Organic chem extended

The pituitary gland, or _______, has an anterior and a
posterior lobe.

The endocrine system consists of ductless glands that secrete
hormones into the ________.

_______ are chemical substances synthesized from amino acids and cholesterol that act on body tissues and organs and affect cellular activity.

Hormones are chemical substances synthesized from _____ and ______ that act on body tissues and organs and affect cellular activity.

Hormones can be divided into two categories:

Hormones from the adrenal glands and the gonads are

The endocrine glands include the

The ________, or hypophysis, is located at the base of
the brain and has two lobes, the anterior pituitary gland
(adenohypophysis) and the posterior pituitary gland (neurohypophysis).

The anterior pituitary gland is called the ________
because it secretes hormones that stimulate the release of
other hormones from target glands, including the thyroid, adrenals, and gonads

The posterior pituitary gland secretes two
neurohormones—

The anterior pituitary hormones are

They control the
synthesis and release of hormones from the thyroid, adrenals, and ovaries

Other hormones secreted from the anterior pituitary gland include

The amount of each hormone secreted from the anterior pituitary gland is regulated by a

TSH, or thyrotropic hormone, stimulates the release of ______ and _________ from the thyroid
gland.

he anterior pituitary gland secretes TSH in response to ________ from the hypothalamus.

______ levels should be checked to determine whether there is a TSH deficit or excess

REMEMBER: A decreased T4 level and a normal or elevated
TSH level can indicate a thyroid disorder.

Secretion of ACTH occurs in response to ________ from the hypothalamus.

ACTH from the anterior pituitary gland stimulates
the release of

REMEMBER: More ACTH is secreted in the morning than in the evening

The _______  regulate hormone secretion from the ovaries
and testes (the gonads).

The anterior pituitary gland secretes the gonadotropic hormones ___,___,___

____ promotes the maturation of
follicles in the ovaries and initiates sperm production in the testes.

____combines with FSH in follicle maturation and estrogen production and promotes secretion of androgens from the testes.

_______ stimulates milk
formation in the glandular breast tissue after childbirth

_______, acts on all body tissues, particularly
the bones and skeletal muscles.

The amount of GH secreted is regulated
by ________ and _________ from the hypothalamus.

_______, _______, _______ can inhibit the secretion of GH

______ increases
the reabsorption of water from the renal tubules, returning it to the systemic circulation.

Secretion of ADH is regulated by the

stimulates contraction of the smooth muscle of the
uterus

The thyroid gland secretes two
hormones,_________________

These hormones affect nearly every tissue and organ by controlling their metabolic rate and activity

Stimulation by the thyroid hormones results in an _______
in cardiac output, oxygen consumption, carbohydrate use, protein synthesis, and breakdown of fat (lipolysis)

Thyroid hormone levels in the blood are regulated by

There are four parathyroid glands (two pairs) that lie on the ___________of the thyroid gland

The parathyroid gland secretes _______ or ________ which regulates calcium levels in the blood

REMEMBER: PTH increases calcium levels by (1) mobilizing calcium from the bone, (2) promoting calcium absorption from the intestine, and (3) promoting calcium reabsorption from the renal tubules

a hormone produced primarily by
the thyroid gland and to a lesser extent by the parathyroid and thymus glands, inhibits calcium reabsorption by bone and increases renal excretion of calcium.

the adrenal glands, located at the top of each kidney, consist of two separate sections—

The adrenal medulla
releases the __________& ____________ and is linked
with the sympathetic nervous system

The adrenal cortex produces two
major types of hormones ___________ & __________

The principal glucocorticoid is _________, and the principal mineralocorticoid is _________

The adrenal cortex also produces small amounts
of ______,_______,______

, located to the left of and behind the stomach, is both an
exocrine and an endocrine gland.

The exocrine section of the pancreas
secretes digestive enzymes into the

The endocrine section has cell
clusters called

The alpha islet cells produce ________,
which breaks glycogen down to glucose in the liver, and the beta cells secrete ______, which regulates glucose metabolism.

Growth hormone drugs cannot be given orally, because they are
inactivated by gastrointestinal enzymes.

Prolonged GH therapy can antagonize _____
secretion and eventually cause diabetes mellitus

REMEMBER: Athletes should be advised not to take GH to build muscle and physique because of its effects on blood sugar and other side effects.

__________ is a growth hormone used to treat
growth failure in children because of pituitary GH deficiency

remember: Somatropin is contraindicated in pediatric patients who have growth deficiency
due to Prader-Willi syndrome and are severely obese or who
have severe respiratory impairment, because fatalities associated with these risk factors have been reported.

