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Advanced Pharm Final > Endocrine > Flashcards

Endocrine Flashcards

ch 34, 35 5 questions

1
Q

What pancreatic cells secrete glucagon?

A

Alpha cells

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2
Q

What pancreatic cells secrete insulin and amylin?

A

Beta cells

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3
Q

What pancreatic cells secrete pancreatic polypeptides (PP cells)?

A

Gamma cells

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4
Q

What substance do Delta cells secrete?

A

Somatostatin

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5
Q

What two types of hormones are secreted by the pancreas and what are their functions?

A

exocrine: aid in digestion (acini cells)
endocrine: in circulation, aid in metabolism (islets of Langerhans)

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6
Q

What 4 substances are secreted by Islets of Langerhans cells?

A

insulin (60% in beta)
glucagon (25% alpha)
somatostatin
pancreatic polypeptide

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7
Q

What venous structure are endocrine substances secreted into?

A

Hepatic portal vein

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8
Q

What is insulin and its half life?

A

insulin is an anabolic hormone that promotes energy storage, it is eliminated by the kidneys and has a rapid half time of about 5 mins

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9
Q

What is the MOA of insulin?

A

stores energy (glucose) by ^ gluc perm in skeletal m, liver, fat (mostly in skeletal m)
converts gluc to fat to ^ cellular amino acid, K, mg, P
encourages protein synthesis and energy for cellular metabolism

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10
Q

The secretion of insulin encourages the use of _____ for energy and slows the use of ____ and _____.

A

glucose, fats, amino acids

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11
Q

Why can’t skeletal muscle glycogen be reconverted into glucose?

A

skeletal muscle lacks the phosphate enzyme needed for this process

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12
Q

___% of glucose eaten in a meal is stored in the _____ as as _____.

A

60, liver, glycogen

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13
Q

What is the antagonist to insulin?

A

glucagon

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14
Q

What is the purpose of glucagon, its 1/2 life, and elimination?

A

Catabolic hormone that promotes energy release from adipose and the liver
3-6 min, elim liver & kidneys

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15
Q

What are the physiological effects of glucagon?

A

increases myocardial contractility (^cAMP), HR, AV conduction, relaxes biliary sphincter, increases glucose release

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16
Q

What stimulates glucagon secretion?

A

low BG, stress, sepsis, trauma, Beta agonists, acetylcholine

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17
Q

What inhibits glucagon secretion?

A

high BG, somatostatin, insulin, free fatty acids, alpha agonists

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18
Q

What is the difference between glucagon and glycogen?

A

glycogen: inactive, stored glucose
glucagon: hormone that encourages glycogen conversion to glucose (active)

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19
Q

______ causes hypoglycemia because it ______ glucagon secretion

A

phenylephrine (alpha agonists), inhibits

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20
Q

______ causes hyperglycemia because it ______ glucagon secretion

A

dobutamine (beta agonists), stimulates

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21
Q

What are some indications for admin of glucagon?

A

low blood glucose, relax biliary sphincter during ERCP, ^CO postMI, treat BB OD

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22
Q

What is the function of Somatostatin?

A

regulates/ibihits illiet cell secretion, manages gastric motility, and splenic/GI blood flow.

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23
Q

What is the function of Pancreatic Polypeptides?

A

inhibits pancreatic exosecretion

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24
Q

What indicates whether an individual has type 1 or 2 diabetes: age or physiology?

A

underlying physiology
DM1: autoimmune destruction of beta cells, virus genetics, beta destruction
DM2: lack of insulin secretion OR insulin resistance

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25
Q

What is the TX for T1DM and the major complication?

A

T: insulin
DKA: ^ anion gap, ^ glucose, kussmaul’s, excess ketones

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26
Q

What is the treatment for DKA?

A

volume resuscitation, insulin, and K replacement after acidosis is corrected (HCO3)

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27
Q

In T2DM, what are the levels of insulin and glucagon?

