BY DEFINITION AND FUNCTIONS OF: (FROM YOUR SLIDES)

Endocrine glands and hormones

- The endocrine system is composed of the endocrine glands, these are ductless glands which
release their secretion directly into the blood. Their secretion is called hormones. These are
chemicals, some are protein in nature and some are lipid in nature that influence many metabolic
processes in the body.
The endocrine system is controlled by the hypothalamus in the central nervous system. The
hypothalamus has connection to the master gland of the body called pituitary gland (also called
hypohysis) called hypothalamo – pituitary tract. Hypothlamus has endocrine function. It releases
hormones that will influence the release of the anterior pituitary gland hormones. This hormone is
also called factor. Example, the hypothalamus releases Thyroid Hormone Releasing Hormone/Factor
stimulating the anterior pituitary gland to release Thyroid Stimulating Hormone. If the hypothalamus
produces Thyroid Stimulating Hormone Inhibiting Hormone/Factor then this will stop the anterior lobe
of the pituitary gland to release Thyroid Stimulating Hormone. The hypothalamus also produces two
hormones that are stored in the posterior lobe of the pituitary gland ( also called neurohypohysis) .
These are Anti – Diuretic Hormone (ADH) or vasopressin and Oxytocin. Hypothalamus produces them
and the posterior lobe of the pituitary gland secretes them if there is a need to. ADH effect is to cause
water retention and vasoconstriction, hence the name vasopressin. This is release by the posterior lobe
in response to decreasing blood volume and blood pressure. The oxytocin function is to cause uterine
contraction and milk ejection and it being released during labor, delivery and lactation.
The anterior lobe of the pituitary gland (also called adenohypohysis) is the part that produces
several hormones that may influence other endocrine glands of the body. This is the reason why
pituitary gland is called the master gland of the body. The anterior lobe of the pituitary gland
produces two types of hormones. The tropic hormones that will influence secretion of other
hormones and the non tropic hormones that will influence metabolism of non endocrine tissues of
the body.

Tropic hormones
1. Thyroid Stimulating Hormone (Thyrotropic Hormine ) – influences the secretion of thyroid
hormones
2. Adrenocorticotropic Hormone (ACTH) – influences the seceretion of the adrenal cortex
hormones
3. Gonadotropic Hormones – infuences the secretions of gonads, both testes and ovaries.
a. Follicle Stimulating Hormone
b. Leutinizing Hormone

Non – Tropic Hormones

1. Growth hormone – stimulates normal body growth
2. Melanocyte Stimulating Hormone – stimulates melanocytes to produce melanin, a pigment in the
skin
3. Prolactin – stimulate production of milk from the mammary glands

Other endocrine glands and their hormone secretion as well as their functions are as follows:
Pineal gland – produces melatonin that induces sleep
Thyroid gland – produces
1. Calcitonin - regulating serum calcium level by decreasing its amount in the plasma
2. Thyroid hormones (T3 & T4) – controls the rate by which glucose is used by the cell as a
source of energy
Parathyroid gland – produces parathyroid hormone (PTH) this also regulates calcium serum level by
increasing its amount in the blood
Thymus gland – produces thymosine, a hormone stimulating production of the T lymphocytes in the
Immune System. This gland is present from birth and degenerates at the age of 8 years old, so
T-lymhocytes then are being produce solely by the bone marrow.
Adrenal gland – this is the most active gland under stress because one of its hormone has antistress
function. Adrenal gland has two parts.

1. Adrenal medulla – produces catecholamines, epinephrine and norepinephrine acting as

neurotransmitters of the SNS
2. Adrenal cortex – produces three hormones

a. Mineralocorticoids – Aldosterone which increases sodium reabsorption by the kidneys and in effect
increases water reabsorpiton as well, it will alson increase potassium excretion
b. Gucocorticoids – Cortisol this has antistress property. It has a diurnal pattern of release having its peak
secretion at 9 am then goes down by late afternoon and at night. Cortisol helps a person to overcome
stress in the morning. Cortisol has a lot of metabolic functions. It increases glucose in the blood. It
incease production of hydrochloric acid in the stomach.It causes mobilization of fats. It also causes water
retention. Cortisol has anti – inflammatory function as it suppresses WBS function.
c. Androgen – a male sex hormone like testosterone.

