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XIO > Pharm week 6 - metabolic and endocrine > Flashcards

Pharm week 6 - metabolic and endocrine Flashcards

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1
Q

vital process regulated by hormones

A

secretory and motor in digestive
energy production
composition of volume and extracellular fluid
adaptation, like acclimaitziaton and immuniyt
growth and development

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2
Q

hormones in clinical practice

A

replacement therapy (insulin, diabetes, adrenal)
pharmacolgic - lareger than endogenous adrenalsteroids for anti-inflammatory - transplant
endocrine testing - TSH, T4, metabolic rate

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3
Q

negative feedback loop

A

internal and external factors may stimulate hypothalamus to + or - anterior pituitary.

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4
Q

anterior pituitary glands

A

growth hormone - femoral head
follicle stimulating
luteninzing hormone
thyroid-stimulating
lacogenic (prolactin and mammotropin)
adrenocorticosteroid
mealocyte-stimulating

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5
Q

anterior pituitary

A

growth hormone - (deficiency - somatrem, somatropin
thyroid-stimualating - thryotropin
adrenocorticotropic - corticotropin

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6
Q

posterior pituitary

A

oxytocin - uterine contractrions - (pitcocin and syntocinon)
vasopressin - vasoconstrictor (antidiruetic hormone ADH (Agipressin)
deficiency of ADH leads to diabetes inspidous

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7
Q

hormones secreted by thyroid

A

have diffuse effect and do not have any specific effect on target organ.
essential for metabolism
long delay in onset and prolonged duration of action.
T4, T3, & calcitonin - regulate basal metabolic rate, lipid/carb metabolism, normal growth and control heat

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8
Q

common thyroid disorders

A

goiter - enlarged thyroid gland
hypothyroidism
hyperthyoidism

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9
Q

hypothyroidism - cause

A

deficiency of thyroid hormone

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10
Q

3 types of hypothyroidism

A

primary - abnormal thyroid
secondary - pituitary gland and decreased secretion of TSH.
tertiery - dec. levels of thyrotropin-releasing hormone from hypothalamus

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11
Q

hashimotos

A

autoimmune

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12
Q

myxedema

A

severe - adult

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13
Q

cretinism

A

infant - dec. metabolic rate, retarded growth, sexual growth, and mental retardation

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14
Q

hypothyroidism symptoms

A

skin is cold and dry
pale, puffy, expressionless face
hair is brittle w/ hair loss
bradycardia
decreased metabolism, lethargy
hypothermia, intolerence to cold

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15
Q

late signs of hypothyroidism

A

decreased temp, decreased HR, weight gain, skin thickening, cardiac complications, decreased LOC

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16
Q

hypothyroidism diagnosis

A

triiodothyronine (T3) T3 is four times greater than T4

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17
Q

TSH normal values

A

0.4 - 4.8 mU/L

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18
Q

hypothyroid management

A

levothyroxine T4 (synthroid, Leovxyl) 25-200 mcg/day
liothyronine - (T3) triosat
Liotrix - black box warning

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19
Q

levothryoxine T4 - action

A

thyroid hormone
increases BMR
enhances gluconeogenesis
stimulates protein synthesis

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20
Q

levothryoxine T4 - uses

A

replacement in decreased or absent thyroid function
hypothyroidims
management of thyroid cancer
thyroid suppression testing

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21
Q

levothyroxine precautions

A

elderly, impaired cardia, 25% less dose
high protein bound - sustained and release and reamins in blood longer - toxcitity
half-life 7 days (need 4 weeks to get steady state)
pregnancy category A

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22
Q

levothyroxine adverse effects

A

hyperthyroidism
palpitations, tachcardia, A-Fib
increased metabolism
weight loss, bone loss
bioequivalence - cannot switch brands

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23
Q

levothyroxine drug interactions

A

digoxin
antiacids
estrogen
insulin
phenytoin
drugs that should be reduced:
warafin
catecholamines (epinephrine, dopamine, dobutamine)

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24
Q

levoxthyroxine - nursing implications

A

monitor HR/temp
monitor weight
TSH (T3 or T4 replacement)
replacement therapy is life long
take meds on empty stomach 30 min before breakfast w/ 6-8 oz of water for better absorption

