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Pharmacology 3 > Module 3: Chapter 50 Drugs Affecting Pituitary, thyroid, parathyroid and hypothalamic function > Flashcards

Module 3: Chapter 50 Drugs Affecting Pituitary, thyroid, parathyroid and hypothalamic function Flashcards

1
Q

what are the functions of the anterior lobe of the pituitary gland?

A

controls the fn of glucocorticoid hormone levels (ACTH)
body growth and metabolism (GH)
fn of the thyroid gland (TSH)
gonadal function (FSH and LH)
milk production and breast growth (prolactin)

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2
Q

what is the fn of the posterior lobe of the pituitary gland

A

stores and secretes two effector hormones: oxytocin and vasopressin (ADH)

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3
Q

what are effector hormones

A

hormones that produce an effect when stimulated

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4
Q

what is the fn of the thyroid gland

A

control cellular metabolism and promotes normal growth and development

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5
Q

what are the 3 target organs of the parathyroid gland

A

bone
kidneys
GI tract

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6
Q

what is the major controlling factor for PTH secretion

A

serum calcium

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7
Q

What are the 6 hormones from the hypothalamus

A 
oxytocin
vasopressin (ADH)
CRH
TRH 
GHRH SRIF
GnRH
PRF PIF
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8
Q

what hormones from the hypothalamus affect the posterior pituitary

A

oxytocin

vasopressin (ADH)

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9
Q

what hormones affect the anterior pituitary

A 
CRH
TRH
GHRH SRIF
GnRH
PRF PIF
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10
Q

what does anterior pituitary gland dysfunction include

A

growth hormone deficiency and excess

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11
Q

what does posterior pituitary gland dysfunction manifest as

A 
diabetes insipidus (DI)
syndrome of inappropriate antidiuretic hormone (SIADH)
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12
Q

what does thyroid gland dysfunction manifest as

A

hyperfunctioning or hypofunctioning gland, malfunctions that may be caused by either a congenital defect or by a problem that occurs later in life

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13
Q

parathyroid gland is a major regulator of ____ _____ and _______

A

serum calcium and phosphate

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14
Q

parathyroid gland dysfunction can manifest in what two ways

A

decr. in serum calcium is the dominant regulator of PTH, with a response rate of just a few seconds
decr. in phosphate causes an indirect effect on PTH by combining with calcium and decreasing serum calcium concentrations

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15
Q

what odes GH deficiency lead to

A

short stature

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16
Q

how was GH deficiency initially treated

A

GH injections extracted from the pituitary glands of cadavers

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17
Q

how is GH deficiency treated now

A

synthetic GH (rhGH), produced from recombinant DNA is available but is very expensive

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18
Q

what is the prototype for growth hormones

A

somatropin

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19
Q

when is somatropin used

A

as long-term replacement of inadequate endogenous GH secretions

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20
Q

how is somatropin administered

A

SC and IM

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21
Q

how is somatropin excreted

A

liver and kidneys

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22
Q

how does somatropin work

A

stimulates cell growth and cellular mitosis
facilitates cellular uptake of a.a for protein synthesis
promotes use of fatty acids for energy

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23
Q

are their any contraindications and precautions associated with somatropin

A

contraindicated in growth promotion in children with closed epiphyses

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24
Q

adverse effects associated with somatropin

A 
headache
HTN
joint and back pain
peripheral edema
muscle aches 
rhinitis
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25
Q

what are the drug interactions for somatropin

A 
anabolic steroids
androgens
estrogens
thyroid hormones 
(these may accelerate epiphyseal maturation)
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26
Q

what pregnancy category is somatropin

A

category C

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27
Q

How can you maximize therapeutic effects for somatropin

A

pts who require chronic cycling peritoneal dialysis should receive their doses of somatropin in the morning after the dialysis is completed

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28
Q

what can occur during somatropin therapy

A

hypothyroidism
insulin resistance
be alert for the development of a limp or complaints of hip or kneww pain, and tell parents to do the same

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29
Q

what is an important part of patient teaching for somatropin

A

explain taht this drug is replacing an important hormone (GH)

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30
Q

what ongoing assessment and evaluation should be done during somatropin therapy

A

evalutate thyroid fn at regular intervals because hypothyroidism compromises rGH drug effects

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31
Q

what lab values should a patient taking somatropni have monitored on a routine basis due to adverse effects of the drug therapy?

A 
TSH (somatropin can cause hypothroidisim)
Glucose lvl (can cause glucose intolerance)
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32
Q

The posterior pituitary stores two hormones that are produced in the hypothalamus, what are they

A

vasopressin and oxytocin

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33
Q

what are the synthetic analogues of the hormones that are stored in the posterior pituitary

A

desmopressin and vasopressin

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34
Q

what is the prototype drug for posterior pituitary hormone regulators

A

desmopressin

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35
Q

what does desmopressin do

A

manages central DI and nocturnal enuresis and maintains homeostasis in hemophilia A

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36
Q

how is desmopressin administered

A

intranasally
orally
parenterally (IV or SC)

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37
Q

where is desmopressin metabolized ?

excreted?

