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Flashcards by Julie Hageman, updated more than 1 year ago
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Created by Julie Hageman
about 4 years ago
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| Question | Answer |
| Pancreas | Exocrine gland- secretes digestive enzymes Endocrine Gland- secretes hormones 1. insulin 2. glucagon |
| Glucose | Used to meet requirements for quick energy |
| Glycogen | excess glucose that is stored in the liver |
| Glucagon | Protein hormone that is released from the pancreas. This hormones breaks down glycogen to glucose |
| Glycogenolysis | The process of glycogen converted to glucose |
| Insulin | Stimulates 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 |
| Hyperglycemia | Blood sugar is above 126 fasting or A1C is equal or greater than 6.5% Normal Blood sugar range (70-100) |
| Goal A1C when treating diabetes | Less than or equal to 7.0 |
| Macrovascular | Secondary to large vessel damage caused by disposition of atherosclerotic plaque 1. CAD 2. Cerebral vascular dx 3. Peripheral vascular |
| Microvascular | Secondary 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 |
| Symptoms of hyperglycemia | Greater than 126 Polyuria, polydipsia, polyphagia, glucosuria, weight loss, blurred vision, and fatigue |
| Type 1 DM | Lack 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 |
| Type 2 DM | Caused by insulin resistance and insulin deficiency Most common forms of diabetes Obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminuria, and increase risk for thrombotic event |
| Gestational DM | Usually 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 |
| Latent Autoimmune diabetes in adults (LADA) | More slowly progressing form of type 1 DM |
| Diabetic 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 |
| Insulin | - 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) |
| Insulin Lispro Humalog | Class: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 |
| Regular insulin (humolin, novolin) | Class: Short acting MOA: Promotes cellular uptake Onset: 0.5 hr Peak: 1 to 5 hr Duration: 6 to 10 hr |
| Insulin 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 |
| Insulin Glargine (Lantus) | Class:Long acting MOA: Promotes cellular uptake of glucose Onset: 70 min Peak: none Duration: 24 hours |
| Glipizide (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 |
| Metformin (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 |
| Pioglitazone (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 |
| Sitagliptin (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 |
| Liraglutide (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 |
| Canaglifozin (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 |
| Glucagon Dextrose 50- IV | Hyperglycemic 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 |
| Chapter 40 | Chapter 40 |
| Thyroid gland | Secretes 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 |
| Hypothyroidism | Deficiency 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) |
| Goiter | Enlargement 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 |
| Hyperthyroidism | Excessive 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 |
| Adrenal Gland: | Adrenal cortex: Secretes corticosteroids (Glucocorticoids) Adrenal Medulla: Secretes catecholamines (Epinephrine, norepinephrine) |
| Cushing's Syndrome | Over 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 |
| Addison's disease | Under 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 |
| Pituitary Gland | Controlled by hypothalamus two distinct lobes 1. Anterior gland 2. Posterior gland |
| Levothyroxine | Thyroid 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 |
| Methimazole | Thionamides 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 |
| Radioactive Iodine | MOA: 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 |
| Nonradioactive Iodine | MOA: 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 |
| Somatropin | Anterior 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 |
| Desmopressin | Antidiuretic 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) |
| Prednisone | Adrenal 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 |
| Octreotide | Hypopituitarism 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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