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XIO > Pharm week 6 - metabolic and endocrine > Flashcards

Pharm week 6 - metabolic and endocrine Flashcards

1
Q

vital process regulated by hormones

A

secretory and motor in digestive
energy production
composition of volume and extracellular fluid
adaptation, like acclimaitziaton and immuniyt
growth and development

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2
Q

hormones in clinical practice

A

replacement therapy (insulin, diabetes, adrenal)
pharmacolgic - lareger than endogenous adrenalsteroids for anti-inflammatory - transplant
endocrine testing - TSH, T4, metabolic rate

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3
Q

negative feedback loop

A

internal and external factors may stimulate hypothalamus to + or - anterior pituitary.

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4
Q

anterior pituitary glands

A

growth hormone - femoral head
follicle stimulating
luteninzing hormone
thyroid-stimulating
lacogenic (prolactin and mammotropin)
adrenocorticosteroid
mealocyte-stimulating

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5
Q

anterior pituitary

A

growth hormone - (deficiency - somatrem, somatropin
thyroid-stimualating - thryotropin
adrenocorticotropic - corticotropin

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6
Q

posterior pituitary

A

oxytocin - uterine contractrions - (pitcocin and syntocinon)
vasopressin - vasoconstrictor (antidiruetic hormone ADH (Agipressin)
deficiency of ADH leads to diabetes inspidous

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7
Q

hormones secreted by thyroid

A

have diffuse effect and do not have any specific effect on target organ.
essential for metabolism
long delay in onset and prolonged duration of action.
T4, T3, & calcitonin - regulate basal metabolic rate, lipid/carb metabolism, normal growth and control heat

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8
Q

common thyroid disorders

A

goiter - enlarged thyroid gland
hypothyroidism
hyperthyoidism

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9
Q

hypothyroidism - cause

A

deficiency of thyroid hormone

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10
Q

3 types of hypothyroidism

A

primary - abnormal thyroid
secondary - pituitary gland and decreased secretion of TSH.
tertiery - dec. levels of thyrotropin-releasing hormone from hypothalamus

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11
Q

hashimotos

A

autoimmune

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12
Q

myxedema

A

severe - adult

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13
Q

cretinism

A

infant - dec. metabolic rate, retarded growth, sexual growth, and mental retardation

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14
Q

hypothyroidism symptoms

A

skin is cold and dry
pale, puffy, expressionless face
hair is brittle w/ hair loss
bradycardia
decreased metabolism, lethargy
hypothermia, intolerence to cold

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15
Q

late signs of hypothyroidism

A

decreased temp, decreased HR, weight gain, skin thickening, cardiac complications, decreased LOC

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16
Q

hypothyroidism diagnosis

A

triiodothyronine (T3) T3 is four times greater than T4

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17
Q

TSH normal values

A

0.4 - 4.8 mU/L

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18
Q

hypothyroid management

A

levothyroxine T4 (synthroid, Leovxyl) 25-200 mcg/day
liothyronine - (T3) triosat
Liotrix - black box warning

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19
Q

levothryoxine T4 - action

A

thyroid hormone
increases BMR
enhances gluconeogenesis
stimulates protein synthesis

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20
Q

levothryoxine T4 - uses

A

replacement in decreased or absent thyroid function
hypothyroidims
management of thyroid cancer
thyroid suppression testing

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21
Q

levothyroxine precautions

A

elderly, impaired cardia, 25% less dose
high protein bound - sustained and release and reamins in blood longer - toxcitity
half-life 7 days (need 4 weeks to get steady state)
pregnancy category A

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22
Q

levothyroxine adverse effects

A

hyperthyroidism
palpitations, tachcardia, A-Fib
increased metabolism
weight loss, bone loss
bioequivalence - cannot switch brands

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23
Q

levothyroxine drug interactions

A

digoxin
antiacids
estrogen
insulin
phenytoin
drugs that should be reduced:
warafin
catecholamines (epinephrine, dopamine, dobutamine)

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24
Q

levoxthyroxine - nursing implications

A

monitor HR/temp
monitor weight
TSH (T3 or T4 replacement)
replacement therapy is life long
take meds on empty stomach 30 min before breakfast w/ 6-8 oz of water for better absorption

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25
Q

iodine

A

ingested through food and water, changed into iodide and stored in thyroid.
thyroid uses it to synthesize thyroid hormones
prolong defecinecy leads to goiter
1 mg/week of iodide is needed in diet

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26
Q

excessive thyroid - causes by what

A

graves disease, miltinodular disease
plummer’s disease (rare) also called toxic nodular disease or toxic goiter

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27
Q

thyroid storm

A

induced by stress or infection. sever and life-threatening

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28
Q

hyperthyroidism

A

diahrrea, flushing, increased appetite, muscle weakness, sleep disorders, altered menstrual flow, fatigue, palpitations, nervousness, heat intolerence, irritability

