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VEEB > Endocrine System(Pharm) > Flashcards

Endocrine System(Pharm) Flashcards

1
Q

Glyburdie(Micronase/DiaBeta)

A 
Generica Name: Glyburdie
Trade Name: Micronase/DiaBeta
Sulfonylureas(drugs)
-Second generation
-last longer 12-24hrs
-2.5-20mg dose-
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2
Q

Vasopressin(Pitressin)

A 
Generic Name:Vasopressin
Trade Name: Pitressin
Posterior lobe agent
Antidiretic Hormone
-taken 1-2x a day
-5-10u tid, nasal spray,subq,im
-tannate(in oil) last for 48-96hr
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3
Q

Levothyroxine(Synthroid)

A

Generic Name: Levothyroxine
Trade Name: Synthroid
-avg dose:100-125mcg
thyroid replacement drug
-increase metabolic rate by replace t4
-use: hypothyroidism(myxedema), hyposecretion of the thyroid
-interaction with oral coag, epi,antidepressants,antidiabetic agent,cns depressents

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4
Q

Propylthiouracil(PTU)

A 
Generic Name: Propylthiouracil
Trade Name:PTU
-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)
-Thiouracil drug
-100-150mg 1-4x a day
-given for 6mos to several years
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5
Q

Calcitriol(Rocaltrol)

A

Generic Name: Calcitrol

Trade Name: Rocaltrol

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6
Q

Potassium Iodine(SSKI)

A

Generic Name: Potassium Iodine
Trade Name: SSKI
-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)

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7
Q

Saturated Solution(Lugols Iodine)

A

Generic Name: Saturated Solution

Trade Name: Lugols Iodine

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8
Q

Dempopressin(DDAVP)

A 
Trade Name:Dempopressin
Generic Name: DDAVP
Posterior lobe agent
Antidiretic Hormone
-in posterior pituitary
-hyposecretion results in diabetes insipidus
-used for diabtes insipidus
-post op abdominal disention
-dispel gas interfering with x-ray
-enuresis(bed wetting)
-hemophilia type A
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9
Q

Calcitonin(Calcimar)

A 
Generic Name: Calcitonin
Trade Name: Calcimar
-drug for hyperparathyroidism
-synthetic hormone
-turns off secretion of the hormone
-calcitonin-salmon-check allergy to salmon
-sq,im,intranasal
-4-8units 1kg every 6-12hrs
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10
Q

Metformin HCL(Glucophage)

A 
Generic Name: Metformin HCL
Trade Name: Glucophage
-oral hypoglycemics
-Biquanides
-500-1000mg 2x a day
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11
Q

Acarbose(Precose)

A 
Generic Name: Acarbose
Trade Name: Precose
Acarbose(precose)
Oral Hypoglycemics
-Alpha glucosidase inhibitor drug
-3x a day dose
-must be taken with first bite of meal
-if they do not eat do not take med
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12
Q

Chlorpropamide(Diabinese)

A 
Generic Name: Chlorpropamide	
Trade Name: Diabinese
-Sulfonylureas(drug First generation)
-titrated(increase slowl)
-avg. dose 150-250mg
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13
Q

Glimepiride(Amaryl)

A 
Generic Name: Glimepiride
Trade Name: Amaryl
Sulfonylureas(drugs)
-third generation
-1-2mg once a day
-given with breakfast/main meal of the day
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14
Q

Sitagliptin(Januvia)

A

Generic Name: Sitagliptin
Trade Name: Januvia
oral hypoglycemics
dipeptidyl peptidase
action: inhibit breakdown of incretin hormones, adjuvant to diet and excersie(type 2)
100 mg po daily
side effect:increase resp tract infection
monitor wbc for infection, and monitor resp tract

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15
Q

Endocrine glands

A

ductless glands that empty their secretions directly into the bloody stream

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16
Q

Hormones

A

chemical substances secreted by the endocrine glands

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17
Q

Pancreas

A

Beta cells of the Islet of Langerhans in the pancreas produce the hormone insulin

