Unit 8 - Endocrine Flashcards
where does glucagon come from
pancreatic alpha cells
how is glucagon secreted
with decreased glucose levels
- promotes glycogenesis
- promotes breakdown of proteins into glucose
- promoted breakdown of lipids into glucose
glucagon
where does insulin come from
pancreatic beta cells
how is insulin secreted
with increased glucose levels
- gatekeeper of glucose into body cells
- encourages formation of glycogen
- prevents breakdown of fat
- promotes protein synthesis
- prevents glucogenesis
insluin
normal serum glucose level
60-100
body controls it to be 80-90
2 different hormones associated with glucose control in the blood
glucagon & insulin
- does alcohol (in and of itself) lower or raise blood sugar
- does chronic alcoholism (liver damage) lower or raise blood sugar
- raises
- lower
does stress (physical or psychological) raise or lower blood sugar
raises
what is cortisol
a type of corticosteroid
autoimmune destruction of beta cells in pancreas = no insulin production
Type I diabetes mellitus
- insulin resistance
- metabolic syndrome: increased risk for CAD, CVA, PVD, DM
Type II diabetes mellitus
diabetes that comes on with pregnancy
gestational diabetes
you have to have _ or more symptoms to be diagnosed for diabetes
3
when diabetics go through a phase where their blood glucose is high, but not high enough to be diagnosed for diabetes
pre-diabetes
T/F: pre-diabetes is an automatic sign of diabetes
FALSE!
3 classic symptoms of Type I Diabetes
- polyurea
- polydypsia
- polyphasia
others:
- weight loss
- diabetic ketoacidosis (DKA)
classic symptoms of Type 2 diabetes
- obesity (80% Type 2 = obese)
- asymptomatic elevated of blood glucose
- hyperosmolar hyperglycemic state (HHS) (BS > 600) (similar s/s to stroke)
Diagnostic tests for diabetes
- fasting plasma glucose level: person fasts for ~8 hours……………….>100
- OGTT (oral glucose tolerance test: pregnancy): have person take in 75g of sugar and test BS 2 hours later……………….>200
- random glucose check:……………….>200
- hgb A1c: test sugar affiliated with hgb in blood cells
prandial means…
eating
test postprandial BS
test BS after person eats
test preprandial BS
test BS before person eats
the drug/treatment of choice for Type I diabetes & gestational diabetes
insulin
…can be used for Type 2
T/F: there are some cells that do not require insulin for sugar to go into them
T = cells are constantly being bombarted if BS is not kept within tight control = if these cells are bathed in high amts of BS they can’t protect themselves and are damaged
types of insulin
Natural:
- short-acting/regular: give immediately with meals to take care of glucose being taken in at the moment
- intermediate/NPH: for in between meals & at night (given in morning to last all day, or at night to last all night
Chemically Altered:
- analogs
Combination: mixed insulin (%NPH + %Regular)
what does “log” mean
rapid acting analog insulins
long acting analog insulins start with…
“L”
onset, peak, duration of rapid acting analog insulin
onset: 5-30 min
peak: 1-3 hrs
duration: 3-5 hrs
onset, peak, duration of long acting analog insulin
onset: within 1 hr
peak: none
duration: ~ 24 hrs
Name 3 rapid acting analog insulin
- insulin lispro (humalog)
- insulin aspart (novolog)
- insuline glulisine (apidra)
Name 2 long acting analog insulins
