pharmacology endocrine drugs: adrenal, thyroid, bone, etc.

hyperthyroidism

• increase in T4

• graves’ disease

• extra exogenous T4 (if taking levothyroxine for hypothyroidism, too much can cause extra exogenous T4)

hyperthyroidism risk factors

• female

• family history

hyperthyroidism expected findings

• hunger

• hot, sweaty

• weight loss

• irritable

• tachycardia

• insomnia

• goiter

• exophthalmos (bulging eyes)

• increased loose stools

• thinning hair

hyperthyroidism lab tests and diagnostic procedures

• lab tests: TSH, increased T4

• diagnostic procedures: ultrasound, palpation, thyroid scans

hyperthyroidism nursing care

• do not take thyroid hormone replacement meds

• limit activity

• monitor electrolytes (related to GI losses)

• nutrition (lots of carbs, protein)

• daily weights

• vital signs

• EKG

hyperthyroidism client education and interprofessional care

• client education: same as nursing care, S/S of hypothyroidism

• interprofessional care: nutrition

hyperthyroidism medications

• methimazole

• PTU

  • destroys the hormone or prevents the secretion of it (both methimazole and PTU)

• radioactive iodine

  • destroys the thyroid cells

• know these 3 drugs worked if patient is euthyroid (metabolic processes and T4 stable)

• these drugs can cause: decrease in WBC (report fever, infection), platelet count, they are hepatotoxic (monitor LFTs and jaundice)

hyperthyroidism complications

• thyroid storm

• heart damage

hypothyroidism

• loss of thyroid

• hashimoto’s

• can be autoimmune

• can be caused by medications

hypothyroidism risk factors

• females

• medications can decrease thyroid hormones

• family history

• decreased iodine intake

• radiation

hypothyroidism expected findings

• weight gain

• hair loss

• fatigue

• constipation

• hypersomnia

• dry skin/hair

• irritable

• irregular menstruation cycle

• bradycardia

hypothyroidism lab tests and diagnostic procedures

• lab tests: lowered T4 and elevated TSH

• diagnostic procedures: thyroid scan, ultrasound, palpate thyroid

hypothyroidism nursing care and interprofessional care

• nursing care

  • monitor vital signs (HR and BP) - they will be lower

  • monitor weight

  • stool softeners

  • high fiber diet/fluids for constipation

• interprofessional care

  • dietary!

hypothyroidism medications

• levothyroxine (hormone replacement drug)

• key points:

  • take 1st thing in the morning w water, avoid food for an hour

  • takes time to work (at least 6 weeks)

  • frequent lab draws

  • stay on same formula

hypothyroidism complications and safety considerations

• safety considerations: cardiovascular disease

• complications:

  • myxedema coma that can cause or result in:

    • respiratory failure

    • hypotension

    • hypothermia

    • bradycardia

    • decreased sodium

    • decreased glucose

cushings disease

• too much cortisol

• could be due to pituitary tumor, hyperplasia of adrenal cortex (where cortisol comes from)

cushing’s health promotion/disease prevention

• monitor blood glucose (goes up with increase of cortisol) and blood pressure (increased cortisol increases overall volume status in body causes this)

cushings risk factors

• females (20-40 yrs old)

cushings expected findings

• rounded faces

• increased weight

• buffalo hump

• decreased energy levels

• fatigue

• sleep disturbances

• menstrual cycle irregularities/changes

• increase in blood glucose

• decreased immunity

• emotional instability

• GI ulcerations

cushing’s lab tests

• elevated cortisol

• elevated blood glucose

• decreased potassium

• elevated sodium

• monitor ACTH (adrenocorticotropic hormone)

• decreased lymphocytes

cushing’s diagnostic procedures

• xray

• MRI

• CT scan

cushing’s nursing care

• monitor vital signs

• monitor blood glucose

• monitor K, Na

• skincare

• adequate nutrition

• monitor volume (turgor and weights)

cushing’s interprofessional care

• dietary

• endocrinology

• neurosurgery

• PT/OT

• home health

cushing’s complications

• infections

• bone fractures (osteo)

• adrenal crisis

cushing’s medications

• ketoconazole (antifungal)

addison’s disease

• call it adrenocortical insufficiency

• always: do not have enough cortisol (glucocorticoids)

