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Pharmacology II > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Who is more affected by thyroid disease?

A

Women 3x more

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2
Q

Active hormones produced by thyroid gland?

A

T3 and T4

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3
Q

Which thyroid hormone is more potent?

A

T3

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4
Q

Which is the major circulating hormone secreted by thyroid?

A

T4

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5
Q

What form is T3 and T4 mostly in?

A

Bound form and T4 is inactive by TBG thyroxine binding globulin

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6
Q

Half life of T4?

A

Slowly metabolized, long half life of 7 days

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7
Q

Half life of T3?

A

Greater potency and shorter half life of 1.5 days

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8
Q

Thyroid hormone acts directly on what 2 sites?

A

Cardiac myocytes (increase contractility) and vascular smooth muscle (vasodilates)

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9
Q

3 usual therapies for hyperthyroidism?

A
  1. Anti thyroid (methimazole or propulthiouracil (PTU))
  2. Iodide
  3. Beta blockers
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10
Q

How does methimazole or PTU work?

A

Inhibit organification and coupling steps in thyroid hormone synthesis (MIT, T3 and T4)

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11
Q

How long does it take methimazole and PTU to work?

A

6-8 weeks to achieve euthyroid status

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12
Q

How does iodide work?

A

Inhibits release of hormones; decreasing thyroid synthesis and release so reducing gland size and vascularity

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13
Q

When is iodide used?

A

Urgent uses because immediate onset but short lived

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14
Q

What is iodide pretreated with?

A

Antithyroid drugs to avoid exacerbation

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15
Q

How does BB propranolol work?

A

Decreases T4 to T3 conversion

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16
Q

Hyperthyroidism general anesthesia changes (2)

A
  1. Induction agent may be slower and require increased concentration of inhaled anesthetic due to increase CO
  2. Increased anesthetic requirements to control BP and HR
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17
Q

Hyperthyroidism is thought to have increased sensitivity to what?

A

Catecholamines (NE, Epi, ephedrine - indirect acting agent)

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18
Q

What is recommended to control BP for hyperthyroidism?

A

Direct acting non catecholamines like phenylephrine

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19
Q

How are hyperthyroidism pts respiratory muscles?

A

Weak so may need prolonged mechanical ventilation post op

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20
Q

Hyperthyroid pts undergoing surgery: (3)

A
  1. Euthyroid status in preop
  2. Elective surgery take up to 6-8 weeks
  3. Treat with antithyroid agents, BB, glucocorticoids
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21
Q

During surgery for hyperthyroidism, what is propranolol’s 2 jobs?

A
  1. Manage CV effects

2. Decrease peripheral T4 to T3 conversion

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22
Q

How much Propranolol should be give for hyperthyroidism during procedure?

A

10mg IV and titrate to HR <90

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23
Q

What else can you give during procedure for hyperthyroidism and why?

A

Dexamethasone

Decrease peripheral conversion of T4 to T3

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24
Q

Steps to occur to treat thyroid storm (8)

A
  1. Immediately administer BB
  2. Consult endocrinologist
  3. Propranolol 10 mg IV
  4. Dexamethasone 2mg IV or hydrocortisone 100-200mg
  5. Cooling blankets
  6. Acetaminophen
  7. Phenylephrine if vasopressor needed
  8. NG administration of antithyroid drug (PTU)
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25
Q

If symptom during or shortly after surgery in pt without known hyperthyroidism and before lab confirmation, how do you mange?

A

Manage like MH

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26
Q

Pts with chronic hypothyroidism are treated with what (3)

A

Thyroid replacement hormone:

  1. Levothyroxine (T4)
  2. L-triiodythyronine (T3)
  3. Liotirx (T4:T3 ratios)
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27
Q

Initiating therapy for hypothyroidism should be taken caution in pt with?

28
Q

Pts with severe hypothyroidism is at higher risk for what?

A

Anesthetic complications

29
Q

What is a term used to denote severe hypothyroidism?

30
Q

Hypothyroidism will typically have what sign and how to treat?

A

Bradycardia and diminished response to adrenergic agents (alpha and beta agonists) so need larger doses

31
Q

Hypothyroidism causes sensitivity to agents that cause what?

A

Suppress respiratory drive and that delays extubation

32
Q

PONV in thyroid surgeries (3)

A
  1. At least one prophylactic agent (ondansetron class)
  2. Opioid sparing strategy for pain relief (acetaminophen or NSAIDs)
  3. TIVA if high risk pt
33
Q

Extubation for thyroid surgeries (2)

A
  1. Extubate under deeper anesthesia

2. Administer remifentanil, dexmedetomidine, or lidocaine during emergence

34
Q

Primary adrenal insufficiency

A

Addison’s disease

35
Q

What is Addison’s disease?

