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Pharmacology N2100 > Unit 8 - Endocrine > Flashcards

Unit 8 - Endocrine Flashcards

1
Q

where does glucagon come from

A

pancreatic alpha cells

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2
Q

how is glucagon secreted

A

with decreased glucose levels

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3
Q
  • promotes glycogenesis
  • promotes breakdown of proteins into glucose
  • promoted breakdown of lipids into glucose
A

glucagon

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4
Q

where does insulin come from

A

pancreatic beta cells

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5
Q

how is insulin secreted

A

with increased glucose levels

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6
Q
  • gatekeeper of glucose into body cells
  • encourages formation of glycogen
  • prevents breakdown of fat
  • promotes protein synthesis
  • prevents glucogenesis
A

insluin

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7
Q

normal serum glucose level

A

60-100

body controls it to be 80-90

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8
Q

2 different hormones associated with glucose control in the blood

A

glucagon & insulin

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9
Q
  • does alcohol (in and of itself) lower or raise blood sugar

- does chronic alcoholism (liver damage) lower or raise blood sugar

A
  • raises

- lower

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10
Q

does stress (physical or psychological) raise or lower blood sugar

A

raises

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11
Q

what is cortisol

A

a type of corticosteroid

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12
Q

autoimmune destruction of beta cells in pancreas = no insulin production

A

Type I diabetes mellitus

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13
Q
  • insulin resistance

- metabolic syndrome: increased risk for CAD, CVA, PVD, DM

A

Type II diabetes mellitus

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14
Q

diabetes that comes on with pregnancy

A

gestational diabetes

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15
Q

you have to have _ or more symptoms to be diagnosed for diabetes

A

3

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16
Q

when diabetics go through a phase where their blood glucose is high, but not high enough to be diagnosed for diabetes

A

pre-diabetes

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17
Q

T/F: pre-diabetes is an automatic sign of diabetes

A

FALSE!

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18
Q

3 classic symptoms of Type I Diabetes

A
  • polyurea
  • polydypsia
  • polyphasia

others:

  • weight loss
  • diabetic ketoacidosis (DKA)
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19
Q

classic symptoms of Type 2 diabetes

A
  • obesity (80% Type 2 = obese)
  • asymptomatic elevated of blood glucose
  • hyperosmolar hyperglycemic state (HHS) (BS > 600) (similar s/s to stroke)
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20
Q

Diagnostic tests for diabetes

A
  • 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
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21
Q

prandial means…

A

eating

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22
Q

test postprandial BS

A

test BS after person eats

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23
Q

test preprandial BS

A

test BS before person eats

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24
Q

the drug/treatment of choice for Type I diabetes & gestational diabetes

A

insulin

…can be used for Type 2

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25
Q

T/F: there are some cells that do not require insulin for sugar to go into them

A

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

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26
Q

types of insulin

A

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)

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27
Q

what does “log” mean

A

rapid acting analog insulins

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28
Q

long acting analog insulins start with…

A

“L”

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29
Q

onset, peak, duration of rapid acting analog insulin

A

onset: 5-30 min
peak: 1-3 hrs
duration: 3-5 hrs

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30
Q

onset, peak, duration of long acting analog insulin

A

onset: within 1 hr
peak: none
duration: ~ 24 hrs

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31
Q

Name 3 rapid acting analog insulin

A
  • insulin lispro (humalog)
  • insulin aspart (novolog)
  • insuline glulisine (apidra)
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32
Q

Name 2 long acting analog insulins

A
  • insulin glargine (Lantus)

- insulin detemir (Levemir)

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33
Q

route of insulin

A

SQ or IV(can only be used with regular)

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34
Q

can you mix long acting analog insulins with other insulin

A

NO

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35
Q

can you mis rapid acting analog insulins with NPH

A

yes

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36
Q

Classify

  • Humulin 70/30
  • Novolin 70/30
  • Humulin 50/50
  • NovoLog Mix 70/30
  • Humalog Mix 75/25
A
  • 70% NPH, 30% regular
  • 70% NPH, 30% regular
  • 50% NPH, 50% regular
  • 70% aspart protamine, 30% aspart
  • 70% lispro protamine, 30% lispro
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37
Q

only ______ or ______ can be used in pumps

A

regular or rapid acting

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38
Q

adverse affects with insulin

A
  • hypoglycemia (BS <50)

- hypokalemia

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39
Q

Allergic reactions or insulin

A

local: erythema, lipodystrophy, itching at site
systemic: skin rash, dyspnea

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40
Q

nursing considerations/pt teaching for insulin

A
  • 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
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41
Q

