Exam 4: Endocrine (Hypothalamus, etc.) Flashcards
What does the small intestine produce?
incretin
What does the pancreas produce?
glucagon and insulin
What hormone do the kindeys produce?
calcitrol - very end product activated Vit D
What are the only two ways to change the release of hormones?
growth releasing hormones OR growth inhibiting hormone
If you have a thyroid that is sick - what problem do you have?
primary thyroid problem
If the thyroid is working, but the anterior pituitary is not ready to do its job - what problem do you have?
secondary thyroid problem
If the thyroid and anterior pituitary are working, but the hypothalamus is not ready to do its job - what problem do you have?
tertiary thyroid problem
What does the hypothalamus talk to the anterior pituitary?
corticotropin-releasing factor
What does the adrenal cortex produce?
glucocorticoids and mineralcorticoids
If the anterior pituary is working and the hypothalamus is working, but the patient cannot produce glucocorticoids and mineralcorticoids - what kind of problem is it?
primary adrenal problem
If the patient doesn’t have glucocorticoids and mineralcorticoids, but the adrenal cortex is still actually working - what problem does this patient have?
secondary adrenal problem OR tertiary adrenal problem
If the patient DOES have (in excess) glucocorticoids and mineralcorticoids, and the adrenal cortex is still actually working - what problem does this patient have?
secondary anterior pituitary problem OR tertiary anterior pituitary problem
How does the hypothalamus talk to posterior pituitary gland?
nerves
What is the a hormone that IS produced by the posterior pituitary gland?
ADH (vasopressin)
The hypothalamus acts as what kind of loop to regulate the amount of hormones being released?
negative feedback loop
The gland that is respsonible for secreting the hormone is not functioning properly is a _________ endocrine disease.
primary
The gland that is responsible for secreting the hormone is functional, but the releasing/inhibiting hormone is the cause of the problem is _______ endocrine disease?
secondary
What are the two main functions of hormones?
1) REGULATE stress response, growth, and metabolism 2) MAINTAIN homeostasis
What endocrine disorders are characterized by over or under secretion of hormones?
1) hyperthyroidism 2) hypothyroidism 3) diabetes mellitus
What endocrine disorder is characterized by altered response by the target area/receptor?
Diabetes mellitus
What are the 4 pharmacotherapy options for regulating hormones?
1) replacement 2) anti-hormone 3) cancer chemo 4) exaggerated response
What are two examples of hormone replacement?
thyroid hormone and insulin
What is an anti-hormone (inhibiting hormone) example to block thyroid hormone?
methimazole, propylthiouracil (PTU)
What cancer chemo hormone is used for breast CA?
testosterone to SUPPRESS breast tissue growth
what cance chemo hormone is used for testicular CA?
estrogen to SUPPRESS testicular tissue growth
What are two examples to create an exaggerated response of hormones in order to stop hormones?
glucocorticoids and oral contraceptives
What does GHRH stand for?
growth hormone releasing hormone
What does GHIH stand for? what is its other name?
growth hormone inhibiting hormone: somatoSTATIN
Where do GHRH and GHIH come from?
hypothalamus
What does GH stand for? what is its other name?
growth hormone: somatoTROPIN
Where does GH come from?
pituitary
What do GHRH and GHIH determine?
level of GH release from anterior pituitary
What four things does the GH manage?
1) metabolism 2) growth of muscle 3) bone 4) fat
What can low GH cause in regards to body size?
dwarfism
What can high GH cause in regards to body size?
gigantism, acromegaly
For hypothalamus pituitary - what drug is used for GH DEFICIENCY?
somatropin
What is the indication for somatropin?
dwarfism (before epiphyseal closure)
What are side effects of somatropin?
1) DM due to DECREASE insulin secretion 2) hypothyroidism
What are two contraindications of somatropin?
1) other types of dwarfism unrelated to GH 2) obesity, respiratory disease (sleep apnea)
For hypothalamus pituitary - what drug is used for GH EXCESS?
octreotide
What are the two main indications for octreotide aside from gigantism and acromegaly?
severe diarrhea and esophageal bleed
Whare are the two side effects of octreotide?
1) pancreatitis 2) hypothyroidism
What organs should you monitor in a patient taking octreotide?
1) kidney 2) liver
Where does TRH come from? (thyrotropin-releasing hormone)
hypothalamus
Where does TSH come from? (thyrotropin-stimulating hormone)
anterior pituitary
Where does T4 and T3 come from?
thyroid
What are the two main functions of T4 and T3?
