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Nur 326 Pathopharm I > WK5: Adrenal/thyroid/GI/ADH > Flashcards

WK5: Adrenal/thyroid/GI/ADH Flashcards

1
Q

Define Cushing Syndrome/disease and discuss the difference between primary hyperfunction, secondary hyperfunction, and exogenous steroid excess.

A

-Cushings is S/Sx associated with hypercortisolism
-SYNDROME: primary hyperfunction, Dz of adrenal cortex (use exogenous steroids to Trx)
-Dz: secondary hyperfunction, Dz of anterior pituitary

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2
Q

Define Cushing Syndrome/disease and discuss the difference between primary hyperfunction, secondary hyperfunction, and exogenous steroid excess.

A

-Cushings is S/Sx associated with hypercortisolism
-SYNDROME: primary hyperfunction, Dz of adrenal cortex (use exogenous steroids to Trx)
-Dz: secondary hyperfunction, Dz of anterior pituitary

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3
Q

what does cortisol do?

A

-increases BG
-protects against stress
-stops inflammatory/immune process
-breaks down proteins/fats (increases BP and cholesterol level)

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4
Q

when cortisol Increases glucose availability, what CM occurs?

A

Glucose intolerance, hyperglycemia

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5
Q

when cortisol Maintains the vascular system, what CM occurs?

A

Hypertension, capillary friability (ecchymoses)

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6
Q

when cortisol breaks down protein, what CM occurs?

A

Muscle wasting, muscle weakness, thinning of skin, osteoporosis and bone pain

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7
Q

when cortisol breaks down fat, what CM occurs?

A

Redistribution of fat to abdomen, shoulders, and face

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8
Q

when cortisol Suppresses the immune and inflammatory responses, what CM occur?

A

Impaired wound healing and immune response, risk for infection

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9
Q

when cortisol increases CNS excitability, what CM occur?

A

Mood swings, insomnia

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10
Q

What is Addisons Dz

A

Dz of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones:
cortisol, aldosterone and adrenaline.**

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11
Q

etiology of addison Dz

A

idiopathic, autoimmune or other

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12
Q

pathogenesis of addison Dz

A
  1. adrenal glad is destroyed
  2. Sx occur when 90% non-functional
  3. ACTH and MSH are secreted in large amounts
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13
Q

early CM of addisons Dz

A

anorexia, weight loss
weakness, malaise, apathy
electrolyte imbalance
hyperpigmentation

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14
Q

Late CM of addisons Dz

A

Hypoaldosteronism
-hypotension
-salt craving
Hypocortisolism
-hypoglycemia
-Wk, fatigue
Unsuppressed ACTH secretion
-hyperpigmentation

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15
Q

Addison adrenal crisis

-caused by?
-results in?

A

MEDICAL EMERGENCY
-caused by: sudden insufficiency of serum corticosteroids
-results in: sudden loss of adrenal gland, sudden increase in stress in chronic condition, sudden cessation of corticosteroid drug therapy

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16
Q

Adrenal insufficiency requires lifelong — replacement therapy

A

corticosteroid

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17
Q

important notes for steroid pharmacotherapy for addison Dz

A

-do not abruptly stop taking
-mimics natural release of hormones
(timing and dose important)
-increase doses during stress
-wear a medical alert bracelet

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18
Q

Pheochromocytoma

A

Rare tumor of the adrenal medulla that
produces excessive catecholamines (epi/norepi)

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19
Q

RF for Pheochromocytoma

A

young to middle age

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20
Q

CM of Pheochromocytoma

A

HTN
HA, diaphoresis, tachycardia

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21
Q

what is the preferred Trx for Pheochromocytoma?

A

surgery

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22
Q

why would a patient with Pheochromocytoma be taking an Alpha adrenergic blocker?

A
  1. inoperable tumor
  2. pre-op decreasing HTN
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23
Q

what are the two ADH conditions?

A

SIADH (high)
Diabetes inspidus (low)

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24
Q

what does SIADH stand for?
Definition?

A

syndrome of inappropriate antidiuretic hormone
-An abnormal production or sustained
secretion of ADH

