Pharm week 2 ch 35, 36, & 37
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What is hyperthyroidism?
excessive TH secretion
What are the treatments for hyperthyroidism? (2)
- 1. "anti-thyroid drugs"
- 2. radio-active iodide to kill of some thyroid
What are "anti-thyroid drugs"? (2)
- 1. prevent synthesis of thyroid hormones
- 2. need to monitor with lab tests in order to assure proper thyroid functioning
What are iodide isotopes?
radioactive form of iodide, oral or parenteral which destroys thyroid tissue
What kind of precautions may be needed for iodide isotopes? (3)
- "radiation precautions" with
- 1. urine
- 2. stool
- 3. contact with kids
Clients taking iodide preparations should be observed for what?
What are the S&S of iodism? (should be watched for when a person is taking iodide isotopes) (6)
- 1. gum soreness
- 2. excessive salivation
- 3. nausea
- 4. fever
- 5. inflammation of the salviary glands
- 6. metallic taste in mouth
When a person recieves a I 131 injection (sodium iodide) what is a very important fact about after their treatment?
- They should stay out of close contact with
- 1. pregnat women
- 2. children
- for one week after admintration b/c they will be emitting small doses of radiation
What may a person develop because of a I 131 injection?
What is propylthiouracil?
Clients taking propylthiouracil and any other anti-thyroid drugs must immediately report what S&S and why? (3S&S, 1 reason)
- 1. sore throat
- 2. fever
- 3. malaise
- B/c they may indicate agranulocytosis
What is hypothyroidism? (2)
- 1. decreased levels of TH
- 2. increased levels of TSH
What is the treatment for hypothyroidism? (2)
- 1. synthetic thyroid oral daily (synthroid):take for life
- 2. need regular lab tests to assess effectiveness
What is levothyroxine sodium?
Synthetic, pure T4
What is the usual dose for levothyroxine?
.0125-.2 mg daily
What are the nursing implications for levothyroxine? (3)
- 1. .1 mg(100mcg) of T4 is approximately equivalent to 65 mg (1 grain)of thyroid USP
- 2. May also be give IV or IM
- 3. The IV dose must be prepared immediately before use
What is the parathyroid's function? (2)
- 1. phosphorus
- 2. Ca
- in and out of the blood/bone
What is hyperparathyroidism?
excessive PTH secretion
What is hyperparathyroidism due to physiologically? (2)
- 1. benign
- 2. malignant
What is the treatment of hyperparathyroidism? (2)
- surgical removal of:
- 1. tumor
- 2. some parathyroid tissue
- 3. Lasix to decrease Ca
- 4. drugs to keep Ca in bone
What is the S&S of hyperparathyroidism?
What is the key concept Pituitary disorders and treatment? (3)
- Patient should be under the care of endocrinologist to assess
- 1. cause
- and decide
- 2. surgical
- 3. Hormonal
- tx is indicated
many hormones cannot be taken orally, why?
due to destruction by HCl in stomach secretions
what is diabeties insipidus?
lack of ADH (vasopresin) from posterior pituitary
what are the signs and symptoms of diabeties insipidus?
- 1. excess urination(polyuria)
- 2. thirst
what is the treatment for diabeties insipidus?
provide synthetic ADH (DDAVP, PITRESSIN)
what routes are available for diabeties insipidus? (3)
- 1. IM
- 2. IV
- 3. intra/nasal spray
who are more prone to get type 1 DM?
who are more prone to get type 2 DM
what is type 1 Dm?
insuffiecent insullin secretion by ISLETS of LANGERHANS in pancreas.
what is type DM?
insensitivity to insullin by target organ cells throughout body.
what are the causes of diabeties1 and 2? (4)
- 2. obesity
- 3. pregnancy
- 4. auto immune
what is FBS for DM?
what is the tx for type 1 DM?
what is the treatment for type 2 DM?
oral agents, if severe insullin
what are the treatments for both DMs? (3)
- 1. dietary control
- 2. lifestyle managment
- 3. in depth education of client/ caregiver
what is insullin?
