Pharm: Endocrine System

Front 1

Function: maintain homeostasis by producing and secreting hormones. Controls and regulates what?

Back 1

Energy
Growth
Fluid and electrolytes
Balance
Stress
Sexual reproduction

Front 2

Endocrine Glands

Back 2

(see picture)

Front 3

The CNS interacts with the endocrine system through

Back 3

a hypothalmus-pituitary pathway

Front 4

Stimulating hormones are believed to be synthesized in what gland?

Back 4

hypothalamus

Front 5

Chemical messengers that transmit information between body cells and organs Some hormones affect __________ Others affect ________, Many hormones are _______

Back 5

all cells
target tissues
cyclic

Front 6

Think in terms of (regarding secretion)

Back 6

hyper-secretion and hypo-secretion

Front 7

Everything in system is responsible for

Back 7

maintaining a balance

Front 8

Pharmacologic Treatment What are the 7 methods of treatment?

Back 8

Hypothalmic and Pituitary Hormones
Corticosteroids come from adrenal glands
Thyroid and Antithyroid
Bone and Calcium regulation
Antidiabetic
Estrogen, progestin, contraceptive
Androgen and anabolic steroids

Front 9

Corticosteroids (glucocorticoids or steroids) - Hormones produced by the adrenal gland Maintain _________ (state); Have profound effects both ________& ________; Act as an _________________

Back 9

Maintain homeostasis
Have profound effects both therapeutic and adverse
Act as an anti-inflammatory

Front 10

ADRENAL CORTEX - What are the 3S’s?

Back 10

sugar, salt and sex

Front 11

Gonadal hormones

Back 11

lookup

Front 12

Glucocorticoids and Mineralocorticoids - What are Cortisol and aldosterone together called?

Back 12

Together called the corticosteroids

Front 13

What are the primary functions of corticosteroids?

Back 13

Carbohydrate, protein and fat metabolism
Electrolyte and water metabolism
Cardiovascular functions
Immune effects
Effects are Widespread

Front 14

Why do you give PO meds with food?

Back 14

to decrease GI upset

Front 15

Why do you take daily doses of PO meds before 9AM

Back 15

to match body’s circadian rhythms

Front 16

Increase dose of PO meds during periods of _______________

Back 16

stress (surgery)

Front 17

Anticipate ulcer formation and start what PO medications?

Back 17

antacids or H2 antagonists

Front 18

Do not abruptly DC PO meds, instead__________

Back 18

taper dose

Front 19

Monitor blood sugars if diabetic – why do you notify the MD while taking steroids?

Back 19

Notify MD for adjustment of diabetic meds while taking steroids

Front 20

With PO meds, monitor for acute infection treat __________

Back 20

treat quickly

Front 21

With PO meds, increase activity to reduce bone __________________

Back 21

reduce bone demineralization

Front 22

Diabetes Mellitus is caused by insufficient secretion of ___________ from _______ cells. It primarily involves the body’s inability to metabolize ________________ due to diminished effectiveness of ___________.

Back 22

Insufficient secretion of insulin from beta cells
Primarily involves the body’s inability to metabolize carbohydrates due to deficiency or diminished effectiveness of insulin

Front 23

Diabetes Mellitus Type 1 = ______________ (%?) Type 2=____________ (%) Third type? __________

Back 23

Type 1: Insulin-Dependent (10-12%)
Type 2: Non-Insulin Dependent (85-90%)
Secondary

Front 24

Type 1 Diabetes – Abrupt failure of the __________________, ________ cells disabled, Absolute insulin ____________________

Back 24

Abrupt failure of the pancreas (autoimmune disease)
Beta cells disabled
Absolute insulin dependency

Front 25

Type 2 – Resistance to ___________ action in target tissues, ____________ insulin secretion, Inappropriate hepatic ________________

Back 25

Resistance to insulin action in target tissues
Abnormal insulin secretion
Inappropriate hepatic gluconeogenesis

Front 26

Secondary: Caused by what?

Back 26

Gestational
Stress Related - Use of adrenal corticosteroids, oral contraceptives, and other drugs that antagonize the effects of insulin

Front 27

Blood Sugar Ranges What is normal? When is a person diabetic according to ADA? (Fasting and Random levels) What determines the amount of medication? What is the most sensitive test?

