Endocrine Flashcards

Question

Type 1 Diabetes

Answer 1

They have little to no inulin - pancreas is shit Usually diagnosed in childhood First sign maybe DKA Appears abruptly, despite years of beta cell destruction Polyuria, polydipsia and polyphagia Oral hypoglycaemic agents will not work with this patient because they don't have insulin

Answer 2

Patho: You need to have insulin to carry glucose out of the blood and into the cell - since there is no insulin, the glucose just builds up in the blood. The blood becomes hypertonic and pulls fluid into the vascular space - the kidneys filter excess glucose and fluids ( polyuria and polydipsia) - the cells are starving so they start breaking down protein and fat for energy - when you break down fat you get KETONES ( an acid) so the client goes into metabolic acidosis with Kussmaul Respirations

Answer 3

Pancreas is still working - clients don't have enough insulin or the insulin they have is no good These clients are usually overweight as they usually cannot make enough insulin for glucose load that the client is taking in Usually found by accident or the client keeps coming back to the primary care provider for things like a wound that won't heal, repeated vaginal infections. Bacteria loves sugar and the immune system in diabetics is compromised as circulation is impaired. These individuals should be evaluated for metabolic syndrome. Treatment: Start with diet and exercise and then add oral agents. some clients will take insulin due to non-compliance

Answer 4

Majority of calories come from complex carbs and then fats and lastly, protein. Carbs should be 45%, Fats 30-40% and protein 15 to 20%. We are worried about carbs because sugars destroy blood vessels just like fat does. High fiber slows down glucose absorption in the intestines, therefore, eliminating the sharp rise/fall in blood sugar

Answer 5

Wait until the blood sugar normalizes to begin exercise and eat something beforehand in order to meet metabolic demand of body Exercise when blood sugar is the highest - do the same amount at the same time daily

Answer 6

Prescribed for type 2 diabetes, can be given orally or Subcut. Assists with how the body makes insulin and how the body USES the insulin and glucose. Works to decreases the amount of circulating glucose Most widely used is metformin - because of weight control for type 2 and some clients with pre-diabetes. Reduces glucose production and enhances how glucose enters the cells. Does not stimulate the release of more insulin, so you don't see hypoglycemia (which also destroys vessels) May be prescribed in PCOS. Clients undergoing surgery or any radiologic procedure that involves contrast dye should temporarily discontinue metformin. they can resume 48 hours after the procedure if kidney function has returned and creatinine is normal.

Answer 7

Dose is initially is based on weight. 0.4 - 1.0 units/ kg/day Dose is adjusted until the blood sugar is normal and there is no more glucose or ketones in the urine

Answer 8

Aspart, Lispro and Glulisine Used in type 1 and 2 diabetes SubQ and IV Onset: 5-15 mins Peak: 1 - 3 hours Duration: 3 -5 hours Interactions: Increased hypoglycemic effect with aspirin, oral anticoagulants, alcohol, oral hypoglycemic, beta blockers and MAOIs MoA: Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of glucose by body cells. ``` Side Effects: Confusion Agitation Tremors Headache Flushing Hunger Weakness Lethargy Fatigue Redness at injection site ``` ``` Adverse Effects: Tachycardia Palpitations Hypoglycemia Rebound hyperglycemia Lipodystrophy Shock Anaphylaxis ``` Nursing Interventions: Administer with meals. DO NOT administer unless meal is readily available. Monitor for hypoglycemia, hypokalemia, lipodystrophy. Always have oral carbohydrate available. Client Education:SubQ medication administration. Glucose self-monitoring. Signs/symptoms of hypoglycemia/hyperglycemia. Always have oral carbohydrate available. Carry a glucose source to treat hypoglycemia

Answer 9

Humulin R, Novolin R Type 1 and 2 Diabetes Onset: 30 min to 1 hour Peak: 2 - 4 Hours Duration: 6 - 8 hours ``` Interactions: Increased hypoglycemic effect with aspirin, oral anticoagulant, alcohol, oral hypoglycemic, beta blockers MAOIs ``` Advantages: Used for dosing clients with Sliding Scale. Can be administered IVP or continuous IV infusion.