A

I: normal to high
G: high/resistant to suppression

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28
Q

What is treatment of T2DM, lab dx, and the complication?

A

T: weight reduction, dietary changes, oral agents, and/or insulin
L: fastinggluc: >126 randgluc >200
C: Hyperglycemic hyperosmolar state: BS>600
tx: same as DKA

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29
Q

What is the goal of insulin therapy?

A

<7% A1c, 70-130 premeal glucose, post meal <180 (varies)

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30
Q

What type of insulin is most commonly given in surgery?

A

short acting insulin

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31
Q

Why are long acting insulins most commonly not given during surgery?

A

they are a long duration of action and it takes a long time for them to be effective

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32
Q

What insulins are rapid acting? what are their peak, duration, and max actions

A

lispro (humalog), aspart (novolog), glulisine (apidra)
start of action: 15-30 min
peak: 1-2hr
duration: 3-6hr, max 4-6hr

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33
Q

What is the one and only short-acting insulin? when does it start, peak, and duration of action?

A

regular insulin
starts: 30min-1hr
peaks: 2-4hr
duration: 3-6hr, max: 6-8

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34
Q

What is the one and only intermediate-acting insulin and its (start, peak, and duration) of effects?

A

NPH: Neutral Protamine Hagedorn insulin
start: 2-4hr
peak: 8-10hr
duration: 10-18hr max: 14-20hr

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35
Q

Use of what type of insulin can cause increase the risks of protamine reaction?

A

NPH: Neutral Protamine Hagedorn insulin

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36
Q

What are the two long-acting insulins and their (start, peak, and duration) of effects?

A

Glargine (Lantus) and detemir (Levemir)
start: 1-2hr
peak: 0
duration: 19-20/24 (L:24, G:20)

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37
Q

What is the half life and elimination of iv insulin?

A

5-10 min via proteolytic enzyme

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38
Q

What patient metabolizes insulin better: renal or liver failure?

A

patient with renal failure due to 50% of insulin being metabolized in the liver via first pass

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39
Q

What type of insulin acts most similarly to endogenous insulin?

A

lispro

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40
Q

What is the ONLY type of insulin that can be given IV?

A

regular insulin (humulin R)

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41
Q

What is the ultra long acting insulin?

A

Degludec

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42
Q

What are side effects and drug interactions of insulin?

A

low BG, allergic reaction, lipodystrophy (site), insulin resistance
interactions: protamine
drugs that counter (epi, glucagon, estrogen), extend, or enhance hypoglycemic effects (MAOIs, tetracyclines, and subcyliates)

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43
Q

What is the indication, moa, and side effects of metformin?

A

T2DM, PCOS, NFLD
activates adenosine monophos via protein kinase which decreases gluconeogenesis+lysis; deactivates livers ability to activate glucose, also decreases gi glucose absorption
SE: lactic acidosis, AKI, gi intol, liver disease, weight loss, b12 def

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44
Q

What is a major pro and a major con of metformin?

A

P: does not cause hypoglycemia
C: must be d/ced 48 hours prior to surgery due to interaction with contract dye

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45
Q

What is the indication, moa, and side effects of surlfonylurea?

A

manages glucose in patients with some Beta cell function
increases release of insulin in beta cells via ATP
SE: hypoglycemia (esp w glyburide)

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46
Q

What is a contraindication of sulfonylurea therapy?

A

sulfa allergy

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47
Q

What should sulfonylurea be discontinued prior to surgery?

A

24-48 hours prior

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48
Q

What is a secondary effect of the antihyperglycemic agent, glipizide?

A

mild diuretic

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49
Q

What drugs work similarly to sulfonylureas by stimulating insulin secretion from beta cells?

A

Meglitinides: Repaglinide & Nateglinide

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50
Q

What drug class is useful in post meal hyperglycemia?

A

α-Glucosidase Inhibitors: acarbase and miglitol

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51
Q

What are thiazolidinediones moa and contraindications?

