NURS 8024 Test 4 Study Guide 2026/2027 | University of Cincinnati |
Endocrinology & Diabetes Pharmacology Exam with Complete
Solution
Pharmacology for APNs-Endocrinology
Endocrine- pituitary/adrenal
• Pharmacologic application of hormone replacement vs. antagonists
o Replacement therapy for hormone deficiency states
o Antagonists for diseases caused by excess production of
pituitary hormones.
• Growth hormone
o Required for normal growth, regulator of lipid/carb
metabolism throughout adulthood
o Deficiency tx:
▪ Somatropin used in children/adults
▪ Children w/ genetic diseases associated w/ short
stature
o Excess tx:
▪ Somatostatin analogs – octreotide, lanreotide
o Treatment of deficiency/excess
• Prolactin
o Principal hormone for lactation
o Hyperprolactinemia
▪ Increase prolactin inhibits GnRH secretion
• amenorrhea/galactorrhea in women
• infertility/dec. libido in men
▪ Etiologies
• Medications: SSRIs, Haldol, reglan, dopamine antagonists
• Prolactin-secreting adenomas
▪ Tx:
• dopamine agonists bromocriptine (parlodel)
o definition, symptoms, etiologies, treatment
• Vasopressin/ADH- effects, deficiency
• Oxytocin- effect, clinical uses
• Glucocorticoids/mineralcorticoids
o Glucocorticoids: effects metabolism, catabolism, immune responses,
inflammation
▪ Stimulated by ACTH
o Mineralocorticoids: regulate Na and K reabsorption in collecting tubules of
kidney
• Organ and tissue effects of glucocorticoids
o Metabolic effects
▪ Glucocorticoids stimulate gluconeogenesis and glycogen synthesis
inc. BG, fat deposition, insulin resistance when too much!
▪ Regulate carb/protein/fat metabolism
▪ Release of amino acids via muscle catabolism
▪ Inhibition of peripheral glucose uptake
o Immunosuppressive effects
▪ Inhibits cell-mediated immunologic functions
• inc. neutrophils, dec.
lymphocytes/eosinophils/basophils/monocytes
• Inhibits leukocyte migration
, ▪ Does not interfere with the development of normal acquired immunity
o Catabolic effects
▪ Decreased muscle mass, thinning skin, osteoporosis, limited growth in
children
o Other effects
▪ CNS – behavioral (“roid rage”, depression)
▪ Gastric acid secretion – lead to ulcers
▪ CV integrity and contractility
• Cortisol (hydrocortisone)
o Follows circadian rhythm regulated by pulses of ACTH (peak in early morning
and after meals)
▪ When you are more stressed or sick, more ACTH will be excreted!
o Metabolized in liver, renally excreted
• Clinical uses of corticosteroids
o Adrenal disorders: dx and tx of adrenal dysfunction
▪ Dexamethasone suppression test
▪ Replacement in adrenal insufficiency
o Non-adrenal disroders
▪ r/t ability to suppress inflammatory/immune responses
▪ stimulation of lung maturation in fetus
• How corticosteroids used for diagnosis of adrenal disorders
• Adrenocortical insufficiency, Addison’s Disease- symptoms, treatment, stress dosing,
side effects
o S/S
o Tx:
▪ Hydrocortisone = drug of choice!!
