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Endocrine System

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Endocrine System Chapters 21, 22, 23, 24, 26 Endocrine System Endocrine system regulates essential activities of the body Metabolism of nutrients Reproduction Growth ... – PowerPoint PPT presentation

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Title: Endocrine System


1
Endocrine System
  • Chapters 21, 22, 23, 24, 26

2
Endocrine System
  • Endocrine system regulates essential activities
    of the body
  • Metabolism of nutrients
  • Reproduction
  • Growth and development
  • Adapting to change in internal and external
    environments

3
Major Endocrine Organs
  • Hypothalamus
  • Pituitary gland
  • Thyroid gland
  • Parathyroid glands
  • Pancreas
  • Adrenal glands
  • Ovaries
  • Testes

4
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5
Local Tissue Hormones
  • Endocrine like cells in the
  • Gastrointestinal mucosa hormones that aid in
    digestion
  • Kidneys erythropoietin hormone that
    stimulates bone marrow to produce RBCs
  • White blood cells cytokines inflammation
  • Body tissues prostaglandins and leukotrienes

6
Tumors
  • Specific tumors produce hormones
  • Lungs - ACTH
  • Kidney parathyroid hormones
  • Elevation of these hormones would aid in
    diagnosing the tumors

7
Endocrine System and Nervous System
  • Closely connected
  • Work together to regulate body function
  • Main connecting link is the hypothalamus
    responds to nervous system stimulation by
    producing hormones
  • Hypothalamus will initiate the hormone response

8
What is the Endocrine System?
  • Endocrine system is in charge of the body
    processes that happen slowly, such as cell
    growth.
  • The nervous system has to do with the faster
    processes, like breathing and body movement.

9
Hormones
  • The bodies chemical messengers
  • Different hormones circulate throughout the blood
    stream, but only affects the cells that are
    genetically programmed to receive and respond to
    the message.

10
Hormones
  • Hormones modify rather than initiate cellular
    response stimulated by the hypothalamus /
    pituitary gland

11
Hormone Pharmacokinetics
  • Water soluble hormones, protein-derived hormones
    have a short duration of action and are
    inactivated by enzymes in liver and kidneys.
  • Lipid soluble hormones and thyroid hormones have
    a longer duration because they are bound to
    plasma protein they are broken down in the
    liver and excreted in bile or urine.

12
Water Soluble Hormones
  • Do not enter the target cells form weak bonds
    with receptor sites on the cell membrane.
  • Sometimes called the second messenger
  • Examples glucagon, adrenalin and parathyroid
    hormones.
  • Hormones are be released as needed.

13
Lipid Soluble Hormones
  • Steroid and thyroid are constantly present in the
    blood.

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15
Cellular Response
  • Up-regulation receptors may be increased if
    there are low levels of hormone.
  • Down-regulation hormones may be decreased when
    there are excessive amounts of hormone.

16
Hormone Disorders
  • Abnormal secretion and function of hormones can
    impair physical and mental health.
  • Malfunction of endocrine organ
  • Hypersecretion (too much)
  • hyposecetion (too little)

17
What Can Influence Hormone Levels?
  • Stress
  • Infection
  • Fluid balance
  • Minerals in blood
  • Structural changes in glands

18
Glandular Hypofunction
  • Congenital defect - infant
  • Damaged or destroyed inflammation - tumor
  • Atrophy of gland due to aging geriatric
    population
  • Receptor defects
  • Intracellular processes malfunction cellular
    level

19
Hormonal Drugs
  • Potent drugs that produce widespread therapeutic
    and adverse side effects.
  • Given when there is hypofunction of a gland.
  • Need to replace what would naturally be produced
    by the body.

20
Two Common Hormonal Drugs
  • Pancreas dysfunction insulin needed to regular
    blood sugar levels.
  • Diabetes type I and II
  • Thyroid dysfunction
  • hypothyroid conditions need replacement of
    hormone
  • hyperthyroid may need to give medication that
    inhibits excess thyroid produced

21
In a nut-shell
  • With hormones the body needs a consistent amount
    to properly function too much or too little can
    be a problem

22
Hypothalamic and Pituitary
  • Chapter 22

23
Hypothalamus
  • Interacts with the pituitary gland to control
    most metabolic functions of the body.
  • Controls secretions of the pituitary gland.

