Lecture 13



Lecture 13

Chapter 12

Vitamin and Mineral

Replacement

Vitamins

Organic chemicals necessary for normal metabolic functions, tissue growth & healing

Body needs only a small amt. of vitamins daily easily obtained through a well-balanced diet

Vitamin supplements not necessary if a well-balanced diet consumed -

Vitamin deficiencies can cause cellular and organ dysfunction - may result in slow recovery from illness

Most people use vitamins for inappropriate reasons: relieve tiredness, improve general overall health, or prophylactic use

Vitamins

Fat-Soluble Vitamins - A,D,E,K - they are metabolized slowly, can be stored in fatty tissue, liver, & muscle - excreted in the urine at a slow rate - Can build up in the body & become toxic

- Vit. A - maintenance of epithelial tissues, skin, eyes, hair & bone growth; s/s of dec. in A( night blindness ( dryness of eyes and ulceration o the cornea ( blindness

- Use - skin disorders (acne); excess doses ( toxic - s/s loss of hair & peeling; excess stored in the liver for up to 2 yrs. - Sources: Beta carotene ( carrots, spinach, tomatoes, & pumpkin; Retinol (pre-formed A) only in foods of animal origin ( eggs, whole milk, butter & liver

Vitamins

- Vit. K - 4 forms – Vit. K 2 not commercially available - stored primarily in the liver

- needed for synthesis of prothrombin & the clotting factors VII, IX, & X

Water-Soluble Vitamins – C & B complex - Not stored by the body & readily excreted in the urine; not usually toxic unless taken in extreme amts.

- Vit. C ( ascorbic acid) - aids in absorption of Fe & in the conversion of folic acid

* Does not cure or prevent the common cold * Excess doses of C ( diarrhea & GI upset

Vitamins

-Vit. B complex - B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine)

Uses: improve nerve conduction d/t damage from ETOH ( (Thiamine); manage dermatologic problems (dermatitis, cracked sides of mouth) ( (riboflavin); dec. chol. (niacin); neuritis caused by INH tx for TB; H2O soluble

Large doses cause GI irritation & vasodilation, resulting in a flushing sensation.

Minerals

Hyperalimentation - Total Parenteral Nutrition (TPN)

- Administered through a central line (delivers nutrient into the superior vena cava ( empties into the R atrium of the heart)

- Used to ‘feed’ clients when unable to tolerate PO nutrition or GI system needs a ‘rest’

- Most important ingredients = dextrose (10%), amino acids

- May also include electrolytes, vitamins and minerals depending on clients lab values. Ordered daily per the MD

Chapter 45

Endocrine System

Endocrine Pharmacology

Endocrine System

Pituitary Gland - Located at base of brain, 2 lobes

- Anterior (adenohypophysis) - master gland - secretes hormones that stimulate the release of other hormones

- Posterior (neurohypophysis) - secretes antidiuretic hormone (ADH, vasopressin) & oxytocin

* Anterior Pituitary Gland secretes 6 various hormones targeting glands & tissues – controlled by hypothalamus

1) growth hormone (GH) - stimulates growth of tissue/bone

2) thyroid-stimulating hormone (TSH) - acts on thyroid gland to promote synthesis and release of thyroid hormones.

3) adrenocorticotropic hormone (ACTH) - stimulates adrenal cortex to release adrenocortical hormones

Endocrine System

4) follicle-stimulating hormone acts on ovary to promote follicular growth & development; In testes, FSH promotes spermatogenesis.

5) luteinizing hormone (LH) – promotes ovulation in women, in men acts on the testes to promote androgen production

6) prolactin – stimulates milk production

*** Growth hormone (GH) - Somatrem (Protropin) & somatropin (Humatrope) - If GH deficiency diagnosed and dwarfism can result - these drugs may be used. Very expensive therapy

* Posterior Pituitary Gland – secretes 2 hormones 1) antidiuretic hormone (ADH, vasopressin) & 2) oxytocin (ch. 47)

- ADH promotes H2O rebsorption from the renal tubules to maintain H2O balance – Dec. ADH( lg. amts. H2O excreted called diabetes insipidus (DI) ( fluid vol. dec & electrolyte imbalance

Endocrine System

Thyroid Gland - Located anterior to the trachea, has 2 lobes (butterfly like), secretes 2 hormones: Thyroxine (T4), & triiodothyronine (T3) – thyroid hormones have 3 actions:

1) stimulation of energy use( inc. basal metabolism rate;

2) stimulation of the heart(leads to inc rate & force of contraction ( inc cardiac output;