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25
iodine
ingested through food and water, changed into iodide and stored in thyroid. thyroid uses it to synthesize thyroid hormones prolong defecinecy leads to goiter 1 mg/week of iodide is needed in diet
26
excessive thyroid - causes by what
graves disease, miltinodular disease plummer's disease (rare) also called toxic nodular disease or toxic goiter
27
thyroid storm
induced by stress or infection. sever and life-threatening
28
hyperthyroidism
diahrrea, flushing, increased appetite, muscle weakness, sleep disorders, altered menstrual flow, fatigue, palpitations, nervousness, heat intolerence, irritability
29
treatment of hyperthyroidism
radioactive iodine works by destroying thyroid gland (ablation) surgery to remove part or all atithyroid drugs - thioamide deravitives - block production ie methimozole (tapazole) propylthiouracil (PTU) potassium iodid - prrophylaxis tx of radition exposure
30
parathyroid fuction
primary is to maintain adaquate levels of calcium in extracellular fluid
31
elevated levels of parathyroid
can result in metabolic bone disease (eg osteoperosis and osteomalacia)
32
hypoparathyroidism leads to
hyocalcemia and tetany (muscle spasm)
33
nursing implications of hypoparathyroidism
teach patients to report unusual symptoms, like chest pain or palpitations teach to not take OTC w/out doc approval theraputic effects may take several months may enhance anticoagulatns diabetics may need to increase dose of hypoglycemic meds may increase digoxin levels
34
nursing implactions - parahypothyroidism
antithyroid meds are better tolerated w/ food. give at same time each day. never stop meds abruptly avoid eating foods high in iodine (seafood, soy sauce, tofu, some bread, iodized salt
35
nursing implications - parahypothyroidism - monitor for
theraputic response, adverse effects. liver and kidney function, bone marrow toxic, increase oral anticoagulants, warafin - bleeding
36
adrenal insufficiency
addison's disease or hypoaldosteronism
37
adrenal hyperfunction
adrenal virilism - premature devel. of male secondary sex characteristics hyperaldosteronism - decreased K, increased Na and water, tired, HA, weak, numbness cushings disease - increase corticosteroids pheochromaocytoma - tumor, surgery, HTN, sweating, incr. HR and HA, blood urine analysis, inc. catecholamines
38
adrenal cortex hormones
Glucocorticoids 🞑 beclomethasone (several formulations) 🞑 fluticasone propionate' 🞑 hydrocortisone (several formulations) 🞑 cortisone 🞑 methylprednisolone 🞑 prednisone
39
MOA adrenal cortex hormones
Most exert their effects by modifying enzyme activity Different drugs differ in their potency, duration of action, & extent to which they cause salt & fluid retention Glucocorticoids inhibit or help control inflammatory & immune responses
40
adrenal cortex hormones - indications
Wide variety of indications 🞑 Adrenocortical deficiency 🞑 Cerebral edema 🞑 Collagen diseases 🞑 Dermatologic diseases 🞑 GI diseases excerbates chronic respiratory illness such as asthema or COPD
41
adrenal cortex hormones - indications
wide variety of indications: organ transplant (decreased immune response) palliative management of leukemias and lymphomas Spinal cord injury 🞑 Many other indications
42
glucocorticoids admin
by inhilation for control of steroid-responsive bronchospastic states nasally for rhinitis and to prevent recurrence of polps after surgery topically for inflammation of the eye, ear, skin
43
antiadreanals
aminoglutethimide - used for cushings, breast cancer and adrenal cancer
44
antiadrenal contraindications
drug allergies Serious infections, including septicemia, systemic fungal infections & varicella (chickenpox) However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory CNS damage
45
contraindiciations
Cautious use in patients with 🞑 Diabetes- Inc.BS 🞑 Cardiac/renal/liver dysfunction
46
adverse effects - antiadrenal
potentially all body systems Cardiovascular - heart failure, edema, hypertension - all caused by electrolyte imbalance (hypokalemia, hypernatremia) CNS - convulsions, headache, vertigo, mood swings, nervousness, insomnia, steroid psychosis
47
adverse effects - endocrine and GI
Endocrine - growth suppression, cushings, menstrual irreg, carb intolerence, hyperglycemia, others GI - peptic ulcer w/ possible perforation, pancreatitis, abdominal distention, others
48
adverse affects - antiadrenal- skin and musculoskeletal
integumentary - fragile skin, petechiae, ecchyomosis (bruising) facial erythema, poor wound healing, hirustism, urticaria (hives) muscloskeletal - muscle weakness, loss of muscle mass, osteoperosis
49
adverse effects - antiadrenal - ocular and other
increased intraocular pressure, glaucoma weight gain
50
nursing implications - antiadrenal
