Download Lecture 13 - Harper College

Lecture 13
Chapter 12
Vitamin and Mineral
Replacement
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Vitamins
Organic chemicals necessary for normal metabolic functions, tissue growth & healing
Body needs only a small amt. of vitamins daily easily obtained through a wellbalanced 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 (preformed 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