46. Endocrine Flashcards
What regulates the endocrine system?
negative feedback loops
5 hormones released from the anterior pituitary
- growth hormone (GH)
- thyroid stimulating hormone (TSH)
- adrenocorticotropic hormone (ACTH)
- follicle stimulating hormone (FSH)
- luteinizing hormone (LH)
2 drugs made in the hypothalamus and stored in and released from the posterior pituitary
- antidiuretic hormone (ADH)
- oxytocin
growth hormone deficiency replacement drug
Somatropin
contraindications of somatropin
- corticosteroids (inhibits effects)
- malignancy (can cause growth)
side effects of somatropin
- arthralgias
- myalgias
- edema
- weakness
- glucose fluctuations (monitor)
- hypothyroidism (monitor)
adverse reactions to somatropin
- seizures
- intracranial hypertension
- secondary malignancy
most common cause and tx of acromegaly (GH excess in adults) or gigantism (GH excess in children)
- cause: pituitary tumor
- tx: radiation or medication (if radiation not effective)
somatostatin analogue that reduces GH effect
Lantreotide
How are growth hormone medications (somatropin and lantreotide) given?
by injection
What is the function of somatostatin that is released from the hypothalamus?
inhibits secretion of GH
side effects of Lantreotide
- N/V/D
- constipation
- ABD pain
- weight loss
excess ADH that causes fluid retention
syndrome of inappropriate antidiuretic hormone (SIADH)
sxs of SIADH
- fluid overload
- edema
- hyponatremia
tx of SIADH
- fluid restriction
- hypertonic saline (pulls fluids back into vessels)
- drug therapy
deficiency of ADH that causes large amounts of water to be excreted by kidneys
diabetes insipidus (DI)
sxs of DI
- severe fluid volume deficit (dehydration)
- electrolyte imbalances (hypernatremia)
tx of DI
Desmopressin acetate
most common cause of SIADH
small cell carcinoma of the lungs
ADH replacement medication
Desmopressin
contraindications of Desmopressin
- renal disease
- hyponatremia or hx of hyponatremia
side effects/adverse effects of desmopressin
- hyponatremia (monitor electrolytes)
- headache
- dyspepsia
- N/V
- seizures (due to electrolyte problems)
sxs of hyperthyroidism
- heat intolerance
- fine straight hair
- bulging eyes
- tachycardia
- increased BP
- diarrhea
- weight loss
- amenorrhea
sxs of hypothyroidism
- cold intolerance
- receding hairline
- extreme fatigue
- anorexia/lethargy
- constipation
- bradycardia
- weight gain
severe hypothyroidism (can be life threatening) with facial swelling, memory loss, lethargy, slow speech, and emotional changes
myxedema
congenital hypothyroidism that results in delayed physical and mental growth
cretinism
medication indicated for primary hypothyroidism with or without goiter
Levothyroxine
MOA of Levothyroxine
- increases metabolic rate, O2 consumption, utilization and mobilization of glycogen stores
- promotes gluconeogenesis and body growth
- stimulates protein synthesis
contraindications for Levothyroxine
- thyrotoxicosis
- MI
side effects of Levothyroxine
- N/V/D
- anorexia
- cramps/tremors
- nervousness
- irritability
- weight loss
- diaphoresis
adverse reactions to Levothyroxine
- tachycardia
- hypertension
- osteoporosis
- thyroid crisis
- cardiovascular collapse
When is Levothyroxine supposed to be taken?
first thing in the morning on an empty stomach (food could interfere w/ absorption)
T/F: it is okay to switch brands of Levothyroxine
False; there is some variability in dosage between brands so stick with the same to get the same dose
2 mechanisms that raise serum Ca levels
- increased PTH secretion from parathyroid glands
- activation of vitamin D to increase intestinal reabsorption of Ca
how does PTH increase serum Ca
- decrease renal excretion of Ca
- increased intestinal absorption of Ca via vitamin D activation
- releaser of Ca from bone
excess secretion of PTH that causes increased serum Ca levels -> pulls Ca from bone and risk for osteoporosis
hyperparathyroidism
deficiency in PTH secretion which causes hypocalcemia; usually caused by damage to parathyroid gland (surgery or radiation)
hypoparathyroidism
vitamin D analogue medication used to treat parathyroid disorders and manage hypocalcemia in chronic renal failure
Calcitriol
MOA of Calcitriol
- enhances Ca deposits into bones by active form of vitamin D’s metabolite (calcitriol)
- increases reabsorption of Ca by kidneys and intestinal absorption
- decreases serum phosphate, bone resorption, and PTH levels
side effects of Calcitriol
early signs of hypercalcemia
- fatigue/weakness
- somnolence/drowsiness
- headache
- N/V/D
- cramps
- dizzy/vertigo
- metallic taste
- constipation
- xerostomia
adverse effects of Calcitriol
late signs of hypercalcemia
- anorexia
- photophobia
- dehydration
- cardiac arrhythmias
- HTN
- sensory disturbances
- hypercalcemia/hypercalciuria
- hyperphosphatemia
What is the class and indication of Alendronate
- class: bisphosphonate
- indication: osteopenia/osteoporosis
MOA of Alendronate
inhibits bone resorption via action on osteoclasts
Side effects of Alendronate
- bone pain
- acid reflux
- upset stomach
Adverse effects of Alendronate
- avascular necrosis of the jaw
- spiral fractures of the femur
- duodenal ulcers
Nursing notes for Alendronate
- must take on an empty stomach w/ water and remain upright for 30 minutes after taking (lower ulceration risk)
- limited to 5 years of use
- report jaw or thigh pain and notify provider before dental work
symptoms of Addison’s disease (adrenocortical insufficiency)
- bronze pigmented skin
- hypoglycemia
- postural hypotension
- weight loss
- weakness
- changes in hair distribution
symptoms of Cushing’s disease (adrenocortical excess)
- hyperglycemia
- moon face
- buffalo hump
- purple striae
- bruises and petechiae
- Na and fluid retention (edema)
- gynecomastia in males
- osteoporosis
- increased risk of infection
Class and indication for Prednisone
- class: glucocorticoid
- indication: adrenocortical insufficiency or Addison’s disease
MOA of Prednisone
- suppresses inflammation, immune responses (humoral), and adrenal function
- has mild mineralocorticoid activity
contraindications for Prednisone
- untreated serious infections
- hypersensitivity
- varicella
side effects of Prednisone
- fluid/Na retention
- nausea and diarrhea
- ABD distention
- increased appetite
- immunosupression
- hyperglycemia
- purple striae, moon face, and weight gain
Adverse reactions to Prednisone
- angioedema
- cardiac arrhythmia
- osteoporosis/fractures (long-term therapy)
- cardiac arrest
- cardiomyopathy
- GI ulceration
Nursing notes for Prednisone
- don’t like to keep pts on long term
- should be tapered to prevent adrenal crisis
- don’t start when someone has infection
- monotor glucose levels
- make sure UTD on vaccines before starting
class for Fludrocortisone
mineralcorticoid
MOA of Fludrocortisone
- promotes Na retention and K and hydrogen excretion
- maintains fluid balance
adverse reactions of Fludrocortisone
- hypokalemia
- fluid imbalance
- fluid overload
- hypertension
Nursing notes for Fludrocortisone
- monitor I&O
- monitor serum Na and K
- monitor BP
T/F: Fludrocortisone will always be given with Prednisone
True; never given on its own
