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86 Cards in this Set

  • Front
  • Back
Adrenal Cortex
Hormone: Corticosteroids
Hyper: Cushing's - Cytaden
Hypo: Addison's - hydrocortisone, prednisone
Ovaries - Estrogen
Hypo: menstrual and metabolic dysfunction - conjugated estrogen and estriol
Ovaries - Progesterone
Hypo: Dysfunctional uterine bleeding - testosterone
Testes - Testosterone
hypo: hypogonadism - testosterone
pancreatic islets
Insulin
Hypo: Diabetes Mellitus - Insulin and oral hypoglycemic
parathyroid
parathyroid hormone
hyper: hyperparathyroidism - surgery
hypo: hypoparathyroidism - Vit D and Ca+ supplements
pituitary - ADH
hypo: Diabetes insipidus - vasopressin and desmopressin
pituitary - growth hormone
hypo: small stature - somatrem and somatropin
hyper: acromegaly - sandostatin
pituitary - oxytocin
hypo: delayed delivery or lack of milk ejection - oxytocin
thyroid
thyroid hormone
hyper: Grave's dz - propylthiouracil (PTU)
hypo: Myxedema - thyroid hormone and levothyroxine (T4)
growth hormone disorders
Gigantism - prior to puberty
acromegaly - after puberty
parlodel
gigantism/acromegaly- activates dopamine receptors to inhibit the release of GH and prolactin (may cause drowsiness, use alternate contraception)
sadostantin
gigantism/acromegaly - blocks GH secretion in the anterior pituitary, inhibits growth hormone
SQ - TID, long acting IM q4wks
given by injection form, usually at HS
Growth Hormone
dwarfism - must be used before closure of bone epiphyses.
antibodies may develop resulting in failure to respond to therapy, namely failure of drug to produce growth.
Somatropin
SQ/IM in PM to mimic body response, rotate sites, may be abused by athletes
Antidiuretic Hormone Disorders
SIADH - excess secretion of ADH
Diabetes Insipidus - deficiency of ADH (neurogenic)
SIADH
marked fluid retention
increased urine osmolality
low serum osmolality
sodium loss in urine
hyponatremia and water retention resulting in muscle cramps, weakness, HA, N/V, lethargy, coma
TX: remove excess fluid
Diuretic: Lasix, Mannitol
Diabetes Insipidus
Large volume of dilute urine
increased thirst
TX: desmopressin (DDAVP) - increases permeability of renal tubules to water, increases the reabsorption of water, produces vasoconstriction of blood vessels at higher doses
intranasally, SQ, IV, PO
monitor BP
store in refrigerator, monitor for water intoxication
also used for enuresis
Osmolality
the number of dissolved particles, or solutes, in a fluid. As water is lost, the osmolality, or concentration of the blood, increases and the hypothalamus directs the posterior pituitary gland to release ADH
Hypothyroidism - meds
Thyroid Hormone - Levothyroxine (T4), liothyronine (T3)
PO, IM, IV(levothyroxine)
actions: increases metabolic rate throughout body, increase O2 consumption, resp rate, blood volume, cardiac output, temp, protein, fat, and CHO metab, weight loss
drug interactions - potentiated by use of ASA, increased effects of stimulants, decrease oral anticoagulants
may require increase in insulin or oral hypogycemics
Hyperthyroidism - meds
antithyroid drugs: tapazole and propylthioruracil (PTU)
actions: inhibit manufacture of of thyroid hormone, may take 3-4 wks to see results, may not be therapeutic (results in thyroidectomy or radioactive iodine tx)
SE: agranulocytosis, oxfoliative dermatitis, granulocytopenia, aplastic anemia, hypoprothrombinemia, and hepatitis, N/V, and paresthesias
hyperthyroidism - iodine solutions
Iodism (excessive amounts of iodine in body), metallic taste, swelling and soreness of parotid glands, burning of mouth and throat, sore teeth and gums, symptoms of head cold, and GI upset, also symptoms of iodine allergy
Radioactive Iodine
used for hyperthyroidism - SE: sore throat, swelling of neck, n/v, cough, pain on swallowing, bone marrow depression, anemia, leukopenia, thrombocytopenia, tachycardia
radioactive iodine - nrsg considerations
may have difficulty swallowing tablet
add iodine solutions to juice or water before administration
has strong salty taste
drink through straw to prevent tooth discoloration
radioactive iodine is given by MD as single dosage only
radiation safety precautions should be followed
androgens
indications: replacement therapy in androgen deficient males
inoperable metastatic carcinoma or the breast in women
fibrocystic breast dz
endometriosis
Testosterone (transdermal, intramuscular - oil based: ASPIRATE)
adverse effects/nrsg care:
acne, flushing of skin
gynecomastia
change in libido
edema
virilization in females
priapism
androgen inhibitors
drugs that block the effects of androgens