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18
Q

Insulin

A

hormones that regulate glucose metabolism and the transporting of glucose across the cell membrane

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19
Q

Indication

A

Diabetes Mellitus is a disorder of carbohydrate

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20
Q

Classification of Diabetes

A

Type 1: (IDDM) Insulin dependent diabetes mellitus=little to no insulin produced

Type 2: (NIDDM) non-insulin dependent diabetes mellitus=decrease in production of insulin, decrease in cell sensitivity to insulin, onset insidious, can treat with oral drug and/or insulin

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21
Q

Forms of Insulin

A

Animal:
1-Porcine: Pig
2-Bovine: Beef

Human
1-Synthetic: Humulin
2-Semisynthetic: Novolibn

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22
Q

Insulin strength/concentration

A

u100=every 1ml contains 100u
u500=every 1 ml contains 500u
u30

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23
Q

Insulin routes(SubCu)

A

1-Abdomen 2-Back of arm 3-Front of thigh 4-upper buttocks

  • 90 degree angle
  • no massage area
  • massage will increase absorbtion rate
  • rotate injection site to prevent lipodystrophy
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24
Q

Insulin routes(Insulin pump)

A
  • must be able to follow direction
  • human insulin in pump
  • either rapid acting or short acting
  • subCu
  • can stay in place for 2-3 days
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25
Q

Insulin routes(IV/IVP)

A

-iv push and bolus dose

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26
Q

Classification

A

1)rapid 2)short 3)intermediate 4)Long acting 5)mixed insulin

properties-
protein-decrease rate of absorption
zinc-modify onset and duration
-dose-determined by HCP
-frequency once or twice a day
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27
Q

Rapid Acting Insulin

A 
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)

onsent: 15mins, novolog 10-20mins
peak: 1-2hrs
duration: 3-4 hrs
route: SC
hypoglycemia: before lunch

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28
Q

Short Acting Insulin

route: SC, only IV route

A

Insulin Regular(Humulin R, Novolin R)

  • onset:30-60mins
  • peak:2-4hrs
  • duration:5-7hrs
  • route:SC
  • hypoglycemia before lunch

(IV) Insulin Regular(Humulin R, Novolin R)

route: iv
onset: 10-30min
peak: 15-30min
duration: 30-60min

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29
Q

Intermediate insulin

A

Insulin Isophane(NPH)-Humulin-N, Novolin-N

onset: 2-4 hrs
peak: 4-10hrs
duration: 10-16hrs
route: sc
hypoglycemia: 3pm to supper

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30
Q

Long Lasting Insulin

A

Insulin Detemir(Levemir)

onset: 3-4 hrs peak: 3-14hrs duration: 6-24hrs
route: SC

Insulin Glargine(Lantus) onset:3-4 peak:(none) duration: 24hrs route: SC

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31
Q

Mixed insulin

A

NPH and regular(Humulin 70/30, Humulin 50/50, Novolin 70/30) onset: 30min, peak: 2-3hrs, duration: 24hrs, route:sc

aspart protamine and aspart(Novolog 70/30) onset: 15min peak: 1-4hrs, duration:18-24hrs, route: sc

Lispro protamine and lispro(Humalog 75/25,Humalog 50/50) onset: 15-30min, peak: 4-8hrs, duration: 24hrs, route: sc

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32
Q

mixing insulin

A
  • intermediate and mixed insulin=cloudy
  • rapid, short, long=clear
  • rotate in palms of hand to warm
  • do not mix levemir/lantus(long acting insulin)
  • air goes in cloudy first then clear, clear is withdrawn first then cloudy
  • long lasting insulin is design to meet basal needs last for 24hrs period, pt should be educated to take at night, once a day, at the same time
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33
Q

storage of insulin

A

-stored in refrigerator unopened and unused, once open stored at room temp for a month

