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PHARM 123 > Endocrine Module > Flashcards

Endocrine Module Flashcards

1
Q

What are the layers of adrenal glands?

A

cortex
medulla

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2
Q

what are the layers of cortex?

A

Zona glomerulosa
Zona fasiculata
zona reticularis

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3
Q

What is the role of the zona glomerulosa

A

secretes mineralocorticoids

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4
Q

What is the role of the zona fasiculata

A

secretes glucocorticoids

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5
Q

What is the role of the zona reticularis

A

secretes sex hormones

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6
Q

What is the role of aldosterone

A

helps regulate BP and electrolytes
Sends signals to the kidneys to promote Na reabsorption and K excretion in the urine

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7
Q

what is the role of cortisol

A

widespread effects on the body
helps regulate the body response to stress
helps regulate fat, protein, and carbs metabolism
helps regulate the inflammatory response and immune system

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8
Q

what is the role of DHEA and DHEA-S

A

promotes protein anabolism and growth
main source of androgens in females
20% as potent as testosterone

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9
Q

Actions of the adrenal medulla

A

releases epinephrine and norepinephrine
helps control BP, HR, sweating for example

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10
Q

What is the role of epinephrine

A

increases blood flow to muscles and brain
increases conversion of glycogen to glucose
stimulation of metabolic rate

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11
Q

what is the role of norepinephrine

A

similar but less potent effect as epinephrine
main action - vasoconstriction to increase BP

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12
Q

What is the adrenal medulla regulation?

A

release stimulated by fight or flight response of sympathetic nervous system

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13
Q

What happens in states of low mineralocorticoid activity

A

lower amt aldosterone
manifests as hypotension

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14
Q

What happens in states of low glucocorticoid activity

A

fatigue
low BP

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15
Q

What happens in states of excess mineralocorticoid activity

A

manifest as hypertension

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16
Q

What happens in states of excess glucocorticoid activity

A

high BP

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17
Q

What is the adrenal cortex regulation?

A

Adrenocorticotropic hormone stimulates the adrenal cortex to release its hormones

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18
Q

What is the HPA axis

A

is the feedback interaction of the hypothalamus, pituitary and adrenal glands

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19
Q

What hormones comprise the endocrine system?

A

Steroids
amines
peptides
proteins

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20
Q

What factors determine circulating levels of hormones?

A

synthesis
secretion
transport

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21
Q

What does hormone transport depend on in the blood?

A

affinity of hormone for plasma protein carriers
hormone degradation
availability of receptors
receptor binding
hormone uptake

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22
Q

What are some functions of hormones binding to a proteins?

A

protects hormone from degradation or uptake
allows for fine control over circulation levels
prevents hormone from binding to unintended sites
allows transport of lipid soluble hormones

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23
Q

What regulates plasma proteins?

A

They regulate themselves

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24
Q

Describe hormone degradation

A

all hormones have half life and will eventually degrade (changing levels)

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25
Q

What are some factors that influence availability of receptors?

A

down regulation
up regulation

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26
Q

What is the main goal of hormones

A

to maintain homeostasis

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27
Q

List the key hormones in the body

A

thyroid
cortisol
parathyroid
vasopressin
mineralocorticoids
insulin

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28
Q

When a hormone binds to cell surface or cell nuceli, the cell may

A

synthesize new molecules
change permeability of the membrane
alter rate of reactions

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29
Q

What is permissive?

A

binding to a target cell allows a different hormone to have its full effect

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30
Q

what is synergistic

A

two hormones act together to achieve a greater effect

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31
Q

What is antagonistic

A

two hormones produce an opposite effect

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32
Q

what ways can hormones work with each other?

A

permissive
synergistic
antagonistic

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33
Q

Where is the pineal gland located?

A

in the epithalamus

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34
Q

What does the pineal gland produce?

A

Melatonin

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35
Q

What is the role of melatonin?

A

binds to melatonin receptors causing anti-excitatory effects
regulates sleep patterns

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36
Q

When does melatonin peak?

A

at 1-2 years of age
remain stable until puberty then declines

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37
Q

What is the role of the hypothalamus?