excessive androgens - BPH which may respond to inhibitor medication
Finasteride - Proscar, Propecia - has been found to also promote hair growth
SE/Nrsg considerations:
pregnant women or women who may become pregnant should avoid skin contact with drug (birth defects)
monitor urine output for decreased output or decreased flow
impotence and decreased libido may occur during therapy
advise patient to avoid exposing a pregnant women or one who may become pregnant to his semen
Estrogens
replacement therapy in menopause or when deficient in estrogens, postpartum breast engorgement, androgen dependent tumors (prostate cancer), contraception
DES, estradiol, conjugated estrogens
SE/Nrsg care:
cholasma, nausea, elevated BP, clotting problems, gall stones, cholestatic jaundice, breakthrough bleeding, depression, given cyclically if the woman has a uterus
Progestins
progestins transform a proliferative endometrium into a secretory one and stimulate the growth of mammary alveolar tissue - the hormone of pregnancy
Amenorrhea, abnormal uterine bleeding caused by hormonal imbalance, endometrial cancer, combination bc pills
hydroxyprogesterone (Duralutin), Medroxyprogesterone (Provera), Progesterone (Gestrol)
SE/Nrsg care: breakthrough bleeding, changes in menstrual flow, edema, thromboembolic disorders, increased BP
Evista
estrogen agonist-antagonist: used for postmenopausal osteoporosis. Reduces resorption of bone and decreases bone turnover. also used in breast cancer prophylaxis.
contraceptive patch
applied anywhere except breasts, palms, soles of feet
patch applied each week for three weeks on same day called "patch change day"
patch free week - menstruation usually occurs (4th week)
emergency contraception if patch is off for more than one or two days
depo provera
usually injected within the first 7 days of menstruation
reinject every 3 months
emergency contraception if late for injection
99.7% effective
not coitus dependent, not associated with estrogen-caused cardiovascular SE
decreases dysmenorrhea, cramping
reduces risk ectopic pregnancy, anemia, endometrial cancer, uterine cancer and PID
safe for breast feeding
does not affect long-term fertility
The Pill
taken daily at same time for 21 days followed by hormone free period of 7 days - menstruation
can be taken up to 84 days on/7 off
emergency contraception if one or two pills missed
progestin-only
similar to depo provera
mini-pill
begins with menses or post-partum while BF
take pill same time each day - 3 hrs late requires emergency contraception
for women who cannot use estrogen, bf'ing women
depo provera, mini pill, norplant, implanon
prevent pregnancy by inhibiting ovulation by suppressing FSH and LH, and eliminating the LH surge. Thickening the cervical mucous and preventing sperm penetration. Producing changes in the endometrial lining. Mirena IUD also contains progestin
Vaginal Ring - NuvaRing
left in place for 21 days, then ring-free week - menstruation
emergency contraception if ring is out of place for more than three hours or if new ring is late
norplant and implanon
Norplant - D/C'd in late 1990s.
Implanon progestin-only implant in europe but not US.
like Depo provera
levonorgestrel
up to 7 years
FSH and LH
influence the secretion of sex hormones, development of secondary sex characteristics, and reproductive cycle
menotropins and urofollitropin
purified preparations of the gonadotropins extracted from urine of postmenopausal women
menotropin - used to induce ovulation and preg in anovulatory female, in male to induce prod of sperm
Urofollitropin - used to induce ovulation in women with PCOD
menotropin adverse rxn
ovarian enlargement, hemoperitoneum and febrile rxns.
Multiple births and birth defects.
urofollitropin adverse rxn
mild to moderate ovarian enlargement, n/v, breast tenderness, ectopic pregnancy
chorionic gonadotropin
hCG - extracted from human placentas and contains FSH and LH. Used to induce ovulation and pregnancy. Also used for prepubertal cryotorchism (failure of testes to descend into the scrotum)
Adverse rxn: HA, irritability, restlessnes, fatigue, edema, and precocious puberty
Clomid (clomiphene citrate)
binds to estrogen receptor sites, reducing the number of sites available for circulating estrogens. The receptors send back signals to hypothalmus and pituitary gland, telling it that there is a lack of circulating estrogens. They hypothalmus responds by increasing secretions of hypothalamic releasing factor. This stimulates pituitary gland to release LH and FSH which in turn stimulates the ovaries to release eggs for fertilization.
