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gland located at the base of the brain, two lobes (anterior and posterior)
pituitary (hypophysis)
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anterior or posterior pituitary? master gland that secretes hormones that stimulate release of other hormones from thyroid, adrenals, gonads
anterior (adenohypophysis)
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anterior or posterior pituitary? secretes two neurohormones
posterior (neurohypophysis)
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two neurohormones secreted by the posterior pituitary
ADH (vasopressin) and oxytocin
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hormone released from anterior pituitary in response to TRH from hypothalamus that stimulates release of T3 and T4
TSH or thyrotropic hormone
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hormone secreted from the anterior pituitary in response to CRF from hypothalamus that stimulates release of glucocorticoids (cortisol), mineralcorticoids (aldosterone), and androgen
stimulates adrenal cortex, adrenocorticotropic (ACTH)
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3 gonadotropic hormones secreted from anterior pituitary
FSH, LH, prolactin
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gonadotropic hormone that promotes maturation of follicles in ovaries and initiates sperm production in testes
FSH
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gonadotropic hormone that combines with another to stimulate follicle maturation and estrogen production and promotes secretion of androgens from testes
LH
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gonadotropic hormone that stimulates milk formation in glandular breast tissue
prolactin
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hormone released from anterior pituitary that acts on all body tissue, esp bones and skeletal muscles
growth hormone (GH) or somatotropic hormone (STH)
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growth hormone is regulated by the release of what 2 hormones from the hypothalamus?
GH-RH (releasing hormone) and GH-IH (inhibiting hormone or somatostatin)
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sympathomimetics, serotonin, and glucocorticoids can inhibit the secretion of what hormone?
growth hormone
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ADH (vasopressin) and oxytocin are secreted and stored in the posterior pituitary after being synthesized here
hypothalamus
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gland located anterior to the trachea that secretes 2 hormones that control the metabolic activity of nearly every tissue and organ
thyroid
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stimulation by these hormones result in increased CARDIAC output, oxygen consumption, carb use, protein synthesis, and lipolysis. also affect body heat regulation and menstrual cycle.
T4 and T3
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4 glands that lie on the dorsal surface of the thyroid gland that secrete parathormone or PTH
parathyroid
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parathyroid hormone regulates these levels in the blood
calcium
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3 ways PTH increases calcium levels
- mobilizing ca from bone
- promoting ca absorption from intestine
- promoting ca reabsorption from renal tubules
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glands located at the top of each kidney, consist of medulla and cortex
adrenal
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releases the catecholamines epinephrine and norepinephrine
adrenal medulla
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produces major types of hormones (corticosteroids) and small amounts of androgen, estrogen, and progestin
adrenal cortex
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the principal glucocorticoid
cortisol
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the principal mineralocorticoid
aldosterone
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corticosteroid that has major influence on electrolytes and metabolism of carbs, protein, and fat- deficiency can result in serious illness or death
glucocorticoid
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GH must be administered before epiphyses ae fused and can be administered through these routes
IM and subQ
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prolonged therapy with this hormone can antagonize insulin secretion and eventually cause d. mellitus
GH
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GH hypersecretion responsible for gigantism and acromegaly are often cause by this
pituitary tumor
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corticosteroid that is controlled by the renin - angiotension - - system
mineralocorticoids (aldosterone)
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2 drugs used to treat dwarfism or GH hyposecretion
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2 drugs to treat GH hypersecretion
- bromocriptine
- octreotide (Sandostatin)
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drug used to treat GH hypersecretion that is also used to treat intestinal conditions (Crohn's, chronic severe diarrhea)
octreotide (Sandostatin)
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drug used to treat insufficient TSH secretion (secondary hypothyroidism)
thyrotropin (Thytropar)
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ACTH stimulates the secretion of this glucocorticoid
cortisol
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drug used to diagnose adrenal-cortical disorders, as an anti-inflammatory, and acute multiple sclerosis. S/E are edema (Na and H2O retention), hypo-K, and hyperglycemia
