CH 44: Endocrine drugs

Question 1

hypersecretion of corticosteroids:
treatment:

Answer 1

Cushing’s syndrome
ketoconazole (Nizoral) and mitotane (Lysodren)

Question 2

hyposecretion of corticosteroids:
treatment:

Answer 2

Addison’s disease
hydrocortisone, prednisone

Question 3

hyposecretion of progesterone:
treatment:

Answer 3

dysfunctional uterine bleeding
medroxyprogesterone (provera) and norethindrone

Question 4

hyposecretion of insulin:
treatment:

Answer 4

DM
insulin and oral antidiabetic drugs

Question 5

hyposecretion of parathryoid hormone treatment:

Answer 5

human parathyroid hormone (Natpara), vitamin D, and calcium supplements

Question 6

DI drug treatment

Answer 6

desmopressin (DDAVP, Noctiva, Stimate) and vasopressin

Question 7

SIADH drug treatment

Answer 7

conivaptan (Vaprisol) and tolvaptan (Samsca)

Question 8

treatment for hyposecretion of GH

Answer 8

somatropin (Genotropin, others)

Question 9

hypersecretion of GH

Answer 9

acromegaly

Question 10

acromegaly drug treatment

Answer 10

octreotide (Sandostatin)

Question 11

Grave’s disease drug treatment

Answer 11

propylthiouracil (PTU) and I-131

Question 12

therapeutic effects of Somatropin (GH)

Answer 12

Treat growth hormone deficiency
Evaluate pituitary function

Question 13

adverse effects of Somatropin (GH)

Answer 13

Pain at the injection site
hyperglycemia
arthralgia
myalgia
abdominal pain
otitis media
headache
bronchitis
hypothyroidism
hypertension (HTN)
flulike symptoms

Question 14

Safety and monitoring for somatropin (GH)

Answer 14

Annual bone assessment for children- epiphyses
Glucose
AST, ALT
thyroid function
Teach about s/s of hyperglycemia,
Need to follow up with lab tests

Question 15

therapeutic effects of bromocriptine (GH antagonist)

Answer 15

acromegaly

Question 16

adverse effects of bromocriptine (GH antagonist)

Answer 16

Pain at the injection site,
hyperglycemia,
arthralgia,
myalgia,
abdominal pain,
otitis media,
headache,
bronchitis,
hypothyroidism,
hypertension (HTN),
flulike symptoms

Question 17

safety and monitoring of bromocriptine (GH antagonist)

Answer 17

Assess for cardiovascular disease
Monitor for pregnancy
Monitor blood pressure

Question 18

therapeutic effects of vasopressin & desmopressin (ADH)

Answer 18

Regulation of fluid balance – reabsorption of water in the kidneys
Treatment of DI
nocturia

Question 19

adverse effects of vasopressin & desmopressin (ADH)

Answer 19

Headache,
nasal congestion or irritation,
nausea
Water intoxication,
coma,
thromboembolic disorder,
hyponatremia

Question 20

safety and monitoring of vasopressin & desmopressin (ADH)

Answer 20

Monitor weight
Input and Output
Electrolytes
Dehydration
Water intoxication – drowsiness listless SOB headache
Hyponatremia
Caution with NSAIDs

Question 21

thyroid hormone increases___

Answer 21

basal metabolic rate (metabolism)

Question 22

life threatening hyperthyroidism

Answer 22

thyroid storm

Question 23

thyroid storm clinical manifestations

Answer 23

high fever
tachycardia
HF
MI
delirium
coma

Question 24

therapeutic effects of levothyroxine T4 (thyroid)

Answer 24

increases T4 levels

Question 25

adverse effects of levothyroxine T4 (thyroid)

Answer 25

Weight loss, headache, tremors, nervousness, heat intolerance, insomnia, menstrual irregularities Dysrhythmias, HTN, palpitations

Question 26

safety and monitoring of levothyroxine T4 (thyroid)

Answer 26

TSH levels T3 and T4 uptake Palpitations, anxiety, heat intolerance Soy can inhibit absorption!!! Take at same time Take 4 hour from multivitamins, aluminum hydroxide etc

Question 27

therapeutic effects of methimazole (anti-thyroid)

Answer 27

decreased levels of T4

Question 28

adverse effects of methimazole (anti-thyroid)

Answer 28

Nausea, rash, pruritus, weight gain, headache, fever, numbness in fingers, leukopenia, diarrhea, hypothyroidism Agranulocytosis, bradycardia, hepatotoxicity (methimazole)

Question 29

safety and monitoring for methimazole (anti-thyroid)

Answer 29

AST, ALT, ALP!!! TSH level VS Weight Signs of hypothyroidism No pregnancy Can increase PT Avoid foods with extra iodine Need to follow up with labs!!! Report flulike symptoms

Question 30

3 classes of steroid hormones

Answer 30

glucocorticoids mineralocorticoids gonadocorticoids

Question 31

gonadocorticoids =

Answer 31

androgens = puberty

Question 32

mineralocorticoids =

Answer 32

aldosterone = regulation of plasma volume with sodium reabsorption and potassium excretion = RAAS

Question 33

= excessive ADH = HTN and hypokalemia

Answer 33

tumors

Question 34

glucocorticoids =

Answer 34

30 = cortisol, cortisone, etc = effect nearly every cell

Question 35

functions of glucocorticoids

Answer 35

oIncrease the level of blood glucose (hyperglycemic effect) by inhibiting insulin secretion and promoting gluconeogenesis, the synthesis of carbohydrates from lipid and protein sources oIncrease the breakdown of proteins and lipids and promote their utilization as energy sources oSuppress the inflammatory and immune responses (see Chapters 33 and 34) oIncrease the sensitivity of vascular smooth muscle to norepinephrine and angiotensin II oIncrease the breakdown of bony matrix, resulting in bone demineralization oPromote bronchodilation by making bronchial smooth muscle more responsive to sympathetic nervous system activation.

Question 36

adverse effects of longterm corticosteroid therapy

Answer 36

Behavioral changes Eye changes Immune response Metabolic changes Myopathy Osteoporosis Peptic ulcers

Question 37

uses for hydrocortisone (corticosteroid)

Answer 37

* Allergies * Asthma * Cancer * Edema * GI disease * Joint disorders * Skin disorders * Shock

Question 38

therapeutic effects of hydrocortisone (corticsteroid)

Answer 38

Increase adrenocortical levels Decrease inflammation

Question 39

adverse effects of hydrocortisone (corticosteroid)

Answer 39

Mood swings, weight gain, acne, facial flushing, nausea, insomnia, sodium and fluid retention, impaired wound healing, menstrual abnormalities Peptic ulcer, hypocalcemia, osteoporosis with possible bone fractures, loss of muscle mass, decreased growth in children, possible masking of infections

Question 40

safety and monitoring for hydrocortisone (corticosteroid)

Answer 40

See table 44.5 Vital signs – bp, pulse, tachycardia Electrolytes and glucose, lipid levels, ALT, AST, BUN Creatinine GI bleed Osteoporosis Vision – cateracts Signs and symptoms of Cushing’s Signs and symptoms of infection Take with food – oral LOTS of interactions Take early in the morning Eat foods with potassium Do not stop abruptly – need to taper