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Pathopharmacology > Endocrine Meds > Flashcards

Endocrine Meds Flashcards

1
Q

What is the purpose of the Endocrine System?

A
  1. Maintain homeostasis
  2. Communicate body’s responses to external environment
  3. Regulates growth, reproduction, energy use & electrolyte balance
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2
Q

What body functions does the hypothalamus regulate?

A

thirst, hunger, water, BP, respiration, emotions

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3
Q

What hormones are produced/secreted by hypothalamus?

A
  1. GHRH
  2. TRH
  3. CRH
  4. PRH
  5. Somatostain (GH inhibiting factor)
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4
Q

What is the thyroid mechanism of action?

A
  1. Regulate activity of genes to change the amount of protein synthesis and enzyme activity
  2. Stimulate mitochondrial oxidation
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5
Q

What does iodine deficiency cause?

A

Hypothyroidism

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6
Q

If a patient had a goiter, what would be your major concerns?

A
  1. Is there airway compromised?
  2. Can the swallow?
  3. Are the nodules cancerous?
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7
Q

What are the causes of hyperthyroidism?

A

too much T3 & T4

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8
Q

What autoimmune disorder causes hyperthyroidism?

A

Grave’s Disease

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9
Q

What are the clinical manifestations of hyperthyroidism?

A
  1. Inc metabolism (which leads to weight loss)
  2. Tachycardia
  3. Increased body temperature (leads to heat intolerance)
  4. Anxiety
  5. Insomnia
  6. Shaky hands
  7. Exophthalmos (protruding eyes)
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10
Q

What is a late sign of hyperthyroidism?

A

Exophthalmos

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11
Q

Propylthiouracil and Methimazole are in what drug class?

A

Thionamides

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12
Q

What is the mechanism of action for thionamides (propylthioruacil & methimazole)?

A
  1. Block production of thyroid hormone (TH)

2. Block conversion of T4 to T3

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13
Q

What are the therapeutic uses for Propylthioruacil & Methimazole?

A
  1. Treats Grave’s Disease
  2. Attain a euthyroid state
  3. Treats Thyroid storm
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14
Q

How long does it take to reach euthyroid state when taking thionamides (propylthioruacil/methimazole)?

A

May take up to 3-12 weeks

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15
Q

What are some adverse effects of propylthioruacil/methimazole?

A
  1. Agranulocytosis
  2. Overmedication may cause hypothyroidism
  3. Liver damage (more common with PTU)
  4. Causes change in taste, N/V, rash, arthalgias
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16
Q

Nursing Interventions for Propylthioruacil/Methimazole

A
  1. Monitor weight/VS/I&Os
  2. Watch for S/S of hypothyroidism
  3. Monitor AST & ALT, jaundice, dark urine
  4. Monitor CBC for agranulocytosis/fever/sore throat
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17
Q

Patient Education for Propylthioruacil/Methimazole

A
  1. Take at same time each day

2. Do not stop medication abruptly

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18
Q

Why would a HCP prescribe Propanolol in conjunction with thianomides?

A

To decrease tremors and tachycardia

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19
Q

Why is Methimazole preferred over propylthiouracil?

A
  1. Revereses hyperthyroidism quickly
  2. Fewer side effects
  3. Given with radioactive iodine treatment
  4. Can be taken once a day
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20
Q

How often must propylthiouracil be taken?

A

2-3 days

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21
Q

What effect does thionamides have on anticoagulants?

A

Increases the effect of anticoagulants

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22
Q

What effect does thionamides have on antidiabtics?

A

Decreases the effect of antidiabetics

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23
Q

Explain the interaction between antithyroid drugs and digoxin/lithium?

A

Digoxin/Lithium increases action of thyroid medications

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24
Q

What effect does phenytoin have on T3 levels?

A

Phenytoin increases T3 levels, so must monitor closely

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25
Q

What patient teaching should the nurse provide if administer propranolol with thionamides?

A

Advise against strenuous activities/exercise to prevent HR increase until hyperthyroidism is regulated

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26
Q

How can Grave’s Disease be treated? What is the most common treatment?

A
  1. Surgical removal
  2. Radioactive treatment

Radioactive treatment most common.

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27
Q

What is the mechanism of action of radioactive iodine?

A

Destroys thyroid producing gland

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28
Q

What are the adverse effects of radioactive iodine?

