Pharm week 6 - metabolic and endocrine Flashcards
vital process regulated by hormones
secretory and motor in digestive
energy production
composition of volume and extracellular fluid
adaptation, like acclimaitziaton and immuniyt
growth and development
hormones in clinical practice
replacement therapy (insulin, diabetes, adrenal)
pharmacolgic - lareger than endogenous adrenalsteroids for anti-inflammatory - transplant
endocrine testing - TSH, T4, metabolic rate
negative feedback loop
internal and external factors may stimulate hypothalamus to + or - anterior pituitary.
anterior pituitary glands
growth hormone - femoral head
follicle stimulating
luteninzing hormone
thyroid-stimulating
lacogenic (prolactin and mammotropin)
adrenocorticosteroid
mealocyte-stimulating
anterior pituitary
growth hormone - (deficiency - somatrem, somatropin
thyroid-stimualating - thryotropin
adrenocorticotropic - corticotropin
posterior pituitary
oxytocin - uterine contractrions - (pitcocin and syntocinon)
vasopressin - vasoconstrictor (antidiruetic hormone ADH (Agipressin)
deficiency of ADH leads to diabetes inspidous
hormones secreted by thyroid
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
common thyroid disorders
goiter - enlarged thyroid gland
hypothyroidism
hyperthyoidism
hypothyroidism - cause
deficiency of thyroid hormone
3 types of hypothyroidism
primary - abnormal thyroid
secondary - pituitary gland and decreased secretion of TSH.
tertiery - dec. levels of thyrotropin-releasing hormone from hypothalamus
hashimotos
autoimmune
myxedema
severe - adult
cretinism
infant - dec. metabolic rate, retarded growth, sexual growth, and mental retardation
hypothyroidism symptoms
skin is cold and dry
pale, puffy, expressionless face
hair is brittle w/ hair loss
bradycardia
decreased metabolism, lethargy
hypothermia, intolerence to cold
late signs of hypothyroidism
decreased temp, decreased HR, weight gain, skin thickening, cardiac complications, decreased LOC
hypothyroidism diagnosis
triiodothyronine (T3) T3 is four times greater than T4
TSH normal values
0.4 - 4.8 mU/L
hypothyroid management
levothyroxine T4 (synthroid, Leovxyl) 25-200 mcg/day
liothyronine - (T3) triosat
Liotrix - black box warning
levothryoxine T4 - action
thyroid hormone
increases BMR
enhances gluconeogenesis
stimulates protein synthesis
levothryoxine T4 - uses
replacement in decreased or absent thyroid function
hypothyroidims
management of thyroid cancer
thyroid suppression testing
levothyroxine precautions
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
levothyroxine adverse effects
hyperthyroidism
palpitations, tachcardia, A-Fib
increased metabolism
weight loss, bone loss
bioequivalence - cannot switch brands
levothyroxine drug interactions
digoxin
antiacids
estrogen
insulin
phenytoin
drugs that should be reduced:
warafin
catecholamines (epinephrine, dopamine, dobutamine)
levoxthyroxine - nursing implications
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
iodine
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
excessive thyroid - causes by what
graves disease, miltinodular disease
plummer’s disease (rare) also called toxic nodular disease or toxic goiter
thyroid storm
induced by stress or infection. sever and life-threatening
hyperthyroidism
diahrrea, flushing, increased appetite, muscle weakness, sleep disorders, altered menstrual flow, fatigue, palpitations, nervousness, heat intolerence, irritability
treatment of hyperthyroidism
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
parathyroid fuction
primary is to maintain adaquate levels of calcium in extracellular fluid
elevated levels of parathyroid
can result in metabolic bone disease (eg osteoperosis and osteomalacia)
hypoparathyroidism leads to
hyocalcemia and tetany (muscle spasm)
nursing implications of hypoparathyroidism
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
nursing implactions - parahypothyroidism
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
nursing implications - parahypothyroidism - monitor for
theraputic response, adverse effects.
