pharm 2 Flashcards
Anterior Pituitary =
adenohypophysis
Posterior Pituitary =
neurohypophysis
“Master Gland” regulates _____
numerous vital processes.
Hormones regulate:
- Growth, metabolism
- Reproductive cycle
- Electrolyte balance
- Water retention or loss
posterior pituitary regulates
ADH
Oxytocin
example of ADH
vasopressin (Pitressin synthetic)
ADH function
Regulates reabsorption of water by the kidneys
ADH is secreted by pituitary when body ____
fluids must be conserved.
- -Water reabsorbed into the blood
- -Urine becomes concentrated
ADH treats-
Diabetes insipidus (failure to secrete vasopressin)
Vasopressin adverse reactions
- Tremors, sweating
- Nasal congestion
- Nausea, vomiting, abdominal cramps
- Water intoxication (toxicity, med. overdose)
vasopressin:
Use cautiously in individuals with
history of: asthma, seizures, migraines, heart failure or vascular disease.
Anterior pituitary regulates which hormones?
- Prolactin
- Lutenizing Hormone (LH)
- Follicle-Stimulating Hormone (FSH)
- Thyroid-Stimulating Hormone (TSH)
- Adrenocorticotropic Hormone (ACTH, corticotropin)
- Growth Hormone (GH)
Influence the gonads (reproductive organs)
Gonadotropins (LH and FSH)
Contributes to the growth of the body during childhood, mainly the muscles and bones
Growth Hormone (GH), also called Somatotropin
Stimulates the adrenal cortex to produce and secrete adrenocortical hormones, especially the glucocorticoids
Adrenocorticotropic Hormone (ACTH)
Stimulates the production of breast milk in the postpartum patient
Prolactin
(ACTH) Corticotropin used to test —
adrenocortical function.
- Reactions may be multisystem (Display 43.2)
- Report symptoms of infection
- Monitor blood sugar
In response to ACTH, the adrenal cortex secretes:
- Glucocorticoids (sugar)
- Mineralcorticoids (salt)
- Sex hormones (androgens)
the adrenal glands are located:
on top of each kidney. (outer cortex, inner medulla)
Glucocorticoids: Most prominent hormones
Hydrocortisone and cortisone
Glucocorticoid functions
- Immune response
- Regulation of glucose, fat, protein metabolism
- Anti-inflammatory action
glucocorticoid examples
Prednisone, cortisone, hydrocortisone
glucocorticoid actions
- Enter target cells and bind to receptor sites
- –Some outcomes are desirable and some are not which lead to the adverse reactions
glucocorticoids used to treat:
- Adrenocortical insufficiency (replacement therapy)
- Allergic reactions
- Systematic lupus erythematosus
- Dermatologic disorders
- Rheumatic disorders
- Shock
GLUCOCORTICOID ADVERSE REACTIONS: Fluid and electrolyte disturbances:
fluid and sodium retention, potassium loss, hypertension, hypocalcemia, shock
GLUCOCORTICOID ADVERSE REACTIONS: Musculoskeletal
muscle weakness, osteoporosis, fractures
GLUCOCORTICOID ADVERSE REACTIONS:
Cardiovascular
thromboembolism, arrhythmias, CHF
GLUCOCORTICOID ADVERSE REACTIONS: GI
abdominal distention, nausea/vomiting, increased appetite and weight gain
GLUCOCORTICOID ADVERSE REACTIONS: Dermatologic
impaired wound healing, thin –fragile skin, bruising, increased sweating, itching
GLUCOCORTICOID ADVERSE REACTIONS: Neurological
convulsions, headache, vertigo, paresthesias, insomnia
GLUCOCORTICOID ADVERSE REACTIONS: Endocrine
amenorrhea, development of Cushings syndrome, increased s/s of diabetes
Mineralocorticoids
Aldosterone and Deoxycorticosterone
- Conserves sodium and increases excretion of potassium
- Controls salt and water balance
- Aldosterone most potent
- Deficiencies = loss of salt and water, and retention of potassium
Mineralocorticoids: Aldosterone and Deoxycorticosterone
Mineralocorticoids adverse reactions most often occurs when —-
the dose is too high, prolonged use, and d/c too rapidly.
