Exam 1 Flashcards
- Thyroid Gland Function?
- need sufficient ________ to produce thyroid hormones
- regulates BMR
—>person must obtain a sufficient amount of iodine to produce thyroid hormones
TRH comes from what part of the brain
hypothalamus
TSH comes from what part of the brain
pituitary
T3 and T4 com from what part of the brain
thyroid gland
T4 (storage) is converted to __ (active) at target tissues
T3
thyroid hormones affect what 5 things
- Heat production and body temperature
- oxygen consumption and CO
- BV
- Enzyme system activity
- Metabolism of carbs, fats, and proteins
what hormone is important for regulator of growth and development, especially with reproductive and nervous systems
Thyroid gland
Targert cells absorb thyroid hormone which sends a message to the ___________ to stop sending out more ___, which stops production of ___, then stops T_ and T_
Hypothalamus; TRH; TSH; 3; 4
What is the clinical definition of Hypothyroidism
(__ is converted to __)
Elevated TSH due to insufficient amount of thyroid hormone (T4 is converted to T3)
5 Causes of Hypothyroidism
- low iodine
- low function of thyroid tissue due to tumor or autoimmune disorder (Hashimoto)
- Thyroidectomy
-Aggressive Tx with antithyroid drugs
(Low mineral, No function, autoimmune/tumor, or antithyroid drugs)
Symptoms of Hypothyroidism
- Chills
- low body temp
- Lethargy, slowed speech
- bradycardia, hypotension
- decreased appetite
- weight gain
- skin pale, dry
(LOW AND SLOW)
What are the 2 types of Hypothyroidism
Cretinism (children)
- dwarfism/severe mental retardation
Myxedema (adults)
- Symptoms of normal Hypothyroidism
Hypothyroidism is related to what disease
Graves Disease
What are the symptoms of Hyperthyroidism
- Inc. BMR
- Tachycardia
- Weight loss
- Inc. Body temp
- Anxiety
name of hyperthyroidism symptom of bulge of the eyes
Exophthalmos
What is the drug of use for someone with hypothyroid conditions?
Levothyroxine
What is the drug of use for someone with hyperthyroid conditions?
Thiomides (class)
- Propylthiouracil (PTU)***
- Methimazole (Tapazole)
- Radioactive Iodine
replacement therapy increases the levels of thyroid hormone and this suppresses what hormone?
TSH
How to teach a patient on how to take levothyroxine
used for hypothyroidism
- take with an empty stomach, 30min before breakfast, with full glass of water
why should you be caustious to give levothyroxine to a patient with a cardiac hx
the drug increases HR and BP and can cause complications
Adverse effects of Levothyroxine
ALL SYMPTOMS OF TAKING TOO MUCH
- HTN
- Tachycardia
- Arrhythmia
- Anxiety, nervousness, jittery, inability to sleep
- Heat intolerance
- Sweating
Warfarin interacting with levothyroxine causes what effect
Increased anticoagulant effect
Digoxin interacting with levothyroxine causes what effect
Decreased effect of levothyroxine
Antiseizue and antidepressants interacting with levothyroxine causes what effect
Increase levothyroxine metabolism
Binding Agents interacting with levothyroxine causes what effect
Decrease levothyroxine absorption
Pharmacokinetics of PTU
inhibits synthesis of thyroid hormones; inhibits peripheral conversion of T4 to T3
- well absorbed in GI tract
PTU adverse effects
(4ish effects)
- thyroid suppression; drowsiness, lethargy
- Watch for increase in liver issues/jaundice (HEPATITIS)
-use with anticoagulants causes INCREASED BLEEDING - GI distress, N/V
Mthimazole(tapazole) have similar effects what drug but is associated with what suppression?
PTU
- Bone marrow suppression
Sodium iodide is sued to treat what type of thyroid issue?
Hyperthyroidism
- it is radioactive so it gets absorbed and then destroys thyroid cells
radiation such as soidum iodide is not safe for???
Pregnant or children
Adrenal Medulla is located on the inside or outside?
Adrenal cortex is located on the outside or inside? and what does it produce?
Medulla: Inner core; part of the SNS
Adrenal Cortex: Outer shell; produces hormones called corticosteroids
What includes androgens, glucocorticoids, and mineralcorticoids (this is mainly what)?
Corticosteroids
Mainly aldosterone
Corticotropin (ACTH) stimulates what to produce what
stimulates the adrenal cortex to produce corticosteroids
Incrasing levels of corticosteroids inhibit the release of what and what to start a negative feedback mechanism
increasing levels of corticosteroids inhibits the release of CRH and ACTH - negative feedback loop
sudden stops of steroids results in a crisis of adrenal ___________ until hypothalamic-pituitary axis controls stimulate the ______ _____ again
sudden stops of steroids results in a crisis of adrenal cortex until hypothalamic-pituitary axis controls stimulate the adrenal gland again
a common cause of adrenal insufficiency is prolonged use of what?
corticosteroid hormones
an exogenous use of this product acts to negate the regular feedback loop, what is it?
