block 6 mix

mesenchymal stem cells(mesoderm)

selective estrogen receptor modulator(SERM)

mimics estrogen in some tissue and angtogonizes it in others.

MEN1
multiple endocrine neoplams type 1

binds tubulin and prevents polimerization

solid or nonsynovial joints poriving structural integrity and minial movment

heterotopias- not in normal place

pancrease divisum- main duct is goes to minor sphincter instead of major papilla like its suppose to.

annular pancreas-pancreas surround duodenum

zona glomerulosa-aldosterone

zona fasiclata- cortisol

zona reticulans- androgens

clarity-transparent
color-clear
viscosity -very high
WBC-less than 200
pmn %- 25
culture- neg

pancreatic beta cells

papillary infolding
scalloping
coloid

drugs that depress the CNS function and will actually cause respiratory depression

primarly used to treat anxeity and insomnia

difference btw antianxiety and hypnotic effects of the drug is often a matter of dosing.

crushing syndrome
hypercortisol

herpes type 1

testosterone is a prohormone for DHT

dopamine D2 receptor antagonists.

estradiol and its ester

estrone
conjugated estrogens

it will take weeks bc thyroid hormone is made and stored in large quantities in the follicles.

depression

they are named by what tissue they resemble(ie lipoma resembles fat) and they are graded by how closley they resemble that tisse.(higher grade the less it resembles)

treats osteoporosis and reduces risks for breast cancer.

menin

preventative

cavitated with joint space allowing for moement situated btw bones and strengthened by capsule, ligaments, and muscles, lined by synovium and filled with clear, viscous plasma filtrate providing lubrication and nutrition for articular hyline cartilage

major cause of pancreatitis

all three zones produce their hormones are created by the same enzymes so its impossible to focus inhibition of to any certain zone based on the enzyme.

clarity-translucent
color-yellow
viscosity- high
wbc-200-2000
pmn%-25
culture-neg

beta cells and alpha cells

nuclear features
cleared out nuclei open ring appearance
psommoma bodies
intranuclear inclusion with groove

benzodiazepines

bc adenoma is more like normal tissue so it more functional and with produce symptoms faster

80% if all types are included

?

that schizophrenic symptoms are the result of excess dopamine activity.

ethinylestradiol
mestranol

secretion of thyroid hormones and calcitonin

30%

tricyclic antidepressants
selective serotonin reuptake inhibitors(SSRI)

serotononin/norepinephrine reuptake inhibiotors(SNRIs)

monoamine oxidase inhibitors(MAOIs)

atypical antidepressants

mesenchyme is present mainly outside organ, vessel, and bone structures but all these things also have mesenchyme within them so its possible for them to arise within organs or bones.

can cause hot flashes
can cause serious blood clots

RET protooncogene

decrease WBC migration/phagocytism

no blood supply or lymph or nerve supply nutrients provided by synovial fluid

increased amylase level

CRH in the hyothalamus stimulates the release of ACTH by the pituitary.
ACTH stimulates the production of all three hormones from the adrenal gland.

Cortisol and ACTH negatively feeds back to shut off CRH release.

color-yellow to opal
clarity-translucent to opaque
viscosity-low
WBC-2000-100k
PMN-50%
culture-neg

secrete glucagon

50% spread to lymph nodes by the time you find it.

insomnia/anxiety
induce general anesthesia
manage seizure disorders, muscle spasm, panic disorder, and withdraw from alcohol

used to screen for hypercortisolsm

99% are asypmtomatic from PRIMARY infection
1% get acute gigivostomatitis as a PRIMARY infection

?

b. Although dopamine antagonists result in anti-DA activity within hours, symptom improvement in schizophrenic patients on these medications takes weeks

diethylstibiestrol

growth
develpment
body temp reg
metabolic rates of cells

aides in these pathways doesn't directly cause

temp regulation is done by epinephrine from sympathetic system but it epinephrine wont cause the temperature regulation in the absence of thyroid hormone.

depressed mood
loss of pleasure or interest
insomnia/hypersomnia
anorexia/hyperphagia
mental slowing and loss of concentration
feelings of guilt, worthlessness, helplessness
thoughts of death and suicide
overt suicidal behaviro
symptoms must be present most of the day nearly every day for at least 2 weeks

undifferentiated

differentiated

hormonally acitve form of vitamin D with three hydroxyl groups

meduallay thryoid carcinoma

decreases UA reabsorption in the kidney by competition

type II

alcohol abuse main
biliary tract stones second
drugs
idiopathic

stress: emotional, physical, hypglycemic, cold exposure, pain.

circadian regulation also occurs.

color-yellow to green
clarity-opaque
viscosity-variable
WBC->100k
PMN-75
culture-positive

inhibitory so in diabetics with decreased or absent insulin secretretion(ie type 1) there will be increased glucagon which is a needed factor in ketoacidosis and that is why ketoacidosis is more commoni in type one DM

like to metastasize to the blood.

diazepam

differentiated btw they type primary or secondary hypercortisolism

50% of the 99% who are asymptomatic during primary infection never develop herpetic lesions
50% of the infected people get periodic outbreaks of secondary herpes due to retention of latent virus

?

phenothiazines

pregnanes-progesterone, medroxyprogesterone acetate

synthetics- 19-nortestosterones
-norethynodrel
-norethindrone/norethindrone acetate
-ethynodiol
-nogestrel
-desogestrel, gestodene, norgestimate

thyroid hormone.

genetic
difficult childood
chronic low self esteem
monoamine hypothesis of depression-depression caused by a functional insufficiency of monoamine neurotransmitters.

ewings sarcoma, PNET, mesenchymoma, alveolar soft part sarcoma, epithelioid sarcoma

increases the level of calcium in the blod by increasing the uptake of calcium from the gut and decreasing the transfer of calcim from the blood to the urine and increaseing the release of calcium in the blood from bone.

2b has neuro ganglioma and other nerve neoplasia

2a doesnt

patients with kidney stones from gout.

chondrocytes, synociocytes, fibroblasts, and inflammatory cells

alcohol/drug damage
hyperlipoproteinemia
hypercalcemia
uremia
pregnancy
diabetes mellitus

3 beta hydroxysteroid dehydrogenase

17 alpha hydroxylase

21 hydroxylase

11 beta hydroxylase

Rheumatoid factor(RF)-positive at a titer of greater than 1:80

HLA-DR4-positive

elvated ESR-not specific

C-reactive protien(CRP)-nonspecific measure of inflammation

ANTI-CCP-fairly specific new test becoming more popular.

nothing normal healthy people have a huge reserve of beta cells you have to lose a lot before you become diabetic

graves disease only thing that has this

exopthalhma bulging eyes also indicitave of this

safer than general CNS depressants
lower potential for abuse
produce less tolerance and physical dependecne
fewer drug interactions

addisons-autoimmune destructions of the adrenal gland

primary herpes sinplex type 1 infection. only occurs in 1% of people who are infected with herpes.

?

i. Low potency: chlorpromazine (prototype)
ii. Intermediate potency: thioridazine
iii. High potency: fluphenazine
iv. The lower potency drugs cause more sedation and less extrapyramidal effects. The higher potency drugs cause less sedation and more extrapyramidal effects.
v. Although there are differences in potency and side effects of the different subfamilies, all of the drugs have roughly the same therapeutic efficacy.

tamoxifen
clomiphene
raloxifene

hypothalamus relsease TRH
stimulates release of TSH from anteriorpituitary. Which in turn stimulates synthesis and release of T3 and T4 from the thyroid gland.

dopamine
norepinephrine
serotonin

adipocyte
fibrocyte
endothleilial cell
histiocyte
pericyte
chondrocyte
myocyte
osteocyte

acts on osteblasts causeing release of RANKL which activates osteoclasts.

prophylatic thyroidectomy

decreases production of uric acid by blocking xanthine oxidase

osteoarthritis(DJD)

antibiotics-didanosidine
pentamidine, sulfonamides, tetracycline

chemotherapy- asparaginase, cytarabine, 6-mercaptopurine

diuretics-furosemide

immunosuppressant-azathioprine

opiates
steroids
estrogen

work as transcription factors

bind to chaperone proteins

mediate their effects by direct alteration of gene products

This is why steroids with very similar chemical structure have such massively different effect in the body.

Rheumatoid factor (RF) is an autoantibody (usually IgM) against the Fc portion of autologous IgG. About 80% or individuals with rheumatoid arthritis have elevated serum RF.

secretion of enzymes needed in digestion espeacially of fat. only 2-3% of pancreatic mass comes from islets

hypothyroidism

normal doses do not depress medullary function

primary hyperaldosteronism

primary herpetic gingivostomatitis - Acute, febrile disease with malaise and
cervical adenopathy. Localizing symptoms in mouth as generalized vesicles
and ulcers, 3-7 mm. with associated acute, hemorrhagic gingivitis. Resolves
in 2 weeks. Does not return. Mostly children and young adults.

gingival swelling, vesicals rupture to ulcers

?

i. Histamine blockadesedation; tolerance develops in a few weeks
ii. Chemoreceptor trigger zone blockadeanti-emetic
iii. Dopamine blockadehyperprolactinemiaamenorrhea-galactorrhea
iv. Dopamine blockadeextrapyramidal dysfunction: Parkinsonism, akathisia, dystonia, tardive dyskinesia, neuroleptic malignant syndrome
v. Cholinergic blockadedry mouth, constipation, urinary retetion, blurred vision
vi. Alpha-adrenergic blockadepostural hypotension
vii. Decreased seizure threshold
viii. Abnormal temperature regulation
ix. Moderate weight gain

mifepristone

stress - inhibits
heath- inhibits
cold- stimulate
-fasting- inhibits
overfeeiding-stimulates
increased iodine- inhibits
decreased iodine - stimulates
High levels of T3/4 - inhibits
low levels of T3/4- stimulates

pharmacotherapy
depression specific psychotherapy(CBT)
electroconvulsive therapy
vagus nerve stimulation.

unknown usually
evironmental factors:
radiation
chemical and thermal burns
herbicides
trauma
immunosuppression
immunologic alterations

minority can have genetic origin

increases absorption of both Ca2+ and phosphate.

worse than people with normal versions of those same tumors

tumors are multifocal

appear at a younger age.

6mercaptopurine
azothioprine

progressive erosion of articular cartilage in weight bearign joints(HIPs, Knees, vertebrae)

related to age wear and tear , decreased capacity of chondrocytes to maintina cartilage matrix. Alterations in proteoglycans and collagen decreases cartilage resilience

cholelithiasis/gallstones

trauma-most common cause of AP in children

iatrogenic: endoscopy/surgery

ischemic/vascular: vasculitis, thrombosis, shock

cortisol

yes about 80% have elevated RF though

they are part of portal circulation, they see the blood right after its absorbed the nuetrients from digestion and before that blood reaches the liver. So they are able to respond very quickly to with hormone secretions in response to a meal and those secretions go very quickly to the liver.

darker the more iodide it takes up

multilobulated goiter-leads to both dark spots and light spots

hyperthyroid- would show dark uniform

hypothyroid would show light uniform

in liver

it is a secondary herpes infection. this is how 99% of people who manifest secondary infections present.

