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53 Cards in this Set
- Front
- Back
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Name of Syndrome for Growth Hormone deficiency
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dwarfism
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Limitations of Using Growth Hormone
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$$$$ - $20k/1yr
Epiphysis can't be fused Deactivated in stomach - only SubQ, IM |
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Maximum Effect of Growth Hormone
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height increase 1 foot
GH taken over several years |
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SE taking Growth Hormone
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diabetes (antagonizes insulin secretion)
develope antibodies to soma___ |
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Contraindication of taking Growth Hormone
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Pediatric clients with Prader-Willis Syndrome
Severely obese Severe respiratory impairment (fatal) |
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Excess Growth Hormone Syndromes: Adult/Pediatric
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Adult - Acromegaly
Ped - Giganticism |
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2 Medications for Growth Hormone Excess
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Bromocriptine - prolactin release inhib, inhib GH secretion from pituitary
Octreotide (Sandostatin) - potent synthetic somostatin used to suppress GH release $$$ - can be used for severe diahrrea d/t carcinoid tumors |
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Common SE of Growth Hormone Inhibitors
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hyperglycemia
electrolyte imbalance |
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ADH is secreted where?
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posterior pituitary gland
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Medication for ADH Deficiency
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Desmopressin acetate (DDAVP)
(acetate is a salt - which makes sense b/c salt helps to retain water) |
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What is unique about the administration of Desmopressin acetate (DDAVP)?
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-used to treat ADH deficiency
-unique - can be admin intranasally or by injection |
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What is nursing priority when administering Desmopressin acetate (DDAVP)?
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monitor I's and O's (fluid level)
monitor electrolyte balance (hyponatremia) Monitor vital signs - increased HR, decreased systolic pressure can indicate fluid volume loss d/t decreased ADH production. (hypervolemia d/t more water excretion) |
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hyponatremia S/S
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ICF (cytosol) solute concentration b/c's higher than ECF solute concentration d/t loss of sodium in ECF so water rushes inside cells resulting in mostly neurological symptoms: - shift of ECF into ICF results in cerebral edema: as it worsens it can lead to confusion, diminished reflexes, convulsions, stupor, or coma
people can develop a severe thirst NV, HA, malaise - vomiting creates positive feedback loop in which ADH is released to counteract water loss d/t vomiting, l/t more hyponatremia . . . urine specific gravity (usg) will become concentrated d/t loss of Na and retention of H2O |
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DDAVP is used for which pediatric condition
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Enuresis - primary (bed-wetting)
(nasal spray banned in 2007 d/t hypnatremia deaths - but pills ok in healthy indiv) |
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DDAVP uses
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synthetic replacement for vasopressin - hormone that reduces urine production during sleep
prescribed for bedwetting and Diabetes insipidus DI - used to distinguish central for nephrogenic DI |
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Hypothyroidism - 2 most common medications
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synthroid
levothyroxin lavatrhoid |
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Unit of measurement of Hypothyroid Tx
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mcg (1000 mcg = 1mg)
*Note Rx can be written either way |
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convert 125 mcg to mg
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0.125
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Describe relationship of TRH, TSH, T3 and T4
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TRH (hypothal) stimulates release of TSH (ant pitu) which stimulates release of T3/T4:
TSH is inverse in relation to T3/T4 - if TSH is high - it is detecting low T3/T4 levels |
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Important client teaching regarding replacement thyroid med
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same time each day
check OTC interactions report S/S hyperthyroidism don't take with food |
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Hyperthyroidism - class of medications used to treat
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Thiourea derivatives - thioamides
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2 most common medications for hyperthyroidism
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Propylthiouracil (PTU)
methimazole (Tapazole) |
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MOA Hyperthyroidism drugs
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inhibit synthesis of T3 and T4
prolonged use can l/t goiters b/c inhibiting T3 and T4 can cause increase TSH secretion |
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Uses of Hyperthyroid drugs
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do not destroy thyroid tissue
treat thyrotoxic crises preparation for subtotal thyroidectomy |
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Cardiac glycoside:
Generic Name and Trade Name |
digitalis/digoxin (Lanoxin)
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Cardiac glycoside Antidote:
Generic Name and Trade Name |
digoxin immune Rab (Digibind)
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Phosphodiesterase Inhibitors:
Generic Name and Trade Name |
amrinone lactate (Inocor)
milrinone lactate (Primacor) |
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Atrial naturetic peptide
generic name (Trade Name) |
nesiritide (Natrecor)
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Nitrates
generic name (Trade Names) |
