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Pharm
Test 2 Endocrine 1
| Question | Answer |
|---|---|
| The system of glands that secrete hormones directly into the bloodstream or the lymph system and are circulated to all parts of the body. | Endocrine System |
| What glands are included in the endocrine system? (7) | Pituitary, thyroid, parathyroid, adrenal, pancreas, gonads, thymus |
| This gland is located in the sella turcica at the base of the brain | Pituitary |
| This gland is butterfly shaped, in the anterior portion of the neck in front of the trachea | Thyroid |
| This gland is behind the upper part of the sternum and atrophies after puberty | Thymus |
| These glands cap each kidney, they have a medulla and a cortex | Adrenal |
| The gonads include the | Ovaries and Testes |
| Fish like organ behind the stomach | Pancreas |
| What is the endocrine function of the pancreas? | To secrete insulin and glucagon into the bloodstream |
| Cluster of cells within the pancreas | Islets of Langerhans |
| What is the exocrine function of the Pancreas? | To secrete enzymes into the small intestines for digestion |
| Pancreatic hormone produced by Beta cells | Insulin |
| How does insulin impact blood glucose level? | Decreases |
| Insulin facilitates the _____ of glucose across the _____. | Transfer, cell membrane |
| What is the key to allow glucose into the cell | Insulin |
| Pancreatic hormone that is produced by Alpha cells | Glucagon |
| What impact does Glucagon have on blood glucose levels? | Increases |
| In the case of hypoglycemia, what does Glucagon do? (2) | Mobilizes fuel in cases of hypoglycemia, Stimulates stored glucose breakdown |
| What is the primary fuel for the CNS? | Glucose |
| For the CNS, a _______ supply of glucose from the body is needed. | Continuous |
| For part of the body other than the CNS, is glucose needed? If not, what can be used when necessary? | Fatty acids |
| What two places are Glucose and fatty acids stored? | In the liver (glycogen), or in fat cells (triglycerides) |
| The combined actions of insulin and glucagon keep blood glucose between __________. | 65-105 mg/dL |
| A chronic disease resulting from deficient glucose metabolism; caused by lack of production of one’s own insulin | Diabetes mellitus |
| What are the two major deficiencies involved with diabetes mellitus? | Lack of insulin, Alpha cells do not produce glucagon to boost blood |
| What is the problem on which most treatments for diabetes focus? | Lack of insulin |
| What is the characteristic trait for diabetes mellitus? | Hyperglycemia (high blood glucose level) |
| What is the goal when treating patients with diabetes mellitus? | To help them maintain optimal glycemic (sugar) control |
| Primary beta cell destruction leading to absolute insulin deficiency – What type of diabetes is this? What percent of diabetics is this? | Type 1, 10% |
| Pancreas makes less insulin over time or reduced ability of most cells to respond to insulin | Type 2, 90% |
| Complete absence of insulin | Type 1 diabetes |
| When is the onset for type 1 diabetes? | Kids, young adults |
| Is the onset for type 1 diabetes slow or sudden? | Sudden |
| Type 1 diabetes can often develop after a _____. | Viral infection |
| Type 1 diabetes is thought to be ____ in origin in ______ individuals. | Autoimmune, genetically susceptible |
| What are signs/symptoms of type 1 diabetes? (9) | Hyperglycemia, polyuria, fluid and electrolyte imbalances, dehydration, polydipsia, polyphagia, weight loss, fatigue |
| What causes polyphagia (excessive hunger) in type 1 diabetes? | Cell starvation from lack of available glucose |
| When should treatment for type 1 diabetes begin? | Day one |
| Type 1 diabetes predisposes the patient to ____if insulin is not provided. | Diabetic ketoacidosis |
| In addition to insulin, _____ and ____ are also managed in someone with type 1 diabetes. | Diet and exercise |
| Dangerous result of uncontrolled hyperglycemia | Ketoacidosis |
| When process causes ketoacidosis? | Body tries to break down fat for energy and free fatty acids released |
| In ketoacidosis, free fatty acids are converted to ____ which can/can not be fully metabolized. | Ketone bodies, cannot |
| _______ in blood changes body pH (acidosis) | Ketone accumulation |
| Ketoacidosis causes hydration or dehydration? | Dehydration |
| In Ketoacidosis, what happens to blood concentration, volume and viscosity? | Increased concentration and viscosity, decreased volume |
| In Ketoacidosis, what happens to circulation and oxygenation to tissue? | Poor circulation, tissue hypoxia |
| Can lactic acid accumulate as a result of Ketoacidosis? | Yes |
| Can ketoacidosis be fatal? | Yes |
| Decreased beta cell function and decreased output of insulin, but there is some | Type 2 diabetes |
