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Pharmacology > Exam 4: Endocrine (Hypothalamus, etc.) > Flashcards

Exam 4: Endocrine (Hypothalamus, etc.) Flashcards

1
Q

What does the small intestine produce?

A

incretin

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2
Q

What does the pancreas produce?

A

glucagon and insulin

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3
Q

What hormone do the kindeys produce?

A

calcitrol - very end product activated Vit D

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4
Q

What are the only two ways to change the release of hormones?

A

growth releasing hormones OR growth inhibiting hormone

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5
Q

If you have a thyroid that is sick - what problem do you have?

A

primary thyroid problem

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6
Q

If the thyroid is working, but the anterior pituitary is not ready to do its job - what problem do you have?

A

secondary thyroid problem

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7
Q

If the thyroid and anterior pituitary are working, but the hypothalamus is not ready to do its job - what problem do you have?

A

tertiary thyroid problem

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8
Q

What does the hypothalamus talk to the anterior pituitary?

A

corticotropin-releasing factor

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9
Q

What does the adrenal cortex produce?

A

glucocorticoids and mineralcorticoids

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10
Q

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?

A

primary adrenal problem

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11
Q

If the patient doesn’t have glucocorticoids and mineralcorticoids, but the adrenal cortex is still actually working - what problem does this patient have?

A

secondary adrenal problem OR tertiary adrenal problem

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12
Q

If the patient DOES have (in excess) glucocorticoids and mineralcorticoids, and the adrenal cortex is still actually working - what problem does this patient have?

A

secondary anterior pituitary problem OR tertiary anterior pituitary problem

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13
Q

How does the hypothalamus talk to posterior pituitary gland?

A

nerves

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14
Q

What is the a hormone that IS produced by the posterior pituitary gland?

A

ADH (vasopressin)

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15
Q

The hypothalamus acts as what kind of loop to regulate the amount of hormones being released?

A

negative feedback loop

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16
Q

The gland that is respsonible for secreting the hormone is not functioning properly is a _________ endocrine disease.

A

primary

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17
Q

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?

A

secondary

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18
Q

What are the two main functions of hormones?

A

1) REGULATE stress response, growth, and metabolism 2) MAINTAIN homeostasis

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19
Q

What endocrine disorders are characterized by over or under secretion of hormones?

A

1) hyperthyroidism 2) hypothyroidism 3) diabetes mellitus

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20
Q

What endocrine disorder is characterized by altered response by the target area/receptor?

A

Diabetes mellitus

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21
Q

What are the 4 pharmacotherapy options for regulating hormones?

A

1) replacement 2) anti-hormone 3) cancer chemo 4) exaggerated response

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22
Q

What are two examples of hormone replacement?

A

thyroid hormone and insulin

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23
Q

What is an anti-hormone (inhibiting hormone) example to block thyroid hormone?

A

methimazole, propylthiouracil (PTU)

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24
Q

What cancer chemo hormone is used for breast CA?

A

testosterone to SUPPRESS breast tissue growth

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25
Q

what cance chemo hormone is used for testicular CA?

A

estrogen to SUPPRESS testicular tissue growth

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26
Q

What are two examples to create an exaggerated response of hormones in order to stop hormones?

A

glucocorticoids and oral contraceptives

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27
Q

What does GHRH stand for?

A

growth hormone releasing hormone

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28
Q

What does GHIH stand for? what is its other name?

A

growth hormone inhibiting hormone: somatoSTATIN

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29
Q

Where do GHRH and GHIH come from?

A

hypothalamus

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30
Q

What does GH stand for? what is its other name?

A

growth hormone: somatoTROPIN

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31
Q

Where does GH come from?

A

pituitary

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32
Q

What do GHRH and GHIH determine?

A

level of GH release from anterior pituitary

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33
Q

What four things does the GH manage?

A

1) metabolism 2) growth of muscle 3) bone 4) fat

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34
Q

What can low GH cause in regards to body size?

A

dwarfism

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35
Q

What can high GH cause in regards to body size?

A

gigantism, acromegaly

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36
Q

For hypothalamus pituitary - what drug is used for GH DEFICIENCY?

A

somatropin

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37
Q

What is the indication for somatropin?

A

dwarfism (before epiphyseal closure)

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38
Q

What are side effects of somatropin?

A

1) DM due to DECREASE insulin secretion 2) hypothyroidism

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39
Q

What are two contraindications of somatropin?

A

1) other types of dwarfism unrelated to GH 2) obesity, respiratory disease (sleep apnea)

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40
Q

For hypothalamus pituitary - what drug is used for GH EXCESS?

A

octreotide

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41
Q

What are the two main indications for octreotide aside from gigantism and acromegaly?

A

severe diarrhea and esophageal bleed

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42
Q

Whare are the two side effects of octreotide?

