Ch 50 Pituitary, Thyroid, Parathyroid Flashcards
What disease results from hyperthyroidism
Graves’ disease
If a persons PSH level is increased what type of disorder do you have
You have a thyroid problem
What are manifestations of hypothyroidism
Decreased BP decreased HR Decreased metabolism, resulting in wt. gain Lethargy Heat intolerance ..........levers thing slows down
What are manifestations of hyperthyroidism
Increased BP increased HR wt. loss Bulging eyes Cold intolerance Thinking slows down Insomnia
What are signs and symptoms of thyrotoxicosis ( thyroid crisis)
Tachycardia Fever Dysrhythmias HF flushed skin ....can lead to coma
What is true of hyperthyroidism
When you have hyperthyroidism some or all of the gland may have to be removed…supplemental hormones will be given for the duration of life
What is anterior pituitary gland dysfunction
Includes growth hormone deficiency and excess
What is posterior pituitary glad dysfunction
Major disorders are diabetes insipidus and syndrome of inappropriate ANTIDIURETIC hormone ( SIADH)
What is thyroid gland dysfunction
Hyper functioning or hypo functioning gland, misfunctions that may either be caused by a congenital defect or by a problem that occurs later in life
Parathyroid gland dysfunction
Hormone is a major regulator of serum calcium and phosphate
A decrease in serum calcium concentration is the dominant regulator of PTH, with a response rate of just a few seconds
A decrease in phosphate causes an indirect effect on PTH by combining with calcium and decreasing serum calcium concentrations
What are growth hormones prototype drug
Somatropin
What is true of GH deficiency
Growth hormone deficiency, leading to short stature, was initially treated with growth hormone injections extracted from the pituitary gland of cadavers.
Presently synthetic human GH ( rhGH), produced from recombinant DNA is available
rhGH is very expensive
What is Somatropin used for
It is used as long term replacement of inadequate endogenous GH secretion
How is Somatropin administered
SC, IM
Excreted in liver and kidneys
What is the pharmacodynamics of Somatropin
It stimulates cell growth and cellular mitosis, facilitates cellular uptake of amino acids for protein synthesis, and promotes use of fatty acids for energy
What are contraindications of Somatropin
Growth hormone in children with closed epiphyses
What are adverse effects of Somatropin
Headache HTN joint and back pain Peripheral edema Muscle aches Rhinitis
What are drug interactions of Somatropin
Anabolic steroids
Androgens, estrogens, or thyroid hormones may accelerate epiphyseal maturation
What can hypothyroidism develop from
Hypothyroidism may develop during Somatropin therapy
For patients who require chronic cycling peritoneal dialysis, when should they receive there doses of Somatropin
In the morning after there dialysis is completed
What may Somatropin therapy induce
It may induce insulin resistance
Be alert for the development of hip or knee pain and inform provider
What is an ongoing assessment of a person with Somatropin therapy
Evaluate thyroid function at regular intervals because hypothyroidism compromises rGH drug effects
Patients taking Somatropin should have what lab values monitored on a routine basis due to adverse effects of drug therapy
TSH
GLUCOSE LEVEL
Because Somatropin can cause hypothyroidism and glucose intolerance.
What two hormones does the posterior pituitary gland store
Vassopressin and oxytocin
They are produced in the hypothalamus. They are synthetic analogues of the naturally occurring posterior pituitary gland hormone.
Prototype: desmopressin
What does the posterior pituitary gland hormone desmopressin do
It manages central DI and nocturnal enuresis and maintains homeostasis in hemophilia A.
How is desmopressin administered
Intranasally
Orally
Parenterally IV or SC
What are adverse effects of desmopressin
Abdominal pain Transient headache Nasal congestion Nausea Rhinitis Facial flushing
What are drug interactions of desmopressin
Carbamazepine, chlorpromazine, and NSAIDS
How can maximize the therapeutic effects of desmopressin
Establish baseline values for wt., BP, electrolytes and urine specific gravity
Protect ADH solutions from agitation and temperature extremes
What can alter the therapeutic response of desmopressin
Alcohol
What are the Pharmacotherapeutics of levothyroxine, Synthroid
These drugs are used as a replacement therapy in hypothyroidism
It acts a replacement for natural thyroid hormone in hypothyroidism
What should a person be cautious of when taking Synthroid or levothyroxine
Be cautious of ppl on anticoagulants and ppl with diarrhea, it can exacerbate it.