?

i. Potentiation of anticholinergic drugs
ii. Potentiation of other CNS depressants, benzodiazepines, opioids
iii. Potentiation of adrenergic-blocking antihypertensive drugs

aromatase inhibitors-anastrzole, exemestane, letrozole

T3- has 3 Iodines
T4- has 4

when drugs and therapy have not worked
sever depressed pt
suicidal
elderaly pt at risk of starving

when rapid response is needed

histologic type
grade
benign/malignant
size
depth-shallow better
location-extremities better than retroperitoneal

used as a diatery supplement.

main use in pt post gastic bypass who may have better bioavailability of this over the cheaper calcium supplements.

radiation

tophouse or long standing gout

slow onset pain in hips knees and vertebrae

morning stiffness made worse by use, crepitus, limiation in movement

bakers cysts

viral-mumps, entervirus, CMV

mycoplasma, mycobacteria

parasites-ascaris, clonorchis

stimulates hepatic glucose formation from glycerol/amino acids

increase storage of glucose as glycogen

diminishes glucose utilization in periphery(catabolic) enhances protein catabolism in muscle and enhances lipolysis in fat.

net result is to increase plasma gluose levels causes muscle wasting at high doses.

antibodies to cirtulline modified peptides

normally bc the liver is the first organ to see the secretions from the pancreas, the level of insulin seen by the liver is several times higher than the rest of the body.

however in diabetics who inject insulin that insulin does not have a higher concentration seen by the liver.

lymphoma

benzos are safer, and cause less dependence /tolerance/abuse

barbiturates cause increased liver enzymes functions(inducer)

all this is based on proper use of benzos and each person will respond differently

localized tingling and swelling followed by a crop of vesicles on lip. Infection contained because of prior antibodies. No fever, adenopathy. Vesicles break, ulcers crust and heal in 2 weeks. All ages affected.

occurs on the LIP not inside the mouth

?

i. High-potency (non-phenothiazine) dopamine blocker

envrionmental estrogen/phytoestrogens- isoflavones, resertrol

1.uptake of Iodine
2. oxidatino/activation of idodine
3. coupling into Tg
4. storage
5. proeolysis and release.

only after treatment with at least four drugs has failed

lung and bone

dont usually involve the lymph nodes.

Loop diuretics act on the Na+-K+-2Cl- symporter (cotransporter) in the thick ascending limb of the loop of Henle to inhibit sodium and chloride reabsorption. This is achieved by competing for the Cl- binding site. Because magnesium and calcium reabsorption in the thick ascending limb is dependent on sodium and chloride concentrations (primarily on the recycling of the potassium due to the lack of the electropositive gradient generation), loop diuretics also inhibit their reabsorption.

beneath sella turcica very close to optic nerves

chronic gout

metal joints leak toxins and cause inflamation that can speed up arititic processes

inciting injury-alcohol/drug/obstuction etc

activations/release of enzymes

acinar injury

increased activation/release of enzymes

more acinar injury

eventually proteolysis

then blood vessel damage-hemorrhage

leads to fat necrosis and release of lipase

that causes acute inflammation and edema.

antiinflammatory

autoimmune reaction stimulated by TNF and IL-1

GLUT2

hypothyroidism

they cause cardiovascular depression

so much be carefull with administration to elderly with cardiac conditinos

respiratory depression is rare unless overdose

Latent virus in trigeminal
ganglion is periodically reactivated by colds and fevers, sun, trauma, stress,menstrual periods

?

ii. High incidence of extrapyramidal side effects: Parkinsonism, akathisia, dystonia, tardive dyskinesia, neuroleptic malignant syndrome.
iii. Can also cause hyperprolactinemia due to dopamine blockade.
iv. Relatively free of cholinergic, alpha-adrenergic, and histamine-blocking side effects.

FSH(urofolliculin)
HCG
menotrophins(hMG=FSH+LH)

40:1

Iodine pump in follicular cell membrane which is stimulated by TSH

may increase suicidal tendency early in the treatement

must observe pt closely

fasicles of eosinophilic spnidle cells intersecting at right angles

spindle cells- cell longer than it is wide

Thiazides also lower urinary calcium excretion, making them useful in preventing calcium-containingkidney stones. This effect is associated with positive calcium balance and is associated with an increase in bone mineral density and reductions in fracture rates attributable to osteoporosis. By a lesser understood mechanism, thiazides directly stimulate osteoblastdifferentiation and bone mineral formation, further slowing the course of osteoporosis.[11]

Because of their promotion of calcium retention, thiazides are used in the treatment of Dent's Disease or idiopathic hypercalciuria.

prolactin
ACTH
TSH
GH
LH/FSH
ADH
Oxytocin

nonpurine version of allopurinaol

leaking of synovial fluid out of joint space

direct acinar cell injury
can cause defective intracellular transport
can cause ductal constriction that leads to duct obstructions.

inhibits the synthesis of leukotrienes, and prostaglandins

decrease cellular conten and release of histamine

decrease the synthesis of interleukins and cytokines

decrease the synthesis of MCF, MAF

decrease activity of MIF

decrease the release of lytic enzymes

decrease the release of reactive O2 products.

found in in synovial infection with lyme disease

glucose

oral contraceptives increase thyroid binding globulin and T4 measures only thyroid binding globulin bound T4

if a pt is hypothyroid you will need a free T4 test to see what their actual thyroid state is.

lower BP
lower HR
Lower SVR

vesicals seen as pool of fluid and degnerating epithelial cells that rapidly rupture and ulcerate

?

phenothiazine
haloperidol
molindone
thiothixene

danazol

thyroidal peroxidase(TPO)

observe pt closely for increases in suicidality/worsen mood/changes in behavior

prescribe lowest number of doeses consisten with good pt mangment.
pt dosing with inpatient should be directly observed and documented

short fasicles of spindle cells radiating from a central point(spokes of a wheel)- also known as storiform

loop diuretic

anterior has single blood supply via portal system

posterior has dual supply both artiers/viens and the portal system.

convertes UA to allountosin

bone spurs
jointing narrowing on Xray
Heberden nodes(women) osteophytes at disatl interphalangeal joints

amylase and lipase

stimulates production of CRH and ACTH, which leads to increased cortisol which decreases immune response leading to less of those products.

seronegative ankylosing spondylopathies

no, glucose must be metabolized beofre it can act to increase insulin release.

triiodothyronine

75-90% bioavailablity
lipophilic distrubution threwout whole body
can be sequestered in fat

cytologic smear of vesicular fluid shows multinucleated cell with glassy nuclei which is indicative of viral infection.

?

g. Molindone
i. Also high-potency with extrapyramidal side effects
h. Thiothixene
i. Less potent than phenothiazines, lower incidence of EP side effects

leuprolide
gonadorelin
nafarelin
goserlin

remember relin for GnRH analogs

MIT and DIT

tricyclics

nuclei arranged in columns-palisading

loop diuretic

the anterior

pegloticase
RAsboricase

pain control till it progresses far enough to perform joint replacement

trypsin

act on renal distal tubuels and collecting duct to increase Na reuptake(increase K and H excretion)
positive Na balance, increases extracellular fluid volume

tertiary syphillis

glucose>>>protein>fat

thyroxine

duration of action 2-6 hours
therefore prescribed to be taken as needed not a constant dose med

positive antibody to the herpes simplex virus usually type 1

?

a. Parkinsonism
i. Can occur within 5-30 days.
ii. Tremors, muscle rigidity, bradykinesia
b. Akathisia
i. 5-60 days
ii. Motor restlessness (unable to remain stationary in one position)
c. Dystonias
i. Also early complication
ii. Prolonged abnormal contractions of the neck, tongue, and mouth muscles
d. Tardive dyskinesia
i. Irreversible complication of long-term use that occurs more frequently in older patients. The disorder consists of rhythmic, involuntary movements of tongue, lip smacking, abnormal postures, and involuntary limb movements.
e. Neuroleptic malignant syndrome
i. Severe muscle rigidity and hyperthermia that occurs about 30 minutes after injection. Can treat with dantrolene and bromocriptine.
f. These are all thought to be due to dopamine blockade.

hypothalamus releases gonadotropin releaseing hormone(GnRH)

its a decapeptide that goes to the pituitary and sims increased synthesis and release of gonadotropins

MIT couples with DIT to create T3

two DITs couple to create T4

MIT never couples with itself.

sedation
othrostatic hypotension
anticholinergic effects

herring bone-cell intersecting at 45 degree angles

Alendronate inhibits osteoclast-mediated bone-resorption

classified as a bisphosphonate.

ant.-adenohypophysis glandular portion
releases hormones.

post-neurohypophysis all modified glial cells and axonal processes. releases neurtransmitters as hormones

hemolytic anemai
g6pd difiency
anaphalaxis

early granulartiy and softening of join cartilage surface leads to break down of cartilage that creates fissuring and flaking of cartilage until exposed bone on bone within the joint

this leads to an ivory or eburnation of appearance of the joint

small fractures break off and float in the synovial fluid

osteophytes form a margin of articular surface, synovium only minimally altered

rapid onset severe constant epigastric pain radiating to the back

nausea and vomiting due to ileus/duodenal obstuctions,sentinel loop

2/3 have fever and most have shock due to fluid shifting to inflamed area

increased blood pressure
hypokalemia, hypernatremia, and alkalosis

gouty arthiritis

it must be phosphoralated by glucokinanase

Gprotein receptor when activated converts GTP to GDP and creates cAMP.

CNS depression-the candy drug each one you take makes you feel better and better.

anterograde amnesia

sleep driving-dont take benzos during day if you going to be driving

paradoxical effects-rare but can cause increased HR, sleeplessness, ects opposite of what you expect

respiratory depression

abuse

dont use in preg especially first trimester probaly shouldnt use during lactation either

14 days

5alpha recutase inhibitor
effective in benign prostate hyperplasia

other stuff?

a. The atypical antipsychotics have a greater occupancy at 5-HT2 receptors relative to D2 receptors. Several of these drugs have also been reported to selectively block dopamine receptors on mesolimbic neurons rather than nigrostriatal neurons. These drugs are typically now first-line agents for schizophrenia due to far fewer extrapyramidal side effects. However, all have been reported to induce severe hyperglycemia and obesity.

its pulsatile over a course of a few mins

TPO

cardiac toxicity

mixture of fasiccles of spindle cells and groups of epitheloid cells-biphasic

glands and spindle cells

calcitonin lowers blood Ca2+ levels in three ways:

Inhibits Ca2+ absorption by the intestines[7]
Inhibits osteoclast activity in bones[8]
Inhibits renal tubular cell reabsorption of Ca2+ allowing it to be secreted in the urine[9]

Vitamin D regulation

somatotrophs
lactotrophs
corticotrophs
thrytorhops
gonaodotrohps

chronic refractory gout

bone on bone leads to flaking and break down of bone to create cavities which will house the excess synovial fluid

release of protyolytic enzymes from the pancreas during pancreatitis leads to blood vessel daamage

decreased blood pressure
hyperkalememia, hyponatremia, and acidosis.