A

decrease insulin resistance work in 4-12 weeks, increases weight gain from fluid, cannot be used in liver failure

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52
Q

What antihyperglycemic agent causes delayed gastric emptying?

A

Glucagon-Like Peptide-1 Receptor Agonists: Exenatide & Liraglutide and Pramlinitide

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53
Q

How do Dipeptidyl-Peptidase-4 Inhibitors (end in liptin) work and what is a consideration?

A

increase insulin release from pancreas. decrease dose in patients with renal failure

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54
Q

When should antihyperglycemic agents be stopped prior to surgery?

A

48hr prior

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55
Q

What type of insulin is used in insulin pumps?

A

rapid acting

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56
Q

What complications can occur with periop insulin pump use?

A

cath occlusion, hypoglycemia, cath dislodgement

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57
Q

How should a insulin pump be managed?

A

check BG preop, Q1H, and post op. continue basal rate and give boluses accordingly via pump

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58
Q

What hormones are secreted by the hypothalamus?

A

luteinizing hormone-decreasing hormone
corticotropin-releasing hormone
thryotropin-releasing hormone
prolactin inhibiting and releasing factors

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59
Q

Where is the pituitary gland located and what is it connected to?

A

lies in the sella turcica at the base of the brain and is connected to the hypothalamus by the pituitary stalk.

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60
Q

What hormones are secreted from the anterior and posterior pituitary gland?

A

A: FSH, luteinizing hormone, ACTH, TSH, Prolactin, Growth hormone
P: ADH (arginine vasopressin), oxytocin

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61
Q

what does growth hormone (somatotropin) do?

A

stimulates linear bone growth, anabolic effects, ketogenic, and diabetogenic

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62
Q

What occurs due to excessive growth hormone secretion?

A

acromegaly, most commonly caused by pituitary adenoma, causes gigantism if prior to puberty

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63
Q

What are anesthesia considerations for patients with acromegaly?

A

distorted facial feature (difficult to mask), large tongue, teeth, and epiglottis (difficult laryngoscopy), subglottic narrowing and vocal cord enlargement (use smaller tube: difficult ETT placement, turbinate enlargement (risk of epistaxis: avoid nasal intubation), OSA is common, entrapment neuropathies are common, skeletal muscle weakness

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64
Q

What is the primary building block for steroids?

A

cholesterol

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65
Q

What anesthesia drugs stimulate and inhibit the secretion of prolactin?

A

Stimulates: metoclopramide, cimetidine, opioids, methyldopa
Inhibits: prolactin, dopamine, l-dopa

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66
Q

What drugs stimulate adrenocorticotropic secretion?

A

alpha agonists and beta antagonists

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67
Q

What drugs inhibit adrenocorticotropic secretion?

A

opioids and etomidate

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68
Q

What does TSH do?

A

accelerates formation of thyroid hormones that manage metabolism
stimulates respiration rate, tremors, and decreases sleep time

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69
Q

Where are the 3 vasopressin receptors?

A

1: vascular smooth muscle
2: collecting duct of kidney
3. fat

70
Q

What is SIADH, what causes it, treatment?

A

excess ADH, low na, low urine na, hypertonic urine
TBI, SAH, cancer, carbamazepine
tx: fluid restrict, hypertonic nacl

71
Q

What is DI, what causes it, treatment?

A

deficit in ADH, caused by pituitary surgery, polyuria, low urine osmolarity
tx: DDAVP, vaso, ACE/ARB
dose: vaso- po: 0.3-0.6mg.day, iv: 1-4mcg/day, nasal: 5-40mcg/day

72
Q

What 3 things does the thyroid secrete?

A

T3
T4
Calcitonin

73
Q

What do thyroid hormones do?

A

controls protein synthesis by activating DNA transcription during cell proliferation, convert alpha receptors to beta receptors, cardiac cholinergic receptors are decreased by thyroid hormones. stimulates iodide pump, iodine and a substrate

74
Q

What 6 things can cause hyperthyroidism?

