MCP Endocrine System Flashcards
(40 cards)
1
Q
Overview of Thyroid Hormone
A
- Produced by the thyroid gland
- Two forms: tiiodothronine (T3) and thyroxine (T4)
- T3 is more potent than T4
- Has effects on nearly every system in the body
- Regulates metabolism, growth, development, and more
2
Q
Hypothyroidism: Definition, Causes
A
- Deficient thyroid hormone production
- Causes:
- Hashimoto’s thyroiditis
- Severe iodine deficiency
- Congenital hypothryoidism
3
Q
Hyperthyroidism: Definition, Causes
A
- Excess thyroid hormone production
- Causes:
- Graves’ disease
- Thyroid nodule
- Postpartum throiditis
4
Q
Hypothyroidism: Symptoms
A
- Cold intolerance
- Weakness
- Fatigue
- Weight gain
- Hair loss
- Constipation
- Decreased libido
5
Q
Hyperthyroidism: Symptoms
A
- Heat intolerance
- Sweating
- Weight Loss
- Increased heart rate
- Irritability
- Nervousness
- Exopthalmos (bulging eyes)
6
Q
Hypothyroidism: Treatment (General Term)
A
- Thyroid hormone replacement therapy
7
Q
Hyperthyroidism: Treatment (General Term)
A
- Anti-Thyroid medications
- Radioactive iodine treatment
- Ultimately leads to hypothroidism
- Surgical removal of thyroid gland
- Ultimately leads to hypothroidism
8
Q
Thyroid Hormone Replacement: Generic vs. Brand
A
- Generic: levothyroxine
- Brand: Synthroid, Levoxyl, Levothroid, Unithroid
- Note: bioavailability may differ between different brands/products
9
Q
Thyroid Hormone Replacement: MOA
A
- Mimics the endogenous thyroid hormone thyroxine (T4)
10
Q
Thyroid Hormone Replacement: Dosing
A
- Titration is necessary
- Dose varies depending on the patient
- 25-200 mcg daily is common
11
Q
Levothryoxine Counseling Point: Administration
A
- Take 30-60 min before the first meal of the day
- Take with a full glass of water
- Separate from antacids, iron supplements, and multivitamins by 4 hours
12
Q
Levothryoxine Counseling Point: Side Effects
A
- Symptoms of hyperthyroidism:
- Indicate that dosing is too high
- Be able to tell the patient what these symptoms are
- Decreased bone mineral density
- With long-term therapy
13
Q
Levothyroxine: Follow-Up and Monitoring
A
- Patient will begin to see symptom improvement within about 2 weeks
- May take 6-8 weeks to see normalized thyroid stimulating (TSH) levels
- Follow up with prescriber 4-6 weeks after beginning therapy
- Monitor TSH levels throughout course of therapy
- Every 6-12 months
- Do not abruptly discontinue this medication
14
Q
Levothryoxine: Precautions, Contraindications, and Drug Interactions
A
- Severe adverse effects include cardiac arrhythmias, and cardiac arrest
- Use with caution in patients with cardiovascular disease
- Contraindiciations
- Recent acute myocardial infarction
- Uncorrected adrenal insufficiency
- Drug Interactions include:
- Warfarin (anticoagulant)
- Levothryozine may increase the anticoagulant effect of warfarin
- Antacids, iron supplements and multivitamins
- May decrease absorption of levothyroxine
- Separate by 4 hours
- Warfarin (anticoagulant)
15
Q
What is Osteoporosis?
