Endocrine Flashcards
What (7) hormones does the anterior pituitary produce?
Growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, prolactin, melanocyte-stimulating hormone, follicle stimulating hormone, luteinizing hormone
What (2) hormones does the posterior pituitary produce?
Antidiuretic hormone and oxytocin
General adverse effects of pituitary medications
Development of allergy, headache, weakness, diarrhea, HTN, weight gain, Elevated LFTs,
What is antidiuretic hormone?
Hormone that enhances reabsorption of water in the kidneys.
What are Desmopressin acetate and Vasopressin?
They are antidiuretic hormones
What is Desmopressin acetate the preferred treatment for?
Diabetes Insipidus
What is vasopressin the preferred treatment for?
Septic shock
Side effects of antidiuretic hormones
Flushing, headache, nausea, water intoxication (basically electrolyte imbalance), HTN, nasal congestion
Signs of water intoxication
Drowsiness, listlessness, shortness of breath, headache
What are Somatropin, Norditropin and Mecasermin?
They are all growth hormone medications
What are Octreotide acetate, Lanreotide, and Pegvisomant?
They are all growth hormone receptor antagonists
What are thyroid hormones?
They are the hormones that control the metabolic rate of tissues and accelerate heat production and oxygen consumption
What kind of medications do thyroid hormones enhance?
Oral anticoagulants, sympathomimetics, antidepressants
What kind of medications do thyroid hormones decrease the efficacy of
Insulin, oral hypoglycemics, digitalis preparations
Special consideration for giving thyroid meds?
Must give at least 4 hours apart from multivitamins, aluminium hydroxide, magnesium hydroxide, simethicone, calcium carbonate, Sevelamer, lanthanum, bile acid sequestrants, iron, sucralfate
Side effects of thyroid hormone
Nausea, decreased appetite, abdominal cramps, diarrhea, nervousness, insomnia, sweating, heat intolerance, tachycardia, HTN, headache
When do we take thyroid medications?
Same time every day, in the morning, an hour before eating
Symptoms of hyperthyroid?
fast heart rate, chest pain, palpitations, excessive sweating
What are antithyroid medications?
These medications that inhibit the synthesis of thyroid hormone
Side effects of antithyroid medications
Nausea, diarrhea, drowsines, headache, fever, hypersensitivity, alopecia, hyperpigmentation, agranulocytosis, leukopenia and thrombocytopenia
What are Methimazole, Propylthiouracil, Potassium iodide and strong iodine solution
They are anithyroid medications
What are levothyroxine sodium, liothyronine sodium and liotrix?
They are thyroid hormones
What is iodism?
- What are the signs of this?
Too much iodine in the body, usually caused by prolonged use of strong iodine solution
- vomiting, abdominal pain, metallic/brassy taste in your mouth, rash, sore gums and salivary glands
Do we take antithyroid meds with or without food?
We take them with food to avoid GI upset
What is thyroid storm?
- What are the symptoms?
It is an acute exaccerbation of hyperthyroidism.
- fever, flushed skin, confusion, behavioural changes, tachycardia, dysrhythmias, signs of heart failure
What is a side effect specific to Methimazole?
Agranulocytosis: Severe form of leukopenia that can lead to sores and infections
What is parathyroid medication?
They are medications that regulate serum calcium levels
What is hyperparathyroidism?
Syndrome that results in a high serum calcium level and bone demineralization
What is hypoparathyroid?
Syndrome that results in a low serum calcium level, increasing muscle excitability.
What cannot be administered with calcium salts?
Cannot administer digoxin, as it increases the risk of digoxin toxicity.
What cannot be administered with oral calcium salts?
Tetracycline hydrochloride as it redces the absorption
Name the (6) oral calcium supplements
Calcium acetate, calcum carbonate, calcium citrate, calcium glubionate, calcium gluconate, tribasic calcium phosphate
Name the (2) Vitamin D supplements
Cholecalciferol and Ergocalciferol
Name the (8) Biphosphonates and Calcium regulators?
Alendronate sodium, Calcotonin salmon, etidronate disodium, ibandronate, pamidronate disodium, risedronate sodium, tiludronate sodium, zoledronic acid
Name the (4) general medicines to treat hypercalcemia
Cinacalcet hydrochloride, doxercalciferol, calcitonin, paricalcitol
What vitamin enhances the absorption of calcium?
