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Pharm 2 > Exam #2 Endocrine > Flashcards

Exam #2 Endocrine Flashcards

1
Q

Hormones regulate function of:

A

Growth, reproduction, metabolism, F&E balance

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2
Q

Thyroid Gland
( 2 Primary hormones )

A
  1. Triiodothyronine ( T3 )
  2. Thyroxine ( T4 )
    - Also contains C cells that secrete Calcitonin.
    - Pituitary gland is responsible for secreting thyroid stimulating hormone ( TSH )
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3
Q

When T3 and T4 levels are low in the blood…

A

The pituitary gland releases more TSH to tell the thyroid gland to produce more thyroid hormones.
- When TSH is high
* HYPOthyroidism

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4
Q

When T3 and T4 levels are high in the blood…

A

Pit Gland releases less TSH
- HYPERthyroidism

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5
Q

The hypothalmus releases

A

TRH

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6
Q

The pituitary gland releases

A

TSH

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7
Q

TSH produces

A

T3 and T4

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8
Q

Nontoxic Diffuse Goiter

A

NOT associated with hypo or hyperthyroidism not resulting from cysts, inflammation, neoplasia
- Simple Goiter

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9
Q

Nontoxic Multi-nodular Goiter

A

Becomes more nodular as some thyroid follicles proliferate more than others.

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10
Q

Endemic Goiter

A

Goiter caused by iodine deficiency

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11
Q

Chronic Autoimmune ( Hashimoto ) Thyroiditis

A

Most common cause of HYPOthyroidism, involves goiter caused by an increase in TSH secretion

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12
Q

Toxic Multinodular Goiter
( Graves Disease )

A

Most common cause of HYPERthyroidism, involves goiter caused by stimulation of TSH receptors by TSH antibodies

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13
Q

Hypothyroidism Etiology

A

Wordwide Iodine deficiency is the most common cause of hypothyroidism
- Occur from Hashimoto Thyroiditis

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14
Q

Hypothyroidism age target

A

Women 65+

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15
Q

Hypothyroidism Patho

A

Reduced or absent hormone secretion from the thyroid gland ( T3, T4 ) resulting in decreased metabolism

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16
Q

Hashimoto’s

A
  • Involves antibodies that cause gradual destruction of thyroid follicles
    -Autoimmune
    -Leads to diminished production of T3 and T4
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17
Q

Hypothyroidism Physical Symptoms

A

Neuro: Impaired memory, confusion, lethargy
Pulmonary: Hypoventillation
Cardio: Bradycardia, dysrhythmias
Metabolic: *** Cold Intolerance
Psychosocial: Depression
GI: Weight gain, constipation
Skin: Cool, pale, yellow
Other: Periorbital Edema, Puffiness, Goiter, Thick tongue

*Increase in time spent sleeping
*Reduction of T3,T4
*High TSH

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18
Q

Myxedema

A

Nonpitting edema forms everywhere especially around the eyes, hands, feet and between shoulder blades. Husky voice.

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19
Q

Myxedema Coma

A

Hypothyroidism Crisis!
- Decreased cardiopulmonary function
- Decreased perfusion and gas exchange
- High mortality
- Respiratory system is a priority!

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20
Q

Hypothyroidism Med: Levothyroxine

A

MOA: Synthetic form of T4, T3 or both.
Complications: Overmedication, thyrotoxicosis, afib
Interactions: Increased cardiac response to catecholamines ( Epi, dopamine ) causing dysrhymias
Admin: Check pulse, low doses first, on empty stomach
* Lifelong med

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21
Q

Hyperthyroidism Patho

A

Excessive quantities of thyroid hormone, also called thyrotoxicosis
- Increased HR, Stroke Volume, Increased CO, BP, blood flow
- Affects protein, fat, glucose
- Protein breakdown exceeds buildup
- Glucose intolerance decreases resulting in hyperglycemia
- Fat metabolism increases and body fat decreases

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22
Q

Graves Disease

A

Common cause of Hyperthyroidism
- Autoimmune thyroid disease production of TSI’s that attach to TSH receptors increasing thyroid production. Increases the glandular cells which enlargers the gland forming goiter.