A
- Osteoporosis is a disease characterized by low bone mass
- The bones become weak and brittle, making them more suseptible to fracture
- Referred to as a “silent disease”
- Often diagnosed after a fracture occurs
- Most commonly affects those over age 50 years
- 80% og those affected are women
- 80% og those affected are women
16
Q
Osteoporosis Risk Factors
A
- Older age
- Female
- Caucasian or Asian
- Physical inactivity
- Smoking
- Excessive alcohol intake
- Dietary factors such as inadequate calcium and vitamin D intake
- Certain illneses and medications
- Family history of osteoporosis
17
Q
National Osteporosis Foundation
A
- Screening through bone mineral density (BMD) exams recommended for:
- All women 65+ yo
- ALl men 70+ yo
- Others of younger age who meet certain clinical criteria
18
Q
Osteoporosis Prevention Stragies
A
- Adequate Calcium intake
- Dietary intake of calcium
- Males less than 70 and females less than 50: 1000mg daily
- Older than that, 1200 mg daily
- Adequate Vitamin D intake
- All persons less than 50: 600-800 units daily
- All persons older than 50: 800-100 units daily
- Regular exercise
- Emphasize weight-bearing exercises and strength training
- Smoking cessation
- Decreased alcohol intake
19
Q
Bisphosphonates
A
- alendronate: Fosamax®
- ibandronate: Boniva®
- risedronate: Actonel®
20
Q
Bisphosphonates: MOA
A
- Inhibit activity of osteoclasts
- osteoclasts break down bone
- Do not affect osteoblasts
- osteoblasts build bone
- Overall effect is to prevent further bone loss
21
Q
Bisphosphonates: Administration
A
- Take immediately upon waking
- Take with a full glass of plain water
- Remain upright and do not lie down for at least 30-60 min
- After taking, do not consume any food, beverages or other medications for at least 30-60 min
22
Q
Bisphosphonates: Calcium and Vitamin D Supplementation
A
- Osteoporosis treatment with bisphosphonates should be supplemented wiht calcium and vitamin D
- Help to preserve bone mineral density
- Prevent hypocalcemia
23
Q
Bisphosphonates: Side Effects
A
- Upper GI tract irritation
- Dyspepsia, abdominal pain
- Follow special administration instructions for prevention
- Use with caution in patients with pre-exisiting GI irriation
- Osteonecrosis of the jaw
- Rare but serious side effect
- Risk factors include invasis dental procedure and poor oral hygiene
- Patients with risk factors should revieve dental exam prior to initiating bisphosphonate therapy
- Patient should contact prescriber if experiencing jaw pain or swelling
24
Q
Bisphosphonate: Follow-Up and Monitoring
A
- Obtain a bone mineral density (BMD) scan at baseline and then at least every 2 years
- central dual-energy x-ray absoptiometry (DXA) of the hip or spine
25
Bisphosphonates: Contraindications
* Abnormalities of esophagus
* Inability to sit upright or stand for at least 30 min
* Hypocalcemia
* Must be resolved prior to initiating bisphosphonate therapy
26
Bisphosphonates: Drug interactions
* Antacids
* Decrease absorption of bisphosphonates
* Oral NSAID
* Increase risk of GI irritation
27
Cortcosteroids: Drugs
* prednisone
* dexamethasone (Decadron®)
* methylprednisolone (Medrol®)
28
Corticosteroids: Uses
* Inflammatory disorders
* Asthma
* Severe allergic reations
* Arthritis
* Irritable bowl syndrome
* Immunosuppressive therapy
29
Corticosteroids: Dosing
* Sometimes dispensed as taper packs
* Usually short-term therapy
30
Oral Corticosteroid: Administration
* Take early in the day
* To prevent hyperactivity
* Take with food or milk
* To prevent GI upset
* Do not discontinue abruptly
* Because of potential rebound
31
Oral Corticosteroid: Short Term Side Effects
* GI irritation
* Hyperactivity
* Insomnia
* Mood changes
* Hyperglycemia
* Sodium/fluid retention
32
Oral Corticodteroid: Long Term Side Effects
* Immunosuppresion (dose related)
* Hypertension
* Bone loss
* Cataract/glaucoma
* Weight gain
* Buffalo hump
* Moon face (dose-related)
33
Oral Corticosteroid: Contraindication
* Systemic fungal infections
34
Oral Corticosteroid: Drug interactions
* Drug interaction are extensive and include:
* NSAIDs
* May cause increased GI irritation
* Live vaccines
35
Oral Corticosteroid: Moinitoring and Followup
* Symptom improvement
* With prolonged use in specific pateint population:
* Blood pressure (patients with hypertension)
* Blood glucose (patients with diabetes)
* Bone mineral density (those with osteporosis risks)
* Opthalmic exams (potential cataract/glaucoma)
* Growth (in children)
36
Topical Corticosteroids: Drugs
* Hydrocortisone: low potency
* Triamcinolone acetonide: medium potency
* Betamethasone dipropionate: high potency
37
Topical corticosteroid: Uses
* Used to treat inflammation, swelling, or itching associated with various skin conditions including:
* Dermatitis
* Eczema
* Rashes
* Insect Bites
* Other irritations
38
Topical Corticosteroid: Administration
* Wash hands before and after application
* Clean and throughly dry the affected area of skin before application
* Apply a thin layer to the affected area and gently rub into skin
* Use on skin only
* Keep out of mouth, nose and eyes
* May use on open or broken skin
* Avoid using high potency preaprations on areas of thin sensitive skin such as genitals, body folds, and eyes
39
Topical Corticosteroid: Side Effects
* More likely to occur with higher potency and are usually local:
* Irriation
* Thinning of the skin
* stretch marks
* skin disscoloration
* bruising
* Thin spidery blood vessels (telangiectasia)
* Potential systemic side effects are rare but may occur with prolongs use
* Mainly a concern in children who need frequent doses of high potency topical corticosteroids, which can affect growth
40
Topical Corticosteroids: Contraindication and Drug Interaction
* Contraindication
* Systemic fungal infections
* Drug interactions
* not as big of a concern with topical corticosteroids as with oral corticosteroids