24
Pituitary Gland
  • The pituitary gland is sometimes called the
    "master" gland of the endocrine system, because
    it controls the functions of the other endocrine
    glands. The pituitary gland is no larger than a
    pea, and is located at the base of the brain. The
    gland is attached to the hypothalamus (a part of
    the brain that affects the pituitary gland) by
    nerve fibers.

25
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26
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27
Anterior Pituitary Gland
  • Anterior pituitary gland
  • Growth hormone
  • Adrenal cortex ACTH glucocorticoids
  • TSH thyroid stimulating hormone
  • FSH follicle stimulating hormone ovary
    estrogen and progesterone
  • LH - luteinizing hormone stimulates ovulation
  • Prolactin breast tissue milk production
  • Testosterone testes

28
Medical Conditions
  • Growth hormone therapy in pediatrics
  • Delayed development of secondary sexual
    characteristics - adolescent
  • Infertility
  • Thyroid conditions

29
Growth Hormone Deficiency
  • In a child what do you think you might see?
  • Height versus weight
  • Growth curve
  • What influences growth?
  • How do you tell the dug is working?

30
Posterior Pituitary Gland
  • ADH antidiuretic hormone kidney regulates
    water balance
  • Oxytocin uterus and breast labor and breast
    feeding

31
Posterior Pituitary Dysfunction
  • Desmopressin (DDAVP) or vasopressin synthetic
    ADH (antidiuretic hormone)
  • Clinical Diagnosis diabetes insipidus
    characterized by high output of dilute urine
    can be idiopathic (do not know the cause) can
    occur after head trauma, with tumor of
    hypothalamus or posterior pituitary
  • Importance of intake and output and specific
    gravity

32
Diabetes Insipidus
33
Dysfunction of Posterior Pituitary
  • Remember the pituitary gland directs function of
    the antidiuretic hormone in the kidneys which has
    to do with normal fluid balance.

34
Specific Gravity
  • Concentration of urine is measured by density
    called specific gravity.
  • Normal specific gravity is around 1.010
  • A high specific gravity would reflect dehydration
    or hypovolemia.
  • A low specific gravity would reflect
    over-hydration or disease process such as
    diabetes insipidus.

35
Intake and Output
  • Why important?
  • How besides urine output can a person lose fluid?
  • Basic measures of intake and output mls or
    ccs

36
Nursing Considerations
  • Observe for headache, nasal congestion, nausea
  • Monitor blood pressure drug may cause increase
    in blood pressure
  • Most serious side effect is water retention and
    hyponatremia

37
Posterior Pituitary Hormone
  • Oxytocin promotes uterine contractibility
  • Clinical uses After delivery of infant and
    placenta in obstetrics.
  • In small dosages to stimulate or induce labor in
    a pregnant woman
  • When you will be doing your obstetrical rotation
    you will see oxytocin (Pitocin) given IV after
    delivery to help the uterus to contract.

38
Ethical Consideration
  • Abuse of Human Growth Hormone in athletes to
    improve performance older people in search of
    the fountain of youth
  • Ovary stimulating drugs use to produce numerous
    ovaries to be artificially inseminated and
    implanted may lead to selective abortion of
    excess embryos after implantation

39
Corticosteroids
  • Chapter 23

40
Corticosteroids
  • Controlled by the hypothalamus
  • Rate of secretion is kept within a very narrow
    range
  • negative feedback mechanism when too much is
    released the mechanism for release shuts down.

41
Nursing Alert
  • Very important concept when we give steroid to a
    patient the higher plasma levels effectively
    shuts down the bodies production of the drug
    naturally this is a drug that cannot be
    abruptly stopped needs to be tapered.

42
Corticosteroids
  • Produced by the adrenal cortex
  • Involved in stress response, immune response and
    regulation of inflammation, carbohydrate
    metabolism, protein catabolism, blood electrolyte
    levels and behavior.