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34
Q

frequency of insulin

A

fingerstick AC(before meals) HS(hour of sleep)

  • q6h if npo
  • urine glucose, use fresh urine on second void
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35
Q

Hypoglycemia(side effects)

A
  • N/v
  • diarrhea, hunger, inability to concentrate
  • confusion
  • nervousness
  • anxiety
  • tremors
  • tachycardia
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36
Q

Hypoglycemia(causes)

A

insulin reaction/shock

  • too much insulin or wrong type
  • delay or omission of food
  • too much exercise
  • illness, diarrhea and vomitting
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37
Q

Hypoglycemia(Findings)

A
  • BS=below 60

- urine negative sugar ketones

38
Q

Hypoglycemia(treatment)

A

10-15grams of simple CHO=to boost it

  • 6oz fruit juice, non diet soda
  • cube sugar, honey or corn syrup
  • 5-6 life savers
  • 2-3 glucose tabs or glucose gel

followed by complex CHO within 1hr=to maintain sugar level

  • skim milk
  • crackers, or meal
39
Q

Hypoglycemia(treatment med)

A

glucagon 1mg(IM,IV,SQ)

  • action: 20min
  • increase bs by releasing glucose
  • do not use with other meds

50% dw ivp or infusion
-followed by 5-10% to stabilze home care

40
Q

Hyperglycemia(s/s)

A
  • n/v
  • ab pain, distention, anorexia, dry mouth
  • irritability
  • hot flushed skin
  • fruity order to breath
  • kussmuals resp., increase urinary output
41
Q

Hyperglycemia(cause)

A

Hyperglycemia can lead to diabetic coma/ketoacidosis

  • too little insulin, missed dose
  • unregulated or extra meals
  • stress
  • increase alcohol
  • injection
  • n/v or diarrhea
42
Q

Hyperglycemia(Findings & Tx)

A
  • bs-over 150
  • urine: positive sugar and ketones
  • glucose cannot be used then fats are used for metabolism-ketones occur
  • fluid and electrolyte imbalance
    tx: regular insulin subQ or IV
43
Q

Lipodystrophy

A
  • destruction of fat tissue

- rotate site and store at room temp to prevent

44
Q

allergic recation

A

local or systemic

  • risk greater in animal insulin and cold insulin
  • insulin resistance rare
  • interaction:
  • alcohol,steriods,NSAIDS,ASA,betablockers,diuretics,MAOI
45
Q

Nursing considerations

A
  • assess FS AC/HS
  • FS 1/2 hr AC/HS
  • weight change may indicate need for medication adjustment
  • objective coordinate blood sugar testing, drug administration, diet and exercise
  • exercise increases rate of absorption in insulin
  • limit activity 30-60min after
  • determine-onset,peak,and duration of insulin
  • double check insulin type and dose
  • absorption varies based on site,technique,formulation and excersice
  • exercise limit 30-40min after meals
  • prefilled
46
Q

Oral Hypoglycemics

A
  • type 2 diabetes mellitus
  • monotherapy
  • multitherapy
47
Q

Sulfonylureas

A
  • Oral Hypoglycemics
  • action: stimulate the beta cella to release insulin
  • must have functional beta cells for the drug to work
  • effective decreases over time
48
Q

Chlorpropamide(Diabinese)

A
  • Sulfonylureas(drugs)
  • first generation
  • titrated(increase slowl)
  • avg. dose 150-250mg
49
Q

Glyburide(Micronase0(Diabeta)

A

Sulfonylureas(drugs)

  • Second generation
  • last longer 12-24hrs
  • 2.5-20mg dose-
50
Q

Glimepiride(Amaryl)

A
  • Sulfonylureas(drugs)
  • third generation
  • 1-2mg once a day
  • given with breakfast/main meal of the day
51
Q

Sulfonylureas(Side effects)

