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44 Cards in this Set
- Front
- Back
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Adrenal gland
-medulla -cortex -zona reticularis |
located @ top of each kidney
-secretes catecholamines- epi -secretes glucocorticoids -cortex, secretes androgens, progesterone and estrogen |
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Cushing syndrome
Addisons syndrome |
-adrenal hormone excess
-adrenal hormone insufficiency |
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negative feedback loop
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stress-hypothalamus-CRH-ant. pituitary-ACTH-adrenal cortex- corticosteroids, estrogen, etc-stops hypothalamus
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3 hormones produced in the adrenal cortex
-glucorticoids -mineralcorticoids -androgens |
-influence carb & glucose metabolism
-salt and water balance -express sex characteristics |
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Mineralocorticoids
-produced where? -aldosterone |
-outer layer of cortex (zona glomerulosa)
-regulates Ca, K and H20 balance in distal renal tubules it promotes reabsorption of Na and secretion of K |
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control of aldosterone levels (3)
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-when Na is low or K is high, aldosterone levels rise
-reduction in renal blood flow increases levels by the RAAS system -pituitary ACTH-glucocorticoid hormones produced in adrenal cortex have mineralocorticoid effects |
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Fludrocortisone
-uses -placenta/milk? -MOA -adverse effects -metabolized by? |
-addison dz, salt-losing adrenogenital syndrome
-crosses placenta, milk -inhances na ^ and K v -hypertension, increased glycogen in liver -met. liver, exc. kidney |
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Diabetes
-type 1 -type 2 |
6th cause of death
-5-10%, usually develops during childhood -middle age +, usually obese, insulin resistance or dec secretion of insulin |
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complications from diabetes
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hypertension
renal failure atherosclerosis most problems from dec blood flow |
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Preventing complications- type 1
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diet- many small meals
exercise insulin replacement ACE inh or ARB- decrease HTN and neuropathy statins- reduce LDL levels |
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Preventing complications- type 2
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glycemic control- most are obese, so diet and ex
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-insulin
-produced by -remember!! -stimulis for release? -inhibited by? |
-2 AA chains A and B connected by disulfide bridges
-beta cells in pancreas -ANABOLIC because it builds up and stores energy -glucose, also AA, ketones, fatty acids -alpha cells |
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What contributes to the sx of diabetes?
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-body is put in a catabolic state
-glycogen-glucose, protein-AA, fats-glycerol |
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3 ways that insulin deficiency promotes hyperglycemia
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-inc glycogenolysis
-inc gluconeogenesis -reduced glucose utilization |
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RASD-rapid acting short duration
-Lispro(Humalog) -Aspart (Novolog) -Glulisine (Apidra) |
-SQ, effect in 15-30 min with or without food
-effect in 10-20 min, give 10 min AC -10-15 min, w/ food, SQ |
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SASD-short acting short duration
-regular insulin- exubera, humulin, novolin |
-only one that can be given IV
-infused SQ to provide basal glycemic control |
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Intermediate duration insulin
-NPH, Humulin N -Detemir, levemir |
-cloudy suspension gently shaken, no rx, protamine slows absorbtion and slows DOA, not with meals, ONLY one that can be mixed
-clear,slow onset, DOSE DEPENDENT |
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Long duration Insulin
-Glargine (Lantus) |
-clear, DOA 24 hours
-less risk of hyper or hypoglycemia |
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What is the ONLY insulin given IV?
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regular insulin
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Which insulin can not be given to smokers?
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Exubera
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IV insulin is usually given for? (2)
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ketoacidosis
hyperkalemia |
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insulin needs
-increased by? -decreased by? |
-infection, stress, obesity, growth spurt, pregnancy
-exercise, pregnancy |
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drugs that lower blood glucose when combined with insulin (4)
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-sulfonylurias
-meglitinides -beta blockers -alcohol |
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what increases hypoglycemia and hides its sx?