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23
Q

Exophthalmos

A

Protruding of the eyeball
- Graves Disease

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24
Q

Pretibial Myxedema

A

Dry, waxing swelling of the front surfaces of the lower legs
- Graves Disease

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25
Hyperthyroidism Assessment (Physical)
History: *** Heat intolerance, vision changes; blurring Cardio: Tachy, AFib, Palpitations Skin: Warm, moist, hair loss *Weight loss *Sweating *Insomnia
26
Hyperthyroidism Assessment
Lab: T3, T4 : High TSH: Low Thyroid Scan Radioactive Iodine Uptake Test ( RAIU ): Measures percentage of radioactivity in the thyroid after admin of radioactive iodine Ultra: Size of nodules ECG: Heart monitor
27
Hyperthyroidism Interventions
-VS Every 4 hrs -Report: Palpitations, chest pain -Monitor Temp for rise indicative of Thyroid Storm
28
Thyroid Storm
High Fever and HTN - Uncontrolled hyperthyroidism - S/S: Fever, tachy, N/V/D, tremors, coma, death - Maintain patency of airway Drug: *Methimazole, PTU
29
Hyperthyroidism Surgical Management
Partial / Total thyroidectomy
30
Hyperthyroidism Pre Op Care
- Thioamide medications to achieve normal thyroid function - HTN, tachy must be controlled before hand - High protien, high carb diet for days/ weeks before surgery
31
Hyperthyroidism Post Op Care
-Pillows to support head -Hypocalcemia -Hemorrhage: First 24 hrs -Resp Distress: Keep emergent trach kit at table - Larygeal nerve damage: Weak voice
32
Thionamides: Methimazole, PTU Hyperthyroidism Med
MOA: Blocks the synthesis of thyroid hormones Complications: Hypothyroidism, Agranulocytosis ( Severely low WBC ) = Sore throat, fever, increased risk for infection, aplastic anemia Contradictions: Do not use w liver failure Interactions: Anticoag, Digoxin can be increased Nursing Admin: Avoid shellfish, no iodine containing foods, with food
33
Radioactive Iodine Hyperthyroidism Med
MOA: Destroys some thyroid hormone producing cells Complications: Radiation Sickness; Hematemesis, N/V, Bone Marrow Depression, Hypothyroidism ( intolerance to cold, edema, brady, weight gain ) Interactions: Pregnant, Antithyroid Medications Admin: 6 ft distance, 2-3 L fluid increase
34
Lugo's solution, Sodium Iodide, Potassium Iodide
Nonradioactive Iodine: Reduces iodine uptake, inhbit thyroid production, and block release of thyroid hormones into blood stream Reduces thyroid size prior to surgery Emergency TX Complications: Iodism; metallic tastes, stomatitis, sore teeth, rash Interactions: High iodine foods, ACE, Potassium Sparing Admin: Dilute in juice, same time each day, increase fluid intake, no OTC Iodine products
35
Acute Infectious Thyroiditis
Infection of the thyroid gland - Pain, neck tenderness, fever
36
Subacute Thyroiditis
Viral infection of the thyroid gland after a cold / URI - Fever, chills, joint pain, pain to ears/jaw
37
Hashimoto Thyroiditis
Autoimmune triggered by bacterial/viral infection - Dysphagia, painless thyroid enlargement
38
Papillary Thyroid Cancer
Most common - Younger women -Slow growing
39
Follicular Thyroid Cancer
Occurs most in older adults - Dyspnea, horseness
40
MTC ( Medullary )
Most common in adults over 50 - Endocrine Aplasia
41
Anaplastic Carcinoma
Rapidly growing, aggressive tumor that invades tissues - Stridor, dysphagia - Treatment: Radioactive iodine * Any other types of thyroid cancer = Levothyroxine to maintain TSH in normal range
42
Parathyroid Glands
- Maintain Calcium and Phosphate Balance
43
PTH
Directly on Kidney - Increases calcium resorption + phosphorus excretion - Release of calcium from bone - Vit D production
44
Hypoparathyroidism
Rare - 3 Types Iatragenic: Removal of all parathyroid tissue Idiopathic: Occurs spontanesously without a cause Hypomagnesemia: Malabsorption, CKD, Malnutrtion supressing PTH
45
Hypoparathyroidism Assessment
Mild tingling, numbness, severe muscle cramps, spasms. Chvostek: Cheeck twitching Trousseau Sign: Blood pressure cuff spasm Treatment: IV Calcium- 10% solution over 10-15 mins
46
Hyperparathyroidism Assessment
Increased PTH= Hypercalcemia and Hypophosphatatemia Cause: Exact is unknown, but one or more parathyroid glands do not respond to normal feedback
47
Hyperparathyroidism Causes
Tumors, Cancer, Hyperplasia, Neck Trauma, Vit D Deficient, CKD
48
Hyperparathyroidism S/S
Kidney stones, anorexia, N/V, weight loss, weakness, fatigue, lethargy, coma, death is possible
49
Hyperparathyroidism Labs
cAMP: calcium, phosphorus, urine cyclic adeonosine monophospahte X rays: kidney stones, lessions
50
Hyperparathyroidism Management
Management: Diuretic, rehydrations Calcimimetic *** : Reduces PTH production Monitor: Cardiac, I/O's
51
Hypopituitarism
Deficiency in 1 or more Pituitary hormones: GH, TSH, ACTH, FSH, LH, MSH, PRL
52
Hypopituitarism Causes
Benign/ Malignant Pit Tumors Head Trauma Radiation
53
Hypopituitarism Interventions