T/F: timing of meals depends on type of insulin

A

T

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42
Q

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
A

oral hypoglycemic drugs

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43
Q

What drug:

interferes with carbohydrate breakdown and absorption; acts locally in GI tract with little systemic absorption

A

alpha-glucosidase inhibitors

prototype: acarbose

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44
Q

What drug:
decreases production and release of glucose from the liver, increases cellular uptake of glucose; lowers lipid levels; promotes weight loss

A

biguanides (antihyperglycemic rather than hypo)

prototype: Metformin

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45
Q

What drug:
slows the breakdown of insulin, keeping it circulating in the blood longer; slows the rate of digestion, which increases satiety

A

incretin enhancers

prototype: sitagliptin

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46
Q

what drug:

stimulates insulin release

A

meglitinides

prototype: repaglinide

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47
Q

what drug:

stimulates insulin release; decreases insulin resistance

A

sulfonylureas

prototype: glyburide

48
Q

what drug:

decreases production and release of glucose from the liver; increases insulin sensitivity in fat and muscle tissue

A

thiazolidinediones (glitazones)

prototype: rosiglitazone

49
Q

Nursing considerations/pt teaching for oral hypoglycemic drugs

A
    • 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
50
Q

inadequate thyroid hormone at birth

A

congenital hypothyroidism

51
Q

dysfunction of thyroid gland

A

primary hypothyroidism

52
Q

dysfunction of the pituitary gland

A

secondary hypothyroidism

53
Q

dysfunction of the hypothalamus

A

tertiary hypothyroidism

54
Q

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

A

levothyroxine

55
Q

nursing considerations/pt. teaching for levothyroxine

A
  • 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
56
Q

adverse affects of levothyroxine

A
    • insomnia
  • D, N, V
  • tremors
  • nervousness
  • increased cardiovascular functions
57
Q

What drug:

increase sodium and water retention by kidneys

A

aldosterone

58
Q

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
A

Cortisol (hydrocortisone)

59
Q

corticoids released by the adrenal cortex

A
  • mineralocorticoids
  • glucocorticoids
  • gonadocorticoids
60
Q

_____ accounts for > 95% of the mineralocorticoids secreted by the adrenal glands

A

aldosterone

61
Q

what corticoid:

retention of sodium & water by kidneys

A

mineralocorticoids

62
Q

what corticoid:

  • increased blood glucose
  • increased breakdown of proteins to amino acids
  • increased breakdown of lipids
  • suppression of inflammatory and immune responses
A

glucocorticoids

63
Q

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)

A

T

indications & affects vary depending on route

64
Q

T/F: corticosteroids are all well absorbed & widely-distributed

A

T

65
Q

Are corticosteroids high protein bound

A

yes

66
Q

Corticosteroids are metabolized by the _____ and excreted by the _________

A

liver, kidneys

67
Q

Pregnancy category of corticosteroids

A

C

68
Q 
side effects of steroid therapy:
CNS:
Immune:
GI:
Cardiovascular:
Eyes:
Musculoskeletal: osteoporosis = bone fractures
Endocrine:
Cushing's Syndrome
A

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

69
Q

goal for steroid therapy

A

use low dose & short term to minimize side effects

70
Q

You always want to use local medications over systemic meds if you can

A

T

71
Q

T/F: you can abruptly stop corticosteroids

A

FALSE! You need to slowly ween off

72
Q

what drug:
anti-inflammatory and immunosuppressent: asthma, allergies, some cancers, arthritis, ulcerative colitis, skin conditions, eye problems

A

Prednisone

73
Q

T/F: low doses and localized routes of Prednisone cause little effects, and ADT minimized adverse effects

A

T

74
Q

Nursing Considerations/pt. teaching for Prednisone

A
    • 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
75
Q

What drug:

treatment of addison’s disease, increases sodium & water retention

A

fludrocortisone

76
Q

what drug:

keep sodium, get rid of potassium

A

fludrocortisone

77
Q

Nursing considerations/pt teaching for Fludrocortisone

A
    • 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
78
Q

What medications help with Type 1 Diabetes

A

insulin:

  • Natural: short-acting (regular)
  • Natural: intermediate (NPH)
  • Chemically Altered: analogs
79
Q

what medications help with Type 2 Diabetes

A

Oral hypoglycemic:

  • Sulfonylureas, Second Generation: Glyburide
  • Alpha-Glucosidase Inhibitors: Acarbose
  • Biguanide (antihyperglycemic rather than hypoglycemic): Metformin
  • Glitazones (thiazolidinediones): Rosiglitazone
  • Meglitinide: Repaglinide
  • Incretin: Sitagliptin
80
Q

What medication helps with hypothyroidism

A

Levothyroxine

81
Q

What medication helps with inflammation/immune issues:

A

corticosteroids:

- glucocorticoid: Predisone

82
Q

what medication helps with sodium & water retention

A

corticosteroid:

- mineralocorticoid: fludrocortisone

83
Q 
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

A. steroid use
B. stress
E. major infection or injury

84
Q

Q: Which insulin is short acting?

