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Endocrine Drug therapy

Endocrine System Consists of ductless glands that secrete hormones into the blood stream. Interacts with neuro system***.
Organs in the endocrine system Hypothalamus pituitary, parathyroid, thyroid, adrenals, pancreas, ovaries, testes
Hormones in endocrine system Chemicals secreted into the blood, regulate growth and development, fluid and electrolyte balance, reproduction, adaptation to stress, metabolism.
Pituitary Gland/Hypophysis Located at the base of the brain 3 lobes. Anterior:growth, reproduction, metabolic processes. Middle:endorphins and enkephalins in response to severe pain or stress. Posterior:osmolarity, fluid balance, uterine contraction, let-down reflex(mother nursing)
Anterior pituitary gland (adenohypophysis) "master-gland"-secretes hormones that stimulate the release of hormones from targer glands.
GH Growth Hormone a hormone that stimulates growth in animal or plant cells, esp. (in animals)
ACTH adrenocorticaltropic hormone stimulates the secretion of cortisone, aldosterone, and other hormones by the adrenal cortex.
FSH follicle stimulating hormone Stimulates ovaries to release eggs
LT Luteinizing hormone In females, an acute rise of LH triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone (ICSH),it stimulates Leydig cell production of testosterone
PRL Prolactin Stimulates milk production after child birth
TSH Thyroid stimulating hormone Regulates the production of thyroid hormones
Leuprolide (Lupron)** Occupies pituitary GnRH receptor sites so that they no longer respond to GnRH. Used as tx for endometriosis and as antineoplastic for some cancers
Nafarelin (Synarel) A potent agonist of GnRH; decreases production of gonadal hormones by repeated stimulation of receptor sites
Corticotropin (Acthar) or ACTH Test* adrenal function and responsiveness
Cosyntropin (Cortrosyn)** Drug used to Diagnose adrenal dysfunction
Menotropins (Pergonal)** Fertility drug. Mimics gonad relasing hormone.
Somatropin (Nutropin) Growth failure, turner's syndrome, AIDS, growth hormone deficiency
Somatropin** Influences growth of bones and muscles (does not have a specific target gland). Influences protein, lipid, carbohydrate and calcium metabolism. Deficiency: dwarfism. Excess: gigantism, acromegaly.
Somatropin as tx of growth hormone deficiency Replacement tx. Given before bone epiphyses are fused. Not for adults to increase muscle. Prolonged use can lead to hypothyroidism and insulin resistance diabetes***. Can be used in adults with short bowel syndrome (slows down GI).
ADH (vasopressin)** Secreted by posterior pituitary. Antidiuretic hormone. Decreases loss of Na and water through renal tubules. Maintains water balance.
Water balance in body excess-fluid overload** deficit- diabetes insipidus, dehydration** ADH replacement to tx diabetes insipidus.
DDAVP (desmopressin acetate)** Can affect clotting. Hemophilia A. Nocturnal enuresis. Given intranasally.
Vasopressin (Pitressin) Can be used for GI bleed, esoph. varices (constricts vessels)
Adrenocorticotropic Hormone (ACTH) Stimulates release of glucocorticoids (cortisol), mineralocorticoids (aldosterone), androgen from adrenal cortex****
ACTH corticotropin (Acthar) Cosyntropin (Cortrosyn)***. Used for diagnosis of adrenal gland disorders. Used to tx adrenal insufficiencies. Used as an anti-inflammatory for allergic response. Used to tx multiple sclerosis, other autoimmune disease.
Adrenal Glands Consist of the adrenal medulla and adrenal cortex** glucocorticoid, mineralocorticoids, androgens. Control salt, sex, and sugar**
Mineralcorticoids Salt: aldosterone regulates Na and H2O
Androgens Sex: regulate some sexual characteristics, small influence
Glucocorticoids Sugar: glucose metabolism and storage, depresses immune system (decreases lymphocyte action). Also referred to as "stress hormone" increased release in fight or flight. Infection, surgery, pain, trauma, fear.
Why does diabetes get out of control in fight or flight situations? Body releases glucocorticoids when stressed.
Actions of Adrenocortical Hormones Increase blood volume (aldosterone effect). Cause the release of glucose for energy. Slow rate of protein production (reserves energy). Block activities of the inflammatory and immune systems (reserves a great deal of energy)
Uses for adrenal corticosteroids Generally used for anti inflammatory and immunosuppression. (Autoimmune diseases, allergy reaction such as asthma. Transplant therapy).
Adrenal Corticosteroids adjunct therapy with chemotherapy in cancer Pain control, nausea control, reduce inflammation related to cell death, reduce brain swelling.
Adrenal Corticosteroid routes of administration Give oral, IM, IV, inhaled, topical, rectal
Mineralocorticoids--Aldosterone Controlled by renin-angiotensin system. Maintain fluid balance by reabsorption of Na and water. Too little= decrease in B/P and vascular collapse. Body can't survive without glucocorticoids and mineralcorticoids!!
Fludrocorticones (Florinef)** An oral mineralocorticoid. High protein diet and monitor serum potassium levels. Sometimes used for elderly. Monitor B/P, and weight for fluid status.