Clomid uses/dose
to induce ovulation in women who are not ovulating because of reduced circulating estrogen levels. Pregnancy occurs 25-30% of pts treated. POTENTIAL FOR MULTIPLE BIRTHS.
50 mg tabs
Clomid nursing care
make sure pt knows to have sex during ovulation - usually 6-10 days after last dose of med
start any time there has been no recent bleeding. If bleeding occurs before therapy, start on or about the 5th day for 5 days. If ovulation does't occur after first course, give 2nd course of 100 mg for 5 days. Do not start any earlier than 30 days after the previous course.
Third course may be given at 100 mg for 5 days.
clomid - monitor for SE, report to MD
Monitor for N/V/D and constipation, hot flashes, abdominal cramping
Report: severe abdominal cramping, visual disturbances, dizziness
Oxytocics - oxytocin, pitocin
stimulates the smooth muscle of the uterus, blood vessels, and mammary glands. When administered during third trimester, active labor is induced
oxytocics - uses
drug of choice for inducing labor or augmenting uterine contractions during the 1st and 2nd stage of labor
routinely given immediately PP to control uterine atony and PP hemorrhage
can be administered intranasally to promote milk letdown and treat breast engorgement during lactation
Oxytocics - dosages
induction of labor: IV 1 to 2 mU/min.
infusion pump must be used
may increase or decrease dosage according to desired response
max usually 20 mU/min
rate change max 20-30 min
may reduce or discontinue after labor has begun to do spontaneous uterine activity

augmentation of labor - IV 0.5 - 2 mU/min
PP hemorrhage - IM 10U given after delivery of placenta
IV - 10-40 U may be added to 100 mL to run at rate necessary to control uterine atony

Milk letdown - intranasal spray, 1 spray or 3 gtts 2 to 3 min before nursing or pumping breasts
oxytocin - nursing care
Monitor uterine contractions and Fetal Heart Rate
contraction > 90 sec require flow rate to be discontinued or slowed
FHR >160 bpm followed by <120 bpm may indicate fetal compromise. If fetal disress noted, reduce oxytocin or d/c, turn mother on left side, admin O2 and notify MD.

Water intoxication - can alter fluid balance by stimulating ADH causing the body to accumulate water. Particularly likely to occur if oxytocin is admn with electrolyte solution.. S/S: drowsiness, listlessness, HA, confusion, anuria, edema, extreme -seizures
anabolic steroids uses
management of anemia or renal insufficiency, control of metastatic breast CA in women, promote weight gain
anabolic steroids
synthetic drug chemically related to androgens, promote tissue-building processes, minimal effect on accessory sex organs and secondary sex characteristics
anabolic steroids - adverse effects
virilization - DEATH
adrenocorticotropic hormone (ACTH)
stimulates adrenal cortex to produce and secrete adrenocortical hormones, primarily glucocorticoids
used for dx testing of adrenocortical function
also used for mfmt of acute exacerbation of MS, nonsuppurative thyroiditis, and hypercalcemia associated with CA.
an antiinflammatory and immunosuppresssant drug when conventional glucocorticoid therapy has not been effective
ACTH adverse effects
b/c stim the release of glucocorticoids from the adrenal gland, adverse reactions are similar to glucocorticoids from the adrenal gland, adverse reactions are similar to glucocorticoids
may mask the s/s of infection including fungal or viral eye infections. May be resistant and inability to localize infection.
Report: c/o sore throat, cough, fever, malaise, sores that do not heal or redness or irritation of eyes.
Observe for behavioral changes: depression, insomnia, euphoria, mood swings or nervousness
adrenocortical hormones
glucocorticoids and mineralcorticoids are called steroids - influence or regulate immune response and regulation of glucose, fat, and protein metabolism, control the antiinflammatory response
uses: antiinflammatory and immunosuppressants to suppress inflammation and modify the immune response
glucocorticoids actions/effects
modifies or changes normal immune response, suppression of inflammation (stops or slows down heat, redness, swelling, pain and varied metabolic responses
SE: sodium and water retention, hypokalemia, suppression of normal adrenal function, muscle wasting, osteoporosis, peptic ulcers, elevated blood sugar, decreased wound healing, mood alterations, cataracts, altered fat distribution, hirsutism, mask s/s infection
mineralcorticoids
replacement therapy for adrenal insufficiency (addison's)
increases reabsorption of sodium and excretion of potassium and hydrogen ions in the kidney
mineralcorticoids s/e, drug interactions
sodium and water retention, hypertension, hypokalemia, HA
additive hypokalemia with other potassium depleting diuretics
glucocorticoids - drug interactions
may increase the need for insulin or oral hypoglycemic agents, oral contraceptives may block drug's metabolism, phenytoin, phenobarbital, and rifampin may decrease glucocorticoid effectiveness with systemic administration, hypoglycemia may potentiate digitalis effects.