Replacement of all deficient hormones to ensure cellular regulation - Endoscopic Transsphenoidal Hypophysectomy : Surgery used to remove tumors - *** Do not bend over after surgery, and report headaches
54
Hyperpituitarism
Hormone over secretion - Most common: GH, Prolactin, ACTH - Most often caused by a benign tumor
55
PRL Prolactin Secreting Tumors
Are the most common type of pituitary adenoma
56
Hyperpituitarism Defintion
Overproduction GH in adults results in Acromegaly = irreversible enlargement of face, hands, feet
57
When excessive secretion of GH occurs before puberty....
the disorder is known as gigantism
58
Hyperpituitarism Drugs
Octreotide, Lanreotide- Inhibits GH release
59
Somatropin Decreased GH
Replaces GH - Used in growth hormone deficiences - Comp: Hyperglycemia, renal calculi - Interactions: Glucocorticoids - Admin: Rotate injection sites; abdomen, thighs
60
Octreotide, Lanreotide For Gigantism/ Acromegaly
Suppresses growth hormone release - Comp: GI, Hypo/Hyperglycemia, Liver injury, chest pain, flu like s/s - Contradicitons: DM, Hypothyroidism, Renal Disease, gallbladder, older clients - Interactions: Conduction delay with antidysrhythmics, brady, opiods can reduce effect
61
ADH
Maintain blood pressure Maintain fluid balance Produced in hypothalamus --> pituitary
62
ADH released when
Decrease in blood pressure Increased serum osmolality
63
Diabetes Insipidus
Water loss caused by ADH deficiency - Large amount of excretion of urine
64
Central ( neurogenic )
Disruptions in ADH synthesis, transportation, release - Caused by brain tumors, head injuries, CNS infections
65
DI Assessment
Increased Urination + Thirst S/S: Poor skin turgur, hypotension, tachy, weak pulse, low specific gravity urine <1.005 - Greater than 4L/24 hrs
66
DI Interventions
Desmopressin: Need to decrease urine output
67
Vasopressin and Desmopressin
Promotes reabsorption of water - DI, Vasoconstriction uses - Water intoxication can occur: HA, drowsiness - Do not use if renal is impaired - DECREASE URINE OUTPUT IS THE GOAL!
68
SIADH Syndrome of Inappropraite Andidiuretic Hormone
Condition in which the body makes too much ADH. - Causing fluid overload - Water retention results in hyponatremia
69
SIADH Assessment
Caused by: Malignancies, CNS Disorder, Pulmonary Disorder, Meds Hyponatremia: GI, N/V, Weight gain, lethargy, HA, bounding pulse
70
SIADH Interventions
Fluid Restriction ( 500-1000 ml daily ) 3% NaCL for extreme hyponatremia. Diuretics I/O Monitor for Edema
71
Adrenal Insufficiency occurs when?
Adrenal glands don't make enough Cortisol
72
Primary Adrenal Insufficiency ( Addisons Disease )
When adrenal glands are damaged! - Don't make enough cortisol and aldosterone! - Symptoms: Hypoglycemia, decreased GFR, excessive BUN, anorexia, weight loss, hyperkalemia, hyponatremia, hypovolemia, hypotension.
73
If the ACTH level is high but the cortisol and aldosterone levels are low?
Usually confirmed it is Addisons Disease
74
Secondary Adrenal Insufficiency
Doesnt make enough ACTH. - Leads to long time steroids use
75
Acute Adrenocortical Insufficiency
This is life threatening! : Addisonian Crisis - Need for cortisol and aldosterone is greater than the bodys supply - Result of stressful event - S/S: Hypotension, hyponatremia, hyperkalemia
76
Adrenal Gland Dysfunciton Assessment
Neuro: Weakness, fatigue, joint pain GI: Anorexia, N/V, weight loss Skin: Vitiligo, hyperpigmentation CV: Anemia, hypotension, hyponatremia, hyperkalemia, hypercalcemia
77
Labs tests for Adrenal Gland Dysfunction
Serum Sodium- Risk for hyponatremia Low level of glucose If ACTH level is high, but cortisol and aldosterone are low = Addisons Disease
78
Adrenal Gland Dysfunction Interventions
Promote fluid balance Monitor for fluid deficit Weigh patient daily VS 1-4 hrs Meds: Hydrocortisone, Oral Cortisol ( prednisone )
79
Adrenal Hormone Replacement Hydrocortisone, Glucocorticoids: Prednisone, Dexamethasone, Fludrocortisone
Mimics effect of natural steroid hormones - Comp: Hyperglycemia, osteoporosis, GI Upset, Infection, Cushing's, Weight gain -Contradictions: Gastric ulcer, kidney disorder, DM, cirrhosis, hypothyroidism - Admin: Do not stop abruptly, tapering dose is best
80
Hypercortisolism Cushing's Disease
Excess of cortisol
81
Primary Cushings
Only at adrenal gland
82
Pituitary Cushings
Problem is the pituitary gland
83
Cushings Syndrome ( Secondary )
Glucocorticoid excess
84
Cushing's Disease Assessment
Moon face, weight gain, HTN, edema, petechia *** Increased risk for infection, reduced immunity, s/s of infection are masked - Atrophy, osteoporosis, bruisng, thinning skin, *** fasting blood glucose levels are high
85
Cushing's Disease Interventions
Fluid overload due to hormone induced sodium retention -Restore fluid balance with drug therapy, monitor I&O - Prevent skin injury -*** Potential risk for infection due to hormone induced reduced immunity

Pharm 2 (10 decks)

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