| Does Type 2 diabetes develop slowly or rapidly? | Slowly, over years the beta cells fail |
| In Type 2 diabetes, does the liver have good control over glucose output? | No |
| Type of diabetes in which the body has a reduction in the ability to respond to insulin | Type 2 diabetes |
| What sorts of factors can lead to onset of Type 2 diabetes? | Overweight, Hereditary, Gestational (delivery of an infant more than 9 lbs.) |
| A group of risk factors - high blood pressure, high blood sugar, high triglyceride levels, low HDL, and belly fat that increases risk of heart disease and diabetes. | Metabolic Syndrome |
| How is type 2 diabetes treated? | Diet, weight control, exercise can delay progression |
| For type 2 diabetes, what influences how much, or if medication has to be given? | Weight loss and exercise |
| What is given in early Type II diabetes? | An oral medication |
| Most patients need to be on some kind of insulin support within ___ years of diagnosis of type 2 diabetes. | Ten |
| Why are individuals with diabetes at risk for atherosclerosis? | Altered fat metabolism put the process on fast forward, hyperlipidemia |
| What cardiac implications are there for those with diabetes? | Early heart disease, heart attack ( MI), heart failure ( cardio myopathy) |
| What are two complications of atherosclerosis? | Stroke, Peripheral Vascular Disease |
| Typically affects the network of tiny blood vessels in the glomerulus resulting in excessive filtration of protein into the urine. | Diabetic nephropathy |
| A common complication of diabetes, in which nerves are damaged as a result of high blood sugar levels | Diabetic neuropathy |
| Damage to the eye's retina that occurs with long-term diabetes, irreversible vision loss | Diabetic retinopathy |
| Protein based hormone used to treat DM1 and may be used to treat DM2 | Insulin |
| Prior to being bioengineered in a lab, where did insulin used to come from? | Beef, pork |
| Insulin is created by what type of technology? | Recombinant DNA |
| What are the four broad categories of insulin? | Fast acting, Intermediate acting, Long acting, Combination |
| What are the two categories of fast acting insulin? | Regular, Rapid acting insulin analogs |
| What is the onset of action for regular insulin? Peak? Duration? | ½ hr, 2-4 hr, 4-6 hr |
| Is regular insulin given before or after meals? | Before |
| The system of glands that secrete hormones directly into the bloodstream or the lymph system and are circulated to all parts of the body. | TRUE |
| Why is the knowledge of peak important? | This is when patient will become hypoglycemic |
| What are critical points to know when giving rapid acting insulin? | Know where food is, know blood sugar prior to injection, know that if pt does not eat well there is more chance for hypoglycemia |
| Should you double check your dose of insulin with another nurse or instructor? | Yes, always |
| Insulin aspart (Novolog): | Onset 15 minutes, Peak 1-3 hours, Duration 4-6 hours. |
| How does insulin impact blood glucose level? | Decreases |
| Most rapid acting insulin analogs CAN be mixed with longer acting insulin if | Given immediately after mixing. |
| Intermediate acting insulin is a suspension of ____. | Isophane insulin |
| What are three examples of Isophane insulin? | NPH, Humulin N, Novolin N |
| Isophane Insulin suspension Onset? Peak? Duration? | Onset: 1-2 hours, Peak: 4-8 hour, Duration 10-18 hours |
| Because intermediate acting insulins are in a suspension, they appear _____. | Cloudy |
| When is intermediate acting insulin given? | Pre Breakfast and Pre Supper |
| Premixed insulin is good for | For twice-daily use for individuals who have difficulty mixing |
| The first figure in the fraction of premixed insulin is the | Percentage of NPH |
| The second figure in the fraction of premixed insulin is the | Percentage of regular |
| How do you handle cloudy insulin before drawing it up? | Roll between hands |
| A long acting insulin with no peak | Insulin Glargine (Lantus) |
| Long acting insulin is released at a ____ rate | Consistent |
| Is long acting insulin compatible with other insulin? | NO! |
| What is the duration of long term insulin? | 24 hours |
| When using long term insulin, expect a _____ where administered. | Firm area |
| Should you rub the area where you administer long acting insulin? | NO! |
| Other than a syringe, what are three other ways to administer insulin? | Insulin pen injectors, Insulin pumps, Insulin jet injectors |
| Approved 1/27/06: inhalable insulin! | Exubera |
| Exubera is ___ acting for before/after meal use. | Short, before |
| What three things should you always know about the insulin you are giving? | Onset, peak, duration |
| Before giving insulin, what should you do? | Take the patient’s blood sugar |