A

Adrenal gland unable to provide corticosteroid, mineralocorticoid androgen hormones

36
Q

Short acting glucocorticoid?

A

Hydrocortisone

37
Q

Intermediate acting glucocorticoid (4)

A
  1. Prednisone
  2. Prednisolone
  3. Methylprednisolone
  4. Triamcinalone
38
Q

Long acting glucocorticoid?

A

Dexamethasone

39
Q

Which drug is most common with adrenal suppression?

A

Prednisone 20 mg for more than 3 weeks

40
Q

8 corticosteroid adverse effects:

A
  1. Increased susceptibility to infection
  2. Musculoskeletal (muscle wasting, poor wound healing, osteoporosis)
  3. Ocular (cataracts)
  4. Endocrine (wt gain, cushingoid state, hyperglycemia)
  5. Dermatologic (acne, striae, skin atrophy, easy bruising)
  6. GI (peptic ulcer, bleeding)
  7. Nervous system (behavior change, insomnia, euphoria, psychosis, suicidal, mood change)
  8. Electrolyte (hypokalemia, Na retention with edema, HTN)
41
Q

11 corticosteroid therapeutic uses:

A
  1. Allergic rxns
  2. Collagen vascular disease (RA, polymyalgia, lupus, arteritis)
  3. GI (IBD)
  4. Hematologic (immune)
  5. Systemic inflammation ARDS
  6. Inflammatory to joints and bones
  7. Neurologic (cerebral edema)
  8. Organ transplant for rejection prevention
  9. Pulmonary disease (COPD, asthma, sarcoidosis)
  10. Dermatologic disease
  11. Nephrotic syndrome
42
Q

Acute withdrawal effects:

A

Occurs with abrupt discontinuation after prolonged administration of pharmacologic doses (greater than physiologic doses)

43
Q

Does superficial surgery (dental, biopsy) need hydrocortisone?

44
Q

Hydrocortisone sode for minor surgery (inguinal hernia repair)

45
Q

Hydrocortisone dose for moderate surgery (cholecystectomy, colon resection)

A

50-75 taper 1-2 days

46
Q

Hydrocortisone dose for major surgery (CV, whipple)

A

100-150 taper 1-2 days

47
Q

Hydrocortisone dose for ICU (sepsis, shock)

A

50-100 to 8hr 2-7 days

48
Q

Tumor from extra adrenal chromaffin cells of the sympathetic ganglia of the thorax, abdomen, and pelvis.

A

Paraganglioma

49
Q

Where are catecholamine secreting tumors that arise from adrenomedullary chromaffin cells mostly located?

A

Adrenal gland

50
Q

Pheochromocytoma mostly secrete what?

51
Q

Pheochromocytoma rarely secrete?

52
Q

About 15% of pheochromocytoma release what?

53
Q

Pheochromocytoma symptoms with NE:

A

Alpha effects

-increased BP with reflex bradycardia

54
Q

Pheochromocytoma symptoms with Epi:

A

Beta effects

-increase BP and tachycardia

55
Q

Pheochromocytoma symptoms of BG?

A

Elevated due to glycogenolysis and inhibition of insulin release

56
Q

Pheochromocytoma diagnosis (4)

A
  1. 24hr urine collection for measurement of metabolites (metanephrines, VMNA)
  2. Plasma free metanephrine concentration
  3. Clonidine suppression test (suppress plasma catecholamines and metabolites)
  4. CT and MRI for tumor location
57
Q

Pheochromocytoma treatment:

A

Assuming predominant NE secreting so alpha blocking and then phenoxybenzamine (non competitive alpha 1 antagonist and some alpha 2 block)

58
Q

Advantage and side effect of phenoxybenzamine?

A

Advantage of noncompetitive block: difficult of excess catecholamines to over
Side effects: orthostatic hypotension

59
Q

If tachycardia, especially with phenoxybenzamine for Pheochromocytoma, what should be added?

60
Q

What should you NEVER do during treatment of Pheochromocytoma?

A

Never administer non selective BB before alpha block

61
Q

What would Pheochromocytoma Epi secreting tumor treatment be:

A

Beat 1 selective antagonist (esmolol)

62
Q

Which Pheochromocytoma treatment is useful for inoperable tumors?

A

Metyrosine

63
Q

Mechanism of metyrosine?

A

Inhibits tyrosine hydroxylase

64
Q

What can other treatments be for Pheochromocytoma?

A

CCB and ACEI

65
Q

Post op management (3)

A
  1. Monitor BG (decrease catecholamines may lead to hypoglycemia)
  2. If bilateral adrenalectomy administer glucocorticoids -dexamethasone
  3. BP may continue to be high for 7-10dys bc stored catecholamines

Pharmacology II (8 decks)

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