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Pharm- Exam 2

Endocrine: chap 43 Pituitary, Thyroid, Adrenal Disorders

Two Types of Cells in the Thyroid Gland Parafollicular Cells (calcitonin) Folliculare Cells (thyroid hormone)
The thyroid is controlled by? Anterior Pituitary Gland
Thyroid controls the... Metabolism of the body (every cell in the body)
Thyroid also affects (4) Growth and Development Mental Development (especially in children) Sexual maturity Affects: Cardiovascular, Respiratory, GI, Neuromuscular
Negative Feedback occurs when...Then... When the hypothalamus does not sense enough T3 or T4. Releases THR, which goes to the Pituitary Gland
What is essential for the synthesis of T3 and T4. Where is it commonly found? Iodine, Morton's Salt
Lack of iodine in a diet can result in... Goiter (enlarged thyroid gland)
The major hormone secreted by the thyroid gland is... T4 (but is converted to T3 before it enters target cells) -T3 is 3-5x more biologically active than T4
What is Hypothyroidism Low T3 and T4 levels
What happens in Hypothyroidism? Hint: negative feedback loop -Hypothalamus is not sensing enough (T3/T4) -tells pituitary to secrete more -High TSH levels -tells the pituitary gland to produce more TSH -TSH tries thyroid, no production (T3/T4) -TSH levels up, low thyroid function. Negative Feedback Loop
Most common cause of Hypothyroid Hashimoto's Thyroiditis -destruction of thyroid gland due to chronic autoimmune thyroiditis --> surgical removal, Amiodarone, aggressive anti-thyroid drugs
Early symptoms of hypothyroid (myxedema) in adults (8) a. general weakness b. muscle cramps c. dry skin 3. Severe symptoms: a. slurred speech b. bradycardia c. weight gain decreased sense of taste and smell d. intolerance to cold
Nursing Assessment for Hypothyroidism Baseline Vitals, Weight, TSH/T3/T4 Lvl, Lifelong med Take on empty stomach before breakfast, No brand change, Not to be used for weight loss-be aware some of your clients may not report adverse effects (pt wants to lose weight) weigh patients
What is Hyperthyroidism and some symptoms/ Too much Thyroid hormone(T3/T4), -Always hot/can't gain wt./diarrhea/irritable/mentally scattered.
What is the most common type of Hyperthyroidism Graves Disease- autoimmune disease that develops antibodies to own thyroid (pregnancy, pituitary tumors, thyroid tumors)
How is Hyperthyroidism controlled Medications or surgical removal
Hyperthyroid treatments (3) -PTU/Tapazole -Iodine 131 (radioactive iodine that kills the thyroid tissue, just enough for thyroid to function normally)
What is a Thyroid Storm Life threatening form of hyperthyroidism -occasionally after surgery (due to extra T3/T4 secretion
What is the mortality rate of a Thyroid Storm if left untreated? 80-90%
Thyroid Storm symptoms (6) High fever Tachycardia heart failure/angina MI agitation restless, delirium progresses to a coma
Hyperthyroid Storm Treatments (2) -PTU/Tapazole is the treatment along with supportive care for the fever (Tylenol) -Beta blockers: to treat the heart rate and blood pressure (remember this storm is from sympathetic nervous system overproduction-best treatment is beta blockers)
Adrenal Glands Locations -Sit on top kidneys -Inner Adrenal Gland "Medulla" (Epinep/Norep) -Outer Adrenal Gland "Cortex"
Outer Adrenal Gland Hormones (3) -Sugar-Glucocorticoids -Salt-Mineralocorticoids -Sex-Gonadocorticoids (Androgens)
Gonadocorticoids Androgens- male sex hormones Small amount of estrogen Onset of puberty Endogenous estrogen for post menopausal women Tumors can lead to hirsutism and masculinity in women
Mineralocorticoids -salts-Aldosterone-95% Aldos-regul-plasma vol/reabsorb NA/K deple -Plasma fall/kidn releas renin to ang 1 to ang 2 to releas Aldos which resorb Na/K depl
Two Ways of Increasing Fluid Volume by Mineralocorticoids -ADH -Aldosterone
ADH Works How? sent by the "PITUITARY" to have the kidneys reabsorb fluid by acting on the collecting ducts of the kidneys -NA UP! / K DOWN!
Aldosterone works how? sensed by the "KIDNEYS"-release of renin-converts angiotensin 1 to 2-angiotensin 2 allows aldosterone to act on the kidneys to increase sodium reabsorption and potassium depletion -NA UP! / K DOWN!
Glucocorticoids scenario: What if you have low glucocorticoid levels? -"HYPOTHALAMUS" senses low glucocorticoid levels! -HYPO releases CRF to PITUITARY! -PITUITARY releases ACTH to ADRENAL CORTEX! -ADRENAL CORTEX releases GLUCOCORTICOIDS!
