comp 8

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    • • Secrete hormones into bloodstream
    • • Hormones chemical substances act on target tissue effect metabolism negative feedback system
    • • Ductless glands 
    • • Endocrine medications either mimic or block the effects of natural hormones
  2. Posterior Pituitary Hormones
    •ADH (antidiuretic hormone) –Increases reabsorption of water in the kidney •Oxytocin: manufactured in hypothalamus and stored in posterior pituitary –Affects uterine muscle, mammary glands
  3. Anterior Pituitary Hormones
    • • Growth hormone (GH) – Stimulates growth in tissue and bone
    • • Thyroid-stimulating hormone (TSH) – Acts on thyroid gland
    • • Adrenocorticotropic hormone (ACTH) – Stimulates adrenal gland
    • • Gonadotropins (FSH), (LH) – Affects ovaries, testes
    • • Acts directly on bones
    • • Stimulates tissue & bone growth, mobilizes glucose and free fatty acids
    • • Alterations in secretion:
    • –Gigantism: excess prior to closure of epiphyseal shafts
    • –Acromegaly: excess after closures –Dwarfism: deficiency during childhood
    • • Replacement Growth Hormone
    • – Promotes growth both skeletal (at epiphyseal plates) and cellular
    • – SQ, IM
    • • somatrem (Protropin)
    • • somatropin (Genotropin, Nutropin)
    • • Side effects: hyperglycemia, insulin resistance, hypothyroidism
    • • Monitor growth rate, electrolytes and blood sugar
    • • Advise athletes not to take GH
  6. Treatment of Excess Growth Hormone Secretion
    • *drugs which inhibit the release of natural growth hormone- mimics the effect of somatostatin
    • -Bromocriptin (pariodel)
    • -octriotide (sandostatin) nhibits growth hormone, insulin AND Glucagon
    • *used to treat acromegaly, metastic carcinoid & other tremors
    • * SE: nausea, vomiting, diarrhea and abdominal pain, hypoglycemia, sometimes hyperglycemia

    **somatostatin stops growth hormone effect- hypoglycemia
  7. ACTH: Corticotropin
    • *action: stimulate adrenal cortex to secrete cortisol
    • *used in dx not treatment
    • *helps differentiate between pituitary and adrenal causes of adrenocortical insufficiency
    • *also used for MS corticotropin= available IV, IM, SQ
  8. ACTH: corticotropin
    *SE: (same as glucocoids) mood swings, increased appetite, edema, water, and sodium retention, GI distress, hypokalemia, hypocalcemia, petechiae, ecchymosis, menstrual irregularities, osteoporosis, muscle atrophy, decreased wound healing, glaucoma, cataracts, ulcer perforation, sweating acne
  9. ACTH: Corticosteroids- NRSG intervention
    • *monitor G&D in children (does cause kids nt to grow)
    • *monitor weight, edema, electrolyte
    • *do not stop drug abruptly, taper dose
    • *warn client to decrease salt intake
    • *instruct client about symptoms to report
  10. Antidiuretic Hormone Vasopressin
    • *stored in posterior pituitary
    • *produce n hypothalamus
    • *facilitates reabsorption of water in kidneys, vasoconstriction of arterioles (antidiuress pulling too much water back)
    • *deficiency: diabetes insipidus
    • *excess: SIADH
    • *deficiency of anti diuretic hormone
    • *urinary excretion of excessive amt of very dilute urine- 5-20 liters/day
    • *polydipsia=incredible thirst
    • *generalized weakness, altered CNS
    • *increased serum sodium and osmolality
    • *severe fluid volume deficit- weight loss, poor tissue tugor, hypotension, tachycardia, shock
    • *fatigue from nocturia
  12. Antidiuretic Hormone Replacement Medications
    • *hormone replacement of ADH- promotes water reabsorption from the renal tubules
    • *Used to treat Diabetes Insipidus, hemophilia A and von Willebrand disease-
    • --desmopressin (DDAVP, Stimulate) PO, IV, nasal spray
    • --vasopressin (Pitressin) IM, SC