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25
general characteristics of SIADH
-Fluid retention -Serum hypoosmolality and hyponatremia -Concentrated urine
26
SIADH etiology
-malignant tumors -CNS disorders -drug therapy -Misc. (hypothyroidism, infection)
27
SIADH osmolality
* Serum osmolality = LOW * Urine osmolality & specific gravity = HIGH * Serum sodium = LOW * Urine output = LOW * Weight = GAIN **Pt is retaining pure water, no NA
28
Sx of SIADH are the same symptoms as what?
hyponatremia
29
what is diabetes insipidus ?
Deficiency of ADH or a decreased renal response to ADH
30
what are the two forms of DI?
* Neurogenic (Central) * Nephrogenic
31
what is the cause of neurogenic DI?
Hypothalamus or pituitary gland damage -sudden onset and usually permanent
32
cause of nephrogenic DI?
* Loss of kidney function * Often drug-related (e.g., Lithium) -slow onset and progressive
33
serum osmolality of DI
* Serum osmolality = HIGH * Urine osmolality and specific gravity = LOW * Serum sodium = HIGH * Urine output = HIGH * Weight = LOSS
34
CM of DI
* Polyuria * Polydipsia * Dehydration -electrolyte imbalance and possible hypovolemic shock leading to death
35
Nephrogenic DI tx
thiazide diuretics d/t: Paradoxical effect: decreases polyuria, increases urine osmolality
36
Neurogenic DI Trx
synthetic ADH replacement
37
DI: DILUTE
Dry I&O Low specific gravity Urinates a lot Treat=vassopressin rEhydration
38
what hormones does the thyroid gland secrete
triiodothyronine (T3) thyroxine (T4)
39
what does Thyroxine do?
regulator of metabolism that influences almost every body system
40
____is a necessary component in the synthesis of thyroid hormone.
iodine
41
The thyroid works off of a ____feedback loop
negative
42
goiter
A goiter is an enlargement of the thyroid gland with or w/o Sx of thyroid dysfunction. +TSH, - iodine levels
43
primary hypothyroidism
increases release in TSH from pituitary
44
what is the most common cause of hypothyroidism
Hashimoto's (autoimmune)
45
what are the antibodies associated with Hashimoto's?
-thyroid receptor antibodies -anti-thyroglobulin antibody -anti-thyroperoxidase antibody ****
46
RF for hypothyroidism
female, >50y/o, caucasian, pregnancy, h/o other autoimmune disorders, Family Hx, medications, Trx for hyperthyroidism
47
early manifestations for hypothyroidism
cold intolerance, weight gain, lethargy, fatigue, memory deficits, poor attention span, memory deficits, poor attention span, increased cholesterol, muscle cramps, raises carotene levels, constipation, decreased fertility, puffy face, hair loss, brittle nails
48
late manifestations of hypothyroidism
below normal temp, bradycardia, weight gain, decreased LOC, thickened skin, cardiac complications (cardiomegaly)
49
how does hypothyroidism affect cholesterol?
raises it, hyperlipidemia
50
how does hypothyroidism affect H&H?
causes anemia
51
Myxedema
-dermatological changes with hypothyroidism
52
characteristics of hyperthyroidism
anxiety, tremor, tachycardia, feeling warm, loss of weight, exophthalmos, atrial fibrillation, decreased fertility
53
Diagnosis of hypothyroidism
High TSH level Low free T3 low free T4 anti-thyroglobulin anti-thyroperoxidase antibodies
54
treatment of hypothyroidism
replace hormone therapy= levothyroxine
55
types hyperthyroidism
-excessive secretion of T3 and T4 -primary: thyroid -secondary: pituitary -tertiary: hypothalamus
56
what is the most common cause of hypothyroidism? other causes?
-graves Dz -thyroid adenoma, subacute thyroiditis, toxic multinodular goiter, excessive iodine ingestion, excessive thyroid hormone replacement
57
RF for hyperthyroidism
family Hx of graves, >40 y/o, women, caucasian, medications, excessive iodine intake, pregnancy
58
graves Dz
autoimmune disorder excess levels of T3 and T4 thyroid stimulating antibodies
59
Graves Dz Sx
nervousness, insomnia, sensitivity to heat, weight loss, gland is enlarged/palpable, audible bruit d/t high glandular blood flow, Afib, Myxedema, Exophthalmos
60
what is exophthalmos
wide eyed stare
61
graves ophthamopathy
periorbital and bulging of the eyes
62
Dx of graves Dz
low TSH high T3 high T4 anti-thyroglobulin anti-thyrotropin receptor antibody US w/ color-doppler evaluation radioactive iodine scanning
63
Trx of hyperthyroidism
-antithyroid hormone medication (Propylthiouracil) -radioactive iodine Trx -surgery
64
thyrotoxic crisis (thyroid storm)
-overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism -life-threatening condition most commonly caused by surgery, trauma, or infection
65
parathyroid gland
4 peas sized glands nestled within the thyroid tissues of the neck -produces/secretes PTH -controls calcium levels -promotes vitamin D production
66
hypoparathyroidism Sx are result of ___
insufficient PTH secretion and resultant hypocalcemia Sx:muscle cramps, irritable, tetany, convulsion hypocalcemia causes: Trousseau's sign, Chvostek's
67
Hypoparathyroidism trx
replace PTH normalize serum Ca and vitamin D levels f parathyroid has been removed then replacement Trx is lifelong
68
hyperparathyroidism
muscle Wk, poor concentration, neuropathies, HTN, kidney stones, metabolic acidosis, osteopenia, pathological frx, constipation, depression, confusion, subtle cognitive deficits
69
Sx of hyperparathyroidism are caused by
excessive secretion of PTH with resulting hypercalcemia and bone breakdown
70
hyperparathyroidism TRx
reduce Ca levels diuretics calcitonin bisphosphonates vitamin D surgical intervention

Nur 326 Pathopharm I (2 decks)

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