43
Two Types
  • Glucocorticoids anti-inflammatory
  • Mineralocorticoids aldosterone controls
    electrolyte and water levels

44
Uses of Corticosteroids
  • Use to treat a number of different disorders
    especially inflammatory or immunologic disorders
  • Arthritis
  • Dermatitis
  • Allergic reactions
  • Asthma
  • Hepatitis
  • Lupus erythematosus
  • Inflammatory bowel disease ulcerative colitis
    and Crohns disease
  • Uveitis inflammation of eye

45
Use in Orthopedics
  • Cortisone can be injected directly into a joint
    to reduce inflammation.
  • Medrol dose pack is often prescribed for chronic
    back pain.

46
When not to use Corticosteroids
  • Fungal infections
  • Clients who are high risk for infection
  • Diabetes
  • Peptic ulcer
  • Hypertension
  • CHF
  • Renal Failure

47
How Administered
  • Topical skin rashes - hydrocortisone
  • Eye drops / ear drops cortisone ear drops or
    ophthalmic suspension
  • Nasal Nasonex
  • Tablet or liquid form prednisone, Decadron
  • IV methyl prednisone or Solu-medrol
  • Inhaled - asthmatic or COPD

48
Goals of Therapy
  • To reduce symptoms to a tolerable level
  • Total suppression of symptoms may require
    excessive dosages
  • Avoid serious side effects

49
Clinical Pearl
  • Whenever possible the physician / nurse
    practitioner will prescribe a topical, nasal
    spray, eye drops or inhaled dosage before going
    to an oral route or intravenous route.
  • Oral and intravenous routes are usually higher
    dosages and more likely to have side effects.

50
Effects on the Body
  • Carbohydrates increased blood glucose levels
  • Protein increase breakdown of protein
  • Increased in blood pressure
  • Decrease in natural cortisol production by the
    body
  • Decrease in bodies inflammatory response

51
Corticosteroids
  • Classification Pharmacology corticosteroids
  • Classification Therapeutic anti-asthmatic,
    cortico-steroids
  • Action suppress inflammation and the normal
    immune response.
  • Adverse reaction and side effects depression,
    euphoria, hypertension, PEPTIC ULCER,
    THROMBOEMBOLISM, cushingoid appearance

52
Administration of PO Prednisone
  • Take with meal or snack to decrease intestinal
    tract upset
  • Avoid consuming grapefruit juice
  • If once a day dosing take in am before 9am
  • If more than once daily be sure to evenly space
    time medication is taken
  • In long term usage may need to take every other
    day in the morning so natural production is not
    totally suppressed

53
Side Effects
  • Moon face, buffalo hump, obese trunk (love
    handles), acne, hirsutism, weight gain
  • Impaired healing or bruising
  • CNS nervousness, insomnia, depression,
    aggravation of pre-existing mental disorders
  • Musculoskeletal long term use can cause
    osteoporosis, muscle weakness and atrophy
  • GI peptic ulcer, increased appetite
  • Cardiovascular fluid retention
  • Ocular increased intraocular pressure, glaucoma,
    cataracts

54
Moon Face
High-dose corticosteroid therapy produces a
characteristic moon face appearance.
55
Before and After
56
Inhaled Corticosteroids
  • Used in asthma and COPD
  • Provided as an inhaled medication
  • Take daily in am
  • Rinse and spit after treatment to prevent thrush
    in mouth
  • Rinse mouth piece after use

57
Oral Thrush
58
Thyroid Drugs
  • Chapter 24

59
Thyroid Gland
60
Thyroid Gland
  • Thyroid cells are the only cells in the body
    which can absorb iodine. These cells combine
    iodine and the amino acid tyrosine to make T3 and
    T4. T3 and T4 are then released into the blood
    stream and are transported throughout the body
    where they control metabolism (conversion of
    oxygen and calories to energy). Every cell in the
    body depends upon thyroid hormones for regulation
    of their metabolism.

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62
Hypothyroidism
  • Primary infant born without a thyroid gland
  • Secondary throiditis, tumor, destruction of
    thyroid tissue from radiation

63
Hypothyroidism
  • All newborns are tested at birth for thyroid
    function.
  • If untreated can lead to retardation due to
    effects on brain development.
  • Treatment is life-long replacment of the hormone.

