NUR 354 Exam 4

What is growth hormone (GH) also called?

Somatotropin

What disorder can be caused by a deficiency of growth hormone (GH)?

Short stature

What is short stature?

Dwarfism caused by deficiency of growth hormone secretion during childhood

What is the MOA of somatotropin?

Stimulates growth of all tissue in the body

What is the indication of somatotropin?

-Short stature
-Growth failure

What is an adverse effect of somatotropin?

Hyperglycemia

What is the route of administration for somatotropin?

Parenterally only

What disorder can be caused by an excess secretion of growth hormone?

Acromegaly

What drug is indicated for the treatment of acromegaly?

Octreotide (Sandostatin)

What is the MOA of octreotide (Sandostatin)?

Somatostatin analog

What is the indication of octreotide (Sandostatin)?

-Acromegaly
-Diarrhea

What is the route of administration for octreotide (Sandostatin)?

Parenterally only

What are adverse effects of octreotide (Sandostatin)?

GI issues such as nausea, vomiting, and diarrhea

What is anitdiuretic hormone (ADH)?

Hormone secreted by the posterior pituitary gland that conserves water

What disorder can be caused by a deficiency of antidiuretic hormone (ADH)?

Diabetes insipidus

What is diabetes insipidus (DI)?

Disorder marked by excessive urination due to lack of secretion of antidiuretic hormone

What drug is indicated for the treatment of diabetes insipidus (DI)?

Desmopressin (DDAVP)

What is the MOA of desmopressin (DDAVP)?

Replaces missing ADH and increases the reabsorption of water from filtrate

In addition to diabetes insipidus, what are other indications of desmopressin (DDAVP)?

-Coagulation disorders (hemophilia A and von Willebrand's disease)
-Nocturnal enuresis

What is nocturnal enuresis?

Bedwetting during the night

What is the preferred route of administration for desmopressin (DDAVP)?

Oral (PO)

What other routes of administration are available for desmopressin (DDAVP)?

-Intranasal
-Parenteral

What drug is indicated as a back-up agent for diabetes insipidus (DI)?

Vasopressin (Vasostrict)

In addition to diabetes insipidus, what is another indication of vasopressin (Vasostrict)?

Cardiac arrest

What is the MOA of vasopressin (Vasostrict)?

Increases the reabsorption of water from filtrate and vasoconstriction

Why is desmopressin (DDAVP) preferred over vasopressin (Vasostrict) for diabetes insipidus?

Desmopressin (DDAVP) does not cause vasoconstriction like vasopressin (Vasostrict)

What disorder can be caused by an excess secretion of antidiuretic hormone (ADH)?

SIADH (syndrome of inappropriate antiduretic hormone)

What must be monitored for a patient with DI or SIADH?

Fluid volume

What disorder can be caused by a deficiency of corticosteroids?

Addison's disease

What is Addison's disease also called?

Adrenocortical insufficiency

What are interchangeable terms for steroids?

-Corticosteroid
-Glucocorticoid

What are examples of corticosteroids?

-Dexamethasone
-Fluticasone (Flonase)
-Hydrocortisone (Cortef)
-Methylprednisolone (Medrol)
-Prednisone

What is the suffix for corticosteroids?

-lone
-sone

What is the MOA of corticosteroids?

Suppresses adrenal function, immune response, and inflammation

What is the indication of corticosteroids?

-Adrenocortical insufficiency (Addison's disease)
-Immunosuppression
-Inflammation
-Nausea

What are examples of specific conditions treated with corticosteroids?

-Allergies
-Asthma
-Cancers
-COVID-19
-Gout
-Rheumatoid arthritis

What are adverse effects of corticosteroids?

-Hyperglycemia
-Hypertension
-Immunosuppression
-Osteoporosis and fractures

What are important education points for a client who is taking a corticosteroid?

-Use with caution in clients with DM because it may elevate glucose (hyperglycemia) and they may need extra insulin, also be mindful of diet
-Use with caution in clients with hypertension because it may further elevate blood pressure
-Recognize signs and symptoms of infection such as fever and avoid those who are sick as you are more susceptible to infection (immunosuppression)
-Female clients should also take calcium and vitamin D

What are the preferred routes of administration for corticosteroids?

-Inhalation
-Injection
-Intranasal
-Topical

Why is the intranasal route of administration preferred over PO or IV administration for corticosteroids?

It has a local (targeted) effect versus a systemic effect

How must steroids be discontinued?

Always be tapered

What is the #1 cause of Addison's disease?

Coming off of steroids too quickly

What is the indication of cosyntropin (Cortrosyn)?

Diagnose the cause of the adrenocortical insufficiency

What disorder can be caused by an excess secretion of corticosteroids?

Cushing's syndrome

What are symptoms of Cushing's disease?

Redistribution of fat around the face (moon face), shoulders, and neck (buffalo hump)

What drugs are indicated for the treatment of Cushing's syndrome?

-Ketoconazole (Nizoral)
-Pasireotide (Signifor)

What is the MOA of ketoconazole (Nizoral)?

Preventing growth of fungus

In addition to Cushing's syndrome, what is another indication for ketoconazole (Nizoral)?

Fungal infections

What are the two main hormones released by the thyroid?

T3 and T4

What is the name for T3?