Four of the following are needed to diagnose RA:

Morning stiffness √
Arthritis in three or more joint areas √
Arthritis of hand joints √
Symmetric arthritis √
Rheumatoid nodules √
Serum rheumatoid factor √
Typical radiographic changes (erosive synovitis)

it is very close to the physiologic concentration of glucose so when glucose concentration goes up it is not saturated the metabolism goes up.

most is bound to thyroxine binding globulin,albumin, or transthyretin protiens

small amount travels in a free unbound state.

additive with any other CNS depressants

cold sore, fever blister most common presenation of secondary herpes infection

?

the atypical antipsychotics

FSH and LH

MIT coupling with DIT creates T3

after proteolysis and release from storage and prior to release into the blood some T4 will be deiodinated into T3 by 5`deiodinase.

phenothiazine antipsychotics

schwann cell and smooth muscle

if its near spine or nerves think schwann

if in area with lot of smooth muscle then think smooth muscle

Cinacalcet (INN) is a drug that acts as a calcimimetic (i.e. it mimics the action of calcium on tissues) by allosteric activation of the calcium-sensing receptor

Cinacalcet is used to treat secondary hyperparathyroidism (elevated parathyroid hormone levels), a consequence of having end-stage renal disease.[1] Cinacalcet is also indicated for the treatment of hypercalcemia in patients with parathyroid carcinoma.[2];

growth hormone

in cancer therapy to deal with tumor lysis syndrome

HLA-DRBI create altered area that acts as a binding site for athritogens

PTPN22 -creates abnormal T cell response

cullens sign-discoloration around umbilicus

grey turner sign- discolorations around the flank

renin angiotensin system

Arthritis is the inflammation of any joint. Acute inflammation is defined with rubor (redness), tumor (swelling), dolor (pain), calor (heat), and functio laesa (loss of function).

glucose uptake by GLUT2
glucose phosphorylation by glucokinase
glucose metabolism generating ATP
increaced ATP/ADP ratio closes ATP sensitive potassium channel
this causes depolarization
depolarization opens voltage gated calcium channel
calcium influx is what signals the release of insulin containing vesicles that migrate and excrete insulin

T3 binds to nuclear receptors with 10 fold affinity compared to T4

can lead to tolerance and dependence espeically when used for sleep aid

primary herpes always presents with inflamed markedly red and often swollen gingiva. with hemorrhage not always generalized but always present

a. In males the androgens are synthesized in the testes and adrenal cortex.
b. In females the androgens are synthesized in the ovaries and adrenal cortex.

clozapine
Olanzipine
Risperidone
Quetaipine
Ziprasidone
Aripiprazole

they are alphabeta dimers

the alpha units is common to hCG, TSH, FSH, and LH

the beta subunit confers biological specificyt

This 5'deiodinase is not targetable by PTU.

imipramine

rod shaped long axis twice as great as short acess

form of vitamin D

prolactin

NSAIDs
corticosteroids

systemic autoimmune process causing sever chronic synovitis leadin gto destruction adn ankylosis of affected joints

can be caused by initial infection

shock
ARDS
acute renal failure
DIC,
pleural effusion
jaudince
hypcalcemia/hypomagnesemia
acidosis(lactic and diabetic ketoacidiosis)

replacement therapy in primary deficiencies and gentic enzyem deficieencies

anti-inflammatory-cortisol(glucocorticoid)

immunosuppressive therapy- cortisol, used mainly in allergies and asthma

diagnostic purposes

gout may be suspected but cannot be proved without uric acid crystals in the synovial fluid or phagocytized by WBCs

dipeptide linked together by two disulfide bonds

binds to a multiprotiene hormone receptor complex that binds thyroid homrone response elements(TREs) in target genes

flumazenil works rapidly to block receptors that benzos target

1 above the waste 2 is genital

c. For synthesis of androgens from cholesterol, functioning 17-hydroxylase and 3-hydroxysteroid dehydrogenase are needed (also cholesterol desmolase and 17,20-desmolase). Adrostenedione is synthesized in the adrenal cortex (zona reticularis) and converted to testosterone in the testis.

i. Blocks 5-HT2, D2, and alpha receptors
ii. Side effects include somnolence, orthostatic hypotension, hyperglycemia, and obesity.
iii. Lowers seizure threshold.
iv. Agranulocytosis may occur.

stimulates ovarian follicular development
increases estradiol output
promotes matureation of ovum
induces LH receptors

T3 is hormonally active but T4 is probably just a prohormone that is converted into T3.

T4 comes exclusively fromt eh thryoid gland

T3 also comes from peripheral deiodination of T4

Treating anathyroidal individuals with T4 will give near normal levels of T3

block reuptake of norepinephrine and serotonin

rhabdomyosarcoma, primitive neuroectodermal tumor(pnet)

Doxercalciferol (trade name Hectorol) is drug for secondary hyperparathyroidism and metabolic bone disease.[1] It is a synthetic analog of ergocalciferol (vitamin D2). It suppresses parathyroid synthesis and secretion.[2]

adrenocotiocotrophic homrone(ACTH_

allopurinol

joints are red, painful, warm, and over time less mobile

pancreatic abscess
pancreatic pseudocyst
duodenal obstruction
hyperglycemia, hyperlipidemia
chonic pancreatitis 75% progress if reccurrent.

4x the activity or glucocoticoid
with only .5 the effect of mineral corticoid.

Examination of the synovial fluid under polarized light may not always reveal uric acid crystals in gout. The crystals may be sparse, or they may be deposited in soft tissue, and not present in the fluid at time of examination.

2alpha subunnits- act as actual receptor for insulin

2 beta subunits- these are tyrosine kinases that span the membrane and autophosphoralate in response to alpha subunit binding insulin they also phosphorylate insulin receptor substrate proteins(IRS)

when activated they bind to target genes and upregulate transcription

drugs with similar effects but slightly different structure

zolipidem

zaleplon

eszoplicone

extremely contagious AND no antibodies present so it is common for patient to spread disease to themselves in other location.

like the eye and this is the most common cause of infection induced blindness

SO DON'T TOUCH THE SORES YOURSELF OR OTHERS

d. Gonadotropin releasing hormone is secreted by the hypothalamus and causes release of leutenizing hormone and follicle stimulating hormone from the pituitary. LH and FSH work on the testis to stimulate testosterone production and spermatogenesis. Testosterone gives negative feedback to the hypothalamus and pituitary to suppress GnRH and LH/FSH secretion, respectively.

i. Blocks several 5-HT receptors, D2 receptors, and alpha receptors
ii. Side effects include somnolence, orthostatic hypotension, hyperglycemia, and obesity.

supports corpus luteal function
midcycle surge of LH leads to ovulation

T4 is limited to plasma while T3 can distribute to entire body water.

long half life 24-36 hours

usually only given once a day

polyhedral with abundant cytoplasm, nucleus is centrally located

Ergocalciferol is a form of vitamin D, also called vitamin D2

TSH

Hyperuricemia can be caused by either under-excretion of uric acid by the kidney or overproduction of uric acid.
b. Urate crystals deposited in a joint are phagocytosed by synoviocytes, which then secrete inflammatory mediators, which attract and activate PMNs and MNPs.

mass of synovium and stroma with marked inflammation

after destroying cartilage, bridge of fibrous tissue forms btw bones, leain to immobility of joint(ankylosis)

seen in RA

serum and urine amylase elavated early(55-60kD)

serum lipase elvated later 72-96 hours nor in urine only serum

hypcalcemia

elvated WBC neutrophils

radiogrphic left sided pleural effusion, sentinel loop

presence of a extra double bond

Examination of stained sediment in which white blood cells are concentrated, under polarized light can increase the sensitivity of the test.

IRS proteins activate phosphotidylinositol 3 kinase pathway and the MAP kinase pathway.

upreg of carbs and lipid catabolism

stim of protein synthesis

net effect increases basal metabolic rate

is ambien
used as sedative-hypnotic
short term managment of insomnia

tirgeminal ganglion

a. Prior to puberty testosterone levels are low. At puberty, LH secretion increases and stimulates testosterone production in the testes (Leydig cells produce testosterone). Testosterone is required for spermatogenesis.
b. Follicle stimulating hormone binds to Sertoli cell receptors in the testes and stimulates spermatogenesis. Once this occurs, spermatogenesis can be maintained by adequate levels of testosterone.
c. In addition to the increase in testosterone that occurs at puberty, there are surges of testosterone during certain periods of gestation and infancy. The first surges of testosterone are important for development of primary sex characteristics (reproductive organs). The second surge during puberty induces the development of secondary sex characteristics (masculinization).

i. Blocks 5-HT and D2 receptors. Also blocks alpha-1, alpha-2, and H1 receptors with lower affinity.
ii. Sedation
iii. Dose-related hypotension/reflex tachycardia
iv. Hyperglycemia, obesity
v. May prolong QT interval with possibility of arrhythmias

estrogen
progesterone
androgens

T3- 1-2 days

T4- 6-7 days

everyone is different in the quality of their symptoms and the way they respond to them so you always have to start low and slowly work your way up

smooth muscle, schwann cell endothelial, epithelioid sarcoma

Teriparatide (Forteo, also available in generic form[1]) is a recombinant form of parathyroid hormone, used in the treatment of some forms of osteoporosis

FSH and LH

c. Acute gouty arthritis refers to an acute attack with pain, swelling, and redness of a joint.

rheumatoid factor

pseudocyst/calcifications, steatorrhea and diabetes mellitus

1x activity as a glucocorticoid
1x activity as a mineral corticoid

uric acid kidney stones. Urine is normally slightly acidic; possibly slightly more acidic in this diabetic patient increasing the chances of uric acid stone formation.

promotes cell growth and differentiation

critical role in brain development absence fo thryoid hormone during fetal/neonatal development = profound intellectual stunting

new class of hypnotics callled the pyrazolpryrimidines
short term managment of insomnia
prolonged use does not appear to cause tolerance

occurs less common than the cold sore type, similar presenation, but in the oral mucosa.
periodic crops of vesicles ulcers

a. Androgens have anabolic and androgenic effects. The androgen effects include the production of masculine characteristics. The anabolic effects include overall body growth, including increased protein synthesis and decreased protein breakdown.

i. Blocks DA, 5-HT, and H1 receptors
ii. Toxicity: marked somnolence, orthostatic hypotension, hyperglycemia, and obesity.

follicle-estrogen

corpus lueteum-estrogen/progesterone

stroma secretes androstenedione/testosterone

affecting binding proteins

inhibiting 5'deiodinatino of iodothryonines

transmitter pumps located in the presynaptic nerve terminal that actively uptake after release.

they metastasize to the lymphnodes. most sarcoma don't.

Teriparatide is a portion of human parathyroid hormone (PTH), amino acid sequence 1 through 34, of the complete molecule (containing 84 amino acids). Endogenous PTH is the primary regulator of calcium and phosphate metabolism in bone and kidney. PTH increases serum calcium, partially accomplishing this by increasing bone resorption. Thus, chronically elevated PTH will deplete bone stores. However, intermittent exposure to PTH will activate osteoblasts more than osteoclasts. Thus, once-daily injections of teriparatide have a net effect of stimulating new bone formation leading to increased bone mineral density.

if you use a stain for something the cells containing that substance will light up on the slide. this can be used to visualize the different cell populations in the ant. pit.

d. Chronic tophaceous gout refers to chronic deposition of monosodium urate in subcutaneous tissue, joints, cartilage, and renal parenchyma. Nodular masses (tophi) are deposited throughout the body.