3) promotion of growth and development(brain & skeletal muscle).- Can be either a thyroid deficiency (hypothyroidism), or an overabundance (Hyperthyroidism)

* Hypothyroidism – a dec. in thyroid hormone secretion;

-primary cause is thyroid gland disorder or secondary cause is lack of TSH secretion = slow metabolic rate - s/s (lethargic, weak, edema, slow pulse, constipation, wt. gain, emotional changes)

- Drugs containing T4 & T3 are used to treat this

Endocrine System

Levothyroxine sodium (Levothroid, Synthroid) - drug of choice for replacement therapy, Used to treat simple goiter & chronic lymphocytic thyroiditis

- Action – inc. T3 & T 4, inc. metabolic rate, inc. cardiac output, PRO synthesis, glycogen usage, O2 consumption, & body growth

- SE - N & V, diarrhea, cramps, nervousness

- DI - Many – increase effects of oral anticoagulants, with adrenergic agents (decongestant or vasopressor) cardiac & CNS effects increase.

Liothyronine (Cytomel) – a synthetic T3 not for maintenance but for initial tx. of Myxedema, because of it’s rapid onset of action

Endocrine System

Adrenal Glands - located at the top of each kidney & composed of 2 sections: adrenal medulla (inner section) & adrenal corex (surrounds the adrenal medulla)

- adrenal medulla releases epi. & norepi. & is linked to the sympathetic nervous system

- adrenal cortex ( 2 major types of hormones called (corticosteroids) 1) glucocorticoids & 2) mineralocorticoids

- main glucocorticoid = cortisol

- main mineralocorticoid = aldosterone

Endocrine System

Corticosteroids promote Na retention & K excretion. A Na ion is reabsorbed from the renal tubules in exchange for a K ion; K ion then excreted.

- Influences electrolytes, carbohydrates, protein & fat metabolism - deficiency ( serious illness or death

- in corticosteroid secretion = Addison’s disease

- in cotricosteroid secretion = Cushing’s Syndrome

Endocrine System

Glucocorticoids - influenced by ACTH, released from the ant. pituitary gland. Affect carbohydrate, protein, & fat metabolism

- can cause Na absorption from the kidney = H2O retention, K loss & inc. BP

- Cortisol - main glucocorticoid = antiinflammatory, antiallergic & antistress effects

- Indications for therapy = trauma, surgery, infections, emotional upsets, anxiety

- Most of the wide variety of glucocorticoid drugs called cortisone drugs - synthetic

Endocrine System

- Cortisone drugs can be given orally, parenteral (IM, IV), topical (creams, ointments), aerosol (inhaler)

- Uses - inflammatory conditions (MS, rheumatoid arthritis, MG, ulcerative colitis), shock, head trauma, asthma, contact dermatitis, anaphylaxis, debilitating conditions (malignancies), organ transplant recipients

- Many glucocorticoids - some more potent than others

- SE - TONS!! - fluid retention, muscle weakness, CV problems, hard on GI system , headache, inc. ICP, masks signs of infection, susceptibility to infection

Endocrine System

Dexamethasone (Decadron) - PO, IV, IM

Action - Not clearly defined. Decreases inflammation, suppresses immune response, stimulates bone marrow

Use - Cerebral edema, inflammatory conditions, allergic rxns, neoplasias

SE - Can effect all systems

* Do not D/C drug abruptly - rebound inflammation poss.

Teach - take w/ food or milk, S&S of early adrenal insufficiency (fatigue, weakness, joint pain), warn about long term therapy cushing symptoms (moon face)

Endocrine System

Prednisone (Deltasone, Orasone) - PO

Action - Suppression of inflammation & adrenal function

Use – Dec. severe inflammation, immunosuppression, dermatologic disorders

SE – N, V, diarrhea, inc. appetite, sweating, depression, mood changes, HA, flushing

Teaching - do not d/c abruptly - Best to start medication at lowest effective dose

CI – psychosis, fungal infection, Caution w/ diabetes

Hydrocortisone (Cortef) - PO, IV, IM, enema

Action - Decreases inflammation

Use - Inflammation, adrenal insufficiency, ulcerative colitis

Endocrine System

Glucocorticoid Inhibitors - Ketoconazole (Nizoral) - an antifungal drug, aminoglutethimide (Cytadren) - an antineoplastic hormone antagonist

- inhibit glucocorticoid synthesis

- Nizoral - Rx Cushing’s syndrome & adjunct to surgery or radiation

- high doses can cause fatal vent. dysrhythmias

- Cytadren – temporary RX of selected clients w/ Cushing’s syndrome, esp. clients w/ adrenal adenoma, carcinoma, adrenal hyperplasia