Pancreas – the endocrine function of this organ lies in their Islets of Langerhans cells.
1. Alpha cells – produces glucagon that regulates glucose in the blood by increasing its amount
2. Beta cells – produces insulin that helps the glucose to enter the liver cells and the muscle cells thereby
decreasing the amount of glucose in the blood.
3. Delta cells – produces somatostatin, which may also be produced by other endocrine
tissues. Somatostatin inhibits other hormones like insulin, growth hormone, thyroid stimulating
hormone and other minor hormone like cholecystokinin.

Gonads
1. Ovaries – produces two types of hormones
a. Estrogen – responsible for secondary sex characteristics in females; responsible for
egg cell production or oogenesis
b. Progesterone – responsible for ovulation and maintaing early pregnancy
2. Testes – produces testosterone which is responsible for secondary sex characteristics of
males.
The knowledge of the functions of different endocrine glands is very important in understanding
drug actions affecting the endocrine system
DMI & II - difference only
- Diabetes mellitus is a metabolic disease characterized by hyperglycemia most commonly due to insulin
dysfunction. Diabetes mellitus may be classified as:
1. Type 1 DM – lack of insulin production
2. Type 2 DM – insulin is produced by the beta cells but the insulin produce may be ineffective or
there is a slow release of insulin from the beta cells or the liver cells and the muscles cells are insensitive
to the presence of insulin.

Laboratories and diagnostics, anatomy and functions of kidneys

- The Kidney - organ for excretion, other homeostatic functions; it is the primary organ for regulating
fluid balance, electrolyte composition, and acid-base balance of body fluids. Our overall health is
strongly dependent on proper functioning of the kidney.

Secreted by kidneys:
Renin - helps regulate blood pressure
Erythropoietin - a hormone that stimulates blood production
Calcitriol - active form of vitamin D, help maintain bone homeostasis
The urinary system consists of two kidneys, two ureters, one urinary bladder. Each kidney contains one
million nephrons, the functional units of the kidney, blood enters the nephron through the large renal
arteries and is filtered through a semipermeable membrane. known as the glomerulus. Water and
other small molecules readily pass through the glomerulus and enter Bowman’s capsule, the first section
of the nephron, and then the proximal tubule. Once in the nephron, the fluid is called filtrate. Then after
leaving the proximal tubule, the filtrate travels through the loop of Henle and, subsequently, the distal
tubule. Fluid leaving the collecting ducts and entering the subsequent portions of the kidney is called
urine.

Complications and treatment of renal failure/ dialysis slides - renal

Pharmacologic management of Renal Failure

Complication Pathogenesis Treatment

Anemia Kidneys are unable to synthesize Epoietin alfa (Procrit, Epogen)
enough erythropoietin for RBC
production.
Hyperkalemia Kidneys are unable to adequately Polystyrene sulfate (Kayexalate) with
excrete potassium. sorbitol
Dietary restriction of Potassium
Hyperphosphatemia Kidneys are unable to adequately Calcium carbonate (Os-Cal 500), Calcium
excrete phosphate. acetate (Calphron) Dietary restriction
of Phosphate
Hypervolemia Kidneys are unable to excrete Loop diuretics in acute conditions,
sufficient sodium and water Thiazide diuretics in mild conditions,
leading to water retention. Dietary restriction of sodium
Hypocalcemia Hyperphosphatemia leads to loss Calcium supplement, corrected by
of calcium. reversing the hyperphosphatemia
Metabolic acidosis Kidneys are unable to adequately Sodium bicarbonate or sodium citrate
 excrete metabolic acids.