Glucocorticoids (Cortisol)** Antiinflammatory, immunosuppressant, adjunct pain, antiemetic effects. Ex: include decadron, prednisone, hydrocortisone
Adverse affects of Glucocorticoids Increase glucose, B/P, decreases K***. Abnormal fat deposits (moon face and buffalo hump), muscle wasting, edema, euphoric, psychosis, nightmares**, skin thinning, infection risk**. Long term can lead to loss of adrenal gland function** ALWAYS TAPER DRUG
Cushing's Syndrome Too much corticosteroid secretion by the Adrenal Glands
Addison's Syndrome Too little corticosteroid secretion by the Adrenal Gland
Drug side effects of corticosteroid resemble Cushing's ** Abnormal fat deposits, muscle wasting, edema, euphoria, psychosis, nightmares. Long term can lead to loss of adrenal gland function.
Drug withdrawal or too little corticosteroid resemble Addison's crisis* Adrenal crisis. low b/p. Low glucose. Fatigue, weakness, physical exhaustion, coma, death.
Nursing interventions Check for drug and herbal interactions. Don't stop suddenly** Dosage adjustment if stressors increased (illness, surgery)**. Monitor weight, I&O, K, Na, Glucose**. Increase vigilance for infection, symptoms may be decreased (inflammatory signs decreased)
Gastric Mucosal Nursing interventions Take with food. Nutrition changes (glucose, Na, fats) appetite increased, gluconeogenesis. May predispose or worsen diabetes mellitus.
Thyroid-stimulating Hormone (TSH) Targets thyroid gland to stimulate production and release of thyroid hormones. Excess=hyperthyroidism. Deficiency=hypothyroidism.
Thyrotropin Used to diagnose primary or secondary hypothyroidism. If drug given and thyroid level increased, indicates that thyroid gland is OK, problem is at pituitary level. If there is no increase in levels, the problem is with the thyroid gland(hypothyroidism).
Actions of thyroid gland Produces two thyroid hormones using iodine found in the diet: Tetraiodothyronine or levothyroxine (T4). Triiodothyronine or liothyronine (T3). Removes iodine from blood, concentrates it, and prepares it for attachment to tyrosine, an amino acid.
Functions of thyroid hormones regulate the rate of metabolism. Affect heat production, and body temperature. Affect O2 consumption, cardiac output, and blood volume. Affect enzyme system activity. Affect metabolism. Regulate growth and development. Bottom line=everything is affected!
Hyperthyroidism Caused by overactive thyroid or high TSH (could be thyroid tumor). Increases the rate of the majority of body functions.
Grave's disease (thyrotoxicosis)** Most common type of hyperthyroidism. S/S: Tachycardia, palpations, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos, and weight loss.
Treatment of Hyperthyroidism Goal is to decrease secretion of thyroid**. Radioactive iodine-kills thyroid cells (must have thyroid hormone replaced synthetically). Iodine SSKI (Lugol's) give pre-op to reduce size and vascularity.
Antithyroid drugs Decrease thyroid hormone production. Propylthiouracil (PTU)**. Methimazole (Tapozole). Sodium iodide IV is used for thyrotoxic crisis.
Iodine solutions Actions: cause thyroid cells to become oversaturated with iodine and stop producing thyroid hormone Indications: presurgical suppression of the thyroid gland. Acute thyrotoxicosis.
Iodine solutions pharmacokinetics Absorbed from GI tract and well distributed throughout the body. Excretion through the urine.
Hypothyroidism Caused by decrease TSH, or thyroid tissue dysfunction causing decreased secretion of T4 and T3, lack of iodine in diet. SLOWS a majority of body functions: Sluggish thinking, weight gain, intolerant to cold.
Myxedema Very severe hypothyroidism**. May lead to heart failure or coma.
Levothyroxine (Synthroid)** Tx of hypothyroidism. Increase T3 &T4. Desire to make euthyroid (normal). Administer drug in morning to avoid sleep disturbances.
Nursing Assessment Assess for improvement of symptoms, watch cardiac function, drug interactions r/t protein binding (fighting for the protein)**
Overdose of Levothyroxine Hyperthyroid symptoms**
Thyroid Desiccated (Armour) Prepared from dried animal thyroid glands and contains both T3 and T4
Hypoparathyroidism* The absence of parathormone. Most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery.
Hyperparathyroidism* The excessive production of parathormone. Can occur as a result of parathyroid tumor or certain genetic disorders.
Parathyroid related to serum calcium Decrease PTH=decrease serum calcium Increase PTH=increase serum calcium
Parathyroid Hormone (PTH)secretion Decrease serum Ca+ stimulates increase PTH. Increase mobilize Ca+ from bone, increase GI absorption, increase renal re-absorption. Increase serum calcium.
Excess of PTH Creates hypercalcemia
Bisphosphonates Alendronate (Fosamax), ibandronate (Boniva). Act on the serum levels of calcium and not directly on the parathyroid gland or PTH. Slow normal and abnormal bone resorption. SE: headache, nausea, and diarrhea
Fosamax Must sit up for at least 30 min, full glass of water**
Calcitonins Decrease serum Ca by increasing renal excretion of Ca+. Ex. Calcitonin salmon (Miacalcin). Inhibit bone reabsorption. SE: flushing of face and hands
Calcitonin and Biphosphonate uses Used to prevent bone density in renal failure pt because they have high phosphorus level, Ca and Phos have inverse relationship, if phos high--serum Ca low.
Hypocalcemia Deficit of PTH. Tx: calcitriol (Rocaltrol) (Vit D)** Increases GI absorption of Ca+ to increase serum Ca. Increase release of Ca+ from bone. Consequences: decreased bone density, fractures.
Teriparitide (Forteo) Management of osteoporosis.
Created by: senmark



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