Drugs for Endocrine System Flashcards
Insulin Lispro
FOR TYPE I DM
Action:
-short duration; rapid onset
-onset: 15m; peak: 1-3h; duration: 3-6h
-take in association w/ meals
-clear solution
-SC (iv in emergency)
ADRs:
hypoglycemia
-blood sugar goes too low
-avoid… insulin OD, skipping meals, VD, intense exercise, alc.
-presents as tachycardia, sweating, shaking, confusion, drowsiness, fatigue -> coma -> death
-consider peak activity
-treat w/ sugar
diabetic ketoacidosis
-too little insulin
-can be from… missing doses, illness/stress, medications (glucocorticoids, thiazides, corticosteroids)
-presents as polydipsia, polyuria, polyphagia, fruity scent from ketones (blood test)
-treat w/ insulin iv
lipohypertrophy/lipoatrophy
-excessive lipid production = hallows/lumps in skin
Implications: drug interactions
-intensity insulin effects; alc. brings you down = risk for hypo
-counteract insulin effects; thiazide diuretics and glucocorticoids raise blood sugar
-beta blockers; block tachycardia
Regular insulin
FOR TYPE I DM
Action:
-short duration; slower onset
-onset: 30-60m; peak 1-5h; duration: 8h (3 doses)
-take in association w/ meals
-clear solution
-SC
ADRs:
hypoglycemia
-blood sugar goes too low
-avoid… insulin OD, skipping meals, VD, intense exercise, alc.
-presents as tachycardia, sweating, shaking, confusion, drowsiness, fatigue -> coma -> death
-consider peak activity
-treat w/ sugar
diabetic ketoacidosis
-too little insulin
-can be from… missing doses, illness/stress, medications (glucocorticoids, thiazides, corticosteroids)
-presents as polydipsia, polyuria, polyphagia, fruity scent from ketones (blood test)
-treat w/ insulin iv
lipohypertrophy/lipoatrophy
-excessive lipid production = hallows/lumps in skin
Implications: drug interactions
-intensity insulin effects; alc. brings you down = risk for hypo
-counteract insulin effects; thiazide diuretics and glucocorticoids raise blood sugar
-beta blockers; block tachycardia
Neutral Protamine Hagedorn (NPH) Insulin
FOR TYPE I DM
-intermediate duration
-onset: 1h; peak 8-10h; duration 12-20h (2 doses)
-cloudy suspension
-allergic reactions possible
-basal control (background)
-often taken in conjunction w SA insulin (SA can rapid or slower onset)
-short before intermediate
-can mix in same syringe
-fixed preps (30/70)
ADRs:
hypoglycemia
-blood sugar goes too low
-avoid… insulin OD, skipping meals, VD, intense exercise, alc.
-presents as tachycardia, sweating, shaking, confusion, drowsiness, fatigue -> coma -> death
-consider peak activity
-treat w/ sugar
diabetic ketoacidosis
-too little insulin
-can be from… missing doses, illness/stress, medications (glucocorticoids, thiazides, corticosteroids)
-presents as polydipsia, polyuria, polyphagia, fruity scent from ketones (blood test)
-treat w/ insulin iv
lipohypertrophy/lipoatrophy
-excessive lipid production = hallows/lumps in skin
Implications: drug interactions
-intensity insulin effects; alc. brings you down = risk for hypo
-counteract insulin effects; thiazide diuretics and glucocorticoids raise blood sugar
-beta blockers; block tachycardia
Insulin Glargine
FOR TYPE I DM
-long duration
-onset: 4h; duration 24h (1 dose)
-SC
-clear solution
ADRs:
hypoglycemia
-blood sugar goes too low
-avoid… insulin OD, skipping meals, VD, intense exercise, alc.
