Endocrine Agents Flashcards
What is the corticosteroid treatment for minimal surgical stress?
25mg hydrocortisone x1
What are some side effects of corticosteroids that we should be aware of in the OR?
electrolyte and metabolic changes (hyperkalemia)
decreased effectiveness of anticoagulants
What is the pathway for the synthesis of cortisol?
Corticotropic-releasing hormone and vasopressin from hypothalamus→ACTH (anterior pituitary)→synthesis of cortisol
What hormones counter the hypoglycemic effects of insulin?
ACTH, estrogens, glucagon
stimulation of ACTH in the perioperative period is caused by what three things?
incision, pain, reversal of anesthesia
Why does the surgeon ask you for Glucagon while doing a ERCP?
relaxes the sphincter of Oddi
What are the intermediate acting insulins?
NPH
What is the dose of dexamethasone for PONV?
2.5-5mg
Which thionamide has a black box warning? What’s the warning for?
Propylthiouracil - cause hepatic toxicity
What is the dose of dexamethasone for post-op pain?
0.1mg/kg
Which synthetic corticosteroid has Na retaining activity?
Fludrocortisone
What can a bolus dose or high infusion rate of oxytocin lead to?
hypotension
What is the onset, peak and DOA of very rapid acting insulins?
onset 15 minutes
peak 45-75 minutes
DOA 2-4 hours
What is the corticosteroid treatment for a patient taking <5mg prednisone with no HPA axis suppression?
No treatment
What inhibits insulin release?
alpha receptor stimulation or beta antagonism
How do the thionamides work?
prevents hormone synthesis by inhibiting the peroxidase catalyzed reactions and blocking iodine organification
How does metformin work?
decreases glucose production, decreases absorption, and increases sensitivity
What medication is used to treat hypothyroidism? Is it synthetic T3 or T4?
Levothyroxine. T4
Which side effect of iodine should we be aware of when intubating?
mucus membrane ulcers
What drugs are the thionamides?
methimazole and propylthiouracil
Which form of insulin is the best choice to treat hyperglycemia and ketoacidosis?
regular insulin
What is the most commonly used preparation of insulin?
U-100, 100 U/mL
What is the glucocorticoid affect of the corticosteroids?
anti-inflammatory
Which medication is used to block sympathetic stimulation seen with thyrotoxicosis?
Propranolol- adrenoreceptor blocker
What are side effects of metformin?
B12 deficiency, lactic acidosis
Inadequate secretion of what leads to DI?
vasopressin
what are the clinical symptoms of diabetic ketoacidosis?
N/V, abdominal pain, kussmal respirations, mental status changes, elevated ketones and glucose.
How do we treat thyroid storm in the OR?
Propranolol 1-2mg slowly, up to 10mg
Esmolol 50-100 mg/kg
Propylthiouracil 500-1000 mg
Hydrocortisone 50mg Q6h
Which sulfonylurea causes severe hyponatremia?
chloropropamide
What inhibits thyroid peroxidase to prevent incorporation of iodine into tyrosine and inhibits formation of thyroid hormone?
Iodides and thioamides
What drugs are the alpha-glucosidase inhibitors?
acarbose and miglitol
How do sulfonylureas work?
inhibits ATP-K channels on beta cells, increasing insulin release
What are the ultra rapid acting insulins?
Lispro, glulisine, aspart
What are the symptoms of hypoglycemia we will notice as anesthetists? Which is he most specific?
tachycardia, HTN Diaphoresis
What increases cortisol release?
increased ACTH, tissue damage, inflammatory mediators
What class of drugs is Metformin?
Biguanides
How does iodine work for the treatment of hyperthyroidism?
antagonizes TSH release
How is aldosterone stimulated?
Hyperkalemia and RAAS.
Which brain structure releases thyrotropin releasing hormone, dopamine, GHRH, somatostatin, GTRH, CTRH, oxytocin, vasopressin
hypothalamus
Corticosteroid binding globulin is increased in which situations?
pregnancy, estrogen administration, hyperthyroidism
What is the onset, peak and duration of regular insulin?
30 min onset
2-4h peak
6-8h duration
What is the dose of insulin is used to treat diabetic ketoacidosis?
0.1 units/kg/h
Do the hypothalamus and pituitary gland lay inside or outside the BBB?
outside
Thiaolidinediones should be used cautiously with CHF patients due to?
increase in ECV -> weight gain and edema
What degrades the protamine in NPH for insulin absorption?
