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66 Cards in this Set
- Front
- Back
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Hypothalamus
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the master gland
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Pituitary gland and Hypothalamus
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govern all bodily functions using hormones and negative feedback loops
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Anterior Pituitary Hormones (6)
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growth hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, adrenocorticotropic hormone
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Posterior Pituitary Hormones (2)
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oxytoxin and antidiuretic hormone
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Anterior Pituitary Drugs
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Somatotropin-mimics GH
Octtreotide-antagonizes GH Cosyntropin- mimics ACTH |
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Posterior Pituitary Drugs
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Vasopressin, desmopressin-mimics ADH; increases absorption of Na + H2O
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Pituitary drugs: indications
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replacement therapy
Drug therapy to produce a specific hormone response (in hormone deficiency) -diagnostic aid (to determine hypo/hyperfuntion) |
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Somatotropin can increase what?
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growth in children
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Vasopressin or desmopressin should reduce what?
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severe thrist and urinary output
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Thyroid Gland: 3 Hormones
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Thyroxine (T4)-we have more of this
Triiodothyronine (T3)-more potent Calcitonin **ALL NEEDS IODINE TO BE PRODUCED |
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4 Function of Thyroid Hormones
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-regulate lipid and carb metabolism
-for normal G&D -thermoregulation -effects on cardiovascular, endocrine, neuromuscular syst. |
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Hypothyroidism
20% in females over 50 |
Can be either:
Deficiency in THs-abnormality in the gland itself Autoimmune- is the most common |
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Hashimoto thyroiditis
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high TSH, low T4
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Secondary Hypothyroidism
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drug induced: Amiodarone (from high iodine content) and lithium
Transient: postpartum period gland dysfunction: does not secrete TSH needed to trigger THs |
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Hypothyroidism S&S
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thickened skin, hair loss/brittle hair, constipation, anorexia, goiter, weight gain, depression, cold intolerance, lethargy
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Levothyroxine
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used for hypothyroidism
-decreases THs -works the same way as thyroid hormones -preferred agent because it is predictable and standardized |
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Levothyroxine: SE
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-cardiac dysrhythmia, heat intolerance, hyperthyroid S&S, insomia
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Levothyroxine: Implications
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increased effect of oral anticoagulants
decreased effects of hypoglycemics may take several months before therapeutic response |
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Hyperthyroidism
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excess T3 and T4 and shuts off TSH
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Hyperthyroidism: caused by
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Graves' disease -autoimmune, body receptors mimic TSH increasing T3 and T4
Toxic nodular disease Multinodular disease |
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Hyperthyroidism: S&S
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goiter, diarrhea, exopthalmos, sleep disorder, flushing, increased appetite,tremor, fatigue, palpitations, nervousness, heat intolerance, warm moist skin, increased sweating
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Tx of Hyperthyroidism
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radioactive-destroys thyroid gland
surgery antithyroid drugs- thioamide derivatives ex: methimazole, propylthiouracil(FIRST LINE DRUG) |
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Antithyroid Agents: SE
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may cause liver and bone marrow toxicity
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Type I Diabetes
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- lack of insulin production
- 10% of casess - prone to ketoacidosis |
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Type II Diabetes: Causes
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Beta Cell Dysfunction-- beta cells responsible for insulin production
Insulin Resistance- cells have diminished ability to respond to insulin liver over produces glucose impairs after meal (post-prandial) glucose metabolism for the response to insulin deficiency |
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____ is responsible for 80% of deaths for those with diabetes
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CVD
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Gestational diabetes
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2-4% in pregnancies
dev. glucose intolerance 30% dev type II diabetes within 10-15 yrs. |
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Hyperglycemia
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FBG > 6.1 [<5.6]
GTT (glucose tolerance test)-75 g glucose is prediabetic |
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Hypoglycemia
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blood glucose < 2.8
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2 types of antidiabetic agents
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human insulin and oral antihyperglycemic agents
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Insulin restores client's ability to: (3)
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metabolize carbs, fats, proteins
store glucose in liver convert glycogen to fat stores |
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Intensive therapy: Insulin: why use Basal-bolus regime?
