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Pharm 2 Exam 2 (Second half of Endocrine) > Endocrine System > Flashcards

Endocrine System Flashcards

1
Q

Leuprolide
nursing considerations & patient teaching

A

nursing:
- decreases effects of anti diabetic drugs
- give med until 11-12 years old
- IM or SQ injection
- rotate site
- effects will take 2-4 weeks
- usually given monthly

patient education:
- teach proper injection technique
- report irritation at injection site
- keep track of monthly dosing
- use nonhormonal birth control

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2
Q

Octreotide
- action
- use
- adverse effects
- contraindications

A

action: mimics somatostatin, inhibiting GH, insulin & some GI hormones
use: Acromegalia, GI bleeding, Diarrhea, some tumors
adverse effects: H/A, dizziness, bradycardia, hyperglycemia, diarrhea
contraindications: pancreatitis & diabetes

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3
Q

Octreotide nursing considerations & patient education

A

Nursing:
- many drug to drug interactions
- IV or IM route
- rotate injection site
- monitor height & weight
- monitor blood glucose
Patient education:
- teach proper injection technique
- monitor blood glucose if at risk
- monitor height & weight
- notify MD if severe GI upset

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4
Q

where are parathyroid glands located & what do they produce?

A

located ON back of thyroid gland; produce parathyroid hormone (PTH)

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5
Q

what two things does PTH regulate?

A

calcium (8.5 - 10.5) & phosphorus (indirectly)

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6
Q

which hormones are involved in calcium regulation? in which 3 ways do these hormones alter the absorption of calcium?

A

parathyroid hormone, calcitonin, & vitamin D
1. from GI tract
2. from bones
3. excreted by kidneys

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7
Q

when calcium levels are low:
- how does this affect PTH & amount of Ca in urine, GI, bone,
& blood?

A

increased PTH released & increased activation of Vitamin D
- decreased loss of Ca+ in urine
- increased GI absorption of Ca+
- Increased Ca+ release from bones
- raise calcium in blood

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8
Q

when calcium levels are high:
- how does this affect PTH & amount of Ca in GI tract, bones, & blood?

A

decreased secretion of PTH & increased secretion of calcitonin
- increased loss of Ca+ in GI tract
- decreased release of Ca+ from bones
- decrease calcium in blood

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9
Q

difference between hypo & hyperparathyroidism & causes

A

Hypoparathyroidism: not enough PTH, low calcium levels
causes: accidental removal of parathyroid glands
Hyperparathyroidism: too much PTH, high calcium levels
causes: tumor or enlargement of glands, genetic disease (Paget’s disease)

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10
Q

S/Sx of hypo & hypercalcemia

A

Hypocalcemia: Hyperactive reflexes, paresthesias, positive Chostek & Trousseau signs, hypotension, prolonged QT intervals, abdominal & muscular spasms & cramps

Hypercalcemia: lethargy, coma, hypertension, shortening of the QT interval, N/V, muscle atrophy, kidney stones, renal insufficiency

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11
Q

calcium supplements (calcium acetate, calcium carbonate (tums), calcium citrate, calcium gluconate)
- action
- use
- adverse effects
- contraindications

A

action: provides supplemental calcium
use: tx & prevent hypocalcemia, decrease bone loss & fractures, treat high phosphorus levels
adverse effects: GI upset (N/V, constipation), EKG changes, weakness
contraindications: kidney stones, cancer w bone involvement, hypercalcemia, hypophosphatemia

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12
Q

Calcium supplement nursing considerations & patient education

A

nursing:
- available PO & IV
- give PO after meals
- monitor IV closely, tissue toxic
- monitor lab values
- monitor EKG for changes
Patient education:
- calcium carbonate (tums) most calcium OTC
- high calcium diet (milk, yogurt, cheese)
- take after meals

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13
Q

without ___ calcium cannot be absorbed

A

Vitamin D

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14
Q

Vitamin D
- action
- use
- adverse effects
- contraindications

A

action: increases calcium & phosphorus, absorption in GI tract, pulls calcium & phosphorus from bones, decreases calcium & phosphorus in kidneys
use: vitamin D deficiency & treatment of hypoparathyroidism
adverse effects: high vitamin D (fat soluble) & high calcium
contraindications: high calcium & vitamin D toxicity

