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83 Cards in this Set
- Front
- Back
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Where is Growth Hormone secreted and how?
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Secreted by the Anterior Pitituitary Gland and it's release is regulated by the hypothalamus.
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When is GH adminstered and what route does it get adminstered at?
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GH is aadminstered at night and should only be given SC or IM (typically 6-7 injections per week). However, should not be given PO because GH is inactivated by the GI tract.
Also, is very expensive ($20,000-40,000 for one year). |
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Can prolonged administration of GH antagonize insulin and lead to diabetes?
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True
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What is Somatropin (Humatrope) used for?
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Increases skeletal growth in children with a GH defficiency.
Can also increase bone density in adults. However, can cause hyperglycemia, so must monitor glucose tolerance. |
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What is Gigantism?
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Excess in GH during childhood that may lead to kids growing as tall as 7-9 feet.
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What is Acromegaly?
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GH excess that happens after puberty that resluts in large hands, feet, and skull. Also, can lead to large heart, hypertension, and arthralgias.
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What is the most frequent cause of Acromegaly?
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Frequently caused by a tumor on the pituitary. Also, overproduction and an underproduction of GH will antagonize insulin and result in hyperglycemia.
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What are the treatments of excess GH?
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Surgery to remove the tumor. However, if entire pituitary is removed, there will be a permanent absence of GH and there will be a need for GH replacement for life.
Pharmocolgic Therapy |
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What are the Pharmacologic Therapy treatments for excess GH?
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Octreotied (Sandostatin) - Synthetic somatostatin that supresses the release of GH (NOT a STATIN for cholestrol).
Pegvisomant (Somavert) - Is the most effective drug for acromegaly, but is very expensive ($50,000-100,000 per year). |
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What is Diabetes Mellitus?
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Disease in which the pancreas is unable to make insulin, not make enough insulin, or the body is resistant to it's own insulin because of reduced receptor sensitivity.
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What is the major functions of insulin?
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Move glucose from the blood stream to the muscle, liver, and fat cells.
Stimulates storage of glucose in the lover and muscle. Enhances storage of dietary fats in adimpose tissue. Tranports amino acids into the cells. |
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What is Type 1 diabetes?
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Insulin dependant due to a lack of insulin secretion.
Beta cells of the pancreas are destroyed by anitbodies. |
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What is Type 2 diabetes?
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Non-insulin dependant as the pancreas in able to secrete insulin, but in deficient amounts (oral meds used to increase production).
Insulin receptors have become insensitive or resistant to the hormone (oral meds used to increase sensitivity). Minimal amounts of insulin bind to the receptors. |
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What are the two groups of Antidiabetic Agents?
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Insulin (SC or IV, not given orally because it would be destroyed by gastric enzymes).
Oral Hypoglycemic Agents |
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What are some characteristics of Short Duration/Rapid Acting Insulins?
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"Clear Solution"
SC administration (although book says they all may be adminstered IV). May be used in combination with Intermediate or Long-Acting insulins. Onset - 10 min Peak - 30-90 min Duration - 3-5 hours |
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What are the names of some Short Duration/Rapid Acting Insulins?
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Lispro (Humalog)
Aspart (Novolog) Glulisine (Apidra) |
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What are some characteristics of Short Duration/Slower Acting Insulins?
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"Clear Solution"
SC, IM, IV, and PO administration. Available in U 100 and U 500 strength (100U/mL or 500U/mL). U500 reserved for patients with insulin resistance and is NEVER given by IV route. Onset - 30-60 min Peak - 1-5 hours Duration - 6-10 hours. |
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What are the names of some Short Duration/Slower Acting Insulins?
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Humilin R (Regular)
Novolin R Exubera (Inhaled, not on market any longer becuase of decreased sales). |
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What are some characteristics of Intermediate Acting Insulins?
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"Cloudy Insulin"
SC injections 2x/day Is the only insulin suitable for mixing with short-acting and rapid-acting insulins. Onset - 1-2 hours Peak - 6-14 hours Duration - 16-24 hours |
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What are some names of Intermediate Acting Insulins?
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Humulin N (NPH)
Novulin N (NPH) |
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What are some characteristics of Long Acting Insulins?
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Adminstered 1x/day AT NIGHT.
The incidence of hypoglycemia is not as common with these drugs as it achieves blood levels that are relatively steady. "Clear Solution" Given SC ONLY! Onset - 70 min Peak - NONE Duration - 24 hours |
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What is the name of a Long Acting Insulin?
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Insulin Glargine (Lantus)
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What are some common Combination preparations?
