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Nursing Pharm - Endocrine, DM, Reproductive

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olanjones's version from 2016-08-01 14:21

Pituitary & Hypothalamic

Question Answer
What are the only hypothalamic hormones used in clinical treatment?Gonadotropin-releasing hormone (treats endometriosis and palliative tx for prostate cancer)
Growth hormone analogs (Somatropin) are intended to treat GH deficiencies such as short stature/dwarfism, under what circumstances are they often abused?by athletes for anabolic effects
What type of drugs suppress GH secretion to treat acromegally?Growth hormone antagonists (Octreotice, Sandostatin)
DDAVP is used to treat DI, how is SIDAH often treated?with fluid restriction/diuretics
Nurses must monitor I&O, electrolytes in pts on ADH, why should they also monitor VS (esp BP)?ADH is potent vasoconstrictor, may cause BP increase
What drugs may decrease the therapeutic effects of ADH?ETOH, epinephrine, heparin, lithium, & phenytoin
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Thyroid

Question Answer
What may hypothyroidism be caused by?low secretion of TSH by pituitary, low function of thyroid gland (commonly Hashimoto’s), destruction of thyroid d/t hyperthyroid treatment
What would a deceased HR, low BP, fatigue, slow speech possibly indicate in a person taking levothryoxine (prototype)?s/s of hypothyroid- insufficient dosing; patient may not be taking as directed (at same time, on empty stomach, without other meds)
What would nervousness, palpitations, heat intolerance, wt loss, diarrhea possibly indicate in a person taking levothryoxine?s/s of hyperthyroid- dosing is too high
Why is it important that a patient on levothyroixne keep lab appts?correct dosing is highly individual. requires monitoring and adjustment
What is the most common cause of hyperthyroidism?Graves' disease (hypersecretion of thyroid gland)
What treatments are used to treat hyperthyroidism? propylthiouracil (PTU), use radioactive isotope sodium iodide-131 (Iodotope), removal of thyroid gland
What are complications of propylthiouracil (PTU)?agranulocytosis, infection risk, increased risk of bleeding (monitor use of anticoagulants carefully)
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Adrenal

Question Answer
What does the adrenal medulla secrete?75-80% epinephrine, remaining amount is norepinephrine
What does the adrenal cortex secrete?gonadocorticoids (androgens, estrogen), mineralocorticoids (aldosterone), glucocorticoids(30+types) [glucocorticoids & mineralocorticoids are collectively known as corticosteroids]+
What the most important glucocorticoid to pharmacology?Cortisol (it is also secreted in the highest amount)
What adverse effects are associated with long-term corticosteroid use?immune suppression & inflammatory response, peptic ulcers, osteoporosis, behavioral changes, eye changes, metabolic changes, myopathy
How can AE of corticosteriods use be minimized?Keep doses at lowest effective dose, combine with other drugs, use alt-day dosing, for acute conditions give large dose and taper down, admin locally whenever possible
When using hydrocortisone/Cortef (prototype) what should the nurse assess for in the patient?Assess VS & temp (may mask infections), Glucose levels, K, T3, T4, Pregnancy/lactation (contraindicated)
What may occur due to prolonged high levels of glucocorticoid?Cushing's syndrome - S/S: adrenal atrophy, osteoporosis, increases BP, infections, decreases wound healing, watch for moon face & buffalo hump
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Diabetes Mellitus

Question Answer
What is the Somogyi phenomenon?rapid decrease of serum glucose that stimulates hormones to elevate serum glucose
What is a hyperosmolar hyperglycemic state?a very serious acute complication of diabetes characterized by extreme hyperglycemia (>600 mg/dL), hyperosmolarity with dehydration, absence of ketoacidosis, & CNS dysfunction
What causes a decrease in blood glucose levels?pancreas reacts to high glucose levels and releases insulin which transports glucose into cells and inhibits gluconeogenesis (also: fasting, exercise, excess ETOH use)
What causes an increase in blood glucose levels?pancreas reacts to low glucose levels and releases glucagon which removes glucose stored in liver (also: stress from infections, injury, surgery, over-consumption of carbs)
What hormones/drugs increase blood sugar?epinephrine, thyroid, growth, glucocorticoids; moderate ETOH use, lithium, ACE inhibitors, beta-adrenergic blockers
What drugs decrease blood sugar?phenytoin, NSAIDs, diuretics
What is the primary AE of using human regular insulin/Humulin R?Over-treatment *Nurse must know s/s of hypo and hyperglycemia*
What should the nurse assess a DM I patient for?Assess adequacy of glucose monitoring, level of understanding of SE, self-administration of insulin knowledge
Why is it important for the nurse to perform comprehensive assessments on diabetic patients?DM affects multiple systems; Lifestyle & psychosocial factors especially important
What are the signs of hypoglycemia?nervousness, confusion, excessive sweating, rapid pulse tremors
What are the signs of hyperglycemia?increased thirst, UI, decreased appetite, excessive fatigue
Why is it important to monitor labs (esp liver function) in patient on metformin/Glucophage (prototype)?Need to keep glucose WNL to prevent complications, metformin works on the liver to decrease production of glucose
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Female Reproductive System

Question Answer
What is classified as dysfunctional uterine bleeding?amenorrhea, endometriosis, oligomenorrhea, menorrhagia, breakthrough bleeding, postmenopausal bleeding, bleeding from endometrial carcinoma
When is HRT used?to treat unpleasant symptoms of menopause, prevent long-term consequences of estrogen loss; SE determine benefits may not outweigh costs
What are pt education points for oral birth control (prototype - estradiol& norethindrone/Ortho-Novum)?combo low dose estrogen & progestins are nearly 100% effective when taken properly. May take several months for ovulation to return to normal when D/Cd
What AE are associated with female hormone therapy?dependent on estrogen-progestin combination but include: MI, CVA, thromboembolic risk, BC, Colorectal CA, hip fx risk
What SE (similar to pregnancy) are common with female hormone therapy?HA, depression, low libido, fatigue, wt gain, breakthrough bleeding
When are oxtyocic agents (prototype - oxytocin/Pitocin) used?stimulate L&D when indicated (not elective), dose is closely monitored to achieve normal patterns and prevent complications. Are also given postpartum to control uterine bleeding
When is oxytocin use contraindicated?in previous uterine sx that presents risk of uterine rupture, CPD, cord prolapse, active HSV, placenta previa
What are tocolytics used?to suppress preterm labor to prevent infant complications – Bedrest is mandatory (magnesium sulfate is traditional drug of choice)
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Male Reproductive System

Question Answer
Why are anabolic steriods rarely prescribed?they produce significant AE with long-term use (often misused by athletes to increase performance). One is prescribed to treat constitutional growth delay: oxandrolone (Oxandrin)
How is male infertility treated?with endocrine drugs that boost sperm production. Organic causes need to be ruled out first
What types of drugs are used to treat BPH?alpha1-adrenergic blockers: doxazoin/Cardura, tamsulosin/Flomax (relax smooth muscle in prostate gland – some patients can’t tolerate CV AE), 5-alpha reductase inhibitors: dutasteride/Avodart (more effective, less CV SE, BUT pregnancy category X, cannot donate blood)
What is the most commonly prescribed drug in the 5-alpha reductase inhibitor class? finasteride/Proscar (also promotes male hair growth)
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