A

liver

kidneys

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38
Q

what receptors does desmopressin interact with

A

V1 and V2

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39
Q

what are some adverse effects of desmopressin

A 
abdominal pain
transient headache
nasal congestion
nausea
rhinitis 
facial flushing
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40
Q

what are known drug interactions for desmopressin

A

carbamazepine
chlorpromazine
nonsteroidal anti-inflammatory drugs

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41
Q

what pregnancy category is desmopressin

A

category b

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42
Q

what lifestyle diet and habits should be assesed with desmopressin treatment

A

lifestyle activites and use of recreational drugs

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43
Q

how can you maxmize therapeutic effects for desmopressin

A

establish baseline values for weight, BP, electrolytes and urine specific gravity
protect ADH solutions from agitation and temperature extremes

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44
Q

how can you mimimize adverse effects for desmopressin

A

assess for preexisting CV or renal disorders and monitor patients carefully for cardiac reactions from desmopressin

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45
Q

what can alter the therapeutic response to desmopressin

A

alcohol

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46
Q

what should you instruct patients to monitor for during desmopressin therapy to ensure drug efficacy

A

monitor urine specific gravity and intake and output as well as to weigh themselves daily

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47
Q

what is desmopressing used to treat

A

central DI
primary noctunral enuresis
hemophilia A
von willebrand disease type 1

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48
Q

true or false: thyroid hromones influence essentially every organ system in the body

A

ture

49
Q

is hyperthyroidism or hypothyroidism commonly mistaken for the normal aging process

A

hypo

50
Q

what is the only treatment for hypothyroidism

A

lifelong replacement of thryoid hormones that are adequate to mee tthe individuals metabolic needs

51
Q

what is the prototype drug for thyroid drugs

A

levothyroxine (T4; levothroid, syntrhoid)

52
Q

what is levothryoxine used for

A

replacement theory in hypothyroidism

53
Q

how is levothryoxine administered

A

orally

54
Q

what organ metabolizes levothryoxine? how is ti excreted?

A

liver

bile

55
Q

what is the onset for levothyroxine

A

6-8 hours

56
Q

how does levothryoxine work?

A

acts as a replacement for natural thyroid hormone

57
Q

what are the contraindications and precautions associated with levothryoxine

A

hypersensitivity
thyrotoxicosis
acute MI complicated by hypothyroidism

58
Q

what are the adverese effects of levothryoxine

A 
HTN
tachycardia
arrhythmias 
anxiety
headache
nervousness
GI irritation
sweating heat intolerance
59
Q

are there any drug itneractions with levothyroxine

A

many drugs

60
Q

what pregnancy class is levothryoxine

A

category A

61
Q

what should be monitored during levothryoxine drug therapy to maximize therapeutic effects

A

cardiovascular response and serum thyroid function

62
Q

true or false: young adults without evidence of coronary artery disease can begin a full replacement dose of levothyroxine

A

true

63
Q

what is important patient and family education is important during levothryoxine therapy

A

avoid OTC drugs

64
Q

what ongoing assessment is necssary with levothyroxine

A

monitor serum thyroid hormone levels periodically

65
Q

levothryoxine is a what pregnancy category drug

A

A

66
Q

what is hyperthyroidism treated with

A

thyroid-hormone antagonist drugs
surgery
radioactive iodine

67
Q

what is the purpose of antithyroid compounds

A

reduce the amount of functional thyroid tissue

68
Q

what is the prototype drug for antithyroid compounds

A

methimazole (MMI)

69
Q

what is methimazole used for

A

palliative treatment of hyperthyroidism

70
Q

how is methimazole administered

A

oraly

71
Q

where is methimazole metabolized? excreted?

A

liver

kidneys

72
Q

how does methimazole work

A

inhibits the synthesis of thyroid hormones

73
Q

what are the adverse effects associated with methimazole

A 
hives
itching
rash
fever
arthralgia
joint swelling
vertigo
drowsiness
N/V
altered taste sensation
74
Q

what drugs are known to have interactions with methimazole

A

beta-blocking agents
theophylline
warfarin

75
Q

what pregnancy category does methimazole lead to

A

category D

76
Q

what are two ways that adverse effects can be minimized with methimazole

A

arrange for periodic blood tests to monitor for hematologic and thyroid fn
monitor pts bone marrow fn

77
Q

what important teaching is necessary with methimazole

A

if the drug is taken in divided doses the patient should take them every 8 hours aroundt he clock

78
Q

what ongoing assessment and evaluation is necessary for methimazole

A

monitor serum thyroid homrone levles to evaulate effectiveness of MMI adn to asess the need for replacement thyroid hormone since the thyroid gland is supressed

79
Q

methimazole belongs to what pregnancy category?

