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Pharmacology: Test 1 > Week 2: Endocrine, DM, Reproductive/Gender Agents > Flashcards

Week 2: Endocrine, DM, Reproductive/Gender Agents Flashcards

1
Q

Endocrine System:

A

-responsible for regulating and maintaining homeostasis in the body using hormones throughout the body

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2
Q

Endocrine system:

hormones role:

A

to maintain body in homeostasis

-a lack of hormone (ex. thyroid hormore lacking) our body will have negative sumptomes and body no longer in homeostasis

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3
Q

Endocrine system:

Feedback mechanism

A
  • helps prevent excessive secretion of hormones, limiting their physiologic responses
  • hormone administred as pharmacotheraphy is negative feedback like normal hormone
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4
Q

Endocrine system:

The hypothalamus controls the __________ which regulates other glands

A

the pituitary

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5
Q

Pituitary agents mimic or antagonize(opposite) actions of
______________ hormones

A

endogenouse

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6
Q

The pituitary gland:

Posterior pituitary

A
  • stores ADH and oxytocin

ADH – kidneys

Oxytocin – breast and uterus

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7
Q

Pituitary Gland:

Anterior pituitary

A

-does most of the job with out organs and with the feedback mechanism

Growth hormone – bones and muscles

ACTH – Adrenals

TSH – Thyroid

FHS, LH, Prolactin – Ovaries, breast, testes

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8
Q

ACTH secretion stimilates the release of:

A

glucocorticoids (cortisol)

Mineralcorticoids (Aldosterone)

Androgen from the adrenal cortex

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9
Q

ADH promotes:

A

water reabsorption from the renal tubles to maintain water balance

  • conserves water in the body
  • secreted by the posterior pituitary gland when hypothalamus senses plasma volume love or blood osmolarity to high
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10
Q

Diabetes insipidus

A
  • Caused by deficincy or absence of antidiuretic hormose (ADH, “Vasopressin”) secretion from posterior pituitary
  • can be R/T: inherited or from head trauma, surgery, cancer, after pituitary surgery
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11
Q

Diabetes Insupidus:

Withouth ADH

A

inability to concentrate urine, polyurie (excessice urination), polydipsia (thirst), leading to dehydration and hyper natremia

with total absence, will need lifelong ADH replacement

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12
Q

Desmopressin (DDAVP)

Class, what is it?, what does it do?

A
  • Class: Vasopressin analog
  • Its a synthetic form of ADH
  • increases wayer resorption by kidneys, concentrates urine, causes potent vasocontriction
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13
Q

Desmopression (DDAVP)

onset, peak, duration

A

onset- immediate IV/ 1 hr for PO

peak- 15-30 mints IV/ 4-7 hr PO

duration- 3 hr IV/ 8-20 hr PO

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14
Q

Desmopresson (DDAVP)

Indications for use

A

may use for:

  • Diabetes insupidus
  • GI bleeding (by vasocontriction)
  • bed wetting

-bleeding disorders (hemophilia A)
b/c increases plasma level of factor VIII

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15
Q

Desmopressin (DDAVP)

Side effects

A
  • be CAREFUL with pts who have cardiac hypertension issues b/c this med has vasocontstriction effects…causes increased BP
  • drowsiness
  • HA
  • flushing, cramping (uterine), tremors
  • sweating
  • Nausea
  • vertigo
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16
Q

DONT give desmopressin to what patients….

A
  • heart attack pts
  • cardiac issues
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17
Q

Nursing considerations when giving Desmopressin

A
  • Monitor vitals (esp. BP)
  • Nasal dose at same time everyday
  • weekly weights
  • avoid OTC meds
  • NO alcohol b/c can be dieuretic/dangerous when monitering I & O
  • detailed instruction on technique for nasal instillation
  • monitor sodium levels
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18
Q

Thyroid:

Anterior pituitary secretes _____ in response to the thyroid releasing hormore from the hypothalamus

A

TSH

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19
Q

Thyroid

define

what are the 2 hormones

A

-helps metabolism, temp/heat regulation, keeps heart in normal rhythm, and growth & developement

2 hormores

  • T3
  • T4
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20
Q

what is needed for the synthesis of T3 and T4

A

Iodine

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21
Q

T3 and T4

A
  • circulate in the body and mimic what the hormone would do typically
  • Their fuction is to regulate protein synthesis and enzyme activity and to stimulate mitocondrial oxidation
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22
Q

to much T3 and T4 leads to…

A

hyperthydoidism

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23
Q

not enough T3 and T4…

A

hypothyroidism

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24
Q

Regulation of Thyroid Function

A

Hypothalamus - in the brain releases the..