Definitions of diuretics
- Diuretics - are drugs that alter the volume and composition of body fluids, indicated for treatment of
HTN, heart failure, and disorders characterized by accumulation of edema/fluid.
Mechanism of action of Diuretics:
✓ increases the rate of urine flow
✓ block the sodium ion reabsorption in the nephron, thus sending more sodium to the urine.Chloride
ions (Cl) follow sodium, water molecules also travel with Na, blocking the reabsorption of Na will
increase the volume of urination.
Other indications:
1. HTN
2. heart failure
3. liver failure or cirrhosis
4. pulmonary edema

Positive and negative feedback

- Positive feedback mechanism – mechanism stimulating the pituitary gland to release tropic
hormone
- Negative feedback mechanism – a mechanism inhibiting the pituitary gland to release tropic
hormones

2 medications for growth failure

- Drug of choice: Somatropin, Somatrem
Somatropin and somatrem are hormones of recombinant DNA origin that are equivalent to human GH.
Somatrem is indicated only for the treatment of children with growth failure due to lack of
endogenous GH. Somatropin is indicated or the treatment of growth failure due to lack of GH or to
chronic renal failure, for treatment of short stature associated with Turner’s syndrome.

Insulin TIME OF ADMINISTRATION

Insulin is given subcutaneously. It is the primary treatment for clients with type 1 DM. It does not cross
the placenta so it is safe to use by pregnant women making it also the drug of choice for clients with
gestational DM. Insulin is destroyed by the digestive enzyme so even it passes the breastmilk and suck
by the baby, insulin is destroyed in the GIT of the baby making it safe for use among lactating mothers.
The primary adverse effect of which is hypoglycemia. This usually happens during the peak of action of
insulin. Insulin maybe given also to type 2 DM and for those with DM associated with other conditions.
Nursing interventions:
o Monitor vital signs, tachycardia can occur during insulin reaction
o Rotate injection sits to prevent lipodystrophy
o Monitor blood sugar level daily
o Monitor for glucose control by determining glycosylated hemoglobin test (HBA1c) periodically
o Provide health teaching on symptoms of hypoglycemia such as tremors, palpitation, dizziness, pallor,
tachycardia and syncope

2 medications for BPH (Benign Prostatic Hyperplasia)

-Alpha blockers
1.Tamsulosin Hcl (Tamsolin)
Indication: Treatment of benign prostatic hyperplasia to relieve symptoms of urinary obstruction
Action: relaxes the bladder muscles, These medications relax the muscle of the prostate and
bladder neck, which allows urine to flow more easily. There are at least five medications in this
category: terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and
silodosin (Rapaflo).
These medications relax the muscle of the prostate and bladder neck, which allows urine to flow
more easily. There are at least five medications in this category: terazosin (Hytrin), doxazosin
(Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo).
Nursing Considerations:
1. Take 30 minutes following meals, do not open, chew, or crush
2. Contraindication to patient with history of orthostatic hypotension
3. Take blood pressure, contraindicated to patient with hypotension
Adverse reaction: headache, chest pain, dizziness, insomnia, decreased libido, erectile disorder.

2. 5a-Reductase inhibitor - also known as dihydrotestosterone blockers, a type of drug that has
antiandrogenic effects used primarily in the treatment of enlarged prostate. (benign prostatic
hyperplasia) and male pattern hair loss. Drugs in this class are finasteride (marketed as Proscar
[finasteride 5 mg] and Propecia [finasteride 1 mg]) and dutasteride (marketed as Avodart).
1. Finasteride (Proscar)
Indication: used primarily to patient with benign prostatic hyperplasia in men with enlarged
prostate.
Action: blocks the action of an enzyme called 5a-reductase - changes testosterone to another hormone
that cause the prostate to grow or hair loss in male. It decrease prostate size and the effect only last as
long as the medicine is taken.
Administration: can be given with or without food
Contraindication: pregnancy, children
Side effects: impotence, abnormal ejaculation, dizziness, swelling in hands or feet,weakness,
headache, skin rash.
Nursing Considerations:
1. Advise patient to notify health care professional promptly if changes in breasts (lumps, pain,
nipple discharge) occur.
2. Inform patient that there is an increased risk of high grade prostate cancer in men taking this
drug.
3. Caution patient that finasteride poses a potential risk to a male fetus.
Antimuscarinic drugs
Reduce the symptoms of incontinence by reducing bladder muscle spasms.
Pharmacodynamics:
1. Trospium chloride - treat an overactive bladder. By relaxing the muscles in the bladder, trospium
improves your ability to control your urination. It helps to reduce leaking of urine, feelings of needing to
urinate right away, and frequent trips to the bathroom.
Administration:
Take tablet 1 hour before meals or on an empty stomach at least 1 hour before meal
Alcohol should not be consumed within 2 hours of administration

