Exam 2 Body Defenses and Endocrine Pharmacology Flashcards by megan kaiser

chemical mediator of inflammation
protein present in an inactive form in plasma and mast cells; increases vascular permeability and causes pain. effects are similar to histamine, broken down by ACE.

Bradykinin

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chemical mediator of inflammation
series of at least 20 proteins that combine in a cascade fashion to neutralize or destroy an antigen; stimulates histamine release by mast cells, causes cell lysis

complement

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chemical mediator of inflammation

stored and released by mast cells; causes vasodilation; smooth muscle constriction; tissue swelling; and itching

histamine

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chemical mediator of inflammation
lipids stored and released by mast cells; effects are similar to those of histamine; synthesized from arachidonic acid; responsible for some symptoms of asthma and allergies

leukotrienes

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chemical mediator of inflammation
lipid present in most tissues and stored and released by mast cells; increase capillary permeability, attract WBCs to the site of inflammation, cause pain, and induce fever; aspirin inhibits their synthesis; some are available as medications

prostaglandins

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tinnitus, deafness, urticaria, nausea, vomiting, confusion, drowsiness, prolonged bleeding time, dyspepsia, stomach pain

Common adverse effects of Salicylates

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bronchospasm, anaphylactic shock, laryngeal edema, hemolytic anemia, salicylism, angioedema, Reye’s Syndrome, metabolic acidosis, severe GI bleeding, hepatotoxicity

Severe Adverse Reactions of Salicylates

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back pain, peripheral edema, abdominal pain, dyspepsia, flatulence, dizziness, headache, insomnia, HTN

Increased risk of cardiovascular events, acute renal failure

adverse effects of celecoxib (Celebrex)

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COX2 Inhibitor, NSAID, anti-inflammatory

celecoxib (Celebrex)

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epigastric pain, abdominal pain

Hepatotoxicity, acute renal failure, GI Bleeding

adverse effects of acetaminophen

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dyspepsia, dizziness, headache, drowsiness, tinnitus, rash, pruritus, increased liver enzymes, prolonged bleeding time, edema, nausea, vomiting, occult blood loss

Peptic ulcer, GI Bleeding, anaphylactic reactions with bronchospasm, blood dyscrasias, renal impairment, MI, HF, hepatotoxicity

adverse effects of ibuprofen

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benefit of selectively blocking COX2 and not COX1

The selective inhibition of COX2 produces the analgesic, anti-inflammatory, and anti-pyretic effects typical of oter NSAIDS, but without causing platelet aggregation or GI Bleeding.

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What should NSAIDs be taken with to decrease GI upset?

food or milk

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Which drug should not be given to children under 19 years old or within two-three weeks of the varicella Vaccine?

aspirin or salicylates

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Which patients should refrain from drinking alcohol?

Those taking acetaminphen

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Adverse effects of Immunostimulant:
flulike symptoms, rash, anemia, nausea, vomiting, diarrhea, confusion, dyspnea

Cardiac arrest, hypotension, tachycardia, thrombocytopenia, oliguria, anuria, PE, capillary leak syndrome

aldesleukin (Proleukin)

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Adverse effects of Immunostimulant:
flulike symptoms, dysuria, hematuria, anemia, lymphadenopathy

Thrombocytopenia, cystitis, UTI, disseminated mycobacteria

bacillus Calmette-Guerin (BCG) vaccine (TheraCys, Tice)

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Adverse effects of Immunostimulant:
flulike symptoms, myalgia, fatigue, headache, anorexia, diarrhea

Myelosuppression, thrombocytopenia, neutropenia, suicide ideation, anaphylaxis, hepatotoxicity

interferons

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Identical to endogenous IL-2
initiates a series of actions thatactivate IFNs, TNF, and other ILs.
Promotes proliferation of both B and T cells, macrophages, NK cells which in turn increase the body’s ability to fight cancer cells

aldesleukin (Proleukin)