64
Hypothyroidism - Adults
  • Presenting clinical manifestations
  • Weight gain
  • Constipation
  • Fatigue
  • Irregular menstrual cycle in women
  • Edema
  • More common in females than males

65
Hypothyroidism
  • Laboratory value to look at
  • TSH thyroid stimulating hormone will be
    increased - it is working hard to stimulate the
    production of T3 and T4.
  • T3 and T4 levels would be low.

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67
How is Hypothyroid Treated?
  • Thyroid drugs such as levothyroxine Synthroid
    or Levothroid
  • Take on empty stomach
  • Do not take with antacids or iron preparations
  • If on Coumadin may need to use smaller dose of
    Coumadin
  • Do not stop when feeling better
  • Dosage of other drugs may need to be reduced due
    to slow metabolism in liver and excretion in
    urine

68
Thyroid Preparations
  • Brand names Levothyroxin, Synthyroid
  • Classification Pharmacologic thyroid preparation
  • Classification Therapeutic hormone

69
Thyroid Hormone
  • Action Principal effect is increasing metabolic
    rate of body tissues, promote gluconeogenesis.
    Increase utilization and mobilization of gycogen
    stores stimulates protein synthesis. Aid in
    development of the brain and CNS.
  • Therapeutic effects Replacement in deficiency
    states with restoration of normal hormonal
    balance.

70
Dosage of Levothyroxine
  • Adults PO 50 mcg as initial dose and may be
    increased to 75-125 mcg/day.
  • PO generic (increased sensitivity to thyroid
    hormone) 12.5 25 mcg increased to 75 mcg/day.
  • Children 2-3 mcg/kg/day

71
How Supplied?
  • Tablets 25 mcg, 50 mcg, 75 mcg, 100 mcg, 175
    mcg, 200 mcg and 300 mcg.
  • Vials come in 200 mcg / 6ml or 10 ml.

72
Hyperthyroidism
  • Excessive secretion of thyroid hormone and
    usually involves an enlarged thyroid gland.
  • TSH levels would be low and the T3 and T4 high.

73
Treatment of Hyperthyroid
  • Depends on the cause
  • If thyroid is enlarged or tumor on thyroid
    surgery may be recommended

74
Antidiabetic Hormone
  • Chapter 26

75
Insulin
  • Protein hormone secreted by beta cells in the
    pancreas.
  • Average adult uses 40 to 60 units of insulin per
    day.
  • At the cellular level insulin binds with and
    activates receptors on the cell membrane of 80
    of body cells.

76
Pancreas
  • The human pancreas is an amazing organ with two
    main functions 1 to produce pancreatic
    endocrine hormones (e.g., insulin glucagon)
    which help regulate many aspects of our
    metabolism and 2, to produce pancreatic
    digestive enzymes.

77
What does the Pancreas Do?
  • Pancreatic production of insulin, somatostatin,
    gastrin, and glucagon plays an important role in
    maintaining sugar and salt balance in our bodies
    and therefore any problem in the production or
    regulation of these hormones will manifest itself
    with problems with blood sugar and fluid / salt
    imbalances.

78
Pancreatic Islets
  • Pancreatic islets are scattered throughout the
    pancreas.  Like all endocrine glands, they
    secrete their hormones into the bloodstream.

79
Insulin and Glucagon
  • The human body wants blood glucose (blood sugar)
    maintained in a very narrow range.  Insulin and
    glucagon are the hormones which make this
    happen.  Both insulin and glucagon are secreted
    from the pancreas, and thus are referred to as
    pancreatic endocrine hormones.

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81
Blood Sugar Levels
  • Normal range is from 80 to 100 mg / dL
  • Levels between 100 and 126 mg / dL would be
    considered pre-diabetic type II.
  • Diabetes is typically diagnoses when fasting
    blood sugar is 126 mg / dL or higher.

82
Diabetes Mellitus
  • Type I chronic disorder of childhood results
    from autoimmune disorder that destroys pancreatic
    beta cells.
  • Type II characterized by hyperglycemia and
    insulin resistance insulin is present but is
    not able to be used impaired insulin action at
    the cellular level.

