Endocrine Flashcards
What are corticosteroids?
hormones secreted from either the adrenal cortex or adrenal medulla (both in the adrenal gland)
What is aldosterone? What does it do?
A mineralcorticoid, it mainly maintains normal Na levels by causing Na reabsorption from the urine in exchange for K and H ions. This increase blood volume and pressure
Hypersecretion of aldosterone
primary aldosteronism, increased Na and water retention, muscle weakness d/t K loss
Addison’s disease
Hyposecretion of adrenocortical hormones, decrease blood Na, glucose, increase K, dehydration, weight loss
What are glucocorticoids?
- usually referred to as corticosteroids
- for glucose metabolism
- maintain adequat “fuel”
Chronic illness causes…
- long-term stress and cortisol
Cortisol causes…
- glycogen to glucose
- tryglycerides into fatty acids & glycerol
- muscle proteins into amino acids
- synthesis of more glucose and ketones for body fuel
- results in muscle weakness & atrophy
- poor healing
- immunosuppresion
dexamethasone indications
- contains glucocorticoids
- relieves inflammation
- treats some arthritis
- skin disorders
- blood disorders
- kidney disorders
- eye disorders
- thyroid disorders
- intestinal disorders (colitis)
- severe allergies
- asthma
acute, short-term stress causes…
- release of epi and norepi from adrenal medulla
catecholamines
- epi
- norepi
- dopamine
epi and norepi
- increase HR & BP
- fight or flight
- dilate airways to raise O2
- vasodilation to important organs
- vasoconstriction to less important
- may cause dry mouth, anorexia, pupil dilation, loss of peripheral vision
Prednisone
most common adrenal drug
Methylprednisone
most common injectable glucocorticoid, followed by hydrocortisone and dexamethasone
Betamethasone
for premature labor, accelerate fetal lung maturation
Glucocorticoid contraindications
- cataracts
- glaucoma
- PUD
- mental health problems
- DM
- serious infections (because of immunosuppression)
- septicemia
- fungal infx
- varicella
Glucocorticoid AE
- moon facies (extra fluid volume)
- hyperglycemia
- psychosis (roid rage)
Glucocorticoid caution
- HF (fluid retention forces heart to work harder)
- can cross placenta barrier
- can be secreted in breast milk
- cause fetal/infant abnormalities
Steroid psychosis
- confusion
- perplexity
- agitation
- within 5 days of initial treatment
- may develop hallucinations, delucsions, cognitive impairment
- exacerbated mental health problems
conditions exacerbated by glucocorticoids and what to look for in a health history
- diabetes
- dyslipidemia
- CVD
- GI disorders
- affective (mood) disorders
- osteoporosis
- sx of/exposure to infx
baseline measures to take before glucoccorticoids
- weight
- height
- bone mineral density
- BP
- CBC
- blood glucose
- lipid profile
glucocorticoids nursing implications
- don’t stop taking abruptly, taper off
- may need concurrent treatment for osteoporosis or high blood glucose
- monitor for adrenal suppression
Type 1 DM
- beta cells don’t produce insulin
- or if pancreas is removed
- synthetic insulin is needed
Type 2 DM
- 95% of all DM
- d/t lifestyle
- pancreas is worn out
- insulin resistence
- may need insulin if BG or A1C is high
Normal blood glucose
- fasting: 80-130 mg/dL
- but SHOULD be < 100 mg/dL
A1C
- glycosylated hemoglobin
- assess long-term BG over 3mo
- varies by age, healt
- generally < 7%
Insulin
- most type 1 treated with multiple prandial and basal insuloin or continuous infusion
Basal insulin
- long-axcting (glargine or detemir)
- or intermediate-acting (NPH)
Prandial insulins
- w/ meals
- rapid acting (lispro, aspart, glulisine)
- or short acting (regular)
Lon-acting insulin
- basal
- Detemir
- Glargine (lantus is one, which goes in by itself)
- steady release
- no peak action
- onset varies
- 1x or 2x a day
- do not dilute
IDDM
insulin dependent DM
Rapid-acting insulin
- bolus
- mimic natural insulins response to meals
- aspart
- glulisine
- lispro
- within 15 min of meal
Short-acting insulin
- bolus
- 30-60 min onset
- 30-45 min before meal
- more likely to cause hypoglycemia