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15
Q

Vitamin D nursing considerations & patient education

A

nursing:
- monitor lab values
- many combination meds available
patient education:
- high vitamin D diet (fish, eggs, milk)
- sunlight good source of vitamin D
- may be taken w out regard to meals

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16
Q

normal range for calcium

A

8.5 - 10.5

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17
Q

Alendronate
- action
- use
- adverse effects
- contraindications

A

action: binds to bone & blocks calcium release, suppresses osteoclasts
use: treat & prevent osteoporosis
- post menopausal
- steroid induced
adverse effects: esophageal irritation / erosion**, bone pain
contraindications: **inability to sit upright for 30 minutes*, esophageal disorders

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18
Q

Alendronate nursing considerations & patient education

A

nursing:
- give first thing in the morning
- give w full glass of water
- nothing to eat or drink for 30 minutes before
- remain sitting upright for 30 minutes
patient education:
- proper administration
- report esophageal pain, heartburn, & difficulty swallowing to MD

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19
Q

which drug should be given instead of Alendronate if a patient is unable to sit upright for 30 minutes?

A

Calcitonin Salon (nasal spray)

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20
Q

adrenal glands
- where are they located?
- what are the two layers & their roles?

A

located on top of each kidney
layers:
1. adrenal cortex (makes 3 corticosteroids controlled by the hypothalamus)
2. adrenal medulla (part of SNS; fight or flight)

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21
Q

which 3 hormones does the adrenal cortex make & what responses do they regulate?

A
  1. Glucocorticoids (immune response)
  2. Mineral corticoids (water & electrolyte balance)
  3. Androgens (male / female reproductive)
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22
Q

what is addison’s disease? what do patients lack? what can it be caused by?

A

lack of adrenocortical hormones
can be caused by:
- lack of ACTH
- lack of response of adrenal glands
- damage to adrenal glands
- prolonged use of corticosteroids

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23
Q

what is an adrenal crisis? list some effects & how it can be treated

A

adrenal insufficiency + extreme stress = body unable to support SNS response
effects: hypotension, exhaustion, shock, death
treatment: massive steroid infusion

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24
Q

cushing’s disease
- what is it?
- what can it be caused by?
- what are some S/Sx?

A

excess adrenocortical hormones
can be caused by: excessive corticotropin & tumors
S/Sx: hyperglycemia, irritability, moon shaped face, fluid retention

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25
Q

treatment for Addison’s disease

A
  • Replace adrenocorticoids
  • Replace mineralocorticoids
  • Lifetime replacement necessary
  • Increase dose in times of stress
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26
Q

treatment for Cushing’s Disease

A
  • Usually surgical treatment
  • Meds in preparation or surgery contraindicated
  • Inhibit cortisol synthesis
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27
Q

Hydrocortisone
- action
- use
- adverse effects

A

action: combo mineralocorticoid & adrenocorticoid, decreases inflammatory response, & increases retention of Na
use: acute & chronic adrenal insufficiency
adverse effects: cardiac (HTN, MI), CNS (dizziness, vertigo, H/A), derm (thin skin & easy bruising), GI (GI upset & weight gain), fluid balance (fluid & Na retention), metabolic (hyperglycemia)
Black box warning to avoid live vaccines

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28
Q

Hydrocortisone nursing considerations & patient education

A

nursing:
- give w food
- give before 0900
- monitor vitals
- monitor fluid volume status
-monitor glucose
patient education:
- take before 0900
- space doses evenly throughout day
- do not stop abruptly
- increase dose in times of stress
- increase calcium diet if long term
- monitor blood glucose
- report S/Sx of Cushing’s disease

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29
Q

Fludrocortisone
- action
- use
- adverse effects
- contraindications

A

action: strong mineralcorticoid action, Na retention & K excretion (increased BP)
use: additional mineralcorticoid supplement in Addison’s
adverse effects: fluid retention, HTN, CHF, growth suppression, hyperglycemia, hypokalemia
contraindications: uncontrolled HTN

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30
Q

Fludrocortisone nursing considerations & patient education

A

nursing:
- many drug to drug interactions
- take along w glucocoticoid
- monitor Na & K levels
- monitor weight
- monitor vitals
patient education:
- high K diet (bananas, OJ, potatoes)
- low Na diet
- monitor weight, call for 5 lb gain
- follow up labs
- report swelling or SOB to MD

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31
Q

Ketoconazole
- action
- use
- adverse effects
- contraindications

A

action: inhibits cortisol synthesis
use: treat Cushing’s disease
adverse effects: itching, GI upset, black box for liver toxicity
contraindications: liver failure

32
Q

what two roles do the endocrine & NS work together on?