83
Diabetic Complication
  • Related to blood vessel disease
  • Small blood vessels
  • Eyes (retinopathy), kidneys (nephropathy), nerves
    (microvascular).
  • Large blood vessels
  • Heart and blood vessels coronary artery disease,
    stokes, lower extremity pain and impaired healing
    due to lack of blood flow (claudication).

84
Insulin
  • Insulin is the only treatment for diabetes type I
    pancreas does not produce insulin
  • Insulin cannot be given orally because it is
    destroyed by the enzymes in GI tract
  • Different types of insulin long term and short
    term
  • Daily insulin injections need to be given Sub Q
    or by a pump short term or regular insulin
  • Daily monitoring of blood sugar levels

85
Goals in Treating Diabetes
  • Controlling elevated blood sugar levels without
    causing unusually low blood glucose level.

86
Control of Diabetes
  • Type I Insulin, exercise, and a diabetic diet
  • Type II weight reduction, diabetic diet,
    exercise and oral hypoglycemic drugs

87
Insulin
  • Used in the treatment of type 1 diabetes
  • Used in type 2 only when blood glucose levels
    cannot be controlled by diet, weight , loss,
    exercise and oral medication.

88
Insulin Administration
  • Administration needs to mimic the natural pattern
    of insulin secretion by a healthy pancreas.
  • To maintain normal glucose levels
  • Home glucose monitoring and multiple insulin
    injections are needed throughout the day.
  • Newer insulin pumps are available to help clients
    maintain better blood glucose levels.

89
Short-acting Insulin
  • Regular Iletin, Humulin R, Novolin
  • (clear appearance)

90
Intermediate Acting Insulin
  • NPH Ilente II, Humulin N, Novolin N

91
Long Acting
  • Humulin U, Ultralente (cloudy appearance)

92
How Given?
  • Sub-Q injection
  • Regular can be given by pump used to cover
    carbohydrates consumed throughout the day.
  • Insulin written in units and delivered
    subcutaneous in a syringe marked in units.

93
Why do I need to know about insulin onset, peaks
and duration?
  • Although you will not be giving sub Q insulin you
    will need to know if your patient is receiving
    insulin.
  • Snacks and meal trays will need to be delivered
    in a timely manner.
  • Blood glucose finger sticks need to be monitored.
  • Always know what the clients last blood glucose
    level was.

94
Hypoglycemic Episodes
  • Shakiness
  • Dizziness
  • Sweating
  • Hunger
  • Headache
  • Pale skin
  • Sudden moodiness or behavior changes
  • Confusion or difficulty paying attention
  • Tingling sensation around the mouth

95
What do you do?
  • Give a simple sugar, glucose tabled, hard candy,
    or ½ cup of juice.
  • Check blood glucose level

96
Diabetes Type II
  • Diet and exercise are key elements.
  • Most often client is overweight and leads a
    sedentary live style.

97
Insulin Resistance
  • Insulin resistance occurs when the normal amount
    of insulin secreted by the pancreas is not able
    to unlock the door to cells.  To maintain a
    normal blood glucose, the pancreas secretes
    additional insulin.  In some cases (about 1/3 of
    the people with insulin resistance), when the
    body cells resist or does not respond to even
    high levels of insulin, glucose builds up in the
    blood resulting in high blood glucose or type 2
    diabetes.

98
Oral Hypoglycemic Drugs
  • Used in Diabetes type II along with dietary
    management and healthy life style choices
    including exercise.

99
Hypoglycemia Drugs
  • 5 oral drug classifications
  • Sulfonylureas Amaryl, Glucotrol, DiaBeta
  • Alpha-glucosidase inhibitors Precose, Glyset
  • Biguanide Glucophage, Glucophage SR
  • Glitazones Actos, Avandia
  • Meglitinides Starlix, Prandin

100
Actions of oral Antidiabetic Drugs
  • The drugs lower blood sugar by decreasing
    absorption or production of glucose, by
    increasing secretion of insulin, or by increasing
    the effectiveness of available insulin
    (decreasing insulin resistance).

101
Sulfonylureas
  • Oldest and largest group of agents lower blood
    glucose by increasing secretion of insulin.
  • Increase peripheral use of glucose and decrease
    production of glucose, increase number of insulin
    receptors.
  • Can be used only when functioning pancreatic beta
    cells are present.