Glucocorticoids support? -Blood Pressure -GI functions -Mental Functions -Help control the Immune response mechanisms
Uses of Glucocorticoids Adrenal Insufficiency Allergies Asthma Inflammatory Bowel Disease (Crohn’s/Ulcerative Colitis Cancer-Hodgkin’s/Leukemia’s/Lymphoma’s Transplant Rejection Prophylaxis Rheumatic Disorders Shock Skin Disorders
Glucocorticoids TYPES 20 Different Types -PO -IV -IM
Glucocorticoids DRUG INFO Prototype Drug: HydrocortiSONE/Cortef -Look for the ending "SONE" -Give with food -Give as prescribed "Contraindications": diabetes, osteoporosis, psychoses, liver disease, hypothyroidism
CORTICOSTEROIDS Methylprednisolone Dexamethasone Prednisone
CORTICOSTEROIDS The Good ! -Stop/control/reduce "INFLAMMATORY RESPONSE" -Local/Systemic (any part of body) -BY: suppressing IMMUNE Systems
CORTICOSTEROIDS The Bad ! -Slow deterioration of the Body! -It's a Trade off! ; Steroid use better than leaving inflammation unchecked
CORTICOSTEROIDS The Ugly ! -Dose amt/Duration use = extent of Dependency/Damage to body! -"Watch For": -Edema -Peptic Ulcers -Delayed Wound Healing -Osteoporosis -Infections
CORTICOSTEROIDS (8) Side Effects ! 1.Immune Response 2.Peptic Ulcers 3.Osteoporosis 4.Psychoses 5.Eye Complications 6.Sodium/water retention 7.Metabolic Changes 8.Myopathy
CORTICOSTEROIDS Special Note! -Helps maintain BLOOD PRESSURE -Stagger Dose Down--so gives --Adrenal Cortex a chance to wake back up! Ex. Addison's crisis you must wean
CORTICOSTEROIDS Side Effects Immune Response! -suppression of the inflammatory response-will be more susceptible to "INFECTION" -signs of infection will be masked-avoid anyone with an infections, -"monitor for fever"
CORTICOSTEROIDS Side Effects PEPTIC ULCERS ! If your pt has Peptic Ulcers, what would you teach them? -Give with Food, -Give prophylactic H2 or PPI, -"Do NOT give with NSAIDS! -Monitor for abd pain! -coffee ground emesis, -tarry stools,
CORTICOSTEROIDS Side Effects If your pt has OSTEOPOROSIS, what would you teach them? -Have client take Calcium and Vit D -or bisphosphanates such as Fosamax -weight bearing exercise-"walking"
CORTICOSTEROIDS Side Effects If your PT. has PSYCHOSES, what would be important to monitor? -Monitor for irritability -nervousness -mood changes before increasing to hallucinations -psychoses -suicidal ideation
CORTICOSTEROIDS Side Effects If your pt. has EYE COMPLICATIONS, such as Cataracts or open angle glaucoma, what would you instruct them to keep up with? -yearly eye exams -"Monitor for increasing need to light to read"
CORTICOSTEROIDS Side Effects-If your pt. comes in with high Blood Pressure, Weight, I/O, Breath Sounds, Sodium and Potassium Levels-Hypernatremia and Hyperkalemia What might you first look at? SODIUM and WATER Retention
CORTICOSTEROIDS Side Effects If a pt is having METABOLIC CHANGES in response to corticosteroids what might you see? -Raises glucose levels-hyperglycemia, mobilization of lipids-hyperlipidemia and abnormal fat deposits and weight gain (if the client is holding a lot of extra fluid can cause hypokalemia)
CORTICOSTEROIDS Side Effects If a pt. has MYOPATHY due to the use of corticosteroids what is happening and what might you monitor? -Muscle wasting-loss of muscles cells-hyperkalemia. -monitor Potassium levels, fatigue and weakness especially of eye and respiratory muscles
Glucocorticoids with ADDISON'S if pt. no longer needs the medication what must you do? and Why? "MUST WEAN OFF DRUGS" -because Adrenal gland shrinks/atrophy with long term use! -If we taper then AG can return to normal function -If we suddenly "STOP" we get "ADDISON'S CRISIS"
"ADDISON'S CRISIS" Would you want to just "Stop" Glucocorticoids? What is it? -No!! If we suddenly "STOP" the glucocorticoids! -start losing there blood pressure -have renal failure -be very tired and lethargic -nausea/vomiting -asthenia (lack of strength) -will "DIE" w/OUT dose of glucocorticoids!
