Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands ...
-
Upload
jadyn-hallman -
Category
Documents
-
view
213 -
download
0
Transcript of Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands ...
![Page 1: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/1.jpg)
1
Drugs that affect the Endocrine System
Pharmacology I
![Page 2: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/2.jpg)
2
Objective 1: define the term hormone
Objective 2: list the endocrine glands
Objective 3: identify the hormones that are secreted by the anterior pituitary and describe their main functions in the body
![Page 3: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/3.jpg)
3
Objective 4: identify the hormones that are released by the posterior pituitary and describe their main functions in the body
![Page 4: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/4.jpg)
4
Objective 5: identify the two main thyroid hormones
Objective 6: describe how the body synthesizes the thyroid hormones
![Page 5: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/5.jpg)
5
Objective 7: identify the actions of drugs used to treat hyperthyroidism
![Page 6: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/6.jpg)
6
Objective 8: list the anti-thyroid agents used to treat hyperthyroidism
Drugs are:◦Iodine-131 (131I)◦Propylthiuracil (PTU, Propacil)◦Methimazole (Tapazole
![Page 7: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/7.jpg)
7
Radioactive iodine ◦Taken up by thyroid◦Destroys hyperactive thyroid tissue Essentially no other tissue is affected
Takes 3-6 months for fully assess effect
If more than one dose needed, three months between doses is needed
![Page 8: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/8.jpg)
8
Dosing is oralAdd to waterNo colorNo taste Be very careful not to spill (hazardous)
Client can not be pregnant
![Page 9: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/9.jpg)
9
Side effects◦Tenderness in thyroid gland◦Hyperthyroidism in 40%, second dose needed
◦Hypothyroidism
![Page 10: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/10.jpg)
10
Drug interactions◦Lithium carbonate
![Page 11: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/11.jpg)
11
PTU and Tapazole◦Block synthesis of T3 and T4◦Takes days to 3 weeks to see effect
◦Can use long term◦Can use short term pre subtotal thyroidectomy
![Page 12: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/12.jpg)
12
Side effects◦Purpuric, maculopapular rash◦Headaches, salivary and lymph node enlargement
◦Bone marrow suppression ◦Hepatotoxicity◦Nephrotoxicity
![Page 13: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/13.jpg)
13
Objective 9: identify the hypothyroid conditions
Hypothyroid condition in adults called myxedema
Congenital hypothyroidism called cretinism
![Page 14: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/14.jpg)
14
Objective 10: list the thyroid agents
Levothyroxine replaces T3 and T4
![Page 15: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/15.jpg)
15
Liothyronine synthetic T3◦Onset of action more rapid than levothyroxine
Liotrix synthetic mixture levothyroxine and liothyronine (4 to 1 ratio)◦Provides consistent levels of T3 and T4
![Page 16: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/16.jpg)
16
Thyroid USP◦From beef, pork, or sheep thyroid glands
◦Oldest form available, cheapest◦Lacks purity, uniformity, stability
![Page 17: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/17.jpg)
17
Side effects◦Hyperthryoidism
Drug interactions◦Warfarin: larger doses needed◦Digitalis: smaller doses needed◦Hyperglycemia can occur early in therapy
![Page 18: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/18.jpg)
18
Objective 11: describe the nursing process associated with administering thyroid or anti-thyroid preparations
![Page 19: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/19.jpg)
19
Assessment important◦Clients sensitive to replacement therapy, monitor for adverse effects
◦Levothyroxine started low and dose increased over weeks
![Page 20: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/20.jpg)
20
Safe handling, storage and disposal of radioactive materials via institution policy
Blood levels need to be monitored
Clients need to be alert to side effects and report
Clients need to report if no improvement
![Page 21: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/21.jpg)
21
Objective 12: name the parts of the adrenal gland
Objective 13: list the types of hormones secreted by the adrenal glands
![Page 22: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/22.jpg)
22
Two hormones from adrenal gland◦Mineralcorticoids◦Glucocorticoids
![Page 23: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/23.jpg)
23
Mineralcorticoids◦Maintain fluid and electrolyte balance
◦Used to treat adrenal insufficiency Fludrocortisone (Florinef) Aldosterone Act on distal tubules, causes water and sodium retention
Causes excretion of potassium and hydrogen
![Page 24: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/24.jpg)
24
Objective 14: describe the metabolic effects of the glucocorticoids, and the consequences of these effects
![Page 25: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/25.jpg)
25
Objective 15: describe how glucocorticoids suppress inflammation
Corticosteroids secreted by adrenal cortex of adrenal glandGlucocorticoids
![Page 26: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/26.jpg)
26
Glucocorticoids include◦Cortisone, hydrocortisone, prednisone etc.
