Lecture 05_Spring

Question 1

Where is Insulin synthesized?

Answer 1

pancreatic beta cells

Question 2

Which drug is given to induce uterine contractions but is contraindicated in patients with asthma?

Answer 2

Carboprost tromethamine (Hemabate)

Question 3

____ is a synthetic thyroid hormone replacement that increases basal metabolic rate by __-___%

Answer 3

Levothyroxine (Synthroid), 60-100%

Question 4

____ is secreted from alpha cells of the pancreas

Answer 4

glucagon

Question 5

Normal insulin secretion is __ unit/hr at rest but __-__units/day in response to food, stress, corticosteroids, other stimuli

Answer 5

~1 unit at rest, 40-50 units/day in response to food, stress, corticosteroids, other stimuli

Question 6

How does stimulation of alpha adrenergic receptors effect secretion of insulin? What about beta stimulation? What about parasympathetic stimulation?

Answer 6

Alpha-stimulation decreases insulin

Beta-stimulation and parasympathetic stimulation increase insulin

Question 7

Which class of oral hypoglycemics decrease insulin resistance at skeletal muscle / adipose tissue
and makes the body more sensitive to insulin?

Answer 7

Thiazolidinediones (TZDs): Rosiglitazone (Avandia*), Pioglitazone (Actos)

Question 8

Even though ___ is not a catecholamine, it increases cAMP just like catecholamines do and increases myocardial contractility, stroke volume, heart rate

Answer 8

Glucagon

Question 9

Which oral hypoglycemic is associated with risk of lactic acidosis and has been classically been held on day of surgery?

Answer 9

metformin

Question 10

1 unit regular insulin will lower plasma glucose by ___ mg/dL in a normal adult

Answer 10

25-30 mg/dL

Question 11

What are the 3 Sulfonylureas listed in this lecture? How do they work?

Answer 11

Glipizide (Glucotrol)
Glyburide (Micronase)
Glimepiride (Amaryl)

Increase beta cell activity which leads to more insulin secretion

Question 12

How does metformin (glucophage) work to decrease blood glucose levels?

Answer 12

Inhibits hepatic gluconeogenesis (lactate glucose)

Question 13

What drug increases myocardial contractility, stroke volume, and heart rate even in the presence of beta-blockade?

Answer 13

Glucagon

Question 14

Where is insulin metabolized? What is the half-time? What is the duration of it’s sustained effect?

Answer 14

Metabolism: kidneys + liver

Half-time is 5-10 minutes

Sustained effect is 30-60 minutes because insulin is tightly bound to receptors

Question 15

Onset of IV insulin is __ minutes, Peak in ___minutes, Duration is ___ minutes

Answer 15

onset = 10 min
Peak in 15-30 minutes
Duration 30-60 minutes

Question 16

What is Propylthiouracil (PTU)?

Answer 16

inhibit thyroperoxidase and blocks peripheral conversion of T4-> T3

Used to treat chronic hyperthyroidism as well as acute thyroid storm (thyrotoxicosis) however, it is no longer recommended as first-line treatment due to severe hepatic failure

Question 17

Beta-blockade (usually propranolol or esmolol) is also used to prevent symptoms of hyperthyroidism

_____ also blocks peripheral conversion of T4 -> T3 (but ____ does NOT)

Answer 17

Propranolol also blocks peripheral conversion of T4T3 (but esmolol does NOT)

Question 18

What directions are given to diabetic patients regarding medications in the pre-op period?

Answer 18

No short-acting insulin on day of surgery, and partial (half) dose of long-acting insulin

Question 19

List the 5 primary stimuli of glucagon secretion

Answer 19

1. hypoglycemia
2. stress
3. trauma
4. cortisol
5. sepsis

Question 20

What oral hypoglycemic inhibits DPP-4,increasing insulin release and decreasing hepatic glucose production?

Answer 20

Sitagliptin (Januvia)

Question 21

What is the target blood glucose levels?

Answer 21

80-120 mg/dL

Question 22

____ can be used to induce labor or for post-partum uterine atony.

Answer 22

Oxytocin (Pitocin)

Question 23

What are the side effects of Pitocin?

Answer 23

hypotension, flushing, tachycardia, nausea

Question 24

0.2 mg of ____ can be given IM for uterine atony, but is contraindicated in patients with severe pre-eclampsia

Answer 24

methylergonovine (methergine)

Question 25

What are the side effects associated with methylergonovine (methergine)?

Answer 25

Side effects: HTN, N/V, cramping, pulmonary HTN.

Question 26

N/V and bronchoconstriction are associated with which OB drug?

Answer 26

Carboprost tromethamine (Hemabate)