IgM antibody against Fc portion of patients own IgG circulatinog complexes of IgM/IgG contribute to process but is not he sole factor in causatino

recurrent acute pancreatitis usually causesd by alcohol abuse or duct obstuction

10x GCC
125x MCC

diabetes

AKt-glucose/protein metabolism

PKClambda- lipid synthesis

thyroid also produces calcitonin via the parafollicular cells(c cells)

promotes absorption of calcium by skeletal system

inhibits resorption of bone by osteoclasts

lunesta
is the S-isomer of zopixlone
used for insomnia
no limitation on how long it can be used.

gingvia/hard palate

b. In most tissues, testosterone serves as a prohormone. Many tissues contain 5-reductase, which catalyzes the conversion of testosterone to dihydrotestosterone (DHT). The cytosolic androgen receptor exhibits a higher affinity for DHT than testosterone, and the DHT-receptor complex is more readily transported to the nucleus than the T-receptor complex

c. In the hypothalamus and pituitary, testosterone is the active steroid and is responsible for feedback inhibition.

i. Blocks D2, 5-HT2, and alpha receptors
ii. Toxicity
1. Somnolence, orthostatic hypotension, hyperglycemia, obesity
2. May prolong QT interval. There is a risk of sudden death, so the use of this drug is restricted to patients who fail other drugs.

all products feedback to inhibit the pituitary and hypothalmus

BUT at midcycle there is a LH surge even in the presence of high estradiol levels, this leads to ovulation

TBG-thyroxine binding globulin, binds t3 and 4

TBPA- thyroxine binding prealbumin binds T4 only

albumin- binds just about everything including T3 and T4.

bipolar
neuropathic pain
chronic insomnia
adhd
panic disorder
OCD

0-3 scale
resemblance to normal tissue- exact-1, identifiable-2, none-3

necrosis, none-0, <50%-1, >50%-2

mitosis/10hpf, <10-1, 10-20=2, >20-3

monoclonal antibody used to treat osteoporosis by targeting RANKL

ADH (vasopressin)
Oxytocin

b. Uric acid is freely filtered at the glomerulus. It also both reabsorbed and secreted in the middle segment (S2) of the proximal tubule. Reaborption is predominantly by the organic anion transporter family URAT-1. Net uric acid excreted is ~10% of what is filtered, meaning that most is reabsorbed.

anticyclic citrullinated peptide

trauma
autoimmune(sjogrens syndrome)
cystic fiborsis
idiopathic
pancreas divisum
hypercalcemia/hyperlipidemia
drugs
tropical pancreatitis
hereditary(AD)

30x GCC
0X MCC

Serum uric acid is the classical test for gout, but it has poor specificity and sensitivity.
90% with hyper-UA do not have gout (PV+ = 10%)
Serum UA may be normal at the time of an acute attack
Identification of monosodium urate crystals in the synovial fluid, especially if present within phagocytes, has the highest probability for the diagnosis of gout.
Gout may mimic septic arthritis & vice versa.
Arthrocentesis with adequate fluid for crystal analysis and culture is crucial to the diagnosis.

insulin binds insulin receptor
insulin receptor stimulates IRS
IRS stimulates PI3 Kinase
PI3 kinase stims Akt
Akt phosphoylates vessicles containing GLUT4 glucose channels
those vessicle insert the GLUT4 into the plasma membrane and increase uptake of glucose.

hypermetabolic state brought on by hyperthyroidism

Ramelteon
new hypnotic non benzo
activation of melatonin receptros
approved for chronic insomnia due to difficulty with sleep onset

no real side effects and it seems to work very well.

herpes that occurs by touching herpetic ulcer on fingers

b. Primary causes include genetic/chromosomal causes (i.e. Klinefelters syndrome) and direct damage to Leydig cells or seminiferous tubules.

i. Complex, unique mechanism that is thought to involve mixed agonist and antagonist activities at the D2 and 5-HT receptor subtypes.
ii. Toxicity
1. Somnolence, orthostatic hypotension, hyperglycemia, obesity
2. Weight gain may be less than other atypicals

growth development and maintence of primary and secondary sex characteristic

proliferation of the endometrium

increase uterine and tubal motility

watery cervical secretions

suppression of FSH

***************below are the pertinent side effects that estrogens cause medically

Na and water retention

increased in clotting factors(eps,. if orally given)

lipid alterations decreased LDL increased HDL decreased cholesterol

relative hyperthyroidism bc there will be an increase in the amount of free T3/4.

sedation helps all of them

2-3

bone softening diseases in children often due to deficiency or imparired metabolism of vitamin D, magnesium, phsoporus, or calcium.

excess sectrtion usually by an adenoma

organic anion transporter family URAT-1

postiive test of both anti-CCP and rheumatoid factor

presence of only anti-CCP may indicate early RA

rheumatoid factor alone is not really specific for RA, but can be useful if clear history is suggestive

sparing of islets
dilated ducts
fibrosis and atrophy
inspissated concretions within dilated ducts

presence of a florine

purines

endogenous insulin secreted into portal cirulation with about 50% destroyed in first pass through the liver before even reaching the majority of tissue. Only 30% is metaabilized by the kidney

injected insulin does not pass through the liver first and as such the kidney plays a much larger role metabolizing 60% of injected insulin.

diffuse gland hyperplasia related to graves disease
hyperfunctional multinodular goiter
hyperfunctional adenoma

ultrashortacting(thiopental)

short acting(secobarbital)

long acting(phenobarbital)

herpies hepatitis and encephalopathy. can be fatal

testerone-low
gonadotropin - high

***************

i. Schizophrenia
ii. Mania, schizoaffective disorder, Tourette’s syndrome
iii. Treatment of agitation and other symptoms of dementia
iv. Anti-emetic

everything is set up for fertilization

inhibits peripheral 5'deiodinase

orthostatics hypotension
anticholinergic effects
Diaphoresis(sweating) seen in low dose
sedation
cardiac tox
seizures
hypomania
yawngasm

4-5

hormone defcit usually bc of destructive proccess like ischemia, surgery, radiation, inflammation

i. Gouty nephropathy
ii. Obstructive nephropathy: acute intratubular crystal deposition leading to acute renal failure.
iii. Nephrolithiasis: kidney stones

Rheumatoid nodules
vasculitis-of the medium and small arteries

abdominal pain
nausea vomiting
weight loss/malabsorption
hyperglycemia
jaundice
fever and elvated amylase
steatoreahea

presence of florine and a extra double bond.and an extra methly group

tumor lysis
kidney failure
ingestion of high protein diet

5mins

graves disease 85%

binds to the GABA receptor-chloride channel complex

herpies type 1 in a patient with a concurrent skin disease like pemphigus or excema. the herpes virus goes crazy and cause small pox like eruptions that can be fatal.

enanthate or cypionate

i. Schizophrenia
ii. Mania, schizoaffective disorder, Tourette’s syndrome

develop of secretory endometrium
viscous, low volume cervical secretions
decreased uterine motility
thermogenic effect(1degree F increase)
suppression of LH release

inhibits 5'deiodination

secondary benifit when used to treat thyroid storm.

primary use is to treat the hypertension and tachycardia.

MAOIs-increased effects
direct aciting sympathomimetics-additive
indirect-acting sympathomimetics-additive
anticholinergic agents-additive
CNS depressants- this can lead to respiratory depression

6-8

visual feild deficit(bilarteral temporal anopsia)

elevated intracranial pressure

pituitary apoplexy(massive hemmorhage at the gland)

i. Drug induced hyperuricemia: diuretics (most common), aspirin (dual effect), ethambutal, L-dopa, cyclosporine, alcohol, nicotine
ii. Miscellaneous medical disorders: uncontrolled diabetes

usually cutaneous, can occur in viscera.

central fibrinoid necrosis surrounded by histiocytes and chronic inflammatory cells

often develop in area of trauma, often seen on back if you sleep on ur back

chonic is hypercalcemia-
acute is hypocalcemia-because of suponification of lipids that release free FA that bind calcium and magnesium

cortisol like mixed function

delta double bond derivatives

6 and 9 alpha fluorinated/ 16 alpha or beta substituted prenisolones

6 mg/dL in women & 7 mg/dL in men.
As levels increase over 8 mg/dL monosodium urate is more likely to precipitate in tissues.

fat, liver, muscle

brain can take up glucose just fine withou any insulin

pituitary adenoma
exogenous thyroid hormone intake
inflammatory conditions

same as benzos but more severe
CNS depression
cardivascular effects
induction of hepatic drug metabolizng enzymes

tolerance to most CNS effects overtime but no toleracne to respiratory depression
physical dependence

lipshit bodies

long acting testoserone esters

condition in the feamle reproductive tract are optimzed for implantation

Propylthiouracil(PTU)

iodinated contrast media(iopanioc acid)

Amiodarone(antiarrhythmic agent)

propranolol

pharmacologic doses of glucocorticoids

primary from anticholinergic and cardiotoxic actions

dysrhythmias
tachycardia
intraventricular blocks
complete atrioventreicular block
ventricular tachycardia
V-fib

keratins-rule out spindle cell sarcoma

melanin, hb45- rule out melanoma

s-100- neural, schwannoma

smooth muscle actin- smooth muscle

desmin-smooth muscle

cb34,31- vascular

functional
nonfunctional

i. Increased rate or purine synthesis due to an enzyme defect: decreased HGPRT or increased PRPP synthetase
ii. Increased rate of cellular turnover: myeloproliferative and lymphoproliferative disorders or cancer chemotherapy.

radial deviation of wrists and ulnar deviation of fingers

articular erosions, subchondral cysts, osteoporosis, and fibrous ankylosis are results of inflammation.

psuedocysts
congenital cysts(polycystsic kidney disease)
cystic neoplasm(<5%)

9 alpha flurocortisol
cortisone
corticosterone
11-deoxycorticosterone
aldosterone
cortisol

Men have higher serum uric acid levels than women and estrogen protects women (until menopause)

one of the effects of Insulin is protien synthesis. so no insulin = no protein and muscle building

abutp onset severe hyperthyroidism

stimulate prodcution of porphrin which leads to heme and stims cytochrome P450

coxsackie virus

lack of gonadotropins. This again may be a genetic abnormality (i.e. Prader-Willi syndrome) or may be due to hypopituitarism or decreased hypothalamus release of GnRH.

follicular phase-development
ovulation
leuteal phase-corpus leuteum

hypothyroidism

gastric lavage(rare)
ingestion of activated charcoal(only if not in intestines yet)

physostigimine

propanolol, lidocaine, or phenytoin-block the arythmic effects

lipoma(most common)

liposarcoma

they produce only one hormone. usually but can produce more

i. Mechanism: binds intracellular protein tubulin, preventing its polymerization into microtubules. This inhibits migration of leukocytes and phagocytosis, and inhibits the formation of leukotriene B4.

fibrinoid necrosis and peripheral palisading of histiocytes

serious cystadeoma-benign
muscinous cysademona
muscinous cystadenomcarcioma
solid-pseudoppallillary neoplasm(young female, benign)

all of them have either both GCC and MCC activity at equal or near equal levels or they are mainly MCC activity

