ATI section 5: Médications for the Endocrine System Flashcards
Oral Hypoglycemics
-Used in conjunction with diet and exorcist control glucose levels in clients who have type 2 DM
Precautions/Interactions:
- Caution in clients with renal, hepatic, or cardiac disorders
- Generally avoided during pregnancy and lactation
Nursing Interventions and Client Education:
- Teach signs and mngt for hyperglycemia, especially with sulfonylureas
- Encourage diet and exercise
- Monitor glycosylated hemoglobin (HbA1C)
- Refer to diabetic nurse educator
Oral Hypoglycemics
Alpha-glycosidase inhibitors:
acarbose (Precose), miglitol (Glyset)
Action:
-slows carbohydrate absorption and digestion
Precautions/Indications:
-contraindicated in clients with intestinal disease due to increased gas formation
Oral Hypoglycemics
Biguanides: metformin (Glucophage)
Action:
- reduces gluconeogenesis
- increases uptake of glucose by muscles
Precautions/Indications:
- Withhold 48 hr prior to and 48 hr after a test with contrast media
- Contraindicated in clients with severe infection, shock, hypoxic conditions
Oral Hypoglycemics
Gliptins:sitagliptin (Januvia)
Action:
-Promotes release of insulin, lowers glucagon secretion and slows gastric emptying
Precautions/Indications:
-Caution with impaired renal function-dose will be reduced
Oral Hypoglycemics
Meglitinides: repaglinide (Prandin), nateglinide (Starlix)
Action:
- Reduces production of glucose within the liver through suppression of gluconeogenesis
- Increases muscle uptake and use of glucose
Precautions/Indications:
-Should not be used with NPH insulin due to risk of angina
Oral Hypoglycemics
Sulfonylureas: glipizide (Glucotrol), glyburide (DiaBeta, Micronase)
Action:
-Promotes release of insulin from the pancreas
Precations/Indications:
-Extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders
Oral Hypoglycemics
Thiazolidinediones: rosiglitazone (Avandia), piglitazone (Actos)
Action:
-Decreases insulin resistance
Precautions/Indications:
-High risk of CHF due to fluid retention
Insulin
- various forms available to manage diabetes
- Medication vary in onset, peak, and duration
Insulin
Rapid-acting: Lispro (Humalog)
Onset:
-less than 15 min
Peak:
-0.5-1 hr
Duration:
-3-4 hr
Insulin
Short-acting: Regular (Humulin R)
Onset:
-0.5-1hr
Peak:
-2-3hr
Duration:
-5-7hr
Insulin
Intermediate: NPH (Humulin N)
Onset:
-1-2hr
Peak:
4-12hr
Duration:
18-24hr
Insulin:
Long-acting: Insulin glargine (Lantus)
Onset:
1hr
Peak:
None
Duration:
10.5-24hr
Insulin
Therapeutic Use
Therapeutic Use:
-Glycemic control of DM (type 1,2, gestational)
-Clients taking oral hypoglycemic agents may require insulin therapy when:
Undergoing diagnostic tests
Pregnant
severe kidney or liver disease is present
Oral agents are inefficient
Tx of hyperkalemia
Insulin
Precautions/Interventions
Precautions/Interactions
- When mixing regular with NPH insulin, draw up regular first
- Do not mix other insulins with lisper, glargine, or combo 70/30
- Only regular insulin is given IV (only in normal saline)
- Admin glargine at bedtime
Insulin
Nursing Interventions and Client Education
- Monitor serum glucose levels before meals and at bedtime or patterned schedule-specific to client
- Roll vial of insulin (except regular) to mix; don’t shake
- Instruct clients to rotate injection sites to prevent lipodystrophy
- Teach signs and mngt for hypo/hyperglycemia
- Encourage diet and exercise to follow ADA recommendations
- Monitor glycosylated hemoglobin (HbA1c)
- Refer to diabetic nurse educator
Glycemic Agent
-Glucagon (GlucaGen)
Therapeutic Uses:
-Emergency tx of severe hypoglycemia
Precations/Interventions:
-Do not mix with sodium chloride or dextrose solution
Side/Adverse effects:
- N/V
- rebound hypoglycemia
Nursing Interventions and Client Education:
