Exam 2 Body Defenses and Endocrine Pharmacology Flashcards
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
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
chemical mediator of inflammation
stored and released by mast cells; causes vasodilation; smooth muscle constriction; tissue swelling; and itching
histamine
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
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
tinnitus, deafness, urticaria, nausea, vomiting, confusion, drowsiness, prolonged bleeding time, dyspepsia, stomach pain
Common adverse effects of Salicylates
bronchospasm, anaphylactic shock, laryngeal edema, hemolytic anemia, salicylism, angioedema, Reye’s Syndrome, metabolic acidosis, severe GI bleeding, hepatotoxicity
Severe Adverse Reactions of Salicylates
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)
COX2 Inhibitor, NSAID, anti-inflammatory
celecoxib (Celebrex)
epigastric pain, abdominal pain
Hepatotoxicity, acute renal failure, GI Bleeding
adverse effects of acetaminophen
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
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.
What should NSAIDs be taken with to decrease GI upset?
food or milk
Which drug should not be given to children under 19 years old or within two-three weeks of the varicella Vaccine?
aspirin or salicylates
Which patients should refrain from drinking alcohol?
Those taking acetaminphen
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)
Adverse effects of Immunostimulant:
flulike symptoms, dysuria, hematuria, anemia, lymphadenopathy
Thrombocytopenia, cystitis, UTI, disseminated mycobacteria
bacillus Calmette-Guerin (BCG) vaccine (TheraCys, Tice)
Adverse effects of Immunostimulant:
flulike symptoms, myalgia, fatigue, headache, anorexia, diarrhea
Myelosuppression, thrombocytopenia, neutropenia, suicide ideation, anaphylaxis, hepatotoxicity
interferons
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)
Dexamethasone is the overdose treatment
aldesleukin (Proleukin)
treats patients with superficial bladder cancer
TheraCys
used to stimulate immunity against Mycobacterium tuberculosis
Tice
Adverse Effects of which immunosuppressant:
Hirsutism, tremor, nausea, vomiting
HTN, MI, **nephrotoxicity, hyperkalemia, seizures, paresthesia, hepatoxicity
Avoid sun exposure
cyclosporine (Gengraf, Neoral, Sandimmune)
calcineurin inhibitor, thus diminishing T and B cell activity and suppressing the immune response
cyclosporine (Gengraf, Neoral, Sandimmune)
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)
