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Pharm 343 > endocrine > Flashcards

endocrine Flashcards

1
Q

adrenal medulla

A

10% of gland and secretes catecholamines

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2
Q

Adrenal cortex

A

90% of gland and secretes Salt, Sugar, Sex

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3
Q

adrenal stimulation

A

CRH form hypothalamus and ACTH from pituitary

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4
Q

Primary adrenal insufficiency

A

Addisons disease is autoimmune issue common in women (CRH and ACTH high), leads to skin hyperpigmentation due to ACTH

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5
Q

Secondary adrenal insufficiency

A

ACTH secretion deficiency (Low CRH, ACTH and cortisol)
Exogenous glucocoritoid therapy (Low everything)

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6
Q

adrenal insufficiency Sx

A

weakless/lethargy
weight loss
nausea/vomiting
hypoglycemia
Mineralocorticoid deficiency

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7
Q

adrenal insufficiency diagnosis

A

Give synthetic ACTH and see if cortisol increases or not

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8
Q

Short acting steroids

A

8-12h
Hydrocortisone 1:1
cortisone 0.8:0.8

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9
Q

intermediate steroids

A

12-36h
prednisone 4:0.4

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10
Q

long acting

A

36-72h
betamethasone 40-0.01

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11
Q

Steroid dose for primary

A

Hydrocortisone 15-25mg daily split 2/3 Qam and 1/3 Qhs
add fludrocortisone 0.05-0.1mg qd for mineralocorticoid action

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12
Q

adrenal crises management

A

for when you are sick, take double dose during febrile illness and continue till feeling better

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13
Q

Hot water adrenal management

A

have to increase dose of mineralocorticoid 2-3 fold to account for water loss

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14
Q

Cushing syndrome

A

Issue with the adrenal gland producing too much or exogenous steroids

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15
Q

cushings disease

A

from too much ACTH from pituitary only

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16
Q

Cushings Sx

A

Fatigability and weakness
increased central body weight
HTN
Hair growth
muscle wasting
skin thinning

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17
Q

diagnosis of cushings

A

dexamethasone supression test <50nmol rules out cushings
>50nmol confirms cushings

18
Q

cushings disease treatment

A

Cut out or irradiate adrenals
enzyme inhibitors (ketoconazole)
decrease ACTH production from pituitary (cabergoline or pasireotide)

19
Q

cushings syndrome treatment

A

Does this patient really need exogenous steroids
monitor patients on >20mg prednisone for >3 weeks

20
Q

drugs that can inhibit dopamine

A

antipsychotics, antidepressants, metoclopramide, domperidone

21
Q

TSH >10

A

Overt hypothyroidism

22
Q

TSH 6.5-10

A

subclinical hypo, can order a T4 to confirm but not recommended
Order a thyroid peroxidase Aby test to look for progression to overt

23
Q

TSH <0.1

A

Then also test T4 if it is high than hyperthyroidism
if T4 is normal then order T3 to search for the various types of hyper

24
Q

thyroid screening

A

not recommended in asymptomatic people
only for people with symptoms or increased risk (pregnant, lithium or amiodarone, other autoimmune, family history)

25
Q

thyroid risk factors

A

(pregnant, lithium or amiodarone, other autoimmune, family history)

26
Q

hypothyroidism Sx (5)

A

swelling of thyroid
hoarseness/deeping of voice
persistent dry sore throat
difficulty swallowing
infertility

27
Q

types of primary hypothyroidism (5(

A

Hashimotos
lactogenic
iodine excess
lithium/amiodarone
congenital

28
Q

types of secondary hypothyroidism (2)

A

pituitary or hypothalamic disease

29
Q

Synthroid counselling notes

A

Take 60min before first meal
don’t take with iron, calcium or aluminum
don’t take with rifampin, carbamazepine and phenytoin

30
Q

Synthroid dosing

A

Normal people start at 1.6mcg/day then test in 6-8 weeks and titrate by 12.5 to 25 mcg
old people start at 1mcg/day
people with heart issues start at 25mcg

31
Q

synthroid over treatment

A

atrial fibrillation and stroke
bone loss and fracture
sleep disturbance and irritability

32
Q

synthoid under treatment

A

increased lipids
slow heart rate
low BP
memory loss
mood impairment

33
Q

are different brands of levothyroxine interchangeable

A

no

34
Q

hypothyroid while pregnant

A

need to increase dose by 20% and keep TSH <2.5 1st and <3.5 for rest of preg

35
Q

types of hyperthyroidism (6)

A

graves disease
toxic nodules
tumors
subacute thyroiditis
hashitoxicosis
excessive dosage

36
Q

Beta-blockers for hyper

A

Can be used before diagnosis for symptom control, will decrease HR and BP will reduce heat intolerance and anxiety

37
Q

Propylthiouracil (PTH)

A

second line but used for 1st trimester of pregnancy, needs more frequent dosing

38
Q

methimazole

A

first line and can be used for longer

39
Q

antithyroid drugs

A

inhibit thyroid peroxidase to prevent secretion of T4 and T3

40
Q

antithyroid drug monitoring

A

Test T4 and T3 every 4 weeks, once normal add TSH and monitor for 2-3 months then taper to 30-50% of dose and continue for 12-18 months

41
Q

radioactive iodine

A

to be used instead of surgery but not in pregnancy people or 6 months before/ after. needs 6-18 weeks for full affect

Pharm 343 (23 decks)

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