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Flashcards in Chapter 12: endocrine disorders Deck (185):
1

 

 

purpose of hormones

 

 

regulate activity of certain cells/organs essential for ADLs

(digestion, metabolism, growth, reproduction, mood control)

2

 

 

major hormones

 

  • thyroid
  • parathyroid
  • pancreatic insulin and glucagon
  • epinephrine and norepinephrine
  • several steroids
  • gonadal hormones

3

 

 

what do hormone regulate

 

  • digestive secretions and motor activity
  • energy production/regulation
  • internal homeostasis
  • reproduction/lactation
  • growth and development
  • adaptation (acclimatization and immunity)

4

 

 

what are the 3 kinds of hormones

 

 

protein, amine, steroid

5

 

 

mechanisms of action for protein hormones

 

 

exerts effects on receptors in the membrane and bind to receptors on the outside of the membrane

6

 

 

which type of hormone has the most rapid effect

 

 

protein hormones

7

 

 

mechanism of action for amine hormones

 

 

also protein hormones so they show similar fast response

8

 

 

mechanism of action of steroid hormones

 

 

bind to the intercellular receptors and have slow action

9

 

 

negative feedback

 

hormone produces a physiologic effect that.  When it is strong enough, further secretion of the hormone is inhibited, which then inhibits the physiologic effect

10

 

 

what could cause increased hormone secretion

 

 

stimuli from emotions, perceptions, or behaviors

11

 

 

primary hypothyroidism

 

 

decreased T3 and T4 levels

elevated TSH

12

 

 

secondary hypothyroidism

 

 

decreased T3, T4, and TSH

 

13

 

 

what type of things can cause secondary hypothyroidism

 

 

hashimotos disease, iatrogenic causes, drugs with iodine (lithium)

14

 

 

when are thyroid hormones NOT used for replacement

 

 

transient hypothyroidism during recovery phase of acute thyroiditis

15

 

 

levothyroxine sodium/thyroxine/L-thyroxine (T4)

(Synthroid, Levoxyl, Unithroid)

clinical uses

 

 

increase basal metabolism

enhace gluconeogensis

stimulates protein synthesis

16

 

 

liothyronine

(Cytomel, Triostat)

mechanism of action

 

 

enhances oxygen consumption by most tissues and increases basal metabolic rate

 

17

 

 

how is myxedema treated

 

 

with liothyronine and synthroid

18

 

 

metabolism of all thyroid preparations

 

 

liver

19

 

 

all thyroid preparations are excreted

 

 

through feces via bile

undergo enterohepatic recirculation

20

 

 

long term thyroid hormone usage can result in

 

 

decreased bone density of the hip and spine

21

 

 

protocol for reaching therapeutic dose of thyroid hormones

 

 

monitor TSH q2-3 months and adjust dose 10-25mcg at 6-8 week intervals until normal TSH levels are reached

22

 

 

What decreases T4 absorption

 

 

bile acid sequestrants, iron salts, antacids

23

 

 

what may decrease response to T4

 

 

estrogen

24

 

 

What medications are made less effective by T4

 

 

beta blockers, digoxin, warfarin

25

 

 

T4 contraindications

 

 

recent MI

thyrotoxicosis if uncomplicated by hypothyroidism

26

 

 

what is the T4 drug of choice and why

 

 

Thyroxine because od consistent potency, good absorption, and prolonged duration of action

27

 

 

Liothytonine

(Cytomel, Triostat)

mechanism of action

 

 

enhances oxygen consumption by most tissues and increases basal metabolic rate

28

 

 

liothyronine

(Cytomel, triostat)

clinical uses

 

 

treatment of myxedema (with synthroid)

short term suppression of TSH for patients having surgery for thyroid cancer

29

 

 

how hypothyroid medications interact with anticoagulants

 

 

thyroid increases catabolism of vitamin K-dependent clotting factor

30

 

 

how hypothyroid medications interact with hypoglycemics

 

 

may have to increase dose of hypoglycemic

31

 

 

how do hypothyroid medications interact with bile acid sequestrants

 

 

they impair absorption of T4 and T3

32

 

 

how do hypothyroid medications interact with tricyclics

 

 

increases tricyclic antidepressant effects because it makes receptors more sensitive

33

 

 

how do hypothyroid medications interact with digoxin

 

 

causes digoxin toxicity

decreased dosages of digoxin are needed

34

 

 

liothyronine contraindications

 

 

diagnosed but untreated adrenal cortical insufficiency

untreated thyrotoxicosis

hypersensitivity

35

 

 

Is Synthroid or liothyronine more cardiotoxic?

