Endocrine: ADH, TPH, SIADH, and DI Flashcards
ADH
What does this target?
Kidney tubules, collecting ducts –> controls permeability to water and water reabsorption
Arterial wall smooth muscle–> vasoconstriction
TPH-Discharge instructions
Report what?
Any post nasal drip or increased swallowing, which ma indicate CSF leak
TPH-Discharge instructions
What is the halo sign?
Light yellow color at edge of clear drainage that indicates CSF
TPH-Discharge instructions
HOB position?
Elevated
TPH-Discharge instructions
Avoid what?
Activities that raise ICP
*cough, sneeze, blow nose, brush teeth, tie shoe, bend at waist
TPH-Discharge instructions
If pt. can’t brush teeth then what do they do to keep mouth clean?
Dental floss, mouth rinse, lub jelly to lips
TPH-Discharge instructions
Decreased sense of smell is normal or abnormal?
Normal
TPH-Discharge instructions
What will the be on the rest of their life?
Vasopressing
TPH-Discharge instructions
Mouth or nose breathing?
MOUTH ONLY!
SIADH
Drug tx?
- Furosemide
- Phenytoin
- Demeclocycline
- Conivaptin and tolvaptin (vasopressin receptor antagonist)
SIADH
What does furosemide do?
Gets rid of water
SIADH
Why give phenytoin?
Inhibits release of ADH
SIADH
What does demeclocycline do?
Decreases renal tubule response to ADH so more water is excreted
SIADH
Who gets vasopressin receptor antagonists?
When hyponatremia present in hospitalized pts
*promotes water excretion w/o Na loss
SIADH
Examples of vasopressin receptor antagonists?
Conivaptin
Tolvaptan
SIADH
What is BBW with tolvaptan?
Rapid increase in serum sodium levels that can cause comp;actions death
If used for more than 30 days at high dose can cause liver failure and death
DI
ADH replacement or excretion?
Replacement
DI
What is the ADH replacement drug?
DDAVP (desmopressin acetate)
*give orally or intranassaly in metered spray
DI
DDAVP for mild issues?
1-2 sprays in 24 hr period
DI
DDAVP for severe?
2 doses 2-3x/d in 24 hr period
DI
SE of DDAVP nasal spray?
Ulceration of MM
Allergy
Sensation of tightening of chest
Lung inhalation
- if SE or URI occur, then oral or sq vasopressin would be given
- in severe, ADH would be given IM or IV
DI
What other drugs can be given beside DDAVP?
Vasopressin
ADH stimulants
Thiazide diuretic
DI–Nephrogenic
What drugs?
Thiazide diuretic
Amiloride