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Humulin 70/30 (70% NPH and 30% Regular)
Humulin 50/50 (50% NPH and 50% Regular) Humulin 75/25 (75% Long Acting and 25% Rapid Acting) |
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What is another name for Hypoglycemic Reaction and what are the Sx?
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Also called Insulin Shock
Drowsy, Cold/Calmy, Confused/Incoherent, Headache, Hungry, Nervousness/Trembling |
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What are the treatments for MIld Hypoglycemia?
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Mild (Fully Conscious) - Oral carbohydrate (life savers, candy, glucose tablet, sugar cubes). However, nothing should be given by mouth if swallowing and/or gag reflex is suppressed.
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What are the treatments for Moderate Hypoglycemia?
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IV Dextrose (Glucose) (D50%, D25%, D10%)
Parenteral Glucagon. |
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What is Glucagon and what are some characteristics of it?
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Rx only and comes in prefilled syringes and is administered IM, SC, IV
Releases stored glucose from the liver. Requires 10 minutes to start elevating blood sugars (this is not very fast during a crisis). ***Patient may vomit immediately after glucagon administration, so if unconscious, turn patient on their side*** |
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Who is typically given Oral Hypoglycemic Agents and why?
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People with Type 2 diabetes because they have some degree of insulin secretion and also may have decreased receptor sensitivity.
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What are Biguanides?
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Drug of choice fro initial therapy in patients with Type 2.
Decreases the hepatic production of glucose, but does not promote insulin release. Decreases appetite, but may cause nausea and diarrhea. However, will not cause hypoglycemia. |
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What is the name of a Biguanide and what are some characteristics?
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Metformin
Poses the risk of lactic acidosis and has a mortalitiy rate of 50%. Therefore, should be avoided in patients with renal insufficiency. However, with good kidney function this is rare. |
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Should Glucophage be withheld for 48 hours prior to, and following administration of contrast media used for Dx procedures.
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True....Metformin in combination with contrast media that contains iodine can lead to acute renal failure and lactic acidosis.
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What are Sulfonylureas and what are some characteristics?
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Stimulates the release of Insulin and also some increase cellular sensitivity to insulin. Divided into two different generations.
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What are some 2nd Generation Sulfonylureas?
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Glipizide (Glucotrol)
Glyburide ((Diabeta and Micronse) Glimepiride (Amaryl) |
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What are some adverse effects of Sulfonyureas?
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Hypoglycemia - most likely with kidney and liver dysfunction.
If taken with alcohol, can cause Antabuse like reaction (flushing, palpitations, nausea) Should be avaided with pregancy. |
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What are Glinides and what are some characteristics?
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Glineds stimuate the release of insulin and have equal efficacy to the Sulfonyureas.
They have a quick onset and short duration of action. Enables the client to take medication immediately before eating and skipping medication if h/she does not eat. |
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What are some common Glinides and adverse effects?
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Repaglinide (Prandin)
Nateglinide (Starlix) Hypoglycemia is a potential side effect. |
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What are Alpha-Glucosidase Inhibitors?
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Delays absorption of carbohydrates by blocking the enzymes in the Sm. intestine responsible for breaking down complex carbohydrates into monosaccharides.
Will not produce hyoglycemia, but has GI side effects (flatulence, cramps, abdominal distension, diarrhea) |
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What is Acarbose (Precose)?
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Is a Alpha-Glucosidase Inhibitors.
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What are Gliptins?
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Ne class of drugs that enhances the action of incretin hormones.
Stimulates glucose-dependant release of insulin when levels are low. Suppresses postprandial release of glucagon. |
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What are Thiazolidinediones (Glitazones)?
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Decreases insulin resistance.
Hypoglycemia is not a concern because it does not change secretion of insulin. |
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What is the name of a Thiazolidinediones (Glitazones) and what are some adverse effects?
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Rosiglitazone (Avandia)
Fluid retention (can lead to hypertension), increases plasma lipids, and can expand blood volume and cause edema (contraindicated in clients with heart failure). |
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What is the name of a new agent used in the treatment of Type 2 diabetes?
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Exanatide (Byetta)
Used in combination with Metformin or Sulfonyureas. Stimulates glucose-dependant release of insulin, inhibits postprandial release of glucagon and suppresses appetite. However, hypoglycemia is common when combined with Sulfonyluria Pancreatitis is an adverse effect. |
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What is ADH and where is it secreted from?
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ADH is secreted from the Posterior Pituitary Gland.
Promotes water reabsorption from the kidney tubules. Maintains water balance in the body fluids and is a POTENT vasoconstrictor. |
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What is ADH released in response to?
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Increase in plasma osmolatity.