 

 

liothyronine

36

 

 

liothyronine conscientious considerations

 

 

it has a shorter half-life than other thyroid preparations

dosage adjustment with hepatic impairment

37

 

 

Liotrix

(Thyrolar, Euthroid)

mechanism of action

 

 

increases metabolic rate of body tissues by promoting gluconeogenesis and increasing the utilization of glycogen stores

38

 

 

Liotrix (Thyrolar) clinical uses

 

 

any type of hypothyroidism except during recovery from subacute thyroiditis

treatment/prevention of euthyroid goiters

supression testing

39

 

 

What is Liotrix a combination of

 

 

liothyronine (T3) and levothyroxine (T4)

40

 

 

Signs of hyperthyroidism

 

weight loss, palpitations, increased apetite, tremors, nervoussness, tachycardia, headache, HTN, menstrual irregularities)

41

 

 

when should thyroid medications be held

 

 

HR >100bpm

42

 

 

patient education for thyroid hormones

 

same time every day (morning)

TFTs at least yearly

 

43

 

 

how long until you see the full effect of thyroid hormones

 

 

a month

44

 

 

what is the most common cause of hyperthyroidism

 

 

Grave's disease

45

 

 

liotrix contraindications

 

 

 

 

thyrotoxicosis

MI without hypothyroidism

hypersensitivity

older patient with cardiac problems

46

 

 

Grave's disease

 

 

thyroid hyperfunction leads to TSH suppression because the feedback loop from elevated levels of thyroid hormone are not being controlled by the immune system

47

 

 

what should be monitored for a patient taking medication for hyperthyroid

 

 

TSH and CBC for first 3 months for agranulocytosis

weight 2-3x/week

48

 

 

conscientious considerations for hyperthyroid medications

 

 

may cause goiter or cretinism in fetus

may need to decrease doses of beta-blockers, digoxin, theophylline

49

 

 

hyperthyroid medications

patient education

 

evenly space doses throughout the day

dietary sources of iodine

call if: fever, sore throat, bleeding, rash, jaundice, N/V

50

 

 

drugs used to treat hypothyroidism

 

 

 

T4

T3

combinations of the 2

51

 

 

drugs used to treat hyperthyroid

 

 

PTU

methimazole

 

52

 

 

propylthiouracil (PTU)

mechanism of action

 

 

inhibits oxidation of iodine in thyroid gland and blocks synthesis of T3 and T4

(time released)

53

 

 

PTU clinical uses

 

 

pallative treatment of hyperthyroidism

adjunct in prep for thyroidectomy or radioactive iodine therapy

control hyperthyroidism while awaiting spontaneous remission

treatment of thyroxicosis

54

 

 

PTU and warfarin

 

 

anticoagulant effect may be increased

55

 

 

PTU contraindications

 

 

pregnancy and breastfeeding

56

 

 

Which is preferred for treating thyroid storm

PTU or methimazole and why 

 

 

PTU because it better inhibits synthesis and peripheral conversion of thyroid hormone

57

 

 

Patient education for PTU

 

 

take the same time every day in regard to meals

(either always with meals or always between meals)

58

 

 

methimazole mechanism of action

 

 

inhibits synthesis of thyroid hormone

59

 

 

methimazole clinical uses

 

 

same as PTU

60

 

 

when can you see the peak effect of methimazole (tapazole)

 

 

4-10 weeks

61

 

 

how long can a patient be on a maintenance dose of methimazole

 

 

up to 2 years

62

 

 

methimazole and warfarin

 

 

may decrease anticoagulant effect

63

 

 

what medications will be decreased by methimazole

 

 

codein, hydrocodone, oxycodone, tramadol

64

 

 

cause pf primary hyperparathyroidism

 

 

adenomas, chief cell hyperplasia, or hypertophy

65

 

 

causes of secondary hyperparathyroidism

 

 

chronic kidney failure on dialysis

66

 