Answer 10

Isophane suspension (NPH, Humulin N, Novolin N) Uses: Type 1 and 2 Diabetes Onset of Action: 1 – 1 ½ hour Peak: 4-12 hours Duration: 16-24 hrs ``` Side effects:Confusion Agitation Tremors Headache Flushing Hunger Weakness Lethargy Fatigue Redness at injection site. ``` ``` Adverse Effects: Tachycardia Palpitations Hypoglycemia Rebound hyperglycemia Lipodystrophy Shock Anaphylaxis ``` Nursing Interventions: Cloudy suspension. Can mix with Regular or Rapid acting insulin: Draw up clear (Regular or Rapid acting), then cloudy (NPH), “Clear to cloudy”. Monitor for hypoglycemia, hypokalemia, lipodystrophy. Always have oral carbohydrate available Client Education: SubQ medication administration. Glucose self-monitoring. Signs/symptoms of hypoglycemia/hyperglycemia. Always have oral carbohydrate available. Carry a glucose source to treat hypoglycemia

Answer 11

Glargine Onset: 2-4 hours Peak: none Duration: 24 hours Once daily SubQ injection provides 24-hour coverage. No peak, insulin delivered at steady level, less risk of hypoglycemia Interventions:Do NOT mix with any other insulin. Monitor for hypoglycemia, hypokalemia, lipodystrophy. Always have oral carbohydrate available.

Answer 12

Blood test that gives an average of what blood sugar has been for 3 to 4 months. 4-6% Diabetic goal <7%

Answer 13

When you are sick, you become hyperglycaemic because usually the normal pancreas can handle these fluctuations. An increase in the blood sugar when sick or stressed, is a normal reaction to help us fight the illness or stressor. Illness = DKA.

Answer 14

Alternative to daily injections. Only rapid insulin is used in these pumps. Obtains a better control, as receiving a basal level of insulin from the pump and boluses of additional insulin as needed with meals or if they have elevated blood sugars

Answer 15

Cold and Clammy, Confusion, Shakey, Headache, Nervous, Nausea, Hunger, Increased pulse, Coma-like

Answer 16

Eat 15 g of a simple sugar, wait 15 minutes and re-assess. Once the blood sugar is up, eat a complex carb and a protein. If you enter the room and pt is unconscious, treat as hypoglycemia. Use D50W in a large bore IV because it is a hypertonic solution. Prevention: Eat, take ya insulin, know hypoglycemia s/s and monitor chem strips

Answer 17

Acarbose and Ligitol Used in Type 2 diabetes Contraindications: DKA, Type 1, Cirrhosis and intestinal obstruction PO Interactions: Decreases levels of digoxin and propranolol MoA: Delays absorption of glucose from the GI tract Advantages: Less likely to cause hypoglycaemic Disadvantages: Can be Hepatotoxic Side Effects: Flatulence, Abd Cramps and diarrhea Adverse Effects : Hepatotoxicity Interventions: Monitor liver functions every 3 months for the first year of therapy and periodically after Monitor for hypoglycemia if also taking a sulfonyurea FSBS Client Education: Importance of diet and exercise. Signs/Symptoms of hypoglycemia and hyperglycemia Take with food at the same time each day. Self-monitoring blood glucose