• Combined glucocorticoid & mineralocorticoid activity
• Adrenal crisis: demands parenteral glucocorticoids
▪ Don’t forget stress dosing
▪ ADE:
• Hyperglycemia, glycosuria, Na retention w/ edema or HTN,
hypokalemia, peptic ulcer, osteoporosis, hidden infections
• Glucocorticoids: indications that are non-adrenal related
• Hypercortisolism- adrenal hyperactivity- Cushing’s
Syndrome
o Resulting from chronic exposure to excessive
circulating levels of glucocorticoid
o Typical signs, symptoms, exam findings
o Diagnosis
▪ 24-hour urine cortisol level HIGH
▪ Check ACTH levels
o Treatment
▪ Surgical removal of ACTH-producing tumor –
irradiation of pituitary tumor
, ▪ 4 agents use preoperatively or as adjunctive therapy postop
• Steroidogenesis inhibitors, adrenolytic agents,
neuromodulators of ACTH release, glucocorticoid-receptor
blocking agents
o Ketoconazole: inhibits glucocorticoid synthesis at high
doses
o Mifepristone: glucocorticoid receptor antagonist
o synthesis inhibitors and antagonists
• Side effects of giving exogenous corticosteroids look like typical findings in Cushing
syndrome
• Corticosteroid weaning
o Abrupt cessation/withdrawal cause symptoms of adrenal insufficiency
o Wean anyone on…
▪ dose comparable w/ 20mg of prednisone a day for > 3 wks
▪ nighttime dose > 5mg of prednisone for more than a few weeks
▪ a cushingoid appearance
• Mineralocorticoids = Aldosterone
o Promotes reabsorption of Na from renal tubules
• Hyperaldosteronism
o S/S: hypokalemia, metabolic alkalosis, inc. plasma volume, HTN
o Treatment options:
• Fludrocortisone
o Potent steroid with glucocorticoid and mineralocorticoid activity
o Used for…
▪ Orthostatic hypotension
o Adrenal insufficiency in some instances (not always needed)
• Mineralcorticoid antagonists
Endocrine- Thyroid
• Thyroid
o Important for maintaining thermogenic and metabolic homeostasis
• Thyroid hormones
o Thyroxine T4
o Triiodothyronine T3
• understand thyroid regulation/HPT axis
o negative feedback loop between
• thyroid hormone effects
o iodine = essential for thyroid hormone production!!
o Nontoxic goiter global prevalence b/c of low iodine in developing countries
o Need iodine supplementation, well absorbed
• Thyroid function tests – check Free T4 and T3, check TSH
• Hypothyroidism:
o incidence/prevalence: 1% of general population, 5% if >60 yrs
▪ more common in women than men
o Primary vs. secondary hypothyroidism
▪ Primary: due to thyroid gland (HIGH TSH, LOW FT4)
▪ Secondary: due to lack of pituitary TSH (LOW TSH, HIGH FT4)
o Causes
▪ Hashimoto thyroiditis***
Endocrinology & Diabetes Pharmacology Exam with Complete
Solution
Pharmacology for APNs-Endocrinology
Endocrine- pituitary/adrenal
• Pharmacologic application of hormone replacement vs. antagonists
o Replacement therapy for hormone deficiency states
o Antagonists for diseases caused by excess production of
pituitary hormones.
• Growth hormone
o Required for normal growth, regulator of lipid/carb
metabolism throughout adulthood
o Deficiency tx:
▪ Somatropin used in children/adults
▪ Children w/ genetic diseases associated w/ short
stature
o Excess tx:
▪ Somatostatin analogs – octreotide, lanreotide
o Treatment of deficiency/excess
• Prolactin
o Principal hormone for lactation
o Hyperprolactinemia
▪ Increase prolactin inhibits GnRH secretion
• amenorrhea/galactorrhea in women
• infertility/dec. libido in men
▪ Etiologies
• Medications: SSRIs, Haldol, reglan, dopamine antagonists
• Prolactin-secreting adenomas
▪ Tx:
• dopamine agonists bromocriptine (parlodel)
o definition, symptoms, etiologies, treatment
• Vasopressin/ADH- effects, deficiency
• Oxytocin- effect, clinical uses
• Glucocorticoids/mineralcorticoids
o Glucocorticoids: effects metabolism, catabolism, immune responses,
inflammation
▪ Stimulated by ACTH
o Mineralocorticoids: regulate Na and K reabsorption in collecting tubules of
kidney
• Organ and tissue effects of glucocorticoids
o Metabolic effects
▪ Glucocorticoids stimulate gluconeogenesis and glycogen synthesis
inc. BG, fat deposition, insulin resistance when too much!
