Endocrine System DisordersEndocrine System DisordersChapter 21Chapter 21

Converting Measuring SystemsConverting Measuring SystemsChapter 8 (page 150 – 160)Chapter 8 (page 150 – 160)

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Thyroid and Diabetes

Ratio-and-Proportion

Common Symptoms of Endocrine Common Symptoms of Endocrine DiseasesDiseases

Mental deviationsChanges in energy levelsGrowth abnormalitiesSkin, hair, and nail changesMuscle atrophy (wasting)Emotional disturbances (mood changes)EdemaChanges in blood pressure Sexual irregularities

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Endocrine systemEndocrine system

Extremely complex

Involves many organs (regulated by hormones)

Seminar will focus on Thyroid disorders and Diabetes

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Thyroid GlandThyroid Gland

Located in the neck

Made up of 2 ‘lobes’ (on either side of the larynx)

3 hormones secreted by Thyroid …◦Thyroxine (T4)◦Tri-iodotyhronine (T3)◦Calcitonin

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)

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What do T3 and T4 do?What do T3 and T4 do?

Protein synthesis Blood sugar (glucose) levelsSerum cholesterol levelsRate of metabolism Normal mental development and

growthT3 and T4 require iodine for production !

◦Diets low in iodine may lead to goiter, enlarged thyroid

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Hypothyroid (Low) levelsHypothyroid (Low) levels

Causes◦Radiation therapy◦Lack of iodine◦Surgical removal of thyroid◦Pituitary dysfunction

Symptoms◦Weight gain◦Fatigue◦Feeling ‘cold’ all the time◦Unable to concentrate

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Oral Thyroid ReplacementOral Thyroid Replacement

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) Approved for supplemental or replacement needs of

hypothyroidism

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Oral Thyroid ReplacementOral Thyroid Replacement

Not used for obesity !◦Doses required for weight loss could be life

threatening

Effects of overdose (like hyperthyroidism)◦Symptoms include

Psychotic behavior Diarrhea Increased blood pressure Increased heart rates Cardiovascular reactions

◦Long term use associated with osteoporosis in post-menopausal women

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Patient Ed: Thyroid ReplacementsPatient Ed: Thyroid Replacements

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

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Antithyroid MedicationsAntithyroid Medications

For the treatment of Hyperthyroid

Hypersecretion of thyroid hormones◦Causes

Tumors Autoimmune diseases (Graves’ disease)

◦Symptoms Increased cell metabolism Weakness Anxiety Heat production

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Treatment of HyperthyroidismTreatment of Hyperthyroidism

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

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Questions? Questions?

questions ???? ……….…

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Diabetes (Hyperglycemia)Diabetes (Hyperglycemia)

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 !

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Be able to compare the two types and Be able to compare the two types and explain differences !explain differences !

Type One Type Two

Juvenile onsetRapid development5-10% of DiabeticsNo Insulin producedSymptoms: Thirst,

Urination, and Weight Loss(thin)

Glucose levels fluctuate with activities, illness

Adult onset (>40)Gradual developmentFamily History90-95 % of DiabeticsInsulin resistance or

decreased insulinMay be asymptomaticObesity a major

factor

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Treatment of DiabetesTreatment of Diabetes

Diet limiting carbohydrates ◦ ( too bad … love those carbs!)

Control body’s use of glucose by consistent exercise, medication.

Drugs fall into 3 categories◦Insulin◦Oral Hypoglycemic agents◦Drugs that affect glucose absorption or production

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Insulin Insulin

Purpose of Insulin ◦(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.

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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Insulin TypesInsulin Types

Rapid or Quick Acting◦Ex: Insulin Lispro and Insulin Asparte◦Onset: 5-minutes, -Duration: ~3hr

Short Acting: Regular Insulin (R)◦Onset: 30-minutes, -Duration: ~6hr

Intermediate: NPH Insulin (N)◦Onset: 2-hours, -Duration: ~20hr

Long Acting: Lantus Insulin◦Onset: 4 to 6-hours, -Duration: ~24hr

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Insulin:Insulin: Patient Education Patient Education

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! ◦ “Check it, check it often … it’s the right thing to do!”

