Endocrine

Question 1

Drugs of the Endocrine System

Answer 1

● Steroids

● Thyroid Medications
○ Thyroid hormone replacements
○ Anti-thyroids

● Parathyroid Medications
○ Calcium
○ Bisphosphonates
○ Calcitonin

● Posterior-Pituitary Hormones
○ ADH
○ Oxytocin

● Diabetes
○ Insulin
○ Oral antidiabetics

Question 2

Steroids

Answer 2

Short Acting - Cortisone, hydrocortisone

Intermediate Acting - methylprednisolone, prednisone, triancinalone

Long Acting - betamethasone, dexamenthasone

Question 3

Steroids - Cortisone, hydrocortisone, methylprednisolone, prednisone…

Answer 3

Cortisone, hydrocortisone, methylprednisolone, prednisone…

Indication: Addison’s disease, inflammation, allergy, autoimmune disorders

Action: Suppress inflammation in the immune system, increase blood glucose, cause
retention of water and sodium (increasing BP), cause excretion of potassium

Nursing Considerations:
● Monitor for too much steroids
○ Cushing’s symptoms; buffalo hump
● Side effects
○ Immunosuppression
○ Hyperglycemia
○ Osteoporosis
○ Delayed wound healing

Question 4

Thyroid Hormone Replacements
Names: Levothyroxine

Answer 4

Indication: Hypothyroidism

Action: Replacement for thyroid hormone

Nursing Considerations:
● Take every day, at the same time, on an empty stomach
● Separate from other medications
● Don’t stop taking abruptly

Question 5

Anti-Thyroid Medications
Iodine (Lugol’s Solution), Radioactive iodine, Methimazole, Propylthiouracil

Answer 5

Indication: Hyperthyroidism

Action: reduces size and vascularity of the thyroid gland, or kills thyroid gland cells, to
decrease the amount of T₃ and T₄ that are secreted

Nursing Considerations:
● Monitor for signs and symptoms of hypothyroidism

Question 6

Parathyroid Medications

Answer 6

● Increase serum calcium
○ Calcium chloride, gluconate, lactate
○ Vitamin D
■ Calcitriol

● Decrease serum calcium
○ Bisphosphonates
■ Alendronate
■ Risedronate

○ Calcitonin

Question 7

Posterior Pituitary Gland Hormones:
Antidiuretic Hormone

Answer 7

Names: Vasopressin, Desmopressin

Indication: DI, Shock

Action: Causes the body to retain water, increasing the blood volume, decreasing the UOP,
and increasing BP

Nursing Considerations:
● Monitor BP and UOP

Question 8

Posterior Pituitary Gland Hormones:
Oxytocin

Answer 8

Names: Carboprost, Pitocin, Oxytocin

Indication: Induction of labor; PPH

Action: Stimulates uterine smooth muscle causing it to contract

Nursing Considerations:
● Monitor contractions
● Monitor fetus
● Warn mother contractions will be more painful
● Monitor BP, HR, glucose, and K

Question 8

Oral Anti-diabetic

Biguanides

Answer 8

Metformin

Inhibit liver glucose
production & reduce
intestinal absorption of
glucose

Increased risk for kidney issues
and lactic acidosis: hold
before/after imaging tests with
contrast & teach client to avoid
alcohol

Common side effect: GI issues

Question 9

Oral Anti-diabetic

Sulfonylureas
Trigger beta cells to
release insulin

Answer 9

Glimepiride
Glyburide

Administer with or just prior to
meals to avoid hypoglycemia
Instruct client to consult PCHP
before combining with OTC
medications (interact with
many other medications)

Question 11

Oral Anti-diabetic

Insulin sensitizers
(Thiazolidinediones)

Answer 11

Reduce glucose
production & increase
insulin receptor sensitivity

Rosiglitazone
Pioglitazone

Increased risk for heart failure:
monitor daily weight for clients
with any cardiovascular
problems

Increased risk for macular
edema: teach clients to report
changes in vision

Question 12

Insulin

Rapid-Acting
Used to manage blood
sugar during snacks/meals
and to correct high blood
glucose levels

Answer 12

Insulin aspart
Onset Peak Duration
15 min 1-3 hrs 3-5 hrs

Insulin lispro
Onset Peak Duration
15 min 30-90 min 5 hrs

Question 13

Insulin

Short-Acting
Used to manage blood
sugar during snacks/meals
and to correct high blood
glucose levels

Answer 13

Regular Insulin
Onset Peak Duration

Regular 30 min 2-4 hrs 5-12 hrs

Question 14

Insulin
Intermediate-Acting

Used to control blood
sugar between meals, while fasting, and
overnight

Answer 14

NPH
Intermediate-Acting
Onset Peak Duration

1-4 hrs 4-12 hrs 10-24+ hrs

Question 15

Insulin

Long-Acting
Used to control blood
sugar between meals, while fasting, and
overnight

Answer 15

Glargine
Onset Peak Duration

2-4 hrs None 24 hrs

Question 16

Water deprivation test

Answer 16

DI can be divided into either neurogenic (central) or nephrogenic. The water deprivation test is used to help differentiate whether the DI is neurogenic or nephrogenic. In this test, the client is deprived of water for up to eight hours (they may still eat dry foods). Serial labs, including plasma and urine osmolality measurements, are obtained during that time. Additionally, the client’s urine volume and weight are meticulously measured hourly. If the client’s body weight should decrease, this supports the diagnosis of DI. At the end of the eight hours, a dose of desmopressin is administered. If there is an increase in urine osmolarity and a decrease in urine volume, it is considered central/neurogenic DI (because the problem responded to the DDAVP). If no response is observed after the DDAVP is administered, nephrogenic DI is likely.

Question 17

DI

Answer 17

DI is a condition that may be central or nephrogenic

✓ The client is at risk for fluid volume deficit because the client may experience polyuria

✓ This may manifest as tachycardia, hypotension, and a thread pulse

✓ Common laboratory findings for an individual with DI include hypernatremia, decreased urine specific gravity (it is dilute), and increased hematocrit (hemoconcentration)

✓ Treatment for central diabetes insipidus is by administering desmopressin (intranasal or tablet)

✓ Nephrogenic diabetes insipidus is treated by withdrawing the offending agent (such as lithium) and administration of thiazide diuretics or NSAIDs