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Pharm- Exam 2
Endocrine: chap 43 Pituitary, Thyroid, Adrenal Disorders
| Question | Answer |
|---|---|
| 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 th.skin/straie |
| 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! |
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