Diabetes/Endocrine (Thyroid/Noninsulin agents) Flashcards
Anti-Thyroid Foods
GOITROGENS
-Broccoli, cauliflower, kale, cabbage, brussel sprouts, cassava, millet, soybeans
Iodine Sources in Diet
Common Sources of Dietary Iodine
Cheese Cows milk Eggs Frozen Yogurt Ice Cream Iodine-containing multivitamins Iodized table salt Saltwater fish Seaweed (including kelp, dulce, nori) Shellfish Soy milk Soy sauce Yogurt
LEVOTHYROXINE (Levothyroid, Levoxyl, Synthroid)
The prototype
THYROID REPLACEMENT DRUGS (Hypothyroidism)
- Synthetic preparation of T4 equivalent to the naturally occurring thyroid hormone
- MOA: Some of the T4 is converted to T3 and therefore replacement of both T4 and T3 occurs
-Indications for usage:
Hypothyroidism due to any cause; cretinism, myxedema coma, insufficient TSH, TRH, post surgical removal of the thyroid gland, radiation effects, and treatment with anti-thyroid drugs.
- A/E:
- In proper dosage, rarely has problems.
- Too much thyroid results in THYROTOXICOSIS** causing symptoms of hyperthyroidism, especially rapid heart rate, atrial fibrillation, angina, tremors, weight loss, diarrhea.
- Patient education:
- **TAKE ON AN EMPTY STOMACH 30-60 MINUTES before breakfast since food interferes with absorption.
DO NOT CHANGE BRAND NAMES
Liothyronine (T3)
-works faster, therefore may be used in myxedema, when fast action is needed
Nursing Implications for Hypothyroidism:
- Monitor effects
- Patient teaching
- Monitor TSH levels every 3 months until regulated, then once a year
Drugs for Hyperthyroidism:
- Propylthiouracil (PTU)
- Methimazole (Tapazole)
Propylthiouracil (PTU)
- PTU is one of two prototype antithyroid drugs.
- MOA – inhibits thyroid hormone synthesis & also decreases the conversion of T4 to T3, the active form of thyroid hormone
- Very short half-life, must be administered 2-3 times a day
- Usually given to patients in thyrotoxicosis
- Serious potential A/E;
- Agranulocytosis
- PTU can be used in the 1st trimester only if absolutely necessary (otherwise avoid in pregnant women)
Methimazole (Tapazole)
- Safer and more convenient than PTU
- MOA: prevents oxidation of iodine and incorporation of iodine into tyrosine; inhibits peroxidase, the enzyme that catalyzes the oxidation process.
- Indications: Sole form of therapy for Graves Disease, Adjunct to radiation therapy, used before surgery for removal of thyroid;
- Adverse effects: agranulocytosis, contraindicated in pregnancy
Oral Hypoglycemic Agents
- Biguanides
- Sulfonylureas
- Meglitinides
- DPP-4 Enzyme Inhibitors
- Exenatide
- Liraglutide
- Thiazolidinedione
- Alpha-glucosidase enzyme inhibitor
- SGLT-2 Inhibitors
Class: 2nd Generation Sulfonylureas
- Glimepiride
- Glipizide
- Glyburide
- MOA: Lowers blood glucose by stimulating release of insulin from the pancreas; increases sensitivity to insulin at receptor sites; may decrease hepatic glucose production
- s/e:HYPOGLYCEMIA, WEIGHT GAIN, disulfiram like reaction with alcohol, GI disturbances (#1 S/E), drug/drug interactions with beta-blockers, antifungals, corticosteroids, thiazide diuretics, and cyclic antidepressants
Approved for PREGNANCY
Class: Biguanides
Drug Name: METFORMIN (Glucophage)
- Preferred starting agent for T2DM
- Approved for use in children 10 years old and greater with T2DM and in pregnancy.
- MOA: Increases sensitivity to insulin; decreases hepatic production of glucose; decreases intestinal absorption of glucose
- Decreases amount of insulin needed by T2DM
- Lowers Basal and postprandial BGs
Biguanides (Metformin) Cont.
s/e: diarrhea, decreased appetite, nausea, lactic acidosis; GI effects subside in time but some may not be able to tolerate
***DOES NOT CAUSE HYPOGLYCEMIA; AIDS IN WEIGHT LOSS (nearly perfect drug)
Biguanides (Metformin) Cont…
- Nursing Implications: Don’t use in acutely ill, renal disease, receiving tests involving IV admin of dyes
- Discontinue drugs several days before and afterwards (48 hours) for dye procedures
- LACTIC ACIDOSIS: Metformin inhibits mitochondrial oxidation of lactic acid which allows it to build up in the bloodstream. s/s include hyperventilation, myalgia, malaise and unusual sleepiness
Drug interaction: Alcohol and cimetidine (tagamet) can lead to lactic acidosis
Class: Thiazolidinediones (Glitazones; TZD’s)
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
- Pioglitazone DECREASES INSULIN RESISTANCE increasing insulin action at receptors and post receptor level in hepatic and peripheral tissue
- Rosiglitazone only available under a restricted program
Thiazolidinediones Cont.
-a/e: upper respiratory infection, headache, sinusitis, myalgia, FLUID RETENTION (can worsen heart failure is person already has heart failure), HYPOGLYCEMIA
-Nursing Implications:
Monitor for weight gain and /or fluid retention, shortness of breath, chest pain; can be used in mild CHF only
-may decrease effect of oral contraceptives; usually given with insulin or sulfonylurea but can be used as monotherapy; check liver enzymes q 2 months for first year
