week 15 last week :D

Pituitary Drugs

action location

– Adrenocorticotropic hormone (ACTH) action

– Growth hormone (GH) action

– Thyroid stimulating hormone (TSH) action

– Prolactin action and excess in males and females leads to what?

• Enhances or blocks the hormones of the anterior pituitary gland:

– Adrenocorticotropic hormone (ACTH) - manages long-term stress, sodium levels

– Growth hormone (GH) – important during childhood

– Thyroid stimulating hormone (TSH) – controls metabolism/growth

– Prolactin – hormone that simulates milk production in the breasts

• Excesses in males leads to decreased sperm count, and milk production

• Excess in females leads to milk production and amenorrhea (no menstruation)

• Deficiencies in females leads to less milk production during breastfeeding

Pituitary Drugs

action location

Vasopressin (antidiuretic hormone/ADH) action spesifically

used for

monitor

can cause/contradicted in

Enhances or blocks the hormones of the posterior pituitary gland

Vasopressin (antidiuretic hormone/ADH) – promotes water reabsorption in the kidney to keep fluid in vessels and maintain blood pressure.

• Given to patients with low blood pressure, diabetes insipidus (caused by head injuries or brain tumors)

• Monitor I&Os, HR, BP and daily weights closely

• Can lead to kidney failure and hyponatremia (contraindicated if these exist)

Underactive thyroid, not enough ____ hormone = HYPOthyroidism

T4

HYPOThyroid Drugs

primary cause of hypothyroidism

Myxedema, define tx with what?

Levothyroxine, define/action

whats used for drug dosing

Too much levothyroxine can cause

Primary or secondary causes (primary most common)

• Decreased T4 and elevated TSH = primary

• Myxedema – severe hypothyroidism (confusion, edema, low body temp, low HR, can lead to COMA): requires IV thyroid hormone

– Oral levothyroxine is drug of choice – replaces T4 and is converted to T3

• Best taken on an empty stomach 30-60min before breakfast

• Lab TSH is used to guide dosing

• Too much levothyroxine can cause heart palpitations, hypertension, osteoporosis and seizures, chest pain, or atrial fibrillation!!!

hypothyroidism vs hyperthyroidism

Overactive thyroid = HYPERthyroidism

(too much T4 and T3)

Hyperthyroid drug

cause of hyperthyroidism

if left untreated can cause

methimazole, action and side effects

Due to thyroid cancer, nodules or increased function of thyroid

– Left untreated, can cause a thyroid storm – fever, flushing, vascular collapse, confusion

– methimazole – drug to inhibit T4 secretion from thyroid

• causes increased TSH and may lead to a goiter with prolonged use

• Increases effects of warfarin (bleeding risk)

• Decreases effect of antidiabetics (high blood sugar risk)

Parathyroid Hormone (PTH):

action

hypoparathyroidism occurs when ____ and results in what?

calcitriol, define/action

• Maintains blood calcium

-stimulates osteoclasts to release calcium from bone

-stimulates kidneys to reabsorb calcium to the blood

-promotes vitamin D production to absorb calcium from GI tract

HYPOparathyroidism – occurs when the thyroid is removed due to thyroid cancer or an overactive thyroid. Results in LOW BLOOD CALCIUM.

-calcitriol is the drug of choice to raise blood calcium, monitor for s/s of kidney stones!!!

hypocalcemia signs

Hypercalcemia signs

Adrenal Cortex – hormones: Glucocorticoids

actions

side effects

drugs:

Glucocorticoids – “cortisones” mimic cortisol (also called “steroids”)

– Anti-inflammatory

– Immunosuppressive – used in autoimmune diseases

– Raises blood sugar and blood pressure

– Fluid retention/edema

Drugs:

1. Dexamethasone – longer duration

2. Prednisone

3. Hydrocortisone

Adrenal Cortex – hormones: Mineralcorticoids

hormone

action

what drug mimics aldosterone

Mineralcorticoids – aldosterone

– Kidneys retain sodium, which retains fluid in blood vessels to maintain BP

– Fludrocortisone mimics aldosterone

addison’s disease vs crushing syndrome

• treatment for addison’s disease

• what can happen when treating addisons disease

Patients with addison’s Disease benefit from glucocorticoid and mineralcorticoid drugs.