A

Grave’s Disease (autoimmune), most common, Myasthenia gravis (autoimmune), Multinodular goiter, Pituitary Adenoma, Carcinoma, Pregnancy

75
Q

What lab findings indicate hyper and hypo thyroidism?

A

hyper: low TSH, high t3, t4
hypo: high TSH, low t3, t4

76
Q

What are s/s of hyperthyroidism?

A

weight loss, exophthalmos, high ca2+, htn, tachyarrythmias, afib, high MV

77
Q

What drugs treat thyroid storm?

A

Thionamides (Methimazole,
Propylthiouracil, Carbimazole), PTU, potassium iodide, radioactive iodide, propranolol, esmolol, glucocorticoids

78
Q

What are the 4 B’s of thyroid storm management?

A

block synthesis
block release
block t4 to t3 conversion ptu
beta blocker

79
Q

What can thyroid storm mimic?

A

MH, pheochromocytoma, NMS, light anesthesia

80
Q

How long does it take PTU to achieve euthyroid state?

A

6-7 weeks

81
Q

What drug is contraindicated to treat fever in patients experiencing thyroid storm?

A

aspirin (dislodge t4 from plasma proteins)

82
Q

What is an airway concern associated with iodine solutions?

A

angioedema and laryngeal edema

83
Q

What are the causes and findings associated with hypothyroidism?

A

hashimoto’s thyroiditis, iodine def, pituitary dysfntn, neck radiation, thyroidectomy
weight gain, fatigue, lethargy, delayed gastric emptying, large tongue

84
Q

What are indications for synthetic thyroxine T3 (liothyronine)

A

thyroid cancer, + surgery and radioiodine, dx to differentiate from thyroid issue, myxedema coma

85
Q

What are indications for synthetic thyroxine T4 (levothyroxine)

A

primary hypothyroidism
decreased dose in older adults and increased in pregnancy
T4 has a half-life of 7 to 10 days, hypothyroid patients can miss several days of T4 without consequences.
Tx or suppression of euthyroid goiters, thyrotropin-dependent thyroid cancer

86
Q

What should occur if a patient presents in myxedema?

A

cancel surgery because:
delayed gastric emptying increases aspiration risk, causes hypodynamic circulation, increased sensitivity to NMB

87
Q

What complications are associated with thyroidectomy?

A

hypothyroid, hemorrhage, tracheal compression, recurrent laryngeal nerve injury, and hypocalcemia

88
Q

How should emergent surgery in a patient with hyperthyroidism be managed?

A

beta-blocker potassium iodide glucocorticoid, and PTU

89
Q

What drugs should be avoided in patients with hyperthyroid?

A

sympathomimetics, anticholinergics, ketamine, and pancuronium

90
Q

What do thioamides and beta blockers do in hyperthyroid management?

A

prevent t4 to t3 conversion

91
Q

When should potassium iodine be given prior to surgery and what does it do?

A

10 days prior, reduces synthesis and release of thyroid hormones

92
Q

What is the therapy of choice for Grave’s disease?

A

radioactive iodine

93
Q

How long should euthyroid be maintained prior to an elective surgery?

A

At least 6-8 weeks

94
Q

What 5 types of hormones are secreted by the adrenal gland?

A

androgens
mineralocorticoids
glucocorticoids
catecholamines
peptides

95
Q

What is Conn’s syndrome and treatment?

A

high aldosterone
primary: caused by increased aldosterone release, secondary: extrarenal cause
HTN, low K, metabolic acidosis
tx: spironolactone and ACE inhibitors

96
Q

What are anesthesia considerations for Conn’s syndrome?

A

sensitive to NMB, dont hypervent or give excess fluids (can cause pulm edema)

97
Q

What are the effects of cortisol?

A

increases gluconeogenesis, breaks down protein, mobilizes fatty acids, anti-inflammatory

98
Q

What is cushing’s syndrome?

