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Chapter 35 Agents Affecting Thyroid, Parathyroid, and Pituitary Function Agents Affecting Thyroid, Parathyroid, and Pituitary Function Goal: maintenance of physiologic stability Hypothalamus and the pituitary gland Form the neuroendocrine system Main director is the hypothalamus 35 - 2 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pituitary Gland Consists of: 35 - 3 Adenohypophysis (anterior pituitary) Neurohypophysis (posterior pituitary) Linked to the hypothalamus Pituitary gland secretes hormones (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Hormones secreted by the anterior pituitary 35 - 4 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pituitary and Thyroid Glands Pituitary gland Thyroid-stimulating hormone (TSH) Thyroid gland location: neck Produces T3 and T4 hormones Cellular metabolism Produces calcitonin Inhibits bone resorption 35 - 5 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Thyroid Disorders Hyperthyroidism Hypothyroidism 35 - 6 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Hyperthyroidism Excessive secretion of thyroid hormones 35 - 7 Increased metabolism (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Hyperthyroidism Clinical signs and symptoms Skin hot and dry Increased cardiac and respiratory rates Weight loss Increased appetite Muscle weakness Nervousness Irritability Unable to sleep well 35 - 8 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antithyroid Drugs Inhibits coupling of iodine Prevent T3 and T4 formation Iodides Stop thyrotropin from being active Radioactive isotopes Diagnose and treat hyperthyroidism 35 - 9 Inhibits the production of T3 and T4 Radiation destroys the thyroid gland (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Antithyroid Drugs Methimazole and propyithiouracil (PTU) Side effects/adverse effects Liver and bone marrow toxicity Interactions Increased activity of oral anticoagulants Additive agranulocytosis when taken with bone marrow depressants Therapeutic results Normal metabolic rate 35 - 10 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Hypothyroidism Decreased secretion of thyroid hormones Clinical signs and symptoms 35 - 11 Decreased metabolism Thickened skin Decreased cardiac and respiratory rates Weight gain Loss of appetite, anorexia Muscle weakness Lethargy (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Hypothyroidism Called cretinism in children Called myxedema in adults 35 - 12 Underdeveloped growth rate Low metabolic rate Mental retardation Low metabolic rate Loss of mental and physical stamina Hair loss Firm edema (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Hypothyroidism Goal is to replace the thyroid hormone 35 - 13 Levothyroxine sodium (Synthroid) Widely prescribed synthetic thyroid hormone (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Hypothyroidism Thyroid (levothyroxine sodium) preparations Cause interactions Oral anticoagulants: increased anticoagulant effect Digitalis: decreased serum levels Hypoglycemic agents: decreased effect 35 - 14 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Client Teaching Tips General client teaching tips for clients with thyroid disorders 35 - 15 Too high of a dose will result in nervousness, irritability, and insomnia Keep a log of pulse, weight, and mood status Avoid foods high in iodine such as soy, tofu, turnips, seafood, and iodized salt (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Client Teaching Tips Immediately report chest pain. Synthroid takes several weeks to months to reach the therapeutic level. 35 - 16 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Parathyroid Glands Parathyroid Pinhead-sized structures located on either side of the thyroid gland Primary function Parathormone secretion It promotes bone resorption (breakdown of the bone) 35 - 17 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Hypoparathyroidism Parathormone deficiency Result Decreased blood levels of calcium Increased phosphate levels Neuromuscular irritability Psychiatric disorders Treatment Replace the calcium 35 - 18 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Hyperparathyroidism Oversecretion of parathormone Result Increased blood levels of calcium Decreased phosphate levels Kidney stones Treatment Replace the calcitonin Replace the phosphate 35 - 19 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pituitary Disorders Hypopituitarism Therapy 35 - 20 Underproduction of pituitary hormones Corticosteroids: a life and death issue Thyroid replacement Sex hormone replacement (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Pituitary Disorders Hyperpituitarism Treatment 35 - 21 Overproduction of pituitary hormones Signs and symptoms: gigantism and acromegaly Chemotherapy Radiation Surgery—inactivation or removal (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Pituitary Disorders Diabetes insipidus Caused by a deficiency or total absence of vasopressin (ADH) Signs and symptoms Huge urine output (polyuria) Increased thirst (polydipsia) Hypernatremia (increased sodium) Dehydration Treatment: antidiuretic hormone 35 - 22 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antidiuretic Hormone (ADH) Directs the body to retain water and sodium Focus is on water versus sodium Causes vasoconstriction Synthetic ADH drugs Lypressin Vasopressin 35 - 23 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.