Karteikarten
Chapter 39 and 40
Karten in diesem Stapel (45)
- 1PancreasExocrine gland- secretes digestive enzymes
Endocrine Gland- secretes hormones
1. insulin
2. glucagon - 2GlucoseUsed to meet requirements for quick energy
- 3Glycogenexcess glucose that is stored in the liver
- 4GlucagonProtein hormone that is released from the pancreas. This hormones breaks down glycogen to glucose
- 5GlycogenolysisThe process of glycogen converted to glucose
- 6InsulinStimulates carbohydrate in skeletal and cardiac muscle and adipose tissue by facilitating the transport of glucose into these cells
Converts glucose to glycogen in the liver - 7HyperglycemiaBlood sugar is above 126 fasting or A1C is equal or greater than 6.5%
Normal Blood sugar range (70-100) - 8Goal A1C when treating diabetesLess than or equal to 7.0
- 9MacrovascularSecondary to large vessel damage caused by disposition of atherosclerotic plaque
1. CAD
2. Cerebral vascular dx
3. Peripheral vascular - 10MicrovascularSecondary to damage to the capillary vessels, which impairs peripheral circulation and damages the eyes and kidneys
1. Retinopathy
2. Peripheral neuropathy
3. Capillary vessel damage to kidney
Lisinopril can be used to prevent vessel damage to the kidneys - 11Symptoms of hyperglycemiaGreater than 126
Polyuria, polydipsia, polyphagia, glucosuria, weight loss, blurred vision, and fatigue - 12Type 1 DMLack of insulin production of defective insulin
Believed that genetically determined autoimmune reaction
Preclinical phase for several years--> rapid transition caused by acute illness or major emotional stress - 13Type 2 DMCaused by insulin resistance and insulin deficiency
Most common forms of diabetes
Obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminuria, and increase risk for thrombotic event - 14Gestational DMUsually diet control but the use of insulin maybe necessary
Monitor for hypoglycemia in newborn and high birth weight
30% of pt develop type 2 Dm in 10 to 15 years
Post partum screening 6-8 weeks postpartum and annually with physical - 15Latent Autoimmune diabetes in adults (LADA)More slowly progressing form of type 1 DM
- 16Diabetic ketoacidosis (DKA)glucose levels are extremely high but no insulin present, the body breaks down fatty acids for fuel producing ketones as metabolic by product
Causes serum acidosis, dehydration, electrolyte imbalance - 17Insulin- unopened, put in fridge good for 3 months
- Risk for hypoglycemia
lipohypertrophy
- open, room temp for 1 month
- Short acting mix with long acting (Short acting first than long acting) - 18Insulin Lispro HumalogClass:Rapid acting
MOA: Promotes cellular uptake of glucose
Onset: 15 to 30 min
Peak: 0.5 to 2.5 hr
Duration: 3 to 6 hour
***Greatest risk for hypoglycemia is at the PEAK - 19Regular insulin (humolin, novolin)Class: Short acting
MOA: Promotes cellular uptake
Onset: 0.5 hr
Peak: 1 to 5 hr
Duration: 6 to 10 hr - 20Insulin isophane suspension (NPH)Class: intermediate
MOA: Promotes cellular uptake of glucose
Onset: 1 to 2 hr
Peak: 6 to 14 hour
Duration: 16 to 24 hour - 21Insulin Glargine (Lantus)Class:Long acting
MOA: Promotes cellular uptake of glucose
Onset: 70 min
Peak: none
Duration: 24 hours - 22Glipizide (glucotrol)Sulfonylurea
MOA: Insulin release from the pancreas
High risk of hypoglycemia (do not mix with insulin)
SE: Hypoglycemia, weight gain
Take with food
Disulfiram like reaction to alcohol - 23Metformin (Glucophage)Biguanide
MOA: Reduces production of glucose within the liver through suppression of glucogenesis
Monitor B12 and folic acid
Nausea and diarrhea- usually will subside within a couple of weeks
SE: Diarrhea, abdominal bloating, nausea, weight loss
CT scan with contrast- hold medication for 24 to 48 hours to help prevent kidney damage
Be aware of lactic acidosis - 24Pioglitazone (Actos)Thiazolidinediones (Glitazones)
MOA: Increase cellular response to insulin by decreasing insulin resistance
Monitor for heart failure- causes fluid retention (Do not use with hx of HF)
SE: Fluid retention, elevation of LDL, Hepatoxicity
Monitor live enzymes - 25Sitagliptin (Januvia)DPP-IV inhibitor
MOA: Augments incretin hormones which promotes release of insulin and decrease secretion of glucagon
SE: tolerated well
Take with or without food - 26Liraglutide (Victoza)GLP-1
MOA: Mimics the effects of naturally occurring GLP-1 which promotes release of insulin, decrease secretion of glucagon and slows gastric emptying
SE: N/V/D, weight loss, pancreatitis
Do not use with history of pancreatitis or medullary thyroid cancer
Used to aid in weight loss
Some daily some once a week - 27Canaglifozin (Invokana)SGLT-2
MOA: Limits the rise for glucose postprandial, excretes glucose through urine
SE: Yeast infections, UTI, increased urination, dizziness and risk for hyptension
Stay hydrated
Increase in urine frequency
Watch for Yeast and UTI infections
Does increase thiazide and loop diuretics - 28Glucagon Dextrose 50- IVHyperglycemic agent
Increased blood glucose levels by increasing breakdown of glycogen into glucose
