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NUR 326 Exam 3 > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

1
Q

Anterior Pituitary secretes 6 hormones; what are the two we are focusing on for class?

A

thyroid stimulating hormone
adrenocorticotropic hormone (ACTH)

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2
Q

Posterior Pituitary secretes what 2 hormones?

A

antidiuretic hormone (AKA Vasopressin)
oxytocin

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3
Q

Adrenal Gland: location and composition

A

sit on top of the kidneys
each gland is composed of an inner medulla and an outer cortex

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4
Q

Adrenal Medulla secretes what 2 catecholamines?

A

epinephrine
norepinephrine

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5
Q

Adrenal Cortex secretes what in response to ACTH? (3)

A

“the 3 S’s”
glucocorticoids (Cortisol) (SUGAR)
mineralcorticoids (Aldosterone) (SALT)
sex steriods (Androgens) (SEX)

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6
Q

Adrenocortical Hormone Disorders (2)

A

Cushing Syndrome
Addison Disease

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7
Q

Cushing Syndrome: Definition

A

a collection of S/S associated with hypercortisolism

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8
Q

Cushing Syndrome: Causes (3)

A

primary hyperdysfunction
secondary hyperdysfunction
exogenous steroids

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9
Q

Primary hyperdysfunction (Cushing)

A

disease of the adrenal cortex and adrenal cortex releases too much cortisol

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10
Q

Secondary hyperdysfunction (Cushing)

A

disease of the anterior pituitary gland, and causes release of too much ACTH, which results in too much cortisol production

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11
Q

Exogenous Steroids

A

Can cause Cushing Syndrome
used in the management of various diseases

prednisone and dexamethasone are MOST common cause of cushing syndrome in the US

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12
Q

Cortisol: Functions (4)

A

Raises blood sugar (opposes insulin)
Protects against the physiologic effects of stress
Suppresses immune and inflammatory processes
Breaks down protein and fat

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13
Q

Cushings: Clinical Manifestations (CM) (6)

A

with increased cortisol:

-Glucose intolerance, hyperglycemia
-HTN, capillary friability (ecchymoses)
-Muscle wasting, muscle weakness, thinning of skin, osteoporosis and bone pain
-Redistribution of fat to abdomen, shoulders, and face
-Impaired wound healing and immune response, risk for infection
-Mood swings, insomnia

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14
Q

Cushings: Drug Therapy

A

treatment depends on cause
-pituitary or adrenal tumor?: surgery or radiation
-exogenous steroids?: taper the drug slowly if possible
-2 drugs possible

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15
Q

Cushings: Drugs (2)

A

aminoglutethimide
ketoconazole

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16
Q

aminoglutethimide (Cytadren): Indication and MOA

A

for Cushings: temporary therapy to decrease cortisol production

blocks synthesis of all adrenal steroids

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17
Q

aminoglutethimide (Cytadren): Effects and SE

A

reduces cortisol by 50%
does NOT affect the underlying disease process

SE:
-drowsiness
-nausea
-anorexia
-rash

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18
Q

ketoconazole (Nizoral): Indication and MOA

A

adjunct therapy to surgery or radiation for Cushings

antifungal drug that also inhibits glucocorticoid synthesis

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19
Q

ketoconazole (Nizoral): SE and Safety Issues

A

MAIN SE: severe liver damage

Do NOT take with alcohol or other drugs that harm liver
Do NOT give during pregnancy (fetal thyroid damage)

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20
Q

Addison Disease: Definition

A

disease of the adrenal cortex that cause HYPOsecretion of all 3 adrenocortical hormones (cortisol, aldosterone, androgens)
* Most SEVERE effects come from the LACK of cortisol

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21
Q

Addison Disease: Etiology (3)

A

idiopathic
autoimmune
other

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22
Q

Addison Disease: Pathogenesis

A

adrenal gland destroyed
symptoms when 90% non-functional
ACTH and melanocyte-stimulating hormone (MSH) are secreted in large amounts

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23
Q

Addison Disease: EARLY CM (7)

A

anorexia
weight loss
weakness
malaise
apathy
electrolyte imbalances
skin hyperpigmentation

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24
Q

With Addison Disease, why do they appear tan (skin hyperpigmentation)?