A
  • hypoglycemia(common)
  • anorexia,n&v,heartburn,weight gain
  • weakness,numbness in extremities
  • heart and blood vessels disease
  • antabuse like reaction
  • hepatoxicity
  • photosensitivity
52
Q

Sulfonylureas(Nursing consideration)

A
  • 30min before breakfast/main meal of the day
  • check allergy to sulfa
  • long acting glipizide-shell in stool
  • recognize hypoglycemia and treatment
  • not for use during pregnany
53
Q

Alpha Glucosidase Inhibitor

A
  • Oral Hypoglycemics
  • action delays carbohydrate and absorption
  • effecting post crandial-after you eat
  • slows the breakdown of meal
54
Q

Alpha Glucosidase Inhibitor Drug

A 
Acarbose(precose)
Oral Hypoglycemics
-Alpha glucosidase inhibitor drug
-3x a day dose
-must be taken with first bite of meal
-if they do not eat do not take med
55
Q

Alpha Glucosidase Inhibitor(side effect)

A
  • gi: upset,flatulence,abdominal pain,diarrhea,hypoglycemia

- contraindicated: liver/bowel disease

56
Q

Biquanides

A
  • Oral Hypoglycemics
  • reduce hepatic glucose production
  • increase insulin sentitivity to muscle and fat cell
  • reduce insulin resistance
  • decrease weight
  • improve lipid levels
57
Q

Biquanides drug

A

Metformi(Glucophage)

  • oral hypoglycemics
  • Biquanides
  • 500-1000mg 2x a day
58
Q

Biquanides(side effects)

A
  • gi:upset,bloating,n/v,flatulance,weight loss,cramping,diarrhea,metallic taste(common)
  • hypoglycemia and lactic acidosis(rare)
  • caustion: liver,kidney disease and excressive alcohol
59
Q

Meglititinides(glinide)

A

oral hypoglycemics

  • Meglititinides(glinide)
  • stimulate insulin release from the pancreas
  • drug: Repaglinide(Prandin)
  • side effect: hypoglycemia, urti,rhinitis,bronchitis,back pain,headache,hepatoxic,monitor liver profile
60
Q

Thiazolidinediones

A

oral hypoglycemics

action: decrease insulin resistance, increase insulin sensitivity
drug: rosiglitazone
- black box warning=drug causes serous AVE commonly CHF
- side effect: increase urti,sinusitis,headache,back pain,diarrhea,
- caution in chf and decrease effectiveness of contraceptive pills

61
Q

Incretin Mimetic

A

oral hypoglycemics

  • mimic hormone incretin
  • increase insulin secretion from beta cells=more hypoglycemia
  • supress glucagon secretion
  • slows gastic emptying
  • indication: adjuvant to improve glycemic control post meal
  • drug:Exenatide(Byetta)-sq-1hr before breakfast 1hr before dinner-pre-filled syring
  • side effect:gastrotoxic
62
Q

Dipeptidyl Peptidase-4 inhibitor

A

oral hypoglycemics
action: inhibit breakdown of incretin hormones
indication: adjuvant to diet and excersise(type 2 dm)
-drug: sitagliptin(Januvia), 100mg po daily
side effect: increase resp tract infection
-monitor wbc for infection, lung sound

63
Q

Amylin Analogue

A

-action:slows movement of food through the stomach
-indication:type 1/2 diabetes that need blood sugar control
-side effect:n/v,severe hypoglycemia(3hrs after pt has eating)
nursing implication: sq,abdomen or upper thigh,given before major meal,store upopened pen in fridge,dose may based on BS

64
Q

Pituitary/Hypophysis agent
Anterior Lobe Agent
Adrenocorticotropic Hormone(ACTH)

A
  • anterior lobe
  • stimulate the adrenal cortex to produce glucocorticoids
  • used to diagnose adrenocortical function, multiple sclerosis,thyroidits,hypercalcemia related to cancer
  • route:parental,measured in units
65
Q