 

why does chronic kidney failure cause hyperparathyroidism

 

 

failing kidneys do not convert vitamin D to active form and do not excrete as much phosphorus

67

 

 

hyperparathyroid drugs can be broken into what 2 main groups

 

 

antiresorptive drugs

drugs that interfere with PTH secretion

68

 

 

what 2 categories are antiresorptive drugs broken into

 

 

estrogen-like compounds, SERMS

biophosphates and calcitonin

69

 

 

what is the only marketed SERM

 

 

evista

70

 

 

cinacalcet (sensispar)

mechanism of action

 

 

intereferes with PTH secretion by increasing the sensitivity of calcium-sensing receptors on the parathyroid gland

71

 

 

clinical uses of cinacalcet

 

 

hyperparathyroidism in dialysis patients

hypercalcemia in patients with parathyroid carcinoma

72

 

 

cinacalcet interactions

 

 

amitriptyline and nortriptylene will increse the presence of cinacalcet

73

 

 

what should patient on cinacalcet be monitored for

 

 

hypocalcemia

74

 

 

signs of hypocalcemia

 

 

paresthesia, myalgias, tetany, cramping, and convulsions

75

 

 

Sensispar in patients with primary hyperparathyroidism

 

 

Not approved by FDA

76

 

 

patient education for sensispar

 

 

take with food

77

 

 

hypoparathyroidism

 

 

decreased levels of PTH that lead to hypocalcemia

(removal of parathyroid gland)

78

 

 

symptoms of hypoparathyroidism

 

 

muscle spasms

convulsions

gradual paralysis with dyspnea

79

 

 

idiopathic hypoparathyroidism

 

 

serum calcium is decreased

serum phosphate is increased

80

 

 

drug treatment of hypoparathyroidism consist of

 

 

either phosphorus or calcium, or both

81

 

 

calcitrol mechanisms of action

 

  • stimulates calcium and phosphate absorption from small intestine
  • promotes secretion of calcium from bone to blood
  • promotes renal tubule phosphate reabsorptionacts on parathyroid gland to suppress hormone synthesis and secretion
  • an analogue of fat-soluble vitamin D

82

 

 

clinical uses of calcijex (calcitrol)

 

 

hypocalcemia

adjunct in renal dialysis

reducing elevated parathyroid hormone levels

83

 

 

clinical use of rocaltrol (calcitrol)

 

 

postmenopausal osteoporosis

84

 

 

calcitrol interactions

 

 

CCBs

85

 

 

how often should seum calcium be monitored when starting treatment with calcitrol

 

 

twice weekly early in treatment

86

 

 

what are early signs of calcitrol overdose

 

 

weakness, headache, nausea, metallic taste, vomiting, constipation, muscle/bone pain

87

 

 

what are late signs of calcitrol overdose

 

 

poluria, polydipsia, anorexia, somnolence, weight loss, photophobia, rhinorrhea, prititus, hallucinations, hyperthermia, HTN, arrythmias

88

 

 

hormones secreted by the ANTERIOR pituitary gland

 

  • growth hormones
  • follicle stimulating hormone
  • lutenizing hormone
  • TSH
  • lactogenic factor (Prolactin)
  • ACTH
  • melanocyte-stimulating hormone

89

 

 

hormones secreted by teh POSTERIOR pituitary gland

 

 

vasopressin and oxytocin

90

 

 

diabetes insipidus

 

 

insufficient secretion of vasopressin causes the body to loose the ability to concentrate urine

91

 

 

oversecretion of vasopressin causes

 

 

syndrome of inapropriate antidiuretic hormone

92

 

 

examples of drugs that affect the posterior pituitary

 

 

vasopressin

oxytocin

desmopressin

lypressin

93

 

 

what should be monitored in patients taking medications that affect the posterior pituitary

 

 

urine osmolality and volume

ECG

94

 

 

Vasopressin (Pitressin) is also called

 

 

antidiuretic hormone

95

 

 

vasopressin mechanism of action

 

 

increases water resorption by renal tubules and stimulates smooth muscle receptors in GI tract and arterioles.  This causes peristalsis and vasoconstriction

96

 

 

clinical uses of vasopressin

 

 

treat diabetes insipidus

prevent abdominal distention post-op

GI hemorrhage

vasodilatory shock

97

 

