Intraoperative Fluid Management and Endocrine Pharmacology

Question 1

Effective vs Innefective Osmoles

Answer 1

Question 2

Total body osmolality

Answer 2

Question 3

Plasma vs Water

Answer 3

Question 4

Colloids in common use

Answer 4

Question 5

Albumin

Answer 5

Question 6

Hydroxyethyl Starches (HES)

Answer 6

Question 7

Adverse effects of Hydroxyethyl Starches (HES)

Answer 7

Question 8

Dextrans

Answer 8

Question 9

Biguanides - metformin

Answer 9

Question 10

Sulfonylurea – glyburide, glipizide, glimepride
meglitinides - nateglinide, repaglinide

Answer 10

Glyburide belongs to the sulfonylurea class of oral hypoglycemic drugs. These medications work by closing potassium channels in the β-cell membranes, leading to depolarization of the cell, and eventual insulin release via calcium reflux.

Question 11

Thiazolidinediones - PPAR-γ ligand

Answer 11

These drugs are synthetic ligands for the transcription factor PPARγ, a member of a superfamily of nuclear receptors including thyroid and steroid receptors. PPARγ is expressed in multiple tissue types (e.g. skeletal muscle, fat & liver). PPARγ stimulation upregulates the expression of genes involved in lipid & glucose metabolism, insulin signal transduction, and adipocyte differentiation. As illustrated, one mechanism contributing to the glucose lowering effect of thiazolidinediones is an increased expression of the glucose transporter GLUT4.

Question 12

Alpha glucosidase inhibitor

Answer 12

Competitively and reversibly inhibits enzymes in the small brush border responsible for the breakdown of oligosaccharides and disaccharides

Question 13

Dipeptidyl peptidase 4 (DPP4) inhibitor

Answer 13

Question 14

Sodium-glucose cotransporter inhibitor (SGLT-2)

Answer 14

Mechanism of Action:

Inhibits the Na-glucose co-transporter 2 (SGLT-2) in the kidney to reduce glucose reabsorption, resulting in increased urinary glucose excretion, and lower plasma glucose.

SGLT-2 is expressed in the proximal tubule and mediates reabsorption of ~90% of filtered glucose (Kuriyama et al, 2014).

Question 15

GLP-1 (glucagon like polypeptide-1) analogs

Answer 15

A synthetic analog of glucagon-like-polypeptide 1 (GLP-1) that is resistant to breakdown by DPP-IV.

Question 16

Pramlintide action – 3 mechanisms

Answer 16

Question 17

Perioperative management of patients
with Diabetes Mellitus

Answer 17

Question 18

Effect of surgery on glucose control

Answer 18

Question 19

Perioperative glycemic control

Answer 19

Question 20

Other drugs that may impact plasma glucose

Answer 20

Question 21

Insulin profiles

Answer 21

Question 22

Commonly used insulin regimens

Answer 22

Question 23

Medications to hold or stop prior to surgery

Answer 23

Question 24

Insulin dosing examples

Answer 24

Question 25

Hypoglycemia recognition

Answer 25

Question 26

Treatment of hypoglycemia - glucagon

Answer 26

Question 27

The sites of action of various drugs that interfere with thyroid hormone biosynthesis

Answer 27

Question 28

Thyroid hormone influences

Answer 28

Question 29

Hyperthyroidism

Answer 29

Question 30

Hypothyroidism

Answer 30

Question 31

Thyroid storm – emergency

Answer 31

Question 32

Adrenal insufficiency

Answer 32

Question 33

Suppression of hypothalamic-pituitary axis

Answer 33

Question 34

Corticosteroid adverse effects

Answer 34

Question 35

Corticosteroid therapeutic uses

Answer 35

Question 36

Acute withdrawal effects - Corticosteriods

Answer 36

Question 37

Recommended glucocorticoid Supplementation for medical or Surgical scenarios

Answer 37