Steps in mixing insulin:

-induce air to cloudy first then to clear; aspirate clear first then the cloudy (RN)

Percent of body water in adult

- 60% of adult’s weight

Chemotherapeutic agents: alkylating, antimetabolites, anti-tumor antibiotics, topo I&2, anti-

microtubules
- Chemotherapeutic Agents, also referred to as antineoplastic agents, are used to directly or indirectly
inhibit the proliferation of rapidly growing cells, typically in the context of malignancy.

- Alkylating agents keep the cell from reproducing (making copies of itself) by damaging its DNA. These
drugs work in all phases of the cell cycle and are used to treat many different cancers, including cancers
of the lung, breast, and ovary as well as leukemia, lymphoma, Hodgkin disease, multiple myeloma, and
sarcoma. Examples of alkylating agents include: Altretamine, Bendamustine, Busulfan, Carboplatin,
Carmustine, Chlorambucil.

- Antimetabolites interfere with DNA and RNA by acting as a substitute for the normal building blocks of
RNA and DNA. When this happens, the DNA cannot make copies of itself, and a cell cannot reproduce.
They are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well
as other types of cancer. Examples of antimetabolites include: Azacitidine, 5-fluorouracil (5-FU), 6-
mercaptopurine (6-MP),Capecitabine (Xeloda), Cladribine, Clofarabine.

- Anti-tumor antibiotics- These drugs are not like the antibiotics used to treat infections. They work
by changing the DNA inside cancer cells to keep them from growing and multiplying. Examples of
anthracyclines include: Daunorubicin, Doxorubicin (Adriamycin), Doxorubicin liposomal, Epirubicin,
Idarubicin,Valrubicin.

- Topoisomerase I inhibitors (also called camptothecins) include: Irinotecan, Irinotecan liposomal,

Topotecan
- Topoisomerase II inhibitors (also called epipodophyllotoxins) include: Etoposide (VP-16), Mitoxantrone
(also acts as an anti-tumor antibiotic), Teniposide.

Chemo goals, treatment modalities, treatment guidelines

Chemotherapy can have different goals:
● To cure cancer.
●To control the growth of cancer.
● To alleviate symptoms such as pain caused by cancer.

Chemotherapy can be used as a single treatment modality, but is also commonly used in combination
with surgery, radiotherapy and biological treatment in order to:
● Shrink a tumor before radiotherapy or surgery. This is called neo-adjuvant therapy.
● Destroy any remaining cancer cells after surgery or radiotherapy. This is called adjuvant therapy.
● Enhance the effect of radiotherapy and biological therapy.
● Destroy recurring cancer or destroy cancer that has spread to other parts of the body.