Answer 18

Pramlintide Adjunct therapy for Type 1 and 2 who have failed to achieve optimal glucose control with insulin alone Contraindications: Gastroparesis SubQ Onset 20 minutes Interactions: Increases effect of Tylenol. Increases hypoglycemia with ACE inhibitors, alcohol, corticosteroids and insulin MoA: Augments the effects of insulin. Decreases post meal glucagon and glucose. Slows stomach emptying. Decreases appetite, leads to decreased caloric intake and weight loss. Advantages: Can assist with weight loss Side Effects: Headache Fatigue Dizziness Blurred vision Nausea/vomiting Anorexia Abdominal pain Adverse Effects; Hypoglycemia Nursing Interventions: Administer immediately prior to meals. Give SubQ in abdomen or thigh. DO NOT administer in arm as absorption is unpredictable. Monitor for hypoglycemia/hyperglycemia Always have oral carbohydrate available. Client education:Medication administration. Give SubQ in abdomen or thigh. DO NOT administer in arm as absorption is unpredictable. Sign/symptoms of hypoglycemia/hyperglycemia. Always have oral carbohydrate available. Carry a glucose source to treat hypoglycemia

Answer 19

Octreotide ``` Common uses: Acromegaly Severe diarrhea Flushing episodes associated with metastatic tumors Variceal bleeding ``` Route: SubQ, IM, IV Onset: 30 minutes Interactions: decreased absorption of dietary fat, Vit B12 Levels MoA: Inhibits growth hormone, promotes fluid and electrolyte reabsorption. ``` Side Effects: Headache GI complaints Fatigue Dizziness Flatulence Constipation UTI ``` ``` Adverse Effects: Dysrhythmias Heart failure Hyperglycemia Hypoglycemia Cholelithiasis Seizure ``` Interventions: Assess growth hormone antibodies. Monitor thyroid function studies. Monitor blood glucose Education: Sub Q self injection and Blood glucose monitoring

Answer 20

Somatropin Common Uses: Growth HormoneL Growth failure die to growth hormone deficiency, AIDS wasting syndrome and short bowel syndrome Contraindications: Growth failure after closure of the epiphyseal plates SubQ and IM Onset: 15 minutes Interactions: Increases epiphyseal closure with androgens, thyroid hormones Decreased growth with glucocorticoids Decrease insulin, anti-diabetic effect MoA: Stimulates growth Side Effects: Headache, Fever, N/V, Joint and Muscle Pain Adverse Effects: Hyperglycemia, Hypothyroidism, Ketosis ``` Interventions: Inject deeply into a large muscle. Aspirate before injection. Rotate injection sites daily. Assess for signs/symptoms of diabetes. Thyroid function tests. ``` Education: Treatment may continue for years. Maintain a growth record. Report knee/hip pain or limping.

Answer 21

Glucagon used for Hypoglycemia Contraindicated in Pheochromocytoma Route: SubQ, IM and IV Onset is 10 mins Interactions: Increased bleeding risk with anticoagulants MoA: Increases blood sugar by stimulating glycogenolysis (glycogen breakdown) in the liver. It protects the body cells, especially in the brain and retina, by providing the nutrients and energy needed to maintain body function Side effects: Dizziness Headache Hypotension Nausea/vomiting Adverse Effects: Hyperglycemia Interventions: Monitor Glucose levels Education: How to use product. Glucose self-monitoring. Sign/symptoms of hypoglycemia/hyperglycemia. Always have oral carbohydrate available. Carry a glucose source to treat hypoglycemia

Answer 22

Methimazole and Propylthiouracil Common uses: Hyperthyroidism, Graves disease, Thyrotoxicosis, Pre-op to stun the thyroid prior to thyroidectomy Contraindications: Pregnancy, Breastfeeding PO Onset is Rapid Interactions: Increase response to digoxin. Decrease effectiveness of warfarin Increase PT, AST, ALT, alkaline phosphate. Side Effects: Rash, Drowsiness, Headache, Vertigo, Nausea/Vomiting, Diarrhea Adverse: Leukopenia, agranulocytosis, Pancytopenia, Hepatitis Interventions: Monitor CBC with differential and PT time for bone marrow suppression. Monitor TSH levels. Assess for s/s of hypothyroidism as well as hyperthyroidism. I&O Daily weight Increase fluids to 3-4 L/day unless contraindicated Client Education: Report unusual bruising or bleeding. Avoid shellfish and iodine products. Teach client how to monitor pulse daily. Report redness, swelling, sore throat, fever. Do not discontinue medication abruptly because thyroid crisis can occur.

