PHARM EXAM 9 Flashcards by malarie carroll

helps to prevent excessive secretion of hormones, thereby limiting their physiologic responses.

neg. feedback system

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growth hormone that stimulates the growth and metabolism of nearly every cell in the body.

somatotropin

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def. of growth hormone in children can cause?

short stature

dwarfism

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Excess secretion of GH in adults, a rare disorder of the pituitary gland known as _____ causes the bones to become deformed

acromegaly

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the onset of acromegaly is gradual and leads to enlargement of?

small bones of the hands, feet, face, & skull as well as a broad nose, protruding lower jaw, & slanting forehead

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tx of acromegaly consists of?

combination of surgery

radiation therapy

pharmacotherapy

to suppress GH secretion or block GH receptors

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when is pharmacology used in pts with acromegaly?

when they are unable to undergo surgical removal of the tumor

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one of the medications for acromegaly, is a synthetic growth hormone antagonist structurally related to growth hormone–inhibiting hormone (somatostatin).

Octreotide (Sandostatin)

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ADH is also called?

vasopressin

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why is ADH called vasopressin?

because it has the ability to constrict blood vessels and raise blood pressure

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a rare condition characterized by the production of large volumes of very dilute urine, usually accompanied by increased thirst.

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Two ADH preparations are available for the treatment of diabetes insipidus:

vasopressin & desmopressin

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is a synthetic drug that has a structure identical to that of human ADH.

vasopressin

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vasopressin acts on the ________ to increase their permeability to water, thus enhancing water reabsorption.

renal collecting tubules

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is the most common form of antidiuretic hormone in use.

desmopressin

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early sx of hypothyroidism (myxedema)?

general weakness
muscle cramps
dry skin

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more severe sx of hypothyroidism?

slurred speech

bradycardia

weight gain

decreased sense of taste and smell

intolerance to cold environments

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Any condition that causes decreased amounts of plasma proteins, such as ___________ can lead to a larger percentage of free thyroid hormone, and hyperthyroidism.

protein malnutrition

liver impairment

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sx of hyperthyroidism

increased body metabolism

tachycardia

weight loss

elevated body temp

anxiety

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most common type of hyperthyroidism

graves dx

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an autoimmune disease in which the body develops antibodies against its own thyroid gland.

graves dx

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other causes of hyperthyroidism are?

adenomas of the thyroid

pituitary tumors

pregnancy

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Very high levels of circulating thyroid hormone may cause _______, a rare, life-threatening form of hyperthyroidism.

thyroid storm

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sx of thyroid storm

high fever

cardiovascular effects
(tachycardia, heart failure, angina, MI)

CNS effects
(agitation, restlessness, delirium, progressing to coma)

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The goal of pharmacotherapy for hyperthyroidism is

is to lower the activity of the thyroid and to relieve distressing symptoms.

The two primary drugs for hyperthyroidism

propyl-thiouracil (PTU) methimazole (Tapazole)

how to hyperthyroid drugs work?

inhibiting the incorporation of iodine atoms into T3 & T4, which decrease the activity of the thyroid gland

is sometimes administered to destroy part of the gland, which results in a permanent solution

radioactive iodine (I-131)

suppresses thyroid function.

nonradioactive iodine

The adrenal medulla is triggered by the sympathetic division of the nervous system to secrete

NE & E

mobilize the body for long-term stress and influence influence metabolism of nearly every cell in the body.

glucocorticoids

regulate plasma by promoting sodium reabsorption and potassium secretion.

mineralocorticoids

are mostly male sex hormones (androgens) with small amounts of estrogen.

gonadocorticoids

Addison’s disease is primary _______ insufficiency

adrenocortical

addison's has a def of?

glucocorticoids and mineralocorticoids

what often causes addison's dx?

autoimmune destruction of both adrenal glands

sx of addison's

N/V lethargy confusion coma

occurs when high levels of corticosteroids are present in the body over a prolonged period.

cushings syndrome

sx of cushings

``` adrenal atrophy osteoporosis HTN increased risk of infections delayed wound healing acne peptic ulcers general obesity redistribution of fat around the face ```

what VS are important to asses when giving ADH hormone therapy

BP and pulse

what neurological sxs should you watch for in ADH therapy

headache and changes in mental status such as drowsiness and confusion

what does desmopression act on?

the kidneys to increase water reabsorption

mechanism of action of levothyroxine

synthetic form of T4 acting like a thyroid hormone

PTU mechanism of action

interfere with the synthesis of T3 & T4 in the thyroid gland

mechanism of action for hydrocortisone

its structurally identical with the natural hormone cortisol.

the primary use for hydrocortisone?

treating adrenocortical insufficiency.

AE of hydrocortisone

sodium & fluid retentition and CNS effects including insomnia, anxiety, headache, vertigo, confusion, and depression.

what may occur in long term therapy of hydrocortisone

HTN tachycardia peptic ulcer dx cushings syndrome

important about systemic corticosteroid therapy?

don't stop abruptly it must be tapered off if used for longer than 1-2 weeks

acts to decrease blood-glucose levels, having a hypoglycaemic effect.

insulin

Without insulin, what does glucose do

stays in the bloodstream and is not able to enter cells

insulin provides for the storage of glucose as?

glycogen

insulin inhibits the breakdown of?

fat & glycogen

insulin increases ____ synthesis

protein

insulin inhibits the production of new glucose from noncarbohydrate molecules--this is called?

gluconeogenesis

Almost all insulin used today is human insulin made by?

recombinant DNA technology

the new human insulin is?

more effective causes fewer allergies creates less resisitance

more rapid human insulin

humalog

more prolonged insulin

lantus

The most serious adverse effect from insulin therapy is

hypoglycemia

hypoglycemia can result from?

an OD of insulin improper timing of insulin dose skipping a meal

sx of hypoglycemia include?