- Edema, hypertension, heart failure, enlargement of the heart
- Increased sweating, allergic skin rash
- Hypokalemia, muscular weakness, headache, hypersensitivity
Mineralocorticoids adverse reactions
Admin of glucocorticoids (5-10) days can result in:
shutting off the pituitary’s release of ACTH (because of high levels in blood)
acute adrenal insufficiency
can result in circulation collapse
Abrupt discontinuation=
acute adrenal insufficiency
- Located in neck in front of trachea
- Secretes two hormones:
- -T4 (Thyroxine)
- -T3 (Triiodothyronine)
Thyroid Gland
____ is essential for manufacture of both T3 and T4
Iodine
TSH (Thyroid Stimulating Hormone) regulates the
manufacture of T3 & T4 by the thyroid gland
When the level of T3 and T4 in the blood is low,
the anterior pituitary gland secretes TSH which activates the cells of the thyroid to release stored T3 and T4
-Decrease in the amount of thyroid hormones manufactured and secreted
Ex = Myxedema (severe)
Hypothyroidism
-Increase in the amount of hormones manufactured and secreted
Ex = Grave’s disease, Tumors of thyroid
Hyperthyroidism
Rx with thyroid Hormones
Hypothyroidism
- Rx with Antithyroid drugs and radioactive iodine
- Rx with thyroidectomy
Hyperthyroidism
S&S Hypothyroidism
- Decreased Metabolism
- Intolerance to cold, low body temp.
- Bradycardia, mod hypotension
- Lethargy
- Pale, cool dry skin, nails thick and hard
- Heavy menses, low sperm count
S&S Hyperthyroidism
- Increased metabolism, increased appetite, elevated temp,
- Weight loss despite increased appetite
- Tachycardia, mod hypertension
- Anxiety, nervousness
- Flushed warm moist skin
- Irregular or scant menses
- Influence every organ and tissue of body
- Contains both natural and synthetic hormones
- Primary goal: increase metabolic rate of tissues
- Used as replacement therapy when patient is hypothyroid : attempt at creating a “Euthyroid” state
thyroid hormones
Medication for Hypothyroidism
Levothyroxine (Synthroid) is the drug of choice
- -Inexpensive
- -Once a day dosage
- -Uniform potency
Thyroid hormone signs of therapeutic response:
- Weight loss
- Mild diuresis
- Increased appetite
- Sense of well being
- Increase in mental activity
- Decreased puffiness
- Vital Signs
- Weigh patient
- Observe for signs of therapeutic response
- Monitor for hyperglycemia in the diabetic patient
- Meds given once a day, early in morning before breakfast
- Dose adjusted based on blood levels (thyroid function tests)
- Monitor for signs of drug-induced hyperthyroidism
Nursing Process for Hypothyroidism
Replacement therapy is for:
life
take hypothyroid med ___
before breakfast in AM
Treated by:
- Anithyroid drugs
- Iodine solutions
- Thyroidectomy (partial or total)
Hyperthyroidism
Does not affect existing thyroid hormones
- Effect of meds may not be observed for 3-4 weeks
- Tapazole and PTU (propylthiouracil)
- May need surgery anyway
- Meds will reduce vascularity of thyroid gland decreasing risk of intra and post up bleeding
antithyroid medication
used because the thyroid gland has an affinity for iodine. Destroys hyperactive tissue without damaging cells outside thyroid gland
Radioactive Iodine –
decrease the vascularity of the thyroid gland by rapidly inhibiting the release of the thyroid hormones
Iodine solution –
decrease in the number of WBC’s (Neutrophils, basophils and eosinophils) = agranulocytosis
adverse reactions of tapazole and PTU
Metallic taste in mouth, swelling of parotid gland, burning of mouth
adverse reactions of strong iodine solution
sore throat, N,V, bone marrow depression
adverse reactions of radioactive iodine
antithyroid meds nursing process
- Obtain history of symptoms of hyperthyroidism
- -Vital signs
- -Weight
- -Symptoms
- If taking Iodine preparation, is patient allergic to iodine or seafood?
- Fever, sore throat, easy bruising, signs of infections (relationship to decreased blood cells)
- Assess for s/s of thyroid storm (thyrotoxicosis)
- -High fever
- -Extreme tachycardia
- -Altered mental state
- Monitor for difficulty swallowing large tablet
- Iodine drops added to juice to disguise taste (drink through straw to prevent teeth staining
- Observe for signs of hyperthyroidism
- Help develop time schedule for q 8 hour doses.
pt teaching for antithyroid meds
- Take meds as directed
- Notify provider of symptoms (sore throat, fever, bruising etc)
- Record weight twice a week; notify MD for sudden weight gain or loss
- Dilute iodine solution with juice