- insulin glargine (Lantus)
- insulin detemir (Levemir)
route of insulin
SQ or IV(can only be used with regular)
can you mix long acting analog insulins with other insulin
NO
can you mis rapid acting analog insulins with NPH
yes
Classify
- Humulin 70/30
- Novolin 70/30
- Humulin 50/50
- NovoLog Mix 70/30
- Humalog Mix 75/25
- 70% NPH, 30% regular
- 70% NPH, 30% regular
- 50% NPH, 50% regular
- 70% aspart protamine, 30% aspart
- 70% lispro protamine, 30% lispro
only ______ or ______ can be used in pumps
regular or rapid acting
adverse affects with insulin
- hypoglycemia (BS <50)
- hypokalemia
Allergic reactions or insulin
local: erythema, lipodystrophy, itching at site
systemic: skin rash, dyspnea
nursing considerations/pt teaching for insulin
- monitor BS
- S/S of hypoglycemia/hyperglycemia
- S/S of proper insulin administration
- healthy diet & lifestyle activiteis to keep BS in control
- teach to get appropriate labs when they need to
- rotate sights of administration
T/F: timing of meals depends on type of insulin
T
What drugs lower blood glucose by either:
- decreasing glucose production: specifically from liver
- decreasing glucose absorption: specifically in GI tract
- increase sensitivity to insulin
- increase insulin secretion: by affecting pancreas
- decreasing insulin resistance
oral hypoglycemic drugs
What drug:
interferes with carbohydrate breakdown and absorption; acts locally in GI tract with little systemic absorption
alpha-glucosidase inhibitors
prototype: acarbose
What drug:
decreases production and release of glucose from the liver, increases cellular uptake of glucose; lowers lipid levels; promotes weight loss
biguanides (antihyperglycemic rather than hypo)
prototype: Metformin
What drug:
slows the breakdown of insulin, keeping it circulating in the blood longer; slows the rate of digestion, which increases satiety
incretin enhancers
prototype: sitagliptin
what drug:
stimulates insulin release
meglitinides
prototype: repaglinide
what drug:
stimulates insulin release; decreases insulin resistance
sulfonylureas
prototype: glyburide
what drug:
decreases production and release of glucose from the liver; increases insulin sensitivity in fat and muscle tissue
thiazolidinediones (glitazones)
prototype: rosiglitazone
Nursing considerations/pt teaching for oral hypoglycemic drugs
- take sulfonylureas c food
- -avoid alcohol
- monitor blood sugar levels
- metformin adverse effects subside c therapy
- take vitamin supplements, eat healthy diet
- glitazones: report swelling & weight gain
- wear med alert bracelet
- s/s lactic acidosis
- notify care provider of pt illness or infection
- monitor I&O
- monitor appropriate labs (LFTs)
- s/s of hypo/hyperglycemia
- monitor for compliance
inadequate thyroid hormone at birth
congenital hypothyroidism
dysfunction of thyroid gland
primary hypothyroidism
dysfunction of the pituitary gland
secondary hypothyroidism
dysfunction of the hypothalamus
tertiary hypothyroidism
What drug:
mimics the action of thyroid hormone: increase o@ use, increases respirations, increases heart rate, nutrient metabolism, promotes growth and maturation, increases weight loss and diuresis, improves activity tolerance
levothyroxine
nursing considerations/pt. teaching for levothyroxine
- contraindications: hypersensitivity, tartazine (aspirin)
- *- don’t take with food!