◦Have antiinflammatory, antiallergic activity
![Page 27: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/27.jpg)
27
Also affect glucose, protein and fat metabolismGlucocorticoids secreted in response to stressorsCause release of epinephrine
![Page 28: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/28.jpg)
28
Objective 16: identify therapeutic uses of glucocorticoids◦Glucocorticoids used for replacement therapy when adrenal gland not functional
◦High doses used for inflammation, allergy, asthma
![Page 29: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/29.jpg)
29
Use of corticosteroids◦Used with caution in those with Diabetes mellitus Heart failure Hypertension Peptic ulcer Mental disturbance Suspected infection
![Page 30: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/30.jpg)
30
After one week, discontinue drug slowly (wean off)
Abrupt discontinuation◦Fever; Malaise; Fatigue◦Weakness; orthostatic dizziness, hypotension
◦Dyspnea; hypoglycemia
![Page 31: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/31.jpg)
31
Topical: apply as directed, may use occlusive dressing
Alternate –day therapy: give between 6 & 9 AM; give with meals
![Page 32: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/32.jpg)
32
Side Effects◦Electrolyte imbalance, fluid accumulation
◦Susceptibility to infection◦Behavioral changes◦Hyperglycemia◦Peptic ulcer formation◦Delayed wound healing
![Page 33: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/33.jpg)
33
Drug interactions◦Loop diuretics: can enhance electrolyte loss
◦Warfarin: can have increased or decreased effect
◦Hyperglycemia: diabetics and children need to be monitored
![Page 34: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/34.jpg)
34
Objective 17: list the glucocorticoid preparations
![Page 35: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/35.jpg)
35
Various drugs for topical, oral, injection, inhalation◦Cortisone◦Dexamethasone (Decadron, Dexone)
◦Fludrocortisone (Florinef)-also mineralcorticoid
![Page 36: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/36.jpg)
36
Fluocinonide (Lidex)Hydrocortisone (Cortef, Solu-Cortef)
Methlprednisolone (Solu-Medrol, Depo-Medrol)
Prednisolone (Delta-Cortef)Prednisone (Deltasone, Apo-Prednisone)
Triamcinolone (Aristocort, Kenalog)
![Page 37: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/37.jpg)
37
Objective 18: describe nursing care responsibilities associated with administering glucocorticoids
![Page 38: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/38.jpg)
38
Objective 19: identify the functions of insulin in the body
Objective 20: define diabetes mellitus
Objective 21: identify the site of insulin production in the body
Objective 22: list the types of diabetes
![Page 39: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/39.jpg)
39
Objective 23: explain the functions of insulin◦Hormone from beta cells of the pancreas (islets of Langerhans) Normally: 0.5 – 1 unit per hour secreted
Adult: 30-50 units per day Insulin transports glucose into cells; helps metabolize protein and fat. Diabetes is a metabolic disorder: all body systems affected
![Page 40: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/40.jpg)
40
Objective 24: identify the onset, the peak, and the duration of action for rapid, intermediate, long acting and fixed combinations of insulin
![Page 41: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/41.jpg)
41
Lispro and Aspart◦Most rapid acting of insulins◦They are synthetic insulin analogs Give within 10-15 minutes of a meal Onset: 10 minutes Peak: 30 to 60 min Duration: 5 hours
Rapid-Acting Insulin
![Page 42: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/42.jpg)
42
Regular insulin◦Human regular insulin available, not just animal derivation Give within 30-60 minutes of meals Onset: 30 minutes Peak: 2.5-5 hours Duration: 5-10 hours Administration: subcutaneous or IV
Short-Acting Insulin
![Page 43: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/43.jpg)
43
Neutral protamine Hagedorn (NPH)◦Contains regular insulin and protamine Protamine binds to insulin: slow release Onset: 1-4 hours (pork is 1-1.5 hrs)
Peak: 8-12 hours (pork: 8-12 hrs) Duration: 18-24 hours (pork: 24 hrs)
Intermediate-Acting Insulin
![Page 44: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/44.jpg)
44
Lispro: can be mixed with protamine◦Humalog mix 75/2575% Lispro with protamine25% LisproRapid acting insulin with intermediate duration of action (12-24 hours)
![Page 45: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/45.jpg)
45
![Page 46: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/46.jpg)
46
Humulin Ultralente◦Crystalline form of Lente insulinOnset: 4-8 hoursPeak: 12-18 hoursDuration: 24-28 hours