A

communicates with the pituitary gland to control homeostasis
regulates almost all aspects of growth, development, metabolism and homesostasis

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38
Q

Is the hypothalamus mainly stimulatory or inhibitory?

A

Inhibitory

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39
Q

What is the role of pituitary gland (anterior)?

A

controlling hormones sent from hypothalamus cause secretion of various hormones

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40
Q

What is the role of human growth hormone?

A

promotes syntehsis of a protein IGFs

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41
Q

Where is the hGH released from?

A

Pituitary hormone

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42
Q

What is the regulation pathway for hGH?

A

low BS stimulates release (increases glycogen breakdown)

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43
Q

What is the consequence of excess hGH?

A

uncontrolled growth of bones
joint pain –> too much in hands, feet and face

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44
Q

How would excess of hGH be treated?

A

By removing the tumor, then using pharm to sublimate

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45
Q

What would you treat hGH deficiency?

A

giving synthetic hGH

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46
Q

Growth hormone releasing hormone would stimulate

A

human growth hormone

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47
Q

Thyrotropin releasing hormone stimulates

A

thyroid stimulating hormone

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48
Q

gonadotropin releasing hormone stimulate

A

follicle stimulating and luteinzing hormone

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49
Q

corticotropin releasing hormones stimulate

A

adrenocorticotrophic hormones

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50
Q

dopamine inhibits

A

prolactin

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51
Q

somatostatin inhibits

A

hGH and thyroid stimulating hormone

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52
Q

What does the thyroid gland look like?

A

butterfly shaped endocrine gland in the front of the neck

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53
Q

What is thyroid gland responsible for?

A

Synthesis, storage and release of T3 and T4

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54
Q

What are the cells of the thyroid gland?

A

colloid
follicular cells
parafollicular cells

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55
Q

What is the regulation pathway for synthesis of T3/T4?

A

TSH
this is controlled TRH

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56
Q

What are the ingredients needed for the creation of T3 and T4?

A

iodide, thyroglobulin and tyrosine

57
Q

Process of creating T3 and T4

A

iodide binds with tyrosine attached to thyroglobulin (mono or di iodo)
MIT + DIT = T3
DIT + DIT = T4
then secreted into circulation

58
Q

Why would the thyroid produce two different thyroid hormones?

A

One has more affinity for binding then the other as a way to regulate and adjust the level of activity needed

59
Q

Steps of T3/T4 synthesis

A

thyroglobulin synthesis
iodide trapping
oxidation of iodide
iodination of tyrosine
coupling of MIT and DIT
secretion of hormones

60
Q

What are the actions of T3 and T4 in the heart

A

chronotropic and inotropic

61
Q

What are the actions of T3 and T4 in the adipose tissue

A

catabolic

62
Q

What are the actions of T3 and T4 in the muscle

A

catabolic

63
Q

What are the actions of T3 and T4 in the bone

A

developmental

64
Q

What are the actions of T3 and T4 in the nervous system

A

development

65
Q

What are the actions of T3 and T4 in the gut

A

metabolic

66
Q

Where is parathyroid gland located?

A

on the posterior surfaces of the lateral lobes of the thyroid

67
Q

what is the purpose of the parathryoid?

A

to produce parathyroid hormone (PTH)

68
Q

what is the role of PTH

A

to regulate calcium and phosphate

69
Q

How does PTH increase blood calcium?

A

Stimulating number and activity of osteoclasts
increasing calcium and magnesium reabsorption from urine
increasing synthesis of calcitriol, which increases calcium and magnesium absorption from GI

70
Q

How does PTH decrease blood phosphate?

A

increasing excretion from kidneys

71
Q

Do the actions of PHT oppose or help the calcitonin?

A

Oppose

72
Q

How does the action of PTH oppose by calcitonin?

A

secreted by follicular cells in thyroid
inhibits activity of osteoclasts
decreases reabsorption of calcium from urine

73
Q

Regulation of PTH and calcitonin works by

A

circulating calcium levels act on parathyroid gland to reduce PTH secretion

74
Q

What are potential consequences of removing the parathyroid gland?

A

lowers Ca and magneisum in the body

75
Q

What are potential consequences of losing calcitonin?