- Administer med for unresponsive client
- Monitor blood glucose level
- Instruct client to self-monitor for early signs of hypoglycemia
- Instruct client to wear med alert badge
- Advise client to teach family members how to administer meds
- Provide carbs when client awakens from hypoglycemic reaction
Thyroid Hormone
-Levothyroxine/T4 (Synthroid)
Therapeutic Uses:
-Hypothyroidism
-Emergency tx of myxedema coma
Precations/Interactions:
-Overmedication can result in signs of hyperthyroidism
Side/Adverse effects:
- Tachycardia
- Restlessness
- Diarrhea
- weight loss
- decreased bone density
- heat intolerance
- Insomnia
Nursing Interventions and Client Education:
- Monitor cardiac symptoms
- Therapy initiated with low doses; advanced to higher doses while monitoring lab values
- Monitor T4 and TSH levels
- Take in early morning
Thyroid Hormone Antagonist
-Methimazole (Tapazole)
Therapeutic Uses:
- Hyperthyroidism
- Preoperative thyroidectomy
- Thyrotoxic crisis
- Thyroid storm
Precautions/Interactions:
- Administer with caution to clients who have bone marrow depression
- hepatic disease
- bleeding disorders
- Discontinue prior to radioactive iodine uptake testing
- Contraindicated with breastfeeding
Side/Adverse effects:
- skin rash, pruritus
- Abnormal hair loss
- GI upset
- periorbital edema
- Joint and muscle pain
- Jaundice
- Agranulocytosis
- Thrombocytopenia
Nursing Interventions and Client Education:
- Admin with food same time every day
- Increase fluids to 3L/day
- Avoid OTC products containing iodine
- Discontinuing dose must be tapered off
- Monitor client for therapeutic response: weight gain, decreased pulse, BP, and T4 levels
- Monitor for signs of overdose: periorbital edema, cold intolerance, mental depression
Anterior Pituitary/Growth Hormones
-Prefix: Somat
Therapeutic Uses:
- Treat growth hormone deficiencies
- Turner’s Syndrome
Precautions/Interventions:
- Contraindicated in clients who are severely obese
- Must be discontinued prior to epiphyseal closure
- Avoid concurrent use of glucocorticoids
Side/Adverse effects:
- Hyperglycemia
- Hypothyroidism
Nursing Interventions and Client Education
- Monitor growth pattern
- Reconstitute medication (do not shake)
- Admin subQ
- Dose is individualized
Posterior Pituitary Hormones/Antidiuretic Hormones
- Desmopressin (DDAVP): oral, intranasal, subQ, IV
- Pitressin (Vasopressin): intranasal, subQ, IV
Therapeutic Uses:
-Diabetes insipidus, cardiac arrest, noctural enuresis
Precautions/Interactions:
-Contraindicated in clients with chronic nephritis or high risk for MI
Side/Adverse effects:
-Hyponatremia, seizures, coma
Nursing Interventions and Client Education:
- Monitor urine specific gravity, BP, and urinary output
- Prevent hyponatremia due to water intoxication
- Instruct use of nasal spray
Adrenal Hormone Replacement
-Suffix: sone
Therapeutic Uses:
- Acute and chronic replacement for adrenocortical insufficiency (Addison’s disease)
- Inflammation, allergic reactions, cancer
Adrenal Hormone Replacement
Precautions/Interactions:
- Contraindicated in clients who have systemic fungal infection
- Caution in clients who have hypertension, gastric ulcers, diabetes, osteoporosis
- Requires higher doses in acute illness or extreme stress
Adrenal Hormone Replacement
Side/Adverse effects:
- Adrenal suppression when admin for inflammation, allergic reactions
- Infection
- Hyperglycemia
- Osteoporosis
- GI bleeding
- Fluid retention
Adrenal Hormone Replacement
Nursing Interventions and Client Education
- Do not skip doses
- Monitor BP, fluid and electrolyte balance, weight, and output, signs of bleeding and GI discomfort
- Teach client to take calcium supplements and maintain vitamin D levels
- Give with food
- Taper off dose regimen when discontinuing
- Provide immunoprotection