Long-Acting Insulin
![Page 47: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/47.jpg)
47
Insulin-Glargine solution (Lantus)◦Biosynthetic Absorbed in a uniform manner-no large fluctuations of insulin levels = reduction in possible hypoglycemiaOnset: 5 hoursPeak: no pronounced peak activity
Duration: 24 hoursDo NOT mix with other insulins
![Page 48: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/48.jpg)
48
![Page 49: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/49.jpg)
49
![Page 50: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/50.jpg)
50
![Page 51: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/51.jpg)
51
![Page 52: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/52.jpg)
52
![Page 53: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/53.jpg)
53
![Page 54: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/54.jpg)
54
Objective 25: describe the local tissue responses that can occur with repeated insulin injections
![Page 55: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/55.jpg)
55
Two problems can occur◦Allergic reactionsFrom proteins in insulin, alcohol, the insulin itselfSwitch types of insulinUse unscented alcoholWill resolve
![Page 56: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/56.jpg)
56
◦LipodystrophiesAtrophy or hypertrophy of subcutaneous fatUse the area because of anesthesia effect
![Page 57: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/57.jpg)
57
![Page 58: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/58.jpg)
58
◦Use of the site decreases insulin absorption
◦Causes erratic absorption of insulin
◦Is cosmetic problem
![Page 59: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/59.jpg)
59
Objective 26: list the symptoms of insulin shock
Hypoglycemia ◦Headache◦Nausea◦Weakness◦Hunger
![Page 60: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/60.jpg)
60
LethargyDecreased coordinationGeneral apprehensionSweatingConfusion Blurred or double visionCan progress to coma and death
![Page 61: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/61.jpg)
61
Objective 27: discuss glucose elevating drugs◦The drug used to raise blood sugarGlucagon Glucose
![Page 62: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/62.jpg)
62
Glucagon◦Hormone from alpha cells of pancreas Breaks down stored glycogen to glucose
Aids in gluconeogenesis Must have glycogen available or drug will not work
![Page 63: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/63.jpg)
63
◦May see 50% glucose administered
◦ IV◦Raises blood sugarUse when no glycogen is stored
![Page 64: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/64.jpg)
64
Objective 28: describe what is meant by sliding scale insulin administration
![Page 65: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/65.jpg)
65
Sliding scale insulin◦Physician orders doses of insulin based upon blood glucose level
◦Regular insulin is usedSliding scale is “catch-up”Read the orders carefully
![Page 66: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/66.jpg)
66
Blood sugar Insulin
0-150 0 units151-200 2 units
201-300 5 units
Over 300, call physician
Example
![Page 67: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/67.jpg)
67
Objective 29: describe the action of the oral antidiabetic agents◦Some act on the cells to decrease resistance
◦Some act on the beta cells to increase production
◦Some inhibit glucose absorption
![Page 68: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/68.jpg)
68
Objective 30: identify the conditions under which an oral antidiabetic agent would be used◦Type 2 diabetesNo control with diet/exercise
![Page 69: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/69.jpg)
69
Objective 31: list the oral antidiabetic agents
![Page 70: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/70.jpg)
70
◦Classifications are Biguanide oral hypoglycemic agents
Sulfonylurea oral hypoglycemic agents
Meglitinide oral hypoglycemic agents
Thiazolidinedione oral hypoglycemic agents
Antihyperglycemic agents
![Page 71: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/71.jpg)
71
Metformin (Glucophage)◦Does not stimulate insulin release◦Will not cause hypoglycemia◦Can be used in combination with sulfonylureas
◦Decreases serum triglycerides and LDL
◦Slightly increases HDL
Biguanide Oral Hypoglycemics
![Page 72: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/72.jpg)
72
Initial dose: 500 mg BID◦Can go up to 2500 mg dailyUse divided doses If blood sugar not controlled, add another agent
![Page 73: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/73.jpg)
73
Side effects to expect◦N/V◦Anorexia◦Abdominal cramps◦Flatulence Will resolve Take with meals to decrease SE
![Page 74: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/74.jpg)