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Dexamethasone is the overdose treatment

aldesleukin (Proleukin)

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treats patients with superficial bladder cancer

TheraCys

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used to stimulate immunity against Mycobacterium tuberculosis

Tice

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Adverse Effects of which immunosuppressant:
Hirsutism, tremor, nausea, vomiting

HTN, MI, **nephrotoxicity, hyperkalemia, seizures, paresthesia, hepatoxicity

Avoid sun exposure

cyclosporine (Gengraf, Neoral, Sandimmune)

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calcineurin inhibitor, thus diminishing T and B cell activity and suppressing the immune response

cyclosporine (Gengraf, Neoral, Sandimmune)

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preferred drug for transplant rejection

cyclosporine (Gengraf, Neoral, Sandimmune) | calcineurin inhibitor

adverse effects of which immunosuppressant? nausea, vomiting, anorexia severe nausea and vomiting, bone marrow suppression, thrombocytopenia, serious infections, malignancy, anaphylaxis *Hematologic disease *Hepatic impairment

azathioprine (Azasan, Imuran)

prophylaxis for kidney rejection

azathioprine (Azasan, Imuran) | Cytotoxic Agent and antimetabolite

local reactions at the injection site (pain, erythema, myalgia), flu like symptoms (malaise, fever, chills) headache, dizziness Anaphylaxis, HTN, infections, thrombocytopenia, leukopenia, renal impairment (basiliximab), PE (muromonab-CD3 and antithymocyte globulin), herpes simplex or cytomegalovirus infections (muromonab-CD3)

adverse effects of antibodies (immunosuppressants)

suppress proliferating B and T cells

cytotoxic agents and antimetabolites (azathioprine)

cortocosteriods used for transplant rejection

prednisone and methylprednisolone

osteoporosis, cataract formation, mental status changes, fluid and salt retention, HTN, hyperglycemia, obesity, and renal atrophy

Long term adverse effects of corticosteriods

avoid grapefruit juice when taking which immunosuppressant?

cyclosporine

which vaccine type stimulates a response from both B and T cells?

Attentuated (live) virus

polio, measles, mumps, rubella, varicella

attenuated (live) virus vaccines

salk polio, flu, rabies, hep A

Inactivated (killed) virus vaccines

tetanus, diphtheria

Toxiod vaccines

hep B

recombinant technology vaccine

Which vaccine is risky for someone with an active infection?

attenuated (live)

Which vaccine type does not confer life long immunity?

inactivated (killed)

Which vaccine requires large amounts of antigen?

toxoid

patients who are immunosuppressed; pregnant; cancer & HIV

contraindications for vaccines

hypersecretion of cortocosteriods

cushings syndrome

hyposecretion of cortisosteriods

addisons disease

how to treat hyposecretion of parathyroid?

vid D and calcium supplements

Hyposecretion of ADH

diabetes insipidus

treatment of diabetes insipidus

vasopressin or desmopressin

ADH comes from which gland?

pituitary

GH comes from which gland?

pituitary

treatment of SIADH

conivaptan (Viprostol) and tolvaptan (samsca)

treatment for hyposecretion of GH--> small stature

somatropin (Genotropin)

treatment for hypersecretion of GH -->acromegaly

octreotide (Sandostatin)

hypersecretion of thyroid gland

graves disease

graves disease treatment

PTU (propylthiouracil) and I-131

hyposecretion of thyroid gland

myxedema (adults) | cretinism (children)

treatment of myxedema and cretinism

thyroid hormone and levothyroxine (T4)

stimulation of corticosteriods

CRH in hypothalamus ACTH in pituitary target organ adrenal cortex

stimulates the release of estrogen and ovarian follicle development in females and increases sperm production in males

GnRH in hypothalamus FSH pituitary target organ: ovaries or testes

triggers ovulation and secretion of estrogen and progesterone in females, increases testosterone secretion in males

