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Endocrine System Disorders, Chapter 21
Converting Between Measurement Systems,
Chapter 8: Pages 150 – 152
Calculating Doses of Nonparenteral
Medications, Chapter 9: Pages 164-177
Thyroid and Diabetes
Ratio-and-Proportion
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
Jerry has recently received a
diagnosis of Type II diabetes. Since
his diagnosis he has seen magazine
ads for a specific form of insulin and
asks his doctor why it wasn’t
prescribed for him. “After all, insulin
is insulin, isn’t it?” he asks. Is this
true?
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Mental deviations
Changes in energy levels
Growth abnormalities
Skin, hair, and nail changes
Muscle atrophy (wasting)
Emotional disturbances (mood changes)
Edema
Changes in blood pressure
Sexual irregularities
Common Symptoms of Endocrine
Diseases
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Extremely complex
 Involves many organs (regulated by
hormones)
 seminar will focus on Thyroid disorders
and Diabetes
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Endocrine system
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Thyroid Feedback System
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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)
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Located in the neck
Made up of 2 ‘lobes’ (on either side of the
larynx)
The 3 hormones secreted by Thyroid are
…
◦ Thyroxine (T4)
◦ Tri-iodotyhronine (T3)
◦ calcitonin
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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)
Thyroid Gland
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Protein synthesis
blood sugar (glucose) levels
serum cholesterol levels
Rate of metabolism
normal mental development and
growth
T3 and T4 require iodine for production !
◦ Diets low in iodine may lead to goiter,
enlarged thyroid
What do T3 and T4 do?
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Causes
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Radiation therapy
Lack of iodine
Surgical removal of thyroid
Pituitary dysfunction
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Weight gain
Fatigue
Feeling ‘cold’ all the time
Unable to concentrate
Symptoms
Hypo (Low) Thyroid levels
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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)
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Approved for supplemental or replacement needs of
hypothyroidism
Oral Thyroid Replacement
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Not used for obesity !
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Effects of overdose (like
hyperthyroidism)
◦ Doses required for weight loss could be life
threatening
◦ Symptoms include
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Psychotic behavior
Diarrhea
Increased blood pressure
Increased heart rates
Cardiovascular reactions
◦ Long term use associated with osteoporosis in postmenopausal women
Thyroid Replacement
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Life long therapy
Take in the morning on a empty stomach
to avoid insomnia.
Palpitations, nervousness, and
headaches may be signs of toxicity
Monitor by blood levels
Ok for use in pregnancy
Patient Ed: Thyroid Replacements
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questions ???? ……….…
Questions?
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For the treatment of Hyper-thyroid
Hyper-secretion of thyroid hormones
◦ Causes
 Tumors
 Autoimmune diseases (Graves’ disease)
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Symptoms
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Increased cell metabolism
Weakness
Anxiety
Heat production
Anti-thyroid Medications
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Irradiation of thyroid gland
Surgical removal of thyroid
Anti-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
Cont, Treatment of Hyperthyroidism
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… do you have a question?
I have a question …
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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 !
Diabetes -Hyperglycemia
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Type One
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Juvenile onset
Rapid development
5-10% of Diabetics
No Insulin produced
Symptoms: Thirst,
Urination, and Weight
Loss(thin)
Glucose levels fluctuate
with activities, illness
Type Two
Adult onset (>40)
 Gradual development
 Family History
 90-95 % of Diabetics
 Insulin resistance or
decreased insulin
 May be asymptomatic
 Obesity a major
factor
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2 Types of Diabetes –be able to
compare the two types and explain
differences !
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Diet limiting carbohydrates ( too
bad … love those carbs!)
 Control body’s use of glucose by
consistent exercise, medication.
 Drugs fall into 3 categories
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◦ Insulin
◦ Oral Hypoglycemic agents
◦ Drugs that affect glucose absorption or
production
Treatment of Diabetes
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Purpose of Insulin
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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 injection
Dose is individualized, and changes over time
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◦ (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.