Corticosteroids
what causes the adrenal glands to no longer be stimulated and produce or secrete hormones?
The use of exogenous corticosteroids
when exogenous corticopsteroids are used, how long does it take fo the adrnal gland to recover from the atrophy of the lack of stimulation
several weeks
Because exogenous corticosteroids can cause atrophy of ACTH hormone release, what is recomennded with the use of steroid therapy
only use for short-term steroid therapy and should be weaned slowly
- this gives the adrenal glands time to recover and start producing hormones again
What steroid is a male and female sex hormone and effect electrolytes, stimulate protein production, and decrease protein breakdown
Androgens
What steroid stimulated an increase in glucose levels for energy
- glucocorticoids have anti-inflammatory properties, help to control metabolism of muscle, fat liver and bone, they effect vascular ton influence mood, behavior, sleep/wake cycle
- primary corticoid is cortisol
glucocorticoids
What steroid affects electrolyte levels and homeostasis
- regulate Na, H2O balance
- primary version of it is aldosterone
Mineralocorticoids
What steroid promotes homeostasis of CV, nervous, and musculoskeletal systems - to a certain extent
Glucocorticoids
What would be the INDICATIONs OF USE for
Adrenal Glands and warnings?
- suppress immune system **
(used mostly for short-term) - short term use: Releace acute inflammation AND for replacement therapy when release of hromone arent adequate
-DOES NOT CURE ANY INFLAMMATORY DISORDERS
What are the TOP 3 glucocorticoid medication names?
Cortisone (generic)
Dexamthasone (generic)
Prednisone (Rayos)
Which glucocorticoid is short acting and what activity does it produce?
Short acting: Cortison: Both glucocorticoid and mineralocorticoid activity
Which glucocorticoid medication is intermediate acting?
Prednisone
Which glucocorticoid medication is long acting?
Dexamethasone
Why are glucocorticoiuds so important (what is their function and use)
they are anti-inflammatory
(anti-inflammatory helps with allergies, rhinitis, asthma, dermatitis, etc.)
- Helps with Maignant disorders (Hodgkin’s disease, leukemias)
- Immunosuppression (Post-transplant surgery)
What is the action of Glucocorticoids/ what does it cause the body to do?
Cause lipogenesis (formation of fat)
- decreases WBC, inhibits tisue granulation and repair
- may cause NA and H2O retention (leading to edema and HTN)
- Opposite of androgens (inc. protein breakdown and dec. rate of protein formation)
Contraindications of glucocorticoids
- allergic
- acute infection
- lactation
Caution with the use of glucocorticoids
- pregnancy
- diabetes
- Acute peptic ulcer
Drug-drug interaction with glucocorticoids
(what drugs increase/decrease it)
- Increase in glucocorticoid function when given erythromycin, ktoconazole or troleandomycin
- Decrease in drug when given with salicylates barbiturates, pehnytoin or rifampin
What is the top adverse effect for the use of glucocorticoids?
Growth retardation in children
What causes Adrenal insufficiency?
Decrease in ACTH from pituitary or decreased output from adrenal cortex
What can Addisons disease or long term treatment with glucocorticoids cause?
Adrenal insufficiency
What are symptoms of Adrenal insufficiency?
- Fatigue
- Low BP
- Hypoglycemia
- GI disturbances
What syndrome is caused from long term use of glucocorticoids and what are the characteristics?
Cushings syndrome
- adrenal atrophy
- lots of fat around shoulder and neck
- increased risk of infection related to delayed wound healing.
Top nursing process protocols for GLUCOCORTICOIDS
- Do not stop abruptly – can cause adrenal crisis
- Drugs are not curative but do suppress the inflammatory process
- Effects of the drug last for several days, sometimes months depending on route
- Medication may increase appetite
Take medication with food as it can upset stomach - Do not use concurrently with NSAIDs – GI effects
- Must assess fluid retention and weight gain at follow up appts
- Long term uses is associated with increased risk for infection
- Increased risk for hyperglycemia
What is secreted by ovarian follicles and responsible for maturation of sex organs and secondary sex characteristics of women
Estrogen
Estrogen affects the release of ___ and __ (fertility hormone)
FSH and LH
what hormone is responsible for proliferatiion of the endometrial lining
estrogen
What are the 6 uses of Estrogen
- Contraception (combined with progestin)
- Hormone replacment
- palliation for discomforts of menopause
- treat female hypogonadism and ovarian failure
- prevent post partum breast engorgment (as part of combo pill)
- slow bone loss in osteoporosis
What are the therapeutic actions of estrogens
- Affects release of FSH and LH
- Maintaining the secondary female sex characteristics
- PROTECTING THE HEART FROM ATHEROSCLEROSIS
- retaining calcium and phosphorus in the bones
- complete with androgens for recepto sites
Adverse effects of Estrogen
break thru bleeding, menstrual irregularities, dis/amenorrhea, changes in libido
- GI tract: nausea, cramps, bloating, colitis
- Systemic effects: BLOOD CLOTS
- Ocular changes:
what is the most important thing to do to prevent blood clots
DONT SMOKE
Estrogen is not indicated in…
prepubesant children
When someone is taking estrogen, what can hapen to the eyes
Ocular changes - corneal changes —- may need new contact lenses
estrogen can decrease effectiveness of _______ and some _________ drugs
warfarin; hypoglycemic
Progestins are secreted by the…
corpus luteum (progesterone most abundant)
progestins prepare endometrium for what?