A

maintaining homeostasis & responding to environment

33
Q

endocrine system communicates within the body to…

A
  • regulate growth & development
  • regulate energy use
  • balance electrolytes
  • respond to internal (infection) & external (weather, jobs) stressors
34
Q

what do endocrine glands produce?

A

hormones that are secreted directly into bloodstream

35
Q

what do hormones do?

A

increase or decrease cellular function; broken down immediately & produced in small amounts

36
Q

in what 2 ways does the endocrine structure work? give examples

A
  1. react w specific receptor sites on the cell (EX: insulin)
  2. enter cell & react w a receptor site inside the cell (EX: estrogen)
37
Q

what 3 hormones does the thyroid gland produce?

A
  1. triiodothyroinine (T3)
  2. thyroxine (T4)
  3. calcitonin (affect calcium & other hormones that regulate calcium)
38
Q

circular follicles

A

store hormones

39
Q

parafollicular cells

A

produce calcitonin

40
Q

list roles of thyroid hormones (T3 & T4)

A
  • regulate metabolism
  • affect heat production
  • affect body temperature
  • oxygen consumption / cardiac output
  • blood volume
  • metabolism of CHO, fats, proteins
  • growth & development
41
Q

thyroid gland role

A

TH production & release regulated by TSH
negative feedback loop: only made when needed, not continuous

42
Q

what is hypothyroidism?

A

absence of thyroid gland:
- lack of iodine (needed to make T3 & T4)
- lack of functioning thyroid tissue
- lack of TSH (no hormones get made R/T message not getting down to thyroid)
- lack of TRH (no first step = no message to TSH or thyroid)

43
Q

list the 2 hypothyroid conditions & explain

A

Myxedema: severe hypothyroidism
Myxedema coma: could be fatal

44
Q

hyperthyroidism
- what is it?
- list a disease

A

excessive amounts of thyroid hormone
Grave’s disease: autoimmune disorder that stimulates TSH to release thyroid hormones
overstimulation from TSH = enlarged thyroid gland = releases too much hormone
thyroid storm: too much thyroid hormone (could be fatal)

45
Q

Propylthiouracil (PTU)
- action
- use
- adverse effects

A

action: inhibits production of thyroid hormone (takes about 1-2 weeks while old hormones get used up)
use: hyperthyroidism
adverse effects: hypothyroidism, bone marrow suppression, BBW: liver failure

46
Q

Lugols solution (iodine solution)
- what is it used to treat?
- use

A

used to tx hyperthyroidism
**give before OR after to reduce size & vascularity of thyroid gland
not safe in pregnancy
may discolor teeth, drink w straw

47
Q

anti-thyroid drugs nursing implications & patient education

A

nursing:
- increases effect of anticoags
- may take 1-2 weeks to start working
- monitor liver function
- monitor metabolism of other drugs as metabolism slows
Patient education:
- take evenly around the clock
- take always w food or always w out food
- may take 1-2 weeks to start working
- alert MD to s/sx of liver failure
- may need blood draws to monitor therapeutic level
- will need lifelong thyroid hormone replacement

48
Q

Levothyroxine
- action
- use
- adverse effects
- contraindications

A

action: synthetic T4, increases metabolic rate
use: hypothyroidism, thyroid cancer
adverse effects: hyperthyroidism (tachy, CP, MI, nervousness, insomnia, weight loss)
contraindications: acute MI

49
Q

levothyroxine nursing considerations & patient education

A

nursing:
- goal TSH 0.5 - 4.2 microunits / L
- many drug interactions (increases effect of anticoags)
monitor metabolism of other drugs as metabolism increases**
- monitor for stress on heart = CP, tachy, sweating
patient education:
**take in morning on empty stomach
- frequent lab draws needed early
- periodic labs drawn later in therapy
- lifelong replacement