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to prevent onset and progression of microvascular complications
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what is a basal-bolus regime?
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first use a basal insulin= intermediate or LA insulin given bid/od + fast acting insulin bolus before meals
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Human-based insulin: Rapid acting
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Peak 60-90 min, 15 onset, shorter duration
ex. lispro (humalog), insulin aspart |
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Human-based Insulin: Short acting
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Peak 2-4 hrs, 30-60 min onset, the ONLY insulin that can be given IV bolus, IV infusion, or IM
-uses sliding scale ex: regular insulin (Humulin-R, novolinge-toronto) |
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Human-based Insulin: Intermediate acting
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cloudy appearance, slow onset and long duration
ex: Isophane insulin suspension (NPH, Humulin-N), Insulin zinc suspension (Lente, humulin-L) |
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Human-based Insulin: Mixed
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a combo of insulin (diff duration and onsets)
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Lispro/aspart: onset and peak
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onset 10-15 min, peak at 60-90 min
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Human regular: onset and peak
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onset 30-60 min, 2-4hrs
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Human NPH/Lente: onset and peak
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onset 1-3hrs, peak 5-8 hrs
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Ultralente: onset and peak
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onset 3-4 hrs, peak 8-15 hrs
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Glargine: onset and peak
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onset 90 min, peak (vary)
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Sliding scale insulin dosing is adjusted according to...
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sc regular insulin adjusted according to blood glucose test results
- sc regular insulin doses increases as blood glucose level increases |
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Oral antidiabetic agents: is it used for type I or II?
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used for type II diabetes alone or in combo with injection
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Oral antidiabetics: 5 Types
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sulfonylureas
biguanides alpha-glucosidase inhibitors thiazolidinediones (TZDs) DDP4-Inhibitors |
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Sulfonylureas ex:
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gliclazide, glyburide
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Sulfonylureas: mechanism
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simulate insulin secreation from beta cells; beta cells must be in working condition
Improve sensitivity to insulin in tissue prevent liver from braking down insulin |
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Biguanides ex:
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metformin
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Biguanides: 3 mechanisms
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-decrease production of glucose by liver
-decrease intestinal absorption of glucose -improves insulin receptor sensitivity in liver, adipose, muscle **** DOES NOT CAUSE HYPOGLYCEMIA -because it does not increase insulin from pancreas |
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Biguanides: metformin drug rxn with
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iodinated contrast
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Alpha-glucosidase Inhibitors ex:
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Acarbose (Prandase)
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Alpha-glucosidase Inhibitors: considerations
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taken with the first bite of each meals
-must be taken with meals to prevent postprandial blood glucose elevations - causes bloating, abd pain |
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Acarbose: Mechanism
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-reversibly inhibit alphaglucosidase that releases glucose from small intestine
-reduces rate of digestion of complex carbs delaying absorption of glucose |
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Thiazolidinediones (TZDs) ex:
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pioglitazone(actos), rosiglitazones (avandia)
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TZDs: mechanism
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decrease insulin resistance
"glitazones" "insulin sensitizing agents" -increase glucose uptake and use in skeletal muscles -inhibit glucose and triglyceride production in the liver |
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DDP4-Inhibitors ex:
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Januvia, very new and improve PPG control, increase amt of incretin
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Oral hypoglycemics is usually given ___min before meals
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30 min
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% of ppl with type II that are overweight or obese
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80-90%
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BMI Overweight
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25-29.9
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BMI obese class I
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>= 30
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BMI obese class II
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30-34.9
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BMI obese class III
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>= 40
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waist circum. of men and women should be
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men < 102cm
women < 88cm |
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Healthy wt loss
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5-10% of initial body wt loss
1-2kg/month |
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Anorexiants/antiobesity drugs
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-drugs to reduce weight which is clinically important
-significant in reducing doses of hyperglycemic agents ex: Orlistat, Sibutramine |
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Orlistat: mechanism
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blocks absorption of fat from GI by 30%
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