Answer 23

Used for Hyperthyroidism Contraindicated in Pregnancy PO ``` Side effects: Hypothyroidism Headache Confusion Paresthesia Metallic taste Stomatitis Nausea/Vomiting Diarrhea ``` Adverse Effects : Hyperthyroidism: rebound effect post radioactive iodine Interventions: Watch for thyroid storm. Monitor for fever, rash, metallic taste, mouth sores, sore throat, GI distress. ``` Education:Stay away from babies for 1 week Don’t kiss anybody for 1 week. Avoid crowds and people who are ill. Report darkening of urine or jaundice. Monitor for weight gain. ```

Answer 24

Metformin Used for Hyperglycemia in Type 2 Diabetes ``` Contraindications: Ketoacidosis Renal impairment Hepatic dysfunction Cardiopulmonary insufficiency Alcoholism ``` PO ``` Interactions: May potentiate hypoglycemia when used with ACE inhibitors, ARBS, calcium channel blockers, beta-blockers, procainamide, digoxin, furosemide, alcohol, cimetidine ``` MoA: Decreases hepatic production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine. Advantages:Does not stimulate the release of more insulin, so less likely to cause hypoglycemia Disadvantages: Clients undergoing surgery or any radiologic procedure that involves contrast dye should temporarily discontinue metformin. They can resume 48 hours after the procedure if kidney function has returned and the creatinine is normal. ``` Side Effects: Dizziness Fatigue Headache Anorexia Nausea/Vomiting Diarrhea Weight loss ``` Adverse Effects : Lactic Acidosis Interventions: Assess for hypoglycemia/hyperglycemia Monitor CBC, renal and studies every 3 months Administer with meals Education:Glucose self-monitoring. Signs/Symptoms of hypoglycemia/hyperglycemia. Avoid OTC medications, alcohol. Glucophage XR tab may appear in stool. Carry emergency ID and glucagon emergency kit.

Answer 25

Glucovance Used for Type 2 Diabetes Contraindications: Renal insufficiency, Type one Diabetes, DKA PO Onset is 15 to 30 minutes Interactions: Thiazides and other diuretics, corticosteroids, phenothiazines, estrogens, oral contraceptives, phenytoin, calcium channel blockings, and isoniazid may cause hyperglycemia. The hypoglycemic action of sulfonylureas may be potentiated by NSAIDS, salicylates, sulfonamides, MAOIs, and beta-adrenergic blocking agents MoA: GLUCOVANCE combines glyburide and metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action, to improve glycemic control in patients with type 2 diabetes. Gluburide directly stimulates the beta cells to secrete insulin, thus decreasing the blood glucose level. Increases the tissue response to insulin and decreases glucose production by the liver. Metformin decreases hepatic production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine. Disadvantages: Contraindicated for clients with renal insufficiency due to possible risk of developing lactic acidosis Side Effect: UTI, Headache, N/V, Abd Pain, Diarrhea, Dizziness Adverse Effects: Lactic acidosis and Hypoglycemia Interventions: Assess for hypoglycemia/hyperglycemia Monitor CBC, renal and studies every 3 months Administer with meals Education:Glucose self-monitoring. Signs/Symptoms of hypoglycemia/hyperglycemia. Avoid OTC medications, alcohol. Glucophage XR tab may appear in stool. Carry emergency ID and glucagon emergency kit. Use sunscreen and wear protective clothing when outside for more than a short time.