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29
Q

treatment of hyperthyroidism

A

radioactive iodine works by destroying thyroid gland (ablation)
surgery to remove part or all atithyroid drugs - thioamide deravitives - block production ie methimozole (tapazole) propylthiouracil (PTU)
potassium iodid - prrophylaxis tx of radition exposure

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30
Q

parathyroid fuction

A

primary is to maintain adaquate levels of calcium in extracellular fluid

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31
Q

elevated levels of parathyroid

A

can result in metabolic bone disease (eg osteoperosis and osteomalacia)

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32
Q

hypoparathyroidism leads to

A

hyocalcemia and tetany (muscle spasm)

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33
Q

nursing implications of hypoparathyroidism

A

teach patients to report unusual symptoms, like chest pain or palpitations
teach to not take OTC w/out doc approval
theraputic effects may take several months
may enhance anticoagulatns
diabetics may need to increase dose of hypoglycemic meds
may increase digoxin levels

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34
Q

nursing implactions - parahypothyroidism

A

antithyroid meds are better tolerated w/ food.
give at same time each day.
never stop meds abruptly
avoid eating foods high in iodine (seafood, soy sauce, tofu, some bread, iodized salt

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35
Q

nursing implications - parahypothyroidism - monitor for

A

theraputic response, adverse effects.
liver and kidney function, bone marrow toxic, increase oral anticoagulants, warafin - bleeding

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36
Q

adrenal insufficiency

A

addison’s disease or hypoaldosteronism

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37
Q

adrenal hyperfunction

A

adrenal virilism - premature devel. of male secondary sex characteristics
hyperaldosteronism - decreased K, increased Na and water, tired, HA, weak, numbness
cushings disease - increase corticosteroids
pheochromaocytoma - tumor, surgery, HTN, sweating, incr. HR and HA, blood urine analysis, inc. catecholamines

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38
Q

adrenal cortex hormones

A

Glucocorticoids
🞑 beclomethasone (several formulations) 🞑 fluticasone propionate’
🞑 hydrocortisone (several formulations) 🞑 cortisone
🞑 methylprednisolone 🞑 prednisone

39
Q

MOA adrenal cortex hormones

A

Most exert their effects by modifying enzyme activity
Different drugs differ in their potency, duration of action, & extent to which they cause salt & fluid retention
Glucocorticoids inhibit or help control inflammatory & immune responses

40
Q

adrenal cortex hormones - indications

A

Wide variety of indications
🞑 Adrenocortical deficiency 🞑 Cerebral edema
🞑 Collagen diseases
🞑 Dermatologic diseases 🞑 GI diseases
excerbates chronic respiratory illness such as asthema or COPD

41
Q

adrenal cortex hormones - indications

A

wide variety of indications:
organ transplant (decreased immune response)
palliative management of leukemias and lymphomas
Spinal cord injury
🞑 Many other indications

42
Q

glucocorticoids admin

A

by inhilation for control of steroid-responsive bronchospastic states
nasally for rhinitis and to prevent recurrence of polps after surgery
topically for inflammation of the eye, ear, skin

43
Q

antiadreanals

A

aminoglutethimide - used for cushings, breast cancer and adrenal cancer

44
Q

antiadrenal contraindications

A

drug allergies
Serious infections, including septicemia,
systemic fungal infections & varicella (chickenpox)
However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory CNS damage

45
Q

contraindiciations

A

Cautious use in patients with
🞑 Diabetes- Inc.BS
🞑 Cardiac/renal/liver dysfunction

46
Q

adverse effects - antiadrenal

A

potentially all body systems
Cardiovascular - heart failure, edema, hypertension - all caused by electrolyte imbalance (hypokalemia, hypernatremia)
CNS - convulsions, headache, vertigo, mood swings, nervousness, insomnia, steroid psychosis

47
Q

adverse effects - endocrine and GI

A

Endocrine - growth suppression, cushings, menstrual irreg, carb intolerence, hyperglycemia,
others
GI - peptic ulcer w/ possible perforation, pancreatitis,
abdominal distention, others

48
Q

adverse affects - antiadrenal- skin and musculoskeletal

A

integumentary - fragile skin, petechiae, ecchyomosis (bruising) facial erythema, poor wound healing, hirustism, urticaria (hives)
muscloskeletal - muscle weakness, loss of muscle mass, osteoperosis

49
Q

adverse effects - antiadrenal - ocular and other

A

increased intraocular pressure, glaucoma
weight gain

50
Q

nursing implications - antiadrenal

A

physical assesment baseline weight, height, I and O, vital, hydration, immunity
check labs
assess for edema and electrolytes
contraindications
allergies
these drugs may alter serum glucose and electrolytes

51
Q

antiadrenal implications -

A

forms may be oral, IM, IV or rectal, but NOT SC.