implantation
In the third final cycle of the uterine cycle, there is ____ progesterone and estrogen levels
HIGH
Progestins provide a ______ feedback to shut off ____, ___, and LH secretions
negative; GNRH; FSH
Progestins is the class of medication
just to know
How can progestins be used
- used to maintain a pregnancy
- contraception
(most effective with combo with estrogens) - treat primary and secondary amenorrhea
- trear dysfunctional uterine bleeding
pharmacokinetics of progestins
well absorbed
- undergo hepatic metabolism and are excreted in the urine
Actions of progesterone
Transform proliferative endometrium into a secondary endometrium
- inhibit the secretion of FSH and LH
What are the contraindications of progestins
- allergy
- if pregnant
- undiagnosed vaginal bleeding
- breast/genital cancer
- Hx of clots (DVT/PE)
Adverse effects of progestins
First tier:
- Weight gain
- depression
- HTN
Second tier:
- NV, dysmenorrhea, and vaginal candidiasis
What drugs have drug-drug interactions with progestins
Barbiturates
- carbamazepine
- phenytoin
- rifampin
If a pt has Hx of blood clots or cancer, they will not be put on what hormone?
Estrogen
Inc in estrogen are not good in pregnant women because…
it will decrease breast milk amount
apply estrogen patches to the trunk not on waistline
- may be discontinued prior to surgeries because of potential clot formation
- take estrogen at bedtime
- notify PCP of swelling, SOB, or chest pain
What are oral contraceptives
Hormones used to prevent pregnancy
Are ortal contraceptives used in combo with estro and progestins?
YES
How to OC help prevent pregnancies
Small doses prevent conception by blocking ovulation
How many -phasic and what are the names
- Monophasic
- Biphasic
- Triphasic
- progestin only
What type of estrogen-progestin contraceptive is the only one used that is approved to treat heavy menstrual bleeding
Quadriphasic (Natazia)
progestin-only oral contraceptive produce what?
Produce thick, viscous mucus at entrance to uterus
- mucus discourages penetration by sperm
- inhibit implantation of fertilized egg
With progestin-only oral contraceptives, there is a higher rate of what?
Higher rate of menstrual irregularities
- they don’t create thromboembolic or breast cancer risk
what is the function (action) of OC combinations with progestin and estrogen?
Inhibit release of FSH and LH thus preventing ovulation
OC combo primary use is…
Contraceptive, improvement in cycle regularity, dec. incidence of dysmenorrhea
What are the adverse effects of OC combo?
edema
- nausea
- abdominal cramps
What is the difference between monophasic, biphasic, and triphasic?
Monophasic - same level of hormone throughout pack
Biphasic- change level of hormone about half way through
Triphasic - 3 different doses of hormones
again smoking increases the risk of…
blood clots
Side effects of OC includes
- appetite changes
- weight gain
- mood swings
- edema
- bloating
- breast tenderness
Use caution giving OC to patients with those with …..
migraine headaches
OC may increase the risk of what type of cancer
breast cancer
before taking OC, the doctor needs to ask client if they plan to do what…. (about breasts) and why
Breastfeeding
- estrogen will decrease milk supply
- should give progesterone only pill if plans to breast feed
- can give combo if client plans to stop breastfeeding
What is the name of the long-term exteended-duration formulations equally effective contraception
Depot injection (depo-provera)
What is the BLACK BOX for depot injections (Depo-Provera)
Bone loss and need break every 5 years
Depo-Provera therapeutic class
hormone; drug for dysfunctional uterine bleeding
Depo-Provera: pharmacologic class?
Progestin
what are the indications for the use of Depo-Provera?
- Endometriosis
- amenorrhea
- uterine bleeding
- contraception
Contraindication of Depo-Provera
- Pregnant
- known or suspected carcinoma of breast
- caution in pat with Hx of:
- depression and discontinued immediately at first signs
What emergency OTC is available
plan B
Function of Emergency Contraception
- Prevents ovulation and implantation of fertilized egg; does not induce abortion
is Menopause the natural process of aging?
yes
What does Menopause do to the body?