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Oral MedicationsOral Medications

Must have some insulin production in pancreas to use oral medications

Used in Type II after diet and exercise fail

A patient who loses weight may be able to discontinue medication

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Classes of Oral Classes of Oral Antidiabetic MedicationsAntidiabetic Medications

Sulfonylureas

Biguanides

Alpha-glucosidase inhibitors

Thiazolidinediones

Metglitinides

Amulin/GL-1 analogs

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SulfonylureasSulfonylureas

First oral agents

Two groupsFirst generationSecond generation

Second Generation Most potent, effects with lower doses and last

longerOnce daily dosingExamples Glipizide, glyburide

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Sulfonylureas Sulfonylureas continuedcontinued

No direct insulin activity, increases insulin-secretions

Most common side effect, Hypoglycemia◦ More severe with elderly

Must keep strict diet time and well balanced mealsAdverse 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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Chapter 8 Chapter 8 (page 150 (page 150 – 160)– 160)

Converting Between Measurement Systems

Why Convert ? …Why Convert ? …Why Convert ? …Why Convert ? …

…“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

Time Conversions:Time Conversions:24-Hour Clock24-Hour ClockTime Conversions:Time Conversions:24-Hour Clock24-Hour Clock

Figure 7-1.

Hints for Time ConversionsHints for Time Conversions

Most countries don’t recognize AM or PM

Remember that 12am (midnight) is either 0000 or 2400

Converting AM to 24-hr clock is relatively easy◦ 4AM = 0400 ◦ 7:45AM = 0745

All other PM times, add 12 to convert to 24 hour clock

For example: ◦ 6PM (+12) = 1800◦ 10:20PM (+12) = 2200

Changing to the 24hour clockChanging to the 24hour clock

1. 11:02 AM = _________2. 2:56 AM = __________3. 10:45 PM = _________4. 8:10 PM = __________5. 12:00 PM = _________6. 12:01 AM = ___________

Convert from 24-hr to 12-hr clockConvert from 24-hr to 12-hr clock

1. 0421 = __________2. 0258 = __________3. 1357 = __________4. 1234 = __________5. 2400 = __________6. 0045 = __________

Ratios and ProportionsRatios and Proportions … …Ratios and ProportionsRatios and Proportions … …

Excellent method!

Ratio—expression comparing two quantities◦separated by colon or written as fraction (1:3 or

1/3)

Proportion—comparing two fractions(ratios) considered to be equal◦1:2 and 2:4 same as 1/2 = 2/4

Solving Unknown VariablesSolving Unknown VariablesSolving Unknown VariablesSolving 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

Ex: How many gtts in 5 ml’s? 1 ml 5ml 15*5=1x

15 gtt x gtt 75=1x75/1 = xx = 75 gtt

Solving Unknown VariablesSolving Unknown VariablesSolving Unknown VariablesSolving Unknown Variables

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!

Cross-multiplyingCross-multiplying

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 tab X tab x = 2 tab325mg 650mg

Volume ConversionsVolume Conversions

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?

5 ml x mL250mg 500mg X = 10 ml’s

Grains & mg’s RelationshipGrains & mg’s Relationship

15 mg = gr ¼ Converting between mg’s and grains

30 mg = gr ½ or gr ss

45 mg = gr ¾

•gr ii =120 mg

•gr iii = 180 mg

•gr I = 60 mg

•ss = gr 1 ½ = 90 mg

Weight ConversionsWeight ConversionsWeight ConversionsWeight Conversions

300 mg = grams (g) ______ ?Remember 60 mg = 1 gr (or 60 mg per gr i )60 mg / gr i = 300 mg / x gr

300 x 1 = 30060 * x = 60x60x = 30060x/60 = 300/60x = 5 300 mg = gr v

60 mg 300 mg gr i x gr

First convert quantities to be used into same unit of measure as you convert within the metric system

Scored Tablet Practice ProblemScored Tablet Practice Problem

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)?

What if the directions were to take 12.5mg TID x30 days ?

Length ConversionsLength ConversionsLength ConversionsLength 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 x 14 = 35• 1 x x = 35• x = 35• 14 inches = 35 cm

2.5 cm x cm1 in 14 in