    *SE: HA, fluid retention, increase BP, nasal congestion, chest pain, MI, abdominal cramps, N/V/D
  13. Anti Diuretics Hormone replacement- NRSG Implications
    • *ADH (vasopressin, desmopressin)
    •  -monitor electrolytes
    •  -monitor BP, Vitals, weight (CRITICAL BP & P)
    •  -monitor for fluid imbalances
    •  -monitor urinary output
    •  -assess ability to utilize nasal sprays and discus URIs
    • *do not take any OTC meds for colds, cough, or allergies (pseudoephedrine)(decongestants-sympathetic med inc BP & P)
  14. Thyroid Gland (drives metabolism)
    • *hormones- trilodothyronine (T3) & thyroxine (T4), calcitonin
    • *increases the metabolism in body
    • *necessary for growth and development in children
    • *TSH (thyroid-stimulating hormone) uses feedback mechanism
    • *deficiency: hypothyroidism
    • *excess:hyperthyroidism
  15. Hypothyroidism
    • *insufficient circulating thyroid hormone
    • *primary or secondary
    • *elevated TSH
    • *risk factor: women >50 y/o
    • *congenital hypothyroidism: cretinism
    • *juvenile hypothyroidism
    • *cause: atrophy of gland with aging, irradiation, iodine deficiency or excess, hashimoto's thyroiditis
  16. hypothyroidism signs
    • *fatigue, lethargy
    • *decreased mental acuity
    • *personality and mental changes
    • *decreased cardiac output and contractility
    • *decreased GI motility- constipation, achlorhydria
    • *cold intolerance
    • *myxedema-> facial puffiness, periorbital edema, masklike affect
    • *weight gain
    • *dry coarse skin
  17. Medications to treat Hypothryoidism
    • *action: increases levels of T3 and T4 thyroid hormones
    • *levothyroxine (synthroid, levothroid)
    • *taken once daily- in am to avoid insomnia
    • *best if taken before breakfast
    • *CRITICAL ASSESSMENT: apical pulse & BP
    • *SE: weight loss, tremor, insomnia, nervousness, hypertensive, tachycardia
    • *many drugs-drug interactions (Inc action of adrenergic and anticoagulant meds)
    • *dose may be adjusted by HCP based on results of TSH level
  18. Hyperthyroidism
    • *sustained increase in synthesis and release of thyroid hormones
    • *most common form: grave's disease
    • *symptoms: tachycardia, palpitations, nervousness, irritability, hyperactivity, emotional lability, decreased attention span, increased appetite, weight loss, heat intolerance, exophthalmos-20-40 %, insomnia, warm sweaty skin with velvety smooth texture, frequent stools-diarrhea
  19. medications to treat hyperthyroidism
    • *action: inhibits thyroid hormone synthesis
    •  -proplthiouracil (PTU)
    •  -methimazole (tapazole)
    • *USE: treat thyrotoxic crisis and in preparation for subtotal thyroidectomy
    • *SE: blood disorders -> low WBCs & platelets, HA, rash, hypothyroidism, GI upset, liver damage