102
Glyburide
  • Classification Pharmacologic sulfonylureas
  • Classification Therapeutic antidibetic
  • Action lower blood glucose by stimulating the
    release of insulin from the pancreas and
    increasing the sensitivity to insulin at receptor
    sites. May also decrease hepatic glucose
    production.
  • Onset of action 45 to 60 minutes
  • Peak of action1-2 hours
  • Duration of action 24 hours

103
Sulfonylurea 2nd and 2rd Generation
  • Glucotrol XL second generation take once a
    day
  • Amaryl third generation take once a day
    different in that it does not bind with protein
    carriers in the blood so it is not effected by
    other medications that do.

104
Laboratory Values
  • Do not take if Creatinine levels elevated
  • Elevated Creatinine levels reflect kidney
    dysfunction
  • Normal Creatinine Levels
  • 0.6 to 1.2 mg / dL
  • Infants my be as low as 0.2 mg / dL
  • Geriatric population may have lower levels
  • Muscular males may have slightly higher levels

105
Acarbose
  • Brand name Precose
  • Classification Pharmacologic Alpha-glucosidase
    inhibitors
  • Action Lowers blood pressure by inhibiting the
    enzyme alph-glucosidase in the GI tract.
  • Therapeutic effect lowering of blood glucose,
    especially postprandial hyperglycemia.
  • Onset unknown
  • Peak 1 hour
  • Duration unknown

106
Cautions and Side Effects
  • Contraindicated in clients with DKA, hepatic
    cirrhosis, inflammatory of malabsorptive
    intestinal disorders and severe renal impairment.
  • Side effects are mainly digestive symptoms,
    bloating, diarrhea, and flatulence (gas).
  • May need to cut down consumption of starches and
    carbohydrates in diet to decrease symptoms.

107
Metformin
  • Brand names Fortamet, Glucophage, Glucophage XR,
    Novo-metformin
  • Classification Pharmacologic bigunide
  • Classification Therapeutic anti-diabetic
  • Action Decreases hepatic glucose production.
    Decreases intestinal glucose absorption.
    Increases sensitivity to insulin.
  • Onset several days
  • Peak 2-4 weeks
  • Duration 12 hours
  • Often used in combination with insulin or
    sulfonylurea

108
Contraindications and Side Effects
  • Contraindications hepatic or renal disorders,
    pregnancy, cardiac or respirator insufficiency
  • Side effects lactic acidosis muscle stiffness

109
Glitazones (Actos Avandia)
  • New class of drugs to treat Diabetes type II
  • First two drugs taken off the market.
  • Helps body to use available amount of insulin
    more effectively
  • Increase plasma blood volume and may cause fluid
    retention and heart failure.
  • Takes a few weeks to work
  • Cost about 100 a month

110
Contraindications and Side Effects
  • Side effects weight gain, edema, severe loss of
    appetite, nausea and vomiting, yellow
    discoloration of eyes and tea or dark colored
    urine
  • Contraindications heart failure and active liver
    disease
  • FDA issued a safety alert in Summer 2007.

111
Meglitinides (Starlix Prandin)
  • Lower blood sugar by stimulating pancreatic
    secretion of insulin
  • Well absorbed in GI tract peak plasma in 1 hour
  • Decreases workload of pancreas
  • Acts more like normal insulin
  • Should be taken 30 minutes before meal
  • Good for people who do not eat full meals or have
    a sporadic eating schedule

112
Contraindications and Side Effects
  • Can be taken in patients with impaired kidney
    function and with sulfa allergies
  • Contraindication liver disease and diabetes type
    I
  • Side Effects nausea and vomiting, muscle aches,
    joint pain, headaches

113
Goals of Anti-diabetic Therapy Drugs
  • To maintain blood glucose at normal or
    near-normal levels.
  • Promote normal metabolism of carbohydrates, fat
    and protein.
  • Prevent acute and long-term complications.
  • Prevent hypoglycemic episodes.

114
Management to Prevent Complications
  • Angiotension-converting enzymes - ACE inhibitors
    to protect kidneys
  • Use of statins to reduce risk of occlusive
    arterial disease
  • Aspirin therapy
  • Smoking cessation
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