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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
Q

Hyperthyroidism Assessment (Physical)

A

History: *** Heat intolerance, vision changes; blurring
Cardio: Tachy, AFib, Palpitations
Skin: Warm, moist, hair loss

*Weight loss
*Sweating
*Insomnia

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26
Q

Hyperthyroidism Assessment

A

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

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27
Q

Hyperthyroidism Interventions

A

-VS Every 4 hrs
-Report: Palpitations, chest pain
-Monitor Temp for rise indicative of Thyroid Storm

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28
Q

Thyroid Storm

A

High Fever and HTN
- Uncontrolled hyperthyroidism
- S/S: Fever, tachy, N/V/D, tremors, coma, death
- Maintain patency of airway
Drug: *Methimazole, PTU

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29
Q

Hyperthyroidism Surgical Management

A

Partial / Total thyroidectomy

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30
Q

Hyperthyroidism Pre Op Care

A
  • Thioamide medications to achieve normal thyroid function
  • HTN, tachy must be controlled before hand
  • High protien, high carb diet for days/ weeks before surgery
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31
Q

Hyperthyroidism Post Op Care

A

-Pillows to support head
-Hypocalcemia
-Hemorrhage: First 24 hrs
-Resp Distress: Keep emergent trach kit at table
- Larygeal nerve damage: Weak voice

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32
Q

Thionamides: Methimazole, PTU
Hyperthyroidism Med

A

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

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33
Q

Radioactive Iodine
Hyperthyroidism Med

A

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

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34
Q

Lugo’s solution, Sodium Iodide, Potassium Iodide

A

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

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35
Q

Acute Infectious Thyroiditis

A

Infection of the thyroid gland
- Pain, neck tenderness, fever

36
Q

Subacute Thyroiditis

A

Viral infection of the thyroid gland after a cold / URI
- Fever, chills, joint pain, pain to ears/jaw

37
Q

Hashimoto Thyroiditis

A

Autoimmune triggered by bacterial/viral infection
- Dysphagia, painless thyroid enlargement

38
Q

Papillary Thyroid Cancer

A

Most common
- Younger women
-Slow growing

39
Q

Follicular Thyroid Cancer

A

Occurs most in older adults
- Dyspnea, horseness

40
Q

MTC ( Medullary )

A

Most common in adults over 50
- Endocrine Aplasia

41
Q

Anaplastic Carcinoma

A

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
Q

Parathyroid Glands

A
  • Maintain Calcium and Phosphate Balance
43
Q

PTH

A

Directly on Kidney
- Increases calcium resorption + phosphorus excretion
- Release of calcium from bone
- Vit D production

44
Q

Hypoparathyroidism

A

Rare
- 3 Types
Iatragenic: Removal of all parathyroid tissue
Idiopathic: Occurs spontanesously without a cause
Hypomagnesemia: Malabsorption, CKD, Malnutrtion supressing PTH

45
Q

Hypoparathyroidism Assessment

A

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
Q

Hyperparathyroidism Assessment

A

Increased PTH= Hypercalcemia and Hypophosphatatemia
Cause: Exact is unknown, but one or more parathyroid glands do not respond to normal feedback

47
Q

Hyperparathyroidism Causes

A

Tumors, Cancer, Hyperplasia, Neck Trauma, Vit D Deficient, CKD

48
Q

Hyperparathyroidism S/S

A

Kidney stones, anorexia, N/V, weight loss, weakness, fatigue, lethargy, coma, death is possible

49
Q

Hyperparathyroidism Labs

A

cAMP: calcium, phosphorus, urine cyclic adeonosine monophospahte
X rays: kidney stones, lessions

50
Q

Hyperparathyroidism Management

A

Management: Diuretic, rehydrations
Calcimimetic *** : Reduces PTH production
Monitor: Cardiac, I/O’s

51
Q

Hypopituitarism

A

Deficiency in 1 or more Pituitary hormones: GH, TSH, ACTH, FSH, LH, MSH, PRL

52
Q

Hypopituitarism Causes

A

Benign/ Malignant Pit Tumors
Head Trauma
Radiation

53
Q

Hypopituitarism Interventions

A

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
Q

Hyperpituitarism

A

Hormone over secretion
- Most common: GH, Prolactin, ACTH
- Most often caused by a benign tumor

55
Q

PRL
Prolactin Secreting Tumors

A

Are the most common type of pituitary adenoma

56
Q

Hyperpituitarism Defintion

A

Overproduction GH in adults results in Acromegaly = irreversible enlargement of face, hands, feet

57
Q

When excessive secretion of GH occurs before puberty….