1) REGULARE metabolism throughout the body 2) CHANGES in mood, weight, and mental/physical energy levels
What are the labs to monitor for the hypothalamus - pituitary - thyroid axis?
TSH (secondary problems), T4 & T3 (primary problems)
What are manifestations of HYPERthyroidism?
Tachycardia, palpitation, diaphoresis, heat intolerance, nervousness, anxiety, irritability, exophthalmos, weight loss, amenorrhea
What is severe hyperthyroidism that may result in death and is a medical emergency called?
thyroid storm
Whare are manifestations of HYPOthyroidism?
bradycardia, cold intolerance, apathy, depression, lethargy, dry skin, facial edema, weight gain, menorrhagia, goiter
What is severe hypothyroidism that may result in death and is a medical emergency?
myxedema coma (or crisis)
What is the synthetic thyroid hormone drug used when the thyroid is not working?
levothyroxine sodium
What are the indications for levothyroxine sodium?
PO: hypothyroidism, IV: myxedema coma
What are four patient educations points or the use of levothyroxine sodium for hypothyroidism?
1) requires life-long replacement 2) DO NOT discontinue or change brand or dose without consulting endocrinologist 3) slow absorption & onset of action, long half-life (one week) 4) full therapeutic effect in 6-8 weeks
What are two nursing considerations when a patient is taking levothyroxine sodium for hypothyroidism?
ONLY on an empty stomach (ONE HOUR before BF) and check levels frequently (TSH, T3, T4)
What are SIDE EFFECTS of levothyroxine sodium for hypothyroidism?
tachycardia, HYPERglycemia, evelated temp., tachypnea, OD (hyperthy s/s), under-dose (hypothy s/s), HIGHLY PROTEIN-BOUND (toxicity w/ other protein bound drugs, ex: AC)
What are ADVERSE EFFECTS of levothyroxine sodium for hypothyroidism?
tachydysrhythmias, chest pain, HTN, seizure
What are contraindications of levothyroxine sodium for hypothyroidism?
MI and adrenal insufficiency
What is the antithyroid drug?
methimazole
What is the MOA of methimazole?
inhibits TH synthesis
How long does it take for methimazole to reach full therapeutic effect? and why?
3-12 weeks, because it does not destory existing TH
What are 4 indications for the use of the antithyroid drug, methimazole?
1) HYPERthyroidism 2) Grave’s disease 3) thyrotoxicosis 4) adjunct to irradiation
What are three side effects of methimazole?
1) s/s of HYPOthyroidism (OD) 2) s/s of HYPERthyroidism (under-dose) 3) GI distress (take with meal!)
What is the contraindication for methimazole?
pregnancy, lactation
What are 4 points of patient education when taking methimazole?
1) take same time daily 2) do not discontinue (thyrotoxicosis) 3) avoid foods high in iodine (seafood) 4) many drug interactions (oral AC, insulin, digoxin, lithium, phenytoin)
For the hypothalamus -pituitary - adrenal cortex axis: 1) what releases CRF 2) what released ACTH?
1) hypothalamus 2) ant. pituitary
What are the three adrenal cortex hormones released?
1) glucocorticoids (cortisol) 2) mineralocorticoids (aldosterone) 3) androgens (testosterone)
EX: When cortisol level rises, negative-feedback loopmechaniusm shuts off further release of ______?
glucocorticoids
What is the adrenocorticotropic hormone drug?
corticotropin
How is corticotropin administered?
MUST be given parenterally (repository or depot injection - slow absorption)
What are the THREE indications for the use of corticotropin?
1) secondary adrenal insufficiency 2) diagnosing secondary vs primary adrenal insufficiency 3) acute severe exacerbation of inflammatory disorders
For the indicated use of corticotropin for secondary adrenal insufficiency - what is the contraindication?
because pituitary insufficiency = low ACTH …. the contraindication is primary adrenal insufficiency (Addison’s disease)
For the indicated use of corticotropin for diagnosing secondary vs primary adrenal insufficiency - what is the test used and how is the test conducted?
ACTH stimulation test: checking cortisol level PRE and q30 min post corticotropin (AKA: cortisol test)
for the indiacated use of corticotropin for acute severe exacerbation of inflammatory disorders - what are some examples of disorders?
lupus, MS, systemic dermatomyositis, systemic sarcoidosis, psoriatric arthritis, RA
What level should a nurse monitor in patient taking corticotropin? and what is important to know about the admin of corticotropin?
cortisol level - taper dose and avoid abrupt discontinuing
What does corticotropin cause water and Na to do?
retention
What organ can suffer side effects from the use of corticotropin?