    ** keep from ppl with infections
  20. NRSG Interventions Thyroid medications
    • *monitor vital signs, weight
    • *administer thyroid replacement drug before breakfast
    • *check labels prior to using OTCs
    • *advise reporting of symptoms of hyperthyroidism
    • *encourage medic alert tag
    • *warn of iodine effects and presence in iodized salts, shellfish, OTC cough medication
    • *administer anti thyroid meds with meals
    • *do not stop abruptly
    • *asvise reporting of symptoms of hypothyroidism
  21. Parathyroid/thyroid hormone
    • *action: promotes calcium absorption from GI tract and secretion of calcium from bone to the bod stream
    • *similar to Vit D
    • *calcitriol (rocaltrol)
    • *Use: treat hypoparathyroidism, hypocalcemia in chronic renal failure
    • *SE: anorexia, N/V/D, drowsiness, HA, dizziness, lethargy, photophobia, hypercalciuria, hematuria, hyperphosphatemia
    • *CRITICAL ASSESSMENT: calcium level
  22. Adrenal gland CORTEX
    • *mineralocorticoids: aldosterone
    • *glucocorticoids : cortisol (hydrocortisone)
    • *androgens
  23. Adrenal gland- cortex hormones
    • *mineralocorticoids-aldosterone: reabsorption of sodium/elimination of potassium
    • *Glucocorticoid-cortisol (hydrocortisone)
    • -carbohydrate metabolism
    • -protein metabolism
    • -fat metabolism
    • -regulates serum glucose
    • -suppresses inflammatory/immune response
    • -supports adaption during stress
  24. Alterations in adrenocortical hormones (mineralcorticoids and glucocorticoids)
    • *deficiency- Addison's disease
    • *excess- cushing's syndrome
    • *failure of adrenal cortex- sudden complete failure->adrenal crisis
  25. adrenal crisis
    • *failure of adrenal cortex
    • -life threatening
    • *symptoms
    •  -confusion
    •  -restlessness
    •  -nausea
    •  -vomiting
    •  -hypotension
    •  -circulatory collapse-> shock
  26. Addison's disease: clinical manifestations
    • *slow insidious onset
    • *progressive weakness
    • *fatigue
    • *Gi distress- weight loss
    • *anorexia
    • *skin hyperpigmentation
    • *hypotension
    • *hyponatremia (lack of aldosterone)
    • *hyperkalemia
    • *N/V/D
    • *addisonian crisis-> shock
  27. Medications to treat Addison's
    • *Replacement therapy:
    •  -Glucocorticoids: hydrocortisone
    •                           methylprednisolone
    •                           prednisone
    •                           triamcinolone
    •                           dexamethasone(decadron)
    •  -Mineralcorticoid: fludrocortisone acetate (florinef)
    • *increase salt in the diet during excess heat/humidity
  28. Corticosteroids (mineralocorticoids, glucocorticoids)
    • *inhalations, nasal, opthalmic, otics, topicals, IMs
    •  -beclomethasone (vanceril)
    •  -fluticasone (Flonase)
    •  -methylprednisolone (solu-Medrol)
    •  -hydrocortisone
    •  -fludrocortsone (florinef)
    • *inhales forms cause fewer systemic effects
  29. indications for corticosteroids
    • *respiratory disorders
    • *allergic reactions
    • *dermatologic disorders
    • *GI disorders
    • *hemolytic disorders
    • *joint inflammation
    • *neoplastic diseases
    • *rheumatic disorders
    • *ophthalmic disorders
    • *organ replacement
  30. glucocorticoids-nrsg implications
    • *give oral forms with milk, food, or nonsystemic antacids to minimize GI upset
    • *must avoid abrupt withdrawl
    • *avoid contact with large crowds and those with infections
    • *monitor for infections particularly fungal with inhaled forms (oral or nasal)
    • *instruct patients to use topical forms exactly as ordered
    • *will need increased doses after stressful evens such as surgery
  31. Cushing's Syndrome
    • *Causes:
    •  -overproduction of corticosteroids
    •  -excessive administration of steroids
    • *S/SX:
    •  -weight gain-truncal obesity
    •  -acne
    •  -muscle wasting
    •  -osteoporosis, fractures
    •  -thin, fragile, skin (moon face, buffalo hump)
    •  -hyperglycemia
    •  -HTN
    •  -psychoses
  32. medications to treat cushing's - anti adrenals
    • *Action:inhibit the normal conversion of cholesterol into adrenal corticosteroids
    •  -aminoglutethimide (cytadren)
    •  -metyrapone tartrate
    •    -used only in diagnostic procedures
    • *SE: nausea, anorexia, dizziness, vertigo, skin rashes, GI bleed
    • *NRSG interventions: take aminoglutethimide with antacid to minimize GI upsat
  33. Diabetes Mellitus (lack of insulin)
    • *chronic disease of deficient glucose metabolism
    • *insufficient insulin secretion from beta cells
    • *impaired insulin utilization
    • *major symptoms: 
    •  -the 3 p's-> polyuria, polydipsia, polyphagia
    • *Types: Type 1 (insulin-dependent DM)
    •             Type 2  (non insulin dependent DM)
    •             gestational
  34. Insulin
    • *Releases from beta cells of islets of Langerhans in pancreas
    • *responds to increase in blood glucose