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beta blockers
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drugs that counteract insulin (3)
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-thiazide diuretics, glucocorticoids, sympathomimetics
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hypoglycemia #
sx of fast falling sx of slow falling if untreated? |
-<50mg
-activation of sympathetic ns, tachy, palpitations, sweating -Ha, confusion, drowsinees, fatigue -brain damage, death |
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Glucagon
-produced by? -does? -time |
-alpha cells
-inc. glucose, decrease GI motility -20 min |
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Type 2 Sulfonylurias
-MOA (3) -side effects -drugs that intensify |
-stimulates release of insulin in pancreas, only in type 2, avoid in pregnant
-hypoglycemia, weight gain -NSAIDs, sulfonamides, ranitidine and cimetidine |
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Type 2 Metglitinides/Short acting Secretagogues
-2 drugs -MOA -side effects -interactions |
-Repaglinide, Nateglinide
-stimulates insulin from pancreas *glucose dependent, pt MUST eat within 30 min -hypoglycemia, weight gain -Gemfibrizol |
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Type 2 Biguanides
-drug name -MOA -contraindications -side effects |
-Metformin
-decrease glucose production and increase glucose use -high creatine, liver dz, infection, alcohol, shock -weight loss, nausea, diarrhea, dec uptake of b12 folic acid, lactic acidosis |
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Type 2 Thiazolidinediones (Glitizones)
-drug names -MOA -adverse effects -interaction |
-Rosiglitizone, Pioglitizone
-dec insulin resistance by inc insulin sensitivity of muscle, liver and adipose. must be insulin present -fluid retention, inc HDL, LDL, contraindicated in HF or hepatotoxicity -Gemfibrizol |
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Type 2 Alpha-glucosidase inhibitors
-drug names -MOA -adverse effects |
-Acarbose, Miglitol
-dec absorbtion of carbs so a dec in glucose rise after meal -flatulence, distention, diarrhea, anemia, liver disfunction |
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Injectables: Amylin Mimetics
-drug name -MOA -adverse effects -drug ixns |
-pramlintide
-delays gastric emptying and suppresses glucagon secretion, type 1 or 2, peak in 20 min -hypoglycemia, nausea, injection rxn -PO drugs should be taken 1hr before |
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Injectables: Incretin mimetics, glucagon-like peptide 1 agonist
-drug name -MOA -adverse effects -drug ixns |
-Exenatide
-slows gastric emptying, stimulates release of insulin, inhibits release of glucagon and suppresses appetite -hypoglycemia -birth control, antibiotics, pts with end stage renal dz |
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Ketoacidosis
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-severe manifestation of insulin deficiency
-hyperglycemia, ketoacids, acidosis and coma -before insulin almost ALL pts died from ketoacidosis |
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3 effects of the thyroid
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metabolism
cardiac fxn growth/development |
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-2 hormones produced by thyroid
-which is more potent? *halflifes? -which is there more of? |
-T3-triiodothyronine(liothyronine)
t4-thyroxine (levothyroxine) mixture-liotrix -t3 is more potent *1day for T3, 7 days for T4 -greater release of t4 but it is mostly turned into T3 |
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3 actions of thyroid hormones
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-stimulation of energy use
-stimulation of heart -promotion of growth and development |
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hyper vs hypothyroid
-eyes -skin -temp -weight -emotional -GI |
-prominent/ptosis
-hot,moist/ dry, cold -heat intolerant/cold int ->appetite/<appetite -irritable/lethargic -diarrhea/constipation |
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-thyroid funciton test
-serum TSH -serum T4 -serum T3 |
when iodine isnt present, thyroid fxn diminishes, more TSH released, inc size of thyroid, goiter
-high TSH for dx of hypO -measures T4 -good for hypER |
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-Myxedema
-Cretinism |
-severe thyroid deficiency
-hypOthyroidism in infancy |
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sx of hypothyroidism
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pale face, brittle hair, hair loss, lethargy, goiter
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Levothyroxine
-MOA -metabolization -adverse effects |
-identical to t4, narrow range, take on empty stomach in morning 30 min AC
-liver -weight loss, palpitation, tachy, angina, CHF, menstrual irregularity, impotence, hyperthermia |
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Levothyroxine
-drugs that dec absorption -drugs that inc absorption -misc |
-iron and Ca+ supplements, Cholestyramine, Colestipol
-phentoin, carbamazepine, rifampin, zoloft -warfarin may need to be reduced, thyroid hormones increase cardiac responsiveness |