Answer 26

Potassium Iodine Used for hyperthyroidism, Pre-op to decrease the chance of bleeding Contraindications: Pregnancy Pulmonary edema TB Bronchitis PO ``` Onset: 24- 48 hours Interactions: Increase: hypothyroidism – lithium Increase: hyperkalemia ACE inhibitors, potassium sparing diuretics. ``` MoA: Decreases the size and vascularity of the thyroid gland. Inhibits secretion of thyroid hormone. ``` Side Effects: Headache Confusion Paresthesia Metallic taste Stomatitis Nausea/Vomiting Diarrhea ``` Adverse Effects: Angioneurotic edema ``` Interventions: Dilute in milk or juice and administer through a straw to prevent teeth discoloration. Administer after meals to prevent GI upset. Assess Vital signs Monitor potassium level Daily weight I&O Monitor thyroid levels ``` Education: Keep of graph of weight, pulse, mood Avoid seafood and other iodine products. Do not discontinue abruptly as thyroid crisis may occur.

Answer 27

Exenatide and Liraglutide Type 2 Diabetes Contraindications: Type one diabetes, DKA, severe renal dsyfunction and severe GI disease SUBQ, Onset 1 hour Interactions:Increase hypoglycemia with ACE inhibitors, sulfonylureas, alcohol. Increase hyperglycemia with corticosteroids. MoA: Suppresses glucagon secretion and stimulates insulin release Advantages: Exenatide added to type 2 diabetic therapy when inadequately managed by Metformin or a Sulfonylurea Disadvantage: Liraglutide not recommended for firstline therapy. Risk of thyroid C-cell tumors including medullary thyroid cancer ``` Side Effects: Headache Dizziness Jitteriness Nausea/Vomiting Diarrhea ``` Adverse Effects: Hypoglycemia Pancreatitis Angioedema Anaphylaxis Interventions: Administer exenatide SQ within 1 hour of morning and evening meals. Monitor for hypoglycemia Always have oral carbohydrate available. Monitor for pancreatitis. ``` Client Education: SubQ medication administration. Glucose self-monitoring. Signs/Symptoms of hypoglycemia/hyperglycemia. Avoid OTC medications, alcohol. Always have oral carbohydrate available. Notify PHCP or severe abdominal pain. ```

Answer 28

T4: Levothyroxine T3: Liothyronine Common uses : Hypothyroidism. Myxedema and Cretinisim Contraindications: Adrenal insufficiency, Recent MI and Thyrotoxicosis PO/IV Onset is 24 hours ``` Interactions: Increase cardiac insufficiency risk with epinephrine products. Decrease levothyroxine absorption/effect with ferrous sulfate, estrogens, antacids, sucralfate ``` MoA: Increases metabolic rate; increases cardiac output, renal blood flow, oxygen consumption, body temperature, blood volume, growth, development at cellular level via action on thyroid hormone receptors ``` Side Effects: Insomnia Weight loss Anxiety Insomnia Headache Nausea Anorexia ``` ``` Adverse Effects: Hypertension Tachycardia Chest pain Cardiovascular collapse Thyrotoxicosis ``` ``` Interventions: Monitor Vital Signs Monitor for thyrotoxicosis. Daily weight Monitor thyroid hormone levels Monitor cardiac status ``` Education Life-long replacement with medication is necessary. Do not switch brands Avoid OTC preparations with iodine. Avoid iodine-rich foods (Iodized salt, soybeans, tofu, turnips, seafood).

Answer 29

The hormones of the pituitary gland help regulate the functions of other endocrine glands. The pituitary gland has two parts—the anterior lobe and posterior lobe—that have two very separate functions. The hypothalamus sends signals to the pituitary to release or inhibit pituitary hormone production. The pituitary gland is often dubbed the “master gland” because its hormones control other parts of the endocrine system, namely the thyroid gland, adrenal glands, ovaries, and testes. However, the pituitary doesn’t entirely run the show. In some cases, the hypothalamus signals the pituitary gland to stimulate or inhibit hormone production. Essentially, the pituitary acts after the hypothalamus prompts it.

Answer 30

Adrenocorticotropic hormone (ACTH): ACTH stimulates the adrenal glands to produce hormones. Follicle-stimulating hormone (FSH): FSH works with LH to ensure normal functioning of the ovaries and testes. Growth hormone (GH): GH is essential in early years to maintaining a healthy body composition and for growth in children. In adults, it aids healthy bone and muscle mass and affects fat distribution. Luteinizing hormone (LH): LH works with FSH to ensure normal functioning of the ovaries and testes. Prolactin: Prolactin stimulates breast milk production. Thyroid-stimulating hormone (TSH): TSH stimulates the thyroid gland to produce hormones.

