endocrine flash cards

8/13/2019 endocrine flash cards

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Endocrine System

(General Key Points)

N203

ATI (Unit 11Endocrine Syste


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• Carbohydrate, fat, and protein metabolism are all affected by diabetes

• All people with type 1 diabetes require insulin for management of blood

• People with type 2 diabetes require insulin when undergoing surgery,

experiencing high levels of physiologic stress (eg infection!, and during pregnancy

• "nsulin is classified two ways#

• $ype % &ow it's made

• atural or regular

• Addition of protein to prolong duration (P&!• "nsulin analogs

• Lispro and A spart insulins have shorter durations than Regular insu

• Glargine insulin has a longer duration than Regular insulin

• )roup % $ime*course*of*action

• +ral hypoglycemics used for type 2 diabetes when dietexercise are not e


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ral !y"o#lycemics

N203

ATI (Unit 11Endocrine System


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Agent Adverse Effect

-ulfonylureas .eglitinides (fast, short*lived

1st

generation /epaglinide (Prandin!$olbutamide (+rinase! (0m ac 1st meal! ( ris h

Chlorpropamide (3iabinese!

2nd generation ( duration! 4iguanides (tae 5 food!

)lipi6ide ()lucotrol! % 0 min ac 1st meal .etformin ()lucophage!

)lyburide (3ia4eta! % 73 with 1st

meal (3on't promote insulin reledon't hypoglycemia!)limepiride (Amaryl! % 73 with 1st meal

$hia6olidinediones 8*)lucosidase "nhibitor

/osiglita6one (Avandia! Acarbose (Precose!

()iven 9 regard to food, usually 1xday! (:ith 1st bit at 0 mealsday


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Ins$lin(1 o% 2)

N203



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Type Duration Route Time Onset P

;ispro(&umalog!

-hort, 7uic (0 * < h!

-C Pump 1= m ac 1= % 0 m > %

Aspart(ovolog!

-hort, 7uic (0 % = h!

-C Pump =*1 m ac 1 % 2 m 1

/egular (&umulin / !

-hort, -lower

(< % 1 h!-C Pump "& ". "?

0 m ac 0 %


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Ins$lin(2)

N203



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Adverse Effects: • &ypoglycemia • ;ipohypertrophy

Contraindications/Precautions: E (F! • +nly regular insulin by "?

Interactions: •

• Additive );C effect with sulfonylurea, meglitinides, β-blocker, EtOH

• Thiaide diuretics, glucocorticoids glucose*reducing effects

Education: •

• :hen mixing short*acting and long*acting draw short*acting first and th

longer*acting in order to eep longer*acting from contaminating shorter*a

• 3isperse particles in suspension before drawing insulin

• Glargine is never "? and should not be mixed

• Gse one general area to produce consistent results (rate thigharmabdo

• );C H*10 mgd; preprandial, I 1J mgd; postprandial &gA1c I K


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S$l%onyl$reas(ral !y"o#lycemics)

N203



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Expected Action:

Proto: 1st % tolbutamide 2nd % g

Oters# 1st % chlorpropamide, 2nd % gl

• Promote insulin release from the pancreas

Terapeutic !ses: • :ith dietexercise, control blood );C in type 2 diab

Adverse Effects: • &ypoglycemia (abrupt-- slowC- symptoms!

Contraindications/Precautions: E (C! • Pregnancylactation

• 3iabetic etoacidosis • /enalliver dysfunction

Interactions: •

EtOH # disulfiram*lie reaction• EtOH, !"#$%s, sulfonamides, ranitidine, cimetidine additive hypoglyce

• Concurrent use of β-blockers may mas awareness of hypoglycemic, spec

-- symptoms of tachycardia, palpitations, and diaphoresis

Education: •

•

);C H*10 mgd; preprandial, I 1J mgd; postprandial &gA1c I K


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&e#litinides(ral !y"o#lycemics)

N203



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Expected Action: Proto: repaglinide (Prandin! L Oters# nateglinide

• Promote insulin release from pancreas

Terapeutic !ses: • $ype 2 diabetes, with diet and exercise

• +ften use with metformin

Adverse Effects: • &ypoglycemia

•

Contraindications/Precautions: E (C! • 3iabetic etoacidosis

• &epatic dysfunction

Interactions: •

• Gemfibroil &Lopid' inhibition of repaglinide metabolism

Education: •



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'i#$anides(ral !y"o#lycemics)

N203



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Expected Action: Proto: .etformin ()luc

• "nhibit gluconeogenesis in liver • muscular uptae and use of

Terapeutic !ses: • $ype 2 diabetes

• Polycystic ovarian syndrome (PC+-!

Adverse Effects: • )" effects (nausea, vomiting, weight loss


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Tiaolidinediones

N203



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Expected Action: Proto: rosiglita6one (Avandia! L Oters# pioglita6one

• "ncreased cellular response to insulin by insulin resistance

Terapeutic !ses: • $ype 2 diabetes with diet and exercise

Adverse Effects: • Mluid retention • ;3; • &epatoto

Contraindications/Precautions: E (C! • 3A N heart failure

• .ild heart failure dt fluid retention effects

Interactions: • $nsulin ris for hypoglycemia

• Gemfibroil &Lopid' metabolism of rosiglitaone hypoglycemia

Education: •



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*-Gl$cosidase Ini+itor (ral !y"o#lycemics)

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: acarbose (Precose! L Oters# miglitol

• -low carbohydrate absorption and digestion

Terapeutic !ses: • Control postprandial blood sugar in type 2 diabetes

Adverse Effects: • /is for anemia dt iron absorption

• &epatotoxicity with long*term use

• "ntestinal effects (abdominal distention, cramping, hyperactive bowel soun

diarrhea, flatulence!