- no breastfeeding
- slow onset = few days for therapeutic affects
- interacts with lots of meds & food, epinephrine & norepinephrine
- draw serum T3&T4
- monitor for GI bleeding, especially if on warfarin
- monitor pulse: hold med if hr >100
- understand therapy is life long
- check for allergies, especially to tartrazine
- assess for thyroid status/hyperthyroid s/s: nervousness, palpitations
- get baseline EKG/VS: especially if on norepinephrine or epinephrine
- monitor for heart issues
- report CNS s/s
- wear med alert bracelet
- tel doc. if pregnant
- shouldn’t change brand of med
- get follow up lab work done
adverse affects of levothyroxine
- insomnia
- D, N, V
- tremors
- nervousness
- increased cardiovascular functions
What drug:
increase sodium and water retention by kidneys
aldosterone
what drug:
- increase blood glucose
- increase protein break down
- Increase lipid break down
- Suppress inflammatory and immune responses
- Stabilize mast cells, decreases inflammatory mediators
- Increase vascular smooth muscle tone
- Increase CNS excitability, affects mood
- Increases bronchodilation
- Encourage bone demineralization
Cortisol (hydrocortisone)
corticoids released by the adrenal cortex
- mineralocorticoids
- glucocorticoids
- gonadocorticoids
_____ accounts for > 95% of the mineralocorticoids secreted by the adrenal glands
aldosterone
what corticoid:
retention of sodium & water by kidneys
mineralocorticoids
what corticoid:
- increased blood glucose
- increased breakdown of proteins to amino acids
- increased breakdown of lipids
- suppression of inflammatory and immune responses
glucocorticoids
T/F: usually all the corticosteroid meds have the same mechanism of action/affect inflammation some way, the same indications (depending on different body tissue/organ), and the same adverse affects (dose dependent)
T
indications & affects vary depending on route
T/F: corticosteroids are all well absorbed & widely-distributed
T
Are corticosteroids high protein bound
yes
Corticosteroids are metabolized by the _____ and excreted by the _________
liver, kidneys
Pregnancy category of corticosteroids
C
side effects of steroid therapy: CNS: Immune: GI: Cardiovascular: Eyes: Musculoskeletal: osteoporosis = bone fractures Endocrine: Cushing's Syndrome
CNS: behavioral changes
Immune: suppress immune function = watch s/s infection
GI: ulcers (especially if take NSAIDS)
Cardiovascular: high BP
Eyes:
Musculoskeletal: osteoporosis = bone fractures
Endocrine: hyperglycemia (watch BS levels)
Cushing’s Syndrome: result of long-term, high-dose steroids
goal for steroid therapy
use low dose & short term to minimize side effects
You always want to use local medications over systemic meds if you can
T
T/F: you can abruptly stop corticosteroids
FALSE! You need to slowly ween off
what drug:
anti-inflammatory and immunosuppressent: asthma, allergies, some cancers, arthritis, ulcerative colitis, skin conditions, eye problems
Prednisone
T/F: low doses and localized routes of Prednisone cause little effects, and ADT minimized adverse effects
T
Nursing Considerations/pt. teaching for Prednisone
- weight gain is expected
- avoid alcohol: alcohol = ulcers
- avoid aspirin & NSAIDS
- encourage oral hygiene
- okay to take with food
- watch out for hypercalcemia
- monitor BP, weight, BS, electrolytes
- be sure older adults c decrease plasma proteins = watch out for adverse effects
- watch out for infections: yeast in the mouth
- monitor bone density
- monitor for behavior changes
- monitor for withdrawal
- report GI distress
- report back ache/chest pain
What drug:
treatment of addison’s disease, increases sodium & water retention
fludrocortisone
what drug:
keep sodium, get rid of potassium
fludrocortisone
Nursing considerations/pt teaching for Fludrocortisone
- monitor for fluid accumulation (wt, I&O)
- hypokalemia = s/s lethargy & fatigue
- increase potassium in diet
- monitor BP
- monitor for overdose = psychosis, severe wt. gain, excessive HR, extreme edema
- report s/s of infection
- report unusual swelling/edema
- report decrease urinary output
What medications help with Type 1 Diabetes
insulin:
- Natural: short-acting (regular)
- Natural: intermediate (NPH)
- Chemically Altered: analogs
what medications help with Type 2 Diabetes
Oral hypoglycemic:
- Sulfonylureas, Second Generation: Glyburide
- Alpha-Glucosidase Inhibitors: Acarbose
- Biguanide (antihyperglycemic rather than hypoglycemic): Metformin
- Glitazones (thiazolidinediones): Rosiglitazone
- Meglitinide: Repaglinide
- Incretin: Sitagliptin
What medication helps with hypothyroidism
Levothyroxine
What medication helps with inflammation/immune issues:
corticosteroids:
- glucocorticoid: Predisone
what medication helps with sodium & water retention
corticosteroid:
- mineralocorticoid: fludrocortisone
Q: Choose all the factors that raise blood sugar levels. Multiple answers: A. steroid use B. stress C. exercise D. insulin use E. major infection or injury
A. steroid use
B. stress
E. major infection or injury
Q: Which insulin is short acting?
regular insulin (Novalin R)
Q: What is the most common and significant adverse effect of insulin?
hypoglycemia
Q: What is an advantage of the biguanide, metformin, that makes it the drug of choice for type 2 diabetes?