Hold if HR is tachycardic because this med increases HR
GIVE 30 min before meals or 2 hr after, because food decreases absorption
If a person is tachycardic and has hyperthyroidism what med will you expect to give
Beta blockers
What can long term hormone treatment result in
Osteoporosis
What is Somatropin
A growth hormone
What is desmopressin
A posterior pituitary hormone regulator
What are anti thyroid compounds
They treat hyperthyroidism
What is the prototype anti thyroid hormone
Methimazole (MMI)
Propythiouracil
Iodine radioactive sodium iodine ( I-131)
What is needed for synthesis of thyroid hormones
Low doses of iodine is needed for thyroid hormone synthesis
What is MMI methimazole
Palliative treatments of hyperthyroidism/ inhibits the synthesis of thyroid hormone.
Administered orally, excreted in the kidneys, metabolized in the liver
What are adverse effects of methimazole
Hives, itching, fever, arthralgia, joint swelling, vertigo, drowsiness,nausea, vomiting, altered taste sensation.
What are drug interactions of methimazole
Beta blockers
Theophylline
Warfarin
What is Lugol
Presurgical solution of iodine prior to surgery
How can one minimize adverse effects of MMI therapy
Arrange for periodic blood tests to monitor hematologic and thyroid functions
Monitor bone marrow function
How many parathyroid glands do we have
4 parathyroid glands
What is the regulation of calcium do strictly to
The regulatio. Of calcium is due strictly to parathyroid glands
Paget’s disease
Softening of bones
Overactive bone formation
What are antihypercalcemic drugs
Antihypercalcemic drugs do not directly affect the parathyroid gland or PTH but rather inhibit bone reabsorption of calcium
Theses drugs are frequently used in Paget’s disease
Individuals with symptomatic disease experience bone pain and deformity, fractures, spinal cord compression, or cranial and spinal cord entrapment.
What is the prototype antihypercalcemic drug
Calcitonin Alendronate Etidronate Pamidronate Risedronate Tiludronate
Any time you see the suffix -nate, what does it mean
Parathyroid supplement
What is calcitonin used for
Treatment of symptomatic Paget’s disease
What are contraindications of calcitonin
Allergies to salmon
What are adverse effects of calcitonin
GI disturbances
Skin rash
Flushing of the face and hands
Nasal irritation or rhinitis if using nasal spray alternate nostrils
What are drug interactions of calcitonin
Calcium supplements
Antacids
Vitamin D
Theophylline
For Paget’s disease, how should calcitonin be administered
INJECTION
What does hypocalcemia lead to
Muscle tetany (severe Charlie horse)
What is an ongoing assessment of the administration of calcitonin
Calcitonin can cause the serum calcium level to drop, resulting in tetany and cardiac arrhythmias
If calcitonin salmon is given with calcium supplements, antacids, or vitamin D, What will happen
There is risk of HYPERCALCEMIA and therapeutic effect is decreased
What are antihypercalcemic drugs
Calcitonin (1,25- dihydroxyvitwmin D3, rocaltrol [ capsules, solution])
Calcijex ( parenteral)
Tell me what you know about vitamin D
Vitamin D Compounds regulate absorption of calcium and phosphate
Vitamin D is considered a hormone, although it is not a natural human hormone.
Vitamin D Metabolites control intestinal absorption of dietary calcium, tubular reabsorption of calcium from the kidney, and mobilization of calcium from the skeleton in conjunction with PTH
vitamin D is also involved in MG metabolism
Vitamin D works together with PTH and calcitonin to regulate calcium homeostasis .
What is calcitrol used for
Management of hypocalcemia
It is a fat soluble vitamin derived fro natural sources ( fish, liver oils) or from conversion of provitamins
What are contraindications of calcitriol
Given carefully to patients at risk for hypercalcemia or hypercalcuria
What are adverse effects of calcitriol
Weakness headache nausea vomiting
Dry mouth constipation bone pain
What are drug interactions of calcitriol
Thiazide diuretics
What should chronic dialysis patients avoid while on calcitriol therapy
Avoid magnesium containing antacids
