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Pharmacology In Nursing > Drugs And The Endocrine System > Flashcards

Drugs And The Endocrine System Flashcards

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1
Q

Name the endocrine systems?

A

Pituitary glands, thyroid glands, adrenal glands, ovaries, kidneys

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2
Q

Explain thyroid disease

A 
Affects the CNS, CVS, metabolic rate
Symptoms:
Hyperthyroidism 
-anxious, nervous, tremor, insomnia
-hypertension, tachycardia, palpitations
-low grade fever, intolerance to heat, increased appetite, weight loss

Hypothyroidism

  • slow speech, lethargy, hyporeflexia
  • hypotension, bradycardia, anaemia
  • weight gain, low body temperature, intolerance to cold
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3
Q

Define goitre

A

Swelling of the neck due to increased thyroid gland

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4
Q

What happens in under active goitre?

A

1- not enough iodine, so insufficient T3/T4

2- disruption to the negative feedback

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5
Q

What happens in an overactive thyroid?

A

1- activation of the TSH receptors by antibodies (Graves’ disease)
2. Increase in size and function of thyroid gland

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6
Q

What happens in hyperthyroidism?

A

Graves’ disease autoimmune condition
Thyroid cells stimulated by auto-antibodies
Patients undergo remission
Treatment doesn’t cure but suppresses hyperthyroidism

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7
Q

What is the treatment for hyperthyroidism?

A

Carbimazole or propylthiouracil
Limit iodine intake
Long term treatment: surgery or radioactive
Iodined replacement therapy “block and replace”

UK: propylthiouracil reserved for patients who are intolerable to carbomazole

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8
Q

How does carbimazole work?

A

It inhibits the synthesis of thyroxine
Used for 4-6 weeks
Initially take 15-40mg daily until euthyroid the reduced dose

It’s absorbed through the gut , converted in the liver to its active form
Excreted via urine
Short 1/2 life

Active form is methimazole, accumulates in the thyroid gland agranulocytosis- bone marrow suppression presents as sore throat

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9
Q

What are the side effects of carbimazole?

A 
Nausea
Allergic rash/ itching
Agranulocytosis 
Insomnia 
Can transfer across placenta and in breast milk resulting in neonatal hypothyroidism
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10
Q

Explain hypothyroidism

A

Patients require thyroxine substitute (T4) If severe administer T3 via IV
T3 much lower half life-balance blood level

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11
Q

What drugs are used for hypothyroidism?

A

Oral thyroxine/ levothyroxine t4

IV Triiodothyronine T3

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12
Q

Why is calcium needed in the body?

A

Calcium is the main hormone for remodelling bones

The parathyroid hormone promotes calcium absorption from the kidneys

Calcitonin (C cells) inhibits osteoclasts and reabsorption from the kidneys and so reduce calcium levels

Calcitriol (vitamin d3) increases calcium levels by increasing bone mobilisation and increase reabsorption from the gut

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13
Q

What are the causes do hypocalcaemia?

A

Inadequate calcium intake
Deficiency in PTH or lack of vitamin d3
Renal problems

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14
Q

What are the symptoms of hypocalcaemia?

A 
Neuromuscular problems
Muscle cramps
Paraesthesia in extremities
Over time- mental deficiency 
Fits
Cataracts
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15
Q

What are the treatments for hypocalcaemia?

A

Calcium glucoronate IV infusion

Ergocalciferol (vitamin d)- can only be sued if kidney function is not compromised- or calcitriol

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16
Q

Why does hypercalcaemia need urgent attention?

A

Caused problems with the kidneys(stones), renal failure
Muscle problems- cardiac arrest
(Problems only last 2 days MAX)

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17
Q

What are the treatments for hypercalcaemia?

A

Bishops phoneys and calcitonin

18
Q

Explain the use of biphosphonates.

A

Used to treat osteoporosis
Oral administration
AA slows rate of bone growth and turnover so prevents calcium loss from bones
Patient must not eat within1/2 hour of taking the medication, as food prevents proper absorption

19
Q

What are the side effects of biphosphonates?

A

Abdominal pain
GI disturbance
Oesophageal problems

20
Q

Explain use of calcitonin.

A 
Usually from salmon-salmontonin
Expensive 
Short life
Ineffective with continuous use
Nasal spray or SC or IM
21
Q

Explain steroids in the body

A

Hormones
Can be given synthetically to treat for endocrine dysfunction or immune disorders
Most synthetic drugs have minercorticoid and glucocorticoid activity

22
Q

What does glucocorticoids do in the body?