``` tachycardia confusion sweating drowsiness convulsions coma death ```

hyperglycemia can result from

undergoes of insulin or oral hypoglycemic

sx of hyperglycemia

blood glucose over 126 polyuria polydipsia polyphagia weight loss or gain fatigue

type 2 DM is ?

insulin resistance

target cells become unresponsive to insulin due to a defect in insulin receptor function caused by a lack of sensitivity of insulin receptors at the target cells

type 2 DM

As cells become more resistant to insulin, blood glucose levels ____ and the pancreas responds by secreting even more insulin.

rise

Eventually, the hypersecretion of insulin causes beta cell exhaustion, and ultimately leads to

beta cell death

The majority of people with type 2 DM are

obese have dyslipidemias will need a medically supervised plan to reduce weight gradually and exercise safely

how is type 2 DM controlled?

``` lifestyle changes then noninsulin antidiabetic agents then insulin ```

The seven primary groups of antidiabetic drugs for type 2 DM are classified by

their chemical structures and their mechanisms of action

acts by decreasing the hepatic production of glucose (gluconeogenesis) and reducing insulin resistance.

metformin

It does not promote ___ release from the pancreas.

insulin release

side effects of metformin

minor and GI related such as anorexia, nausea, & diarrhea

one of the first oral hypoglycemics available,

glyburide

act by stimulating the release of insulin from pancreatic islet cells and by increasing the sensitivity of insulin receptors on target cells.

sulfonylureas

AE of sulfonylureas

HYPOGLYCEMIA usually caused by taking too much meds or not eating enough food

The mechanism of action is to promote the entry of glucose, amino acids, and potassium into cells; to promote protein synthesis, glycogen formation and storage, and fatty acid storage; and to conserve energy stores by promoting the utilization of glucose for energy needs and inhibiting gluconeogenesis.

human regular insulin

primary use for human regular insulin

by it self to lower blood glucose levels in pts with type 1 DM or in combo with other agents in type 2 DM emergency management of diabetic ketoacidosis gestational diabetes

AE of human regular insulin

HYPOGLYCEMIA irritation at injection sites may occur, including lipohypertrophy weight gain

the accumulation of fat in the area of injection

lipohypertrophy

The mechanism of action is to decrease the hepatic production of glucose and reduce insulin resistance in target cells.

metformin (Glucophage)

when do you plan insulin administrations and peak times?

around mealtimes

hold insulin dose if blood sugar is less than?

70 mg/dL, then report to provider

assess for signs of hypoglycemia, especially around the time of ?

insulin peak activity

what labs to check before oral hypoglycemic therapy?

``` electrolytes glucose A1C level lipid profile hepatic & renal function studies ```

Regulation of the female reproductive system is achieved by hormones from the

hypothalamus, pituitary gland, and ovary

secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

hypothalamus

Both of these pituitary hormones act on the ovary and cause immature ovarian follicles to begin developing.

FSH & LH

create two interrelated cycles that occur on a periodic, monthly basis, the ovarian and uterine cycles.

the rising and falling of levels of pituitary hormones

are used for hormone replacement therapy (HRT) during and after menopause to treat unpleasant symptoms of menopause and to prevent the long-term consequences of estrogen loss.

estrogen-progestin combinations

In 2002 the results of a large clinical study, the Women’s Health Initiative (WHI) suggested that HRT increased risks of

cardiac problems stroke breast cancer

HRT appears to prevent

osteoporotic bone fractures and may protect against colorectal cancer

Because of the risk of thromboembolism in HRT, monitor the patient closely for signs and symptoms of thrombus or embolus, such as

``` such as pain in calves, limited movement in legs, dyspnea, sudden severe chest pain, or anxiety. ```

Encourage the patient to report signs of what if on HRT?

``` depression decreased libido headache fatigue weight gain ```

When using HRT to treat male patients, inform them that secondary female characteristics, such as ___ may occur?

higher voice sparse body hair increased breast size impotence may also occur

contains a mixture of different natural estrogens

HRT

HRT is used as replacement for female sex hormones to exert several positive metabolic effects, including

an increase in bone density and a reduction in LDL cholesterol.

The primary use is for postmenopausal replacement therapy and to

treat abnormal uterine bleeding due to hormonal imbalance.

AE of HRT

nausea, fluid retention, edema, breast tenderness, abdominal cramps and bloating, acute pancreatitis, appetite changes, acne, mental depression, decreased libido, headache, fatigue, nervousness, and weight gain.

note personal or family history of ____ disorders in pt with estrogen and progestin therapy

thromboembolic

is released from the hypothalamus and stimulates the release of hormones from the pituitary.

gonadotropin-releasing hormone (GRH)

regulates sperm production in men.

Follicle-stimulating hormone (FSH)

regulates the production of testosterone, an androgen secreted by the testes and the primary hormone contributing to the growth, health, and maintenance of the male reproductive system;

luteinizing hormone (LH)

is also responsible for maturation of the male sex organs and the secondary sex characteristics of men.

testosterone

androgens inlcude

testosterone adrostenedione dehydroepiandrosterone (DHEA)

is a lack of sufficient testosterone secretion by the testes.

hypogonadism

Primary hypogonadism is due to

testicular disorder

secondary hypogonadism is due to lack of?

FSH or LH

Pharmacotherapy with androgens increases ____ and corrects __________.

Libido; erectile dysfunction

AE of testosterone?

increased or decreased libido and salt and water retention, causing edema, and a diuretic may be indicated. Liver damage is rare, although it is a potentially serious adverse effect with high doses.

what to check for in adrogen therapy?

BP at each visit weight and presence of edema hepatic-function labs periodically