A

lower the Ca and Mg that is absorbed from GI

76
Q

Where is the thymus located?

A

in front of the heart and behind the sterum

77
Q

What is the purpose of the thymus?

A

critical part of immune system and T cell development

78
Q

What hormones does the thymus release and what does this stimulate?

A

thymosin alpha 1
thymulin
thymopoietin

T cell development

79
Q

What other hormones can stimulate T cell development?

A

Prolactin, T3 and T4 and LH

80
Q

What is hyperthyroidism?

A

disease caused by excess synthesis and secretion of thyroid hormone

81
Q

What is a definitive treatment of hyperthyroidism?

A

radioactive iodine or surgery

82
Q

What are common causes of hyperthyroidism?

A

toxic diffuse goiter (graves disease)
toxic multi-nodular goiter (plummers disease)
acute phase of thyroiditis
toxic adenoma

83
Q

What is the age group for graves disease?

A

20-50 yr old (most common)

84
Q

What is Graves disease?

A

Autoimmune disorder
immune system creates antibodies against the TSH receptor
can result in hyperplasia of thyroid gland leading to a goiter

85
Q

What is the pathway of plummers disease?

A

iodine deficiency –> less T4 production –> thyroid cells grow larger –> TSH receptors mutate –> continually active

86
Q

What is plummers disease?

A

second most common cause of hyperthyroidism
iodine deficiency most common trigger for nodules to grow but can be many others
develops slowly over several years

87
Q

what is toxic adenoma?

A

benign tumors growing on thyroid gland
become active and act just like thyroid cells
secretting T3/4 but not responding to negative feedback

88
Q

Acute Phase of Thyroiditis

A

causes inflammation and damage to the thyroid gland
damage causes excess hormones to be released
eventually leads to hypothyroidism once T3/T4 stores exhausted

89
Q

List some non specific hyperthyroidism symptoms

A

tremor hands
diarrhea
heat intolerance
unintentional weight loss
weakness

90
Q

Symptoms of toxic diffuse goiter specific

A

exophthalmos
periorbital edema
diplopia
diffuse goiter
pertibial myxedema

91
Q

Treatments of hyperthyroidism

A

Pharmacotherapy
Radioactive Iodine
surgery

92
Q

What are thioamides?

A

includes PTU and MMI
not typically used life long
main use is to reduce severity of hyperthyroidism to prepare a pt for curative therapy

93
Q

Thioamides of MOA

A

inhibits production of thyroid hormone by preventing iodine from incorporating with tyrosine residue on thyroglobulin
inhibits coupling reaction of MIT and DIT
inhibits peripheral conversion of T4 –> T3

94
Q

Which thioamide has different doses for the levels of hyperthyroidism?

A

propylthiouracil

95
Q

What is the dosing for MMI for mild hyperthyroidism?

A

initial 10-15 mg OD
then 5-15 mg OD to maintain

96
Q

What is the dosing for MMI for moderate hyperthyroidism?

A

initial 20-30 mg OD
then 5-15 mg OD to maintain

97
Q

What is the dosing for MMI for severe hyperthyroidism?

A

initial 30-40 mg OD
then 5-15 mg OD to maintain

98
Q

What is the dose for PTU?

A

initial 300 mg BID-TID
then 100-150 mg BID-TID

99
Q

Common side effects for thioamides

A

GI upset
Rash
Arthralgia

100
Q

What serious side effects of thioamides?

A

Agranulocytosis
neutropenia
hepatotoxicity and cholestatic jaundice
vasculitis
polyarthritis

101
Q

What is agranulocytosis?

A

a condition with very low granules (WCB) count

102
Q

what is neutropenia?

A

having too few neutrophils (WCB) count

103
Q

What is cholestatic jaundice?

A

Too much cholestate that causes the block the bile

104
Q

What is vasculitis?

A

The inflammation of the blood vessels

105
Q

What is polyarthritis

A

having arthritis in multiple joints
high degree of pain and swelling

106
Q

Which thioamides should you use during pregnancy?

A

to balance the risk of teratogenicity and hepatotoxicity
1 st trimester –> PTU
2nd and 3rd trimester –> MMI

107
Q

What factors are involved when deciding which thioamide to use during pregnancy?