A

MSH secretion- excess melanocyte stimulation

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25
Q

Addison Disease: CM: 2 Main Types

A

hypoaldosteronism
hypocortisolism

26
Q

Addison Disease: Hypoaldosteronism CM

A

hypotension
-decreased vascular tone
-decreased CO
-decreased circulating
blood volume
salt craving
-decreased Na levels
-increased K levels
-dehydration

27
Q

Addison Disease: Hypocortisolism CM (4)

A

hypoglycemia
weakness and fatigue
unsuppressed ACTH production
hyperpigmentation

28
Q

Addison Disease: Pharmacotherapy

A

Adrenal insufficiency requires lifelong corticosteroid replacement therapy
All patients require a glucocorticoid
-Hydrocortisone (Cortef)
-Prednisone
-Dexamethasone
Some patients require a mineralcorticoid
-Fludrocortisone
(Florinef)

29
Q

Addison Disease: what is drug of choice for AD?

A

Hydrocortisone (Cortef)
Has glucocorticoid and mineralcorticoid activity

30
Q

Addison Disease: Pharmacotherapy: Important Issues

A

Dosing mimics natural release of hormones
-timing is important-
CONSISTENT
-doses are small
NEVER abruptly stop therapy
Dose will need to be increased during stress
-example: infection,
surgery, trauma
-“3x3 Rule”: 3x usual
dose for 3 days
Always maintain emergency supply
Wear a medical alert bracelet

31
Q

Adrenal Crises: 2 Types

A

Severe Cushing Syndrome
Addisonian Crisis

32
Q

Pheochromocytoma: Definition

A

adrenal medulla disorder
90% of the time benign

rare tumor of the adrenal medulla that produces excessive catecholamines

33
Q

Pheochromocytoma: Risk Factor and Pathogenesis

A

young-middle age

SNS stimulation–> excessive release of epi, norepi

34
Q

Pheochromocytoma: CM (4)

A

HYPERTENSION: stroke risk
tachycardia
headache
diaphoresis

35
Q

Pheochromocytoma: Drug Therapy

A

*Principal cause of hypertension is activation of the alpha 1 receptors on blood vessels
Preferred treatment: surgery
Alpha-adrenergic blockers may be used (1):
-inoperable tumors
-pre-operatively to
reduce risk of acute HTN

36
Q

Pheochromocytoma: Drug

A

phenoxybenzamine HCl (Dibenzyline)

37
Q

phenoxybenzamine HCl (Dibenzyline): Indication and MOA

A

pheochromocytoma

long-lasting, irreversible blockage of alpha-adrenergic receptors

38
Q

phenoxybenzamine HCl (Dibenzyline): Drug Effects and SE

A

DE: lowers BP
SE:
-orthostatic hypotension
-reflex tachycardia
-nasal congestion
-sexual SE in men

39
Q

Antidiuretic Hormone (ADH)

A

Function: causes water retention via action in the kidneys
Released in response to high serum osmolality and/or hypotension

40
Q

ADH Disorders (2)

A

SIADH
Diabetes Insipidus

41
Q

SIADH: Definition

A

Syndrome of Inappropriate AntiDiuretic Hormone
An abnormal production or sustained secretion of ADH

42
Q

SIADH: Characterized by (3)

A

fluid retention
serum hypoosmolality and hyponatremia
concentrated urine

43
Q

SIADH: Etiology (4)

A

Malignant Tumors
-ex: small cell carcinoma
of the lung
(Adenocarcinoma)-
MOST common cause of
SIADH
Central Nervous System Disorders
-ex: head trauma, stroke,
brain tumors
Drug Therapy
-ex: morphine, SSRIs,
some chemo drugs
Miscellanous Conditions
-ex: hypothyroidism,
infection