A

1) pancreatitis 2) hypothyroidism

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43
Q

What organs should you monitor in a patient taking octreotide?

A

1) kidney 2) liver

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44
Q

Where does TRH come from? (thyrotropin-releasing hormone)

A

hypothalamus

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45
Q

Where does TSH come from? (thyrotropin-stimulating hormone)

A

anterior pituitary

46
Q

Where does T4 and T3 come from?

A

thyroid

47
Q

What are the two main functions of T4 and T3?

A

1) REGULARE metabolism throughout the body 2) CHANGES in mood, weight, and mental/physical energy levels

48
Q

What are the labs to monitor for the hypothalamus - pituitary - thyroid axis?

A

TSH (secondary problems), T4 & T3 (primary problems)

49
Q

What are manifestations of HYPERthyroidism?

A

Tachycardia, palpitation, diaphoresis, heat intolerance, nervousness, anxiety, irritability, exophthalmos, weight loss, amenorrhea

50
Q

What is severe hyperthyroidism that may result in death and is a medical emergency called?

A

thyroid storm

51
Q

Whare are manifestations of HYPOthyroidism?

A

bradycardia, cold intolerance, apathy, depression, lethargy, dry skin, facial edema, weight gain, menorrhagia, goiter

52
Q

What is severe hypothyroidism that may result in death and is a medical emergency?

A

myxedema coma (or crisis)

53
Q

What is the synthetic thyroid hormone drug used when the thyroid is not working?

A

levothyroxine sodium

54
Q

What are the indications for levothyroxine sodium?

A

PO: hypothyroidism, IV: myxedema coma

55
Q

What are four patient educations points or the use of levothyroxine sodium for hypothyroidism?

A

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

56
Q

What are two nursing considerations when a patient is taking levothyroxine sodium for hypothyroidism?

A

ONLY on an empty stomach (ONE HOUR before BF) and check levels frequently (TSH, T3, T4)

57
Q

What are SIDE EFFECTS of levothyroxine sodium for hypothyroidism?

A

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)

58
Q

What are ADVERSE EFFECTS of levothyroxine sodium for hypothyroidism?

A

tachydysrhythmias, chest pain, HTN, seizure

59
Q

What are contraindications of levothyroxine sodium for hypothyroidism?

A

MI and adrenal insufficiency

60
Q

What is the antithyroid drug?

A

methimazole

61
Q

What is the MOA of methimazole?

A

inhibits TH synthesis

62
Q

How long does it take for methimazole to reach full therapeutic effect? and why?

A

3-12 weeks, because it does not destory existing TH

63
Q

What are 4 indications for the use of the antithyroid drug, methimazole?

A

1) HYPERthyroidism 2) Grave’s disease 3) thyrotoxicosis 4) adjunct to irradiation

64
Q

What are three side effects of methimazole?

A

1) s/s of HYPOthyroidism (OD) 2) s/s of HYPERthyroidism (under-dose) 3) GI distress (take with meal!)

65
Q

What is the contraindication for methimazole?

A

pregnancy, lactation

66
Q

What are 4 points of patient education when taking methimazole?

A

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)

67
Q

For the hypothalamus -pituitary - adrenal cortex axis: 1) what releases CRF 2) what released ACTH?

A

1) hypothalamus 2) ant. pituitary

68
Q

What are the three adrenal cortex hormones released?

A

1) glucocorticoids (cortisol) 2) mineralocorticoids (aldosterone) 3) androgens (testosterone)

69
Q

EX: When cortisol level rises, negative-feedback loopmechaniusm shuts off further release of ______?

A

glucocorticoids

70
Q

What is the adrenocorticotropic hormone drug?

A

corticotropin

71
Q

How is corticotropin administered?

A

MUST be given parenterally (repository or depot injection - slow absorption)

72
Q

What are the THREE indications for the use of corticotropin?

A

1) secondary adrenal insufficiency 2) diagnosing secondary vs primary adrenal insufficiency 3) acute severe exacerbation of inflammatory disorders

73
Q

For the indicated use of corticotropin for secondary adrenal insufficiency - what is the contraindication?

A

because pituitary insufficiency = low ACTH …. the contraindication is primary adrenal insufficiency (Addison’s disease)

74
Q

For the indicated use of corticotropin for diagnosing secondary vs primary adrenal insufficiency - what is the test used and how is the test conducted?

A

ACTH stimulation test: checking cortisol level PRE and q30 min post corticotropin (AKA: cortisol test)

75
Q

for the indiacated use of corticotropin for acute severe exacerbation of inflammatory disorders - what are some examples of disorders?

A

lupus, MS, systemic dermatomyositis, systemic sarcoidosis, psoriatric arthritis, RA

76
Q

What level should a nurse monitor in patient taking corticotropin? and what is important to know about the admin of corticotropin?

A

cortisol level - taper dose and avoid abrupt discontinuing

77
Q

What does corticotropin cause water and Na to do?