Vitamin D
Special considerations do we have to follow for taking calcium regulators?
Must take tablet whole, with water, at least 30 mins prior to eating and do not lie down for at least 30 minutes
When do we give calcium supplements?
We dont give any other medications within one hour of taking calcium supplements
What are mineralocorticoids?
Steroid hormones that enhance the reabsorption of sodium and chloride and promote the excretion of potassium and hydrogen from the renal tubules, thereby helping to maintain fluid and electrolyte imbalance
What is Fludrocortisone acetate?
It is a mineralocorticoid
Adverse effects of mineralocorticoids
Sodium and water retention, edema, HTN, hypokalmia, hypocalcemia, osteoporosis, weight gain, heart failure
With what must we take Mineralocorticoids?
With food or milk
What do Glucocorticoids do?
3
Affects glucose, protein and bone metabolism.
Alter the normal immune response and suppress inflammation.
Produce antiinflammatory, antiallergic and antistress effects
Adverse effects of glucocorticoids
Adrenal insufficiency, hyperglycemia, hypokalemia, hypocalcemia, sodium, edema, mood swings, moon face, buffalo hump, hirsutism, acne, fragile skin, GI irritation
What does dexamethasone decrease the effect of?
Orally administered anticoagulants and antidiabetic agents
What do barbituates, phenytoin and rifambin decrease the effect of?
Prednisone
When should we take glucocorticoids?
Best to take in the early morning with food or milk
What are the signs of Cushing’s syndrome?
Moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding, menstrual irregularities.
What are Androgens?
Medications used to replace deficit hormones or to treat hormone-sensitive disorders
What alternate effects do Androgens have?
Increase effects of anticoagulants, decrease serum glucose, increase risk of hepatic damage, avoided with prostate and breast cancer.
Adverse effects of Androgens
Maculine secondary sex characteristics, bladder irritation, UTIs, breast tenderness, gynecomastia, priaprism, virilism, edema, changes in libido
Name the (8) glucocorticoids
Betamethasone, Cortisone acetate, Dexamethasone, Hydrocortisone, Methylprednisolone, Prednisolone, Triamcinolone
Name the (10) androgens
Methyltestosterone, Testosterone pellets, Testosterone transdermal, Testosterone cypionate, Testosterone enanthate, Testosterone proprionate, Testosterone undecanoate, Testosterone buccal patch, Testosterone topical gel, Testosterone nasal gel
When should we take androgens?
Anytime with a meal or a snack
What do we assess for liver dysfunction?
Right upper quadrant abdominal pain, malaise, fever, jaundice, pruritis.
What are Estrogens?
Steroids that stimulate female reproductive tissue
What are Progestins?
Steroids that specifically stimulate the uterine lining
What are Estrogens and Progestins used for?
Stimulate the endogenous hormones to restore hormonal balance or to treat hormone sensitive tumors
What are contraindicated with Estrogens
Clients with breast cancer, endometrial hyperplasia, endometrial cancer, history of thromboembolism, pregnancy, lactation,
Contraindications of estrogen
HTN, gallbladder disease, liver and kidney dysfunction
Contraindications of Progestin
History of thromboembolic disorders, breast or hepatic disease
Side effects of Progestins and Estrogens
Breast tenderness, menstrual changes, nausea, malaise, depression, weight gain, edema, atherosclerosis, HTN, MI, thromboembolism
What are contraceptives?
Medications that contain a combination of estrogen and progestin or progestin alone
What specifically do contraceptives suppress?
Suppress ovulation, change cervical mucus making it difficult to make sperm enter
Contraindications of contraceptives
Avoid use with hepatotoxic meds, bromocriptine mesylate, anticoagulants, and tricyclic antidepressants
What decreases the effectiveness of antibiotics?
Contraceptives
Adverse effects of contraceptives
Breakthrough bleeding, excessive cervical mucus formation, breast tenderness, HTN, nausea and vomiting.
How long can it take for contraceptives to take effect?
May take up to a week for full effectiveness
How should the contraceptive patch be worn?
Worn for 3 weeks and then removed for 1-week. Using a new location each time.
What should be done if the contraceptive patch falls off?