44
Q

SIADH: Pathogenesis

A

increased antidiuretic hormone–> increased water reabsorption in renal tubules–> increased intravascular fluid volume—> dilutional hyponatremia and decreased serum osmolality

45
Q

SIADH: Osmolality

A

Serum Osmolality= LOW
Urine osmolality and specific gravity= HIGH
Serum Na= LOW
Urine output= LOW
Weight= GAIN
*Remember: pt. is retaining pure water without salt

46
Q

SIADH: CM (11)

A

Symptoms of HYPOnatremia:
-dyspnea, fatigue
-Neurologic: lethargy,
confusion, dulled
sensorium
-muscle twitching,
convulsions
-GI: impaired taste,
anorexia, vomiting,
cramps
Manifestation depends on severity and rate of onset of hyponatremia
Severe Symptoms: Na= 100-115 mEq/L–> IRREVERSIBLE neurologic damage

47
Q

Water Intoxication: Definition and Symptoms

A

When serum levels of Na become lower than what is INSIDE the cells
Cells SWELL
Symptoms: neurologic primarily–>confusion, lethargy, coma, death

48
Q

SIADH: Pharmacotherapy

A

Not the first line of treatment–> instead directed at the underlying cause: ex: discontinue offending medication, head trauma: might wait it out, etc.

Chronic SIADH= demeclocycline (Declomycin)

49
Q

demeclocycline (Declomycin): Classification and MOA

A

tetracycline broad-spectrum antibiotic

interferes with renal response to ADH

50
Q

demeclocycline (Declomycin): Indication and SE

A

chronic SIADH
antibiotic therapy

photosensitivity
teeth staining
NEPHROTOXIC

51
Q

Diabetes Insipidus (DI): Definition

A

A deficiency of ADH or a decreased renal response to ADH
Characterized by: excessive loss of water in the urine

52
Q

Diabetes Insipidus: Two Forms

A

NEUROgenic (Central)
NEPHROgenic

53
Q

DI NEUROgenic: Etiology

A

Neuro origin (Central DI)
CAUSE: hypothalamus or pituitary gland damage
Associated disorders:
-stroke, traumatic brain
injury
-brain surgery
-cerebral infections
Sudden onset
Usually permanent

54
Q

DI NEPHROgenic: Etiology

A

Renal origin
CAUSE:
-loss of kidney function
-often drug-related
(ex: Lithium)
Associated Disorders: CKD
SLOW onset
PROGRESSIVE course of disease

55
Q

DI: Pathogenesis

A

decreased ADH–> decreased water reabsorption in renal tubules–> decreased intravascular fluid volume–> increased serum osmolality (hypernatremia) AND excessive urine output

56
Q

DI: Osmolality

A

Serum osmolality= HIGH
Urine osmolality and specific gravity= LOW
Serum Na= HIGH
Urine output= HIGH
Weight= LOSS

57
Q

DI: CM (5)

A

polyuria
polydipsia
dehydration
others based on severity
-electrolyte imbalances
-hypovolemic shock–>
death

58
Q

DI Pharmacotherapy: NEUROgenic

A

synthetic ADH replacement
Desmopressin (DDAVP)

59
Q

Desmopressin (DDAVP)

A

NEUROgenic DI
synthetic ADH replacement, anti-diuretic effects
Delivery: nasal spray, PO, IV, SQ
SE:
-small doses: none
-nasal spray: nasal
irritation
-large doses:
hyponatremia, water
inoxication

60
Q

DI Pharmacotherapy: NEPHROgenic

A

thiazide diuretics
paradoxical effect:
-decreases polyuria
-increases urine
osmolality

61
Q

DI: D-I-L-U-T-E

A

Dry
I & O, daily weight
Low specific gravity
Urinates lots
Treat= desmopressin
rEhydrate

NUR 326 Exam 3 (11 decks)

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