Hypoxanthine-guanine phosphoribosyl-transferase deficiency
Primary idiopathic hyperuricemia (increased production & decreased excretion)

leptin-stims satiety

adiponectin- enhances insulin response

TNF-alpha- stimulates inflammation which promotes insulin resistance

earliest and most consiten features
increased cardiac output b/c of increased contractility and peripheral oxygen needs
tachycardia, palpitation, cardiomegaly, arrhythmias

lipid solubilty high will cross BBB, placental and into breast milk

rapid onset brief druation

children to young adults

test-low
gonad-low

*******

follicular phase

congential defect of thyroid
iodine deficiency
chronic autoimmune(hashimotos) thyroiditis
postablative

panhypopitutarism(secondary hypothyroidism)

hypothalmic problems(tertiary hypothyroidism)

takes weeks to months for onset start low and go slow give each amount a long time before assessing its function

reactive pseudosarcomatous proliferations(nodular pasciitis, myositis ossificans)

fibromatoses

fibrosarcoma

they do not produce hormone/hormones dont get released/homrones produced are not functional

can destroy surrrounding tissue leading to hypopituitarism.

abdominal discomfort, nausea, and diarrhea

usually aries in the skin of the ulnar area, elbows, occiput, and lumbosacral area. Soft tiusse locations include the lungs, spleen, pericardium, myocardium, heart valves, aorta

cystic fibrosis

aldosterone
11-deoxycorticosterone
corticosterone
9 alpha flurocotisol

Proliferative disease; incr. tissue turnover; rhabdomyolysis, tumor lysis

4%

wide staring gaze with lid lag
graves Ds with exopthalmos

seizure disorders
induction of anesthesia
insomnia

Acute outbreak of vesicles and ulcers throughout mouth accompanied by viral constitutional symptoms and cervical adenopathy and concomitant lesions on hands, feet and buttocks. Resolves and does not recur.

ii. Treatment should include treating the underlying cause of the hypogonadism if possible. Gonadotropins have been used, and adrogens are not added until the time of normal puberty. You want to slowly increase to mimic the normal surge of testosterone

LH sustains corpus

coprus release progesterone

progesterone inhibits LH

loss of LH cause death of corpus

cretinism
usually presents firist month after birth
manifests as jaundice, constipation, somnolence, and feeding problems

this can be hard to differentiate from normal behavior and since this can lead to major developmental concerns all infants are screened for T4 and or TSH levels

there are 9 equally effective ones selection is based on side effects.

dermatofibroma

mutation of gene encoding the alpha subunit of the Gs

acute gouty arthritis

morning stiffness
arthritis in three or more joints areas
arthritis of hand joints
symmetric arthritis
rheumatoid nodules
serum rheumatoid factor
typical radiographic changes(osteoporosis/subchondral cyst)

any four of the above

inhertied epithelial transport disorder
abnormal fluid secretion in exocrine glands, sweat, pancreatic respriatory tract, GI, and reproductive
extremely thick secretions
abnomral clearance and obstuctions

prenisolone
prednisone
6 alpha methylprednisolone.

Renal insufficiency
Diabetes mellitus (ketoacidosis)
Lactic acidosis
Lead intoxication
Drugs - salicylates, diuretics, alcohol
Many more

insulin

overactive sympthaetic nervous system
-tremors, hyperactivity, emotinoal lability, anxiety, inability to focus, insomnia

Resp. depre.
suicide
abuse
use in pregnancy bad
excerabation of intermittent prphyria
hangover
paradocial excitement
hyperalgesia

lacks gingivitis, has digital lesions, does not recur.

1. Virilizing effects in adolescent males and females – acne, hirsuitism, male pattern baldness, coarsening of the voice
2. Inhibition of spermatogenesis
3. Feminizing effects because testosterone is converted to an estrogen by aromatase enzymes in peripheral tissues.
4. Hepatic abnormalities – cholestatic hepatitis, hepatic adenocarcinoma
5. Changes in lipoprotein profiles (decrease HDL, increase LDL)
6. Increase in aggressive behavior (roid rage) can cause psychotic symptoms

progesterone is low, and estrogen is low as well as LH and FSH low.

all these are low so there is no feedback inhibition on pituitary. so it starts to amp back up its production and starts cycle over again.

protruding tongue
broad flat nose, wide set eyes
dry skin, coarse hair
imparied mental development
retarded bone growth/dentition
enlarged gland

SSRIs

skeletal-rhabdomysoarcoma

smooth- leiomyomas, leiomyosaromas

microadenoma-less than 1cm
macroadenoma ->than 1cm

iv. Because of the toxic effects, treatment of gout is largely switching to NSAIDs.

bone erosion is found in RA but not in lupus

recurrent pulmonary infections
bronchiectasiss
pancreatic insufficiency
steatorrhea/malnutrition
hepatic cirrhosis,
intestinal obsturction
male infertility

all have 4 to 5 x GCC activity with only 0.5 to 0.8x MCC activity

acute gouty arthirtis
gouty nephropathy

cardiovascular -atherosclerosis
infarcts and strokes
heart failure
periperal vascular disease

these are the leading cause of death in DM

vasodilated warm flushed moist trying to rid heat

graves disease with inlfitrative dermopathy

resp. dep.
coma
pinpoint pupils

coxsakie viral infection that presents with acute fever with small vesicles and ulcers, but is limited to the SOFT PALATE and PHARYNX as oppesed to hard palate and gingiva as in herpes.

1. Male pattern baldness
2. Virilizing syndromes in women (i.e. hirsutism)
3. Acne
4. Hyperplasia and carcinoma of the prostate
5. Male contraception

very carefully dont even get out of bed little movement at all can lead to increased temp. use of special thermometer

retardation of linear growth
delayed puberty
poor school performance

fatigue, lethargy, constipation
slowing of the central and muscular activity
decreased appetite, increased weight
deeper, hoarse voice
severe myxedema-doughy cool skin, enlarged heart, can lead to coma

as effecive as TCAs but do not cause hypotension, sedatino or anticholinergic effects, and does not cause cardiac tox

synovial sarcoma

a homogenous appearance of one cell type

atypial, hemorrhage, and necrosis may be present but dont imply malignancy

decreased reticulin network(black outlines) now only seen around vessels

normal pituitary histo is very diverse with different colors and glands this is not its all homogenous

indomethacin
naproxen
sulindac

occurs before age 16,
larger joints
absent rheumatoid nodules and factor, commonly positive ANA(antinuclear antibody)

most common lethal genetics disease affecting the caucasion populations

paramethasone
triamcinolone
dexamethasone
betamethasone

Quantitation of white blood cells is an important part of synovial fluid analysis, especially because it is the major basis for classification of an effusion as septic, inflammatory, or noninflammatory

blindness/retinopathy
neuropathy
renal failure

hypermotility, malabsoprtion, diarrhea

removal from the body
maintain adequate O2 supply to brain

no

androgen suppression, inhibitors of androgen synthesis, 5-reductase inhibitors, and androgen receptor antagonists.

all estrogens are synthesyzed from an androgen by the action of aromatase.

T4 and FT4I are low in all conditions that induce hypothyroidism.

death by overdose is extremely rare

lipomas

nonfunctioning

i. Mechanism: inhibits PG synthesis, inhibits urate crystal phagocytosis

RA with splenomegaly, and neutropenia due to sequesters neutrophils in the spleen

AR
chromosome 7
CFTR gene-cholorid channel
500 to 600 different mutations
clinical testing for most common 70
most common mutation is F508

all have 5-25x GCC with 0x MCC

Obesity, diabetes, and hypertension increase the risk factors for many disease.
Increased weight can contribute to arthritis
Acidosis and progressive renal disease in diabetics can contribute to under excretion of uric acid.
Hyperuricemia is also associated with the use of diuretics, especially thiazides, which are commonly used in the treatment of hypertension.

short term-
relieve hyperglycemia
overcome acute ketoacidosis

long term-
aim to decrease complications with good blood glucose control.

limited most by pt. compliance, requires multiple daily injetions and frequient finger sticking


limited by risk of hypglycemia

osteoporosis

nonselective CNS depressants
actions much like those of barbiturates
acute overdose resembles poinsing with barbiturates
avoid use during preg/lact

chloral hydrate

meprobamate

paraldehyde

secondary infection of varicella, with primary disease being chicken pox. shingles appear after immunity is weakened due to stress or another disease.

i. They are effective when used to counter muscle wasting due to various causes, such as muscle wasting due to anti-inflammatory steroid use. They induce a positive nitrogen balance in hypogonadal individuals.
ii. Use by athletes with normal gonadal function has not been proven to reliably increase muscle mass. There is often an increase in muscle mass seen in these individuals, but this may be due to increased aggressiveness leading to a greater training limit, rather than the steroids actually causing more muscle to form.
iii. Increased muscle mass is seen in well-trained athletes who use these, but not in a normal male.
iv. There may be a more beneficial effect in females
v. Double-blind studies have yielded both positive and negative results regarding use of androgens to increase muscle mass.

ovary primary source
adrenal secondary source-this is where men and postmenopausal women get estrogen from) they are secreted as androgen and converted peripherally to estrogen

in most cases it will be low, but it can be normal if T4 deiodination is able to compensate in this case T4 will be low and T3 will be normal pt still considered hypothyroidic even though they will be asymptomatic.

fluxetine

cured by simple excision benign

stalkeffect/lactotroph hyperplasia,

probenecid

sulfinpyrazone

ulcerative colitis
Sjogren syndrome(autoimmune disorder in which the glands that produce tears and saliva are destroyed, causing dry mouth and dry eyes)

vit. a, d e, and K

primary adrenal insufficinecy

Uric acid is the end product of purine (adenine and guanine) metabolism
Humans don't have uricase which converts uric acid to soluble allantoin

poor glucose control leads to problems with blindness/renal/neuro stuff but it does not increase mortatlity. there is some evidcence that suggest that tight glucose control (keeping blood glucose as low as normal population) has increased risk of hypoglycemia, and as a result may actually lead to increased mortality.

This means that its possible that you don't want to have glucose control be to tight or too loose. possilby best to keep glucose as slithglty above normal population but below level that can lead to the dangerous DM complications.

cardiac effects

sometimes its a failure to get into deep sleep. the sedatives will help pts get into stage IV.

pain often in the flank that is so severe that simpley brushing it with clothing can cause severe burning sensation

b. Androgens stimulate RBC development, both directly and indirectly. They stimulate the synthesis of erythropoietin by the kidney (indirectly increasing RBC production) and also directly stimulate elements in the bone marrow causing stem cell differentiation. Because of these effects, androgens are useful in treating various anemias.

LH stims theca cell to produce androstenodione(androgen)

the androgen floats over to a granulos cells which is stimulated by FSH to produces estrogen from the androgen.

