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
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
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
4
Q
Endocrine system:
The hypothalamus controls the __________ which regulates other glands
A
the pituitary
5
Q
Pituitary agents mimic or antagonize(opposite) actions of
______________ hormones
A
endogenouse
6
Q
The pituitary gland:
Posterior pituitary
A
- stores ADH and oxytocin
ADH – kidneys
Oxytocin – breast and uterus
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
8
Q
ACTH secretion stimilates the release of:
A
glucocorticoids (cortisol)
Mineralcorticoids (Aldosterone)
Androgen from the adrenal cortex
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
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
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
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
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
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
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
16
Q
DONT give desmopressin to what patients….
A
- heart attack pts
- cardiac issues
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
18
Q
Thyroid:
Anterior pituitary secretes _____ in response to the thyroid releasing hormore from the hypothalamus
A
TSH
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
20
Q
what is needed for the synthesis of T3 and T4
A
Iodine
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
22
Q
to much T3 and T4 leads to…
A
hyperthydoidism
23
Q
not enough T3 and T4…
A
hypothyroidism
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
25
Regulation of T3 and T4....
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
26
Hypothyroidism
" \_\_\_\_\_\_\_\_\_\_"
and
Signs and symptoms
"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
27
Hypothyroidism
Define, whats going on? and treatment
- 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
28
How could they dx hypotheyroidism?
look at lab work...TSH, TRH, T3 and T4 would be low
29
Myxedema
- severe hypothyroidism in adults
- edema of hands, feets, face, peroorbital
- potentially fatal
30
Hyperythyroidism
signs and symptoms
"hyper, reved up!"
hot, loose weight, tachy, heart racing, nervous, cant sit still ,repo system irregular
31
Hyperthyroidism
what is it?
how do you get it?
- 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
32
Graves disease
- can cause hyperthyroidism
- autoimmune disease in which body develops antibodies against its own thyroid gland
33
Hyperthyroidism treatment
- decrease hormone production by
- Surgery (total thyroidectomy), radiation, antithyroid medications
- treatment does not improve expothalamos
34
Expohthalmos
- "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
35
Thyrotoxicosis
Define
how do you get it?
- Toxic state caused by excessive levels of circulating thyroid hormone (T3 and T4)
- Can result from autoimmune disorders, infections, cancer, goiters
36
Thyrotoxicosis
signs and symptomes
tachycardia, hyperactivity, nervousnes, diaphoresis, weight loss, heat intolerance, fatigue, tremors, lip lag and stare from increased sympathetic tone (b/c so reved up)
37
Thyrotoxicosis in the elderly
- 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
Treatment for thyrotoxicosis
- Antithyroid medications
- radioactive iodine (uptakes in thyroid which helps destroy the thyroid tissue
- partial thyroidectomy
39
Throtoxic Crisis
"Thyroid Storm"
what is it? what induces/causes it?
- 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
Throtoxic Crisis
"Thyroid Storm"
Signs and symptoms
- 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
Thyrotoxic Crisis
"Thyroid Storm"
Immediate treatment
- 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
The goal of beta blockers with a thyroid storm
slow down signs and symptoms
and
slow down cataclamine release
43
Ongoing treatment of thyrotoxic crisis
- 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
Iodid effects on throtoxic crisis
help supprss how thyroid releases hormone to decrease tissue reaction to drecrease hormones in the body
45
Goiters
- 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
Thyroid Replaecment drug:
**_Levothyroxine (Synthroid)_**
Class, what it treats, side effects, onset/peak/duration
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
Antithyroid drug
Propylthiouracil (PTU)
class, what its for, how it works, adverse effects, onset/peak/duration
how long before you see effects?
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
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Adjunct drug therapy
Propanolol (Inderal)
class, onset/peak/duration, adverse effects, what it doest
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
Nursing condsiderations for thyroid medications
-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
Diabetes
- disorder of carbohydrate metabolism
- s/s result from decreased insulin or resistance to actions of insulin
51
Diabetes
Type 1
- 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
Diabetes
Type 2
- 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
Acute and Chronic complications of diabetes
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
Treatment
for Type 1 and Type 2 diabetes
-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
Insulin Therapy
- 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
What does insulin do?
- 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
Regular Insulin
- 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
NPH Insulin
**-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
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Lispro Humalog Insulin
**-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
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Glargine (Lantus)
**-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
Inhaled Insulin
- new
- rapid acting mealtime insulin
- for type 1 or 2
- Afrezza waiting FDA approval
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Oral hypoglycemics do what?
- 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
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\_\_\_\_\_\_ insulin needed with increase in excerside
less
64
\_\_\_\_\_\_ insulin needed with infection or fever
more
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Class: Sulfonylureas (Oral Hypoglycemic)
example: Glipizide (Glucotrol)
- 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
Sulfonylurease (Oral hypoglycemic)
Adverse effects
- hypoglycemia
- GI distress
- hepatotoxicity
- hypersensitivity
- increased risk for CV problems
- cam interfere with oral contraceptives
67
Class: Biguanides (Oral hypoglycemic)
ex. Metformin (Glucophage)
- 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**
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Class: Thiazolidinediones or **GLITAZONES
Examples: Rosiglitazone (Avandia)
and
proglitazone (Actos)**
- 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
Oral hypoglycemic
Sulfonylureas
ex. glyburide (glucovance)
- 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
Oral hypoglycemic
Exenatide (Byetta)
- 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
Patient teaching with oral hypoglycemics
- teach s/s of hypo vs hyper
- blood glucose monitering
- diet, excersise, lifestyle changes
- foot care, infection control
- medic alert braclet
- insulin administration
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To minimize risk of long term complication r/t diabetes
- 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
Insulin Administration
- 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
places to give insulin injections: SQ
- upper outer arms
- buttocks
- upper outer thighs
- lower abdomen
75
Insulin storage
-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
Insulin dosage:
Insulin needs to be increased (amount adjusted up) with:
- increased calorie uptake
- infection
- stress
- obesity
- adolescent growth spurt
- pregnancy after 1st trimester
77
Insulin dosage:
Needs to be decrease with
- decreased caloric intake
- exercise
- pregnancy during 1st trimester
78
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
example of when insulin may need to changed
79
Pauls blood sugar is high before dinner...the intermediate insuline before breakfast is increased 10-20%
example of when insulin may need to be changed
80
Choice of insulin
- 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
Sliding Scale insulin
- 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
Glucose Monitoring
HgbA1C
- 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
Home glucose monitoring
- 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
Use of glucometer
- 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
Complications of diabetes therapy:
Hypoglycemia
- 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
Complications of diabetes therapy:
Ketoacidosis
- 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
other complications of insulin therapy
- change SQ fat deposits at injection sites
- allergiic reaction usually occurs with beef insulin
88
Insulin Inhaled
-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)
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