Back 27

Normal is 90’s-120’s
According to the American Diabetes Association a person is diabetic if:
Fasting blood glucose >126 mg/dl
Random blood glucose > 200 mg/dl
Serum glucose levels determine amount of medication
Most sensitive test is glycated or glycosylated hemoglobin (Hgb A1c)

Front 28

Polyuria (↑peeing) is an example of

Back 28

Hyperglycemia

Front 29

Seizures is an example of

Back 29

Hypoglycemia

Front 30

Coma is an example of

Back 30

Hypoglycemia

Front 31

Polydipsia (↑thirst) is an example of

Back 31

Hyperglycemia

Front 32

Polyphagia(↑ hunger) is an example of

Back 32

Hyperglycemia

Front 33

Nausea is an example of

Back 33

Hypoglycemia

Front 34

Numbness is an example of

Back 34

Hypoglycemia

Front 35

Tingling of lips/tongue is an example of

Back 35

Hypoglycemia

Front 36

Weight loss is an example of

Back 36

Hyperglycemia

Front 37

Fatigue is an example of

Back 37

Hyperglycemia

Front 38

Hunger is an example of

Back 38

Hypoglycemia

Front 39

Weakness is an example of

Back 39

Hyperglycemia

Front 40

Vision changes is an example of

Back 40

Hyperglycemia

Front 41

Irritability is an example of

Back 41

Hypoglycemia

Front 42

Tremors is an example of

Back 42

Hypoglycemia

Front 43

Frequent skin infections is an example of

Back 43

Hyperglycemia

Front 44

Confusion is an example of

Back 44

Hypoglycemia

Front 45

Vaginal discomfort is an example of

Back 45

Hyperglycemia

Front 46

Dry, itchy skin is an example of

Back 46

Hyperglycemia

Front 47

Cold & clammy skin is an example of

Back 47

Hypoglycemia

Front 48

Hot & sweaty skin is an example of

Back 48

Hyperglycemia

Front 49

What are the Oral Hypoglycemics?

Back 49

Sulfonylureas (PO)
Alpha-Glucosidase Inhibitors (PO)
Biguanide (PO)
Glitazones (PO)
Meglitinides (PO)

Front 50

Short Acting insulin Starts how fast? Peaks when? Gone after how long? Given by what route? What are the types?

Back 50

Start ½ to 1 hr
Peak 2-3 hrs
Gone 5-7 hrs
The only insulin given IV
Types - Regular, Humulin R, Novolin R

Front 51

Intermediate Acting insulin Starts how fast? Peaks when? Gone after how long? What visually indicates Intermediate Acting insulin? What are the types?

Back 51

Start 1-2 hrs
Peak 8-12 hrs
Gone 18-24 hrs
Cloudy
Types - NPH, Humulin N, Novolin N

Front 52

Long Acting insulin Starts how fast? Peaks when? Gone after how long? What is the type?

Back 52

Start 4-8
Peak 10-30
Gone 36 plus
Type – Ultralente

Front 53

What are some other situations when insulin may be beneficial?

Back 53

May also be required during times of stress such as illness, infection or surgery
Used to control diabetes induced by pancreatitis, hormones, drugs and pregnancy
Also used to treat hyperglycemia related to IV parenteral nutrition or Hyperkalemia

Front 54

What is Hyperkalemia?

Back 54

Insulin and dextrose causes potassium to move from blood into the cells

Front 55

Insulin – Absorption

Back 55

(see picture)

Front 56

Insulin Administration – Keep at what temp? How is it administered? Do you massage the site? Which insulin do you draw up first?

Back 56

Kept at room temp
Given SQ in units using an insulin syringe and needle
Do not massage site
Mixing Insulin: Draw up regular insulin first; NPH next

Front 57

Nursing Considerations

Back 57

Assess for ketoacidosis
Assess for hypoglycemic reaction
-Treat with OJ, hard candy, glucose 10-20g po or SL or buccal mucosa; follow with milk,
bread, crackers, or meal
-THINK, THINK, THINK---if giving NPH, when might you expect to see a hypoglycemic reaction?
When it peaks
Teach when they should take it.
Medic-Alert bracelet
Adverse effects:
-Hypoglycemia, weight gain, allergic reactions

Front 58

What is notable about Insulin Pen Injectors?

Back 58

Prefilled and reusable
Examples: Humulin 70/30 and Humalog 75/25, Lantus

Front 59

What is different about Insulin Pumps? What kind of insulin can be used in a pump?

Back 59

Implantable (abd) and portable
Can be d/c for bathing, swimming for 1-2 hrs
Rapid acting only (Regular or Humalog)
Not NPH or Lente – unpredictable results

Front 60

PO Anti-Diabetic Drugs

Back 60

(see pic)

Front 61

Sulfonylureas
Action

Back 61

Lowers blood glucose by increasing insulin secretion
Requires functioning beta cells
Contraindicated in hypersensitivity to sulfa drugs, severe renal or hepatic impairment, pregnancy.