Answer 31

Posterior Lobe Hormones: Anti-diuretic hormone (ADH): This hormone prompts the kidneys to increase water absorption in the blood. Oxytocin: Oxytocin is involved in a variety of processes, such as contracting the uterus during childbirth and stimulating breast milk production.

Answer 32

Rosiglitazone (Avandia), Pioglitazone (Actos) Commonly used for type 2 diabetes ``` Contraindications: Symptomatic heart disease Class 3 / 4 Heart failure DKA Type 1 diabetes ``` PO Interactions: avoid concurrent use with insulin, nitrates Increased anti-diabetic effect with garlic MoA: Improves glucose uptake in the muscle and decreases endogenous glucose production. decreases insulin resistance and improve blood glucose control. Advantages: Does not induce hypoglycemic reactions if taken alone. Lowers triglyceride level. May raise HDL cholesterol Disadvantages: May cause HF or MI, can be hepatotoxic, may raise LDL cholesterol ``` Side Effects: Fatigue Headache Weight gain Diarrhea UTI ``` Adverse Effects: MI CHF Hepatotoxicity anaphylaxis ``` Interventions; Monitor for hypoglycemia. Monitor ALT level Monitor glucose Use effective contraception ``` Education: Monitor blood glucose Signs/Symptoms of hyperglycemia / hypoglycemia Daily weight Report edema Report SOB, chest pain Report symptoms of hepatic dysfunction – Nausea/ Vomiting, abdominal pain, dark urine, jaundice, anorexia

Answer 33

Nateglinide (Starlix), Repaglinide (Prandin) Type 2 Diabetes Don't use with Type one or DKA PO/30 minutes Stimulates the release of insulin from the pancreas Advantages: Maybe used alone or in combination with Metfrmin Disadvantages: Should be avoided in clients with liver dysfunction due to possible decreased liver metabolism. ``` Side Effects: Headache Weakness Tinnitus Sinusitis Nausea/vomiting Diarrhea Constipation Dyspepsia Angina URI ``` ``` Adverse Effects: Hypoglycemia Pancreatitis Hemolytic anemia Leukopenia ``` Intervention: Administer 15-30 minutes before meals. Skip dose if meal skipped. Monitor for hypoglycemia. Education: Blood glucose monitoring. Signs/Symptoms of hypoglycemia/hyperglycemia Eat after taking medication to prevent hypoglycemia.

Answer 34

stimulate insulin release via the pancreas and carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended by the Beers Criteria. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin)

Answer 35

is an uncommon condition caused by an overproduction of growth hormone (GH). It is usually due to pituitary adenoma, and onset in adult clients generally occurs at age 40-45. In an adult, increased GH results in overgrowth of soft tissues of the face, hands, feet, and organs. Additional heart sounds (S3, S4) require further assessment for cardiac conditions (eg, heart failure). Local tumor effect :Pituitary enlargement, visual field defects, headache Musculoskeletal/skin :Gigantism, maloccluded jaw, arthralgias/arthritis, hyperhidrosis, skin tags Cardiovascular: Hypertension, heart failure Enlarged organs : Tongue, thyroid, salivary glands, liver, spleen, kidney, prostate Endocrine : Galactorrhea, decreased libido, diabetes mellitus

Answer 36

1-1.8 mmol/L

Answer 37

0.4-5.0 mU/L

Answer 38

13-27 pmol/L and | 3.5-6.5 pmol/L

Answer 39

120-420 μmol/L

Answer 40

30 - 90ug/ml

Answer 41

9 - 33 µmol/L

Answer 42

13-31 μmol/L (male) | 5-29 μmol/L (female)

Endocrine Flashcards

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