Insulin - uses
Type I/II DM, DKA, also may be used to promote K+ shift from blood cells in hyperkalemia
Types of Insulin
pork or beef derivatives - rarely used r/t pt allergies
Human insulin - made from biosynthetic process using DNA, rDNA, less allergic rxn
Insulin analogs, Insulin lispro, insulin aspart - newer forms of human insulin (made using rDNA processing) are very similar to human insulin
protamine, zinc
when insulin is combined with protamine (protein) it's absorption rate is slower and its duration is prolonged
when zinc is added it changes the onset and duration of action
insulin classification
rapid acting, intermediate, or long acting
rapid acting insulin
Insulin Injection
HUMULIN R, NOVOLIN R - only insulin that can be used intravenously
rapid acting insulin
Insulin Lispro (insulin analog)
Humalog, Humalog mix 50/50, Humalog mix 75/25
rapid acting insulin
Insulin Aspart (insulin analog)
NovoLog
eat within 5-10 minutes afer using NovoLog to avoid low blood sugar
do not mix with any other insulins when used in a pump or with any insulins other than NPH when used with injections by syringe
Humalog and NovoLog are used to cover meals and snacks
Leaves your body faster so will not have residual insulin causing low blood sugars in the late afternoon or middle of the night
rapid acting insulins are
Humulin R, Novolin R, lispro (Humalog), aspart (NovoLog)
Intermediate Acting Insulins
Isophane Insulin Suspension NPH (neutral protamine hegadorn)
Insulin Zinc Suspension (Lente)
Intermediate Acting Insulin
Isophane Insulin Suspension (NPH)
Humulin N, Novolin N
Intermediate Acting Insulin
Insulin Zinc Suspension (Lente)
Humulin L, Lente Iletin II, Novolin L
Long Acting Insulins (basal insulins)
Insulin glargine solution (lantus)
Insulin detemir (levemir)
Long Acting Insulins (basal insulins)
Insulin glargine solution
Lantus
Long Acting Insulins (basal insulins)
Insulin detemir
Levemir
should not be diluted or mixed with any other insulin or solution
Mixed Insulins
Isophane Insulin suspension and insulin injections (NPH) and reg
Mixed Insulins
Isophane Insulin suspension and insulin injections (NPH)
Humulin 70/30, Novolin 70/30
Mixed Insulins
Isophane Insulin suspension and insulin injection (reg)
Humulin 50/50
Mixed Insulins
70% insulin aspart protamine suspension and 30% insulin aspart injection (rDNA origin)
NovoLog mix 70/30
it is important to take your dose within 15 minutes of a meal
sulfonylureas
stimulate pancreatic B-cells to increase insulin output
Diabeta, Micronase (glyburide), Glucotrol (glipizide), Amaryl (glimepiride)
Meglitinides
stimulate pancreatic B-cells to increase insulin output
Starlix (repaglinide)
Biguanides
Target liver to decrease glucose production, increase insulin sensitivity in liver and muscle
Glucophage (metformin)
-stopped for 48 hrs before or after radiologic tests using contrast dye
Alpha-glucosidase inhibitors
inhibit intestinal enzymes that break down CHOs, which delays CHO absorption
Precose (acarbose)
Glyset (miblitol)
Thiazolidinediones
Increase insulin sensitivity in fat cells and muscle
Avandia (rosiglitazone)
Actos (pioglitazone)
glucovance
glyburide and metformin
Rapid acting
novolog (aspart)
humalog (lispro)
onset - 10 to 30 min
peak - 30 min to 1 hr
duration - 3-5 hrs
Short acting
NOVOLIN R
HUMULIN R
onset - 30 min to 1 hr
peak - 1.5 to 2 hrs
duration - 5 - 12 hrs
Intermediate acting
NOVOLIN N
onset - 1 to 2 hours
peak - 6 to 12 hrs
duration - 12 to 24 hrs
Long Acting
LEVIMIR/LANTUS
onset - 1 to 2.5 hrs/1 to 2 hrs
peak - no peak
duration - 20 hrs20 - 24 hrs