corticotropin (Acthar)
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neurohormone that is secreted in response to peaking estrogen levels at the end of 3rd tri
oxytocin
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neurohormone that is responds to serum osmolality
ADH
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caused by the hyposecretion of ADH characterized by polyuria and lowered BP, can occur aafter brain trauma, cerebral edema, and brain cancer
d. insipidus
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2 drugs used to treat d. insipidus
- vasopressin (Pitressin) - used in codes to quickly elevate BP
- desmopressin acetate (DDVAP) - nasal spray, bedwetters
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hypersecretion of ADH causes this syndrome, too much H2O is reabsorbed from renal tubules, output falls drastically, BP goes up
SIADH (syndrome of inappropriate diuretic hormone)
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causes myxedema in adults and cretinism in children, primary is most commonly caused by the slowing of secretion with age, secondary is insufficient TSH
hypothyroidism
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symptoms of this include "cold, dry, slow, swollen", cold intoleance, thick dry skin, slow speech and movement, memory impairment, slow GI (constipation), slow emotional response (apathy), bradycardia (possible hypotension), swollen eyelids, edema, weight gain
hypothyroidism
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drug used to treat hypothyroidism, lots of interactions
levothyroxine (Synthroid)
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causes Grave's disease or toxicosis, symptoms are "hot, wet, speeded up, shrunken", heat intolerance, diaphoresis, rapid speech, nervousness and irritability, N/V, diarrhea, tachycard, hypertension, palpitations, dysrhythmias, shrunken eyelids and orbits, weight loss
hyperthyroidism
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drug class used to treat hyperthyroidism, lots of interactions
thioamides (thiourea derivatives) - propylthiouacil (PTU) and methimazole (Tapazole)
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thyroid storm (severe hyperthyroidism) can lead to death due to this
vascular collapse
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treatment for thyroid storm can include these
- radiation reduction of thyroid
- surgical removal of thyroid
- thioamides during radiation or before surgery
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parathyroid hormone (PTH) responds to changes in these serum levels
calcium
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hypoparathyroidism will cause this
hypocalcemia
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vit D analogue used to treat hypoparathyroidism, promotes Ca absorption from GI, Ca reabsorption from renal tubules and some secretion of Ca from bone
calcitriol (Rocaltrol)
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hyperparathyroidism cause hypercalcemia and has this effect on muscle
weakens, become flabby (GI - constipation, cardiac - brady)
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drug used for hyperparathyroidism that decreases serum Ca by depositing back at osteoclast and promoting renal excretion
calcitonin
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disease process that involves adrenal insufficiency and results in serious illness or death
Addison's disease
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corticosteroids (glucocorticoids or cortisol and mineralcorticoids or aldosterone) regulate these electrolytes and influence carb, protein, and fat metabolism
- Na (retention)
- K (excretion)
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corticosteroids are produced here
the adrenal cortex
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adrenal hypersecretion results in this syndrome, the same signs and symptoms can be seen with high-level chronic therapy with glucocorticoids
Cushing's
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two hormones that help regulate the diurnal rhythm
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stress like surgery, sepsis, trauma, and emotional keep ACTH and cortisol levels high which leads to what
- increased glucose
- sometimes hypoK
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oral mineralcorticoid drug used to treat Addison's disease that causes a neg nitro balance causing a need for a high proetin diet, DO NOT STOP ABRUPTLY
fludrocortisone (Florinef)
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signs and symptoms of Cushing's syndrome is rarely caused by adrenal hyperplasia or endocrine cancers but is more commonly caused by this
glucocorticoid therapy
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therapy used as an anti-inflammatory, immunosuppressive, anti-allergic, for COPD, asthma in IV, PO, topical, oral inhalant, nasal inhalant, eyedrop forms...
glucocorticoid
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a common oral steroid used as an anti-inflamm and immunosupp. sometimes as an anti-allergic when topicals fail
prednisone (Deltasone)
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immunosuppression, hyperglycemia, thinning of skin, poor wound healing, abnormal fat accumulation, and electrolyte changes are all signs and symptoms or adverse reactions of this therapy, risk for peptic ulcer, mood changes (irritability, depression) TAPER to prevent Addison's crisis
glucocorticoid
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why suddenly stopping prednisone can cause deadly adrenal insufficiency
long-term use can cause adrenal atrophy
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complication from this disease is the third leading cause of death in the U.S.