 

in diabetes insipidus, vasopressin may be administered how

 

 

intranasaly

98

 

 

what should be monitored while on vasopressin and why

 

 

ECH, fluid/electrolytes because extravasation and necrosis may occur

99

 

 

Oxytocin (Pitocin, Syntocinon)

mechanism of action

 

 

stimulates contraction of uterine smooth muscle and enhances lactation

100

 

 

clinical uses of oxytocin

 

Dosage specific to:

induce labor, abortion, control postpartum bleeding

101

 

 

oxytocin interactions

 

 

dinoprostone and misoprostol increase effect

102

 

 

oxytocin contraindications

 

 

anticipation of nonvaginal delivery

103

 

 

Desmopressin (DDAVP, stimate)

mechanism of action

 

 

increases reabsorption of water by increasing permeability of collecting ducts in the kidney

104

 

 

clinical uses of desmopressin

 

 

primary nocturnal enuresis

diabetes insipidus

hemophilia and von Willebrand's disease

105

 

 

what medications increase the effect of desmopressin

 

 

chlorpropamide and ethanol

106

 

 

what medications decrease effect of desmopressin

 

 

demeclocycline and lithium

107

 

 

desmopressin contraindications

 

 

mild to moderate renal impairment

108

 

 

patient education for desmopressin

 

 

drink only enough water to satisfy thirst

109

 

 

How is Lypressin (Diapid) manufactured

 

 

lysine derivative of vasopressin

harvested from pituitary glands of swine and then stabilized

110

 

 

Lypressin mechanism of action

 

 

promotes the reabsorption of water by increasing the cellular permeability of the kidney's collecting ducts.  This decreases urine output by increasing the osmolality of urine

111

 

 

clinical uses of lypressin

 

 

antidiuretic and vasopressor to control symptoms of diabetes insipidus

112

 

 

what medications increase lypressin effect

 

 

carbamazepin, chlorpropamide, clofibrate

113

 

 

which medications decrease effect of lypressin

 

 

demeclocycline, lithium, and norepinephrine

114

 

 

what should be monitored every 3-6 months during therapy with drugs that affect the anterior pituitary

 

 

 

 

bone age and growth

115

 

 

Somatrem (Protrpin), and recombinant somatropin (Genotropin, humatrope, norditropin, nutropin, serostim)

drug makeup

 

 

biosynthesized chain of 192 poypeptide amino acids that is produced by recombinant DNA processes using E. coli as a carrier

116

 

 

somatrem and recombinent somatropin mechanism of action

 

 

minimics human growth hormones

medicated by insulin-like growth factore

117

 

 

Somatrem, and recombinent somatrem

clinical uses

 

  • long term treatment of growth failure caused by pituitary growth hormone deficienfiency (pituitary dwarfism)
  • hypopituitarism from disease, radiation, surgery, ot traum
  • negative response to standard growth hormone stimulation test

118

 

 

Examples of recombinanat somatropin

 

  • genotropin
  • humatrope
  • norditropin
  • nutropin
  • serostim

119

 

 

what medications interact with somtrem and recombinant somatropin

 

 

anabolic steroids

thyroid hormones

120

 

 

contraindications for somatrem and recumbinant somatropin

 

 

closure of epiphyses

active neoplasms

121

 

 

what happens with prolonged use of somatrem and recombinanat somatropin in a person who does not have acromegaly

 

acromegaly develops

organ enlargement

DM

arteriosclerosis

HTN

carpal tunnel syndrome

122

 

 

what conditions must be determined prior to placing a patient on somatrem or recombinant somatropin

 

sensitivity to any growth hormone products

concomittent use of corticosteroids of ACTH

any untreated hypothyroidism

123

 

 

what must be monitored while a patient is on somatrem or

recumbinant somatropin

 

growth curves

periodic thyroid function tests, glucose, and IGF-1 levels

for Prader-Willi syndrome

Turners syndrome

124

 

 

symptoms of prader willi syndrome

 

 

sleep apnea, respiratory infections, snoring

125

 

 

symptoms of Turner syndrome

 

 

ear and cardiovascular disorders

126

 

 

what happens after 2 years of treatment with growth hormones

 

 

growth rate decines

127

 