• However, too many glucocorticoids can cause Cushing Syndrome. (moon face and buffalo hump, rosy cheeks)

• Addison’s disease to low in steroid hormones (cortisol and aldosterone)

• Cushing to high in steroid hormones (especially cortisol) 

Diabetes Mellitus type 1

define

causes

risk factors

onset

s/s

onset

tx

Autoimmune disorder causing destruction of pancreatic beta cells

• Absolute insulin deficiency

risk factors:

Autoimmune destruction of beta cells in Pancreas

• Family history

• Genetic predisposition

• Often childhood/adolescence onset

s/s:

• Polyuria

• Polydipsia (thirsty)

• Polyphagia (hunger)

• Fatigue

• Blurred vision

• Unexplained weight loss

• kussmaul breathing: rapid deep breathing

• Rapid onset

Treatment:

• Lifelong insulin therapy

• Carbohydrate counting

• Continuous glucose monitoring

Diabetes Mellitus type 2

define

causes

risk factors

s/s

onset

tx

Insulin resistance

• Progressive beta-cell dysfunction

• Relative insulin deficiency

risk factors:

Obesity

• Sedentary lifestyle

• Age >40

• Family history

• Ethnicity (African American, Hispanic, Native American)

• Hypertension & dyslipidemia

s/s:

• Polyuria

• Polydipsia (thirsty)

• Polyphagia (hunger)

• Fatigue

• Blurred vision

• Slow onset

• Recurrent infections

• Poor wound healing

Treatment:

• Lifestyle modification

• Oral antidiabetics (e.g., Metformin)

• GLP-1 agonists

• Insulin (as progression occurs)

• Carbohydrate counting

Diagnosing Diabetes: fasting blood sugar

normal

prediabetic

diabetic

Fasting Blood Sugar:

Normal < 100 mg/dL

Prediabetes 100–125 mg/dL

Diabetes ≥ 126 mg/dL (on two separate tests for confirmation)

Complications of Uncontrolled Diabetes

• stroke

• vision loss

• cardiovascular disease, HF, MI, arrythmia

• HTN

• foot damage

• diabetic neuropathy: numbness, tingling and pain

Diabetic Ketoacidosis

caused by

high glucose + high ketones

ketosis in normal people is fine

ketosis in diabetic people is bad

ketosis = when the body starts using fat for energy instead of carbs

Diabetic Ketoacidosis Lab Diagnostics

Nursing Implications for DKA

monitor

tx for DKA, monitor what

assess for

look for kussmal respirations: rapid deep breathing

• Monitor vital signs & neurological status

• Initiate IV fluids to correct dehydration

• Administer IV insulin infusion for DKA

• Monitor potassium levels & replace as needed (insulin causes low potassium, pushes k+ into cells and out of blood)

• Assess for precipitating causes (infection, missed insulin)

• Monitor blood glucose & ketones frequently

class

insulin

route

action

storage

what increases insulin needs

what meds increase risk for hypoglycemia

metabolized by what?

insulin improves what?

class: Anti-Diabetics

Insulin – given subQ or intravenously, NEVER ORAL!

– Lowers blood sugar and blood potassium

– Abdomen subQ is preferred site for best absorption

• Rotate sites to prevent skin lipodystrophy (atrophy in women, hypertrophy in men)

• 45-90 degree angle of needle

– Refrigerated until opened, then can be at room temp for 1 month or refrig for 3 mos.

– Illness, stress and fever increase insulin needs

– Aspirin, warfarin, alcohol, and many BP meds increase risk for hypoglycemia

– Metabolized by liver and muscles, excreted in urine

– Insulin improves cholesterol levels

NPH vs Regular insulin

appearance

• NPH (intermediate) insulin is always cloudy.