Decrease in blood volume. Orthostatic Hypotension Hypotension |
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What is Diabetes Insipidus?
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Partial or complete deficiency of ADH.
Large amoutns of water are excreted by the kidneys. Can lead to severe fluid volume deficit and electrolyte imbalances. Therefore, decrease in BP and increase in HR. |
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What are some clinical manifestations of Diabetes Insipidus?
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Polydipsia - Excessive thirst
Polyuria - very dilute urine (normal is 1.010-1.025 SG) Increased serum osmolality resulting hypernatremia (water is leaving and sodium does not follow water). Severe Dehydration |
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What are the two agent used for Diabetes Insipidus?
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Vasopressin (Pitressin)
Desmopressin (DDAVP) (Agent of Choice) |
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What are some characteristics of Vasopressin?
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Duration of action - 2-8 hours.
Adminstered IM or SC Is a potent Vasoconstrictor and can be used to raise BP, but should not be used if patient has pre-existing heart condition. |
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What are some characteristics of Desmopressin (DDAVP)?
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Duartion of action - 8-2- hours.
Available as a nasal spray, but also adminstered SC, IV, and PO. Does not have the intense vasoconstrictor effect that Vasopressin has. Therefore, this is the agent of choice. |
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What are some things that the Thyroid Gland controls by controlling the metabolic rate and activity?
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Cardiac output
Oxygen consumption Fat, protein & carbohydrate metabolism Body Heat Regulation Brain and nervous system function Menstrual Cycle |
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What is Hypothyroidism?
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Decrease in Thyroid Hormone Secretion T3 and T4.
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What is the Primary cause of Hypothyroidism?
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Thyroid gland disorder.
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What is the Secondary cause of Hypothyroidism?
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Lack of TSH secretion from the anterior pituitary.
TSH stimulates T4 from Thyroid Gland. |
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What are some Hypothyroidism Sx?
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Slow and subtle onset of symptoms
Fatigue Weight gain Hair loss Dry skin Cold intolerance Low exercise tolerance Excess sleep Impaired memory Lethargy |
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What are some treatments of Hypothyroidism?
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Levothyroxine Sodium
Levothroid and Synthroid Synthetic T4 |
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What are some characteristics of Levothyroxine?
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Administered PO or IV.
IV administration is for (Myxedema Coma, Medical emergency, and Severe Hypothyroidism). Symptoms include hypothermia, hypotension, hypoventilation, loss of consciousness, coma |
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What are the pharmacologic aspects of Levothyroxine?
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Will increases metabolic rate and oxygen demand/consumption.
Be careful with cardiac patients and hypertensive patients due to increase in O2 consumption. May result in angina… Educate patient regarding symptoms of hyperthyroidism. Will take about one month to reach therapeutic plasma levels. |
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What is Hyperthyroidism?
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Increase in circulating T3 and T4 levels.
Due to an overactive Thyroid Gland. May be mild with few symptoms or severe leading to death. |
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What is Grave's Disease?
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The most common form of Hyperthyroidism (75% of cases).
Autoimmune disease of unknown etiology and patients develop antibodies to the TSH receptor sites. These antibodies attach to the receptors and stimulate the thyroid gland to release more T3 and T4. Graves Disease has remissions and exacerbations, with or without treatment. |
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What are the Grave's Disease Sx?
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Rapid Pulse
Palpitations Excessive Perspiration Heat Intolerance Nervousness Irritability Exophthalmos (abnormal protrusion of the eyeball). Weight Loss Goiter |
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What is a Thyrotoxic Crisis (Thyroid Storm)?
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Life Threatening Emergency (Hyperthyroid symptoms are heightened).
May be brought upon by stress, infection, surgery, trauma. |
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What are some clinical manifestations of a Thyroid Storm?
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Severe tachycardia
Heart failure Hyperthermia Restlessness/ Agitation Seizures/ Delirium/ Coma |
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What are some common Hyperthyrodisim treatments?
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Surgical Removal of part of the Thyroid Gland.
Radioactive Iodine Therapy (treatment of choice for non-pregnant patients). Antithyroid Drugs (inhibits the synthesis/release of T3 & T4). Also, any of these can cause Hypothyroidism very quickly. |
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What are some Antithyroid Drugs are what are some adverse effects?
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Thionamides:
Propylthiouracil (PTU) Methimazole (Tapazole). Does NOT destroy existing stores of thyroid hormone. Thus may take 3 – 12 weeks to stabilize thyroid level. Adverse Effects: Agranulocytosis (sore throat and fever are the earliest indicators). Must monitor white blood cell counts closely. |
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Why would a beta blocker be used in the treatment of Hyperthyroidism?