74
SE to report◦Malaise◦Myalgias◦Respiratory distress◦HypotensionLactic acidosis can occurMore if renal failure or excess alcohol intake
![Page 75: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/75.jpg)
75
Drug interactions◦Drugs that depend upon kidney for excretion can block metformin excretionCan have lactic acidosis develop
![Page 76: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/76.jpg)
76
Drugs that cause hyperglycemia with metformin◦OBC◦Corticosteroids◦Phenothiazines◦Diuretics◦Thyroid replacement
![Page 77: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/77.jpg)
77
Stimulate release of insulinUse when pancreas can still secrete insulin
Sulfonylurea Oral Hypoglycemic Agents
![Page 78: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/78.jpg)
78
Two generations◦First generationExample: Dymelor (500 mg daily)
◦Second generationExample: Glucotrol (2.5-5 mg daily)
![Page 79: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/79.jpg)
79
Allergy: if allergic to sulfonamides, probably allergic to sulfonylureas◦Do not administer
![Page 80: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/80.jpg)
80
SE to expect◦N/V◦Anorexia◦Abdominal crampsUsually mildDecrease with continued therapy
![Page 81: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/81.jpg)
81
SE to report◦HypoglycemiaMonitor blood sugarTreat with glucose source
◦HepatotoxicityAnorexia, N/V, jaundice, increased liver function tests
![Page 82: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/82.jpg)
82
◦Blood dyscrasiasRBC, WBCMonitor for sore throat, fever, purpura, jaundice
◦Dermatologic reactionsRash or pruritus If occurs: hold drug, call MD
![Page 83: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/83.jpg)
83
Drug interactions◦Various drugs can cause hypoglycemia such as Warfarin, ethanol
![Page 84: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/84.jpg)
84
◦Hyperglycemia with corticosteroids, phenothiazines and others
◦Beta-adrenergic blockers: cause hypoglycemia or mask the symptoms
◦Alcohol: Antabuse-like reaction
![Page 85: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/85.jpg)
85
Stimulate release of insulin from pancreas
Can be used alone or in combination◦Have short duration of action◦Must take up to QID
Meglitinide Oral Hypoglycemics
![Page 86: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/86.jpg)
86
Examples of drugs◦Repaglinide (Prandin)◦Nateglinide (Starlix)
![Page 87: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/87.jpg)
87
Dosing ◦Can take 1-30 minutes before a meal
◦Must take up to QID: compliance
◦If skip meal, skip dose
![Page 88: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/88.jpg)
88
SE to expect and report◦HypoglycemiaDose adjustments may be needed
Monitoring of blood glucose important
![Page 89: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/89.jpg)
89
Drug interactions◦HypoglycemiaEthanol, NSAIDs, Warfarin, MAOIs
◦Hyperglycemia Corticosteroids, phenothiazines, estrogens
![Page 90: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/90.jpg)
90
B-blockers: cause hypoglycemia or mask symptoms
Tegretol and others: increase repaglinide metabolism
Some macrolides and antifungals can inhibit repaglinide metabolism
![Page 91: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/91.jpg)
91
Increase sensitivity of muscle and fat tissue to insulin◦Allows more glucose to enter cells
◦Inhibit gluconeogenesisDecreases hepatic output of glucose
◦Do not increase insulin output
Thiazolidinedione OHA
![Page 92: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/92.jpg)
92
Can be used alone or in combination with other OHA’s or insulin
Examples ◦Pioglitazone (Actos)◦Rosiglitazone (Avandia)
![Page 93: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/93.jpg)
93
Baseline labs: liver function and alkaline phosphatase, CBC, WBC, HDL, LDL, triglycerides
Premenopausal, anovulatory females◦Ovulation may resume
Nursing Process for TZD’s
![Page 94: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/94.jpg)
94
SE to expect◦N/V◦Anorexia ◦Abdominal crampsMildResolve with continued therapy
![Page 95: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/95.jpg)
95
SE to report◦Hypoglycemia◦Hepatotoxicity ◦Weight gain
![Page 96: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/96.jpg)
96
Drug interactions◦Various drugs can cause an increase in hypoglycemia or hyperglycemia
◦B-adrenergics can mask hypoglycemia or cause it
◦Pioglitazone can enhance metabolism of ethinyl estradiol and norethindroneOvulate, become pregnant
![Page 97: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/97.jpg)
97