A

PTU - low teratogenenicity but higher hepatoxicity
MMI - some teratogenic concern in 1st but lower hepatotoxicity

108
Q

MOA of beta blockers for hyperthyroidsim

A

reduces symptoms related to cardiac over stimulation

109
Q

Surgery for hyperthyroidism

A

thyroidectomy
leads to permanent hypothyroidism

110
Q

Radioactive iodine

A

curative option
taken up by the thyroid causing ablation

111
Q

Explain what a thyroid storm

A

Rare, life-threatening condition
Characterized by severe manifestations of hyperthyroidism
Can occur in patients with untreated hyperthyroidism

112
Q

What can trigger a thyroid storm?

A

Thyroid surgery or radioactive iodine
Trauma
Infection
Giving birth

113
Q

Define hypothyroidism

A

A condition of thyroid hormone deficiency caused by a defect anywhere on the hypothalamic-pituitary-thyroid axis

114
Q

What is the most common cause of hypothyroidism?

A

chronic autoimmune thyroiditis
hashimoto’s disease

115
Q

Tx options for hypothyroidism

A

involves replacement of thyroid hormones
Desiccated thyroid
Liothyronine
Levothyroxine
Combined T3/T4

116
Q

Desiccated thyroid

A

first agent
prepared from thyroid glands of animals
contians t3 and t4
causes high peaks

117
Q

Liothyronine

A

Contains T3, no effect on T4
Causes wide fluctuations in serum levels
Costly

118
Q

Levothyroxine

A

Analogue of T4
Standard 1st line therapy
Half life of 7 days
Conversion to T3 regulated by body

119
Q

Levothyroxine dose

A

Average dose is 1.6mcg/kg/d
Starting dose ranges from 12.5mcg/day to max wt based
Often give 100mcg empirically (average replacement dose)

120
Q

Risk factors for levothryoxine

A

Any CVD (eg. ischemic heart disease)
Rhythm disturbances
>50 years old
Severe, long-standing hypothyroidism

121
Q

Levothyroxine AE

A

Hyperthyroidism symptoms
Cardiac risk increase
Aggravate existing CVD
BMD reduction

122
Q

Levothyroxine DI

A

Antacids / H2 blockers / PPIs
Iron
Calcium / mineral supplements
Cholestyramine
Raloxifene
Manage by taking levothyroxine 2 hours before, or 4 hours after these meds

123
Q

Monitoring plans for levothyroxine

A

getting blood test to check levels

124
Q

What does the HPA axis regulate?

A

Stress response
Digestion
Immune system
Mood and emotions
Energy storage and expenditure

125
Q

Define cushing syndrome

A

a condition characterized by hypercortisolemia usually due to ACTH producing pituitary tumor

126
Q

Tx for cushing Disease

A

surgery is the treatment of choice

127
Q

Tx Rx for cushing disease

A

ketoconazole
metyrapone
mitotane
pasireotide

128
Q

MOA of ketoconazole

A

inhibits cortisol biosynthesis at the first step

129
Q

MOA of metyrapone

A

inhibits cortisol biosynthesis at the final step

130
Q

MOA of mitotane

A

inhibit cortisol biosynthesis at various steps

131
Q

MOA of pasireotide

A

binds to somatostatin and inhibits ACTH secretion

132
Q

Explain addison’s disease

A

primary adrenal insufficiency
caused by destruction of the adrenal glands
- all 3 zones of the adrenal cortex

133
Q

Tx of chronic insufficiency

A

Daily glucocorticoid and mineralocorticoid replacement
E.g. HC 15-30mg/d (divided) and fludricortisone 0.1mg daily
May require stress dosing
Perhaps DHEA for women

134
Q

Tx acute adrenal crisis

A

Emergency situation: IV corticosteroids and IV fluids

135
Q

What does the adrenal glands release

A

cortex produces glucorticorticoids, mineralocorticoids and androgens

136
Q

What does the pancreas release

A

produce insulin

137
Q

What does the ovaries release

A

produce E, P, T

138
Q

what does the testes release

A

produces T

PHARM 123 (4 decks)

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