liver and kidney function, bone marrow toxic, increase oral anticoagulants, warafin - bleeding
adrenal insufficiency
addison’s disease or hypoaldosteronism
adrenal hyperfunction
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
adrenal cortex hormones
Glucocorticoids
🞑 beclomethasone (several formulations) 🞑 fluticasone propionate’
🞑 hydrocortisone (several formulations) 🞑 cortisone
🞑 methylprednisolone 🞑 prednisone
MOA adrenal cortex hormones
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
adrenal cortex hormones - indications
Wide variety of indications
🞑 Adrenocortical deficiency 🞑 Cerebral edema
🞑 Collagen diseases
🞑 Dermatologic diseases 🞑 GI diseases
excerbates chronic respiratory illness such as asthema or COPD
adrenal cortex hormones - indications
wide variety of indications:
organ transplant (decreased immune response)
palliative management of leukemias and lymphomas
Spinal cord injury
🞑 Many other indications
glucocorticoids admin
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
antiadreanals
aminoglutethimide - used for cushings, breast cancer and adrenal cancer
antiadrenal contraindications
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
contraindiciations
Cautious use in patients with
🞑 Diabetes- Inc.BS
🞑 Cardiac/renal/liver dysfunction
adverse effects - antiadrenal
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
adverse effects - endocrine and GI
Endocrine - growth suppression, cushings, menstrual irreg, carb intolerence, hyperglycemia,
others
GI - peptic ulcer w/ possible perforation, pancreatitis,
abdominal distention, others
adverse affects - antiadrenal- skin and musculoskeletal
integumentary - fragile skin, petechiae, ecchyomosis (bruising) facial erythema, poor wound healing, hirustism, urticaria (hives)
muscloskeletal - muscle weakness, loss of muscle mass, osteoperosis
adverse effects - antiadrenal - ocular and other
increased intraocular pressure, glaucoma
weight gain
nursing implications - antiadrenal
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
antiadrenal implications -
forms may be oral, IM, IV or rectal, but NOT SC.
antiadrenal should be given with
food or milk to minimize GI upset
clear nasal before
giving antiadrenal nasaly
after using inhaled cortisteroid,
instruct patient to rinse mouth to prevent oral fungus.
teach patient to avoid pp. w/ infections, fever, weakness, tired, sore throat
adrenal meds should be taken
same time every day, usually morning, w/ food
teach patients about effects w/ warafin
should not take alcohol, aspirine or NSAIDS
adrenal meds sudden discontination
can cause adrenal crisis by sudden drop in sesrum levels of cortisone
taper
nurse monitor for
theraputic response and adverse effects
pancreas
2 internal secretions - insulin and glucagon
type 1
no insulin, less than 10% of all cases.
complications - diabetic ketoacidosis - deyhdration
hyperosmolar nonketotic syndrome (HNK) dehydration
type 2
many tissues are resistent to insuline - reduced # of receptors and receptors are less responsive
type 2 commorbid conditions
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
gestational diabetes
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
long term complications of both DM
coronary arteries - MI
cerebral arteries - stroke
periperheral arteries - PVD
microvascular (capillary damage)
retinopathy - blindness
neuropathy - amputation
nephropathy - HD
compromised circulation
screening for DM
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
HbA1c
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
non diabetic HbA
less than 5.7
prediabetes HbA
5.7 - 6.4%
diabetes HbA
greater than 6.5
insulin does what?
promotes intercellular K and Mag into cells. helps metabolize carbs, fats, and proteins. stores glucose in liver. converts glycogen to fat stores
recombinant insulin produced by
bateria or yeast
goal of insulin
tight glucose control
rapid insulin
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
short acting
regular insulin (Humalin R)
onset 30 -60 min
only one that can be given IV bolus, IV infusion, or IM
intermediate acting
isophane (NPH) neutral prtamine hagedorn
cloudy
slow onset more prolonged than endogenous
long acting
glargine (lantus) determir
clear,
referre to as basal insulin
combo insulin
NPH 70% regular 30%
NPH 50% and regular 50%
short acting usually used in
hospitals or those on enteric feeding tubes
SC insulin is ordered in
amounts that increase as glucose increases. disadavantegs - delays insulin admin until hyperglycemia occurs
oral DM meds
insulin secretgogues
insulin resistance agents
oral antidiabetic drugs
biguanides - metformin (decreases glucose prodcution in liver)
sulfoylureas - binds to beta cells stimulates insulin release - chlorpropamide, tolazamide, 2nd gen - glimepiride, glipizide, and glyburide
oral antidiabtic beta cell function
must be present
glincides
increase insulin secretion from the pancrease
thiazolidinediones - TZD
decrease insulin resistence, “insulin sensitizing drugs” cautious use
alpha-glucosidase inhibitors
result in delayed absorption of glucose. must be taken with meals.
antidiabetic -amylin mimetic
slows gastric emptying
antidiabetic MOA
enhances glucose-driven insulin secretion
oral antidiabetic - adverse
metallic taste, does not cause hypoglycemia
oral antidiabetic -sulfonylureas
hypoglcemia
oral antidiabetic - glinides
hypoglycemic effects
oral antidiabetic - thiazolidinedione
increased heart failure and MI risk
oral antidiabetic - sulfonylureas
allergic cross-senseitivity may occur with loop diuretics and sulfonamide antibiotics
nursing implications - before givign glucose altering drugs
blood glucose, A1c level
metformin will be discontinued if
the patietn is undergoing studies w/ contrast dye because of renal effects