Pituitary/Hypophysis agent
Anterior Lobe Agent
Adrenocorticotropic Hormone(ACTH)
Side Effects:

A 
Electrolute imbalance
dcrease wbc increase rbc(thrombi)
-increase appetite,thinning mucosa,peptic ulcer
-decrease would healing, 
-water and na retention
-weight gain, moon face,buffalo hump,retarded growth in children
-muscle/skeletal weakness,atrophy,osteoporosis
-glucose intolerance
-mood swings
-abrupte withdrawal leads to crissi
-suppress immune response
-suppresses inflammation
66
Q

Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)

A
  • increase size and number of skeletal muscles
  • increaase lean body mass in adults
  • increase production in Aids
  • replace GH in children who fail to grow
67
Q

Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
(side effects)

A
  • hypothyroids
  • cause insulin resistance-hyperglycemia
  • drop in Bp: hypotension
  • decrease in body fat
  • tachycardia
  • nephrotoxic
  • increase sugar levels
  • acromegaly
  • monitor vs
68
Q

Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
(Nursing implication)

A
  • route: subq/Im
  • 1x-7x/week for 6months - 2yr
  • dose based on BSA(monitor daily weight)
  • teach how to give injection
  • monitor ADR@injection site
  • glycouria
  • stadio-meter measurements
  • antibody production against GH
  • follow up doctor q3-6mos
69
Q

Posterior lobe agent

Antidiretic Hormone

A
  • in posterior pituitary
  • hyposecretion results in diabetes insipidus
  • used for diabtes insipidus
  • post op abdominal disention
  • dispel gas interfering with x-ray
  • enuresis(bed wetting)
  • hemophilia type A
70
Q

Posterior lobe agent
Antidiretic Hormone
Vasopressin(Pitressin)

A
  • taken 1-2x a day
  • 5-10u tid, nasal spray,subq,im
  • tannate(in oil) last for 48-96hr
  • in posterior pituitary
  • hyposecretion results in diabetes insipidus
  • used for diabtes insipidus
  • post op abdominal disention
  • dispel gas interfering with x-ray
  • enuresis(bed wetting)
  • hemophilia type A
71
Q

Posterior lobe agent
Antidiretic Hormone
DDAVP(Desmopressin)

A
  • nasal spray solution(via rhinal tube)
  • in posterior pituitary
  • hyposecretion results in diabetes insipidus
  • used for diabtes insipidus
  • post op abdominal disention
  • dispel gas interfering with x-ray
  • enuresis(bed wetting)
  • hemophilia type A
72
Q

Posterior lobe agent
Antidiretic Hormone
(Side effect)

A

-hypersensitivity
-termors,vertigo,sweating
-belching,n/v,diarrhea
-water intoxication
-spasm in uterus and coronary artery
-thrombosis
-watch for water intox=n/v,headache,drowsy,confusion,weight gain,seizures,coma,
contraiindicated for children aged, children under 11mos

73
Q

Posterior lobe agent
Antidiretic Hormone
(nursing implication)

A
  • monitor s/s of dehydration
  • record I&O
  • urine SG
  • skin tugor
  • weight
  • BP,HR,EKG
  • have NTG(Nitroglycerin) available=treat angina
  • labs-electrolytes/coags
  • check for changes in nasal mucosa
  • switching from nasal to oral forms-give first tab within 12hr of last nasal dose
  • rinse bottle tip in hot water,dry with tissue and recap
  • iv-use pump,check for infiltration and tissue necrosis
74
Q

Thyroid gland

A

regulation of metabolism of carb,protein,lipids by the secretion of t3 and t4

75
Q

thyroid replacement drug

A

-increase metabolic rate by replacing thyroid hormone t3/t4
used for hyposecretion of thyroid hormone/hypothyroidism(myxedema in adults
-euthyroid state-return to normal

76
Q

thyroid replacement drug(side effect)