 

what is the result of growth hormone therapy in adults

 

 

increase in lean body mass, total body water, and physical performance

decrease in body fat and waist circumference

128

                                                                    

 

                                 when is octreotide (Sandostatin) used

 

                                                                                                                                                                

 

 

to reduce growth hormones in patients with acromegaly that have not responded to other treatment

129

 

 

octreotide (Sandostatin)

mechanism of action

 

 

reducing blood levels of growth hormone and IGF-1

by mimicing the action of somatostatic

(8 sided protein salt)

130

 

 

clinical uses for octreotide (Sandostatin)

 

 

acromegaly

supress severe diarrhea and flushing associated with metastatic cancer

131

 

 

which medications may need dosage adjustment if patient is placed on actreotide (Sandostatin)

 

insulin and oral hypoglycemics, beta blockers, CCBs, any drug affecting fluid/electrolyte balance

any drugs with low therapeutic index should be used with caution because it is cleared by CYP450 enzymes

132

 

 

contraindications for octreotide (Sandostatin)

 

hypersensitivities

133

 

 

Acromegaly patients are already at risk for a number of factors that usage of otreotide (Sandostatin) potentiates.  What are they

 

 

diabetes, hypothyroidism, cardiovascular disease

134

 

 

patient on octreotide (Sandostatin) for up to a year must be monitored for what

 

 

gallbladder stones or sludge

135

 

 

patient education for octreotide )Sandostatin)

 

 

has many side effects

136

 

 

where are adrenal glands located

 

 

top of each kidney

137

 

 

what is secreted by the inner portion of the adrenal gland

 

 

epinephrine and norepinephrine and dopamine

138

 

 

what is secreted by the outer portion of the adrenal gland

 

 

aldosterone and cortisol

139

 

 

what is produced by outermost layer of adrenal cortex

 

 

mineralocorticoids

140

 

 

what is produced by the middle layer of the adrenal cortex

 

 

glucocorticoids, cortisol

141

 

 

what is roduced by the innermost layer of the adrenal cortex

 

 

androgens, primarily dehydroepiandrosterone

142

 

 

what are the most frequently used drugs for anti-inflammatory and immunosuppressive properties

 

 

glucocorticoids

143

 

 

glucocorticoid mechanism of action

 

 

suppress inflammatory and immune systems through inhibiting prostaglandins, leukotrienes, and histamine

144

 

 

glucocorticoid clinical uses

hormone replacement in Addison's disease

cancer therapy

decrease inflammation in SLE (lupus)

RA

IBD

asthma/COPD

respiratory distress syndrome in infants

acute renal insufficiency

shock

simple inflammatory rashes

145

 

 

glucocorticoids predominantly affect what

 

 

metabolism of carbohydrates

to a lesser extentfats and proteins

146

 

 

chronic treatment with glucocorticoids

 

 

may lead to adrenal suppression

use lowest possible dose for shortest possible time

monitor hematological values, serum electrolytes, serum and glucose levels

147

 

 

glucocorticoids in relation to strss and infection

 

 

dosing may need adjusted with stress

signs of infection may be masked

148

 

 

when should glucocorticoids be administered

 

 

in the morning to coincide with body's natural secretion of cortisol

give with meals if PO

shake suspension if given SC or IM

149

 

 

glucocorticoid patient education

 

avoid people with contagious diseases and vaccines

do not have surgery

wear medical alert bracelet

diet should be high in protein, calcium, potassium and low in sodium and carbs

avoid alcohol

abrupt withdrawals

150

 

 

glucocorticoids and oral anticoagulants

 

 

may increase prothrombin time

151

 

 

glucocorticoids and potassium-depleting diuretics

 

 

risks for hypokalemia

152

 

 

glucocorticoids and cardiac glycosides

 

 

increased risk for cardiac toxicity and arrhythmia

153

 

 

glucocorticoids and calcium

 

 

interferes with calcium absorption

154

 

 

glucocorticoids and St. John's wort

 

 

decreases absorption of glucocorticoids

155

 

 

glucocorticoid contraindications

 

fungal disease

live virus vaccine

HTN

HF

renal impairment

infections resistant to ABT treatment

156

 

 

serious effects of long term glucocorticoid use

 