TRH (thyroid releasing hormone)- which tells the pituitary to release the

TSH (thyroid stimulating hormone) - which tells the thyroid
to release T3 and T4

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25
Q

Regulation of T3 and T4….

A

If body doesnt have enough T3 and T4 the pituitary recognizes that and tells TSH which will tell thyroid to produce more T3 and T4

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26
Q

Hypothyroidism

” __________”

and

Signs and symptoms

A

“hypo makes you slow”

everything is on a negative

S/S: cold, tired, skin dry, hair falling out, weakness, muscle cramps, slurred speech, bradycardia, weight gain, intolerance to cold, decreased smell/tast

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27
Q

Hypothyroidism

Define, whats going on? and treatment

A
  • a decrease in thyroid hormone secretion
  • causes by autoimmue disorders, thyroidectomy, radiation, genetics, high doses on medication can induce this

OR

  • can be due to decreased secretion of TRH, TSH b/c they may not be acting correctly
    treatment: life long thyroid hormone replacement
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28
Q

How could they dx hypotheyroidism?

A

look at lab work…TSH, TRH, T3 and T4 would be low

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29
Q

Myxedema

A
  • severe hypothyroidism in adults
  • edema of hands, feets, face, peroorbital
  • potentially fatal
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30
Q

Hyperythyroidism

signs and symptoms

A

“hyper, reved up!”

hot, loose weight, tachy, heart racing, nervous, cant sit still ,repo system irregular

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31
Q

Hyperthyroidism

what is it?

how do you get it?

A
  • overproduction of thyroid hormore by the thyroid gland
  • increase in ciruculating T3 and T4 levels, which results in over active thyroid
  • most common cause: graves disease
  • can also be caused by thyroid or pituitary tumors or pregnancy
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32
Q

Graves disease

A
  • can cause hyperthyroidism
  • autoimmune disease in which body develops antibodies against its own thyroid gland
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33
Q

Hyperthyroidism treatment

A
  • decrease hormone production by
  • Surgery (total thyroidectomy), radiation, antithyroid medications
  • treatment does not improve expothalamos
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34
Q

Expohthalmos

A
  • “bulding eye look”
  • cause by increased levels of thyroid hormores
  • not improved by lowering thyroid hormore production
  • if severe, can be treated with high doses of oral glucocorticoids
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35
Q

Thyrotoxicosis

Define

how do you get it?

A
  • Toxic state caused by excessive levels of circulating thyroid hormone (T3 and T4)
  • Can result from autoimmune disorders, infections, cancer, goiters
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36
Q

Thyrotoxicosis

signs and symptomes

A

tachycardia, hyperactivity, nervousnes, diaphoresis, weight loss, heat intolerance, fatigue, tremors, lip lag and stare from increased sympathetic tone (b/c so reved up)

37
Q

Thyrotoxicosis in the elderly

A
  • may be subtle
  • can cause: weight loss, fatigue, lethary, depression
  • no signs of catecholamine excess
  • consider thyrotoxicosis in older pts that have mood swings
38
Q

Treatment for thyrotoxicosis

A
  • Antithyroid medications
  • radioactive iodine (uptakes in thyroid which helps destroy the thyroid tissue
  • partial thyroidectomy
39
Q

Throtoxic Crisis

“Thyroid Storm”

what is it? what induces/causes it?

A
  • Acute, life threatening, hypermetabolic state with extremely high thyroid hormone levels
  • induced by excessive release of thyroid hormones in pts with thyrotoxicosis
  • can be instigted by stressful events (like grieft, illness, infection, hospitlization)
40
Q

Throtoxic Crisis

“Thyroid Storm”

Signs and symptoms

A
  • thyrotoxicosis effects, hyperthermia, severe tachycardia, weakness, hypertension, anxiety, a-fib (especially in elderly)
  • HTN can be followed by CHF that is associated with hypotension and shock
  • fatal if left untreated
41
Q

Thyrotoxic Crisis

“Thyroid Storm”

Immediate treatment

A
  • supportive and focused on protecting organs and cells from the actions of excessive thyroid hormones
  • IV fluids, sedation, cooling, glucocorticoids (steriods) to decrease inflammation/protect organs

-Beta blockers:
(used to treat tachycardia, hypertension, tremors, anxiety, diaphoresis)
-effects seen rapidly….will supress symptoms without treating underlying disease

42
Q

The goal of beta blockers with a thyroid storm

A

slow down signs and symptoms

and

slow down cataclamine release

43
Q

Ongoing treatment of thyrotoxic crisis

A
  • high doses of potassium idodid can be given to suppress thyroid hormore
  • Antithyroid meds suppress thyroid hormore synthesis and conversion of T3 to T4
44
Q

