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endocrine Flashcards

1
Q

type 1 diabetes

A

DM peaks at age 10-15 yrs
75% of cases diagnosed prior to 18 yrs of age
DMI: destruction of pancreatic beta cells

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2
Q

ketoacidosis

A

Dehydration
Electrolyte imbalance, acidosis
Coma
Death

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3
Q

long term complications of diabetes

A

Microvascular and macrovascular complications

Primary microvascular:
Nephropathy
Retinopathy
Neuropathy

Tight glycemic control diminishes longterm effects of the disease

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4
Q

diabetes insipidus

A

Underproduction or under secretion of antidiuretic hormone
Results in fluid and electrolyte imbalances
May be transient or lifelong condition
Patients may feel weak and tired due to nocturia
Characterized by polydipsia (thirst) and polyuria (increased urination)
Typical urine output for DI: 5L-20L
Serum osmolality elevated (>300 mmol/kg) due to water loss through kidneys
Very low specific gravity (<1.005)***

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5
Q

diabetes insipidus water deprivation test

A

Water deprivation test (positive for central DI)
No fluids for 8-16 hrs
Hourly monitoring of BP, weight and urine osmolality
Test stopped when orthostatic hypotension develops, weight loss of 3%, or urine osmolality stabilizes

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6
Q

main treatment goal for diabetes insipidus

A

fluid and electrolyte balance
DDAVP used as a hormone replacement
Vasopressin utilized as ADH replacement

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7
Q

nephrogenic diabetes insipidus

A

Kidney does not respond to ADH
Treatment
Low Na diet
Thiazide diuretics
(slows the GFR and allows more water reabsorption in the Loop of Henle and distal tubules)
Indocin may also be prescribed (increases renal responsiveness to AHD)

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8
Q

syndrome of inappropriate antidiuretic hormone (SIADH)

A

Typical population: older adults
Results from abnormal production of ADH

Caused by: 
small cell lung cancer (chronic)
Head trauma or medications (self limiting)
Characterized by:	
fluid retention
serum hypo-osmolality
Dilutional hyponatremia
Hypochloremia
Concentrated urine with increase intravascular volume
Normal renal function
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9
Q

effects and treatment of SIADH

A 
Effects:
Muscle cramping
Nausea and vomiting
Muscle twitching
Seizures
Diagnosed by:
Urine specific gravity >1.005
Serum osmolality<28 mmol/L
Serum sodium <134mmol/L
Treatment: 
Limit fluids to 800-100ml/day for mild
Limit fluids to 500/day for severe

Severe hyponatremia may be treated with hypertonic saline administered very slowly

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10
Q

hypo/hyperthyroidism

A

TSH (controlled by anterior pituitary)(hypothalamus controls thyrotropin-releasing factor)
(issue may be organ defect or secretion issues)
T3
T4
Calcitonin
TREATMENT:
TSH replacement: synthroid

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11
Q

hypothyroidism medications

A 
Desiccated thyroid
Natural preparation
Source: cattle and pigs
Synthetic preparations:
Levothyroxine (Synthroid ) T4 
Liothyronine T3
Labs required: TSH, T4, T3
Dosing based on lab values
Pregnancy: dosage may change q4 weeks
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12
Q

hypothyroidism medications contraindications

A 
Known drug allergy
Recent MI
Adrenal insufficiency
Hyperthyroidism
Caution: the fillers often contain starch—may cause problems (gluten intolerant individuals or celiacs)
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13
Q

hypothyroidism medications adverse effects

A

Cardiac dysrhythmias
Tachycardia, palpitations, angina, hypertension
Insomnia, tremors, headache, anxiety
Nausea, diarrhea, cramps
Menstrual irregularities, weight loss, sweating, heat intolerance, fever

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14
Q

hypothyroidism medications interactions

A

Enhances oral anticoagulants (dose may need to be lowered of anticoagulant
Lower digoxin serum levels (digoxin dose may need to be increased)
Cholestyramine :absorption of both medications may be decreased
Diabetics: hypoglycemic medications may need to be increased

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15
Q

graves disease

A

antithyroid medications
radioactive iodine
Surgery

Graves’ disease is most often treated with the anti-thyroid drug methimazole (Tapazole, generic versions).

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16
Q

graves disease medications

A

TREATMENT: aimed at
The disease
or symptoms of the disease

DISEASE medications:
Antithyroid medications
Iodides
Ionic inhibitors
Radioactive isotopes

SYMPTOM medications:
B-blockers

17
Q

antithyroid medications

A

Thiamazole and propylthiouracil
Mechanism of Action: inhibit the iodine molecules from forming tyrosine
Cannot inactivate already circulating thyroid hormone
Indications: hyperthyroidism
Contraindications: known drug allergy
Adverse Effects: liver and bone marrow toxicity
Interactions: added bone marrow depression with antineoplastics

18
Q

cushing’s syndrome

A 
SYMPTOMS:
Weight gain (central obesity)
Hyperglycemia
Protein wasting
Mood disturbances
HTN
Hypokalemia
Hirsutism in women
Menstrual disorders
Buffalo hump
DIAGNOSTICS:
24 hour urine sample to measure cortisol
Goal of treatment:
normalize hormone secretion
Surgical Interventions:
Surgical removal of pituitary adenoma tumour
Irradiation of the pituitary adenoma
Adrenalectomy (may be bilateral)
**High risk for hemorrhage**
19
Q

cushing’s syndrome medication interventions

A

Drug therapy (mitotane—Lysodren) inhibits adrenal function
Ketoconazole inhibit cortisol synthesis. Dosage of medication required to reduce cortisol synthesis often toxic. This medication is used cautiously.
Cause may be due to prolonged administration of corticosteroids
Gradual discontinuance of corticosteroid therapy
Reduction of corticosteroid dose
Conversion from daily to every other day dosing

20
Q

cushing’s syndrome nursing interventions

A

Complicated disease to treat
Patients are seriously ill
Patients need to monitor diligently for: cardiac disease, diabetes mellitus and infection
Emotional support for patient important
Physical changes can be reversed once disease treated
High protein diet

21
Q

addison’s disease

A

Occurs in adults younger than 60 yrs of age
If autoimmune is the cause: more White females affected

Signs and symptoms:
Very slow onset of weakness
Fatigue 
Weight loss
Anorexia
Skin hyperpigmentation
Other signs and symptoms:
Hypotension
Hyponatremia
Hyperkalemia
N&V
Diarrhea
Irritability and depression
22
Q

addison’s disease diagnostics and treatment

A

Diagnostics:
Low cortisol levels
Or adrenocorticotropic hormone (ACTH) stimulation testing with failure of cortisol levels to rise

Lab findings:
Hyperkalemia
Hypochloremia
Hyponatremia
Hypoglycemia
Anemia
Increased BUN
Free cortisol low in urine
Treatment:
Underlying condition
Glucocorticoid replacement
mineralocorticoid replacement
Salt additives
*increased dosage during stressful situations (like hospitalizations during sickness)
23
Q

addison’s disease adrenal crisis

A

Adrenal Crisis: (Life threatening emergency)
Caused by:
Stress
Sudden withdrawal of corticosteroid hormone therapy
Adrenal surgery
Sudden pituitary gland destruction

**may be unresponsive to vasopressors and fluid replacement*

Symptoms:
Hypotension
Tachycardia
Dehydration
Hyponatremia
Hyperkalemia
Hypoglycemia
Fever 
Weakness 
Confusion

498 (9 decks)

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