52
Q

antiadrenal should be given with

A

food or milk to minimize GI upset

53
Q

clear nasal before

A

giving antiadrenal nasaly

54
Q

after using inhaled cortisteroid,

A

instruct patient to rinse mouth to prevent oral fungus.
teach patient to avoid pp. w/ infections, fever, weakness, tired, sore throat

55
Q

adrenal meds should be taken

A

same time every day, usually morning, w/ food
teach patients about effects w/ warafin
should not take alcohol, aspirine or NSAIDS

56
Q

adrenal meds sudden discontination

A

can cause adrenal crisis by sudden drop in sesrum levels of cortisone
taper

57
Q

nurse monitor for

A

theraputic response and adverse effects

58
Q

pancreas

A

2 internal secretions - insulin and glucagon

59
Q

type 1

A

no insulin, less than 10% of all cases.
complications - diabetic ketoacidosis - deyhdration
hyperosmolar nonketotic syndrome (HNK) dehydration

60
Q

type 2

A

many tissues are resistent to insuline - reduced # of receptors and receptors are less responsive

61
Q

type 2 commorbid conditions

A

obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminemia (protein in urine)
increased risk for thrombotic (blood clotting) evening
these are collectively referred to as metabolic syndrome or insulin-resistence or syndrome X

62
Q

gestational diabetes

A

hyperglycemia during preg, insulin must be given to prevent birth defects
usually subsides after delivery
30% of patients may develop type 2 DM within 10 - 15 years

63
Q

long term complications of both DM

A

coronary arteries - MI
cerebral arteries - stroke
periperheral arteries - PVD
microvascular (capillary damage)
retinopathy - blindness
neuropathy - amputation
nephropathy - HD
compromised circulation

64
Q

screening for DM

A

fasting plasma glucose higher than or equal to 110 mg/dL but less than 126 is pre diabetes
impaired glucose tolerence test (oral glucose challenge) am bld test before eating drink 75 gm glucose 2 hrs bld draw normal is less than 140
screen every 3 years for all patients 45 and older
normal range BS is 70 -100 mg/dL

65
Q

HbA1c

A

percentage of glyocslated hemoglobin
forms over lifespan of RBCs in proportion to degree of glycemia
provides estimate level of glycemia over lifetime of RBC, about 90 days

66
Q

non diabetic HbA

A

less than 5.7

67
Q

prediabetes HbA

A

5.7 - 6.4%

68
Q

diabetes HbA

A

greater than 6.5

69
Q

insulin does what?

A

promotes intercellular K and Mag into cells. helps metabolize carbs, fats, and proteins. stores glucose in liver. converts glycogen to fat stores

70
Q

recombinant insulin produced by

A

bateria or yeast

71
Q

goal of insulin

A

tight glucose control

72
Q

rapid insulin

A

5 - 15 min, short duration, patient must eat after injection.
lispro (humalog)
similiar to endogenous
asparat (novalog)
glulisine
newest
may be given SC or continous SC infusion, but not IV

73
Q

short acting

A

regular insulin (Humalin R)
onset 30 -60 min
only one that can be given IV bolus, IV infusion, or IM

74
Q

intermediate acting

A

isophane (NPH) neutral prtamine hagedorn
cloudy
slow onset more prolonged than endogenous

75
Q

long acting

A

glargine (lantus) determir
clear,
referre to as basal insulin

76
Q

combo insulin

A

NPH 70% regular 30%
NPH 50% and regular 50%

77
Q

short acting usually used in

A

hospitals or those on enteric feeding tubes

78
Q

SC insulin is ordered in

A

amounts that increase as glucose increases. disadavantegs - delays insulin admin until hyperglycemia occurs

79
Q

oral DM meds

A

insulin secretgogues
insulin resistance agents

80
Q

oral antidiabetic drugs

A

biguanides - metformin (decreases glucose prodcution in liver)
sulfoylureas - binds to beta cells stimulates insulin release - chlorpropamide, tolazamide, 2nd gen - glimepiride, glipizide, and glyburide

81
Q

oral antidiabtic beta cell function

A

must be present

82
Q

glincides

A

increase insulin secretion from the pancrease

83
Q

thiazolidinediones - TZD

A

decrease insulin resistence, “insulin sensitizing drugs” cautious use

84
Q

alpha-glucosidase inhibitors

A

result in delayed absorption of glucose. must be taken with meals.

85
Q

antidiabetic -amylin mimetic

A

slows gastric emptying

86
Q

antidiabetic MOA

A

enhances glucose-driven insulin secretion

87
Q

oral antidiabetic - adverse

A

metallic taste, does not cause hypoglycemia

88
Q

oral antidiabetic -sulfonylureas

A

hypoglcemia

89
Q

oral antidiabetic - glinides

A

hypoglycemic effects

90
Q

oral antidiabetic - thiazolidinedione

A

increased heart failure and MI risk

91
Q

oral antidiabetic - sulfonylureas

A

allergic cross-senseitivity may occur with loop diuretics and sulfonamide antibiotics

92
Q

nursing implications - before givign glucose altering drugs

A

blood glucose, A1c level

93
Q

metformin will be discontinued if

A

the patietn is undergoing studies w/ contrast dye because of renal effects

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