LH from pituitary | target organ: ovaries or testes

Stimulates pigmentation

MSH (melanocye stimulating hormone) from pituitary | target organ: skin

stimulates release of thyroid hormone

TRH (thyrotropin releasing hormone) hypothalamus THS (thyroid stimulation hormone) pituitary target organ: thyroid

regulates growth and development of bones, muscles, cartilage, organs, general body metabolism

GHIH/GHRH hypothalamus GH from pituitary target organ: most body cells

regulates lactation

PIH (prolactin inhibiting hormone)/PRH hypothalamus Prolactin in pituitary target organ: mammary glands

tremor, pallor, nausea, vomiting, water retention, intoxication Angina, acute MI, gangrene, anaphylaxis, cardiac arrest

adverse effects of vasopressin | hypothalamic and pituitary agent

pain at injection site, hyperglycemia, arthralgia, myalgia, abdominal pain, otitis media, headache, bronchitis, hypothyroidism, HTN, flulike symptoms Severe respiratory impairment with obese patients with Prader Willi syndrome, diabetes, pancreatitis, scoliosis or the spine, papilledema, intracranial tumor

somatropin adverse effects | hypothalamic and pituitary agent

headache, nasal congestion or irritation, nausea water intoxication, coma, thromboembolic disorder, hyponatremia

desmopressin adverse effects | hypothalamic and pituitary agent

nausea, vomiting, diarrhea, headache, flushing, injection site pain, cholelithiasis dysrhythmia, worsening heart failure, sinus bradycardia

octreotide (Sandostatin) adverse effects | hypothalamic and pituitary agent

dietary suggestion for patients receiving growth hormone therapy

increase fluid intake and eat small, high calorie, nutrient dense meals rather than large infrequent meals

What is the best time of day to administer GH?

with the evening meal to mimic the body's natural rhythms

what triggers the release of ADH from the posterior pituitary gland?

as water is lost, the osmolality, or concentration of the blood, increases and the hypothalamus directs the posterior pituitary to release ADH. hypotension, decreased fluid volume, dehydration, pain, nausea, and vomiting

High blood glucose triggers the pancreas to release ___ and the liver _____ glycogen while the cells take up glucose from the blood. As a result, blood glucose ___

pancreas releases INSULIN liver PRODUCES glycogen blood glucose FALLS

Low blood glucose triggers the pancreas to release _____ and the liver _____ glycogen which causes the blood glucose to ________

pancreas releases GLUCAGON liver BREAKS DOWN glycogen blood glucose RISES

antihypoglycemic agent

glucagon

used to treat hypoglycemic emergencies in patients with diabetes who are unconscious or unable to eat or drink a sweetened bevereage

glucagon (GlucaGen)

GlucaGen is NOT effective in patients who experience hypoglycemia due to _____ because their glycogen stores are depleted

Starvation

more rapid onset insulin

Humalog

more prolonged duration of action insulin

Lantus

why must insulin be given as an injection

the GI tract destroys insulin

what is the primary adverse effect of insulin therapy?

overtreatment: insulin may remove too much glucose from blood, resulting in hypoglycemia.

patient is pale, cool, skin is moist, blood glucose is less than 50mg/dL and symptoms occur suddenly

symptoms of hypoglycemia that differentiate from DKA

which hormones elevate blood glucose levels?

epi, cortisol, and glucagon

Which insulin cannot be mixed with any other insulin?

Lantus (insulin glargine) and Insulin detemir (Levemir) | both are long-acting insulins

which insulin is intermediate acting? | onset 1-2 h, peak 6-14h, duration 16-24h

isophane insulin suspension (NPH, Humilin N)

Which insulin is short acting? | onset 30-60 min, peak 1-5h, duration 6-10h

Insulin Regular (Humilin R, Novolin R)

How long before a meal should you give short-acting Humilin R or Novolin R (insulin regular)?

30-60 min before meal

How long before a meal should you give rapid acting insulin lispro (Humalog) or insulin glulisine (Apidra)?