▪ Regulate carb/protein/fat metabolism
▪ Release of amino acids via muscle catabolism
▪ Inhibition of peripheral glucose uptake
o Immunosuppressive effects
▪ Inhibits cell-mediated immunologic functions
• inc. neutrophils, dec.
lymphocytes/eosinophils/basophils/monocytes
• Inhibits leukocyte migration
, ▪ Does not interfere with the development of normal acquired immunity
o Catabolic effects
▪ Decreased muscle mass, thinning skin, osteoporosis, limited growth in
children
o Other effects
▪ CNS – behavioral (“roid rage”, depression)
▪ Gastric acid secretion – lead to ulcers
▪ CV integrity and contractility
• Cortisol (hydrocortisone)
o Follows circadian rhythm regulated by pulses of ACTH (peak in early morning
and after meals)
▪ When you are more stressed or sick, more ACTH will be excreted!
o Metabolized in liver, renally excreted
• Clinical uses of corticosteroids
o Adrenal disorders: dx and tx of adrenal dysfunction
▪ Dexamethasone suppression test
▪ Replacement in adrenal insufficiency
o Non-adrenal disroders
▪ r/t ability to suppress inflammatory/immune responses
▪ stimulation of lung maturation in fetus
• How corticosteroids used for diagnosis of adrenal disorders
• Adrenocortical insufficiency, Addison’s Disease- symptoms, treatment, stress dosing,
side effects
o S/S
o Tx:
▪ Hydrocortisone = drug of choice!!
• Combined glucocorticoid & mineralocorticoid activity
• Adrenal crisis: demands parenteral glucocorticoids
▪ Don’t forget stress dosing
▪ ADE:
• Hyperglycemia, glycosuria, Na retention w/ edema or HTN,
hypokalemia, peptic ulcer, osteoporosis, hidden infections
• Glucocorticoids: indications that are non-adrenal related
• Hypercortisolism- adrenal hyperactivity- Cushing’s
Syndrome
o Resulting from chronic exposure to excessive
circulating levels of glucocorticoid
o Typical signs, symptoms, exam findings
o Diagnosis
▪ 24-hour urine cortisol level HIGH
▪ Check ACTH levels
o Treatment
▪ Surgical removal of ACTH-producing tumor –
irradiation of pituitary tumor
, ▪ 4 agents use preoperatively or as adjunctive therapy postop
• Steroidogenesis inhibitors, adrenolytic agents,
neuromodulators of ACTH release, glucocorticoid-receptor
blocking agents
o Ketoconazole: inhibits glucocorticoid synthesis at high
doses
o Mifepristone: glucocorticoid receptor antagonist
o synthesis inhibitors and antagonists
• Side effects of giving exogenous corticosteroids look like typical findings in Cushing
syndrome
• Corticosteroid weaning
o Abrupt cessation/withdrawal cause symptoms of adrenal insufficiency
o Wean anyone on…
▪ dose comparable w/ 20mg of prednisone a day for > 3 wks
▪ nighttime dose > 5mg of prednisone for more than a few weeks
▪ a cushingoid appearance
• Mineralocorticoids = Aldosterone
o Promotes reabsorption of Na from renal tubules
• Hyperaldosteronism
o S/S: hypokalemia, metabolic alkalosis, inc. plasma volume, HTN
o Treatment options:
• Fludrocortisone
o Potent steroid with glucocorticoid and mineralocorticoid activity
o Used for…
▪ Orthostatic hypotension
o Adrenal insufficiency in some instances (not always needed)
• Mineralcorticoid antagonists
Endocrine- Thyroid
• Thyroid
o Important for maintaining thermogenic and metabolic homeostasis
• Thyroid hormones
o Thyroxine T4
o Triiodothyronine T3
• understand thyroid regulation/HPT axis
o negative feedback loop between
• thyroid hormone effects
o iodine = essential for thyroid hormone production!!
o Nontoxic goiter global prevalence b/c of low iodine in developing countries
o Need iodine supplementation, well absorbed
• Thyroid function tests – check Free T4 and T3, check TSH
• Hypothyroidism:
o incidence/prevalence: 1% of general population, 5% if >60 yrs
▪ more common in women than men
o Primary vs. secondary hypothyroidism
▪ Primary: due to thyroid gland (HIGH TSH, LOW FT4)
▪ Secondary: due to lack of pituitary TSH (LOW TSH, HIGH FT4)
o Causes
▪ Hashimoto thyroiditis***