Iodid effects on throtoxic crisis

A

help supprss how thyroid releases hormone to decrease tissue reaction to drecrease hormones in the body

45
Q

Goiters

A
  • a complication of hyperthyroidism for a long time
  • enlargements of thyroid glands due to increased stimulation of the gland by TSH or by thyroid-stimulating immunoglobulins
  • may be in response to inadequate synthesis of thyroid hormones, iodine deficiency, genetic defects, drug effects
  • hyperthyrodism can result but not always
46
Q

Thyroid Replaecment drug:

Levothyroxine (Synthroid)

Class, what it treats, side effects, onset/peak/duration

A

Class: thyroid hormone replacement

-its a synthetic T4

-Treatment for hypothyroidism
(life long treatment usually required)

  • Rare adverse effects: if they get to much: will become hyper state, thyroid storm
  • very highly individualized dosing for elderly pts
    onset: 3-5 hrs
    peak: 3-4 wks
    duration: 1-3 wks
47
Q

Antithyroid drug

Propylthiouracil (PTU)

class, what its for, how it works, adverse effects, onset/peak/duration

how long before you see effects?

A

Class: Antithyroid agent

  • for hyperthyroidism
  • inhibits thyroid hormone synthesis
  • For treatment of Graves disease with radiation, suppress hormones prior to surgery
  • Rare adverse side effects: agranulocytosis (fever, sore throat), hypothyroidism, rash, liver and bone marrow toxicity
  • DOES NOT inactivate current stores of thyroid hormore
  • 1-2 weeks of therapy before stores depleted and effects become evident
    onset: 30-40 min
    peak: 1-1.5 hrs
    duration: 2-4 hrs
48
Q

Adjunct drug therapy

Propanolol (Inderal)

class, onset/peak/duration, adverse effects, what it doest

A

Class: beta-adrenergic antagonist

  • beta blockers can be used to suppress tachycardia and other s/s of hyperthyroidism
  • inderal will decrease HR, decrease BP for people until radiation or surgery
  • adverse effects: fatigue, hypotension, bradycardia, hypoglycemic effects
    onset: 0.5-1 hr
    peak: 1-2 hr (6 hr extended release)
    duration: 6-12 hrs (24 hr ER)
49
Q

Nursing condsiderations for thyroid medications

A

-Meds should be taken at same time every day
(usually once a day, in the morning)

  • no OTC drugs
  • with PTU, avoid foods high in iodine
  • monitor metabolic status: VS, weight, mood, appetite
  • Effects can take months to show improvement
50
Q

Diabetes

A
  • disorder of carbohydrate metabolism
  • s/s result from decreased insulin or resistance to actions of insulin
51
Q

Diabetes

Type 1

A
  • Insuline dependant
  • typically occurs in the younger population
  • pancreatic cells of beta cells produce little or NO insuline
  • usually childhood onset
  • abrupt onset
  • s/s: weight loss, polyuria, polydipsia, increased hunger, hyerpglycemia, fatigue
52
Q

Diabetes

Type 2

A
  • typically in older adults
  • noninsulin dependant
  • cells become resistant to insulin or dont produce enough and to much glucose circulating
  • gradual onset
  • may be asymptomatic
  • frequently obese
53
Q

Acute and Chronic complications of diabetes

A

Acute: hypoglucemia (low glucose), hyperglycemia( high glucose), ketoacidosis

long term: most are vascular changes, hyerptension, stroke, MI b/c of accelerated atherosclerosis, poor circulation, nephropathy, retinopathy, neuropathy, erective dysfunction, gastroparesis, delayed healing, skin changes

54
Q

Treatment

for Type 1 and Type 2 diabetes

A

-Maintain acceptable glucose levels in order to prevent or lessen complications

normal = 60 -110

(IDDM)
Type 1: diet, excersise, insulin replacement

(NIDDM)
Type 2- diet, excerside, meds if needed
(oral hypoglycemics and insulin as adjuncts if necessary

55
Q

Insulin Therapy

A
  • required for type 1
  • sometimes needed for type 2 diabetics if unable to managle with diet, excesise and meds

-b/c normal insulin secretion varies so much in response to daily activities, insulin pharmacotherpy must be carefully planned along with proper meal planning, behavior modifications, and home glucose monitoring

-the right amount of insulin must be available to cells when glucose is available to blood
(giving insulin when glucose not available = HYPOGLYCEMIA)

56
Q

What does insulin do?

