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NUR 326 Exam 3 > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

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1
Q

Anterior Pituitary secretes 6 hormones; what are the two we are focusing on for class?

A

thyroid stimulating hormone
adrenocorticotropic hormone (ACTH)

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2
Q

Posterior Pituitary secretes what 2 hormones?

A

antidiuretic hormone (AKA Vasopressin)
oxytocin

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3
Q

Adrenal Gland: location and composition

A

sit on top of the kidneys
each gland is composed of an inner medulla and an outer cortex

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4
Q

Adrenal Medulla secretes what 2 catecholamines?

A

epinephrine
norepinephrine

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5
Q

Adrenal Cortex secretes what in response to ACTH? (3)

A

“the 3 S’s”
glucocorticoids (Cortisol) (SUGAR)
mineralcorticoids (Aldosterone) (SALT)
sex steriods (Androgens) (SEX)

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6
Q

Adrenocortical Hormone Disorders (2)

A

Cushing Syndrome
Addison Disease

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7
Q

Cushing Syndrome: Definition

A

a collection of S/S associated with hypercortisolism

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8
Q

Cushing Syndrome: Causes (3)

A

primary hyperdysfunction
secondary hyperdysfunction
exogenous steroids

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9
Q

Primary hyperdysfunction (Cushing)

A

disease of the adrenal cortex and adrenal cortex releases too much cortisol

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10
Q

Secondary hyperdysfunction (Cushing)

A

disease of the anterior pituitary gland, and causes release of too much ACTH, which results in too much cortisol production

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11
Q

Exogenous Steroids

A

Can cause Cushing Syndrome
used in the management of various diseases

prednisone and dexamethasone are MOST common cause of cushing syndrome in the US

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12
Q

Cortisol: Functions (4)

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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13
Q

Cushings: Clinical Manifestations (CM) (6)

A

with increased cortisol:

-Glucose intolerance, hyperglycemia
-HTN, capillary friability (ecchymoses)
-Muscle wasting, muscle weakness, thinning of skin, osteoporosis and bone pain
-Redistribution of fat to abdomen, shoulders, and face
-Impaired wound healing and immune response, risk for infection
-Mood swings, insomnia

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14
Q

Cushings: Drug Therapy

A

treatment depends on cause
-pituitary or adrenal tumor?: surgery or radiation
-exogenous steroids?: taper the drug slowly if possible
-2 drugs possible

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15
Q

Cushings: Drugs (2)

A

aminoglutethimide
ketoconazole

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16
Q

aminoglutethimide (Cytadren): Indication and MOA

A

for Cushings: temporary therapy to decrease cortisol production

blocks synthesis of all adrenal steroids

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17
Q

aminoglutethimide (Cytadren): Effects and SE

A

reduces cortisol by 50%
does NOT affect the underlying disease process

SE:
-drowsiness
-nausea
-anorexia
-rash

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18
Q

ketoconazole (Nizoral): Indication and MOA

A

adjunct therapy to surgery or radiation for Cushings

antifungal drug that also inhibits glucocorticoid synthesis

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19
Q

ketoconazole (Nizoral): SE and Safety Issues

A

MAIN SE: severe liver damage

Do NOT take with alcohol or other drugs that harm liver
Do NOT give during pregnancy (fetal thyroid damage)

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20
Q

Addison Disease: Definition

A

disease of the adrenal cortex that cause HYPOsecretion of all 3 adrenocortical hormones (cortisol, aldosterone, androgens)
* Most SEVERE effects come from the LACK of cortisol

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21
Q

Addison Disease: Etiology (3)

A

idiopathic
autoimmune
other

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22
Q

Addison Disease: Pathogenesis

A

adrenal gland destroyed
symptoms when 90% non-functional
ACTH and melanocyte-stimulating hormone (MSH) are secreted in large amounts

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23
Q

Addison Disease: EARLY CM (7)

A

anorexia
weight loss
weakness
malaise
apathy
electrolyte imbalances
skin hyperpigmentation

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24
Q

With Addison Disease, why do they appear tan (skin hyperpigmentation)?

