Lectures Exam 2 Pt. 2 (Exam 2)

Question 1

What do the appetite suppressors Orlistat and Belviq do?

Answer 1

a. Orlistat: Lipase inhibitor, diminishes fat absorption in intestines.
b. Belviq: Is a 5-HT2 agonist.

Question 2

What is the most common cause for amputations in the US?

Answer 2

• Complications from Diabetes

Question 3

What organ of the body has release and management controlled by hypothalamic TRH stimulating TSH from pituitary and where excessive activation causes hypermetabolic state causing protein catabolism and enhanced sympathetic nervous system activity?
Disease of this organ is most common in whom?

Answer 3

• Thyroid

- Females

Question 4

How would you diagnose a person with Nervousness, Hot and sweating (heat intolerant), Weight loss, Muscle weakness/tremor, Palpitations/tachycardia, Low TSH, High TRH? This can also cause something called ‘Thyroid Storm’ what are its symptoms? What disease causes 90% of the cases of Hyperthyroidism? What causes this disease? What are the 3 symptoms of this disease? What disease causes 5-10% of hyperthyroidism and is noted by having a multi-nodular goiter? What 4 medications are used to treat Hyperthyroidism and what do they do?

Answer 4

• Hyperthyroidism
• Thyroid Storm: Fever, tachycardia, sweating, shaking, agitation, and unconsciousness.
• Graves Disease
• Antibodies function as agonists to thyroid-related receptors, causing excessive thyroid receptor activation.
• Hyperthyroidism, Exophthalmos and Enlarged thyroid gland (hyperplasia).
• Plummer’s Disease
• Drugs:
  
  • Thiomides: Inhibit thyroid peroxidase reaction and block synthesis of hormone.
  • Iodides (Lugol): Inhibit hormone release.
  • Beta Blockers (Propanolol): Inhibit conversion of T4 to T3.
  • Radiation Iodine: Destroys thyroid parenchyma.

Question 5

How would you diagnose Hypometabolic state, In children will see Cretinism with reduced mental and physical development, Enlarged thyroid, Low temperature, Dry coarse skin and hair, Sluggish feeling, Cold intolerance, Modest weight gain, Myxedema (swelling of skin), High TSH, Low TRH? What disease is usually associated with this and is the MOST common form of thyroid deficiency in the US? What are symptoms of this disease? What drugs are used Hypothyroidism?

Answer 5

• Hypothyroidism
• Hashimoto’s Disease
• Autoimmune (usually in women), can start as hyperthyroidism but can lead to hypothyroidism, thyroid enlargement and then atrophy.
• Thyroid replacement or Levothyroxine (T4) or Liothyronine (T3).

Question 6

What is the MOST common lesion of the thyroid-usually a thyroid enlargement? What is this usually associated with? How is it diagnosed?

Answer 6

• Goiter
• Iodine deficiency (NOT hypothyroidism)
• Diagnosed with fine needle aspiration (versus biopsy) to determine if have large Follicles filled with Colloid and relatively Few cells.

Question 7

What is the MOST common thyroid neoplasm that is not malignant?

Answer 7

• Thyroid Adenoma

Question 8

The Parathyroid organ secretes what hormone and what does this hormone do? What occurs in Hyperparathyroidism? What occurs in Hypoparathyroidism?

Answer 8

• Secretes parathyroid hormone (PTH) regulated by free calcium in blood-reverse relationship (low calcium increases PTH). PTH activates osteoclasts and bone resorption (resulting in osteoporosis if excessive) and increases serum calcium; also increases tubular reabsorption of calcium, activates vitamin D and increases GI absorption.
• Hypercalcemia which causes osteoporosis (fractures), stones, Arrhythmias, malabsorption of vitamin D and Hypophospatemic (decrease in phosphates).
• Hypocalcemia, decreases PTH, tetany (muscle spasms), dental changes in children.

Question 9

The Pituitary gland has an Anterior and Posterior portion, what are the jobs of each? The Hypothalamus stimulates the Pituitary gland which stimulates the desired organ depending upon the hormone. What pituitary hormones regulate ovulation? What hormone is an insulin antagonist and has anabolic effects? Which hormone is also known as Somatostatin? **(Should know chart on study guide)

Answer 9

• Anterior-portal circulation from hypothalamus (sends “releasing” factors).
• Posterior-axons go into systemic circulation (e.g., ADH, Oxytocin).
• FSH and LH
• GH
• GIH

Question 10

The Pituitary gland has four types of possible Adenomas (benign tumors) that are defined by the location and hormone that they effect. What are they and what do they effect?

Answer 10

• Prolactin: Reproduction
• Growth hormone: Gigantism [before puberty] and Acromegaly [after puberty]
• Corticotropin: Affect ACTH which causes Cushing’s Disease

Question 11

What is the disease where the most common cause for the disease is consecratory pituitary adenomas? What are the 3 consequences of this? What would inappropriate ADH secretion from the pituitary cause? *(this is caused by carcinomas and CNS infections)

Answer 11

• Hypopituitarism
• Loss of sex characteristics, such as sterility. Retard growth in children and Hypothyroidism.
• Would alter kidney function such as hyponatremia and hemodilution.

Question 12

Adrenal Glands also make and release certain hormones, what do the Medulla and Cortex make/release?