A
  • hyperthyroid/increase bmr
  • tachycardia,palp,htn(monitor apical)
  • nervousness,headache,insomnia
  • diarrhea,decrease weight
  • intolerance to heat, sweating
77
Q

thyroid replacement drug

Levothyroxine(synthroid)

A
  • avg dose:100-125mcg

- interaction with oral coag, epi,antidepressants,antidiabetic agent,cns depressents

78
Q

thyroid replacement drug(nursing implicaiton)

A
  • start with low dose
  • take at same time each day
  • early am before breakfast to prevent insomnia
  • record apical pulse=hold if bp above 100
  • see improvement within 10-14days
  • life long therapy
  • keep in dark bottle
  • replace q3mos
  • avoid iodine salt, iodoine
  • children monitor bone growth and development
79
Q

Antithyroid drug

A

-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)

80
Q

Antithyroid drugs used

A

thiouracil
iodides
radioactive isotopes

81
Q

Thiouracils

A
  • inhibit synthesis and release of the thyroid hormone
  • prevent the conversion of t3/t4 in the peripheral circulation
  • indication:hyperthyroidism
  • return to euthyroid state
82
Q

Thiouracil(drug)

A
  • propylthiouracils(PTU)
  • 100-150mg 1-4x a day
  • given for 6mos to several years
83
Q

Thiouracil(side effects)

A
  • s/s of hypothyroidism
  • lupus like symptoms(butterfly rash,joint pain,photosensitivity)
  • hepatotoxic-jaundice up to 10wks even after md discontinues
  • arganulocytosis(monitor blood)
  • n/v
  • hay fever,sore throat,skin rash,puritis,headache,paresthesia
84
Q

Thiouracil(Nursing implication)

A
  • given at the same time w/meals
  • sudden stop=thyroid storm(agitation,change in LOC,tachycardia,shaking,fever,sweating,diarrhea)
  • available suppository or enema
  • instruct pt to report chills,fever,skin rash,sore throat,malaise,enlarged lymph node,jaundice,monitor cbc,pt,no vaccine w/ permission
85
Q

Iodides(Antithyroid drug)

A

-reduce the size and vascularity of the thyroid gland

86
Q

Iodides(Antithyroid drug)(Indication)

A
  • use 7-10days before surgery so the thyroid is more sturdy
  • mild to severe thyroid hyperactivity in the young
  • onset-24hr peak:10-15 days
87
Q

Iodides(drugs)

A
  • potassium iodide(sski)
  • 130mg/day child is hald 65
  • side effects: iodism=toxicity of iodine=metallic taste in the mouth,fever,rash,on the skin or mucous membrane,parotits,increase salivation,and allergic reaction

nursing implication:

  • check for drug allergy to seafood,iodine
  • dilute in milke,cola,fruit juice
  • improves taste
  • prevents staining of teeth
88
Q

Radioactive iodine(RAI)(antithyroid drug)

A

-action:emit beta rays which DESTROY hyperactive thyroid cells
use: hyperthyroidism, thyroid cancer, diagnostic testing
drug :radiactive iodine(RAI), sodium iodide
-if destroying going to need thyroid replacement

side effect: hypothyrodism
-thyroidits swelling of the neck,back,sore throat,cough, and pain on swallowing,n&v,bone marrow suppresion-monitor cbc,wbc

contrainticated in pregnacy

89
Q

Parathyroid agents

A
  • hormones working in opposite direction
  • not functioning levels go in same direction
  • parathyroid glands regulate calcium metabolism and secretes its hormone when blood calcium levels drops to promote reabsorption of calcium from the bones
90
Q

Hyperparathyroidism

A

hypersecretion of parathyroid hormone causing increase in calcium levels
use for osteoporosis and hypercalciema

91
Q

Calcitonin(calcimar)

A
  • synthetic hormone
  • turns off secretion of the hormone
  • calcitonin-salmon-check allergy to salmon
  • sq,im,intranasal
  • 4-8units 1kg every 6-12hrs

VEEB (25 decks)

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