Endocrine System Disorders Chapter 21 Converting Measuring Systems Chapter 8 (page 150 – 160)

1. Endocrine System DisordersChapter 21Converting Measuring SystemsChapter 8 (page 150 – 160) Thyroid and Diabetes Ratio-and-Proportion

2. 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

3. Extremely complex • Involves many organs(regulated by hormones) • Seminar will focus on Thyroid disorders and Diabetes Endocrine system

4. 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) Thyroid Gland

5. 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?

6. Causes • Radiation therapy • Lack of iodine • Surgical removal of thyroid • Pituitary dysfunction • Symptoms • Weight gain • Fatigue • Feeling ‘cold’ all the time • Unable to concentrate Hypothyroid (Low) levels

7. 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 Oral Thyroid Replacement

8. 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 Oral Thyroid Replacement

9. 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

10. For the treatment of Hyperthyroid • Hypersecretion of thyroid hormones • Causes • Tumors • Autoimmune diseases (Graves’ disease) • Symptoms • Increased cell metabolism • Weakness • Anxiety • Heat production Antithyroid Medications

11. 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 Treatment of Hyperthyroidism

12. questions ???? ……….… Questions?

13. 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)

14. Type One Type Two • Juvenile onset • Rapid development • 5-10% of Diabetics • No Insulin produced • Symptoms: Thirst, Urination, and Weight Loss(thin) • Glucose levels fluctuate with activities, illness • Adult onset (>40) • Gradual development • Family History • 90-95 % of Diabetics • Insulin resistance or decreased insulin • May be asymptomatic • Obesity a major factor Be able to compare the two types and explain differences !

15. 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 Treatment of Diabetes

16. 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 Insulin

17. 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 Insulin Types

18. 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!” Insulin: Patient Education

19. 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 Oral Medications

20. Sulfonylureas • Biguanides • Alpha-glucosidase inhibitors • Thiazolidinediones • Metglitinides • Amulin/GL-1 analogs Classes of Oral Antidiabetic Medications

21. First oral agents • Two groups • First generation • Second generation • Second Generation • Most potent, effects with lower doses and last longer • Once daily dosing • Examples Glipizide, glyburide Sulfonylureas

22. No direct insulin activity, increases insulin-secretions • Most common side effect, Hypoglycemia • More severe with elderly • 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 bewaredisulfram reaction Sulfonylureas continued

23. Chapter 8 (page 150 – 160) Converting Between Measurement Systems

24. …“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 Why Convert ? …

25. Time Conversions:24-Hour Clock Figure 7-1.

26. 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 Hints for Time Conversions

27. 11:02 AM = _________ • 2:56 AM = __________ • 10:45 PM = _________ • 8:10 PM = __________ • 12:00 PM = _________ • 12:01 AM = ___________ Changing to the 24hour clock

28. 0421 = __________ • 0258 = __________ • 1357 = __________ • 1234 = __________ • 2400 = __________ • 0045 = __________ Convert from 24-hr to 12-hr clock

29. 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 Ratios and Proportions …

30. 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 ml5ml 15*5=1x 15 gttx gtt 75=1x 75/1 = x x = 75 gtt Solving Unknown Variables

31. 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! Solving Unknown Variables

32. 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 tabx = 2 tab 325mg 650mg Cross-multiplying

33. 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 mlx mL 250mg 500mg X = 10 ml’s Volume Conversions

34. 45 mg = gr ¾ Converting between mg’s and grains 15 mg = gr ¼ • gr ii =120 mg • gr iii = 180 mg • gr I = 60 mg • ss = gr 1 ½ = 90 mg 30 mg = gr ½ or gr ss Grains & mg’s Relationship

35. 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 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 = 300 • 60 * x = 60x • 60x = 300 • 60x/60 = 300/60 • x = 5 • 300 mg = gr v Weight Conversions

36. 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 ? Scored Tablet Practice Problem

37. 2.5 cm x cm 1 in 14 in 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 Length Conversions