50
Q

hypothalamus

A
  • “master gland”
  • constantly monitor’s body’s homeostasis
  • coordinates responses through autonomic, endocrine, & NS
  • receives input from the rest of the brain (acts as a sensory to electrolytes, chemicals, & hormones)
  • stimulates or suppresses endocrine, autonomic, & CNS activity
51
Q

Leuprolide
- action
- use
- adverse effects

A

action: inhibits gonadotropin secretion: suppressing LH & FSH, decreasing testosterone in males
use: treatment of early puberty (< 8 years old), tx of prostate cancer, tx of endometriosis
adverse effects: pain at injection site, labile emotions

52
Q

Desmopressin (DDAVP) nursing considerations & patient education

A

nursing considerations:
- available in multiple routes (IM, SQ, IV, Nasal)
- monitor I’s & O’s
- monitor electrolytes (Na, K)
- monitor urine osmolality
- assess hydration status
patient education:
- report HA, drowsiness, lethargy to MD
- rotate injection site of IM or SQ
- rotate Nares for nasal spray

53
Q

Desmopressin (DDAVP)
- action
- use
- adverse effects

A

action: synthetic ADH, decreases urine volume
use: tx of Diabetes Insipidus
adverse effects:
- swelling & burning at injection site
- nasal irritation
- black box: cardiac arrest d/t rapid fluid volume change
- black box: for risk of hyponatremia leading to seizures & death

54
Q

Somatropin nursing considerations & patient education

A

nursing:
- monitor for hyperglycemia
- med is given IM or SQ
- rotate injection sites
- monitor height & weight for effectiveness (should increase)
- medication given until desired height reached
- x-rays needed to monitor for epiphyseal closure
patient education:
- monitor height & weight at home
- monitor glucose at home if at risk
- teach proper injection technique

55
Q

Somatropin
- action
- use
- adverse effects
- contraindications

A

action: replaces growth hormone, stimulates bone / muscle growth
use: growth failure in children
adverse effects: muscle pain / hyperglycemia
contraindications:
- *closed epiphyses if closed, no room for bone growth; already sealed
- malignancy

56
Q

precocious puberty

A

early development of sex characteristics (prior to age 8)
r/t excess gonadotropin hormones or excess androgen / estrogen (can be from exposure to estrogen)

57
Q

acromegaly

A

gigantism r/t excess growth hormone

58
Q

growth deficiency in children

A
  • deficiency in growth hormone
  • growth below 3rd percentile
59
Q

diabetes insipidus

A
  • dysfunction of posterior pituitary
  • deficiency in ADH production
  • large quantity of dilute urine (up to 30 liters)
60
Q

role of ADH

A

regulates water balance

61
Q

role of oxytocin

A

uterine contractions, milk letdown

62
Q

role of ACTH

A

stimulates production of corticosteroids

63
Q

role of growth hormone (GH)

A

stimulates growth of body tissues

64
Q

role of TSH

A

regulates secretion of thyroid hormones

65
Q

role of FSH

A

stimulates function of sex glands

66
Q

role of LH

A

stimulates hormone production

67
Q

role prolactin hormone (PLH)

A

milk production in mothers

68
Q

what are the posterior pituitary hormones?

A

ADH & Oxytocin

69
Q

what are the anterior pituitary hormones?

A

ACTH, GH, TSH, FSH, LH, & PLH

70
Q

which hormone is on the pars intermediate lobe & when is it secreted?

A

endorphins / enkephalins
secreted in response to pain, stress
overactivity of pain nerves, sympathetic stimulation, guided imagery, & vigorous exercise

71
Q

role of CRF

A

release of corticotropin during stress

72
Q

role of GHRH

A

release of growth hormones

73
Q

role of TRH

A

releases TH during stress

74
Q

role of GnRH

A

releases FSH & LH

75
Q

role of PRF

A

lactation & childbirth

76
Q

role of somatostatin

A

inhibits release of growth hormone

77
Q

role of PIF

A

inhibits lactation

Pharm 2 Exam 2 (Second half of Endocrine) (1 decks)

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