Proteolytic enzymes
Which sulfonylureas have a diuretic effect?
glyburide, and glipizide
What is the most abundant hormone in the anterior pituitary?
growth hormone
Which patients should we avoid metformin use?
lactic acidosis, kidney injury, hepatic disease
If you are doing a thyroidectomy, what drugs will you likely see on the home med list?
Thionamides – methimazole and propylthiouracil
Why do we give dexamethasone to patients after they are asleep?
causes perianal burning
When catecholamines are released, what does the thyroid hormone do to beta receptors?
increase the number of beta receptors
What is the onset, peak and duration of long acting insulin?
1.5-2h onset
3-9h peak
6-12h duration
Which drugs prolong the duration of insulin?
Antibiotics (tetracyclines, chloramphenicol), salicylates, phenylbutazone
What do glucocorticoid target cells contain that converts cortisol to cortisone?
11-beta hydroxysteroid dehydrogenase
Which thionamide is the preferred treatment for hyperthyroid?
methimazole, 10x more potent than propylthiouracil
What is the corticosteroid treatment for a patient taking 5-20 mg prednisone for more than 3 weeks in the last year?
further analysis needed…
What is the corticosteroid treatment for moderate surgical stress?
50-75 mg hydrocortisone, 1-2 days
What medication is used for Graves disease?
radioactive iodine
Where are sulfonylureas metabolized and excreted?
metabolized in the liver, excreted in the kidneys
What is the risk in giving sulfonylureas to a patient that with a history of MI?
It inhibits a cardio protective mechanism, increased risk of mortality
What does cortisol do in the body?
gluconeogenesis, decrease immune function, anti-inflammatory, breaks down protein, mobilizes fatty acid
What medications are synthetic corticosteroids?
Prednisolone, predinisone, methylprednisolone, betamethasone, dexamethasone, triamcinolone
What is desmopressin?
intense antidiuretic
Which class of drugs is used to treat Graves Disease?
Thioamides. Methimazole > propylthiaouracil
What is the cascade of events starting with TRH and ending with the release of T4 and T3?
TRH released from the hypothalamus, stimulates TSH, TSH stimulates release of T4 and T3
What class of medications do corticosteroids potentiate?
beta adrenergic agonists
What is Cushings syndrome?
ACTH secreting pituitary adenoma - excess of cortisol
What is the corticosteroid treatment for major surgical stress?
100-150mg hydrocortisone, 2-3 days
What is the only sulfonylurea that excretes uric acid in the urine?
acetohexamide
Is graves disease hypothyroid or hyperthyroid?
hyperthyroid
What is the preferred drug in anesthesia for PONV?
dexamethasone
What is the dose of hydrocortisone for Addisons Disease?
20-30mg
Cortisol is stimulated by the release of what hormone?
ACTH
What can high concentration of oxytocin cause?
fluid retention, hyponatremia, heart failure, seizures, death
what type of drugs affect insulin production and release?
beta adrenergic
What class of drugs is used to treat hyperthyroidism?
Thionamides
In what instances do we use corticosteroids in the OR?
anti-inflammatory for difficult intubation
PONV prevention
What is a side effect of inhaled glucocorticoids that can be exacerbated by extubation?
hoarse voice, dysphonia
What is the bolus dose for rapid acting insulin?
1-5 units
Where is metformin eliminated?
kidneys
How do we treat the patient taking Metformins lactic acidosis?
Bicarb
What causes intermediate acting insulins to have a delayed onset?
addition of protamine
Exhaustion of beta cells can occur due to prolonged use of (3)?
glucagon, GH, corticosteroids
How do thiaolidinediones work?
decrease insulin resistance and glucose production
Which diabetic agent should you avoid in pheochromocytoma?
Glucagon, its causes release of catecholamines and increases BP
What is the treatment for hyperkalemia?
dextrose and insulin
What is the mineralocorticoid affect of the corticosteroids?
Distal convoluted tubule reabsorption of Na in exchange for K
What are adjunct medications used to treat hyperthyroidism?
B blockers, CCBs, barbiturates, cholestyramine
What are parenteral glucocorticoids used for?
prep treatment of RAD
Intraop bronchospasm
If a patient is taking NPH insulin and we give protamine intraop, what is a risk?
allergic reaction
How do we treat DI?
Desmopressin (DDAVP)
How does propylthiouracil work?
inhibits deiodination of T4 and T3
What type of drugs decreases thyroxine levels? (bad thing)
metabolic inducers. rifampin, phenobarb, carbamazepine, phenytoin, tyrosine kinase inhibitors, HIV protease inhibitors
What links the CNS to the endocrine system?