Gigantism (excessive growth during childhood) and acromegaly (excessive growth after puberty) can occur with GH
hypersecretion and are frequently caused by a pituitary
tumor. If the tumor cannot be destroyed by radiation, the
prolactin-release inhibitor _________ can inhibit the
release of GH from the pituitary gland

is a potent synthetic somatostatin used to suppress GH release. It can be used alone or with surgery or radiation.

______, a purified extract of TSH, is used as a diagnostic agent to differentiate between primary and secondary
hypothyroidism.

Administration of ACTH intravenously
(IV) should increase the serum cortisol level in __ to __
minutes if the adrenal gland is functioning.

_________ stimulates the adrenal gland to
secrete corticosteroids

____ is added to some formulations to slow the absorption rate. (corticotropin)

Corticotropin has numerous drug
interactions. _____________ & __________ such
as piperacillin can decrease the serum potassium level (hypokalemia).

__________, __________, ________increase the metabolic rate, which can decrease the effect of the ACTH drug

REMEMBER: Persons with
diabetes may need increased insulin and oral antidiabetic
(hypoglycemic) drugs because ACTH stimulates cortisol
secretion, which increases the blood sugar level

The posterior pituitary gland, known as the neurohypophysis, secretes

a deficiency of ADH, large amounts of water are excreted by
the kidneys. This condition, called ________
can lead to severe fluid volume deficit and electrolyte imbalances.

_____ & ______ resulting in trauma to
the hypothalamus and pituitary gland can also cause DI

_____________ must be closely monitored in
these patients, and ADH replacement may be needed.

Observe patient’s weight. Check for edema if weight
gain occurs. A side effect of repository corticotropin is
___ & ________

REMEMBER: Dose should be tapered and not stopped
abruptly, because adrenal hypofunction may result.

Direct patient to decrease _______ to decrease or
avoid edema. Potassium supplement may be needed. (ACTH PT)

When there is excess secretion of ADH from the posterior
pituitary gland, the most common cause is _________

This ______ fluid volume causes enhanced glomerular filtration and _______ tubular sodium reabsorption. (eXCESS SECRETION OF ADH)

Natriuresis __________ results,
leading to hyponatremia.

SIADH can be treated by

The functions of T4 and T3 are to regulate
_________ & _________ and to stimulate mitochondrial oxidation

___ of circulating T3 is secreted from the thyroid gland, and ___ of T3 comes from the degradation of about 40% of T4, which occurs in the periphery

T4 and T3 are carried in the blood by _________ & ________ which protect the hormones from being degraded.

REMEMBER: T3 is more potent than T4, and
only unbound free T3 and T4 are active and produce a hormonal response.

REMEMBER: Excess free T4 and T3 inhibit the hypothalamus-pituitarythyroid (HPT) axis, which results in decreased TRH and TSH secretion. Likewise, too low an amount of T4 and T3 increases
the function of the HPT axis.

For thyroid deficiency (hypothyroidism), __________ may be prescribed, either alone or in combination.
When the thyroid gland secretes an overabundance of thyroid
hormones (hyperthyroidism), __________ are usually
indicated

a decrease in thyroid hormone secretion,
can have either a primary cause (__________) or
a secondary cause (____________).

Decreased _____ and elevated
_____ levels indicate primary hypothyroidism, the causes of
which are acute or chronic inflammation of the thyroid
gland,radioiodine therapy, excess intake of antithyroid drugs,
and surgery.

is severe hypothyroidism in the
adult; symptoms include lethargy, apathy, memory impairment, emotional changes, slow speech, deep coarse voice,
edema of the eyelids and face, dry skin, cold intolerance, slow punch, constipation, weight gain, and abnormal menses.

In children, hypothyroidism can have a congenital (______)
or prepubertal (_______) onset.

__________ is the drug of choice for
replacement therapy for the treatment of hypothyroidism.

__________ is also used
to treat simple goiter and chronic lymphocytic (Hashimoto)
thyroiditis.

__________ is a synthetic T3 that has a short
half-life and duration of action; it is not recommended for
maintenance therapy

. It increases the levels of T3 and T4.

REMEMBER: Liothyronine is better absorbed from
the GI tract than levothyroxine, and because of its rapid onset
of action and short half-life, it is frequently used as initial
therapy for treating myxedema.

_______ a mixture of levothyroxine sodium and liothyronine sodium in a 4 :1 ratio.

REMEMBER: For treating hypothyroidism, there is NO SIGNIFICANT ADVANTAGE to using liotrix over
levothyroxine sodium alone, because levothyroxine converts
T4 to T3 in the peripheral tissues

TRUE OR FALSE: The half-life of levothyroxine is longer than that of liothyronine.
True False

Liotrix is a combination of T4 and T3 with a greater
concentration of ___.

Thyroid preparations increase the effect
of __________ because of drug displacement from the
protein-binding sites

When these thyroid replacement drugs
are taken with an __________ (e.g., decongestant or
vasopressor), the cardiac and central nervous system (CNS)
actions are increased.