A
  • promotes entry of glucose into cells
  • provides storage of glucose as glycogen
  • inhibits breakdown of fat and glycogen
  • increases protein synthesis and inhibits gluconeogenesis (production of new glucose)
57
Q

Regular Insulin

A
  • clear solution
  • ONLY FORM THAT CAN BE GIVEN IV

-Short acting

  • promotes cell uptake of flucose amino acids and potassium, promotes protein synthesis, conserves energy
  • given within 30 mint. of meals

side effects: hypoglycemia, weight gain

onset: 30 mint
peak: 2-5 hrs
duration: 5-8 hrs

58
Q

NPH Insulin

A

-intermmediate onset

  • mixed with protein to delay onset, increase duration of action…protein can cause allergic reaction
    onset: 1-3 hrs
    peak: 6-12 hrs
    duration: 6-24 hrs
  • hypoglycemia is a side effect
59
Q

Lispro Humalog Insulin

A

-rapid acting

onset: 10-15 mints
peak: 30-60 mints
duration: 5 hrs
- Often used in insulin infusion pumps
- with meals or after..never before

60
Q

Glargine (Lantus)

A

-Long acting

Onset: 1.1 hr

Peak: no peak

duration: 24 hrs
- made from dna tech.
- cant be mixed in a syringe with any other insulin
- given SQ
- constant long duration hypoglycemic effect with no peak effect
- once daily at bedtime
- HOPEFULLY causes less hypoglycemia

61
Q

Inhaled Insulin

A
  • new
  • rapid acting mealtime insulin
  • for type 1 or 2
  • Afrezza waiting FDA approval
62
Q

Oral hypoglycemics do what?

A
  • help control trype 2 diabetes
  • prescribed after diet and excersise have failed to control
  • NOT effective for type 1 diabetics
  • they lower blood glucose levels
  • failure to control blood glucose with two hypoglycemics will result in need for insulin
63
Q

______ insulin needed with increase in excerside

A

less

64
Q

______ insulin needed with infection or fever

A

more

65
Q

Class: Sulfonylureas (Oral Hypoglycemic)

example: Glipizide (Glucotrol)

A
  • stimulate insulin release form pancreatic islet cells
  • increases sensitivity of insulin receptors on target cells
  • THE PANCREASE MUCH HAVE SOME FUNCTION for meds to be effective
  • Adjunct to diet control
  • common side effects: hypogycemia from too much med or not eating enough
  • should NOT be used for type 1 diab
    onset: 15-30 min
    peak: 1-2 hrs
    duration: 24 hrs
66
Q

Sulfonylurease (Oral hypoglycemic)

Adverse effects

A
  • hypoglycemia
  • GI distress
  • hepatotoxicity
  • hypersensitivity
  • increased risk for CV problems
  • cam interfere with oral contraceptives
67
Q

Class: Biguanides (Oral hypoglycemic)

ex. Metformin (Glucophage)

A
  • decrease hepatic glucose production and intestinal glucose absorption
  • increase peripheral uptake and utilization of glucose
  • NO change in insulin secretion
  • reducing insulin resistance, does not promote insulin release
  • does NOT change hypoglycemia
  • adjunct to diet control

Adverse effects: not for pts with renal dysfunction, lactic acidosis, gi distress, metallix tase

-FOOD decreases and delays absorption

68
Q

Class: Thiazolidinediones or **GLITAZONES

Examples: Rosiglitazone (Avandia)

and

proglitazone (Actos)**

A
  • decrese insulin resistance
  • increase glucose uptake by muscle
  • decrease glucose production by liver

Adverse effects: does not cause hypoglycemia, not for use in pts with active liver disease, fluid retention, headache, weight gain, can interfere with oral contraceptives

  • may take 3 to 4 months to show signs of improvement
  • NOT for pts with heart failure or pulmonary edema

Avadia: onset- unknow, peak-unknow, duraton- 12-24 hrs

Actos: onset-30 mints, peak- 2-4 hrs, duration- 24 hrs

69
Q

Oral hypoglycemic

Sulfonylureas

ex. glyburide (glucovance)

A
  • lowers glucose by stimulating the release of insulin from the pancrease and increasing the sensitivity to insulin at receptor sites. also decrease hepatic glucose production
  • side effects: constipation, N/V/D, heart burn, hypoglyemia, hyponatremia, aplastic anemia, thrombocytopenia
70
Q

Oral hypoglycemic

Exenatide (Byetta)