Chemotherapy Safety Guidelines

A. Antineoplastic drugs are potentially hazardous to personnel and may have teratogenic and/or
carcinogenic effects.
B. Safety guidelines have been issued by the Occupational Safety and Health Administration (OSHA).
• Obtain special training for drug administration.
• Use two pairs of powder-free, dispensable chemotherapy gloves, and a disposable, closed, long-
sleeved gown with outer pair of gloves covering gown cuff whenever there is risk of exposure to
hazardous drugs.
• Provide syringes and IV sets with Luer lock fittings for preparing and administering hazardous drugs.
Also provide containers for their disposal.
• Use a closed-system drug-transfer device and needleless system to protect nursing personnel during
drug administration.
• Label all prepared drugs appropriately.
• Double-bag chemotherapy drugs once prepared, before transport.
• Have equipment ready to clean up any accidental spill (spill kit).
• Dispose of all materials in marked containers labeled hazardous waste.
• Dispose of all needles and syringes intact.
• Follow facility’s policies and procedures when preparing to administer chemotherapy.
• Double-check chemotherapy orders with another oncology nurse.
• Read material safety data sheets (MSDS) prior to administration.
• Use personal protective equipment (PPE).
• Wash your hands both before you put on and after you take off gloves.
• After infusion is complete, promptly dispose of any equipment that contained the drug in a puncture-
proof container that is clearly marked.
• Chemotherapy agents may be excreted in body fluids; these may be contaminated for 48 hours after
the last drug dose. Wear PPE when handling such excreta, and wash your hands after removing gloves.
• Check facility’s policies about handling linen that’s been contaminated with chemotherapy.
• If a chemotherapy drug comes into contact with your skin or a client’s skin, thoroughly wash the
affected area with soap and water, but don’t abrade the skin with a scrub brush.
• If the drug gets in your eyes, flush with copious amounts of water for at least 15 minutes while holding
back your eyelids. Then get evaluated by employee health or the emergency department (ED).

Name of Antibiotic groups (except)

In preparations of medicines antibiotics are subdivided into the following seven groups.
1. Penicillins (including semi synthetic methicillin, oxacillin, ampicillin) and cephalosporins.
2. Broad-Spectrum antibiotics (tetracycline)
3. Streptomycin group (streptomycin, neomycin etc.)
4. Reverse antibiotics (erythromycin, chloramphenicol ristomycin, novobiocin)
5. Antifungal (levorin, nystatin etc)
6. Antituberculosis (streptomycin, kanamycin, phiorimycin, etc)
7. Antineoplastic (bruneomycin, olivomycin etc)

Garrod, Lambert and O’ Grady have classified Antibiotics on the basis of general similarity of chemical
structure
1. Penicillin and related Antibiotics:- any of several antibiotics of low toxicity, produced naturally by
molds of the genus Penicillium and also semi synthetically, having a bactericidal action on many
susceptible Gram-positive or Gram-negative cocci and bacilli, some also being effective against certain
spirochetes.
2. Aminoglycoside Antibiotics:- Aminoglycosides are used in the treatment of severe infections of the
abdomen and urinary tract, as well as bacteremia and endocarditis. They are also used for prophylaxis,
especially against. This group comprises the streptomycin, neomycin, kanamycin,
paromonycinentamycin, tubramycin and amikacin.
3. Macrolide Antibiotics:- used to treat infections caused by Gram-positive bacteria (e.g., Streptococcus
pneumoniae) and limited Gram-negative bacteria (e.g., Bordetella pertussis, Haemophilus influenzae),
and some respiratory tract and soft-tissue infections This group comprises erythromycin, oleandomycin
and spiromycin.
4. Tetracycline Antibiotics:- Tetracycline is used to treat a wide variety of infections, including acne. It
is an antibiotic that works by stopping the growth of bacteria. This antibiotic treats only bacterial
infections. It will not work for viral infections (such as common cold, flu). This group consists of
tetracycline, chlortetracycline, demeclocycline, oxytetracycline and minocycline,
5. Chloramphenicol- is an antibiotic useful for the treatment of a number of bacterial infections. This
includes use as an eye ointment to treat conjunctivitis. By mouth or by injection into a vein, it is used to
treat meningitis, plague, cholera, and typhoid fever.
6. Peptide Antibiotics:- are naturally synthesized structures built from amino acids into chains. The
body produces peptides to aid in healing, fight infection and inflammation and rebuild tissues. this
category include bacitracin, gramicidin and the polymyxins.
7. Antifungal Antibiotics:- An antifungal medication, also known as an antimycotic medication, is a
pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot,
ringworm, candidiasis (thrush), serious systemic infections such as cryptococcal meningitis,.
8. Unclassified:- These antibiotics have varied structures. They are not classified among the main
groups described above Antibiotics in this group include cycloserine, tusidic acid, novobiocin,
prasinnomycin, spectinomycin and vancomycin.