- Progressive decrease in estrogen secretion by the ovaries
- permanent cessation of menses
- can be accompanied by hot flashes, night sweats, irregular menstrual cycles, bone mass loss
For hormone replacement rherapy for menopause, what ius the caution for combo vs estrogen alone?
Estrogen-progestin combination
- Increased risk of MI, stroke, breast cancer, dementia, and venous thromboembolism
- Decreased risk of hip fracture and colorectal cancer
Estrogen alone
- Increased risk of stroke and thromboembolism
- No increased breast cancer or MI
Pros and cons of HRT
- Cardiac problems
- Stroke
- Breast Cancer
- Dementia
- HRT may dec. risk of hip fractures and colorectal cancer
conjugated equine estrogen (Premarin) is given when ovarian activity is…
blocked/absent or menopause
conjugated equine estrogen (Premarin) is given when relief is needed from s/s of
menopause who STILL HAVE UTERUS
Benefits of HRT
Reduced Hot flashes
- prevents osteoporosis
- reduced vaginal dryness
Side effects of HRT
breakthrough bleeding
- inc risk of CV events
Fertility drugs do what and what are the indications to use it?
Stimulate release of FSH and/or LH
- Infertility
Clomiphene (Clomid) do what
treat female/male infertility
- Stimulates OVULATION
Chorionic gonadotropin (Pregnyl)
Stimulation of Ovulation!!!
When are fertility drugs contraindicated? What are some cautions?
- need the ability to ovulate
- thyroid or adrenal dysfunction
- ovarian cyst
- Pregnancy
- allergic
Caution:
- breastfeeding
- thromboembolic disease
- resp. disease
Adverse effects of fertility drugs
-inc. risk of multiple births and birth defects
- Ovarian overstimulation
- Headache, fluid retention, nausea, bloating
- uterine bleeding
- gynecomastia (males)
Clomiphene
- indications
- action
Indication: Tx of ovarian failure in pts with normal liver function and normal endogenous estrogens; off-label use, tx of male sterility
Actions: Binds to estrogen receptors and give hypothalamus false signal to increase FSH and LH secretion causing ovarian stimulation
What are Oxytocic
Natural hormones secreted by posterior pituitary
- Stimulates uterine contractions to induce labor
- Suckling stimulates release of oxytocin
- Causes more milk ejection
Oxytocin induces what?
Labor: by inc. frequency and force of uterine contractions
Adverse effects of Oxytocin
Complications in fetus include dysrhythmias or intracranial hemorrhage
serious complications using Oxytocin can cause what?
Uterine rupture, seizures, or coma
contraindications for Oxytocin (Pitocin)
- allergy
- Cephalopelvic Disproportion ( if pelvis not structured to accommodate the fetus during birth)
Adverse effects of Pitocin (oxytocin)
- excessive effects: Uterine hypertonicity
- Uterine rupture
- GI upset
- Headache
- BP changes
- Water intoxication
Oxytocin
indication:
Actions:
Indications: To start or improve uterine contractions for early vaginal delivery; stimulate labor; manage abortion; control postpartum bleeding hemorrhage
Actions:
- Synthetic form stimulates the uterus, especially the gravid uterus; causes myoepithelium of the lacteal glands to contract, results in milk ejection
Tocolytics
- Slow uterine contractions to delay labor
- Used in patients with premature labor
- Delays labor by 24-72 hrs, often enough time for fetus to develop normal lung function
- adverse effects include tachycardia in both mother and fetus
What are the uses of tocolytics
- Relax the uterine smooth muscle and prevent contractions
- Usually reserved for use after 20 weeks of gestation
What is the name of the tocolytics prototype name?
Terbutaline (Brethine)
What drug is a great choice for a patient with both preterm labor and asthma and works in both the lungs and the uterus
Terbutaline (Brethine)
[Tocolytics]
What drug is widely used agent to relax gravid uterus
Tocolytics (Terbutaline)
Tocolytics are the opposite of what drug
Oxytocic
Abortifacients do what?
Terminate pregnancy at 12-20 weeks
- Dislodge any implanted trophoblast and preventing implantation of fertilized egg
What is the name of the drug for Abortifacients
Dinoprostone (Cervidil)
What are the contraindications of Abortifacients
- Allergies
- After 20 weeks gestation
- Previous C-sections - risk for uterine rupture
Adverse effects of abortifacients
- amniotic fluid embolism
- Perforated uterus or uterine rupture***, heavy bleeding
can dinoprostone (Cervidil) induce labor or help getting pregnant
NO, it helps to induce labor but helps to terminate pregnancy
What drug promotes ripening (softening), shortening, and dilating of cervix before inducing labor
Dinoprostone (Cervidil)
Pitocin is given in what type of pump
infusion pump