RF
In a DM patient taking corticotropin - what should be monitored?
High BG = monitor closely
What trend should be monitored in a patient taking corticotropin and why?
BP for HTN
What drugs are given for the indication: Primary Adrenocortical Insufficiency (Addison’s Disease) and adrenal crisis?
glucocorticoid drugs: MAIN - methylprednisolone and prednisone
glucocorticoid drugs (methylprednisolone and prednisone) can aslo be given for what others indications?
inflammatory, autoimmune, and allergic diseases
The suddden withdraw of corticosteroids leads to what acute issues (an adrenal crisis)?
adrenal insufficiency, HYPOtension, lethargy, RF, asthenia, n&v
What is the disorder when the Posterior Pituitary has an ADH deficiency?
Diabetes Insipidus (DI)
What is DI?
when you have a large amount of dilute urine = Na retention (hypernatremia)
What drug is indicated for DI?
desmopressin
What is MOA of desmopressin for DI?
DECREASE urine output = INCREASE osmolality of urine (and a little vasoconstriction effect)
What is the DOA of desmopressin for DI?
LONG = 20 hours.
What drug is an emergency drug for severe hypotension, as in shock? (under ADH deficiency, but NOT indicated for DI)
vasopressin
What is MOA of vasopressin?
peripheral vasoconstriction (strong!)
What is the DOA of vasopressin?
SHORT = 30-60 min. ONLY given IV (vesicant).
For the side effect of fluid overload (therefore, worsening HF) when taking desmopressin - what should a nurse monitor for?
I & O, daily weight, CMP (electrolyte changes), AMS (water intoxication)
For the side effect of vasoconstriction when vasopressin is administered - what should a nurse monitor?
agina & MI, dysrhythmia, HTN
What is the disorder when the Posterior Pituitary has an ADH excess?
SIADH
What three main things happen with SIADH?
1) water retention (edema) 2) natruiresis (urinating Na) 3) hyponatremia
What drug is used for SIADH?
tolvaptan
What is the MOA of tolvaptan used for SIADH?
aquaresis (excretion of water without electrolyte loss)
What are the side effects of tolvaptan used for SIADH?
1) hypovalemia 2) HIGH K 2) HIGH BG
What makes calcitonin?
the thyroid
What empties the bones?
Parathyroid
What fills the bones?
thyroid
If a patient’s Parathyroid hormone is LOW, and therefore, calcium is LOW - what is the treatment?
kidney hormone (calciTRIOL) to INCREASE Ca absorption & bone resorption
If a pateint’s Parathyroid hromone is HIGH, and therefore, calcium is HIGH - what is the treatment?
thyroid hormone (calciTONIN) deposit in the bones
For HYPOparathyroidism (HYPOcalcemia) - what is drug used to managed?
calciTROL (active Vit D - a renal hormone)
For HYPOparathyroidism (HYPOcalcemia) - what is the MOA of calciTROL?
INCREASE Ca absorption in the GI tract (and increases resorption to increase release of Ca from bone into the blood)
For HYPOparathyroidism (HYPOcalcemia) - what are the side effects of calciTROL?
dizziness, vertigo, falls, metallic taste
For HYPOparathyroidism (HYPOcalcemia) - what are the three indications for calciTROL?
1) hypothyroidism 2) vit D deficiency 3) RENAL HORMONE REPLACEMENT!! (ESRD on HD)
For HYPERparathryroidism (HYPERcalcemia) - what are the three main causes?
1) hyperparathryroidism: malignancies of parathyroid 2) drug-induced by: THIAZIDE, VIT A/D, MILK-ALKALI SYNDROME 3) prolonged immobility
Since we don’t have drugs to stop parathyroid - what do we give to offset hypercalcemia?
we use thyroid hormone calciTONIN (calciTONIN-salmon)
What are the three MOA of calciTONIN-salmon used for HYPERcalcemia?
1) calcitonin receptor agonist (stimulator) 2) DEPOSIT Ca into the bone (hence, for osteoporosis) 3) increase renal excretion
What are the side effects of calciTONIN-salmon used for HYPERcalcemia? (hint: HYPOcalcemia)
numbness ot tingly around mouth, tachycardia, muscle spasms, hyperactive deep tendon reflexes (DTR), seizure, nasal spray causes nasal dryness (alternate nostrils and use NS nasal spray)