ADDISON'S DISEASE Describe it? -Adrenocortical Insufficiency-
ADDISON'S DISEASE Symptoms -Bronze Pigmentation of Skin -Tachycardia -Depression -Hypoglycemia -Postural Hypotention (Orthost Hypotent) -Wt Loss (Anorexia) -Weakness Fatigue -GI Disturbances
"ADRENAL CRISIS" Addison's Disease -"Death" w/out Glucocorticoids -Profound Fatigue -Dehydration -Vascular Collapse (Drop BP) -renal failure -NVD -Lack of Strength -Drop Serum NA+ -Drop serum K+
Cushing’s Syndrome Too much glucocorticoids for a long time
Cushing’s Syndrome Signs -"MOON FACE"- -Adrenal atrophy, osteoporosis, hypertension, increased risk of infections, delayed wound healing, acne, peptic ulcers, general obesity, redistribution of fat around-shoulders, and neck-Buffalo Hump-Mood/personality changed
Cushing’s Syndrome Complications: If person has Cushing syndrome and also has hypertension from Na and water retention what could happen? High "MORTALITY" rate = "DEATH"
Cushing’s Syndrome Medication Complications NSAID’s and Alcohol-may increase chance of GI Bleed Oral Anticoagulants may increase or decease anticoagulation Use with diuretic, may increase K depletion-monitor EKG and K levels Vaccines-may reduce the antibody response to vaccine
Cushing’s Syndrome Medication Interactions #2 Oral Anticoagulation -may increase or decrease anticoagulation
Cushing’s Syndrome Medication Interactions #3 USE WITH DIURETIC, What should you monitor? -may increase K depletion -monitor EKG and K levels
Cushing’s Syndrome Medication Interactions #4 If you get vaccinated and have Cushing syndrome what might you expect? -might have reduced antibody response to vaccine.
If a pt is taking Corticosteroids and is having water and NA retention what are 2 major things that can be going on? -HYPERNATREMIA AND HYPERKALEMIA
A PT. has "Metabolic changes due to being on corticosteroids, there glucose levels are high(hyperglycemia),and (hyperlipidemia)if pt is holding a lot of extra fluid what can it cause? -HYPOKALEMIA
A pt. has MYOPATHY (muscle wasting/loss of m.cell) due to use of corticosteroids, what is the first thing you should look for? -HYPERKALEMIA
If you over treat a pt. with Tapazole(PTU) for hyperthyroid what can happen/ "Slug" = hypothyroid
If you over treat a pt. with Hypothyroid with SYNTHROID(synthetic T3)you can cause what? Hyperthyroid
T3 is 3-5 times more biologically more active than? T4
Isolated Fact: The strongest stimulation for Thyroid Hormone production? -Exposure to cold
Pituitary: Another word for Growth Hormone(GH)? -Somatotropin
How can growth hormone help children? -can increase height by 6 inches
Growth hormone can now be obtained through? -DNA technology
Some side effects to Growth hormone can be these 2? -Hyperglycemia -Hypothyroidism
What should you NOT give with Growth Hormone? Corticosteroids
Three basic things that should be monitored with GH is? -Height -Weight -Growth Patterns
You are preparing the growth hormone before administration, how should you handle the vial? -gently rotate to mix -DO NOT SHAKE!!
ALL!! Recombinant DNA meds are Not to be? SHAKEN!!!
the pituitary regulates ADH, what is it used to maintain? -Fluid Balance -Control BP -Cardiac output in body!
Because diuretics allow fluids to be lost through kidneys, ADH does what? -HOLDS FLUID!!
Hypothalamus will send ADH to increase the amt. of fluid retained by kidneys when? -if plasma volume decreases -Na levels have risen/osmolality of blood
Diabetes Insipidus is basically? -no ADH -Insufficient ADH
When you don't have any ADH, like in Diabetes Insipidus what happens in your body? -Allows for Large amt. of "FLUID LOSS"
If a pt comes in with a head injury or lung cancer what might you see? -DI
ADH/Vassopressin/Desmopressin/DDAVP can all be given when? During a Code
What is the Half life of Vassopressin? 2-8 hours
What is the Half life of Desmopressin? 20 hours
An off label use- for bedwetting in Children would lead you to use what drug(s)? ADH/Vassopressin/Desmopressin/DDAVP
ADH/Vassopressin/Desmopressin/DDAVP promotes? -water reabsorption by kidneys -vasoconstriction -increase Clotting factor VIII
What is Clotting factor VIII used with? -Hemophilia -Von Wildebrand's Disease
ADH side effects? -Fluid Overload -Myocaridal Ischemia from Vasoconstriction
If Fluid overload(reabsorbed too much water)is a side effect From the use of ADH,that a pt. is experiencing what would you monitor for? -Edema -Hypertension -Pounding Headache -Sleepiness
If MI is a side effect from the use of ADH, what would you monitor for? -Monitor EKG -Blood Pressure -Chest pain -Dyspnea -Diaphhoresis
Category for ADH and Pregnant women? X
When should you NOT use ADH in patients? -pts with CAD -pts with Decreased Peripheral Circulation -pts with Chronic Nephritis
Nursing considerations for ADH: Monitor for? -Vital signs -I/O -specific Gravity -daily weights -Electrolytes -signs of water Intoxication -headache(pounding), confusion, edema, hypertension, sleepiness
When using ADH, Extravasation of IV vasopression Can lead to? Gangrene!!
How do you know if ADH use has been effective? -When have normal urine output, without signs of fluid overload.
What is a major Nursing Consideration to watch for with use of ADH? -Water INTOXICATION!!
What food's is Iodine found fish, gravies, Yogurt, Dairy, eggs
With Aldosterone retaining Na is means that you also retain water with leads to _______? High BP!
Created by: learning19



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