    • *function
    •  -promotes uptake of glucose, amino acids, and fatty acids
    •  -converts to glycogen for future glucose needed in liver and muscle
  35. Symptoms of high blood sugar (hyperglycemia)
    • *polyuria
    • *polyphasia (increase hunger)
    • *polydipsia (increase thirst)
    • *weight loss (type 1)
    • *blurred vision
    • *fatigue
    • *fruity acetone odor of breath
  36. complications of Diabetes Mellitus
    • *Kidneys- nephropathy
    • *nerve- neuropathy
    • *circulatory system-peripheral vascular disease
    • *eyes-retinopathy
    • *heart- atherosclerotic heart disease
    • *accelerated athrosclerosis can lead to acute MI and stroke
    • **effects every system except lungs
  37. insulin
    opens up the cell, allows glucose to get into the cells
  38. medications to treat Type 2 DM
    • *oral antidiabetic medications
    •  -sulfonylureas
    •  -meglitinides
    •  -biguanides
    •  -thiazolidinediones (TZDs)
    •  -alpha glucosidase inhibitors
    • *insulins
  39. Sulfonylureas
    • *action: stimulates beta cells to INCREASE INSULIN SECRETIONS alters sensitivity of peripheral insulin receptors
    •  -glyburide (diabeta, micronase)
    •  -glimepiride (amaryl)
    •  -glipizide (Glucotrol)
    • *uses: control hyperglycemia in type 2 diabetes
    • *administer once daily with breakfast
    • *cautions: liver or kidney dysfunction, elderly, malnourished, adrenal or pituitary insufficiency
    • *SE: Hypoglycemia, BLOOD DISORDERS, weight gain, seizures, coma
    • *direct effects insulin available
  40. Meglitinides
    • *action: stimulate beta cells to INCREASE INSULIN SECRETION from the pancreas
    •  -nateglinide (starlix)
    •  -repaglinide (prandin)
    • *for decreasing BS at mealtimes
    • *taken 1-30 minutes PRIOR to eating (make sure meal is there)
    • *decreased chance of hypoglycemia
    • *SE: URI symptoms, HA, Hypoglycemia, weight gain
  41. Biguanides
    • *metformin (Glucophage)
    • *action:
    •  -decreases glucose production by the liver
    •  -decreases intestinal absorption of glucose
    •  -increases use of glucose by muscles and fat cell
    • *take with meals
    • *discontinue before giving contrast dye and restart after evaluating renal funciton
    • *SE: dizziness, fatigue, HA, agitation, metallic taste, GI distress, lactic acidosis, hepatotoxicity
    • *not directly stimulating insulin
  42. Thiazolidinediones (ATZDs)
    • *action: decrease insulin resistance by stimulating receptors on muscle cells to increase uptake of insulin
    •  -pioglitazone (actos)
    •  -rosiglitazone (Avandia)
    • *monitor weight
    • *SE: URIs, HEPATOTOXICITY, HA, edema, anemia, fluid retention, increase plasma volume
  43. Alpha Glucosidase Inhibitors
    • *action: inhibits enzyme that break down carbohydrates, thus slows digestion (works on GI tract)
    •  -acarbose (precise)
    •  -miglitol (glyset)
    • *can be combined with sulfonyurea
    • *give with the first bite of each meal
    • *SE: GI->flatulence, diarrhea, abdominal pain, cramping
  44. Contraindications for use of all oral antidiabetic medications
    • *known drug allergy
    • *severe kidney disease
    • *severe liver disease
    • *pregnancy
  45. NRSG implications: oral antidiabetic medications
    • *many combinations drug products avail-know what you are administrating
    • *must be sure client will tolerate food and plan to eat before administering
    • *check with MD for specific orders when patient is placed on NPO
    • *monitor liver and kidney function
    • *teach client to recognize symptoms and the treatment of hyperglycemia and hypoglycemia
    • *warn client to avoid alcohol
    • *encourage the use of medical alert bracelet
  46. Insulins
    • *rapid acting (clear)
    •  -onset 5-25 minutes
    •  -peak 30-90 minutes
    •  -lispro (Humalog)
    •  -Aspart (Novolog)
    •  -glulisine (apidra)

    • *short acting (clear)
    •  -onset 30 minutes
    •  -peak 2-4 hours
    •  -regular (humulin R)
    •  -only insulin which can be given IV

    • *Intermediate acting (cloudy)
    •  -onset 1-2 hrs
    •  -peak 6-12 hrs
    •  -isophane suspension (NPH, Humulin N)
    •  -zinc suspension (lente, humulin L)
    •  -given only sc

    • *long acting (clear)
    •  -onset 1 hr
    •  -peak- NONE
    •  -lantus
    •  -can not be mixed with any other insulin

    *mixtures (cloudy)
  47. sliding scale
    • *sliding scale insulin coverage
    • *adjusted doses dependent upon INDIVIDUAL blood glucose
    • *usually done before eating and at bedtime
    • *usually utilizes rapid or short acting insulin
  48. glucagon
    • *Glucagon
    •  -hyperglycemia hormone secreted by alpha cells of the isle of Langerhans in the pancreas
    •  -action: stimulates breakdown of stores glycogen to glucose in liver
    • *use: insulin induces hypoglycemia
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comp 8
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