Front 62

Sulfonylureas Drugs:

Back 62

1st Generation: rarely used
2nd Generation: stronger duration of action; less s/e than 1st Generation - Glipizide (Glucotrol, Glucotrol XL)
Glyburide (DiaBeta, Glynase, PresTab,) - Glimepiride (Amaryl)

Front 63

Sulfonylureas: Side Effects?

Back 63

Hypersensitivity
Hypoglycemia
NV
Metallic taste (like tin can)
Blood dyscrasias (a lysing of blood cells)

Front 64

Sulfonylureas: Administration

Back 64

Take 30 min before breakfast or BID (or r/o hypoG.)
Verify admin w/ NPO status
Avoid ETOH (sugar from yeast)

Front 65

Biguanide Action:

Back 65

Increases the use of glucose by muscle and fat
Decreases hepatic (liver) glucose production
Decreases intestinal absorption of glucose

Front 66

Biguanide Drugs

Back 66

Metformin (Glucophage)
Drug of choice in obese clients with new onset type 2

Front 67

Biguanide Side Effects:

Back 67

Weight loss
Anorexia
Flatulence
Nausea
Stomach pain
Vomiting
Lactic acidosis

Front 68

Biguanide Contraindications

Back 68

Diabetes with fever or infections
Trauma or surgery
Pregnancy
Hepatic or Renal impairment
Cardiac or respiratory insufficiency
Lactic acidosis

Front 69

Biguanide Administration:

Back 69

Given 2-3 times qd w/ meals
Does not cause hypoglycemia
Excreted unchanged by the kidneys. Do not give with liver/renal disease.
Avoid ETOH.

Front 70

Alpha-Glucosidase Inhibitors & PTU ACTION:

Back 70

Delay digestion of complex CHI into glucose

Front 71

Alpha-Glucosidase Inhibitors & PTU DRUGS:

Back 71

Acarbose (Precose)
Glitazones

Front 72

New Diabetic Agents

Back 72

Pramlintide (Symlin)
Exenatide (Byetta)
Sitagliptin (Januvia)

Front 73

Pramlintide (Symlin) Is a synthetic version of _________________? Action? Side Effects? Administer with what therapy?

Back 73

Synthetic version of human amylin
Slows gastric emptying of food
Can decrease appetite, potentially resulting in weight loss
Use with insulin therapy

Front 74

Exenatide (Byetta) 2 Actions?

Back 74

Increases glucose sensitive insulin secretion from beta-cells
Slows gastric emptying of food

Front 75

General Nursing Considerations

Back 75

Teaching
Nutrition and exercise
Medic alert bracelet
Maintain good foot and skin care
Neuropathy (can’t feel them)
No sticking, trimming nails, etc.
Teach client and family the sx, prevention, and tx of hypoglycemia (elderly especially) and hyperglycemia.
Watch for liver toxicity
Jaundice, pale stools, dark urine
Best Practices—careful medication management watch for “opathys”

Front 76

What is the Thyroid ?

Back 76

The thyroid is a small, butterfly-shaped gland in the mid-lower neck.
It’s primary function is to control the body’s metabolism.

Front 77

What does the Thyroid secrete? What has to be present in order to produce?

Back 77

Secretes T3 andT4 (thyroxine) and Calcitonin
Production of T3 and T4 is dependent on the presence of iodine
Probably all cells have receptors for thyroid hormones
Regulates metabolism
Stimulates protein and fat catabolism
Insulin antagonist
Necessary for growth and development (esp brain and skeletal)

Front 78

Hypothyroidism – What are the 4 types?

Back 78

Primary
Secondary
Congenital
Adult

Front 79

Primary Hypothyroidism (it’s in the gland)

Back 79

Chronic (Hashimoto’s) thyroiditis
Autoimmune disorder
Treatment of Hyperthyroidism (radiation or surgery)

Front 80

Secondary Hypothyroidism (from pituitary gland)

Back 80

Decreased TSH from the pituitary or hypothalamus

Front 81

Congenital Hypothyroidism (cretinism)

Back 81

Child is born without a thyroid gland or with a poorly functioning gland

Front 82

Adult Hypothyroidism (myexedema)

Back 82

Myxedema coma: severe, life-threatening hypothyroidism

Front 83

Myxedema (see pics)

Back 83

Flattens ridge of nose, tongue swollen

Front 84

Signs and Symptoms of Hypothyroidism (everything slow, cold & shut down)

Back 84

Decreased BP
Decreased HR
Slowed drug metabolism
Use caution with opioids and sedatives
Lethargy, fatigue
Weight gain
Cold intolerance
Constipation
Dry skin
Dry and thinned hair
Thick, hard nails
Prolonged menstrual periods
Increased susceptibility to infection

Front 85

Drugs to Treat Hypothyroidism (These drugs provide an exogenous source of thyroid hormone)

Back 85

Levothyroxine (Sythroid, Levothroid)
Liothyronine (Cytomel, Triostat)
Liotrix (Thyrolar)

Front 86

Liothyronine (Cytomel, Triostat)

Back 86

Synthetic T3
Rapid onset and shorter duration of action
More pronounced CV side effects

Front 87

Liotrix (Thyrolar)

Back 87

contains levothyroxine and liothyronine

Front 88

Levothyroxine (Sythroid, Levothroid) Action and Use?