A

excessive cortisol, pituitary adenoma, ACTH syndrome, or endogenous steroids

99
Q

What is addison’s disease?

A

low cortisol, autoimmune, HIV or TB
treatment cortisol replacement therapy, fluid replacement D5ns

100
Q

What are the dosages of steroid replacement for addison’s disease?

A

acute insuff: 15-30mg cortisol
crisis: hydrocortisone 100mg + 100-200mg/24hr
++ dexamethasone for anti inflammatory and analgesia effects

101
Q

What are the two types of corticosteroids?

A

mineral: evoke distal renal tubular reabsorption of Na in exchange for K ions
gluco: anti inflammatory (T&Bcells effects)

102
Q

Where are mineralocorticoid receptors?

A

renal distal tubules, colon, salivary glands, hippocampus

103
Q

Which type of steroid suppresses the HPA axis?

A

systemic glucocorticoids (due to having both systemic and local immunosuppressant effects)

104
Q

How do steroids decrease inflammation?

A

target 11-BHSD which prevents cortisol and cortisone activation

105
Q

What is the difference between permissive and protection steroid concentrations?

A

Permissive: low basal rate, allows the body room to react to stressors
Protective: high levels causing anti-inflammatory and immunosuppressive effects

106
Q

What are the derivatives of synthetic cortisol?

A

dexamethasone, prednisolone, prednisone, methylprednisolone, betamethasone, triamcinolone, and hydrocortisone

107
Q

What OTC medication interferes with the absorption of corticosteroids?

A

oral antacids

108
Q

How are the synthetic corticosteroids dosed?

A

based on their equivalence to 20mg of cortisol
dexamethasone and betamethasone are most efficacious

109
Q

What are in indications for synthetic corticosteroids?

A

anti-inflammatory, immunosuppression, allergies, asthma, cancer, antiemetic, analgesia, cerebral edema, cardiac arrest

110
Q

What corticosteroid produces the strongest glucocorticoid effects?

A

methylprednisolone

111
Q

Why is dexamethasone better than betamethasone?

A

B does not have mineralocorticoid effects of cortisol.
D used in cerebral edema, PONV, and inflammation

112
Q

What is a common indication for triamcinolone?

A

epidural injections for lumbar disc disease. initially causes mild diuresis
SE: skeletal muscle weakness anorexia, sedation

113
Q

What are the 2 choice steroids for anti-inflammation? + consideration

A

prednisolone and prednisone
technically palliative as the underlying cause remains- masks s/s/delaying diagnosis and treatment

114
Q

What are two indications specifically for dexamethasone?

A

analgesia and cardiac arrest

115
Q

What is the dosage for chronic adrenal insufficiency?

A

25-37.5mg cortisone po
mineralocorticoid (fludrocortisone): 0.1-0.3mg

116
Q

What are the effects of topical steroids in the setting of an allergic reaction?

A

decrease cytokines, chemokines, and immune cell recruitment. induces cutaneous vasoconstriction

117
Q

What are the inhaled corticosteroids and how are they absorbed?

A

beclomethasone, budesonide, fluticasone, ciclesonide, and triamcinolone. absorbed in oropharyngeal tissues and swallowed

118
Q

for treatment of asthma, inhaled glucocorticoids should be used in conjunction with:

A

first line beta2 agonist therapy

119
Q

What are the indications and dose of iv corticosteroids to treat asthma?

A

active reactive airway disease, bronchospasm. 1-2mg/kg of cortisol equivalent which is 4-8mg of dexamethasone

120
Q

When should inhaled corticosteroids for asthma be given prior to surgery?

A

1-2hrs prior to induction

121
Q

corticosteroids enhance the effects of ______ agonists.

A

Beta, 4-6 hrs, decreases risk of bronchospasm

122
Q

What corticosteroid is first line for antiemetic effects?

A

dexamethasone. prevents PONV only when administered near the beginning of surgery
was used in conjunction with TIVA as first-line and second-line methods of prophylaxis against PONV, also effective in suppressing chemo induced NV

123
Q

What is the PONV steroid dose?