_________
can increase the effect of liothyronine.

__________ is an increase in circulating T4 and T3
levels, which usually results from an overactive thyroid
gland or excessive output of thyroid hormones from
one or more thyroid nodules.

is the most common type of
hyperthyroidism caused by hyperfunction of the thyroid
gland. It is characterized by a rapid pulse (tachycardia),
palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos (bulging eyes), and
weight loss.

____________
can control cardiac symptoms like palpitations and tachycardia that result from hyperthyroidism. It does not lower T4
and T3

Hyperthyroidism can be treated by surgical removal of
a portion of the thyroid gland (subtotal thyroidectomy),
radioactive iodine therapy, or antithyroid drugs,which inhibit
either synthesis or release of thyroid hormone. Any of these
treatments can cause __________

REMEMBER: The purpose of antithyroid drugs is to reduce the excessive secretion of thyroid hormones (T4 and T3) by inhibiting
thyroid secretion. The use of surgery (subtotal thyroidectomy) and radioiodine therapy frequently leads to hypothyroidism.

______________ are the drugs of
choice used to decrease thyroid hormone production. This
drug group interferes with synthesis of thyroid hormone.

Thiourea derivatives do not destroy thyroid tissue, but rather

are effective thioamide antithyroid drugs. They are useful for
treating thyrotoxic crisis and in preparation for subtotal thyroidectomy

does not inhibit peripheral conversion of T4 to T3 as does PTU; however, it is 10 times more
potent and it has a longer half-life than PTU.

Prolonged use of thioamides may cause _____ because of increased TSH secretion and inhibited T4 and T3 synthesis.

Strong iodide preparations such as ________ ______
have been used to suppress thyroid function for patients
who have undergone subtotal thyroidectomy as a result
of Graves’ disease

Antithyroid drugs interact with many
other drugs. When used with oral anticoagulants (e.g., warfarin [Coumadin]), they can cause an increase in the ________

thyroid drugs ________ the effect of insulin and oral antidiabetics;

______ & _________
increase the action of thyroid drugs; and phenytoin (Dilantin) increases serum T3 level.

The parathyroid glands secrete ____________  
which regulates calcium levels in the blood

A decrease in serum calcium stimulates the release of _____. _______ decreases serum calcium levels by promoting renal excretion of calcium

Parathyroid hormone agents treat __________.

___________ can be caused by PTH
deficiency, vitamin D deficiency, renal impairment, or diuretic
therapy, and PTH replacement helps correct the calcium
deficit.

REMEMBER: The action of PTH is to promote calcium absorption
from the GI tract, promote reabsorption of calcium from the
renal tubules, and activate vitamin D

________ is a vitamin D analogue that promotes calcium
absorption from the GI tract and secretion of calcium from
bone to the bloodstream

Calcitriol is readily absorbed from the GI tract.
Its half-life is moderate (____ to ____). Most of the drug is excreted in feces.

Caution patient to avoid foods that can inhibit thyroid
secretion

REMEMBER: Monitor patient’s weight. Weight gain commonly occurs in patients with hypothyroidism. (Thyroid Hormone, Nursing Interventions)

Encourage patient to take drug at same time each day,
preferably _______ breakfast. Food will hamper absorption rate.
(Thyroid Hormone, Patient Teaching)

Emphasize importance of drug compliance; abruptly
stopping antithyroid drug could bring on ______

REMEMBER: Advise patient to avoid antithyroid drugs if pregnant or breastfeeding. Antithyroid drugs taken during pregnancy can cause hypothyroidism in fetus or infant.

A serious adverse reaction of antithyroid drugs is ______________. Complete blood count should be monitored for leukopenia.

The paired adrenal glands consist of the

The adrenal cortex produces two types of
hormones, or corticosteroids:

______ is secreted by the
adrenal glands in response to the hypothalamus-pituitaryadrenal (HPA) axis as a result of the feedback mechanism

A decrease in serum cortisol levels increases  _____ & _____ secretions, which stimulate the adrenal glands to secrete and release cortisol.

promote sodium retention and potassium excretion. A sodium ion is reabsorbed from the renal tubule in exchange for a potassium ion; the potassium ion is then excreted

A decrease in corticosteroid secretion is called __________

increase in corticosteroid secretion is called

REMEMBER: Monitor serum calcium level. Normal reference value is 4.5 to 5.5 mg/dL (ionized or free-flowing calcium in
the blood) or 8 to 10 mg/dL (total calcium, including
free-flowing calcium or calcium bound to albumin).