A
  1. Radiation sickness
  2. Bone Marrow Suppression
  3. Hypothyroidism (may need long term Synthroid/levothyroxine
  4. Pregnancy Cat X
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29
Q

Nursing Interventions for Radioactive Iodine

A
  1. Monitor CBC
  2. Monitor for signs of hypothyroidism
  3. Do not administer with other antithyroid meds
  4. Dispose of body waste per protocol
  5. Limit client contact
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30
Q

Patient Education for Radioactive Iodine Treatment

A
  1. Increase fluid intake
  2. Stop treatment if there’s severe N/V
  3. Increase fluid intake
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31
Q

Clinical Manifestations of Thyroid Storm

A
  1. Extremely High Fever (T>105)
  2. Severe Tachycardia
  3. Agitiation
  4. Tremors
  5. Coma
  6. Hypotension
  7. HF
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32
Q

What causes severe thyrotoxicosis (Thyroid Storm)?

A
  1. Surgery

2. Development of concurrent illness

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33
Q

Nursing Interventions for patients with Thyroid Storm

A

Isolate for 2 weeks

34
Q

What causes Myxedema?

A

Prolonged hypothyroidism with no treatment

35
Q

What is Cretinism? What causes it?

A
  1. Congenital Hypothyroidism

2. Mother iodine deficiency during pregnancy

36
Q

Clinical Manifestations of Cretinism

A
  1. Large protruding tongue
  2. Pot Belly
  3. Dwarfish Stature
37
Q

Common S/S of Hypothyroidism

A
  1. Dry Skin
  2. Weight Gain
  3. Constipaiton
  4. Hair Loss
  5. Short stature (in kids)
38
Q

Purpose of Levothyroxine

A

Synthetic salt form of T4

39
Q

What is Levothyroxine used for?

A
  1. Hypothyroidism treatment

2. Emergency treatment of Myxedema Coma

40
Q

Adverse Effects of Levothyroxine

A
  1. Overmedication –> Hyperthyroidism
  2. Increases effect of Warfarin
  3. Dont give with Sucralfate (reduces effect)
  4. Use cautiously with cardiac patients
41
Q

Nursing Interventions for Levothyroxine

A
  1. Monitor VS and weight
  2. Administer before breakfast w/ water
  3. Check labels before using OTC
  4. Advise pt to report signs of hyperthyroidsim
42
Q

Patient Education for Levothyroxine

A
  1. Take missed dose as soon as you remember

2. Report signs of hyperthyroidism

43
Q

Purpose of Parathyroid Glands

A
  1. Secrete PTH

2. Regulate Calcium, Vit D, & Phosphate levels

44
Q

What is Hyperparathyroidism?

A

Excessive production of PTH

45
Q

What does an excessive production of PTH lead to?

A

Hypercalcemia

46
Q

What causes hyperparathyroidism?

A
  1. Osteroporosis
  2. Paget disease
  3. Renal failure
  4. Malignancies
47
Q

Clinical manifestations of Hyperparathyroidism

A
  1. Hypercalcemia symptoms (BACKME)
  2. Lethargy
  3. AV Block
  4. Hypertension
    4, Muscle weakness
  5. Osteoporosis
  6. Kidney Stones
  7. Excessive Urination
48
Q

Purpose of Calcitonin Salmon

A
  1. Balance effects of PTH
  2. Inhibits bone resorption
  3. Lowers calcium levels
  4. Increases Ca excretion
49
Q

Purpose of Alendronate

A

Slows/blocks bone resorption to lower Ca levels

50
Q

What drug class is alendronate in?

A

Biphosphonates

51
Q

What is the therapeutic use for Calcitonins & Biphosphonates?

A

Treat osteoporosis, Paget’s disease, hypercalcemia, and multiple myeloma

52
Q

What are the adverse effects of Calcitonins?

A
  1. Flushed face/hands
  2. N/V
  3. Urinary frequency
  4. Inflammation at injection site
53
Q

Nursing Interventions for Calcitonins

A
  1. Increase fluid intake
  2. Rotate injection sites
  3. Monitor serum calcium levels
  4. Treat bone pain with acetominophen
  5. Monitor Kidney fx
  6. Do not administer if fish/salmon allergy
54
Q

Adverse effects of Biphosphonates

A
  1. Headache
  2. N/D
  3. Initial bone pain
  4. Esophogeal erosion
  5. Femoral fractures (long term use)
55
Q

Nursing Interventions for Biphosphonates

A
  1. Contraindicated with hypocalcemia

2. Dont use if pregnant/breastfeeding

56
Q

Patient Education for Biphosphonate

A
  1. Take 30 min before breakfast with full glass of water
  2. Stay upright for 30 min after taking
  3. Only take for 3-5 years
  4. Avoid aspirin/antacids/Ca products/iron
57
Q

What causes hypoparathyroidism?