It has a low risk of causing hypoglycemia.
Q: True or False: Levothyroxine should be taken with food.
F
Q: Choose all the appropriate teaching points for people taking levothyroxine.
A. Report CNS adverse effects such as tremors and nervousness
B. Report cardiac adverse effects such as tachycardia and palpitations
C. Do not change brands without consulting your doctor.
A. Report CNS adverse effects such as tremors and nervousness
B. Report cardiac adverse effects such as tachycardia and palpitations
C. Do not change brands without consulting your doctor.
Q: Which of the following is NOT an appropriate use for glucocorticoids (steroids)?
treating osteoporosis
Q: Which of the following is a strategy to avoid adverse effects of steroids?
use local routes (inhaled, topical)
Q: Which is an important teaching point for patients using prednisone?
don’t abruptly stop takng
Q: What is fludrocortisone used for?
to decrease fluid loss
What is ADT
alternate day therapy
- a way to minimize adverse affects with Prednisone
“ide” =
insulin secretion
mechanism of action for repaglinide
insulin release
nursing considerations/pt. teaching of repaglinide
- take with meals/within 30 min of eating
- if you skip eating = you have to skip your dose
adverse effects of repaglinide
- *-hypoglycemia
- GI distress
contraindication of Type 2 diabetes medications
type 1 diabetes
contraindication of repaglinide
- type 1 diabetes
- DKA
- pregnancy
- lactation
- hepatic impairment
- any systemic infection
contraindications for sitagliptin
- type 1 diabetes
- DKA
- pregnancy
- lactation
- sever renal problems
mechanism of action for rosiglitazone
*increases cell sensitivity to insulin
adverse effects of rosiglitazone
- pitting edema
- weight gain
- hepatotoxicity
contraindications of rosiglitazone
- edema
- excessive fluid
- liver disease
nursing considerations/pt teaching for rosiglitazone
- withhold if s/s of liver dysfunction
- monitor daily weight (fluid retention)
- NO pregnancy!
- report rapid weight gain, edema, SOB
- s/s of sick liver (jaundice)
- s/s congestive HF
mechanism of action for metformin
*decreased hepatic production of glucose (gluconeogenesis)
adverse effects of metformin
- BLACK BOX WARNING: lactic acidosis = fatal if untreated
- metallic taste
- GI distress
- malaise
- myalgia
- depression
contraindications of metformin
- decrease liver function
- issues with increased lactic acid
- GI issues
- pregnancy
- alcoholism
nursing considerations/pt teaching for metformin
- Yes food! Give with meal.
- NO alcohol
- report s/s of infection
mechanism of action for Glyburide
- increase insulin release
- hypoglycemia
adverse effects of Glyburide
- hypoglycemia
- blurred vision
- GI distress
contraindications of Glyburide
- type 1 diabetes
- sensitivity/known allergy to sulfa meds
- DKA
- major surgery/trauma/infection
nursing considerations/pt teaching for Glyburide
- eat sugar
- report blurred vision
- can use with pregnancy, but stop within last month
mechanism of action for Acarbose
*- decrease breakdown of carbs = slows digestions
adverse effects of Acarbose
- diarrhea
- flatulence
- abdominal distention
- hypoglycemia c other drugs
- sleepiness
contraindications of Acarbose
- abdominal problems (irritable bowel syndrome, GI issues)
- bowel obstruction
- pregnancy
- lactation
nursing considerations/pt teaching for Acarbose
*- have Dextrose ready to treat hypoglycemia
