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Treatment Test > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Metformin MOA

A
  1. Does’t stimulate insulin production
  2. Reduce hepatic glucose production
  3. Increase insulin sensitivity
  4. Increase insulin receptor, so insulin can be used more efficient
  5. Help with basal and post- prandial glucose
  6. Help with platelet aggregation and lipid profile
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2
Q

Sulfonylureas MOA

A

Insulin secretaogous. Stimulate pancreas to secrete insulin & increase insulin sensitivity

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3
Q

DPP-4 inhibitor MOA

A

DPP is an enzyme that inactivate GLP-1 (help to reduce postprandial glucose). So this male more GLP-1 available to reduce glucose

“Gliptin”

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4
Q

SGLT-2 inhibitor MOA

A

Let glucose excreted in urine

Gliflozin

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5
Q

Amylin

Glucagon

Grelin

Incretin

A

Amylin: Hormone increase satiety & suppress glucagon release

Glucagon: hormone to increase glucose production (opposite of insulin)

Grelin: hormone release from stomach and pancreas to regulate food intake. Energy, and hormone secretion (low in Grelin cause insulin resistance)

Incretin: hormone to synthesize & insulin in H1 tract

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6
Q

Parathyroid hormone

A

Help with Ca concentration

Low Ca–> increase PTH—> increase Ca
High PTH–> increase Ca + reduce phosphate

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7
Q

Thyroid hormone function

A

Affect
1. Growth
2. Ca metabolism (high thyroid hormone, high Ca)
3. Metaboism

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8
Q

Thyroid hormone production process

A

Basically needs amino acid+ iodine to make thyroglobulin

Then when TSH stimulate–> thyroglobulin become T3 & T4

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9
Q

T3 T4

A

T3 is more active

T4 is more common

Difference: T3 has 3 iodine molecules; T4 has 4

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10
Q

Grave’s disease vs Hashimoto thyroiditis

A

Grave: Trab autobody binds to TSH–> increase thyroid hormone

Hashimoto: deformation of autoantibodies to thyroglobulin (TgAb), cause gradual inflammation of thyroid tissue–> lead to hypothyrodism

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11
Q

Thyroid hormone from TSH…process

A

Thyroid releasing hormone (TRH: from hypothalamus)

TSH (from anterior pituitary)

T3, T4: from thyroid

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12
Q

Hyperthyrodism’s S&S

A
  1. High metabolism (high HR, O2 neeed, BP), diarrhea, weight loss
  2. Palpitation
  3. Reduce muscle tissue
  4. Exophthalmia (ekseuf’ thomia): eyeball protrusion
  5. Sex: irregular menses
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13
Q

Primary vs secondary thyroid disorder

A

Primary is loss of thyroid function

Secondary is pituitary fail to synthesize TSH or lack of TRH

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14
Q

Hypothyrodism’s S&S

A

Weight gain
Weak
Tired
Cold
Myxedema (non-pitting, boggy edema around eyes, hand, feet and supraclavicular fossae: indicate severe or long standing hypothyrodism)

Hoarseness voice

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15
Q

Primary, secondary. Tertiary hypothyrodism

A

Primary: thyroid sy function
Secondary: anterior pituitary problem
Tertiary: hypothalamus problem

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16
Q

When treating hypothyrodism

A

T4 is preferred;

Combination of T3 & T4 is not better than T4 alone

17
Q

Treat hyperthyrodism

A
  1. Methimazole is preferred: normalize T3 T4 within a week (inhibit an enzyme that synthezie thyroid hormone )
  2. Radioiodine: radioactive sodium iodine: everybody responses it differently; can become hypothyrodism later
  3. Symptoms control: BBB
  4. Iodine: inhibit T3T4 release for days to weeks, then stop: only used at ER for thyrodism storm
18
Q

Thyroids storm

A

Sudden release and increase action of T3 T4

Can die 48 hr without treatment (heart failure, delirisium, high vital signs, N/V/D)

19
Q

Cortisol

A

Hormone secreted by adrenal cortex

What trigger cortisol release: unpleasant, suddenness, degree of discomfort

Reduce when watching a pleasant movie

20
Q

Adrenal cortex secret hormone

A

Hypothalamus (CRH: corticosteroid release hormone)–> anterior pituitary (ACTH: adrenocorticotropin hormone)—> adrenal gland (release mineralcorticoid cortisol, androgen).

