. Alpha blockers:
    • Phenoxybenzamine
    • Metyrosine
    • Phentolamine
  3. 10-14 days prior
21
Q

What is the most important rule for pheochromocytoma patients? Why?

A

ALPHA BLOCK BEFORE BETA BLOCKADE
Giving beta blockers prior to alpha blockade causes unopposed alpha agonism → severe vasoconstriction → severe HTN
**May beta blockade after successful initiation of alpha blockade

22
Q

Pheochromocytoma

  1. What drugs should be used intraoperatively for HTN?
  2. What drugs should be avoided?
  3. What should you be cognizant of after tumor removal?
A
  1. Phentolamine, Nitroprusside, Nicardipine
  2. Ketamine, Ephedrine, Pancuronium
  3. Watch for hypotension -> Usually responsive to fluids, however, may need phenylephrine drip
    * Often due to residual anti-hypertensives on board
23
Q

In a patient that there is no concern for Addison’s disease with daily steroid therapy, when should additional steroids be administered for surgery?

A

If patient has been on MORE than 5 mg prednisone (or equivalent) per day for LONGER than 3 weeks
AND:
High stress case: 100-150mg hydrocortisone
Moderate: 50-75 mg hydrocortisone OR 10-15mg methylprednisolone OR 4-8 mg decadron
Low stress: 25 mg hydrocortisone OR 5mg methylprednisolone OR 4-8 decadron

Anesthesia Pharm Study Guide (13 decks)

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