If it is off under 24hrs then just stick it (or a new one) back on. If it is off over 24hrs then you must re-start a whole 4 week cycle.
How should the vaginal ring be worn?
Inserted and left for 3 weeks and removed for 1 week.
How long to contraceptives implants and depot shots last?
From 3 months to 5 years
What are fertility medications?
Medications that act to stimulate follicle development and ovulation in functioning ovaries and are combined ith human chorionic gonadotropin to maintain the follicles once ovulation has occured.
Contraindications of fertility medications
In the presence of primary ovary dysfunction, thyroid or adrenal dysfunction, ovarian cysts, pregnancy, or idiopathic uterine bleeding.
Side effects of fertility medications
Risk of multiple births, ovarian overstimulation, headache, irritability, bloating, nausea, uterine bleeding, ovarian enlargement, gynecomastia, fever
Signs of ovarian hyperstimulation
Abdominal pain, distention, ascites, pleural effusion
Name the (7) fertility medications
Chorionic gonadotropin, Clomiphene citrate, Follitropin alfa, Follitropin beta, Menotropins, Urofollitropin, Cetrorelix
What is insulin?
A hormone that increases glucose transport into the cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels
What are Oral antidiabetic agents?
Medications that stimulate the pancreas to produce more insulin, increase the sensitivity of peripheral receptors to produce insulin, decrease hepatic glucose output, delay intestinal absorption of glucose, enhance the activity of incretins and promote glucose loss through the kidney
What kind of oral antidiabetic agents can be used by type 1 diabetics?
Only the sodium glucose co transporter 2 inhibitors can be used by type 1 diabetics
What do we have to watch for with antidiabetic medication use?
We have to be aware that they can cause hypoglycemia abd that some medications may also mask the symptoms of this
Adverse effects of Sulfonylureas
- What happens if you take this with alcohol?
GI symptoms, dermatological reactions and hypoglycemia.
If combined with alcohol may cause a disulfiram-type reaction (flushing, tachycardia, nausea, thirst, vertigo hypotension).
Name the (3) Sulfonylureas
Glimepiride, Glipzide, Glyburide
When might additional insulin be needed for those on oral antidiabetic agents?
During times of increased stress, surgery or infection
When should Metformin be withheld?
When the patient is going to have a procedure with contrast. Usually, hold the 1 dose before and for 48 hours after.
How does insulin act?
Acts primarily on the liver, muscle and adipose tissue by attaching to receptors on cellular membranes and facilitating the passage of glucose, potassium, and magnesium
Who is prescribed insulin?
Type1 diabetics and type 2 diabetics whose blood glucose is nt adequately controlled by oral antidiabetic agents
Where are the main insulin injection sites?
- which site has the most even absorption
Abdomen, arms, thighs and hips
- The abdomen may absorb more evenly and quickly than the other sites
How would a patient use the systematic rotation method of insulin injection?
This means that if the patient uses only one anatomical area for insulin injection they shouldnt be injecting into exactly the same spot for 2-3 weeks. (Just make sure that they are using different spots in the same anatomical region).
What concentration is insulin in?
All insulins are concentrated 100units/ml.
Humulin R does come in a special concentrated 500 units/ml formulation.
What is the gauge and length of an inuslin needle?
The syringes are usually 27-29 gauge and 0.5inch long
What is the most common biguanide medication?
- What is it’s action
Metformin is a Biguanide medication
- This decreases glucose production by the liver and increases tissue response to insulin
What is the mechanism of action for Second-generation sulfonylureas?
Promotes insulin secretion by the pancreas, may also increase tissue response to insulin
Name the (2) Meglitinides
Nateglinide and Repaglinide
What is the mechanism of action for Meglitinides
They promote insulin secretion by the pancreas
Name the (2) Thiazolidinediones
Pioglitazone and Rosiglitazone
What is the mechanism of action for Thiazolidinediones
Decrease insulin resistance, by increasing glucose uptake by muscle and adipose tissue and decrease glucose production by the liver.