 

hypocalcemia, osteoporosis, edema, muscle wasting, fluid/electrolyte disturbance, spontaneous fractures, amenorrhea, cataracts, glaucoma, peptic ulcer disease, CHF

157

 

 

serious effects of abrupt glucocorticoid withdrawal from long term therapy

 

 

anorexia, nausea, fever, headache, joint pain, rebound inflammation, fatigue, weakness, lethargy, dizziness, orthostatic hypotension

158

 

 

why must discontinuation of glucocorticoids be gradual

 

 

symptoms of abrupt withdrawal can last up to a year

159

 

 

conscientious consideration for glucocorticoids

 

 

page 216

160

 

 

fludrocortisone (Florinef)

clinical uses

 

replace aldosterone in Addison's disease

congenital adrenal insufficiency

161

 

 

fludrocortisone (Florinef)

drug make-up

 

 

synthetic corticosteroid

162

 

 

florinef in low doses

 

 

acts on distal tubules to increase potassum and hydrogen ion secretion, thereby replacing sodium

163

 

 

florinef in high doses

 

 

inhibits exogenous adrenal cortical secretion, thymic activity, and secretion of corticotropin in the pituitary gland

164

 

 

what medication interact with Fludrocortisone (Florinef) by causing excessive potassium depletion

 

amphotericin

loop diuretics

thiazide diuretics

 

165

 

 

florinef and digitalis

 

 

can induce dig toxicity and hypokalemia

166

 

 

which medications will decrease effect of florinef

 

 

rifampin

barbituates

hydantoins

167

 

 

serious side effects can result if florinef is taken with

 

 

oral contraceptives

other corticosteroids

168

 

 

how long should florinef therapy last and why

 

 

no longer than a few weeks cause it can be addictive

169

 

 

signs of florinef overdose requiring emergency attention

 

 

muscle weakness, HYN, unusual weight gain, hypokalemia, water retention

170

 

 

symptoms of abrupt florinef withdrawal

 

 

anorexia, nausea, fever, headache, joint pain, rebound inflammation, fatigue, weakness, lethargy, dizzines, and orthostatic hypotension

171

 

 

florinef with pregnancy

 

 

contraindicated, can absorb just by touching

172

 

 

what should be avoided while a patient is taking florinef

 

 

skin tests

vaccinations

alcohol

173

 

 

diet while on florinef

 

 

high protein

low salt

potassium rich

174

 

 

drugs used to treat adrenal insufficiency

 

 

aminoglutamide (Cytadren)

fludrocortisone (Florinef)

anastrozole (Arimidex)

175

 

 

aminoglutamide (Cytadren)

mechanism of action

 

 

adrenal androgen inhibitor

blocks corticosteroids from being made which stops them from signaling the body to produce more hormones

176

 

 

aminoglutamide (Cytadren)

clinical uses

 

  • suppression of adrenal function in certain patients with cushings syndrome
  • adrenal carcinoma and ectopic ACTH-producing tumors
  • treatment of breast cancer in postmenopausal women
  • treatment of metastatic prostate cancer

177

 

 

aminoglutethimide (Cytadren)

interactions

 

 

all corticosteroids

178

 

 

cytadren contraindications

 

 

hypersensitivities

pregnancy/lactation

179

 

 

what labs should be monitored while on cytadren

 

 

thyroid function, baseline hematological, serum glutamicoxaloacetic transaminase, alkaline phosphatase, bilirubin

180

 

 

other conscientious considerations for cytadren

 

 

page 218

 

181

 

 

anastrozole (Arimedex)

mechanism of action

 

 

 

orally active, potent, third line aromatase inhibitor in the management of hormone-sensitive breast cancer

can decrease tumor mass or delay progression of tumor growth

182

 

 

anastrozole (Arimedex)

clinical uses

 

 

breast cancer in postmenopausal women

adjuvant therapy for early estrogen receptor positive breast cancer

first line therapy for metastatic breast cancer

advanced therapy if treatment with tamoxifen fails and disease progression continues

183

 

 

anastrozole (Arimedex)

interactions

 

decreased effects with estrogen replacement therapy

page 219

184

 

 

anastrozole (Arimedex) contraindications

 

 

Pregnancy

185

 

 

implications for pregnant, pediatric, geriatric patients

 

 

page 219-220