A
  • class: antidiabetic, incretrin memetic agents
  • Injectable drug that mimics the effects of hormones that are secreted by the intesting following a meal, when glucose is elevated. They signal the pancreas to increase insulin secretion adn the liver to stop producing glucagon.
  • lowers blood glucose by increasing secretion of insulin, slowing down absorption of insulin and slowing the absorption of glucose, reducing action of glucagon
  • given SW
  • can cause significant GI distress
    onset: 30 min
    peak: 2.1 hr

duration- 8 hrs

71
Q

Patient teaching with oral hypoglycemics

A
  • teach s/s of hypo vs hyper
  • blood glucose monitering
  • diet, excersise, lifestyle changes
  • foot care, infection control
  • medic alert braclet
  • insulin administration
72
Q

To minimize risk of long term complication r/t diabetes

A
  • keep hgbA1C less than 7 percent
  • maintain a healthy blood pressure..for diabetics (130/80)
  • watch cholesterol levels…have cholesterol tested regulary and take meds to lower it
  • dont smoke
  • no alcohol
  • get enough excersise and eat right
73
Q

Insulin Administration

A
  • give SQ
  • roll bottle gently to mix particles in suspension (insulins other than regular will appear cloudy)
  • dont shake bottle
  • rotate injection sites
  • do not massage after injections
74
Q

places to give insulin injections: SQ

A
  • upper outer arms
  • buttocks
  • upper outer thighs
  • lower abdomen
75
Q

Insulin storage

A

-keep unopened vials in fridge

-vials currently in use can be kept at room temp. up to a month
(avoid sunligh and heat)

-mixed insulins can be kept in vial for 1 month at room temp, 3 months in fridge

76
Q

Insulin dosage:

Insulin needs to be increased (amount adjusted up) with:

A
  • increased calorie uptake
  • infection
  • stress
  • obesity
  • adolescent growth spurt
  • pregnancy after 1st trimester
77
Q

Insulin dosage:

Needs to be decrease with

A
  • decreased caloric intake
  • exercise
  • pregnancy during 1st trimester
78
Q

Scotts morning blood sugar is low….his diabetes team suggests lowering the before-supper intermediate dose by 10-20%, which increases his morning blood sugar levels

A

example of when insulin may need to changed

79
Q

Pauls blood sugar is high before dinner…the intermediate insuline before breakfast is increased 10-20%

A

example of when insulin may need to be changed

80
Q

Choice of insulin

A
  • timing
  • best control usually obtained by giving ultralente (b/c long acting) at night to provide base level and regular (short acting) prior to each meal
  • dose adapted to fingerstick glucose reading and meals
  • sliding scale
  • can use continuous SQ insulin infusion pump
81
Q

Sliding Scale insulin

A
  • administered in adjusted to doses according to individual blood glucose test results
  • helpful when pt has large variances in insulin requirements (stress from illness or hospitilization, surgery, trauma, infection)
  • provides more constant blood glucose levels
82
Q

Glucose Monitoring

HgbA1C

A
  • blood test that monitors glucose control over 3 months
  • want it between 6 and 7
  • reflects average glucose levels over prolonged period of time
  • If the level reads high (ex 9) then the blood glucose has been high and uncontrolled
83
Q

Home glucose monitoring

A
  • requires exonomic resources, motivation and ability to perform the task
  • most glucometeres require calibration
  • with all these barriers, many diabetic pts have less than adequate home monitoring of their glucose levels
  • can lead to increased complications
84
Q

Use of glucometer

A
  • glucometeres may be helpful by should be used cautiously is values are borderline
  • treat pt, not the glucometer
  • important to know your pts range of blood glucose levels
85
Q

Complications of diabetes therapy:

Hypoglycemia

A
  • from overdose of insulin
  • can occur with decreased food intake, V/D, alcohol consumption, excessive exersice
  • treat: if pt conscious..give oral sugars (oragen juice, honey, hard candy)

if no gag reflex…give IV glucose, glucagon

“Cold and clammy, give some candy”

86
Q

Complications of diabetes therapy:

Ketoacidosis

A
  • hyperglycemia for a long pd of time, production of ketoacids, hemoconcentration, acidosis, coma
  • typically from type 1 diabetics
  • b/c glucose is unable to enter cells, lipids are utilized for energy and ketoacids are produced as waste products
  • to treat: restore insulin levels, correct acidosis, replace lost fluids and sodium, normalize potassium and glucose levels
87
Q

other complications of insulin therapy

A
  • change SQ fat deposits at injection sites
  • allergiic reaction usually occurs with beef insulin
88
Q

Insulin Inhaled

A

-reaches peak levels in about an hr

-could be used by type 1 or 2 diabetics
(alone, with oral hypoglycemics or with longer-acting SQ insulin

-not for smokers or pts with other lung conditions (asthma, bronchitic, copd)

89
Q
A

Pharmacology: Test 1 (4 decks)

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