  1. Mineralcorticoid (aldosterone is the most potent mineralcorticoid: Na retention, K secretion)
  2. Adrenal androgen (androgen then become estrogen or testosterone)
  3. Glucocorticoid: cortisol, corticosteroid (RBC, appetite, fat deposit, reduce Ca, growth)
21
Q

Cushing syndrome vs Cushing disease vs Cushing- like syndrome

All three Cushing has?

A

Cushing syndrome: excessive cortisol

Cushing disease: excessive ACTH

Cushing like syndrome: side effect of log term use glucocorticoid (cortisol, corticosterone)

same S&S:
1. Weight gain (water & Na retention)
2. Diabetes (glucose intolerance)
3. Protein wasting
4. HTN: vasoconstriction (increased catecholamine)
5. Change in mental status: learning, memory, depression, irritability
6. Infertility, grow facial hairs, oliomenorrhea (ess period)

22
Q

Hypercortisolism

A

High cortisol

Risk for HD, CAD, stroke

23
Q

Diagnostic test for Cushing syndrome

A
  1. 24 hr urine test: stop the drug that affect cortisol, then collect 24 hr urine; if urinary free cortisol > 120mcg/hr hour: Cushing syndrome
  2. Dexamethasone suppression test: give decadron 11pm and measure cortisol in 8 am (if cortisol > 1.8 mcg/dL–> Cushing syndrome); in normal people, decadron will suppress cortisol level (should be < 1.8)
24
Q

Treatment of Cushing syndrom

A

Depends on what causes it

  1. Tumour: remove or radiation
  2. Excessive ACTH: dopamine agonist glucocorticoid receptor antagonist
  3. Severe S&S: block cortisol secretion: metyrapone
25
Q

Hyperfunction of adrenal cortex

A

Hyper: Cushing syndrome (excessive cortisol)

Hypo: Addison disease (can’t secret adrenocortical hormone: low cortisol & aldosterone)

26
Q

Addison’s S&S

A

Think of the hormone it affect:

  1. Low cortisol: tired, weak,
  2. Low aldosterone: hypovolemia, postural hypertension, dizziness, dehydration, high K
  3. Low androgen: not obvious in men, but in women (low sex desire, loss pubic & axillary hair)
27
Q

Treatment of Addison disease

A

Lifelong gucocorticoid & mineralcorticoid replacement

28
Q

When to taper steroid hormone

A

Osteoporosis
Low cortisol/Cushing look
Hyperglycemia
DLP
Mental problem: learning agitation
Low immune
Cataract and glucose: corticosteroid can increase intraocular pressure
Growth suppression

29
Q

Pancreas secrete

A
  1. Islets of langerhans: produce insulin
  2. Islet amyloid: appetite, gastric empty, glucagon, insulin
  3. Glucagon: increase glucogenesis
  4. Pancreatic somatostatin: inhibit alpha, beta pancreatic cells’ secretion
  5. Pancreatic peptide: help digestion
30
Q

Diabete
Prediabetes

A

A1C> 6.5 DM; Prediabete: 6-1.4

Fasting glucose: >7: DM; 6-7: prediabete

31
Q

Hypothyrodism treatment

A

Only treat if TSH> 10+ symptomatic

32
Q

Hypothyrodism diagnostic tests

A

T4
TSH
If T4 low, TSH high–> 1st degree; if both low: central hypothyrodism

TPO antibody: hashimoto’s disease;
TRab: Grave’s disease
Anti- TPO: check if caused by autoimmune

33
Q

Celiac disease diagnostic test

A

IgA- TTG antibodies: must have gluten containing diet for a month (if not, 3 slices of wheat bread daily x 1 month before the test)

Treatment Test (14 decks)

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