Glucagon- oral pills for pts feeling low (tachycardia, diaphoresis, lightheaded, tremors, anxious, flushed)
D 50- used through IV, unresponsive pts - 29Chapter 40Chapter 40
- 30Thyroid glandSecretes three hormones
1. Thyroxine (T4)
2. Triodothyronine (T3)
3. Calcitonin
TSH- made make T4 and T3
Located near the parathyroid gland, which is responsible for maintaining adequate levels of calcium in the extracellular fluid - 31HypothyroidismDeficiency in Thyroid Hormones
1. Primary: Abnormality in the thyroid gland itself
2. Secondary: results when the pituitary gland is dysfunctional and does not secrete TSH
3. Tertiary: Results when they hypothalamus gland does not secrete thyrotropin (stimulates the release of TSH) - 32GoiterEnlargement of the thyroid gland (swelling of thyroid)
Results from overstimulation by elevated levels of TSH
TSH is elevated because there is little or no thyroid hormone in circulation - 33HyperthyroidismExcessive thyroid hormones
Caused by:
1. graves' disease- over production of thyroid hormone
2. Multinodular disease
3. Plummer's disease- Toxic multi nodular disease
4. Thyroid storm- induced by stress
SX- diarrhea, flushing, increased appetite, muscle weakness, sleep disorders, altered menstural flow, fatigue, palpitations, nervousness, heat intolerance, irritability - 34Adrenal Gland:Adrenal cortex: Secretes corticosteroids (Glucocorticoids)
Adrenal Medulla: Secretes catecholamines (Epinephrine, norepinephrine) - 35Cushing's SyndromeOver secretion leads to cushing's
personality changes, mood face, gynecomastia, buffalo hump in neck, Fat deposits on face and back of shoulders, stretch marks, GI distress, osteoporosis - 36Addison's diseaseUnder secretion leads to addison's
Bronze pigmentation of skin, changes in body hair distribution, GI distrubances, weak, weight loss, postural hypotension, hypoglycemia
Can lead to Adrenal Crisis: Profound fatigue, dehydration, vascular collapse, renal shut down, decrease sodium, and increase potassium - 37Pituitary GlandControlled by hypothalamus
two distinct lobes
1. Anterior gland
2. Posterior gland - 38LevothyroxineThyroid Hormone
MOA: Thyroid hormones are synthetic form of T4 and T3
Obtain baseline vital signs
Monitor for signs of cardiac excitability
Monitor TSH yearly
Take on empty stomach 30-60 min prior to breakfast
Lifelong
Takes 6-8 weeks to see full effect
SE: Overmedication - 39MethimazoleThionamides
Blocks the synthesis of thyroid hormones, blocks conversion of T4 to T3
Takes 3-12 weeks for therapeutic effects
Monitor vital signs
Can use propranolol (beta Blocker) to help with symptoms until effects occur
Take consistently, same time daily
Monitor liver enzymes and CBC periodically
Avoid seafood- contains iodine, increase thyroid function
SE: Hypothyroidsm, Agranulcytosis
Liver injury, hepatitis - 40Radioactive IodineMOA: Radioactive Iodine is absorbed by the thyroid and destroys some of the thyroid producing cells
Stay 6 feet away from pt. Do not prepare food or share utensils
2-3 L a day of water
Limit contact. 30 min/day/person
Dispose of body waste per protocol
Precautions last 3 days
SE: Reaction sickness, bone marrow
Suppression, hypothyroid - 41Nonradioactive IodineMOA: creates high levels of iodine that will reduce iodine reuptake which inhibits thyroid hormone production
Conjunction therapy- no usually complete or permanent
Mix with juice to improve taste
Same time daily, maintain therapeutic levels
Do not stop abruptly
Iodism: metallic taste, stomatitis, sore
Teeth, and gums, headache - 42SomatropinAnterior pitutary hormones/ growth hormones
MOA: Anterior pituitary hormones stimulate overall growth and the production of protein
Baseline height and weight
Monitor growth patterns usually monthly
Mix gently, do not shake- do not contain particulates or is discolored
SE: Hyperglycemia, hypercalciuria and
Renal calculi
Monitor calcium level- turns to kidney stones - 43DesmopressinAntidiuretic hormone
MOA: posterior pituitary, promotes reabsorption of water within kidney
Do not use with CAD or decreased peripheral- vascular constriction
Monitor renal function and urine
Monitor BP and HR
Headache, confusion (over hydration)
Intranasal desmospression starts with bedtime dose- when nocturia controlled, doses are given twice daily
SE: Reabsorption of too much water-
(overhydration)
Myocardial ischemia (Vasoconstrictor) - 44PrednisoneAdrenal Hormone Replacement
MOA: mimic effect of natural steroid hormones
Monitor weight BP and electrolytes
Give with food to decrease gastric distress
Do not stop abruptly- taper
Addison’s disease- life time
SE: Osteoporosis
Adrenal suppression, ulcer, GI
Discomfort
Infection, Cushing’s syndrome - 45OctreotideHypopituitarism
MOA: Suppress growth hormone release
Subcut injection
Rotate sites
IM- injection, admin slowly in large muscle at room temp
GI disturbances, Hypo/hyperglycemia
Used in acromegaly
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- Beschreibung
- Karteikarten am Chapter 39 and 40, erstellt von Julie Hageman am 28/04/2020.
- Erstellt von
- Julie Hageman
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