A

Cortisol or hydrocortisone increase glucose mobilisation (gluconeogenesis)

23
Q

What does minieralocorticoid do in the body?

A

Aldosterone increase sodium retention and thus h20 retention, and potassium loss in DCT of the kidney nephron

24
Q

Where is steroids secreted from?

A

Cortex of adrenal glands

25
Q

Which drug is used to treat adrenal insufficiency?

A

Fludrocortisone

26
Q

Use of glucocorticoids?

A

Administered orally
Metabolised in liver
Used topically for eczema (h45 cream)
Given low does orally for Addison’s disease/ crisis-adrenal insufficiency

Higher dose for the reduction of information following acute allergy

27
Q

What are the four types of glucocorticoids?

A

Prednisolone- orally, acute asthma attack

Methylprednisolone- oral or parenterlly, not via GI tract, prevent rejection of transplant

Dexanethasone- orally or parenterally, high anti inflammatory action, treat cerebral oedema

Beclametasone- inhalation(brown inhaler), treat asthma

28
Q

What are the effects of oral glucocorticoids?

A

Hydrocortisone- low dose few adverse effects. High dose both glucocorticoid and minieralocorticoid effects

Dexamethasone: glucocorticoid systematic effect

Topical therapy minimised effects

Cushingoid features 
Oral thrush
Hoarseness 
Psychiatric reactions 
Risk of chicken pox
29
Q

What is the withdrawal plan?

A 
Gradual, If sudden can disrupt the negative feedback mechanism of ACTH/cortisol 
Low BP
Low Glucose
High potassium 
Low sodium
Steroid card
30
Q

What are the types of reproductive steroids?

A

Oral contraceptives
Hormone replacement therapy
Oestrogens
Progesterone

31
Q

Why use oral contraception?

A

Contains one or more female sex hormones, prevents conception. Blocks the normal process of ovulation and menstrual cycle

32
Q

What is the combined pill?

A

Inhibits ovulation
Taken for 21 days, stopped for 7
Uterine bleeding during withdrawal period

Absorbed lol orally
Metabolised by liver
Excreted in bile

Can be prescribed for dysmenorrhea (regulate menstrual cycle)
Reliable and reversible
Reduces PMT
High dose can be given as morning after pill up to 72 hours

33
Q

Adverse effects of the combined pill

A 
MI and Strokes risk increase in smokers 
Hypertension
Venous thromboembolytic disease - DVT/PE- high oestrogen preparation more risk p, increase clotting capacity of blood. Common with gestodene( new progesterone preparations)
Links to carcinomas cervical/ breast 
Headaches
34
Q

What is the mini pill?

A

Progesterone only pill
Alters the endometrium and cervical mucus to prevent implantation
Inhibits ovulation in 40% of women

Medroxyprogesterone- injection lasts 3 months or orally

35
Q

What are the effects of the mini pill?

A

Nausea
Vomiting
Breast discomfort

36
Q

What are the drug are the drug reaction?

A

Both combined pill and mini pill interact with hepatic enzyme inducers causing an increase in metabolism

Some antibiotics also have similar effect (amoxycillin, ampicillin, doxycycline) reduce the effectiveness

37
Q

When is HRT used?

A

Post menopausal women
Decrease in oestrogen levels and increase in LH/FSH
Cessation of ovulation

38
Q

What risks are involved in HRT?

A

CVD
Oestrogen levels in pills
Osteoporosis

39
Q

What does HRT treat?

A

Symptoms
Daily dose orally: oestrogens, oestrodiols
Flushes, long term use- breast cancer

40
Q

What are the hormone modulators?

A

Tamoxifen-treat breast cancer, prophylaxis in high risk patients
Oestrogen receptor antagonist reduce oestrogen levels

Clomiphene- fertility treatment, oestrogen antagonist, inhibits the negative feedback if FSH/LH, can result in multiple births

Somatatrophin-analogue of hGH, short stature children, turners syndrome or after pituitary surgery. IM OR SC. insulin resistance. Swelling, join pain, headaches

Oxytocin-PP- induce labour. Reduce post-Parton haemorrhage

41
Q

How is the endocrine system managed?

A

Hormones

Pharmacology In Nursing (11 decks)

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