A

4-6mg or 8–10mg (has ceiling dose), lasts up to 24hr

124
Q

When should glucocorticoids be given to exhibit analgesic effects? what is the MOA?

A

preop to 30mins prior to induction. inhibit phospholipase enzyme for the inflammatory chain reaction along with the cyclooxygenase and lipoxygenase pathways

125
Q

When are corticosteroids given for immunosuppression r/t to transplant?

A

high dose at surgery, eventually taper to small maintenance dose
dose should be increased in the setting of rejection

126
Q

What steroid and dose should be given to treat post intubation laryngeal edema?

A

0.1-0.2mg/kg iv dexamethasone (4-6mg)
0.6mg/kg po for peds with croup

127
Q

When should corticosteroids be given to mom prior to delivering if 24-36 weeks to prevent respiratory distress syndrome?

A

at least 24 hours prior

128
Q

T/F dexamethasone should be given for prolonged periods for low-birth weight babies

A

True- reduces risks of bronchopulmonary dysplasia

129
Q

How do steroids assist recovery in cardiac arrest?

A

CA is associated w/ lower cortisol levels, vasoplegia, and myocardial dysfunction
this enhances cardiac function

130
Q

Why do patients on chronic steroids receive steroids prior to surgery?

A

due to the suppression of the HPA axis, pt cannot release increased cortisol in response to operative stress

131
Q

What steroid dose indicates suppression of the HPA axis?

A

prednisone >20mg for >3 weeks + stress dose
prednisone 5-20mg/day > 3 weeks
dexamethasone is sometimes used for stress dosing

132
Q

What 3 steroids do not have mineralocorticoid effects?

A

dexamethasone, betamethasone, and triamcinolone

133
Q

What are the doses of intraop stress doses of steroids?

A

minor surgery (carpel tunnel) no replacement
minor stress (hernia repair): 25 mg hydrocortisone or 5 mg methylprednisolone
mod stress (open belly, joint replacement): 50-75 mg/day hydrocortisone x 1-2 days
major stress: 100-150 mg hydrocortisone/day x 2-3 days

134
Q

What are the side effects of chronic steroid use?

A

suppression of HPA axis, electrolyte/metabolic changes, osteoporosis, PUD, skeletal m myopathy, central nervous system dysfunc, peripheral blood changes, inhibits norm growth

135
Q

use of chronic steroids causes increased clearance of what two drug types?

A

anticoagulants (increases clot risk) and salicylates

136
Q

What are metabolic changes related to steroid use?

A

lowk, metabolic alk, edema, weight gain, inhibits glucose use in tissues> leading to high BG (manage w/ diet, insulin +or both), thin skin, osteo

137
Q

How/what are the CNS effects of steroids?

A

psychosis, mania, depression (increases with high dose), suicidal tendencies

138
Q

What is an ophthalmic SE of chronic steroid use?

A

cataracts

139
Q

What 3 things regulate calcium?

A

parathyroid hormone, calcitonin, and vitamin D

140
Q

What is the treatment for hypercalcemia?

A

IVF, bisphosphonates, calcitonin, and glucocorticoids (decreases vit D)

141
Q

What are two SE of bisphosphonates?

A

Renal injury and jaw osteonecrosis

142
Q

What are the causes, s/s, and management of hypocalcemia?

A

rhabdo, pancreatitis, sepsis, burns, fat embolism, recent MTP, hypoalbuminemia, hypomagnesemia, thyroidectomy/neck surgery, or renal insufficiency
s/s: CHF, low BP, arrhythmias, and nm irritability
IV calcium

143
Q

Where is octreotide secreted and how does it work?

A

anterior pituitary, inhibits release of growth hormone, increases development of gallstones

144
Q

What are the clinical uses of of vasopressin?