protien based horomone secreted by pancreas islets of langerhans
what 2 hormones does the pancreas secrete?
insullin 1 and glucagon
what is insullins function?
allow glucose to enter cell from blood
what is the function of glucagon?
convert glycogen in liver to glucose (glycogenolysis)
(IMPORTANT CONSIDERATIONS OF INSULIN) Cannot be taken orally because?
stomach enzymes destroy it
(IMPORTANT CONSIDERATIONS OF INSULIN) What are the routes for insulin? (2)
- 1. Subcu (pump or injection)
- 2. intranasally
(IMPORTANT CONSIDERATIONS OF INSULIN) Is fragile so must be stored? (2)
- 1. proper temp.
- 2. not shaken (just rolled and warmed up to room temp. before administering)
(IMPORTANT CONSIDERATIONS OF INSULIN) What are the types of insulins? (3)
(IMPORTANT CONSIDERATIONS OF INSULIN) Reuse of injections sites may result in?
lipodystrophy (a loss of fat from ejection sites over time)
what is lipodystrophy?
a loss of fat from injections sites over time
(IMPORTANT CONSIDERATIONS OF INSULIN) Must be used with diet customizable to? (2)
- 1. type of insulin
- 2. client activity
How is insulin medication measured?
(IMPORTANT CONSIDERATIONS OF INSULIN) Administeration requires proper? (2)
- 1. syringe size
- 2. type of needle
What should you always check before giving insulin?
How many nurses are required to sign off on an insulin injection?
What is regular insulin?
short acting, peaks in 1-5 hours
What is regular insulin used to treat?
hyperglycemia (only had it for a few hours)
What does regular insulin look like?
clear, like water, in vial
When giving a mixed injection of insulin, what is always important to note?
ALWAYS draw regular insulin FIRST when giving injection.
What is the insulin name for short-acting insulin?
What are the trade names for regualr insulin? (3)
- 1. Novolin R
- 2. Humulin R
- 3. lletin ll (pork)
What are the onsets of action for Humulin R & Novolin R?
When is the peak of action for Humulin R & Novolin R?
What is the duration of action for Humulin R & Novolin R?
What is the appearance of all regular insulin?
The onset of action and peak of action are more rapid for?
lletin ll (pork)
What is the duration of action for lletin ll (pork)?
What is the insulin names for intermediate acting insulin? (2)
What are the trade names for intermediate acting insulin? (3)
- 1. Novolin N
- 2. Humulin N
- 3. lletin ll NPH (pork)
What is the onset of action for novolin N and Humulin N?
What is the peak of action for novolin N and Humulin N and lletin ll NPH (pork)?
What is the duration of action for novolin N and Humulin N?
What is the appearance for all intermediate acting insulins?
The onset of action for lletin ll NPH (pork) is?
more rapid than 1-2 hours
The duration of action for lletin ll NPH (pork) is?
What is a type of long lasting insulin?
What is th duration of action for long lasting insulin?
When does long lasting insulin peak?
what is the safest route of injection for insulin?
what are oral hypoglycemic agents? (2)
- 1. drugs which act to stimulate pancreas to release more insulin
- 2. increase binding of insulin at cell membrane receptor sites
What are oral hypoglycemic agents a tx for?
Oral hypoglycemic agents must only be used in conjunction with? (2)
- 1. thorough client education program
- 2. follow-up supervison
What is one type of oral hypoglycemic agent?
What do sulfonlyureas help with? (2)
- 1. lowering BS
- 2. cause insulin release from beta cells
How long have we been using first-generation sulfonlyureas?
How long have we been using sencond-generation sulfonlyureas?
First generation sulfonlyureas drugs are less?
strong than 2nd
2nd generation sulfonlyureas drugs have less?
Who should NOT use sulfonlyurea? (2)
- 1. DM 1
- 2. allergies to sulfonamides (sulfa drugs)
What are 6 important key points about sulfonlyureas?