d. mellitus
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ethnic cultures within the age group of 45 - 65 with higher incidences of d. mellitus
- native american
- hispanics
- african american
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three "polys" of DM
- polyuria
- polydypsia
- polyphagia
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the most common cause of type 2 DM
insulin resistance
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two mechanisms of insulin resistance
- deficiency of insulin receptors
- receptors become unresponsive to person's own insulin
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normal range for serum glucose
70 - 110 mg/dL
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fasting serum blood glucose that indicates DM
>200
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onset of rapid acting insulin
5 minutes
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with combination insulins, the first number represents what type of insulin
intermediate acting
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clear insulin with no real peak and a duration of 24 hours. not associated with hypoglycemia, higly acidic, can't be mixed
Lantus
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types of DM patients that use insulin
- all type 1
- gestational - oral antidiabetics aren't safe
- often type 2
- medication induced diabetics
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insulin that is typically the first used for treatment of DM type 2
Lantus
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insulin dosage is determind using this
sliding scale from HCP or hospital protocol
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common meds that raise glucose
- steroids
- thiazide diuretics
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"wet and crazy" indicate this. (sweating, confusion, slurred speech, uncoordination, nervousness, agitation)
hypoglycemia
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how to treat a hypoglycemic event
- 15 gm of fast acting glucose (4 oz OJ, soda, candy works slower)
- check in 15 min (level should be 75 - 100)
- give long acting glucose with protein and fat
- in clinical setting D50W IV push or glucagon
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"dry and cranky" dry mucous membranes, poor skin turgor, thirst (polydypsia), fruity breath, tachy, polyuria, Kussmaul resp (deep rapid breathing), fatigue indicate this
hyperglycemia
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how to treat hyperglycemia
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types of insulin used in insulin pumps
clear rapid or short acting (regular or humalog) for type 1
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first oral antidiabetics
sulfonylureas
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generation of sulfonylureas that are more potent (more effective with lower doses, longer duration, fewer SE but have a higher risk of hypoglycemia, esp in elderly
second gen
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second gen sulfonylureas that stimulate beta cells to secrete insulin and increase insulin receptor sensitivity
- glipizide (Glucotrol)
- glyburide (Diabeta)
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4 classes of nonsulfonylureas
- biguanides
- thiazolidinediones
- meglitinides
- alpha-glucosidase inhibitors
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most common antidiabetic PO drug, low incidence of hypogly, lowers post-prandial glucose, increases binding of insulin to receptors, increases cell sensitivity to insulin, decreases hep. production of glucose, reduces of glucose absorption in sm intestine, NOT COMPAT. WITH DYES, hold, flush wih IV fluids, mucomyst
BIGuanide - glucoPHAGE - does not work in pancrease
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nonsulfonyurea that enhance insulin receptor sensitivity decreasing insulin resistance, adverse reactions include cardiac concerns
Thiazolidinediones "glitazones"
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nonsulfonyurea that stimulates release of insulin from betas of pancreas, quick bursts, short duration, frequent dosing if not stable
meglitinides "glinides"
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2 hyperglycemic agents used to RAISE glucose
- glucagon (SC, IM)
- proglycem (oral form)
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hypergly agent (raise sugar) that is used for acute insulin-induced hypogly, alpha cells of the islets of Langerhans, works in liver to stimulate breakdown of stored glycogen to glucose
glucagon
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Insulin who's fast - onset 5 - 15 min, peak 30 - 1 h, duration 2 - 4 h
Lispr, humalog, aspart, exubra
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shorty acting insulin - onset 30 to 60 min, peak 2 - 3 h, duration 3 - 4 h
regular humulin r
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Long acting insulin - onset 4 - 8 h, peak 14 - 20, duration 24 - 36 h
humulin u
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insulin that keeps riding for 24 h, evenly dispersed
Lantus, Lavamer, Insulin Glargine
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intermediate acting - onset 2 - 4 h, peak - 4 - 12 h, duration 18 - 24 h
NPH, humulin N, Lente
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combination insulins never include this insulin
long acting
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insulin - increase or decrease hypogly with aspirin, oral anticoags, alcohol, beta blockers, tricyclic anti-depress, MAOIs, tetracyclines
increase
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insulin - increase or decrease hypogly with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking
decrease
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