A

D

80
Q

do antihypercalcemic drugs directly affect the parathyroid gland or PTH

A

no

81
Q

how do antihyperglycemic drugs work

A

inhibit bone resorption of calcium

82
Q

what disease are antihypercalcemic drugs used for treatment in

A

paget diseae

83
Q

individuals with sypmtomatic disease expereince bone pain and deformity, fractures, spinal cord compression or cranial and spinal cord entrapment are often perscribed whtat type of drug

A

antihypercalcemic

84
Q

what is the prototype drug for the class antihypercalcemic, calcium-regulator drugs

A

calcitonin

85
Q

what is another name for symptomatic disease

A

Paget disease

86
Q

what are the symptoms of paget disease

A 
bone pain
bone deformity 
fractures
spinal cord compression
cranial and spinal cord entrapment
87
Q

how is calcitonin commonly administered

A

SC, IM or intranasal

88
Q

how is calcitonin metabolized and excreted

A

kidneys for both!

89
Q

What is a contraindication and precaution for calcitonin

A

salmon allergies

90
Q

what are the adverse effects associated with calcitonin

A 
GI distubrnaces
skin rash
flushing of the face and hands
nasal irritation 
rhinitis (if using the nasal spray)
91
Q

what drug interactions are known regarding calcitonin

A

calcium supplements
antacids
vitamin D
theophylline

92
Q

what pregnany category does calcitonin belong to

A

C

93
Q

for paget disease what route is necessary to give calcitonin

A

injection

94
Q

what are the most common adverse effects with SC or IM adminsitration of calcitonin

A

nausea

95
Q

what are the most common adverese effects of nasal calcitonin

A

rhinitis
nasal crusts
dryness

96
Q

what important patient and family education is important in calcitonin therapy

A

to report twitching, muscle pain, severe diarrhea or dark urine

97
Q

why must serum calcium level be assessed and evaluated during treatment

A

because calcitonin can cause the serum clacium level to drop resulting in tetany and cardiac arrhythmia

98
Q

is there an increase in the therapeutic effect of calcitonin when it is administered with vitamin D

A

no,

99
Q

what are the 4 things that can put clients at risk for hypercalcemia if they are taking calcitonin

A

salmon
calcium supplements
antacids
vitamin d

100
Q

what do vitamin D compounds do

A

regulate absorption of calcium and phosphate

101
Q

is vitamin D a natural hormone

A

no

is considered a hormone but not a natural hormone

102
Q

what do vitamin D metabolites control

A

intestinal absorption of dietary caclicum
reabsorption of Ca by the kidney
bobilization of Ca from the skeleton in conjunction with PTH

103
Q

Vitamin D is also involved in what elements metabolism

A

magnesium!

104
Q

vitamin D works toether with what two things to regulate calcium hometostasis

A

PTH and calcitonin

105
Q

what is the prototype antihypocalcemic drug?

A

calcitrol

1,250dihydroxyvitamin D3, Rocaltrol [capsules, solution], Calcijex [parenteral]

106
Q

what is calcitrol used for

A

management of hypocalcemia

107
Q

how is calcitrol administered

A

orally or IV

108
Q

where is calcitrol metabolized? where is it excreted?

A

liver

urine and feces

109
Q

how does calcitrol work? i.e what are it’s pharmacodynamics

A

fat-soluble vitamin derived from natural sources (fish liver oils) or from conversion of provitamins

110
Q

what are the contraindications and precautions regarding calcitrol treatment

A

give carefully to patients at risk for hypercalcemia and hypercalciuria

111
Q

what are the adverse effects for calcitrol

A 
weakness
headache
N/V
dry mouth 
constipation 
bone pain
112
Q

are there any known drug interactions for calcitriol

A

thiazie diuretics

113
Q

what pregnancy category does calcitriol belong to?

A

C

114
Q

why are IV doses of calcitriol given following dialysis

A

to increase calcium levels

115
Q

can calcitrol capsules be broken, crushed or chewed?

A

capsules should always be swalled whole

116
Q

if high therapeutic doses of calcitriol are used, what is important to monitor

A

frequent serum and urinary calcium, phosphate and BUN determinations are necessary

117
Q

what should chronic dialysis patients avoid taking when on calcitriol

A

magnesium containing antacids

118
Q

True or False: calcitriol dosing guidelines are established for all age groups

A

false:
dosing guidelines for patients with hypoparathyroidism who are <1y.o, or pts wih pseudohypoppartahtyroidism who are younger than 6 years have not been established

Pharmacology 3 (6 decks)

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