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NUR 326 Exam 3 > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

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1
Q

anterior pituitary

A

secretes 6 different hormones, including TSH and adrenocorticotropic hormone (ACTH)

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2
Q

posterior pituitary

A

secretes 2 hormones –> antidiuretic hormone, oxytocin

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3
Q

where are adrenal glands situated?

A

sit on top of kidneys

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4
Q

anatomical components of adrenal glands

A

composed of inner medulla and outer cortex

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5
Q

what does the adrenal medulla secrete?

A

epi and norepi

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6
Q

what does the adrenal cortex secrete?

A

–glucocorticoids (Cortisol)
–mineralcorticoids (Aldosterone)
–sex steroids (Androgens)

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7
Q

definition of Cushing Syndrome

A

a collection of signs and symptoms associated with hypercortisolism

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8
Q

Primary hyperfunction cause

A

disease of adrenal cortex (Cushing’s syndrome)

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9
Q

Secondary hyperfunction cause

A

disease of anterior pituitary (Cushing’s disease)

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10
Q

what do exogenous steroids cause?

A

Cushing’s syndrome

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11
Q

Cortisol functions

A

–raises blood sugar (opposes insulin)
–protects against the physiologic effects of stress
–suppresses immune and inflammatory processes
–breaks down protein and fat

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12
Q

increased cortisol effect on glucose availability

A

–glucose intolerance
–hyperglycemia

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13
Q

increased cortisol effect on maintenance of vascular system

A

–hypertension
–capillary friability

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14
Q

increased cortisol effect on protein breakdown

A

–muscle wasting
–muscle weakness
–thinning of skin
–osteoporosis and bone pain

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15
Q

increased cortisol effect on fat breakdown

A

–redistribution of fat to abdomen, shoulders, and face

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16
Q

increased cortisol effect on suppression of immune and inflammatory responses

A

–impaired wound healing and immune response
–risk for infection

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17
Q

increased cortisol effect on CNS excitability

A

–mood swings
–insomnia

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18
Q

clinical manifestations of Cushing’s

A

–red cheeks
–abdominal stretch marks
–pendulous abdomen
–fat pads (Buffalo hump)
–bruise easily
–thin arms and legs

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19
Q

treatment for Cushing’s

A

treatment depends on cause
–pituitary or adrenal tumor: surgery or radiation

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20
Q

drugs used with Cushing’s

A

–aminoglutethimide
–ketoconazole

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21
Q

MOA of aminoglutethimide

A

blocks synthesis of all adrenal steroids

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22
Q

indication of aminoglutethimide (Cytadren)

A

temporary therapy to decrease cortisol production

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23
Q

effects of aminoglutethimide (Cytadren)

A

–reduces cortisol levels by 50%
–does not affect the underlying disease process

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24
Q

adverse effects of aminoglutethimide (Cytadren)