-presents as tachycardia, sweating, shaking, confusion, drowsiness, fatigue -> coma -> death
-consider peak activity
-treat w/ sugar
diabetic ketoacidosis
-too little insulin
-can be from… missing doses, illness/stress, medications (glucocorticoids, thiazides, corticosteroids)
-presents as polydipsia, polyuria, polyphagia, fruity scent from ketones (blood test)
-treat w/ insulin iv
lipohypertrophy/lipoatrophy
-excessive lipid production = hallows/lumps in skin
Implications: drug interactions
-intensity insulin effects; alc. brings you down = risk for hypo
-counteract insulin effects; thiazide diuretics and glucocorticoids raise blood sugar
-beta blockers; block tachycardia
Metformin
FOR TYPE II DM
Action:
-oral, tablet
-increase tissue response to insulin
-decrease liver production of glucose
ADRs:
-GI (take w/ food)
-lactic acidosis from poor kidney function and alc. (hypoventilation, malaise)
Glipizide
FOR TYPE II DM
Action:
-oral, tablet
-increase tissue response to insulin
-increase insulin by pancreas
ADRs:
-hypoglycemia (no alc.)
Somatropin
GROWTH HORMONE DEFICIENCY
Action:
-give GH
-replacement therapy for dwarfism (works well in kids)
-treatment of non-healing fractures (build up bones in adults)
ADRs:
-DM
-gigantism, acromegaly
Implications:
-monitor h/w, blood glucose levels
-pain at injection site
-guide administration (SC, IM)
-note: possible abuse = anabolic effects
Octreotide
GROWTH HORMONE EXCESS
-inhibits GH
ADRs:
-NVD
-abdominal pain
Levothyroxine
THYROID DEFICIENCY
Action:
-orally active, tablet
-take in morning on empty stomach
ADRs: everything is too high
-irritability
-insomnia
-nervousness
-headache
-CV (tachycardia, angina)
Implications:
-check ECG
-monitor weight, edema, pallow, fatigue, thyroid function tests
-start with lose dose then increase to reach euthyroid state
Methimazole
THYROID EXCESS
Action:
-inhibits synthesis of thyroid hormones and the conversion of T4 to T3 in peripheral muscles
-takes days/weeks for observable response
-orally active (take for a year then come off)
ADRs:
-fever
-itching
-skin rash
-blood dyscrasias (agranulocytosis)
Radioactive Iodine
THYROID EXCESS
Action:
-accumulates in thyroid = radiation destruction from beta waves
CI:
-pregnancy and lactation
Use:
-diagnosis (tests function of thyroid)
-treat hyperthyroidism
-prepare a hyperthyroid patient for surgery (helps finish and shrink scar)
Implications:
-patients can often become hypothyroid
Prednisone
ADRENAL DEFICIENCY
Action:
-oral therapy for chronic adrenal insufficiency
-slow onset, long duration
ADRs:
-electrolyte disturbances (hypernatremia = water retention, hypokalemia)
-glucose tolerance (increase risk of DM)
-bone loss (osteoporosis, muscle wasting)
-susceptibility to infection
-mood changes
Implications:
-lifelong therapy
-start with lower dose until stabilized
-dosing schedule (dose in morning since cortisol is high)
-use lowest drug possible, ADT
-MUST increase dose in stress, such as surgery, trauma, infection (3x3 rule)
-do not discontinue abruptly (system is sensitive)
-educate, Medic-Alert bracelet
-RARE: adrenal crisis (life threatening) shock -> low BP -> LOC = treat with glucocorticoid injection
Hydrocortisone
ADRENAL DEFICIENCY
Action:
-oral therapy for chronic adrenal insufficiency
-slow onset, long duration
ADRs:
-electrolyte disturbances (hypernatremia = water retention, hypokalemia)
-glucose tolerance (increase risk of DM)
-bone loss (osteoporosis, muscle wasting)
-susceptibility to infection
-mood changes
Implications:
-lifelong therapy
-start with lower dose until stabilized
-dosing schedule (dose in morning since cortisol is high)
-use lowest drug possible, ADT
-MUST increase dose in stress (surgery, infection, trauma)
-do not discontinue abruptly
-educate, Medic-Alert bracelet
Mitotane
ADRENAL HORMONE EXCESS
Action:
-used as adjunct therapy
-anti-cancer
ADRs:
-nausea
-abdominal distress
-headache
-dizziness
-drowsiness
-rash
Semalutide
FOR TYPE II DM
Action:
-glucagon-like peptide-1 agonist
-SC (once a week, high dose oral)
-decrease liver production of glucose
-increase secretion of insulin
-inhibition of glucagon release
ADRs:
-GI: NVD
-pancreatitis (delays peristalsis; food stays in stomach) = weight loss
