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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
Q

general characteristics of SIADH

A

-Fluid retention
-Serum hypoosmolality and hyponatremia
-Concentrated urine

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26
Q

SIADH etiology

A

-malignant tumors
-CNS disorders
-drug therapy
-Misc. (hypothyroidism, infection)

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27
Q

SIADH osmolality

A
  • Serum osmolality = LOW
  • Urine osmolality & specific gravity = HIGH
  • Serum sodium = LOW
  • Urine output = LOW
  • Weight = GAIN

**Pt is retaining pure water, no NA

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28
Q

Sx of SIADH are the same symptoms as what?

A

hyponatremia

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29
Q

what is diabetes insipidus ?

A

Deficiency of ADH or a decreased renal response to ADH

30
Q

what are the two forms of DI?

A
  • Neurogenic (Central)
  • Nephrogenic
31
Q

what is the cause of neurogenic DI?

A

Hypothalamus or pituitary gland damage
-sudden onset and usually permanent

32
Q

cause of nephrogenic DI?

A
  • Loss of kidney function
  • Often drug-related (e.g., Lithium)
    -slow onset and progressive
33
Q

serum osmolality of DI

A
  • Serum osmolality = HIGH
  • Urine osmolality and specific gravity = LOW
  • Serum sodium = HIGH
  • Urine output = HIGH
  • Weight = LOSS
34
Q

CM of DI

A
  • Polyuria
  • Polydipsia
  • Dehydration
    -electrolyte imbalance and possible hypovolemic shock leading to death
35
Q

Nephrogenic DI tx

A

thiazide diuretics d/t: Paradoxical effect: decreases polyuria, increases urine osmolality

36
Q

Neurogenic DI Trx

A

synthetic ADH replacement

37
Q

DI: DILUTE

A

Dry
I&O
Low specific gravity
Urinates a lot
Treat=vassopressin
rEhydration

38
Q

what hormones does the thyroid gland secrete

A

triiodothyronine (T3)
thyroxine (T4)

39
Q

what does Thyroxine do?

A

regulator of metabolism that influences almost every body system

40
Q

____is a necessary component in the
synthesis of thyroid hormone.

A

iodine

41
Q

The thyroid works off of a ____feedback loop

A

negative

42
Q

goiter

A

A goiter is an enlargement of the thyroid gland with or w/o Sx of thyroid
dysfunction.
+TSH, - iodine levels

43
Q

primary hypothyroidism

A

increases release in TSH from pituitary

44
Q

what is the most common cause of hypothyroidism

A

Hashimoto’s (autoimmune)

45
Q

what are the antibodies associated with Hashimoto’s?

A

-thyroid receptor antibodies
-anti-thyroglobulin antibody
-anti-thyroperoxidase antibody **

46
Q

RF for hypothyroidism

A

female, >50y/o, caucasian, pregnancy, h/o other autoimmune disorders, Family Hx, medications, Trx for hyperthyroidism

47
Q

early manifestations for hypothyroidism

A

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
Q

late manifestations of hypothyroidism

A

below normal temp, bradycardia, weight gain, decreased LOC, thickened skin, cardiac complications (cardiomegaly)

49
Q

how does hypothyroidism affect cholesterol?

A

raises it, hyperlipidemia

50
Q

how does hypothyroidism affect H&H?

A

causes anemia

51
Q

Myxedema

A

-dermatological changes with hypothyroidism

52
Q

characteristics of hyperthyroidism

A

anxiety, tremor, tachycardia, feeling warm, loss of weight, exophthalmos, atrial fibrillation, decreased fertility

53
Q

Diagnosis of hypothyroidism

A

High TSH level
Low free T3
low free T4
anti-thyroglobulin
anti-thyroperoxidase antibodies

54
Q

treatment of hypothyroidism

A

replace hormone therapy= levothyroxine

55
Q

types hyperthyroidism

A

-excessive secretion of T3 and T4
-primary: thyroid
-secondary: pituitary
-tertiary: hypothalamus

56
Q

what is the most common cause of hypothyroidism? other causes?

A

-graves Dz
-thyroid adenoma, subacute thyroiditis, toxic multinodular goiter, excessive iodine ingestion, excessive thyroid hormone replacement

57
Q

RF for hyperthyroidism

A

family Hx of graves, >40 y/o, women, caucasian, medications, excessive iodine intake, pregnancy

58
Q

graves Dz

A

autoimmune disorder
excess levels of T3 and T4
thyroid stimulating antibodies

59
Q

Graves Dz Sx

A

nervousness, insomnia, sensitivity to heat, weight loss, gland is enlarged/palpable, audible bruit d/t high glandular blood flow, Afib, Myxedema, Exophthalmos

60
Q

what is exophthalmos

A

wide eyed stare

61
Q

graves ophthamopathy

A

periorbital and bulging of the eyes

62
Q

Dx of graves Dz

A

low TSH
high T3
high T4
anti-thyroglobulin
anti-thyrotropin receptor antibody
US w/ color-doppler evaluation
radioactive iodine scanning

63
Q

Trx of hyperthyroidism

A

-antithyroid hormone medication (Propylthiouracil)
-radioactive iodine Trx
-surgery

64
Q

thyrotoxic crisis (thyroid storm)

A

-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
Q

parathyroid gland

A

4 peas sized glands nestled within the thyroid tissues of the neck
-produces/secretes PTH
-controls calcium levels
-promotes vitamin D production

66
Q

hypoparathyroidism Sx are result of ___

A

insufficient PTH secretion and resultant hypocalcemia

Sx:muscle cramps, irritable, tetany, convulsion

hypocalcemia causes: Trousseau’s sign, Chvostek’s

67
Q

Hypoparathyroidism trx

A

replace PTH
normalize serum Ca and vitamin D levels
f parathyroid has been removed then replacement Trx is lifelong

68
Q

hyperparathyroidism

A

muscle Wk, poor concentration, neuropathies, HTN, kidney stones, metabolic acidosis, osteopenia, pathological frx, constipation, depression, confusion, subtle cognitive deficits

69
Q

Sx of hyperparathyroidism are caused by

A

excessive secretion of PTH with resulting hypercalcemia and bone breakdown

70
Q

hyperparathyroidism TRx

A

reduce Ca levels
diuretics
calcitonin
bisphosphonates
vitamin D
surgical intervention

Nur 326 Pathopharm I (2 decks)

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