TSH is high in primary hypothyroidism and usually results in a goiter

TSH will be normal or low in secondary or tertiary hypothyroidism.

acts on serotonin reuptake pumps to inhibit them and keep serotonin in the synapse longer

excitatory effect on CNS

1-2 cm, shallow, soft, mobile and painless mass

normally lactorphs want to produce tons of prolactin but that action is inhibited by dopamine released from hypothalmus if that is inhibited then lactotrophs will produce in excess

a. Mechanism: inhibit uric acid reabsorption, decrease urate concentration, decrease body pool of urate in patients with tophaceous gout.

nonerosive arthritis which involves two or more peripheral joints, and tenderness, swelling, or effusion

recurrent respiratory infection
treated with lung/liver/pancreas transplantation

replacement therapy with cortisol

30-40mg of cortisol (2/3 given in am and 1/3 given late afternoon)

cortisol usually supplies suffiecient glucocorticoid and mineralcorticoid activity but if additional MCC is needed

fludrocotisone is usually given

less than 7

elderly have bad reactions with hypoglycemia

Serum TSH
will be low in primary
will be elevated in secondary

benzodiazepines specifically Busprione

vesicular eruption followed by redness and ulceration. ALWAYS ALONG NERVE CLUSTER

usually in flank area but can aries in the head and neck along the trigeminal nerve cluster.

a. Testosterone is a poor drug. It exhibits a high first pass effect when given orally. When injected, it is rapidly absorbed and metabolized. It also has mixed anabolic and androgenic effects that cannot be separated out.
b. Synthetic manipulation of testosterone seeks to solve these problems.
i. Type B manipulation: 17 substitution (methyltestosterone)
ii. Type C manipulation: ring alteration (mesterolone)
iii. Type B and Type C manipulation allows drugs to be orally active. These drugs are not metabolized to testosterone proper. They can cause liver toxicity and liver cancer.
iv. Type A manipulation: 17 esterification (enanthate or cypionate)
1. This modification causes absorption of the drugs to be greatly delayed. They are injected weekly or monthly and are metabolized to testosterone proper.
v. Most preparations involve combinations of type AC or type BC changes.

can be made synthetic'
given parentally or nasally

cant take orally

TRH response is a test which measures TSH levels in response to TRH.

in primary hypothyroid TSH levels will be high in response to a dose of TRH

in secondary TSH levels will be low and flat even in response to TRH

in tertiary TSH levels will go up but only after a delayed response and will be low prior to dose. this is bc it takes some time for the pituitary to react to sudden TRH after going so long without it.

main use is depression

other uses- OCD,bulimia, premenstrual dysforic disorder.

variants with fibrosis, vessels, spindle cells, pleomorphic, encapsulated with mature fat cells

often can seem to be a dangerous tumor bc its histo presentation is so irregular but its totally benign

lactroph hyperplasion caused by tumor in the suprasellar compartment that compresses the stalk and prevent dopamine from getting down to pituitary.

GI irritation, hypersensitivity

neutrophils and fibrin enter the synovium, with perivascular mononuclear cell infiltrate in subsynovial tissue

termed proliferative synovitis

obstructive jaundice
pain
weight loss
anorexia,
acholic stools
courvoisiers sign-dialated GB palpable in RUQ
mirgratory thrhombophlebitis

all these symptoms are seen late

fludrocotisone

unlike many of the calcium-containing stones, are radiolucent.

type 1 diabetes
type 2 DM when diet alone or oral agents fail or during periods of illness or stress
gestational diabetes

TSH if secondary
Free T4 (used to confirm diagnosis)
Free T3 sometimes
increased radioactive iodine uptake

non-CNS depressant
does not cause sedation
has no abuse potential
does not inensify the effects of CNS depressants
anxiolytic effects develop slowly
well absorbed orally

stops at halfway mark becuase its following the nerve

methyltestosterone-typeB

mesterolone-type C

derived from natural, cant synthesize

not given orally, must be parentally

T4,FT4I
T3, FT3I
TSH
123I uptake- low in hypothyroidisms
elevated serum cholesterol(primary hypothyroidism)

elevated CPK and ALT

Pernicious anemia(autoimmune mediated hypothyroidism hashimotos)

excessive serotonin response.

it take the normal effects of serotonin and ampilfies them by factor of 10

very rare less than 2% of pt have this response, but it can be life threatening

marrow elements

most are macroadenomas
can be found with imunostain for PrL
serum PrL tend to correlate with size of adenoma

i. Mechanism: non-purine, potent, selective inhibitor of xanthine oxidase

arithritis negative for RF, but it is HLA-B27 positive

4th more common lethal cancer

illness or stress requires dose adjustment up to 2-3 timex nomral dose.

check for C-peptide

hyperthyroidism due to hyperfunctional diffuse enlarged thryoid

infiltrative opthalmopathy with resulting exopthalmos

infiltrative localized dermopathy-pretibial myxedema

dizziness
nausea
heachache
nervousness
lightheadedness
excitement

most are transient

almost always has eye invovlement. refer to opthamology immediately can lead to blindness

iii. Type B and Type C manipulation allows drugs to be orally active. These drugs are not metabolized to testosterone proper. They can cause liver toxicity and liver cancer.

most bound to proteins main protein is Sex hormone binding globulin. only 2% is free and available for action.

therefore there is a huge resouire for estrogens.

iodide supplementation
thyroid hormone suppliementation

2-72 hours usually within first 24

large, deep

prolactinomas 30% of all adenomas

well tolerated when there is allopurinol intolerance

occurs in males in the vertebrae and sacroiliac joints, follows an infection of adolescence.

codon 12 K-ras
inactivation of p16 and p53

21 hydroxylase defeiency

the rate of absorption: this affects duration of action and time till onset

normal is just wide staring gaze and lid lag but in exopthalmos eyes are bulging out.

erythromycin and ketoconazole and grape fruit juice interfere with oral absorption.

should have shingles shot which is 14 times stronger than chicken pox vacine

enanthate or cypionate

just like estrogen except its bound to coticosteroid binding globulin mainly

rarely seen in US since 1920 due to iodide added into salt.

you can get withdrawal syndrome, which has aggitation, and behavior changes. only occurs if stopped suddenly not seen if you properly taper down off dose

40-60 yo
large deep tumor

amenorrhea, galactorrhea, loss of libido, infertility,

diarrhea, nausea, vomiting, liver function.

triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis.

60% found in head

decreased cortisol leads to increased ACTH production until cortisol is high enough to produce inhibition. This causes adrenal hyperplasia and overproduction of all the products that dont require 21 hydroxylase.

self aggregation or binding to protiens like protamine

thickening of skin on anterior shins

antidepressants
-venlafaxine
-paroexetine
-escitalopram

necrosis in jaw

SEVERE pain. so severe and long lasting people commit suicide even after the outbreak is resolved due to continueing pain.

1. This modification causes absorption of the drugs to be greatly delayed. They are injected weekly or monthly and are metabolized to testosterone proper.

phase 1 oxidations
phase 2 conjucation with sulfates and glucuronides

endemic goiter

little risk if given in early pregnancy(may be some risk of teratogenesis, but not well documented)

main risk is when taken in late pregnancy it can lead to babies being born with serotonin syndrome

well differentieated, myxoid, round cell, and pleomorphic,

surgury and bromocripitine(dopamine style drugs that inhibit lactotrohps from secretion)

a. 6-MP and azathioprine are partially metabolized by xanthine oxidase. Inhibition of xanthine oxidase by allopurinol and febuxostat decreases metabolism of 6-MP and azathioprine, increasing the chance of toxicity.
b. There may also be interactions with oral anticoagulants and an increased risk of ampicillin-induced rash.

arthritis following GI infections

usually salmonella and shegella

antibodies against these infections become cross sensitive to antigen sources in the joinst

liver lung and bone

DEHP(androgen)

regular human insulin

autoimmune

propanolol to block the sympathetic response

antidepressants
-SSRIs
-Tricyclicls
-MAOIs

benzodiezepines- THIS IS FIRST LINE TREATMENT

acute necrotizing ulcerative gingivitis
also known as trench mouth.

v. Most preparations involve combinations of type AC or type BC changes.

urinary and fecal as conjugates

problem is not in the gland. its a defiency of iodine.

gland is enlarged so if you provide iodine you will actually cause massive surge in production which will cause hyperthyroidism.

serotonin syndrome(2-3%risk)
withdrawal if taken off to fast
neonatal effects when used late in preg
teratogenesis(only known for sure in animals)
extrapyramidal side effect(movement disorders)-seen in high dose and extended use
bruxism(clenched teeth) seen in most pt who are on it for long time
bleeding disorders
sexual dysfunction
weight gain

very hard to find the border because its a fatty tumor and the surrounding tissue is fat.

somatotroph cell growth hormone adenoma

>7mg/dL in men
>6mg/dL in women

seroneagtive spondyloarthritis that occurs mainly in the small joints of the hand and feet but may extend to larger joints

occurs in people with severe psoriasis rarely

invasion of the celiac axis

100mg/day of cortisol for 5days then reduced to replacemnt therapy levels.

rapid acting- fastest
short acting- second
intermediate acting- third
long acting- slowest

autoantibodies to TSH receptors
they bind and stimulate

SSRIs

anerobic, fusopriochetal bacterial infection.

a. Side effects of high androgen levels:
i. Virilizing effects: acne, hirsutism, male pattern baldness, coarsening of the voice.
ii. Inhibition of spermatogenesis
iii. Feminizing side effects
iv. Hepatic abnormalities, including hepatocellular carcinoma
v. Changes in lipoprotein profiles (decrease HDL and increase LDL)
vi. Increase in aggressive behavior

premarin and CEE

suppliment for a time with thyroid hormone to decrease enlargment then suppliment Iodine.

MAOIs- increased risk of serotonin syndrome
Warfarin-increased bleeding effects
TCAs and lithium- elevate levels of SSRIs and can lead to serotonin syndrome as well.

greater than 8 cm
nucleus present in nearly every fat cell
nuclear atypia in shape and larger size
presence of lipoblasts

40% with mutant GTPase defeicient alpha subunit of G protien Gs

freely filtered at glomerulus
both reabsorption and sectretion in proximal tubule

net uric acid excreted is 10% of that filtered.

ankylosing
rieters
enteritis associated
psoriatic

CA19-9-elevated in many types of GI cancer and 10% of caucasions lack the lewis antigen and do not produce CA19-9

CEA-also elavated in GI cancers as well as lung and breast, elvated in smokers, pancreatitis, cirrhosis and COPD

low cortisol
low aldosterone
slightly high DEHP

U100

20-40yo women

citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Clomiprmaine

Anterior gingiva are painful and swollen with punched out necrotic ulcers of gingival papillae. Foul odor. Sialorrhea. Fever, malaise and lymphadenopathy present.

b. High, prolonged doses of drugs that have a 17 substitution or a ring alteration can cause liver toxicity and hepatocellular carcinoma. (types B and C)

minutes to hours to be turned on and to be turned off

patients are quite sensitive to exogenous thyroid hormone due to decreased metabolic acitivy especially the elderly and those with CHF so full replacement dose is not given immediatedly but titrated up to.