Medication error
-any preventable event that may cause or lead to inappropriate medication use or patient harm while
the medication is in the control of the healthcare professional, patient, or consumer. Such events may be
related to professional practice, healthcare products, procedures, and systems, including prescribing,
order communication, product labeling, packaging, and nomenclature, compounding, dispensing,
distribution, administration, education, monitoring, and use.

How to apply 10 rights in giving medications with proper assessment, consent, waiver.
-Ten Right of Safe Drug Administration
1. Right Drug.
2. Right Patient
3. Right Dose
4. Right Route
5. Right Time and Frequency
6. Right Documentation
7. Right History and Assessment
8. Drug approach and Right to Refuse
9. Right Drug-Drug Interaction and Evaluation
10. Right Education and Information.
How to properly transcribe meds

Philippine nursing act

- In article V, The Nursing Practice, of the Republic Act no. 9173, otherwise known as the
“Philippines Nursing Act of 2002”, section 28.a, states the duty of a nurse to: “Provide nursing care
through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and
innovative approaches, therapeutic use of self, executing health care techniques and procedures,
essential primary health care, comfort measures, health teachings, and administration of written
prescription for treatment, therapies, oral topical and parenteral medications….” This encompasses the
importance of a nurse in the administration of medication to patients. By doing so, nurses must ensure
the safety of the patient to achieve favorable outcomes that is geared to limiting patient’s risk and
improvement of the quality of life.

6 core values
- Care
- Compassion
- Competence
- Communication
- Courage
- Commitment
Definitions: empathy, applied therapeutics, teaching, code of ethics, professionalism (3 technologies
from the videos)

- Empathy- A nursing school should teach its students the true value of empathy and compassionate
care. At Goodwin University, we believe empathy is a nurse’s ability to understand, be aware of, be
sensitive to, and vicariously experience the feelings, thoughts, and experiences of the patient and their
family. The faculty believes that it is the nurse’s ability and willingness to “tune in” to and focus on the
patient’s experiences that is fundamental to the methods nurses use to manage care. Empathy is based
upon respect for the dignity of the client and an appreciation for the independence and self-actualization
of the patient.

- Applied therapeutics- A nurse applies medically-ordered therapeutic modalities, like pharmacological

and nutritional interventions, etc. A nurse’s application of these modalities is based on a knowledge base
regarding their therapeutic uses, as well as skills in patient assessment and evaluation. The competent
application of nutritional knowledge also involves its use in health and wellness, as well as when
therapeutic diets are prescribed.

- Teaching- We believe one of the most important roles of a nurse is to assist patients and their families
with receiving information necessary for maintaining a patient’s optimal health. A nurse provides
patients and families with information that is based on their assessed learning needs, their abilities, their
learning preference, and their readiness to learn. Fundamental to the provision of patient education is a
nurse’s belief that patients have the right to make informed decisions about their care. Nurses provide
information that is accurate, complete, and relevant to client needs. A nurse often clarifies information
provided by other members of the health care team.

- Code of ethics- Ethical and Legal Considerations A nurse plans, provides, and evaluates nursing care
guided by specific ethical and legal boundaries. We believe the Code of Ethics for Nurses provides the
ideal framework for safe and correct practices and behavior. Ethical behavior also involves accountability,
responsibility, confidentiality, truthfulness, fidelity, and justice. Nurses who clarify their values are
enhanced in their ability to practice ethically.

- Professionalism- Professionalism involves the characteristics of a nurse that reflects his or her
professional status. These characteristics involve behaviors with regard to self, patients, others, and the
public as they reflect the values of the nursing profession. Professional personas are knowledgeable in
their subject matter, conscientious in their actions, and responsible for themselves and others. Written
standards for practice and professional performance guide the behaviors of professional practitioners.
We believe nurses enhance their professionalism by understanding history, educational choice,
professional research and theory, and their professional organizations and standards.