A

retention

78
Q

What organ can suffer side effects from the use of corticotropin?

A

RF

79
Q

In a DM patient taking corticotropin - what should be monitored?

A

High BG = monitor closely

80
Q

What trend should be monitored in a patient taking corticotropin and why?

A

BP for HTN

81
Q

What drugs are given for the indication: Primary Adrenocortical Insufficiency (Addison’s Disease) and adrenal crisis?

A

glucocorticoid drugs: MAIN - methylprednisolone and prednisone

82
Q

glucocorticoid drugs (methylprednisolone and prednisone) can aslo be given for what others indications?

A

inflammatory, autoimmune, and allergic diseases

83
Q

The suddden withdraw of corticosteroids leads to what acute issues (an adrenal crisis)?

A

adrenal insufficiency, HYPOtension, lethargy, RF, asthenia, n&v

84
Q

What is the disorder when the Posterior Pituitary has an ADH deficiency?

A

Diabetes Insipidus (DI)

85
Q

What is DI?

A

when you have a large amount of dilute urine = Na retention (hypernatremia)

86
Q

What drug is indicated for DI?

A

desmopressin

87
Q

What is MOA of desmopressin for DI?

A

DECREASE urine output = INCREASE osmolality of urine (and a little vasoconstriction effect)

88
Q

What is the DOA of desmopressin for DI?

A

LONG = 20 hours.

89
Q

What drug is an emergency drug for severe hypotension, as in shock? (under ADH deficiency, but NOT indicated for DI)

A

vasopressin

90
Q

What is MOA of vasopressin?

A

peripheral vasoconstriction (strong!)

91
Q

What is the DOA of vasopressin?

A

SHORT = 30-60 min. ONLY given IV (vesicant).

92
Q

For the side effect of fluid overload (therefore, worsening HF) when taking desmopressin - what should a nurse monitor for?

A

I & O, daily weight, CMP (electrolyte changes), AMS (water intoxication)

93
Q

For the side effect of vasoconstriction when vasopressin is administered - what should a nurse monitor?

A

agina & MI, dysrhythmia, HTN

94
Q

What is the disorder when the Posterior Pituitary has an ADH excess?

A

SIADH

95
Q

What three main things happen with SIADH?

A

1) water retention (edema) 2) natruiresis (urinating Na) 3) hyponatremia

96
Q

What drug is used for SIADH?

A

tolvaptan

97
Q

What is the MOA of tolvaptan used for SIADH?

A

aquaresis (excretion of water without electrolyte loss)

98
Q

What are the side effects of tolvaptan used for SIADH?

A

1) hypovalemia 2) HIGH K 2) HIGH BG

99
Q

What makes calcitonin?

A

the thyroid

100
Q

What empties the bones?

A

Parathyroid

101
Q

What fills the bones?

A

thyroid

102
Q

If a patient’s Parathyroid hormone is LOW, and therefore, calcium is LOW - what is the treatment?

A

kidney hormone (calciTRIOL) to INCREASE Ca absorption & bone resorption

103
Q

If a pateint’s Parathyroid hromone is HIGH, and therefore, calcium is HIGH - what is the treatment?

A

thyroid hormone (calciTONIN) deposit in the bones

104
Q

For HYPOparathyroidism (HYPOcalcemia) - what is drug used to managed?

A

calciTROL (active Vit D - a renal hormone)

105
Q

For HYPOparathyroidism (HYPOcalcemia) - what is the MOA of calciTROL?

A

INCREASE Ca absorption in the GI tract (and increases resorption to increase release of Ca from bone into the blood)

106
Q

For HYPOparathyroidism (HYPOcalcemia) - what are the side effects of calciTROL?

A

dizziness, vertigo, falls, metallic taste

107
Q

For HYPOparathyroidism (HYPOcalcemia) - what are the three indications for calciTROL?

A

1) hypothyroidism 2) vit D deficiency 3) RENAL HORMONE REPLACEMENT!! (ESRD on HD)

108
Q

For HYPERparathryroidism (HYPERcalcemia) - what are the three main causes?

A

1) hyperparathryroidism: malignancies of parathyroid 2) drug-induced by: THIAZIDE, VIT A/D, MILK-ALKALI SYNDROME 3) prolonged immobility

109
Q

Since we don’t have drugs to stop parathyroid - what do we give to offset hypercalcemia?

A

we use thyroid hormone calciTONIN (calciTONIN-salmon)

110
Q

What are the three MOA of calciTONIN-salmon used for HYPERcalcemia?

A

1) calcitonin receptor agonist (stimulator) 2) DEPOSIT Ca into the bone (hence, for osteoporosis) 3) increase renal excretion

111
Q

What are the side effects of calciTONIN-salmon used for HYPERcalcemia? (hint: HYPOcalcemia)

A

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)

Pharmacology (7 decks)

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