• Regular insulin is clear and is the only type given via IV fusion (insulin drip).

• rapid acting

• short acting

• intermittent acting

• long acting

onset, peak action, duration of action

hypoglycemia vs hyperglycemia

morning hyperglycemia

• Somogyi effect

• dawn phenomenon

for each:

• define

• between what time

• tx

• how to distinguish

Prevention of Morning Hyperglycemia

• Somogyi effect

• dawn phenomenon

• for both

Treatment for Hypoglycemia

if alert

if not alert

How to raise blood sugar with hypoglycemia (too much insulin):

1. If alert, drink 4 oz of orange juice, pop or hard candy

2. If not alert, administer IV glucagon or IV dextrose

Treatment for Hyperglycemia

tx

for DKA

monitor

• subQ or IV Insulin

• For DKA: Insulin Drip via IV pump

o Close glucose monitoring required!!!

Oral Antidiabetics

used for

Sulfonureas, drug, action

biguanides, drug, action, side effects, risks?, administer, if getting CT/MRI?, cheak what, what may occur

• Only used by people with type 2 diabetes, over 40, fasting glucose 200mg/dL or less, less than 40 units of insulin needed/day

• Sulfonureas: Ex. glipizide - Lowers blood sugar by stimulating beta cells of pancreas to secrete insulin, risk for hypoglycemia

• Biguanides: Ex. metformin – decreases conversion of glycogen to glucose in the liver and decrease glucose absorption in small intestine

– no risk for hypoglycemia

– diarrhea common side effect; should be taken with low-fat meal

– Hold for 48 hours before and after CT/MRI with contrast due to

renal failure

– Check creatinine prior to administering

– Weight loss may occur

Glucagon-Like Peptide 1 Agonists (GLP-1s)

class

route

Semmaglutides: route, Brand names: (Trulicity, Ozempic, Rybelsus), wegovy, side effects

Injectable anti-diabetics - subQ

– Triggers insulin release from pancreas, decreases appetite and slows digestion

– Semmaglutides: Some oral and others weekly injections (Ozempic and Wegovy)

– Brand names

• Trulicity, Ozempic, Rybelsus (for type-2 diabetes only)

• Wegovy (only for weight loss)

– Side effects: nausea, vomiting, fatigue, headache, diarrhea, constipation

Monitoring Diabetes and Medication Dosing

• A1c,

• fasting blood sugar

• Glucose tolerance test

• Urinalysis

• Labs: Hemoglobin A1c (3 months of blood sugar control), potassium, cholesterol

o Keep < 7-8% if diabetic

• Fasting blood sugar (FBS) two separate tests on two separate days that is greater than 125mg/dL is diabetes.

• Glucose tolerance test – patient fasts, then is given a sugary drink and blood sugar is checked every 2 hours. >200mg/dL after 2 hours is diabetes.

• Urinalysis – presence of ketones and glucose in urine can be a sign of diabetes

Patient Education for Living with Diabetes

Patient Education to Prevent Complications

insulin types and timing

• rapid

• short

• intermediate

• long

onset, peak ,duration

“When is the patient most at risk for hypoglycemia?”

At the insulin’s peak time.

insulin Nursing Interventions

Double-check insulin type and dose

Ensure food is present before rapid or short-acting insulin

Rotate injection sites to prevent lipodystrophy

Monitor blood glucose frequently

Be ready with orange juice or glucose tablets for low BG

mnemonic meanings

• RN

• Need food NOW

• Peak=play

• Never mix Long

💡 Mnemonic: "RN and NPH-L"

“R before N” When mixing Regular (clear) and NPH (cloudy), draw up Regular insulin first.

“Need food NOW” Rapid and short-acting insulins require food immediately after administration to prevent hypoglycemia.

“Peak = Play” During insulin peak, the risk for hypoglycemia is highest — that’s when nursing actions are most important.

“Never mix Long” Do not mix long-acting insulins like Glargine or Detemir with other types.