Endocrine System Disorders, Chapter 21 Endocrine System Disorders, Chapter 21

Converting Between Measurement Systems, Converting Between Measurement Systems, Chapter 8: Pages 150 – 152 Chapter 8: Pages 150 – 152

Calculating Doses of Nonparenteral Calculating Doses of Nonparenteral Medications, Chapter 9: Pages 164-177 Medications, Chapter 9: Pages 164-177

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Thyroid and Diabetes

Ratio-and-Proportion

Common Symptoms of Endocrine Common Symptoms of Endocrine DiseasesDiseases

Mental deviationsChanges in energy levelsGrowth abnormalitiesSkin, hair, and nail changesMuscle atrophy (wasting)Emotional disturbances (mood changes)EdemaChanges in blood pressure Sexual irregularities

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Endocrine systemEndocrine system

Extremely complexInvolves many organs (regulated by

hormones)seminar will focus on Thyroid disorders

and Diabetes

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Thyroid Feedback SystemThyroid Feedback System TRH- Thyroid Releasing

Hormone TSH- Thyroid Stimulating

Hormone Thyroid Hormones- T3, T4,

Calcitonin **Thyroid gland requires

iodine for thyroid hormone formation

Negative feedback:◦Increased blood levels->

ant pit releases less TSH◦Decreased blood levels-

> ant pit releases more TSH

Hypothalamus|\/

TRH

Anterior Pituitary|\/

TSH

Thyroid Gland**|\/

Thyroid Hormones ------------------ (negative feedback on anterior pituitary)

Thyroid GlandThyroid Gland

Located in the neckMade up of 2 ‘lobes’ (on either side of the

larynx)The 3 hormones secreted by Thyroid are

…◦Thyroxine (T4)◦Tri-iodotyhronine (T3)◦calcitonin

TSH (Thyroid-Stimulating Hormone) ◦Secreted by the anterior pituitary gland◦TSH controls the secretion of T3 and T4

(see table 21-5 on page 411)

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What do T3 and T4 do?What do T3 and T4 do?

Protein synthesis blood sugar (glucose) levelsserum cholesterol levelsRate of metabolism normal mental development and

growthT3 and T4 require iodine for production !

◦Diets low in iodine may lead to goiter, enlarged thyroid

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Hypo (Low) Thyroid levelsHypo (Low) Thyroid levels

Causes◦Radiation therapy◦Lack of iodine◦Surgical removal of thyroid◦Pituitary dysfunction

Symptoms◦Weight gain◦Fatigue◦Feeling ‘cold’ all the time◦Unable to concentrate

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Oral Thyroid ReplacementOral Thyroid Replacement

Old method: extracted from endocrine glands of animals New method: Synthetically prepared Gradually adjust dose for patient needs Life Long Therapy is the norm … Can be … (see table 21-2, page 413):

◦ T3 (example Cytomel- liothyronine )◦ T4 (example Levothroid/Synthroid/Levoxyl-levothyroxine)◦ Combo of T3 and T4 (examples thyroid desiccated,

Thyrolar) Approved for supplemental or replacement needs of

hypothyroidism

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Thyroid ReplacementThyroid Replacement

Not used for obesity !◦Doses required for weight loss could be life

threateningEffects of overdose (like

hyperthyroidism)◦Symptoms include

Psychotic behavior Diarrhea Increased blood pressure Increased heart rates Cardiovascular reactions

◦Long term use associated with osteoporosis in post-menopausal women

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Patient Ed: Thyroid ReplacementsPatient Ed: Thyroid Replacements

Life long therapyTake in the morning on a empty stomach

to avoid insomnia.Palpitations, nervousness, and

headaches may be signs of toxicityMonitor by blood levelsOk for use in pregnancy

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Questions? Questions?

questions ???? ……….…

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Anti-thyroid MedicationsAnti-thyroid Medications

For the treatment of Hyper-thyroidHyper-secretion of thyroid hormones

◦Causes Tumors Autoimmune diseases (Graves’ disease)

Symptoms◦Increased cell metabolism◦Weakness◦Anxiety◦Heat production

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Cont, Treatment of Cont, Treatment of HyperthyroidismHyperthyroidism

Irradiation of thyroid glandSurgical removal of thyroidAnti-thyroid Medications:

◦Interfere with production of thyroid hormones Iodine or iodide ions Radioactive iodine (Iodine 131 destroys the thyroid) Thionamide derivatives

◦BEWARE! crosses placenta, stops fetal thyroid development!