SSRI

nonspecific marker of liposarcoma

nucleus is scalloped or indented in a fat cell.

this is found in many sarcomas found in fatty areas, but is useful to differentiate liposarcoma from lipoma

children before epphyseal closure-gigantism increased total body size

adults after epiphyseal closure-acromegaly

URATE-1

gonococcus, staph, strep, H influenza, gram neg coliforms.

tuberculous

lyme

viral

insulinoma

glucagonoma

somatostatinoma

normal cortisol an aldosterone

super high DHEA

subcutaneous injection or pump

regular insulin can be given IV for emergency

PTPN22, CTLA-4, HLA-DR3

used second line drug bc its less tolerated than the SSRIs

it is a trycyclic antidepressant

poor oral hygiene (plaque and calculus)

GnRH long acting- constant GnRH is inhibitory instead of stimulating

ketoconazole-blocks androgens synthesis at super high levels(higher than used in corticosteroid blocking) only mildly effective will lead to adrenal hyperplasia to overcome

finasteride- 5alphareductase inhibitor

cyproterone acetate/flutamide-androgen receptor blockers

androgen receptor blockers/5alphareductase inhibitors are both used in prostate cancer.

seconds to minutes to turn on and turn off.

thryoid secretes 80ug of T4/day

full replacement dose is 150-200ug/day in a 70kg male bc only 50-75% oral absorption.

must monitor regularly to ensure that dose is both adequet and not reaching toxic levels bc amount of replacement needed is directly related to severeity of deficit.

blocks uptake of serotonin and dopamine

well differentiated looks like fat, its well circumscribed, and hard to differentiate from lipoma

pleomorphic may not even look like fat cell tumor. It is often necrotic and hemorrhagic,

failure to suppress GH production with oral glucose is a very sensitive test for acromegaly

diuretics,
aspirin
ethamutal
L-dopa
cyclosporine
alcohol
nicotine

spread from nearby bone,

usually benign, hypoglycemia, elevated C-peptide and insulin distinguishes from injected insulin

11 beta hydroxylase

21 hydroxylase

ketoacidosis

other autoimmune diseasese

such as lupus, type I DM, pernicious anmeia, Addisons disease

must maintain drug and dose for 1-2 months to check for efficacy before switching takes a long time for these meds to work

necrosis of papillae, not common in children, the ulcers are only on the ginigiva. REALLY BAD smell.

gingival papillae=area between teeth

destroys seminefarious tubules inhibits speratogenesis also decreases sperm motility

the ones the have ethine addition to the 17 alph carbon. this prevents liver metabolism of them and allow them to survive first pass metabolism when given orally. normal estrogen will be almost entirely metabolized in first pass if given orally so they arent.

mestranol
quiestrol
ethyl estradiol

enlarged thyroid is needed to meet demands due to problem treat this with supplimentation of TH to maintian normal levels and take stress off gland so it can shrink back to normal.

major depression
panic disorder
OCD
PTSD
PMDD
social anxiety disorder

minimal effects on reducing seizures so not used alone in seizure pt but if seizure pt comes in with depression this could be a good drug to use.

non neoplastic lesions usually due to trauma physical or ishcemic

cushing disease

600mg

tuberculous infection arthritis with spinal invovlement

usually malignant, hyperglycemia, DM rash(migratory necrolytic erythema)

17alpha hydroxylase

insulin lispro, aspart, glulisine

T cell infiltration of retro orbital space

inflammaroty edema/swellling of muscles

extracellulary matrix compenets accumulate in space

increased adipocytes in area

all these things work together to increase pressure and take up space behind eye pushing it out

SSRI
benzos
other antidepressants
same stuff as with the other anxiety disorders

dental prophalaxis, and antibiotics
like penicillin
no antivirals

high FSH
normal LH
low T

17 ethinylestradiol

thyroid USP
Thyroglobulin USP

TRANSIENT AND RARE
headache
nausea
tremor
diarrhea
insomnia

RARE BUT LONGER LASTING
weight gain
agitation
sexual dysfunction

when used late in preg can lead to neonatal abstinence syndrome/neonatal pulmonary hypertension

can also cause nervousness

develop suddenly and grow rapidly(can develop over a week)

mimic sarcomas with hypercellularity , mitosis and primitive cells

include nodular fasciitis and myositis ossifiacans

cushing syndrome is any time a pt has high levels of cortisol

cushing disease is when that syndrome is caused by adenoma in the pituitary.

low does preferentially inhibits UA secretion causing hyperuricemia

high doses such as those used in treatment of inflammation preferentially causes inhibition of UA reabsorption causes hypuricemia.

follows skin infection, remitting and migratory, primarily occurs in the large joints

DM steatorrhea, gallstones, achlorhydria

masclinization

not low cortisol or aldosterone effects bc of the eventual adrenal hypertrophy

regular insulin

gross-diffusely enlarged thyroid

histo-hypertrophy and hyperplasia of follicular epithelial cells

crowding of colmnar follicular cells into irregular papillary folds

decresed colloid due to excess size of follicle cells

hyperplastic lymphoid tissue

endogenous. these are common bacteria of the mouth that only act up due to poor hygiene.

normal FSH
High LH
low T

they are teratogenic so you must make sure they are not pregnant when you give them.

especially diethylstibestrol.(DES)

they are cheaper but have major variability and safetly issues mainly with immune responses

MAOIs
pimozide

nodular fasciitis

myositis ossificans

Fibromatoses:
dupuytren contracture
peyronie disease
desmoid tumors

removal of the adrenals= loss of inhibitons of cortisol on ACTH= development of large adenomas= mass effects and hyperpigmentatino of skin.

HGPRT defiency

HGPRT is responsible for purine salvalge pathway.

may be due to direct infection or triggered by immunodifficency process like HIV.

chronic disorder of carbohydrate, fat, and protein metabolism, accompanied in most cases by a deficient or defective insulin secretory response to a carbohydrate load, with resultant hyperglycemia.

CNS effects drugs may produce euphoria

steroid diabetes-prediabetic may exhibit signs of clinical diabetes

skeletal effects- osteoporosis bc steroid decrease Ca absorption which leads to increased PTH stimulation of bone resorption.

increased infectivity- pt may need prophylacitc antibiotics

ulcers- may play a permisive role in ulcer developement(dont cause just make it easier for them to develop)

delayed wound healing

adrenal atrophy

NPH

low

erythema multiforme that affects the mouth, eyes, skin and genital mucosa.

phytoestrogens-soy flavones often taken as dietary supplement

DDT- not on market but still present in enrivonement as pesticide

bisphenol- found in some plastics

genistien- one of the soy derived phytoestrogens

synthetics

SSRI used in OCD much more often than depression

trauma-15-20%
Rapidly growing painful tumor of adults
volar aspact of forearm, chest and back
cellular, mitoitcally ative, plump immature fibroblasts

can be hard to distingihs from a sarcoma like fibrosarcoma

cured by simple excision.

ACTH is complexed to form preopiomelanocorticotropin(POCM) has a stimulatory effect on melanocytes

HGPRT deficicney accompanied by increased rate of purine synthesis de novo ie increased PRPP

increased rate of cell turnover; such as myeloproliferative and lyphoproliferative disorders and in cancer chemotherapy.

no antibodies can make it into the synovial fluid so if an infection occurs there it will rapidly proliferate and destroy the joint, septic joint disease is considered a medical emergency

insulin and C-peptide

adrenal atrophy may start after only 1 week of therapy

adrenal atrophy leads to impaired reactions to stress

insulin determir
insulin glargine-longest

intrinsic problem of thryoid
goitrous: Hashimotos, dietary iodine def, inborn errors of metabilism, medications

small thryoid-surgury, radiation, infiltrative disroder, genetic

cytotoxic T cell mediated, type IV delayed hypersensitivity reaction

interfere with gonadotropin release and susequent ovarian estrogen production

inhibit synthesis (aromatase inhibitors)

block estrogen receptors

desiccated powder from animal thyroid glands

contains .17 to .23% of organic iodide

bc of variabliliity in batches comercially available products are not bioassayed so potency is not know.

availabe in tablets containing 15-500mg of the powder

rapidely absorbed from GI tract
half life about 15hours
interacts adversely with MAOIs

trauma - 50%
seen in young athletes
metaplastic bone formation after about 3 weeks
early signs swollen and painful
later painless, hard well demarcated mass, may also miim sarcoma

not usually detected till the start causing neuro symptoms by mass effect

binds intracellaur protein tubulin prevents polymerazation into microtubules

inhibits migration of leukocytes and phagocytosis

inhibits the formation of leukotriens B4

hyperuricemia leads to precipitation of urate cystals in the joints

this causes compliment activation and phaocytosis by moncytes which release IL-1, TNF alpha, IL-6 and IL-8

This causes inflammation and swelling

Also neutrophils phagocytize the crystals and lyse bc they are unable to break them down or fully absorb them this releases lysosomal enzymes which further increase swelling and inflammation and tissue damage

fasting plasma glucose greater than 126mg/dL on more than one occasion

random PG greater than 200mg/dL plus classic signs/symptoms of DM(polyuria/polydipsia/polyphagia)

PG greater than 200mg/dL 2 hours after glucose load(normal 75-100)

Hb A1c> 6.5%

slowly titrated off of the steroids

recover from adrenal atrophy long term
if > 30mg/d for >4 weeks
or > 80mg/d for >2 weeks
there could be atrophy for over a year with needed supplimental GCC.

almost 1 hour till peak onset decent action at 15mins

with 2-3 hour duration

Hashimotos

recent herpes outbreak, medication, URI, lymphoma

often we don't know what the cause is but these are the ones we do recognize

clomiphene
tamoxifen

purified extract of pig thyroid

contains USP standard iodide content

it is bioassayed( potency is known)

available 15-300mg tablets.

nausea
vomiting
constipation
weight gain
dry mouth
headache
sexual dysfunction

develop fast over a few weeks
occur after trauma
painful

null cell- generate no detectable hormonal product

nonsecretory variant= silent adenoma more common of the two hormone is being produced but no secreted

abdominal discomfort
nausea and diarrhea

idiopathic, alcohol and obesity enhances a genetic predisposition for hyperuricemia

adipose
striated muscle
liver

given acutely not long term
pt switch to alternate day dosing if possible with double daily dose

if dose is given like this adrenals do not atrophy stress repnse remains nomral and other side effets are decreased.

rapid or short acting injection prior to each meal, with one long acting taken at begining of day.

probelm of pituitary, TSH defcit

young adult males, with seasonal recurrence in spring and fall

anovulatory inhertility treatment
helps people get pregnant

originally created to be used as a contraceptive but ended up making people have twins and triplets instead!

levothyroxine

abnormal liver function in long term use

so you need to take regulary liver enzyme tests when on this drug long term.

adolescent athlete undergoes trauma, develops mass over a week or two, mass turns in to boney lesion, cured by simple excision

bone shows up on xray while soft tissue mass shouldn't

very very rare

must have demonstation of metastases to call it carcinoma bc necrosis atypia and all that occur in the adenoma

acute gouty arthritis

can be used profalcatively

associated with increased nucleic acit turnover such as hematologic diseases, drugs or renal failure.

Uric acid is the end product of purine metabolism so any process which increases the amount of purines being broken down can lead to hyperuricemia.

such things like tumor lysis syndrome in chemo therapy

increase glucose uptake
increase lipogenesis
decrease lipolysis

results from pituitary gland secreting excess ACTH(pituitary adeonma=true cushing disease not syndrome),

lipoddystrophy-atrophy of subcutaneous fat at injection site- rare now

allergy- rare now with pure insulins

hypoglycemia- main concern by far

problem with hypothalmus, TRH deficiency

very rare

Acute onset of debilitating, confluent oral ulcers producing bloody, crusted lips. Typically spares the gingiva. Skin lesions are red macules, papules, blisters and TARGETOID LESIONS of palms and soles. Resolves in 1 month.

useful fro the manegment of estrogen dependent cancers but it is being replaced by the aromatase inhibitors

L isomer of synthetic T4
sodium salt

paroxetine
can see effects a week or two instead of several weeks to months

dupuytren contracture-hand/foot mainly hand

peyronie disease- penis

all these may be called dupuytren contractures though its usually in the hand that are called this

75% must be gone before hypofunction occurs

inhibits PG synthetase, inhibits urate crystal phaogcytosis

tophi which are deposits of cystals in the tissue

decrease gluconeogenesis
increase glycogen synthesis
increase lipogenesis

i. R-A-A system: decreased blood volume  increased renin secretion  conversion of angiotensinogen to angiotensin I  angiotensin I is converted to angiotensin II by angiotensin-convering enzyme (ACE)
ii. Angiotensin II acts on the zona glomerulosa of the adrenal cortex to increase synthesis of aldosterone.

confusion, coma, seizure,and death most common in patient with very tight control

primary-high
secondary-low

spares gingiva, confluent slough, skine an dother mucosal lesions.

anastrozole
exemestane
Ietrozole

used in treatment of estrogen dependent cancers as well as just overall decreasing of endogenous estrogens.

selectie estrgen recepotr modulator

RALOXIFENE- SERMs are drugs that have a selective affinity for sublasses of estrogen receptors.