nigroglycerin - NTG - generic
Nitrostat (SL), Nitrobid (PO) Nitro-Bid (ointment) Transderm-Nitro patch Tridil (IV gg) *also in aerosol spray for inhalation |
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Nitrates - long term therapy
generic name (Trade Names) |
isosorbide dinitrate (Isordil)
isosorbide mononitrate (Imdur) |
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Beta-adrenergic blockers
generic (Trade) names |
B1 ONLY
atenolol (Tenormin - B1) metoprolol (Lopressor - B1; Toprol XL - B1) B1 and B2: nadolol (Corgard) propranolol (Inderal) |
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Calcium (slow) channel blocker
generic (Trade) names |
amlodipine (Norvasc)
diltiazem (Cardizem) felodipine (Plendil) nicardipine (Cardene) nifedipine (Procardia & Adalat) verapamil (Calan & Isoptin) |
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Sodium (fast) channel blockers
generic (Trade) names |
disopyramide phosphate (Norpace)
procainamide (Procanbid - PO, Pronestyl - IV) lidocaine (Xylocaine) mexiletine (Mexitil) flecainide (Tambocor) propafenone (Rhythmol) |
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Drugs that prolong repolarization
generic (Trade) names |
adenosine (Adenocard)
amiodarone (Cordarone) |
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Drugs with Antidysrhythmic Properties (previously discussed)
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verapamil (Calan, Isoptin)
diltiazem (Cardizem) digoxin (Lanoxin) |
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Anticoagulants
generic (Trade) names |
unfactionated heparin (UF) and heparin sodium (Lipo-Hepin)
dalteparin sodium (Fragmin) enoxaparin sodium (Lovenox) dalteparin sodium (Fragmin) enoxaparin sodium (Lovenox) warfarin (Coumadin) |
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Heparin antagonist
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Protamine sulfate IV
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dalteparin sodium (Fragmin) and enoxaparin sodium (Lovenox) antagonist
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Protamine
(both of these drugs are Heparin derivatives) |
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warfarin (Coumadin) antagonist
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vitamin K (AquaMEPHYTON)
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Antiplatelet
generic (Trade) names |
aspirin (Bayer, . .& in cold meds)
clopidogrel (Plavix) dipyridamole (Persantine) cilostazol (Pletal) ticlopidine (Ticlid) dipyridamole and ASA combined(Aggrenox) |
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More Antiplatelets: Glycoprotein IIb/IIIa receptor antagonists
generic (Trade) names |
abciximab (Reo Pro)
eptifibatide (Integrilin) tirofiban (Aggrastat) |
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Thrombolytics
generic (Trade) names |
streptokinase (Streptase)
tissue-type plasminogen activator (tPA) - (Activase) reteplase (Retivase) |
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Antagonist for thrombolytic drugs
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aminocaproic acid (Amicar)
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digitalis/digoxin (Lanoxin)
Highlights |
Pos inotrope
Neg chronotrope Neg dromotrope V. narrow therapeutic level: 0.5 - 2 mg/ng/ml Tx: SVT, AFib/flutter; 2ndary HF Tx SE: contraind heart block toxic when used with thiazide and loop diuretics (hypoK) S/S toxic: yellow halo (xanthopsia) Assess HR before admin (must not be below 60) |
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Phosphodiesterase Inhibitors
generic (Trade) names |
amrinone lactate (Inocor)
milrinone lactate (Primacor) |
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Atrial naturetic peptide
generic (Trade) names |
nesiritide (Natrecor)
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Phosphodiesterase Inhibitor
Highlights |
Positive inotrope of LV
Vasodilation Improve cardiac output Short term tx: severe HF IV gtt (drops) for 48 - 72 hr SE: life threat dysrythmias Nurse Impl: close monitor EKG |
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Atrail naturetic peptide
Highlights |
Inhibits ADH
promotes Na loss and diuresis Short term tx severe HF Given IV gtt SE: hypotension hyponatremia (cramps, weak, fatigue) Nurse Impl: monitor Na levels monitor B/P closely monitor electrolytes |
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Nitrates
Highlights |
dilation
lowers preload and afterload lowers MVO2 (less O2 used by the heart) relax coronary arteries increase O2 supply to myocardium Indication: prevention of angina attacks Contraindicated in AMI, hypotension SE: weakness, dizziness, hypotension, refelx-tachycardia **enhanced hypotension with beta-blockers, Ca++ channel blockers, vasodilators, and/or alcohol Nursing Implications: SL (sublingual) - sit/lie down first repeat every 5 min up to 3 - then call 911 if still in pain store away from heat/light not childproof containers do not touch if you are nurse applying tolerance can occur - supervised drug free period keep away from body (too hot) |
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Beta Blockers
Highlights |
Selective - 1 heart B1
Block catecholamines and lower BP, HR, and MVO2 Control stable angina, Manage HTN, Manage HF SE: bradycardia, hypoten contraind: pts with heart block Nurse Impl: teach pt NEVER abrupt stop, how to monitor pulse, report dizziness Non-Selective - 2 lungs (B2) same as B1, but also risk for bronchospasm |
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Calcium (slow) channel blocker
"CCB" Special Indications |
**verapamil (Calan/Isoptin) special indication for AFIB
(very (vera) good for AFIB) **nifedipine (Procardia/Adalat) - immediate release preps in hospitals for acute HTN assoc with sudden death **diltiazem (Cardizem) - hypotensive effect not as severe as nifedipine |
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Calcium (slow) channel blockers
Highlights |
"A (Angina) Story of How (Htn) Calcium Calms Hearts (Hf)"
Mgt angina and HTN and HF (think "cHAnnel" - Htn/Hf/Angina) (think "ChanneL" - monitor C(K)idney and Liver fx) Generally, all can cause changes in liver and kidney fx (nursing implication is to monitor fx) Monitor BP and HR Teach pt not to abruptly stop (don't abruptly stop "Cs and Bs" - calcium/beta - blockers), monitor pulse and BP, and report dizzy/faintness |
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Sodium (fast) channel blockers
Memory Trick and Explanation |
Picture a salt shaker filling the ventricles with salt to stop PVC
Sodium is Serious! - previous MI, so myocardial scarring, damage l/t eletrical damage: PVC (premature ventricular contraction) l/t VT, l/t VFib (no output), l/t sudden death!: diag with widened PQRS - looking for extra beats Front line for Dysrhythmia - O2 lacking so compensate with dysrhythmia |