Name the (2) Alpha-glucosidase inhibitors
Acarbase and Miglitol
Mechanism of action for alpha-glucosidase inhibitors
Delay carbohydrates digestion and absorption, thereby decreasing the postprandial rise in blood glucose
Name the (4) DPP-4 inhibitors aka Gliptins
Alogliptin, Linagliptin, Saxagliptin, Sitagliptin
Mechanism of action for Gliptins
Enhance the activity of incretins and thereby increase insulin release, reduce glucagon release and decrease hepatic glucose production.
Name the (3) Sodium-glucose co-transporter 2 inhibitors
Canagliflozin, Dapagliflozin, and Empagliflozin
Mechanism of action for sodium-glucose co-transporter 2 inhibitors
Increase glucose excretion via the urine by inhibiting sodium-glucose co-transporter in the kidney tubules, decreasing glucose levels and inducing weight loss via caloric loss through urine
Name the dopamine agonist antidiabetic medication
- What is it’s mechanism of action
Bromocriptine
- Activates dopamine receptors in the central nervous system. How it actually regulates blood glucose is unknown
Name the (3) Incretin Mimetics
Exenatide, Liraglutide and Albiglutide
Mechanism of action for Incretin Mimetics
Lowers blood glucose by slowing gastric emptying, stimulating glucose-dependent insulin release, suppressing postprandial glucagon release and reducing appetite
Name the Amylin Mimetic
- What is the mechanism of action
Pramlintide
- Delays gastric emptying and suppresses glucagon secretion, decreasing the postprandial rise in glucose
What is the onset, peak and duration for Insulin Lispro
Onset: 15-30 mins
Peak: 30 mins - 2.5 hrs
Duration: 3-6 hrs
What is the onset, peak and duration for Insulin Aspart
Onset: 10-20 mins
Peak: 1-3hrs
Duration: 3-5hrs
What is onset, peak and duration for Insulin Glulisine
Onset: 10-15 mins
Peak: 1-1.5hrs
Duration: 3-5hrs
What is the onset, peak and duration for Regular Insulin
Onset: 30-60 mins
Peak: 1-5 hours
Duration: 6-10 hours
What is the onset, peak and duration for NPH Insulin
Onset: 60-120 mins
Peak: 6-14hrs
Duration: 16-24 hrs
What is the onset, peak and duration for Insulin Glargine
Onset: 70 mins
Peak: none
Duration: 18-24hrs
What is the onset, peak and duration for Insulin Detemir
Onset: 60-120 mins
Peak: 12-24hrs
Duration: varies
Before administering cloudy or NPH insulin what must you do?
We must roll the bottle between out hands to mix the suspension (do not shake as this causes bubbles)
What is the rule for drawing up two insulins in one syringe?
We MUST draw up the shortest acting insulin first.
Put air in both vials, draw up short, draw up long
How long within mixing two insulins must we administer them?
We have to administer the mixed insulin within 5-15 mins otherwise the short-acting binds to the long reducing its action
What are Glucagon-like peptide receptor agonists (aka Incretin Mimetics)
They cause the same effects as the incretin hormone in the body. Restore first phase insulin response, lower the production of glucagon after meals, slowing gastric emptying, reduce fasting and postprandial blood glucose levels and reduce caloric intake, resulting in weight loss.
Who uses glucagon-like peptide receptor agonists
Type 2 diabetics who are not taking insulin
How are Exenatide, Liraglutide and Albiglutide administered?
Exenatide: injected BID within 60 mins before breakfast and dinner. (do not give after meals, if missed wait until next dose.
Liraglutide: Injected once daily regardless of meals
Albiglutide: Injected once weekly
Special consideration for non-insulin injectable medications
Should give other oral medications an hour before injection as it causes delayed gastric emptying.
What is an Amylin Mimetic?
Synthetic form of Amylin, a hormone secreted by the pancreas
How is Pramlintide given?
Injected before meals to lower blood glucose after the meal, leading to less fluctuation during the day and better long-term glucose control.
Special considerations for Pramlintide
Must give other oral medications 1 hour before or 2 hours after the injection as it causes delayed gastric emptying.
What is glucagon?
Hormone secreted by the alpha cells in the islets of Langerhans that increases blood glucose levels by stimulating glycogenolysis in the liver.
What is Glucagon used for?
- How quickly does it begin to work?
Treats insulin-induced hypoglycemia when the patient is unable to ingest liquids.
- It begins to raise blood glucose within 5-20 mins