25-5--ug

it is an SSRI but it does not block recetpros for seotonin, acetlcholine, NE, or histamine.

we don't know how it works but is has simialar side effects including neonatal serotonin withdrawal/syndrome so we call it an SSRI

more frequent in males, cause contractions and masses, may recur aftger excision

sudden rapid enlargment of tumor which causes really bad headache, diplopia, hypopituitaritarim, and can even have sudden death

sudden enlargment caused by hemorrhage into the pituitary usually the result of damage from an adenoma

in acute gouty attacks

prefered over colchicine because of the side effects colchicine has

must see the crystals

increase glucose uptake
increase glycogen synthesis
increase protein synthesis

fat accumulation at the trunk

stress raises cortisol cortisol increases belly fat!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

sympathetic symptoms: increased HR, palpatations, sweating, hunger, and weakness.

rapid fall in BG detected by hypthalamus and leads to increased epinephrine production which promtes glycogenolysis

hypothryoidism which develops during infancy or early childhood

steroids

targets the bone estrogen receptors to prevent post menapausal osteoporosus, but it does not stimulate breast or uterine tissue which could cause increased risk for estrogen induced cancers.

more uniform preparation when compared to thyroid USP

provides large pool of T4 that can be converted to T3

missing a dose is not as serous as compared to supplementing T3

T3 serum profiles more uniform than with T3 administration(bc the body decided when to convert this to T3 and when to just keep it as T4)

S-isomer of citalopram

same as citalopram we dont know how it works bc doesnt block any of the reuptakes things

main difference btw this and citalopram is that escitalopram is better tolerated the side effects are less severe less common and last less time.

usually in women
abdominal wall/mesyntery most common but can occur elseware
hard to excise
reccurent

Sheehan syndrome

NSAIDs are prefered over colchacine due to GI side effects of colchacine

sometimes all the crystals have been deposited in these gouty tophi so none can be seen in the fluid aspirated.

however if patient has hyperuicemia and you have a flare up that looks very much like gout you can make a diagnosis of "presumptive gout" and then next time they have a flare up you will try again to find the crystals.

insulin- anabolic hormone, causes transmembrane transport of glucose and amino acids, and fromation of glycogen in liver and skeletal muscle
glucose conversion to triglycerides
decreases plasma glucose


glucagon-catabolic hormone, glycogenolysis, gluconeogenesis, ketogenesis, increases plasma glucose

autoimmune 70-80%

overdose, excerise, skipped meals

mainly caused by lack of dietary iodine

some cases result from inborn errors of metabolism or congenital developmental failure of the thryoid

lyle disease

progestin is name of class of agents and progesterone is the name of a specific molecule that is in that class (the main biologic one)

its not effective in people who can't convert T4 to T3 such as people with liver disease

venlafaxine
duloxetine

bland fibroblastic cells infiltrating btw skeletal muscle.

postpartum necrosis of the anterior pituitary secondary to sudden infarction b/c of obstetic hemoorhage/shock

inhibits migration of leukocytes inhibits urate cystral phagocytosis

useful in acute gouty attack

NSAIDs

in the urine

ketonuria

low dose dex turns off ACTH in normal pt

4x hither needed to turn off true cushing disease

if that is still not enough then you suspect cancer.

oral or IV glucose

impaired develpment of skeletal sytem and CNS

severe MR

short

coarse facial features

wide set eyes

large proturding tongue

umbillical hernia

skin falls off all over

from this you lose fluid and electrolytes constantly

extremely vulnerable to infection

often fatal

natureal-progesterone

semi-synthetic
medroxyprogesterone and derivatives

synthetic
19-notestosterones

because liver is main site of peripheral 5'deiodoninase.

block reuptake pumps for both serotonin and NE.

fish flesh consistency

carcinoma are usually hard

bc in pregnancy ant. pituitary is hyperplastic due to gearing up for elevated secretion of prolactin, but there is not increased blood flow to support this increased tissue. It is common to lose a lot of blood during delivery so the pituitary is the most vulnerable thing during this time it becomes ischemic and then necrotic.

naproxyn, and indomethcin

calcium pyrophosphate deposition in the joints

presents very similar to gout

is hereditary, sporadic of associated with trauma or surgyer, seen often in osteoarthritis

autoimmune destruction of beta cells in the pancreatic islets (insulitis) by T lymphocytes resulting in deficiency of insulin production.

blood sample from viens that directly drain pituitaries

CRH given and ACTH levels are measrued

compared with peripheral veinous blood.

if ACTH elevated due to cushings then petrosal will be higher than peripheral

if its due to peripheral tumor then it will be higher in the periphery.

reduced hypoglycemic response means less symptoms and pt may not recognize the need for treatment.

generalized hypothyroid state in the older child or adult

oral lesions
ocular lesions
gential lesions

19-nortestosterones

L isomer of synthetic T3
sodium salt

used in major depression, generalized anxiety disorder and social anxiety disorders.

basically its used for depression and anxiety instead of mainly depression like the SSRIs

unecapsulated, infiltrative, soft fish flesh, with hemorrhage and necrosis

enlarged, empty sell turcica lacking pituitary tissue

primary- anatomic defect in which CSF is able to leak into pituiatary space and compress it leading to hypopituitarism

secondary- surgury done that removes tumor and results in hole that allows CSF in.

inhibits uric acid reabsorption
decreases serum urate concetration
decreases pool of urate in pts with tophaccous gout
maintains large urine volume

crystals are rhomboid rather than needle shaped, and polarization is not the same.

knee most common site

HLA-D linked

cotisol excess
truncal obesity
buffalo hump
muscle wastin
steroid diabetes
bone demineralization
growth retardatin
CNS
Hypertension
delayed wound healing
hypokalemic alkalosis

hirsutism
amenorrhea

IV regular insulin
electrolyght and fluid replacement

progressive over time slowing of mental an physcial activity

fatigue, cold intolerance, apathy

periobital edema(NO EXOPTHALMIA)

coarsening of skin/facial features

cardiomegaly,

pericardial effusion,

fine hair/hair loss

accumulation of MPS rich ground substanc with dermis of all tissue(specifically the myxedema)

can be many different way erythemous
vesicular, ulcers, plaques etc

the main one is TARGETOID lesions
often seen on PALMS and FEET

....gestrels
.....drone
nore.....
norg......

norethindrone
norethyndodrel
norethindrone acetate
ethynodiol diacetate
levonorgetrel
di-Nogestrel
desogestrel
gestodene
norgestimate

5-50ug

serious reaction if combined with MAOIs

herringbone, high cellualrity, pleomoprhic with mitoses

supraoptic and paraventricular nuclei of the hypothalmus

must be able to maintain high urine volume otherwise all the UA that is secreted into the tubules may cause obstuctions or stones. you need high flow to keep the tubules clear.

ganglion lesion

baker cyst

ketoacidosis

removal of pituitary adenoma-surgical ressection or radiatino

exctopic acteh syndrome treated with aggressive ablation therapy

adrenl tumors- treated with adrenalextomy

symptomatic type 2 diabetes not controlled by diet alone, and pateint cannot or does not want to use insulin

myxedema is due to hypothyroid and is generalized

pretibial edema is in graves disease and is only in the pretibial region.

lyle disease it would encourage infection

increasing progestin potency and decreaseing androgenic effects as you get to higher and higher generations

4th gen drugs desogetrel and gestodene have high levels of cardiac negative effects than any of the prior gen drugs.

mixture of levothyroxine and liothryonine

4:1 mix

developed to mimic normal thryoid releases.

same the side effects of the SSRIs exept that they can cause hyponatremia as well mainly in elderly

bc of this you need to run electrolyte panels routinely on pts taken these.

aggressive-50% reccurrent
and 25% metastasizing

stims contraction of uterine smooth muscle in gravid uterus and cells of lactiferous ducts in mammary glands

no clinically recognized diseases that are affected by this.

start low and slowly increase

synovial cyst herniation of the knee usually associated with excess fluid

anti-islet auto antigen
anti-insulin
anti-GAD(glutamic acid decarboxylase)

o,p-DDD(mitotane)
-aminoglutethimide
-metyrapone

insulin secretagogues
closes beta cell potassium channels leading to depolarization and sitmulation of more insulin secretion.

inflammation of the thyroid gland

canker sores

chlormadinone acetate
megestrol acetate
medroxyprogesterone acetate

more closely resemble chemical progesterones.

hyperthyroidism

cardiac and neurologic effects

storiform/pinwheel appearance

poluria
polydispsia
hypernatremia

pt can pee freely
pt has no kidney stones
mainly used in tophous chronic gout not acute gouty attack.

small multicystic lesion of joint capsule or tendon ssheaths, arising from myxoid defeneration fo connective tissue

usually palpable yeilding, subcutaneous nodule of the wrist easily surgically treated.

appear years before onset of DM due to failure of self tolerance in T cells

pharm treatments focus on blocking cortisol production

however the problem is usually excess ACTH production

cortisol inhibits ACTH production so blocking cortisol actually increases ACTH production

This will lead to eventual hyperplasia and overcoming of the drugs to bring back the hypercortisol levels

also ACTH stims mineralcorticoids as well so super high ACTH during this treatement leads to increased androgen and MCC productions

so pharm treatment is only good as a temporary bridge till cause of cushing is established and fixed.

tolbutamide, tolazamide, chlorpropamide

fever chills, pain in neck, malaise

caused by several differnt organisms

smoking if you quite it can develop even later in life when its less common

pregesterone receptor antagonist
inhibits the uterine quieting effects of progesterone which leads to less ability to implant or maintain a pregancy

used as early term abortion pill.

graves disease
trophoblastic tumor
chronic thryoiditis

pituitary tumor(secondary)
nigestion of contaminated foods.

inhibits serotonin and NE and also weakly inhibits dopamine reuptake

this is the first drug so far that causes increase in all these neurtransmitters that are implicated in depression

facultative fibroblasts: makes collagen(fibro) and resembles phagocytic cells(histiocytics)

spontaneous
result of head trauma
tumors, inflammatory disorders or surgical procedures of hypothalmus/pituitary

probenecid
sulfinpyrazone

tenosynovial giant cell tumor.

almost 50%

risk is less if you don't have all three present

DDT

glyburide, glimepiride, glipizide

autoimmune disorder
that causes inflammation of the thyroid

20%

alone only 75% effective

usually given with a prostaglandin-prostaglandins direclty stimulate uterine contractions which in combo with mifepristone will cause abortion

graves disease.

it is the drug of choice in diabetec peripheral neuropathy.

it is also used in depression and OCD but its frontline in DPN.

common lesion of dermis and subcutis
usually mid life, simply excised
example is dermatofibroma which is benign which is the most common one

lack of ADH secondary to pituitary is central DI

when kidney doesn't respond to ADH its nephrogenic DI