Triiodothyronine

What is the name for T4?

Thyroxine

What disorder can be caused by a deficiency of thyroid hormone?

Hypothyroidism

What is hypothyroidism also called?

Myxedema

What are symptoms of myxedema?

-Dry skin
-General weakness
-Muscle cramps
-More severe symptoms include slurred speech, bradycardia, weight gain, decreased sense of taste and smell, and intolerance to cold environments

What drug is indicated for the treatment of hypothyroidism?

Levothyroxine (Synthroid) - T4

What is the MOA of levothyroxine (Synthroid)?

Synthetic form of T4 (thyroxine)

How is levothyroxine (Synthroid) dosed?

Must be titrated up in small increments and tapered down

What is the black box warning for levothyroxine (Synthroid)?

Not to be used for weight loss

What is the onset for levothyroxine (Synthroid)?

3-5 days, however, peak effects take 4-6 weeks

What are important education points for a client who has just been prescribed levothyroxine (Synthroid)?

-Routine TSH monitoring every 4-6 weeks with lab work will be needed to reach targeted dose
-Therapy is generally lifelong
-It should be taken in the morning to prevent insomnia

What would lab results show for hypothyroidism?

-TSH will be elevated
-T4 will be decreased

What is the most common cause of hypothyroidism in the US?

Hashimoto's thyroiditis

What disorder can be caused by an excess secretion of thyroid hormone?

Hyperthyroidism

What is hyperthyroidism also called?

Graves' disease

What drug class is indicated for the treatment of hyperthyroidism?

Thioamides

What are examples of thioamides?

-Methimazole (Tapazole)
-Propylthiouracil (PTU)

What is the black box warning for methimazole (Tapazole)?

Cannot be taken in the first trimester of pregnancy (teratogenic)

What is the black box warning for Propylthiouracil (PTU)?

Increased risk of hepatotoxicity

What is a nursing consideration for the use of PTU?

ALT and AST must be evaluated

What is the MOA of thioamides?

Blocks the synthesis of thyroid hormone

In addition to methimazole (Tapazole) and propylthiouracil (PTU), what is another drug indicated for hyperthyroidism?

Potassium iodide

What is potassium iodide also called?

Lugol's solution

What is an additional indication of potassium iodide (Lugol's solution)?

Suppress thyroid prior to surgery

What is the goal of pharmacotherapy with radioactive iodine (I-131)?

Destroy just enough of the thyroid gland so that levels of thyroid function return to normal

What is an important education point for a client who is taking radioactive iodine (I-131)?

May destroy more than what was meant, so it is possible to become hypothyroid and require levothyroxine therapy

What are symptoms of a thyroid storm?

-Exophthalmos
-High fever
-Cardiovascular effects (tachycardia, heart failure, angina, MI)
-Central nervous system (CNS) effects (agitation, restlessness, delirium, progressing to coma)

What is the goal of calcitonin?

Restore calcium in bone

What does the body release when there is a deficiency of serum calcium (hypocalcemia)?

PTH (parathyroid hormone)

What drug is indicated for the treatment of hypocalcemia and parathyroid disorders?

Calcitriol

What is the MOA of calcitriol?

Increases calcium reabsorption by the kidneys, absorption by the intestines, and secretion of calcium from the bones to the bloodstream

What vitamin is required for a normal calcium level?

Vitamin D

What does the body release when there is an excess of serum calcium (hypercalcemia)?

Calcitonin

What is the MOA of calcitonin?

Lowers serum calcium by inhibiting break down of bones

What is the indication of calcitonin?

-Hypercalcemia
-Osteoporosis
-Paget's disease of bone

What is insulin?

Hormone secreted by the pancreas and supplied as a drug for type 1 diabetes

What is the MOA of insulin?

Stimulates cellular uptake of glucose and promotes conversion of glucose into glycogen

What is the indication of insulin?

-Diabetes
-Acute hyperkalemia

What is type 1 diabetes?

Metabolic disease characterized by hyperglycemia caused by a lack of secretion of insulin by the pancreas (insulin deficiency)

What is type 2 diabetes mellitus?

Chronic metabolic disease caused by insufficient secretion of insulin by the pancreas and a lack of sensitivity of insulin receptors (insulin resistance)

What is the effect of glucagon on blood glucose levels?

Increases blood glucose level

What is a normal blood glucose?

70-110 mg/dL

What are the primary tests used for diagnosing diabetes?

-Fasting blood glucose
-Hemoglobin A1C
-Oral glucose tolerance test

What fasting blood glucose level indicates diabetes?

> 126 mg/dL

What is an advantage of an A1C level?

It provides an average measure of glucose from the past 90 days

What A1C level indicates diabetes?

7.0%

What is diabetic ketoacidosis (DKA)?

A type of metabolic acidosis due to an excess of ketone bodies, most often occurring when diabetes mellitus is uncontrolled

What are symptoms of hyperglycemia?

-Polydipsia: Increased thirst
-Polyphagia: Increased hunger
-Polyuria: Excessive urination

What is the primary symptom of hypoglycemia?

Altered mental status

How must insulin be stored?

It must be kept in the refrigerator and once taken out, it can be unrefrigerated for 30 days

Can a patient be on multiple insulins?

Yes, it may be used to provide for basal coverage in addition to prandial coverage