Hypothalamus
which type of diabetes s caused by beta cell dysfunction and tissue resistance to insulin?
DM2
What drugs are in the class of sulfonylureas?
End in -ide
Tolbutamide, Glyburide, Glipizide, acetohexaide, chloropropamide
What drugs potentiate the effects of sulfonylureas?
sulfonamide antibiotics, alcohol, salicylates, and warfarin
What is the dose of insulin for DM1?
0.5-1 units/kg/day
Where do meglitinides work?
pancreatic beta cells
can lower A1C by 1%
What is the dose of cortisol for RAD and bronchospasm?
1-2mg
What class of drugs potentiates hypoglycemia?
MAOIs
Where is cortisol released from?
adrenal cortex
What drugs are the thiaolidinediones?
end in -glitazone
rosiglitazone, pioglitazone
Cortisol is regulated by negative feedback from which two organs?
hypothalamus and anterior pituitary gland
which type of diabetes is caused by autoimmune destruction of beta cells?
DM1
which organ releases thyroxine, and triiodothyronine
Thyroid
What endocrine organ regulates serum calcium
parathyroid glands
What is the loading dose of T3 used to treat myxedema coma?
5-20 mcg IV
What are the rapid acting insulins?
Regular insulin
What are the adverse effects of triamcinolone?
weakness, anorexia, sedation
Whats the treatment for hypoglycemia?
D50, 50-100mL
Glucagon 0.5-1 mg
How is amiodarone induced hypothyroidism treated?
Levothyroxine
What does glucagon do?
stimulates glycogenolysis
increases gluconeogenesis
What is the dose of oxytocin to stimulate uterine contractions?
0.5-2 mU/min, max 20mU/min
If you are unable to treat thyroid storm with B blockers, what medication do you use?
Diltiazem 5-10mg
What is the epidural steroid injection dose of triamcinolone?
25-50 mg with lidocaine
What causes Hashimoto Thyroiditis?
inhibited thyroid hormone synthesis - Hypothyroidism
What is the onset, peak and duration of rapid acting insulin?
30 min onset
2-4 peak
6-8 duration
What are the ultra long acting insulins?
Degludec
Which synthetic corticosteroid is used for replacement therapy in adrenocortical deficiency?
Prednisolone
What is the onset, peak and duration of intermediate insulin?
2h onset
4-14h peak
18-28h duration
What is the dose of oxytocin to control post-op uterine bleeding?
10-40 units added to a 1L bag of fluids
10 units IM
What hormone released by the thyroid decreases serum calcium?
calcitonin
What drugs are the meglitinides?
end in -glinide
Repaglinide and nateglinide
Which drugs are best used for short term TSH suppression?
T3 drugs
Liothyronine
How does myxedema coma present?
weakness, stupor, hypothermic, hyperventilate, hypoglycemia, hyponatremia, shock, death
Corticosteroid binding globulin is decreased in which situations?
hypothyroid, genetic defects, protein deficiency
What is the onset and duration of ultra long acting insulin?
2h onset
>40h duration
What hormone is highly bound in plasma corticosteroid binding globulin?
Cortisol
What releases oxytocin, vasopressin,, stored ADH?
Posterior Pituitary
How does aldosterone affect BP and fluid status?
increases blood pressure and CVP.
How do the alpha-glucosidase inhibitors work?
interfere with intestinal glucosidase activity, decreasing carb digestion and absorption
60% of islet cells from the pancreas are what type of cells?
beta cells
what is the dose of DDAVP?
1-4 mcg/day
Why can glucagon be given for beta blocker overdose?
Potent inotrope and chronotrope, increasing cAMP production
Where is glucagon degraded?
liver, kidney, and plasma at tissue receptor sites
Does cortisol inhibit or potentiate beta agonists?
potentiate
What is the loading dose of levothyroxine used to treat myxedema coma?
300-400 mcg IV
What releases GH, TSH, Adrenocorticotropic hormone, FSH, LH, and prolactin?
anterior pituitary
Which form of thyroid hormone is the active form
T3 is active
T4 is the prohormone
What is the corticosteroid treatment for a patient taking >20mg prednisone for more than 3 weeks with HPA axis suppression?
Treat
What are the long acting insulins?
Detemir and glargine
Which diabetic agent should you avoid with sulfa allergies?
sulfonylureas
What stimulates insulin release?
beta receptor stimulation and acetylcholine
What does perioperative stress do to pituitary hormone secretion?
stress increases SNS activation, increasing pituitary hormone secretion