A

AVP sens. DI, refract. low BP (esp w/ ACE/ARB use), hem. varices, sepsis, cardiac arrest

145
Q

What should be given to low BP r/t anaphylaxis OR severe catecholamine deplet. 2/2 resect. of pheocytcromtoma?

A

vasopressin

146
Q

what are the 3 causes of hypotension during sepsis and tx?

A

excessive nitric oxide, +++ renin/ang system, and low lvls of vasopressin
tx: vaso @ 0.01-0.04u/min

147
Q

___ units of vaso has similar effects to ____ mg of epi in the setting of ventricular fibrillation and PEA

A

40, 1

148
Q

What is more effective in treating asystole: epinephrine or vasopressin?

A

vasopressin

149
Q

What is the dose of vasopressin for management of bleeding esophageal varices?

A

20u/5min: decreases hepatic blood flow due to splanchnic vasoconstriction
-can also give vaso directly into superior mesenteric artery

150
Q

What are the side effects associated with vasopressin?

A

vasoconstrictive complications, facial pallor, baroreceptor reflex (if major ^^^ in BP), CA constriction (angina), increased peristalsis, low plts

151
Q

How does oxytocin work and what is the dosage?

A

prevents uterine atony which decreases hemorrhage, 1-3u/30sec. can cause hypotension

152
Q

What pressor may be needed if giving large amounts of oxytocin?

A

phenylephrine

153
Q

How does previous exposure to oxytocin effect efficiency?

A

causes downre/desens which results in higher risk of PPH r/t uterine atony

154
Q

When should synthroid be d/ced prior to surgery?

A

take the morning of, do not d/c

155
Q

What are the effects of hyperthyroidism on pt response to meds (esp vasopressin)

A

increased response

156
Q

Treatment of hyperthyroidism can cause:

A

hypothyroidism

157
Q

What are the effects of thyroid alterations on MAC?

A

nothing:) same as normal doses

158
Q

What sympathomimetic should not be used in patients with hypothyroidism?

A

phenylephrine

159
Q

How does steroid administration play a role in multimodal anesthetic management?

A

by decreasing inflammation to site

160
Q

T/F dexamethasone should be given postop to treat PONV

A

False, has no effect if given post operatively

161
Q

What are some anesthesia considerations for the effects of dexamethasone

A

causes perineal itching (give after induction), decreases need for inhaled anesthetics

162
Q

endogenous cortisol and synthetic corticosteroids are examples of ________, while aldosterone is an example of a _______.

A

glucocorticoids, mineralocorticoid- goal: balance na/h2o balance

163
Q

What is the ONLY type of insulin that can be given both IV and SUBQ?

A

regular insulin

164
Q

What 3 drugs counter the hypoglycemic effect of insulin and what 3 drugs extend/enhance the effects?

A

counter: epi, glucagon, and estrogen
E/E: MAOIs, salicylates, and tetracyclines

165
Q

What is the most common cardiovascular side effect related to the use of radioactive iodine?

A

bradycardia

166
Q

what are the effects of sympathomimetics on thyroid hormones?

A

greater sensitivity of beta receptors to release T3 and T4 which is why these medications are contraindicated in thyroid storm
due to over responsiveness (HTN)

167
Q

What is the treatments for acute adrenal crisis?

A

100mg hydrocortisone + 100-200mg every 24H
(same tx for HPA supp)

168
Q

Why shouldnt life threatening allergic reactions be treated with corticosteroids?

A

because the anti inflammatory effect has a delayed onset

169
Q

How long after after surgery (thyroidectomy,parathy,neck) do patients experience symptomatic hypocalcemia?

A

within 12-24 hours

170
Q

What is the dose of oxytocin after giving birth?

A

10-20u/1000mL

171
Q

opinion r/t corticosteroid use in anesthesia:

A

must be aware of both chronic and acute use and proper dosing. MOA r/t surgical stress, anti inflammation, immunosuppression, and analgesia. blood sugar effects.
long term therapy is bad and should be last resort

172
Q
A

Advanced Pharm Final (5 decks)

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