Answer 12

• Medulla: Makes and Releases Catecholamines

- Cortex: Makes Steroids (Mineralocorticoids, glucocorticoids and sex steroids)

Question 13

What disease is a Cortical Insufficiency (65% of cases), that is an autoimmune response more common in white women, where the adrenal are reduced, an increase in infection is seen, and weakness, nausea, Hyponatremia (decrease in sodium), hypotension and skin pigmentation due to an increase of MSH and ACTH? What is the difference between this and a adrenocortical insufficiency that is due to hypothalamic/pituitary problems? What is a sudden increase of steroid output and can be cause by massive adrenal hemorrhage?

Answer 13

• Addison’s Disease
• Won’t have hyperpigmentation, aldosterone levels are normal but will have hypoglycemia.
• Adrenal Crisis

Question 14

What disease is caused by Hypercortisolism, adrenal hyperplasia, shrunken adrenals due to hypercortisol, ACTH is low, Cortisol is high, causes moon face, osteoporosis, buffalo hump, obesity, thin skin, amenorrhea, muscle weakness, and poor wound healing? **(This disease looks like someone on chronic corticosteroids for arthritis and other inflammatory diseases)

Answer 14

• Cushing’s Disease

Question 15

What is usually the result of extended use of exogenous (pharmaceutical) steroids such as prednisone, and if the normal adrenal is suppressed due to treatment being abruptly stopped, there is a transient, but critical, hypocortisolic reaction?

Answer 15

• Secondary Adrenocortisol Insufficiency

Question 16

What syndrome is due to Hyperaldosteronism and causes Na+ retention and K+ excretion, and suppression of the Renin-Angiotensin system?

Answer 16

• Conn Syndrome

Question 17

What is a tumor of adrenal medulla (usually benign), increases secretion of catecholamines,effects typically look like increased sympathetic nervous system function (Hypertension, flushing and increased urine catecholamines)?

Answer 17

• Pheochromocytoma (adrenal medullary tumor)

Question 18

What disease has a cause that is not known, but may be triggered by viral infections, normal osteoclastic and osteoblastic remodeling activity is disrupted resulting in excessive bone removal followed by excessive bone formation leading to an irregular and weakened bone pattern and increased likelihood of fractures, is common (3-4% Caucasians), is the Second most frequent bone disease after Osteoporosis, is chronic usually >40 years of age, often asymptomatic, can cause bone pain and fractures, can cause arthritis if near joint, high serum alkaline phosphates, Vertebrae/skull and long bones are common sites, Enhances osteoclastic activity, some rebound osteoblastic response;
Described as a disorder of bone remodeling?
What is used as treatment for this?

Answer 18

• Paget Disease (Osteitis Deformans)

- Calcitonin: Actions opposite of parathormone: inhibits osteoclastic activity.

Question 19

Osteoporosis has 4 different treatment medications, what are they and what makes them different? Chronic use of what drugs can cause Osteoporosis?

Answer 19

• Denosumab (XGEVA): Antibody to the osteoclastic-stimulating protein (RANK)- this drug blocks osteoclast number and activity.
• Teraparatide (Forteo): A recombinant form of parathormone segment which selectively activates osteoblasts and stimulates new bone formation.
• Estrogens or estrogen modulators: Prevent bone loss in early postmenopausal period. The estrogens should be used in combination with progestin in postmenopausal women to protect against venous thrombi
• Bisphosphonates (Ibandronate-Boniva; or Alendronate-Fosamax): Suppress activity of osteoclasts and inhibit bone resorption; used to treat osteoporosis and Interferes with maxilla and mandible boney repair after surgery leading to bone necrosis.
• Glucocorticoids: Antagonizes vit. D-stimulated intestinal Ca++ transport and stimulates renal secretion and blocks osteoblastic function.

Question 20

What drug type is the primary use for their rapid and dramatic anti-inflammatory effects, suppress leukocytes and inflammatory cytokines/chemokines and topical inhibits histamine release and skin thinning?
What are short to medium acting drugs of this? Long acting?

Answer 20

• Glucocorticoids
• Hydrocortisone, Cortisone, Prednisone
• Dexamethasone

Question 21

What disease is chronic and when the adrenal glands produce too little cortisol and aldosterone? What is used to cure this?

Answer 21

• Addison’s disease

- Hydrocortisone with salt retaining hormone

Question 22

What is chronic high levels of cortisol-usually due to ACTH-secreting tumor, has fatty hump on shoulders (buffalo hump), Moon face, Stretch marks on skin, Osteoporosis and Hypertension? What drugs are used for treatment of this? These drugs can also be used to cure what?

Answer 22

• Cushing’s disease
• Drugs:
  
  • Ketoconazole: inhibits adrenal steroid synthesis
  • Metyrapone: selective inhibitor of cortisol/corticosterone synthesis
• Osteoporosis and Paget’s disease

Question 23

Intrinsic pathway (Caused by trauma from within the vascular system and involving Factors 10a and 11a) are measured by what, what are its normal limits? What intrinsic anti-clotting agent is typically used in a hospital setting? 
Extrinsic factors (Caused by trauma outside the vascular system and involving Factors 7a and 10a) are measure by what, what are its normal limits? What extrinsic anti-clotting agent is typically used as a prescribed out patient medication? 
What other anti-clotting drug has fewer side effects and is more popular than heparin or warfarin, affects PTT sensitive pathway, has a unique mechanisms that makes it distinct from heparin and warfarin. Used on out patient basis?

Answer 23

• PTT (25-35 seconds)
• Heparin
• PT (11-13.5 seconds)
• Warfarin
• Dabigatran