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endocrine drugs
pharm exam 3: hormonal agents
| Question | Answer |
|---|---|
| define hormone | chemical, synthesized within an organism which alters the rate of cellular processes (metabolism) |
| sources of hormones used as drugs | animals, plants, fermentation |
| 2 types of hormones | steroid and protein |
| describe steroid hormones | cholesterol base; taken by mouth |
| describe protein hormones | destroyed by digestive enzymes; cannot be taken by mouth |
| hormones released from posterior pituitary | oxytocin; ADH |
| hormones released from anterior pituitary | TSH; ACTH; FSH; LH; grwoth hormone; Prolactin; endorphins |
| function of oxytocin (pitocin) | stimualtes uterine muscles, promotes ejection of milk from breasts |
| when will uterus respond to pitocin? | only when pregnant |
| therapeutic uses of pitocin | induce labor, constrict uterus, decrease hemorrhage after birth |
| Why would patient have hemorrhage after birth? | uterus is not contracting well |
| kinetics of pitocin | IV |
| side effects of pitocin | uterine tetany (seizure = clamping down) |
| nursing considerations of pitocin | titration of dosage according to uterine response; monitoring fetal heart rate |
| action of ADH (vasopressin) | maintain osmotic pressure and extracellular fluids by water reabsorption in distal tubules of kidney |
| 3 examples of osmoreceptors and vascular baroreceptors | carotid; aortic; pulmonary |
| when is vasopressin released? | blood osmolarity increases; extracellular fluid decreases |
| define inappropriate ADH | increased secretion |
| define anuria | no urine output; water retention; hyponatremia |
| When vasopressin is prescribed what treatment is seen along with it? | fluid restriction |
| describe diabetes insipidus | decrease secretion; polyuria |
| what does polyuria lead to in diabetes insipidus | dehydration; hypernatremia, polydipsia |
| define polydipsia | excessive thirst |
| What is DI associated with | brain trauma; meningitis |
| prototypes for decreased ADH secretion | vasopressin (Pitressin); desmopressin acetate (DDAVP) |
| Why is DDAVP the most common ADH secretion prototype | no vasopressor action = does not elevate BO |
| action of vasopressin/DDAVP | restore fluid and electrolytes |
| kinetics of vasopressin/DDAVP | po (DDAVP); IM; SQ; nasal spray; sublingual |
| what type of hormone is vasopressin/DDAVP | steroid |
| side effects of vasopressin/DDAVP | HTN; water intoxication; anginal pain; cardiac arrest |
| signs and symptoms of water intoxication | headache; drowsiness; confusion |
| nursing considerations of wasopressin/DDAVP | monitor urinary output; specific gravity; EKG |
| dynamics of growth hormone (somatotropin) | body growth, cellular protein (needs thyroid); fat metabolism; increased hepatic glucose |
| names of excess in growth hormone | gigantism, acromegaly |
| describe acromegaly | after growth plates close; GH still released; fingers enlarge |
| name of deficiency in growth hormone | dwarfism |
| describe dwarfism | proportional but short |
| describe chondroplasia | little people = big torso; small arms |
| what happens to frontal lobe in gigantism | thins out |
| drug prototype for growth hormone excess | octreotide (Sandostatin) |
| what does octreotide (sandostatin) do | suppress GH release |
| How is octreotide (sandostatin) used | alone or with radiation/surgery |
| octreotide (sandostatin) kinetics | po |
| side effects of octreotide (sandostatin) | constipation |
| drug prototype for growth hormone deficit | somatrem (protropin) and somatotropin (Humatrope) |
| When is somatrem (protropin) given | if child is in low percentile for consecutive years |
| effects of somatrem (protropin) on children | will grow 1 inch per year and can only give for 5 years |
| dynamics of somatrem (protropin)/somatotropin (humatrope) | new formed bones (before epiphyses formed) = increased height |
| side effects of somatrem (protropin)/somatotropin (humatrope) | hyperglycemia (diabetes); stimulates metabolism and damages pancreas |
| metabolism is associated with which gland | thyroid |
| actions of thyroid | increased metabolic rate; increased CO; protein metabolism; regulated calcium metabolism; growth and development of CNS |
| define goiter | enlarged thyroid |
| what does a goiter result from | low iodine in diet or soil |
| What region of the country has low iodine in diet | midwest |
| where do you get iodine in diet | shell fish; salt water; fish; seaweed; vegetables |
| Why does goiter result from low idoine in diet | gland enlarges to try to produce more |
| What drug is used for goiter | iodine |
| what fish is high in iodine | eel |
| what vegetables are high in iodine | spinach, kale, dark green vegetables |
| kinetics of iodine | po (iodized salt) |
| What is given before a goiter surgery | Lugal's solution or SSKI |
| define SSKI | saturated solution of potassium iodine |
| How far before surgery is Lugal's solution/SSKI give | 10 days before surgery |
| why is Lugal's solution/SSKI given before goiter surgery | to make thyroid less vascular |
| nursing considerations when administering iodine | give in juice, coke; use a straw to prevent staining teeth |
| When is goiter surgically fixed | if it is so big it interferes with airway |
| define cretinism | not enough iodine for brain = develop mental retardation in 6 months |
| Why is thyroid funciton checked in all newborns | to early diagnose cretinism if present |
| is damage in cretinism reversible? | not after 6 months old |
| symptoms of hypothyroidism | slowing of mind/body; weak heartbeat; constipation; slow reflexes; high LDL; hair thinning; depression; big tongue; croaky voice; dry skin; cold skin; cold intolerance |
| define myxedema | muscles enlarged; swelling of muscle; hypothyroidism |
| prototype for hypothyroidism T4 | levothyroxine sodium (synthroid) |
| prototype for hypothyroidism T3 | cytomel |
| kinetics of levothyroixine/cytomel | po |
| What medications do levothyrodine/cytomel interact with | insulin and oral hypoglycemics (anything that affects metabolism) |
| What effect does levothyroxine/cytomel and insulin cause | drug induced hyperthyroidism |
| why should levotyroxine/cytomel be taken on an empty stomach | better absorption |
| nursing considerations of levothyroxine/cytomel | monitor thyroid function studies |
| patient education for levothyroxine/cytomel | hypo and hyperthyroid symptoms; do not stop without consultation; full effect seen in a couple of weeks |
| excessive thyroid hormone | grave's disease (thyrotoxicosis) |
| Symptoms of grave's disease | increased BMR; weight loss; nervous; increased heart rate; exopthamus |
| why does exopthamus occur in grave's disease | tissue behind eye begins to grow and push eyes forward |
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