15 min before or immediately after a meal

signs and symptoms of hypoglycemia

nausea, paleness, sweating, diaphoresis, tremors, irritability, headache, light-headedness, anxiety, decreased LOC

signs and symptoms of hyperglycemia

flushed, dry skin, polyuria, polyphagia, polydipsia, drowsiness, glycosuria, ketonuria, acetone-breath

preferred drug for managing type 2 diabetes bc of its effectiveness and safety

Biguanides (Metformin-Glucophage)

with which oral antidiabetic agent is alcohol consumption contraindicated completely?

sulfonylureas (Glyburide)

which oral antidiabetic agent may cause hepatic toxicity?

sulfonylureas

which oral antidiabetic may cause lactic acidosis?

biguanides (Metformin-Glucophage)

With which two oral antidiabetic agents is hypoglycemia most likely to occur?

sulfonylureas or meglitinides

Which oral antidiabetic agent should you monitor for edema, blood pressure, and lung sounds (s/s of worsening HF)?

Thiazolidinediones

Normal T3 serum test

80-200 ng/dL decreased-->hypothyroid increased--> hyperthyroid

normal T3 uptake

25-35% relative percentage uptake No change hypothyroid increased hyperthyroid

Free T4

1.0-2.3 ng/dL decreased-hypothyroid increased hyperthyroid

Total T4 (radioimmunoassay)

5-12 mcg/dL decreased- hypothyroid increased hyperthyroid

TSH (Serum)

0.35-5.5 microinternational units/mL INCREASED hypothyroid DECREASED hyperthyroid

tachycardia, hyperthermia, tachypnea, hypercalcemia, hyperglycemia, metabolic acidosis, cardiovascular collapse: cardiogenic shock, hypovolemia, arrythmias, depressed LOC, emotional lability, psychosis, tremors, restlessness

Thyroid Storm

bradycardia, hypothermia, hypoventilation, hyponatremia, hypoglycemia, respiratory and metabolic acidosis, cardiovascular collapse: decreased vascular tone, depressed LOC, seizures/coma, hyporeflexia

Myxedema Coma

weight loss, headache, tremors, nervousness, heat intolerance, irritability, sweating, insomnia, mentrual irregularities Dysrhythmias, hypertension, palpitations, angina

adverse effects of hypothyroid medication: Levothyroxine (Levothroid, Synthroid, Levoxyl)

Which foods should patients on thyroid replacement therapy avoid?

foods containing iodine: soy sauce, tofu, yogurt, milk, strawberries, eggs

when should thyroid replacement therapy be administered daily

same time every morning

Which endocrine system drug may cause agranulocytosis?

Antithyroid drugs

What teaching is important to patients treated with radioactive iodine?

limit contact with family to 1 h per day per person until the treatment day is over. Young children and pregnant women should avoid contact all together.

do you take antithyroid drugs with or without food?

with food

do you take thyroid replacement drugs with or without food?

either 1 h before a meal or 4 h after a meal

corticosteriod use by mothers at risk for preterm labor

giving corticosteriods to mothers at risk of preterm labor helps to develop the baby's lungs and reduces the chance for serious complications such as infact respiratory distress syndrome if the baby is born premature.

mood swings, weight gain, acne, facila flushing, nausea, insomnia, sodium and fluid retention, impaired wound healing, mentrual abnormalities Peptic ulcer, hypocalcemia, osteoporosis, loss of muscle mass, decreased growth in children, possible masking of infections

adverse effects of corticosteriods

Which endocrine system drug should be tapered off?

corticosteriods-adrenal insufficiency and crisis may occur with profound hypotension, tachycardia, and other adverse effects if the drug is stopped abruptly

What time of day should you take corticosteriods?

same time every morning with food

preferred drug for Cushing Syndrome

antifungal drug ketoconazole (Nizoral)

Exam 2 Body Defenses and Endocrine Pharmacology Flashcards

(112 cards)