| How should insulin be stored? If opened/once opened? | Unopened – refrigerated, opened – room temp one month or refrigerated for three months |
| What are the three “nevers” when it comes to insulin storage? | Freeze, sunlight, high temp |
| Unopened vials of insulin lose their strength in ___ | Three months |
| Too low of blood sugar, below ____is called _____ | 70 mg/dL |
| What is the normal range for blood sugar? | |
| Hypoglycemia activates the ____ resulting in what seven things? | Tachycardia, sweating, pallor, shakiness, cloudy mentation, hunger, headache |
| If left untreated, hypoglycemia can lead to what two things | Seizures, death |
| What are the first two signs of hypoglycemia? | Mental cloudiness, personality change |
| What two ways can you avoid hypoglycemia? | Eating on time and after insulin |
| If having symptoms of hypoglycemia, what rule should you follow? | 15 grams carbs, check blood sugar again in 15 minutes |
| With hyperglycemia, dehydration is ____ and perspiration is ____. | Present, absent |
| Protein based hormone used to treat DM1 and may be used to treat DM2 | Insulin |
| With hyperglycemia, respirations are ____ and ___. They are called _____ respirations. | Rapid, deep, Kussmaul |
| What result does dehydration of a person with hyperglycemia have on blood pressure? | Causes orthostatic hypotension |
| Food and regular insulin must be coordinated. True/False | TRUE |
| Does a person with hyperglycemia have ketones in the blood and urine? | Yes |
| What is the serum glucose level for a person with hyperglycemia? | Greater than 250 mg/dL |
| What type of insulin can be given IV? | Only regular |
| What are two examples of Rapid acting insulin analogs? | Lispro, Humalog/Insulin aspart, Novolog |
| What types of drugs can decrease blood sugar? | Tricyclic antidepressants, MAO inhibitors, Aspirin products, Oral anticoagulants |
| Lispro (Humalog): Onset? Peak? Duration? | Onset 15-30 minutes, Peak 30-90 minutes, Duration 4 – 6 hours |
| What type of diabetes can oral anti-diabetic drugs be used for? | Type II only |
| What are side effects of sulfonylureas? | HYPOGLYCEMIA, GI distress, rash, and weight gain, can cause bone marrow disturbance & changes in blood counts |
| How do biguanides work? | Increase use of glucose by muscle and fat cells (improves insulin sensitivity), Decreases liver glucose production, Decreases intestinal absorption of glucose |
| Do biguanides cause hypoglycemia? | No ( they are considered an anti-hypertensive) |
| What are side effects of biguanides? | Bloating, nausea, diarrhea |
| Biguanides must be withdrawn a few days prior to dye procedures. True/False | TRUE |
| How to Thiazolidinediones work? | Decrease insulin resistance and improve uptake of glucose by tissues |
| The patient gets insulin at 0730 and eats at 0740. When is he most likely to drop blood sugar? | |
| Can you take alcohol with oral antidiabetic drugs? | No |
| Regular insulin CAN be mixed with longer-acting insulins. True/False | TRUE |
| If NPO what should you do before giving insulin? | Clarify order |
| Beta blocking agents can ____ the SNS symptoms | Mask |
| 15 grams of carbs can be achieved by ingesting what? | Three pieces hard candy or a tablespoon of sugar or about 4 ounces of orange juice or sugared soda |
| Once blood sugar starts coming up after a period of hypoglycemia, what should person do if feeling better? | Eat a meal |
| Repeat “15 and 15” if blood sugar is still very low, and has symptoms what is given? | Oral glucose gel delivered in cheek if not fully conscious and unable to swallow |
| With hyperglycemia this skin is ___ and ____ | Hot, dry |
| What kind of breath does a person with hyperglycemia have? | Foul odor |
| What is the LOC like for a person with hypoglycemia? | Decreased |
| What types of drugs can increase blood sugar? (4) | Thiazide diuretics, Cortisones (steroids), Thyroid medications, Estrogen |
| What types of things should we teach patients who are taking insulin? | s/s of hypo/hyperglycemia, danger of when hypoglycemic reactions can occur, onset/peak/duration, how to treat hypoglycemia, necessity of compliance, call PHP if having trouble controlling, etc |
| How do sulfonylureas work as a hypoglycemic drug (2)? | Works on beta cells in pancreas to secrete more insulin, may enhance actions of insulin in liver, muscle and adipose tissue |
| Biguanides are contraindicated in what patients (2)? Why? | Debilitated patients and patients with poor renal function due to possibility of lactic acidosis |
| What are the side effects of Thiazolidinediones? | Can be toxic to liver, Avandia associated with cardiac issues, fluid retention, weight gain |
Created by:
anastasia158
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