Two drugs◦Acarbose (Precose)◦Miglitol (Glyset)◦They inhibit pancreatic and GI enzymes from digesting sugars This delays glucose absorption and decreases postprandial hyperglycemia
Antihyperglycemic Agents
![Page 98: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/98.jpg)
98
Acarbose ◦Does not cause hypoglycemia◦Can be used with sulfonylureas or metformin
◦DosingTID at start of main meals
![Page 99: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/99.jpg)
99
SE to expect◦Abdominal cramps◦Diarrhea◦FlatulenceCaused by metabolism of carbohydrates in gut
Usually mild, resolve
![Page 100: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/100.jpg)
100
SE to report◦Hypoglycemia◦Hepatotoxicity Can cause increased AST, ALTHas caused hyperbilirubinemia
![Page 101: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/101.jpg)
101
Hyperglycemia can occur with some drugs such as corticosteroids, phenothiazines, OBC, thyroid
Digestive enzymes and intestinal adsorbents reduce effect of acarbose
Acarbose can decrease absorption of digoxin
![Page 102: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/102.jpg)
102
Miglitol (Glyset)◦Used alone or with sulfonylureas
◦Check liver function before treatment
◦Assess for malabsorption syndrome or obstruction in gut
![Page 103: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/103.jpg)
103
Dosing ◦Take with first bite of food◦Start with 25 mg TID
![Page 104: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/104.jpg)
104
SE to expect◦Abdominal cramps◦Diarrhea◦Flatulence
![Page 105: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/105.jpg)
105
SE to report◦Hypoglycemia
![Page 106: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/106.jpg)
106
Drug interactions◦Hyperglycemia with various agents such as cortisone, phenothiazines
◦Propranolol, Ranitidine not absorbed with concurrent miglitol
◦Digestive enzymes, intestinal adsorbents reduce effect of miglitol
![Page 107: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/107.jpg)
107
Objective 32: describe the nursing interventions associated with teaching the diabetic about the treatment
![Page 108: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/108.jpg)
108
Objective 33: list the therapeutic uses of estrogen and progesterone◦Stimulate maturation of female sex organs
◦Responsible for menstrual cycle◦Drugs used for replacement, birth control, control of prostate cancer, breast cancer, osteoporosis (controversial use)
![Page 109: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/109.jpg)
109
Objective 34: name the estrogen preparations◦Various estrogens Conjugated estrogen (Premarin) Esterified estrogens (Estratab) Estradiol (Estrace) Estropipate (Ogen) Ethinyl estradiol (Estinyl)
![Page 110: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/110.jpg)
110
Objective 35: name the progesterone preparations◦Progestins inhibit ovulation Norethindrone Ethynodiol diacetateDesogestrelLevonorgestrel
![Page 111: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/111.jpg)
111
Objective 36: identify the most commonly used ovulatory agents
Clomiphene citrate (Clomid)◦Structurally similar to natural estrogens Stimulates ovaries to release ova Used for women with reduced circulating estrogen
![Page 112: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/112.jpg)
112
Objective 37: describe the actions of the oral contraceptives◦Estrogens and progestins induce contraception by inhibiting ovulation Estrogen blocks pituitary release of FSH
Progestin inhibits LH Both alter cervical mucus May change endometrial wall
![Page 113: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/113.jpg)
113
Minipill is progestin-only◦Must take every day
Combination pill ◦Take in 21 day cycle
![Page 114: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/114.jpg)
114
Complete physical needed before therapy
SE expected: nausea, weight gain, spotting, changed menstrual flow, missed periods, depression, mood changes, chloasma, headaches
![Page 115: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/115.jpg)
115
SE to report: vaginal discharge, breakthrough bleeding, yeast infections
Blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain
![Page 116: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/116.jpg)
116
Various drugs can decrease effect of OBC◦Barbiturates, Tegretol, St. John’s Wort, antibacterial agents
Drugs enhance effect and toxic effects◦Some antifungals, Warfain, phenytoin, thyroid hormones, benzodiazepines
![Page 117: Pharmacology I 1. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted.](https://reader030.fdocuments.us/reader030/viewer/2022032523/56649d835503460f94a69221/html5/thumbnails/117.jpg)
117
Objective 38: identify the nursing process for clients with conditions for which female hormones are used