◦Removal or destruction of the thyroid will result in the need of life time replacement therapy.

◦Not as common as Hypothyroidism

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I have a question …I have a question …

… do you have a question?

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Diabetes -HyperglycemiaDiabetes -Hyperglycemia

The Pancreas secretes hormones :◦Insulin◦Glucagon◦These hormones regulate metabolism of

protein, fat and most importantly carbohydrates

Sixth leading cause of death in U.S.Effecting >16 million Americans !

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2 Types of Diabetes –2 Types of Diabetes –be able to be able to compare the two types and explain compare the two types and explain

differences !differences !

Type One Type Two

Juvenile onsetRapid development5-10% of DiabeticsNo Insulin producedSymptoms: Thirst,

Urination, and Weight Loss(thin)

Glucose levels fluctuate with activities, illness

Adult onset (>40)Gradual developmentFamily History90-95 % of DiabeticsInsulin resistance or

decreased insulinMay be asymptomaticObesity a major

factor

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Treatment of DiabetesTreatment of Diabetes

Diet limiting carbohydrates ( too bad … love those carbs!)

Control body’s use of glucose by consistent exercise, medication.

Drugs fall into 3 categories◦Insulin◦Oral Hypoglycemic agents◦Drugs that affect glucose absorption or production

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Insulin Insulin

Purpose of Insulin ◦(1)Aids in the utilization of glucose as energy◦(2)Prompts the storage of excess glucose as

glycogen in liver◦(3)Responsible for conversion of glucose to fat.

Decreases blood glucose levels, but if becomes too low, glucagon stimulates the breakdown of glycogen to increase glucose to bring blood sugar levels to normal

Usually given SQ injectionDose is individualized, and changes over time

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Insulin TypesInsulin TypesRapid or Quick Acting

◦Ex: Insulin Lispro and Insulin Asparte◦Onset: 5-minutes, -Duration: ~3hr

Short Acting: Regular Insulin (R)◦Onset: 30-minutes, -Duration: ~6hr

Intermediate: NPH Insulin (N)◦Onset: 2-hours, -Duration: ~20hr

Long Acting: Lantus Insulin◦Onset: 4 to 6-hours, -Duration: ~24hr

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Insulin:Insulin: Patient Education Patient Education

Generally well toleratedMay cause allergic reactions

a different product can eliminate this problemWeight Gain common side effect of Insulin Therapy Hypoglycemia is the most common side effect

Beware of skipping meals!Rotate injection sitesWear medical identificationPatient should ask before taking OTC medicationsMonitor blood sugar! Extra-credit: who

says … “Check it, check it often … it’s the right thing to do!”

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QUESTIONSQUESTIONS

Have any of these?

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Oral MedicationsOral Medications

Must have some insulin production in pancreas to use oral medications

Used in Type II after diet and exercise fail

A patient who loses weight may be able to discontinue medication

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Classes of Oral Classes of Oral Antidiabetic MedicationsAntidiabetic Medications

Sulfonylureas**we will be discussing today

BiguanidesAlpha-glucosidase inhibitorsThiazolidinedionesMetglitinidesAmulin/GL-1 analogs

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SulfonylureasSulfonylureas

First oral agentsTwo groups

First generationSecond generation

Second Generation Most potent, effects with lower doses and last

longerOnce daily dosing(See table 21-10 Page 429 for more info)Examples Glipizide, glyburide

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Sulfonylureas continuedSulfonylureas continued

No direct insulin activity, increases insulin-secretions (of no use in treatment of Type-I … WHY?)