A
  1. Absent parathyroid from birth

2. Accidental removal upon thyroid removal

58
Q

S/S of Hypoparathyroidism

A
  1. Hypocalcemia (CATS)
  2. Sensitive nerves
  3. Uncontrollable spasms
  4. Hyperactive reflexes
  5. Positive Chvostek&Trousseau
  6. Hypotension
  7. Abdominal cramps
59
Q

How do you treat hypoparathyroidism?

A

Daily calcium and Vitamin D

60
Q

What is the purpose of calcitriol?

A
  1. Regulate Ca and Phosphate absorption from small intestine
  2. Mineral resorption in bones
  3. Phosphate reabsorption in renal tubules
61
Q

Therapeutic Uses of Calcitriol

A
  1. Hypocalcemia management
  2. Hypoparathyroidism
  3. Chronic renal dialysis
62
Q

Adverse effects of Calcitrol

A
  1. GI Effects
  2. CNS Effects (weakness, headache, irritability)
  3. Hypermagnesemia (if taken with Mg antacids)
  4. Muscle pain, bone pain
63
Q

What is calcitrol?

A

Vitamin D Compound

64
Q

Nursing Interventions for Calcitrol

A
  1. Monitor serum calcium levels
  2. Administer acetominophen for bone pain
  3. Caution use with history of kidney stones
  4. Educate on weight bearing exercises and smoking/drinking cessation
65
Q

What hormones are secreted by anterior pituitary gland?

A
  1. GH
  2. ACTH
  3. FSH
  4. LH
  5. PRL
  6. TSH
66
Q

What hormones are secreted by posterior pituitary gland?

A
  1. ADH

2. Oxytocin

67
Q

Somatropin Mechanism of Action

A
  1. replaces human growth hormone (GH)

2. stimulates skeletal anf internal organ growth

68
Q

What are the therapeutic uses of Somatropin?

A
  1. Long term use for children with growth failure (Turner syndrome)
  2. AIDs wasting
  3. GH Deficiency (Hypopituitarism)
69
Q

What is somatropin?

A

Recombinant growth hormone

70
Q

Adverse Effects of Somatropin

A
  1. Slipped Capital Femoral Epiphysis (SCFE)
  2. Hypothyroidism (rare)
  3. Insulin Resistance
  4. Increased intracranial pressure (treat with lumbar puncture)
  5. May cause scoliosis to be more prominent
71
Q

What type of diabetes does somatropin cause?

A

Type 2 Diabetees

72
Q

Nursing Interventions for Somatropin?

A
  1. Administer IM or SQ
  2. Rotate injection sites
  3. Store meds in fridge
  4. Monitor for headache
  5. Monitor for hip pain
73
Q

What causes Diabetes Insupidus?

A

low ADH due to disease/injury of pituitary gland

74
Q

Clinical Manifestations of Diabetes Insipidus

A
  1. Large amounts of dilute urine
  2. Concentrated blood (due to dehydration
  3. Polyuria, polydipsia
  4. Normal glucose levels
75
Q

How do you treat diabetes insipidous?

A

Replace ADH and fluids

76
Q

What is demopressin?

A

recombinant ADH

77
Q

What is desmopressin mechanism of action?

A
  1. Produce antidiuretic effects
  2. Increase water reabsorption
  3. Decrease urine formation
78
Q

Therapeutic Uses or desmopressin

A

treats diabetes insipidus

79
Q

Adverse Effects of Desmopressin

A
  1. Water intoxication (drowsiness, vision changes, dizziness)
  2. Tremors
  3. Sweating
  4. Vertigo
  5. N/V
  6. Abdominal cramps
80
Q

Nursing Interventions for desmopressin

A
  1. Use cautiously in patients with epilepsy, asthma, hyponatremia
  2. No pregnant ppl
  3. Monitor daily weight and I&Os
  4. Monitor for “hangover” symptoms
  5. Advise to stop during acute illness

Pathopharmacology (6 decks)

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