- 1. must take before meals and eat right after
- 2. patient need DM education
- 3. hypoglycemic S&S will occur if meals are skipped or patients exercises vigoriously
- 4. do not skipp doses
- 5. call dr if side effects are too untolerable
- 6. diet is just as important as the drug
Whatt are the 2 safety considerations for people with DM?
- 1. Instruct patient to wear DM ID
- 2. instruct pateints not to take any drug without consulting pharmacist/dr.
When unsure if a patient is haveing a insulin reaction or diabetic ketoacidosis what do you treat for?
Treat for insulin reaction (too low BS)
Insulin reaction is treated with?
4 oz of rapidly absorbable sugar if client is conscious, follow with simple carb or regularly scheduled meal
If someone with an insulin reaction is unable to swallow how may you treat them?
apply syrup or sugary paste to buccal mucosa
With a insulin reaction, family members should be able to reconstitute and adminster?
Insulin is not required for clients who are fasting for other tests (T or F)
1. What may mast the S&S of hypoglycemia? 2. B/c of this patients must be aware of?
- 1. beta-adrenergic blocking agents.
- 2. MUST BE AWARE OF subtle indicators like dizziness and weakness
What are the mainstays of tx for someone with TYPE 2 DM? (2)
Excessive hypoglycemia may occur in clients taking what when they have DM 2?
Drugs that intensify the hypoglycemic action of oral hypoglycemics are? (9)
- 1. salicylates
- 2. phenylbutazone
- 3. sulfonamides
- 4. monoamine oxidase inhibitors
- 5. clofibrate
- 6. probenecid
- 7. dicumarol
- 8. NSAIDs
- 9. chloramphenicol
Ovaries secrete what with the influence of FSH and LH? (2)
- 1. estrogen
- 2. progesterone
What are the 2 functions of the ovaries?
- 1. control ovulation
- 2. control uterine lining shedding and growth
IUD causes what physiologically and releases what?
- CAUSES: endometrial inflammation
- RELEASES:exogenous hormones
What are the 3 functions of exogenous hormones?
- 1. inhibit ovulation
- 2. make cervical mucus difficult to transverse
- 3. thins endometrial lining which egg needs to implant well
Certain exogenous hormones increase your risk of ectopic pregnancy? (t or F)
PRL levels affect fertility, in other words?
breastfeeding moms often DO NOT ovulate (usually)
Do females secrete testosterone?
What is the testes function?
secrete testosterone for sperm development
What is the placenta?
temporary endocrine hormone during pregnancy
What does the placenta secrete? (3)
- 1. estrogen
- 2. progesterone
- 3. human chorionic gonadotropin (HCG or "pregnancy test hormone")
People are at a higher risk of what 2 things because of exogenous hormones?
Estrogen/progesterone products are contraindicated by what 2 disorders?
- 1. thrombophlebitis
- 2. thromboembolic
PAtients with long term therapy of estrogen products should be check periodically for? (2)
- 1. weight
- 2. BP
- (Estrogen products increase them)
What S&S should be reported for people using estrogen products?
Long use of progesterone products is associated with what S&S? (5)
- 1. edema
- 2. weight gain
- 3. GI disturbances
- 4. breast swelling
- 5. depression
When should a person avoid the use of progesterone products?
when they are pregnat
What should be reported if a person is using progesterone products? (2)
- 1. visual disorders
- 2. migraine
What does androgen products cause? (3)
- 1. sodium &
- 2. water
- 3.increase BP (check frequently)
What is BPH?
begning prostatic hyperplasia
What is PSA?
prostate specific antigen
(clients taking androgen hormone inhibitors) before taking what 2 drugs, a baseline PSA should be conducted to rule out prostate cancer as a reason for BPH?
- 1. dutasteride
- 2. finasteride
(clients taking androgen hormone inhibitors) should always use protection when having intercourse with a pregnat woman because?
The semen could hurt a male fetus because of the drugs presence in it
Pregnant woman should not be in contact with what drug because it could hurt a male fetus?
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