Contraindications/Precautions: E (4! • 3iabetic etoacidosis

• )" disorders (inflammatory disease, ulceration, obstruction!

Interactions: • $nsulin, sulfonylureas ris of hypoglycemia

• (etformin Additive )" effects and ris for hypoglycemia with concurren

Education: • $ae medication with first "ite

• Postprandial blood glucose I 1J mgd; • &gA1c I K


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,or Ins$lin erdose

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: )

• glycogenolysis • glycogenesis • gluconeogenesis

Terapeutic !ses: • &ypoglycemia 2O insulin overdose

• )" motility while undergoing radiological procedures of stomach inte

Adverse Effects: • )" distress (turn on left side to ris of aspiration!

Contraindications/Precautions: E (F! •

• Pheochromocytoma dt catecholamine stimulating effects

• "neffective for starvation*related hypoglycemia because depleted glycogen

Education: • Provide food as soon as patient is able to eat


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Tyroid !ormones

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: levothyroxine (-ynthroid! L Oters# liothyronin

• -ynthetic thyroxine metabolic rate, protein synthesis, cardiac output,

perfusion, oxygen use, body temperature, blood volume, and growth proc

Terapeutic !ses: • &ypothyroidism (all forms!

• mergency treatment of myxedema coma by "?

Adverse Effects: •

• &yperthyroidism (anxiety, tachycardia, palpitations, appetite, heat into

fever, diaphoresis, and weight loss!

Contraindications/Precautions: E (A! • $hyrotoxicosis and ."

• Cardiovascular problems and pregnancy

Interactions: • Le)othyro*ine breas down vitamin +arfarin effect

• .any antisei6ure and antidepressant meds lie carbamaepine, phenytoin

phenobarbital, sertraline le)othyro*ine metabolism

• 4inding agents (iron, calcium, antacids, cholestyramine!and sucralfate

le)othyro*ine absorption


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Antityroid &edication

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: propylthiouracil L Oters# methima6ole ($

• 4loc thyroid hormone synthesis Prevent oxidation of "odine $@ $0

Terapeutic !ses: • )rave's disease • AdQunct to thyroid irradiation

• Produce euthyroid state prior to thyroid removal • mergency thyrotoxtreatment

Adverse Effects: • +vermedication hypothyroidism (drowsiness, weigh

edema, bradycardia, cold intolerance, dry sin!

• Agranulocytosis .onitor for early signs (fever, pharyngitis! $x# !eupo

Contraindications/Precautions: E (3! • Pregnancy

• .arrow depression or immunosuppression

Interactions: • anticoagulant effects

Education: • $ae at consistent time and with meals ( )" distress!

• &yperthyroidism may get R*adrenergic blocer ( propranolol ! to tremo


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.adioactie Iodine (I131 )

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: /adioactiv

• 3estroys thyroid cells at high doses

Terapeutic !ses: • &yperthyroidism ( dose! • $hyroid cancer ( d

• doses# $hyroid function studies

Adverse Effects: • .arrow suppression (anemia, leuopenia, thrombocyto

• /adiation sicness# &ematemesis, epistaxis, intense nausea, vomiting

Contraindications/Precautions: E (S! • Pregnancy, childbearing age, lac

Interactions: • /educed uptae with antithyroid meds

Education: • $ae on empty stomach

• ?oid frequently ;imit contact to > hrdayperson fluids

•

3ispose of body wastes per protocol •

Avoid coughing and expectorat


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Nonradioactie Iodine

N203 ATI (Unit 11

Endocrine Syste


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Expected Action:

Proto: strong iodine solution (;ugol's solution! L Otersiodide, potassium

• iodide levels uptae (by thyroid!, thyroid hormone production, a

bloc release of thyroid hormones into blood streamTerapeutic !ses: • 3evelopment of euthyroid state and si6e prior to r

• mergency treatment of thyrotoxicosis

Adverse Effects: •

• "odism symptoms dt corrosive property (metallic taste, stomatitis, sore tegums, gastric distress! % drin through straw tae 5 food +3 preventi

Contraindications/Precautions: E (3! • Pregnancy

Interactions: • Moods high in iodine (fish, salt! /is for iodism

Education: •

3ilute ;ugol's solution with Quice to improve taste


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Gro/t !ormones(Anterior Pit$itary)

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: -omatropin L Oters# -omatrem (Pr

• -timulate overall growth, production of proteins, and use of glucose

Terapeutic !ses: • )rowth hormone deficiencies

• 4uling up so you can hit the long ball

Adverse Effects: • &yperglycemia (polyphagia, polydipsia, polyuria!

Contraindications/Precautions: E (C! • +bese or respiratory impairmen

• 3iabetes /is for hyperglycemia • 3c $x before epiphyseal clos

Interactions: • Glucocorticoids can counteract growth*promoting effects

Education: • ". or -C (less painful!


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Antidi$retic !ormone

N203 ATI (Unit 11

Endocrine Syste


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Expected Action: Proto: vasopressin (Pitressin! L Oters# desmopressin (3

• Promote &2+ reabsorption in idneys (desmopressin preferred!

• ?asoconstriction due to smooth muscle contraction ()asopressin!

Terapeutic !ses: • 3iabetes insipidus • Cardiac arrest

Adverse Effects: • +verhydration (sleepiness, pounding headache!

Contraindications/Precautions: E (S! • Pregnancy

• CA3 or peripheral circulation (ris for gangrene!

Education: • .onitor site carefullyT extravasation can cause gangrene

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