physical assesment baseline weight, height, I and O, vital, hydration, immunity check labs assess for edema and electrolytes contraindications allergies these drugs may alter serum glucose and electrolytes
51
antiadrenal implications -
forms may be oral, IM, IV or rectal, but NOT SC.
52
antiadrenal should be given with
food or milk to minimize GI upset
53
clear nasal before
giving antiadrenal nasaly
54
after using inhaled cortisteroid,
instruct patient to rinse mouth to prevent oral fungus. teach patient to avoid pp. w/ infections, fever, weakness, tired, sore throat
55
adrenal meds should be taken
same time every day, usually morning, w/ food teach patients about effects w/ warafin should not take alcohol, aspirine or NSAIDS
56
adrenal meds sudden discontination
can cause adrenal crisis by sudden drop in sesrum levels of cortisone taper
57
nurse monitor for
theraputic response and adverse effects
58
pancreas
2 internal secretions - insulin and glucagon
59
type 1
no insulin, less than 10% of all cases. complications - diabetic ketoacidosis - deyhdration hyperosmolar nonketotic syndrome (HNK) dehydration
60
type 2
many tissues are resistent to insuline - reduced # of receptors and receptors are less responsive
61
type 2 commorbid conditions
obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminemia (protein in urine) increased risk for thrombotic (blood clotting) evening these are collectively referred to as metabolic syndrome or insulin-resistence or syndrome X
62
gestational diabetes
hyperglycemia during preg, insulin must be given to prevent birth defects usually subsides after delivery 30% of patients may develop type 2 DM within 10 - 15 years
63
long term complications of both DM
coronary arteries - MI cerebral arteries - stroke periperheral arteries - PVD microvascular (capillary damage) retinopathy - blindness neuropathy - amputation nephropathy - HD compromised circulation
64
screening for DM
fasting plasma glucose higher than or equal to 110 mg/dL but less than 126 is pre diabetes impaired glucose tolerence test (oral glucose challenge) am bld test before eating drink 75 gm glucose 2 hrs bld draw normal is less than 140 screen every 3 years for all patients 45 and older normal range BS is 70 -100 mg/dL
65
HbA1c
percentage of glyocslated hemoglobin forms over lifespan of RBCs in proportion to degree of glycemia provides estimate level of glycemia over lifetime of RBC, about 90 days
66
non diabetic HbA
less than 5.7
67
prediabetes HbA
5.7 - 6.4%
68
diabetes HbA
greater than 6.5
69
insulin does what?
promotes intercellular K and Mag into cells. helps metabolize carbs, fats, and proteins. stores glucose in liver. converts glycogen to fat stores
70
recombinant insulin produced by
bateria or yeast
71
goal of insulin
tight glucose control
72
rapid insulin
5 - 15 min, short duration, patient must eat after injection. lispro (humalog) similiar to endogenous asparat (novalog) glulisine newest may be given SC or continous SC infusion, but not IV
73
short acting
regular insulin (Humalin R) onset 30 -60 min only one that can be given IV bolus, IV infusion, or IM
74
intermediate acting
isophane (NPH) neutral prtamine hagedorn cloudy slow onset more prolonged than endogenous
75
long acting
glargine (lantus) determir clear, referre to as basal insulin
76
combo insulin
NPH 70% regular 30% NPH 50% and regular 50%
77
short acting usually used in
hospitals or those on enteric feeding tubes
78
SC insulin is ordered in
amounts that increase as glucose increases. disadavantegs - delays insulin admin until hyperglycemia occurs
79
oral DM meds
insulin secretgogues insulin resistance agents
80
oral antidiabetic drugs
biguanides - metformin (decreases glucose prodcution in liver) sulfoylureas - binds to beta cells stimulates insulin release - chlorpropamide, tolazamide, 2nd gen - glimepiride, glipizide, and glyburide
81
oral antidiabtic beta cell function
must be present
82
glincides
increase insulin secretion from the pancrease
83
thiazolidinediones - TZD
decrease insulin resistence, "insulin sensitizing drugs" cautious use
84
alpha-glucosidase inhibitors
result in delayed absorption of glucose. must be taken with meals.
85
antidiabetic -amylin mimetic
slows gastric emptying
86
antidiabetic MOA
enhances glucose-driven insulin secretion
87
oral antidiabetic - adverse
metallic taste, does not cause hypoglycemia
88
oral antidiabetic -sulfonylureas
hypoglcemia
89
oral antidiabetic - glinides
hypoglycemic effects
90
oral antidiabetic - thiazolidinedione
increased heart failure and MI risk
91
oral antidiabetic - sulfonylureas
allergic cross-senseitivity may occur with loop diuretics and sulfonamide antibiotics
92
nursing implications - before givign glucose altering drugs
blood glucose, A1c level
93
metformin will be discontinued if
the patietn is undergoing studies w/ contrast dye because of renal effects

XIO (400 decks)

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