Drug therapy: Endocrine system

Question 1

Sulfonylureas

Answer 1

type 2 diabetes: glipizide (glucotrol)
Stimulate release of insulin on a functioning pancreas
SE: Mild hypoglycemia, nausea, diarrhea
Admin: If unconscious IV glucose or 1mg glucagon subQ, check blood glucose q 15-20min
Interactions: Alcohol risk of antabuse reaction, thiazides conteract effects, beta blockers mask hypoglycemia

Question 2

Meglitinides

Answer 2

Type 2 diabetes: repaglinide (prandin)
Pts who dont respond to sulfonylureas wont respond to meglitinides
SE: hypoglycemia, nausea, diarrhea
Admin: If unconscious IV glucose or 1mg glucagon subQ, check blood glucose q 15-20min
Skip dose if they skip a meal and add dose if they add a meal dont exceed 4 doses

Question 3

Biguanides

Answer 3

Type 2 diabetes (new diagnosed): metformin (glucophage)
Decrease absorption of glucose from intestines and decrease the synthesis of glucose by the liver
SE: nausea, diarrhea, anorexia, Vit. deficiencies, lactic acidosis (hyperventilation, lethargy)
Monitor fluid I&O
Interactions: Alcohol & cimetidine increase the risk of lactic acidosis, ginseng & garlic increase hypoglycemic effects

Question 4

Thiazolidinediones

Answer 4

Type 2 diabetes (w/ or w/out drug therapy w/ insulin):pioglitazone (actos)
Reduce insulin resistance of tissue
SE: fluid retention, hepatotoxicity, increased serum lipid levels
Obtain ALT levels baseline & q 3-6 months
Oral once daily
Gemfibrozil increase hypo effects, green tea, ginseng, garlic increase hypo effects

Question 5

Alpha-glucosidase inhibitors

Answer 5

Type 2 diabetes: acarbose (precose)
Inhibits enzyme that breaks down carbs in the intestine
SE: GI effects, hypoglycemia, liver dysfunction, anemia
Give w/ 1st bite of food 3x daily
Metformin worsens GI effects, estrogens, thiazides, phenytoin counteract effects

Question 6

Gliptins

Answer 6

Type 2 diabetes: sitagliptin (januvia)
lower fasting and postprandial blood glucose
SE: upper respiratory tract infections, headache, pancreatitis
Give reduced dosage to those with renal impairment and low Cr clearance
May increase digoxin levels

Question 7

Insulin

Answer 7

Diabetes (all types): Lispro(humalog), Regular, NPH, insulin glargine
Chemically identical to that produced by pancreas promotes cellular uptake and use of glucose & storage
SE: hypoglycemia, hypokalemia, lipohypertrophy
Give SubQ, when mixing short with long acting draw short up first, rotate vial btw palms, dont give if cloudy

Question 8

Amylin Mimetics

Answer 8

Type 1 and 2 diabetes: pramlintide (symlin)
Slow gastric emptying, inhibit secretion of glucagon
SE: hypoglycemia, nausea, injection site reactions
Just before meals that contain at least 30mg of carbs, peak after 20min, room temp. for 28 days

Question 9

Incretin Mimetics

Answer 9

Type 2 diabetes: exenatide (byetta)
SE: hypoglycemia, N/V, diarrhea, pancreatitis
60min prior to meals
Take contraceptives and antibiotics 1-2hrs before

Question 10

Hyperglycemics

Answer 10

Hypoglycemia from insulin overdose: Glucagon (GlucaGen), glucose
COnverts liver glycogen to glucose, ~20min
GI effects (N/V)
IV or IM, provide food after regain consciousness

Question 11

Thyroid Replacements

Answer 11

Hypothyroidism: Levothyroxine (synthroid)
Synthetic form of T4
SE: hyperthyroidism excessive doses, HTN, tachycardia
Daily on empty stomach, measure baseline weight and VS, monitor cardiac excitability, and expect lifelong replacement therapy
Antacids, anti-seizure and depressant, increase anticoagulant effects

Question 12

Antithyroid Drugs/Propylthiouracil

Answer 12

Hyperthyroidism, thyrotoxic crisis: Propluthiouracil (PTU)
Blocks synthesis of thyroid hormone
SE: Hypothyroidism, agranulocytosis, rash, arthralgia
Give oral at regular intervals, takes about 3-12 weeks to produce euthyroid state and 6-12months to stabilize

Question 13

Antithyroid Drugs/Radioactive Iodine

Answer 13

Thyroid cancer, hyperthyroidism: iodine-131
Gradually destroys thyroid tissue, decrease fx
SE: hypothyroidism, bone marrow depression, radiation sickness
Give oral once, neg. pregnancy test, full effects in 2-3months

Question 14

Growth Hormone

Answer 14

Turners syndrome, deficiency, and AIDS wasting syndrome: Somatropin (genotropin)
SE: hyperglycemia, myalgia, hypercalciuria
IM or SubQ several times a week, costly, rotate vial dont shake, inject into thigh/abdomen

Question 15

Antidiuretic Hormone

Answer 15

Diabetes insipidus: desmopressin, vasopressin
Increase reabsorption of water, decrease urine vol.
SE: fluid retention, hyponatremia, vasoconstriction
Oral, SubQ, IV, or nasally, lifelong therapy

Question 16

Glucocorticoids

Answer 16

Acute and chronic adrenocortical insuffciency (addisons disease): hydrocortisone (cortef)
SE: few effects at low levels
Give oral, total daily at bedtime, 2 doses 2/3 in morning 1/3 in afternoon, IV for emergency situations life long therapy

Question 17

Mineralocorticoids

Answer 17

Fludrocortisone
SE: Fluid/electrolyte imbalance, HF, hypokalemia
Oral daily or 3x per week, obtain CBC, medical alert band
Rifampin decreases levels