A

–drowsiness
–nausea
–anorexia
–rash

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25
MOA of ketoconazole (Nizoral)
antifungal drug that also inhibits glucocorticoid synthesis
26
indication for ketoconazole (Nizoral)
adjunct therapy to surgery or radiation for Cushing syndrome
27
main adverse effect of ketoconazole (Nizoral)
severe liver damage
28
safety issues with ketoconazole (Nizoral)
--do not take with ETOH or other drugs that harm liver --do not give during pregnancy (fetal thyroid damage)
29
definition of Addison disease
disease of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones
30
cortisol = ?
sugar
31
salt = ?
aldosteron
32
sex = ?
androgens
33
etiology of Addison disease
idiopathic, autoimmune, or other
34
patho of Addison disease
--adrenal gland destroyed --symptoms when 90% non-functional --adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH) are secreted in large amounts
35
early clinical manifestations of Addison disease
--anorexia --weight loss --weakness --malaise --apathy --electrolyte imbalances --skin hyperpigmentation
36
symptoms of hypoaldosteronism
--hypotension (decreased vascular tone, decreased CO, decreased circulating blood volume) --salt craving (decreased serum NA levels, decreased serum K levels, dehydration)
37
symptoms of hypocortisolism
--hypoglycemia --weakness and fatigue --unsuppressed ACTH production --hyperpigmentation
38
pharmacology for Addison Disease
--lifelong corticosteroid replacement therapy (adrenal insufficiency) --glucocorticoid --hydrocortisone (drug of choice) --prednisone --dexamethasone --some require mineralcorticoid --fludrocortisone
39
important issues with pharmacotherapy
--dosing mimics natural release of hormones --never abruptly stop therapy --dose will need to be increased during stress --always maintain emergency supply --wear Medic Alert bracelet
40
adrenal medulla disorder
pheochromocytoma
41
pheochromocytoma
rare tumor of the adrenal medulla that produces excessive catecholamines
42
risk factor for pheochromocytoma
young-middle age
43
What does a pheochromocytoma trigger in the body?
SNS stimulation --> excessive release of epi, norepi
44
symptoms of pheochromocytoma
--HA --hypertension --diaphoresis --tachycardia
45
drug therapy for pheochromocytoma
--principal cause of hypertension = activation of alpha 1 receptors on blood vessels --treatment = surgery --alpha-adrenergic blockers for inoperable tumors, pre-op to reduce risk of HTN
46
example of alpha-blockers for pheochromocytoma
phenoxybenzamine HCl (Dibenzyline)
47
indication for phenoxybenzamine HCl (Dibenzyline)
pheochromocytoma
48
MOA for phenoxybenzamine HCl (Dibenzyline)
long-lasting, irreversible blockage of alpha-adrenergic receptors
49
drug effects of phenoxybenzamine HCl (Dibenzyline)
lowers BP
50
adverse effects of phenoxybenzamine HCl (Dibenzyline)
--orthostatic hypotension --reflex tachycardia --nasal congestion --sexual side effects in men
51
antidiuretic hormone (ADH)
released in response to high serum osmolality and/or hypotension
52
function of ADH
causes water retention via action in the kidneys
53
way to remember function of ADH
"ADH--this hormone stops the pee pee"
54
SIADH
syndrome of inappropriate antidiuretic hormone
55
SIADH definition
an abnormal production or sustained secretion of ADH
56
what is SIADH characterized by?
--fluid retention --serum hypoosmolality and hyponatremia --concentrated urine
57
etiology of SIADH
--malignant tumors --CNS disorders --drug therapy --miscellaneous (hypothyroidism, infection)
58
malignant tumors associated with SIADH
small cell carcinoma of the lung
59
CNS disorders associated with SIADH
--head trauma --stroke --brain tumors
60
patho of SIADH
increased antidiuretic hormone --> increased water reabsorption in renal tubules --> increased intravascular fluid volume --> dilutional hyponatremia and decreased serum osmolality
61
serum osmolality in SIADH
low
62
urine osmolality and specific gravity in SIADH
high
63
serum sodium in SIADH
low
64
urine output in SIADH
low
65
weight in SIADH
gain
66
water retention in SIADH
retaining pure water without salt
67
what do symptoms depend on with SIADH?
depend on severity and rate of onset of hyponatremia
68
symptoms of hyponatremia
--dyspnea --fatigue --lethargy --confusion --dulled sensorium --musical twitching --convulsions --impaired taste --anorexia --vomiting --cramps
69
severe symptoms of SIADH
sodium = 100-115 --> irreversible neuro damage
70
water intoxication
when serum levels of sodium become lower than what is INSIDE the cells --cells swell
71
symptoms of water intoxication
--neurologic: confusion, lethargy, coma, death
72
pharm with SIADH
--not first line of defense --treatment --> underlying cause --chronic SIADH = demeclocycline
73
classification of demeclocycline (Declomycin)
tetracycline broad-spectrum antibiotic
74
MOA of demeclocycline
interferes with renal response to ADH
75
adverse effects of demeclocycline
--photosensitivity --teeth staining --nephrotoxic
76
definition of diabetes insipidus
a deficiency of ADH or a decreased renal response to ADH
77
what is DI characterized by?
excessive loss of water in the urine
78
two forms of DI
--neurogenic (central) --nephrogenic
79
cause of neurogenic DI
hypothalamus or pituitary gland damage
80
associated disorders with neurogenic DI
--stroke, TBI --brain surgery --cerebral infections
81
etiology of neurogenic DI
--sudden onset --usually permanent --neuro origin
82
etiology of nephrogenic DI
--renal origin --slow onset --progressive
83
cause of nephrogenic DI
--loss of kidney function --often drug-related
84
associated disorders of nephrogenic DI
CKD
85
patho of DI
decreased antidiuretic hormone --> decreased water reabsorption in renal tubules --> decreased intravascular fluid volume --> increased serum osmolality/excessive urine output
86
serum osmolality in DI
high
87
urine osmolality and specific gravity in DI
low
88
serum sodium in DI
high
89
urine output in DI
high
90
weight in DI
loss
91
symptoms of DI
--polyuria --polydipsia --dehydration --electrolyte imbalances --hypovolemic shock --> death
92
pharm for neurogenic DI
--synthetic ADH replacement
93
pharm for nephrogenic DI
--thiazide diuretics
94
why are diuretics used in someone who is peeing constantly?
paradoxical effect decreases polyuria and increases urine osmolality
95
desmopressin (DDAVP)
treatment for neurogenic DI
96
MOA for desmopressin
--synthetic ADH replacement --anti-diuretic effects
97
route for desmopressin
--nasal spray --PO --IV --SQ
98
adverse effects for desmopressin
small doses: none nasal spray: nasal irritation large doses: hyponatremia, water intoxication
99
DI acronym
D: dry I: I&O, daily weight L: low specific gravity U: urinates lots T: treat=desmopressin E: rEhydrate

NUR 326 Exam 3 (11 decks)

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