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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 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 heartleads 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