A

regular insulin (Novalin R)

85
Q

Q: What is the most common and significant adverse effect of insulin?

A

hypoglycemia

86
Q

Q: What is an advantage of the biguanide, metformin, that makes it the drug of choice for type 2 diabetes?

A

It has a low risk of causing hypoglycemia.

87
Q

Q: True or False: Levothyroxine should be taken with food.

A

F

88
Q

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

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.

89
Q

Q: Which of the following is NOT an appropriate use for glucocorticoids (steroids)?

A

treating osteoporosis

90
Q

Q: Which of the following is a strategy to avoid adverse effects of steroids?

A

use local routes (inhaled, topical)

91
Q

Q: Which is an important teaching point for patients using prednisone?

A

don’t abruptly stop takng

92
Q

Q: What is fludrocortisone used for?

A

to decrease fluid loss

93
Q

What is ADT

A

alternate day therapy

  • a way to minimize adverse affects with Prednisone
94
Q

“ide” =

A

insulin secretion

95
Q

mechanism of action for repaglinide

A

insulin release

96
Q

nursing considerations/pt. teaching of repaglinide

A
  • take with meals/within 30 min of eating

- if you skip eating = you have to skip your dose

97
Q

adverse effects of repaglinide

A
  • *-hypoglycemia

- GI distress

98
Q

contraindication of Type 2 diabetes medications

A

type 1 diabetes

99
Q

contraindication of repaglinide

A
  • type 1 diabetes
  • DKA
  • pregnancy
  • lactation
  • hepatic impairment
  • any systemic infection
100
Q

contraindications for sitagliptin

A
  • type 1 diabetes
  • DKA
  • pregnancy
  • lactation
  • sever renal problems
101
Q

mechanism of action for rosiglitazone

A

*increases cell sensitivity to insulin

102
Q

adverse effects of rosiglitazone

A
    • pitting edema
    • weight gain
  • hepatotoxicity
103
Q

contraindications of rosiglitazone

A
    • edema
  • excessive fluid
  • liver disease
104
Q

nursing considerations/pt teaching for rosiglitazone

A
    • 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
105
Q

mechanism of action for metformin

A

*decreased hepatic production of glucose (gluconeogenesis)

106
Q

adverse effects of metformin

A
  • BLACK BOX WARNING: lactic acidosis = fatal if untreated
    • metallic taste
    • GI distress
  • malaise
  • myalgia
  • depression
107
Q

contraindications of metformin

A
    • decrease liver function
    • issues with increased lactic acid
  • GI issues
    • pregnancy
    • alcoholism
108
Q

nursing considerations/pt teaching for metformin

A
    • Yes food! Give with meal.
    • NO alcohol
  • report s/s of infection
109
Q

mechanism of action for Glyburide

A
    • increase insulin release

- hypoglycemia

110
Q

adverse effects of Glyburide

A
    • hypoglycemia
    • blurred vision
    • GI distress
111
Q

contraindications of Glyburide

A
    • type 1 diabetes
    • sensitivity/known allergy to sulfa meds
  • DKA
  • major surgery/trauma/infection
112
Q

nursing considerations/pt teaching for Glyburide

A
  • eat sugar
  • report blurred vision
    • can use with pregnancy, but stop within last month
113
Q

mechanism of action for Acarbose

A

*- decrease breakdown of carbs = slows digestions

114
Q

adverse effects of Acarbose

A
  • diarrhea
  • flatulence
  • abdominal distention
  • hypoglycemia c other drugs
  • sleepiness
115
Q

contraindications of Acarbose

A
    • abdominal problems (irritable bowel syndrome, GI issues)
    • bowel obstruction
    • pregnancy
    • lactation
116
Q

nursing considerations/pt teaching for Acarbose

A

*- have Dextrose ready to treat hypoglycemia

Pharmacology N2100 (26 decks)

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