• sometimes: decrease in mineral corticoids (aldosterone)

addison’s risk factors

• autoimmune

• adrenalectomy

• cancer, radiation

addison’s expected findings

• weight loss

• salt cravings

• hyperpigmentation of skin (JFK)

• weakness/fatigue

• anorexia

• nausea and vomiting

• decreased volume

addison’s lab tests

• low Na

• high K

• low glucose

• BUN/creatinine

addison’s diagnostic procedures

• xray

• MRI

• CT

addison’s nursing care

• monitor kidney function

• input and output

• electrolytes (Na, K)

• glucose

• treat high potassium levels

• watch for postural hypotension (tilt test - take pt vitals when lying down, take vitals again when sitting up, take vitals again when standing up) need volume if they tilt

addison’s client education

• same as nursing care

• be sure to decrease alcohol and caffeine bc they are both diuretics

addison’s complications

• circulatory collapse/shock (addisonian crisis)

• addisonian crisis is decreased volume, blood glucose, increased potassium (treat w fluids, dextrose, insulin)

addison’s medications

• hydrocortisone (synthetic cortisol)

• prednisone (glucocorticoid)

• cortisone

• *fludrocortisone (synthetic aldosterone) - works by increasing salt and fluid retention in the body

• know that treatment is working if symptoms relieved (euvolemic, sodium within normal range along w potassium, glucose is within normal range)

osteoporosis health promotion and disease prevention

• calcium and vitamin d intake

osteoporosis risk factors

• female

• white/asian descent (higher risks)

• greater than 50 years of age

• malnutrition (decrease in intake of calcium and vitamin d)

• smoking, drinking alcohol, caffeine

• sedentary lifestyle

osteoporosis expected findings

• decreased bone density

• manifests as back pain, restriction in movement

• bone fractures

osteoporosis lab tests

• calcium levels

• vitamin d levels

• phosphorous levels

osteoporosis diagnostic tests

• bone density test

• x-rays

osteoporosis safety considerations

• falls

osteoporosis nursing care

• diet - increase calcium intake, vitamin d

• safety related things to decrease fall risk at home

osteoporosis client education

• milk, dairy, green leafy vegetables, grains (cereals, breads), orange juice

• do not drink alcohol, decrease caffeine

• increase outside sun time

• increase weight bearing activities

osteoporosis medications

• calcium supplements (too much, pee it out)

• vitamin d (fat-soluble vitamin, body will store it)

• calcitonin

• bisphosphonates (prototype: alendronate)

  • for osteopenia or osteoporosis

  • take first thing in morning w a full glass of water and sit up for 30 mins after to prevent esophageal burning

growth hormone

• somatropin (injection)

• for kids/pediatrics

• growth plates have to be open if a pt is going to continue to grow (check this by x-ray)

• know pt needs to be put on this hormone thru growth protection chart

octreotide

• if have too much growth hormone, give this drug

• need to know indications:

  • if someone has too much growth hormone (acromegaly)

  • GI bleed (vasoconstricts blood vessels)

  • GI (carcinoid tumors) in bowel

diabetes insipidus

• low ADH (antidiuretic hormone)

• decreased ability for kidney to concentrate urine

diabetes insipidus risk factors

• kidney disease

• traumatic brain injury, tumor

diabetes insipidus expected findings

• increased urine output

• increased thirst, dehydration

• increased fluid intake

• lots of dilute urine

• hypotension

• tachycardia

• decrease in weight

diabetes insipidus lab tests

• urine:

  • low specific gravity, low osmolality, low sodium and potassium

• blood:

  • high osmolality, high sodium and potassium

diabetes insipidus nursing care and interprofessional care

• intake and output

• vital signs (BP and HR)

• weights

• stay hydrated

• diet

• neuro status

• manage fluid and electrolytes

• interprofessional care: diet

diabetes insipidus medications

• desmopressin (synthetic ADH)

• DDAVP

  • these two are given when someone has chronic DI and goes home on these meds

• vasopressin (vasoconstricting drug, gives back ADH)

• if giving these meds the goal is to see: euvolemia, serum osmo normal, electrolytes normal

• if we give too much of these meds: fluid overload, decreased urine output, decreased serum osmo, decreased serum sodium

diabetes insipidus complications

• dehydration

• high osmolarity

• high sodium

• circulatory collapse

• seizures