Endocrine System

Mineralocorticoids - secrete aldosterone

- maintains fluid balance by promoting reabsorption of Na from the renal tubules

- Na attracts H2O = H2O retention

- hypovolemia ( in circulating fluid) ( more aldosterone secreted to Na and H2O retention ( restore fluid balance

- W/ Na reabsorption = K lost hypokalemia

- severe in aldosterone ( hypotension & vascular collapse - Addison’s disease

Endocrine System

Fludrocortisone (Florinef) - an oral mineralocorticoid given w/ a glucocorticoid

Action - Increases Na+ reabsorption & K+ secretion

Use - Addison’s disease (adrenocortical insufficiency)

SE - hypertension, Na+ & H2O retention

Alert - monitor clients BP & electrolytes ( esp. K+)

* Can cause a neg. nitrogen balance - a high-protein diet indicated

Chapter 43

Disorders of the Eye

Eye Disorders

Diagnostic Aids – Used to locate leisions or foreign objects & to provide anesthesia. Fluorescein sodium – a dye turns scratches green & circle foreign objects in green.

Topical Anesthetics - used for exams & removal foreign objects - proparacaine HCL (Ophthaine, Ophthetic), tetracaine HCL (Pontocaine) - anesthesia in 1min. lasts about 15 min. blink reflex temporarily lost - patch the eye

Antiinfectives - frequently used for eye infections

- Conjunctivitis (inflammation of the membrane covering the eyeball & lining the eyelid) -SE (local skin/eye irritation, allergy to med.

Eye Disorders

Pharm tx reduces IOP by 1) facilitating aqueous humor outflow or 2) reducing aqueous humor production

Miotics - used in open-angle glaucoma to lower the intraocular pressure & increasing aqueous outflow ( decrease retinal damage & loss of vision.

- Direct-acting cholinergics & cholinesterase inhibitors = 2 types of miotics

- cause a contraction of the ciliary muscle & widening of trabecular meshwork

- Systemic absorption poss. but not common

Eye Disorders

*Pilocarpine (Isopto Carpine, Pilocar)

- Action - produces miosis (contracts pupil) which widens angle, allows outflow of aqueous humor & dec. intraocular pressure; Onset = 10-30 min; duration 4-8 hrs

- SE - headache, eye pain, decreased vision. Systemic absorption: N & V, frequent urination, inc. salivation

--Ocusert is a disk with time release pilocarpine, replaced q 7 d.

-CI = retinal detachment, adhesions, infection(eye), Many illness caution: asthma, HTN, CVD, UT obstruction, GI obstruction

Eye Disorders

- used only when other agents not effective

- drugs developed as diuretics

* Acetazolamide (Diamox) - PO

SE - lethargy, anorexia, drowsiness, polyuria, hypokalemia - clients frequently d/c from side effects

- do not use w/ clients allergic to sulfonamides

- can cause photosensitivity

Eye Disorders

Osmotics - generally used pre-op and post-op to dec. vitreous humor volume ( dec. IOP

- Use - in the emergency Rx of acute closed-angle glaucoma d/t ability to rapidly reduce IOP

* Mannitol (Osmitrol) - IV

- SE - headache, nausea, N & V, diarrhea, electrolyte dist.

- also used to dec. ICP in head trauma

Anticholinergic Mydriatics & Cycloplegics -

- Mydriatics = dilate the pupils

Eye Disorders

- cycloplegics - paralyze the muscles of accommodation

- both are used in diagnostic procedures & ophthalmic surgery

- relax the ciliary & dilator muscles of the iris by blocking acetylcholine

* Atropine sulfate (Atropisol) - cycloplegic

SE - tachycardia, photophobia, dryness of the mouth

s/s toxicity = dry mouth, blurred vision, photophobia, constipation tachycardia, confusion hallucinations

Beta-Adrenergic Blockers - used to dec. elevated IOP in chronic open-angle glaucoma. Dec. aqueous production and inc. outflow

Eye Disorders

* Other Ophthalmic Products:

- Antifungal - Natamycin (Natacyn) - (Sol’n)

- Antiviral - Vidarabine (Vira-A) - (Oint) inhibits viral replication

- Corticosteroids - Dexamethasone (Maxitrol) - (Oint.) dec. inflammatory/redness - corneal abrasions

- Antibiotics - Tobramycin (Tobrex) - (Oint. or Sol’n) inhibits or kills organisms causing infection - eye infections, corneal abrasions

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