A

MSH secretion- excess melanocyte stimulation

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25
Addison Disease: CM: 2 Main Types
hypoaldosteronism hypocortisolism
26
Addison Disease: Hypoaldosteronism CM
hypotension -decreased vascular tone -decreased CO -decreased circulating blood volume salt craving -decreased Na levels -increased K levels -dehydration
27
Addison Disease: Hypocortisolism CM (4)
hypoglycemia weakness and fatigue unsuppressed ACTH production hyperpigmentation
28
Addison Disease: Pharmacotherapy
Adrenal insufficiency requires lifelong corticosteroid replacement therapy All patients require a glucocorticoid -Hydrocortisone (Cortef) -Prednisone -Dexamethasone Some patients require a mineralcorticoid -Fludrocortisone (Florinef)
29
Addison Disease: what is drug of choice for AD?
Hydrocortisone (Cortef) Has glucocorticoid and mineralcorticoid activity
30
Addison Disease: Pharmacotherapy: Important Issues
Dosing mimics natural release of hormones -timing is important- CONSISTENT -doses are small NEVER abruptly stop therapy Dose will need to be increased during stress -example: infection, surgery, trauma -"3x3 Rule": 3x usual dose for 3 days Always maintain emergency supply Wear a medical alert bracelet
31
Adrenal Crises: 2 Types
Severe Cushing Syndrome Addisonian Crisis
32
Pheochromocytoma: Definition
adrenal medulla disorder 90% of the time benign rare tumor of the adrenal medulla that produces excessive catecholamines
33
Pheochromocytoma: Risk Factor and Pathogenesis
young-middle age SNS stimulation--> excessive release of epi, norepi
34
Pheochromocytoma: CM (4)
HYPERTENSION: stroke risk tachycardia headache diaphoresis
35
Pheochromocytoma: Drug Therapy
*Principal cause of hypertension is activation of the alpha 1 receptors on blood vessels Preferred treatment: surgery Alpha-adrenergic blockers may be used (1): -inoperable tumors -pre-operatively to reduce risk of acute HTN
36
Pheochromocytoma: Drug
phenoxybenzamine HCl (Dibenzyline)
37
phenoxybenzamine HCl (Dibenzyline): Indication and MOA
pheochromocytoma long-lasting, irreversible blockage of alpha-adrenergic receptors
38
phenoxybenzamine HCl (Dibenzyline): Drug Effects and SE
DE: lowers BP SE: -orthostatic hypotension -reflex tachycardia -nasal congestion -sexual SE in men
39
Antidiuretic Hormone (ADH)
Function: causes water retention via action in the kidneys Released in response to high serum osmolality and/or hypotension
40
ADH Disorders (2)
SIADH Diabetes Insipidus
41
SIADH: Definition
Syndrome of Inappropriate AntiDiuretic Hormone An abnormal production or sustained secretion of ADH
42
SIADH: Characterized by (3)
fluid retention serum hypoosmolality and hyponatremia concentrated urine
43
SIADH: Etiology (4)
Malignant Tumors -ex: small cell carcinoma of the lung (Adenocarcinoma)- MOST common cause of SIADH Central Nervous System Disorders -ex: head trauma, stroke, brain tumors Drug Therapy -ex: morphine, SSRIs, some chemo drugs Miscellanous Conditions -ex: hypothyroidism, infection
44
SIADH: Pathogenesis
increased antidiuretic hormone--> increased water reabsorption in renal tubules--> increased intravascular fluid volume---> dilutional hyponatremia and decreased serum osmolality
45
SIADH: Osmolality
Serum Osmolality= LOW Urine osmolality and specific gravity= HIGH Serum Na= LOW Urine output= LOW Weight= GAIN *Remember: pt. is retaining pure water without salt
46
SIADH: CM (11)
Symptoms of HYPOnatremia: -dyspnea, fatigue -Neurologic: lethargy, confusion, dulled sensorium -muscle twitching, convulsions -GI: impaired taste, anorexia, vomiting, cramps Manifestation depends on severity and rate of onset of hyponatremia Severe Symptoms: Na= 100-115 mEq/L--> IRREVERSIBLE neurologic damage
47
Water Intoxication: Definition and Symptoms
When serum levels of Na become lower than what is INSIDE the cells Cells SWELL Symptoms: neurologic primarily-->confusion, lethargy, coma, death
48
SIADH: Pharmacotherapy
Not the first line of treatment--> instead directed at the underlying cause: ex: discontinue offending medication, head trauma: might wait it out, etc. Chronic SIADH= demeclocycline (Declomycin)
49
demeclocycline (Declomycin): Classification and MOA
tetracycline broad-spectrum antibiotic interferes with renal response to ADH
50
demeclocycline (Declomycin): Indication and SE
chronic SIADH antibiotic therapy photosensitivity teeth staining NEPHROTOXIC
51
Diabetes Insipidus (DI): Definition
A deficiency of ADH or a decreased renal response to ADH Characterized by: excessive loss of water in the urine
52
Diabetes Insipidus: Two Forms
NEUROgenic (Central) NEPHROgenic
53
DI NEUROgenic: Etiology
Neuro origin (Central DI) CAUSE: hypothalamus or pituitary gland damage Associated disorders: -stroke, traumatic brain injury -brain surgery -cerebral infections Sudden onset Usually permanent
54
DI NEPHROgenic: Etiology
Renal origin CAUSE: -loss of kidney function -often drug-related (ex: Lithium) Associated Disorders: CKD SLOW onset PROGRESSIVE course of disease
55
DI: Pathogenesis
decreased ADH--> decreased water reabsorption in renal tubules--> decreased intravascular fluid volume--> increased serum osmolality (hypernatremia) AND excessive urine output
56
DI: Osmolality
Serum osmolality= HIGH Urine osmolality and specific gravity= LOW Serum Na= HIGH Urine output= HIGH Weight= LOSS
57
DI: CM (5)
polyuria polydipsia dehydration others based on severity -electrolyte imbalances -hypovolemic shock--> death
58
DI Pharmacotherapy: NEUROgenic
synthetic ADH replacement Desmopressin (DDAVP)
59
Desmopressin (DDAVP)
NEUROgenic DI synthetic ADH replacement, anti-diuretic effects Delivery: nasal spray, PO, IV, SQ SE: -small doses: none -nasal spray: nasal irritation -large doses: hyponatremia, water inoxication
60
DI Pharmacotherapy: NEPHROgenic
thiazide diuretics paradoxical effect: -decreases polyuria -increases urine osmolality
61
DI: D-I-L-U-T-E
Dry I & O, daily weight Low specific gravity Urinates lots Treat= desmopressin rEhydrate

NUR 326 Exam 3 (11 decks)

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