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Controls cardiac symptoms of hyperthyroidism and does not effect T3 and T4 levels.
Propanolol (Inderal) (Non-Selective). Beta Blocker that blocks Beta 1 and Beta 2. |
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What are the sections that the adrenal glands consist of?
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Adrenal Medulla (secretes Epinephrine and Norepinephrine).
Adrenal Cortex - Produces Corticosteroids(glucocorticoids - Cortisol) Mineralcorticoids(Aldosterone). |
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What is Cortisol and when is it neccesary?
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Is a Glucocorticoid and is necessary during times of stress to allow the body to have glucose and protein available.
Secretion is influenced by emotional stress, such as trauma, surgery, hypotension, illness. |
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Whatt are the functions of Cortisol?
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Increases blood glucose through facilitation of hepatic gluconeogenesis.
Decreases peripheral glucose use in the fasting state. Prevents increased capillary permeability. Inhibits production of prostaglandins and Leukotrienes. Increases breakdown of proteins and lipids to be utilized as energy source. Maintains fluid volume. Affects mood. Maintains vascular integrity. |
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What is Cushing Syndrome and what causes it?
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Spectrum of clinical manifestations caused by excess corticostoids.
Causes of Cushing Syndrome: Prolonged administration of corticosteroids. Pituitary Tumor Adrenal Tumor Carcinoma of the lung Causes excess secretion of ACTH. |
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What are some clinical signs and syndromes of Cushing's Syndrome?
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Truncal Obesity
Thin Extremities Moon Face Buffalo Hump Thin/ fragile skin Bruising Poor wound healing Hypertension Hypernatremia, Hypokalemia, Suppresses inflammation, Edema of lower extremities, Hyperglycemia. |
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What are some treatments of Cushing's Syndrome?
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Removal or radiation of tumors…
Adrenalectomy Discontinuance of, or alteration in administration of exogenous corticosteroids. |
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What are some medications that suppress Cortisol production and/or decrease plasma levels of it?
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Aminoglutethimide (Cytadren).
Ketoconazole (Nizoral). Both agents inhibit the synthesis of adrenal steroid hormones. Most commonly used as an adjunct to surgery or radiation, not as primary treatment. |
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What is Ketoconazole (Nizoral)?
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Also classified as an antifungal medication.
Used in a much higher dose for inhibition of glucocorticoids than when used for fungal infections. |
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What is Addison's Disease?
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Decrease in Glucocorticoid/Mineralcorticoid Secretion is called:
Addisons Disease Adrenal Insufficiency |
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What is Cushing's Disease?
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Increase in Glucocorticoid/Mineralcorticoid Secretion is called:
Cushings Syndrome Adrenal Hypersecretion. |
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What are some clinical manifestations of Addison's Disease?
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Symptoms will not be evident until 90% of the adrenal cortex is not working.
Hypoglycemia Weakness, fatigue Weight loss/ Anorexia Hyperpigmentation of the skin Hypotension Hyponatremia/ Hyperkalemia |
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What are some treatment options for Addison's Disease?
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Hydrocortisone:
Synthetic Steroid Drug of choice Contains both a glucocorticoid and mineralocorticoid. |
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What happens if treating Addison's and additonal minearlcorticoid is needed?
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“Fludrocortisone” is added.
Is the only Mineralocorticoid available. However, sodium retention/edema are adverse effects of Fludrocortisone. |
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What are some characteristics of Hydrocortisone?
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Administered orally for chronic replacement therapy.
Administered IV for acute adrenal insufficiency. May be administered only in the evening. May be administered BID (2/3 of dose upon awakening in the morning and 1/3 of dose in late afternoon). May need to increase dose during times of physiologic stress. Must never stop abruptly. |
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What are some other Glucocorticoid Agents?
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Dexamethasone (Decadron):
Treats inflammation as a result of cerebral edema (after neuro surgery). Treats Allergic Reactions. Prednisone: Inexpensive Frequently Prescribed |
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What are some adverse effects of Corticosteriods?
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When given as therapy for non-endocrine disorders, the dose required is higher, thus more side effects with chronic use.
Corticosteroids are used for problems such as allergies, asthma, inflammation, immunosuppression. Adverse effects will be “Cushing symptoms”. |
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What is Adrenocortical Insufficiency?
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Results when glucocorticoids are abruptly withdrawn from a patient who has been on long-term glucocorticoid therapy.
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What are some Sx of Adrenocortical Insufficiency?
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Nausea/ vomiting
Lethargy Confusion Coma ***Requires immediate administration of IV Hydrocortisone*** |