A

the disorder is known as gigantism

58
Q

Hyperpituitarism Drugs

A

Octreotide, Lanreotide- Inhibits GH release

59
Q

Somatropin
Decreased GH

A

Replaces GH
- Used in growth hormone deficiences
- Comp: Hyperglycemia, renal calculi
- Interactions: Glucocorticoids
- Admin: Rotate injection sites; abdomen, thighs

60
Q

Octreotide, Lanreotide
For Gigantism/ Acromegaly

A

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
Q

ADH

A

Maintain blood pressure
Maintain fluid balance
Produced in hypothalamus –> pituitary

62
Q

ADH released when

A

Decrease in blood pressure
Increased serum osmolality

63
Q

Diabetes Insipidus

A

Water loss caused by ADH deficiency
- Large amount of excretion of urine

64
Q

Central
( neurogenic )

A

Disruptions in ADH synthesis, transportation, release
- Caused by brain tumors, head injuries, CNS infections

65
Q

DI Assessment

A

Increased Urination + Thirst
S/S: Poor skin turgur, hypotension, tachy, weak pulse, low specific gravity urine <1.005
- Greater than 4L/24 hrs

66
Q

DI Interventions

A

Desmopressin: Need to decrease urine output

67
Q

Vasopressin and Desmopressin

A

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
Q

SIADH
Syndrome of Inappropraite Andidiuretic Hormone

A

Condition in which the body makes too much ADH.
- Causing fluid overload
- Water retention results in hyponatremia

69
Q

SIADH Assessment

A

Caused by: Malignancies, CNS Disorder, Pulmonary Disorder, Meds
Hyponatremia: GI, N/V, Weight gain, lethargy, HA, bounding pulse

70
Q

SIADH Interventions

A

Fluid Restriction ( 500-1000 ml daily )
3% NaCL for extreme hyponatremia.
Diuretics
I/O
Monitor for Edema

71
Q

Adrenal Insufficiency occurs when?

A

Adrenal glands don’t make enough Cortisol

72
Q

Primary Adrenal Insufficiency
( Addisons Disease )

A

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
Q

If the ACTH level is high but the cortisol and aldosterone levels are low?

A

Usually confirmed it is Addisons Disease

74
Q

Secondary Adrenal Insufficiency

A

Doesnt make enough ACTH.
- Leads to long time steroids use

75
Q

Acute Adrenocortical Insufficiency

A

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
Q

Adrenal Gland Dysfunciton Assessment

A

Neuro: Weakness, fatigue, joint pain
GI: Anorexia, N/V, weight loss
Skin: Vitiligo, hyperpigmentation
CV: Anemia, hypotension, hyponatremia, hyperkalemia, hypercalcemia

77
Q

Labs tests for Adrenal Gland Dysfunction

A

Serum Sodium- Risk for hyponatremia
Low level of glucose
If ACTH level is high, but cortisol and aldosterone are low = Addisons Disease

78
Q

Adrenal Gland Dysfunction Interventions

A

Promote fluid balance
Monitor for fluid deficit
Weigh patient daily
VS 1-4 hrs
Meds: Hydrocortisone, Oral Cortisol ( prednisone )

79
Q

Adrenal Hormone Replacement
Hydrocortisone, Glucocorticoids: Prednisone, Dexamethasone, Fludrocortisone

A

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
Q

Hypercortisolism
Cushing’s Disease

A

Excess of cortisol

81
Q

Primary Cushings

A

Only at adrenal gland

82
Q

Pituitary Cushings

A

Problem is the pituitary gland

83
Q

Cushings Syndrome
( Secondary )

A

Glucocorticoid excess

84
Q

Cushing’s Disease Assessment

A

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
Q

Cushing’s Disease Interventions

A

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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