Most common side effect, Hypoglycemia◦ More severe with elderly

Must keep strict diet time and well balanced mealsAdverse reactions

◦ Photosensitivity◦ Jaundice◦ Rashes

Should not be used in Pregnancy Become less effective after 10 years use. Many type

II’s will have to use insulin for control in later years. Avoid Alcohol beware disulfram reaction

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Chapters 8 and Chapters 8 and 9:9:

Converting Between Measurement Systems

why Convert ? …why Convert ? …why Convert ? …why Convert ? …

…“to change from one form to another”

Necessary in medical field (no world standard)

When numbers are converted from one system to another, they will be approximately equal

Ratios and ProportionsRatios and Proportions … … my my favorite!favorite!Ratios and ProportionsRatios and Proportions … … my my favorite!favorite!Excellent method! (have I mentioned these are

my favorite)

** Please see the ‘practice-sheet’ I made for you in DocSharing.

Ratio—expression comparing two quantities◦separated by colon or written as fraction (1:3 or

1/3)Proportion—comparing two

fractions(ratios) considered to be equall◦1:2 and 2:4 same as 1/2 = 2/4

Solving Unknown VariablesSolving Unknown VariablesSolving Unknown VariablesSolving Unknown Variables

Numerators must be same unitsDenominators must be same

units1 mL : 15 gtts is the same as 2 mL : 30 gtts1 mL/15 gtts = 2 mL/30 gtts

Ex: How many gtts in 5 ml’s? 1 ml 5ml 15*5=1x

15 gtt x gtt 75=1x75/1 = xx = 75 gtt

Solving Unknown VariablesSolving Unknown VariablesSolving Unknown VariablesSolving Unknown Variables

Either method will allow you to solve for XNotice both are arranged as g/ml (grams/ml)(both have ‘like’ UNITs in the same position

on both sides of the equal sign - Important!)

cross-multiplyingcross-multiplying

A physician orders Tylenol 0.65 gram but when you check your inventory you notice you have Tylenol 325mg tablets. How can you fill this prescription?

1. How can we make our units equal? 0.65g => 650mg (move decimal 3 units to the right)2.Cross multiply & divide (650mg*1tab / 325mg) to solve

for X

X = 2 tab =dose in other words, 2 of the (325mg tablets) = 650mg

=0.65 grams

1 tab X tab x = 2 tab325mg 650mg

Volume ConversionsVolume Conversions

MD orders penicillin 500mg tid. You check your inventory and have 250mg/5mL solution available. How many teaspoonfuls of medication are needed per dose? Per day?

1. Ensure units are equal (both are mg’s)2. Cross multiply to find out how many ml’s are

required per dose (5mL * 500mg / 250mg =10ml’s) 5 ml x mL

250mg 500mg3. To find out how many teaspoonfuls are needed, convert mL to tsp Remember 5mL=1 tsp, so 10mL = 2tsp4. 2 tsp’s per dose5. Since dose is 500mg (2tsp’s) tid need 6 tsp’s per day

X = 10 ml’s

Scored Tablet Practice ProblemScored Tablet Practice Problem

Md writes prescription for metoprolol 12.5mg bid, you have on hand metoprolol 25mg scored tablets. How many tablets would be required for a one month supply (30 days)?

How can you make a 12.5mg dose from 25mg ‘scored’ tablets ? Split them in half each half ( ½ tab) =12.5mg

12.5mg bid x 30 days ½ tablet bid x 30 days½ tab* 2 (twice daily) = 1 whole tablet per day x

30days = 30 whole tablets for a one month supply

…hey, what if the directions were to take 12.5mg TID x30 days ?

Length ConversionsLength ConversionsLength ConversionsLength Conversions

An abdominal cavity was opened with a 14-inch incision. Convert this measurement into cm (centimeters)

• Use this conversion factor: 2.5 cm = 1 inch• 2.5 cm / 1 in = x cm / 14 in

• 2.5 x 14 = 35• 1 x x = 35• x = 35• 14 inches = 35 cm

2.5 cm x cm1 in 14 in