HYPOPARATHYROIDISM - PATIENT TEACHING :Direct patient to report symptoms of tetany ( symptom of involuntary muscle cramps and spasms due to abnormal electrolyte levels, especially calcium )

HYPERPARATHYROIDISM - PATIENT TEACHING: Teach patient to report signs and symptoms of hypercalcemia: bone pain, anorexia, nausea, vomiting, thirst, constipation, lethargy, bradycardia, and polyuria

_________ are influenced by ACTH, which is released
from the anterior pituitary gland. They affect carbohydrate,
protein, and fat metabolism and muscle and blood cell activity.

REMEMBER: Because of their many mineralocorticoid effects, glucocorticoids can cause sodium absorption from the kidney,
resulting in water retention, potassium loss, and increased
blood pressure.

the main glucocorticoid, has antiinflammatory, antiallergic, and antistress effects.

Indications for glucocorticoid therapy include trauma, surgery, inflammation, emotional upsets, and anxiety

Most of the wide variety of glucocorticoid drugs, frequently called ________, is synthetically produced.
These drugs have several routes of administration: oral, parenteral (IM or IV), topical (creams, ointments, lotions), and aerosol (inhaler). The IM route, although seldom used,
should be administered deep into the muscle. The subQ route
is not recommended.

Among the inflammatory conditions that may
require glucocorticoids are autoimmune disorders (e.g., multiple sclerosis, rheumatoid arthritis, myasthenia gravis);
ulcerative colitis; glomerulonephritis; shock; ocular and vascular inflammations; polyarteritis nodosa; and hepatitis.
Allergic conditions include asthma, drug reactions, contact
dermatitis, and anaphylaxis

Organ transplant recipients
may require ________ to prevent organ rejection.

________ has been used to treat
severe inflammatory response resulting from head trauma or
allergic reactions

An inexpensive glucocorticoid frequently
prescribed is ______

The major actions of prednisone are to suppress an acute inflammatory process and for immunosuppression

Most of the glucocorticoids are pregnancy category

Agents used for adrenocortical insufficiency contain
both__________ and ________, whereas drugs
for antiinflammatory or immunosuppressive use contain
mostly _________.

The side effects and
adverse reactions of glucocorticoids that result from high
doses or prolonged use include increased blood sugar, abnormal fat deposits in the face and trunk so called -

. Long-term use of glucocorticoid drugs can cause___________

REMEMBER: When drug therapy is discontinued, the dose should be tapered to allow the adrenal cortex to produce cortisol and other corticosteroids. Abrupt withdrawal of the drug can result in severe adrenocortical insufficiency

Barbiturates, phenytoin, and rifampin decrease the effect
of ________ because they increase glucocorticoid metabolism.

a potent glucocorticoid, interacts with
many drugs.

REMEMBER: Phenytoin, theophylline, rifampin, barbiturates,
and antacids decrease the action of dexamethasone, whereas
NSAIDs, including aspirin, and estrogen increase its action.

Glucocorticoids can increase blood sugar levels, so _____ or
________ drug dosage may need to be increased

REMEMBER: When the drug (glucocorticoids) is given with diuretics or anti-Pseudomonas penicillin preparations, the serum potassium level may decrease markedly.

_________ the second type of corticosteroid, secrete
aldosterone

Aldosterone is controlled by the _________ , not by ACTH

These hormones maintain
fluid balance by promoting the reabsorption of sodium from
the renal tubules

Sodium attracts water, resulting in

(decrease in circulating fluid) occurs, more aldosterone is secreted to increase sodium and water retention and restore fluid balance.

With sodium reabsorption, potassium is lost and _____________ can occur.

Some glucocorticoid drugs also contain
mineralocorticoids; these include ______ & ______

A severe decrease in the mineralocorticoid aldosterone
leads to _________ & _______, as seen in Addison’s disease.

Mineralocorticoid deficiency usually occurs
with glucocorticoid deficiency, frequently called

____ is an oral mineralocorticoid that can be given with a glucocorticoid. .It can cause a negative
nitrogen balance; therefore a HIGH-PROTEIN DIET is usually indicated.

REMEMBER: Because potassium excretion occurs with the use of
mineralocorticoids and glucocorticoids, the SERUM POTASSIUM LEVEL should be monitored.

Watch carefully for signs and symptoms of hypokalemia: nausea, vomiting, muscular weakness, abdominal
distention, paralytic ileus, and irregular heart rate.
■ Assess for side effects from glucocorticoid drugs when
therapy has lasted more than 10 days and drug is
taken in high dosages. Cortisone preparation should
not be abruptly stopped, because adrenal crisis can
result.

Advise patient to take drug as prescribed. Caution
patient not to abruptly stop drug. When drug is discontinued, dose is tapered over 1 to 2 weeks

Direct patient not to take cortisone preparations (oral
or topical) during pregnancy unless necessary and prescribed by health care provider. Drugs may be harmful
to fetus.

Encourage patient to carry MedicAlert identification
card, tag, or bracelet stating glucocorticoid taken