Insulin
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Insulin Types
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Rapid or Quick Acting
◦ Ex: Insulin Lispro and Insulin Asparte
◦ Onset: 5-minutes, -Duration: ~3hr
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Short Acting: Regular Insulin (R)
◦ Onset: 30-minutes, -Duration: ~6hr
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Intermediate: NPH Insulin (N)
◦ Onset: 2-hours, -Duration: ~20hr
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Long Acting: Lantus Insulin
◦ Onset: 4 to 6-hours, -Duration: ~24hr
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Generally well tolerated
May cause allergic reactions
 a different product can eliminate this problem
Weight Gain common side effect of Insulin Therapy
Hypoglycemia is the most common side effect
 Beware of skipping meals!
Rotate injection sites
Wear medical identification
Patient should ask before taking OTC medications
Monitor blood sugar! Extra-credit: who
says … “Check it, check it often … it’s the right
thing to do!”
Insulin: Patient Education
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Have any of these?
QUESTIONS
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Must have some insulin production in
pancreas to use oral medications
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Used in Type II after diet and exercise fail
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A patient who loses weight may be able to
discontinue medication
Oral Medications
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Sulfonylureas**we will be discussing
today
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones
Metglitinides
Amulin/GL-1 analogs
Classes of Oral
Antidiabetic Medications
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First oral agents
Two groups
 First generation
 Second generation
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Second Generation
 Most potent, effects with lower doses and last
longer
 Once daily dosing
 (See table 21-10 Page 429 for more info)
 Examples Glipizide, glyburide
Sulfonylureas
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No direct insulin activity, increases insulinsecretions (of no use in treatment of Type-I …
WHY?)
 Most common side effect, Hypoglycemia
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◦ More severe with elderly
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Must keep strict diet time and well balanced meals
Adverse 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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Sulfonylureas continued
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Chapters 8 and 9:
Converting Between
Measurement Systems
why Convert ? …
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…“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 Proportions … my
favorite!
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Excellent method!
(have I mentioned these are
my favorite)
** Please see the ‘practice-sheet’ I made for you
in DocSharing.
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Ratio—expression comparing two
quantities
◦ separated by colon or written as fraction (1:3
or 1/3)
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Proportion—comparing two
fractions(ratios) considered to be equall
◦ 1:2 and 2:4 same as 1/2 = 2/4
Solving Unknown Variables
Numerators must be same units
Denominators must be same
units
 1 mL : 15 gtts is the same as
2 mL : 30 gtts
 1 mL/15 gtts = 2 mL/30 gtts
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Ex: How many gtts in 5 ml’s?
1 ml
5ml
15*5=1x
15 gtt
x gtt
75=1x
75/1 = x
x = 75 gtt
Solving Unknown Variables
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Either method will allow you to solve for X
Notice both are arranged as g/ml (grams/ml)
(both have ‘like’ UNITs in the same position
on both sides of the equal sign Important!)
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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
1 tab
325mg
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X tab
650mg
x = 2 tab
X = 2 tab =dose
in other words, 2 of the (325mg tablets) = 650mg
=0.65 grams
cross-multiplying
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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 X = 10 ml’s
250mg
500mg
3. To find out how many teaspoonfuls are needed, convert
mL to tsp
Remember 5mL=1 tsp, so 10mL = 2tsp
4. 2 tsp’s per dose
5. Since dose is 500mg (2tsp’s) tid  need 6 tsp’s per day
Volume Conversions
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 days
 ½ tab* 2 (twice daily) = 1 whole tablet per day x
30days = 30 whole tablets for a one month supply
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…hey, what if the directions were to take
12.5mg TID x30 days ?
Scored Tablet Practice Problem
Length 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 cm
x cm
1 in
14 in
• 2.5 x 14 = 35
• 1 x x = 35
• x = 35
• 14 inches = 35 cm