Back 88

ACTION: Synthetic form of T4
USE: Drug of choice for long-term treatment of hypothyroidism
May take several months to reach peak effect

Front 89

Levothyroxine SIDE EFFECTS:

Back 89

Adverse effects include signs and symptoms of hyperthyroidism
Watch for chest pain, heart palpitation, nervousness, or insomnia

Front 90

Levothyroxine NURSING CONSIDERATIONS:

Back 90

Take every morning on an empty stomach
Iron, antacids, cholestyramine, sucralfate (these decrease absorption)
Check pulse before taking—hold and notify MD if >100
Do not stop taking drug abruptly can lead to life-threatening illness
Brand names differ; do not switch drugs
Monitor T4 and TSH

Front 91

Hyperthyroidism is caused by what? What disease falls under this category and what is the treatment?

Back 91

Usually associated with excessive number of thyroid cells and excessive secretion of thyroid hormone

Front 92

Graves Disease (See Pic) - Treatment is:

Back 92

drugs to block thyroxine
Radiation to destroy the gland
Subtotal thyroidectomy

Front 93

Hyperthyroidism carries a risk of _________storm or ____________ crisis

Back 93

thyroid storm or thyrotoxic crisis
Going to explode, have a stroke right there

Front 94

Symptoms of Hyperthyroidism:

Back 94

Rapid pulse
Palpitations
Tremors
Heat intolerance
Irritability
Exophthalmos
Weight loss
Excessive perspiration
Nervousness
Increased appetite

Front 95

Drugs for Hyperthyroidism

Back 95

Methimazole (MMI) [P]
Propylthiouracil (PTU)
Potassium Iodide (Lugol’s Solution, SSKI)
Sodium Iodide (Radioactive Iodine)
Propranolol (Inderal)

Front 96

Methimazole (MMI)– Prototype Action, Use and Adverse effects:

Back 96

ACTION:
Inhibits production of thyroid hormones therefore new T4 and T3 are not produced
Does not interfere with release of previously produced hormone
So therapeutic effects may not occur for several days or weeks---not good in thyroid storm
USE:
Suppress hyperthyroidism and Graves disease
ADVERSE EFFECTS:
s/s of hypothyroidism, blood disorders, rash, headache, N/V/D, hepatitis.

Front 97

Potassium Iodide - Lugol’s Solution and SSKI (strong iodine solution and saturated solution of potassium iodide) Action, Use and Nursing Consideration?

Back 97

ACTION:
Inhibit secretion of thyroid hormones
USE:
Iodine preparation used in short-term treatment of hyperthyroidism
Used to treat thyroid storm and decrease size of thyroid gland before thyroidectomy
NURSING CONSIDERATION:
Do not give PTU, methimazole, or radiactive iodine after giving this drug

Front 98

Sodium Iodide (Radioactive Iodine) Action, Use, Side Effects?

Back 98

ACTION:
Is converted to protein-bound iodine by the thyroid gland for use when needed
Contraindicated in pregnancy and lactation
USE:
In small amounts can be used in diagnostic tests of thyroid function
In large amounts used to treat thyroid cancer
SIDE EFFECTS:
May cause cancer and chromosomal damage in children
In children should only be used for hyperthyroidism that cannot be controlled by other drugs or surgery
May lead to hypothyroidism, necessitating lifelong hormone replacement
Bone marrow depression

Front 99

Hyperthyroidism: Patient Teaching Guidelines for Medications - Nursing Considerations:

Back 99

Take at regular intervals around the clock
Avoid foods high in iodine (soy, tofu, seafood, salt)
May need to be taken for up to 1year or longer in order to decrease thyroid hormone levels to normal
DO NOT stop abruptly!
Tests of thyroid function and dosage adjustments may be needed (TSH, T3 and T4)

Front 100

Propranolol (Inderal) is NOT an antithyroid, what is it? When is it used?

Back 100

Antiadrenergic---NOT antithyroid
Used in thyroid storm and to control symptoms while waiting for response to anti-thyroids