Endocrine Flashcards
Thyroid Gland
Produces T3, T4 and Calcitonin. Relies on dietary iodine to make hormones. Thyroid hormones give us ENERGY.
Calcitonin
Decreases serum calcium levels by taking calcium out of the blood and pushing it back into the bone.
Hyperthyroidism : Diagnosis
Diagnosis:
T4 will be increased and TSH would be down
Thyroid scan: Client must discontinue any iodine containing meds 1 week prioir to the thyroid scan and must wait 6 weeks to restart medications
U/S, MRI and CT
Hyperthyroidism : Signs and Symptoms
Signs/Symptoms ( Could be confused with mania) Nervous Irritable Attention span DOWN Appetite UP Weight DOWN Sweaty/Hot Exophthalmos GI fast BP and Pulse up (increased workload of the heart) Arrthymias/palpitations Thyroid would be bigger
Hyperthyroidism: Medications - 4 kinds
Anti-thyroids: methimazole or propylthiouracil
Stops the thyroid from making thyroid hormones. Used pre-operatively to stun the thyroid.
Iodine Compounds: Different than dietary iodine. Decreases the size and vascularity of the thyroid gland, decreasing the bleeding risk. Put in milk or juice, as it can stain the teeth
Beta Blockers - supportive therapy. Decreases myocardial contractility. Could decrease Cardiac Output, HR and BP. Decreases Anxiety. Potential to decrease perfusion. Do not give to asthmatics or diabetics ( blocks symptoms of hypoglycemia)
Radioactive Iodine Therapy
One dose. Given PO. Rule out pregnancy. Destroys thyroid cells, causing hypothyroidism. Follow radioactive precautions. Stay away from kisses and babies for one week.
WATCH FOR A THYROID STORM. can lead to a heart attack or MI. Can be a rebound effect post-radioactive iodine.
Partial/Complete Thyroidectomy : Post op
Priority: Hemorrhage
Report feelings of pressure in the neck area ( Bleeding or swelling)
Check for bleeding at incision site anteriorly and posteriorly
Assess for recurrent laryngeal nerve damage by listening for hoarseness and weak voice, as it could lead to vocal cord paralysis, leading to an airway obstruction - needs a trach
Trach should be at the bedside for swelling, paralysis of vocal cords, hypocalcemia (follow the serum calcium levels), PTH removal (lead to hypocalcemia - NOT ENOUGH SEDATIVE)
SUPPORT THE NECK - no tension on the suture line
Elevated HOB to decrease edema
More calories
Parathyroid
Secrete PTH which makes you pull calcium from the bone and place it in the blood, therefore serum calcium goes up. Too much - High CA, Too little - low CA
Hyperparathyroidism = Hypercalcemia = hypophosphatemia
SEDATED.
Bones are brittle, Kidney stones, DTR are decreased, Muscle tone decreased, Arrthymias, LOC is down, Pulse down and Respirations down
Treatment:
Partial parathyroidectomy - take out two PT and PTH secretion decreases as well as serum calcium.
Ventilator and Dialysis
Monitor for hypocalcemia post op ( tight rigid muscles, airway spasms, seizure, arrhythmia)
Hypoparathyroidism = Hypocalcemia = Hyperphosphatemia
Not enough PTH, Low calcium - Not enough sedative
Muscle tone increased, SEIZURE, airway spasm, Chvostek/Trousseus, Arrthymias, LOC changes, Swallowing problems
Treatment: IV calcium, phosphorus binding drugs.
Adrenal Medulla - Function, Issues and Treatment
Produces epinephrine and Norepinephrine ( the fight or flight hormones)
Pheochromocytoma: Benign tumors that secrete epi and norepi in boluses. Tend to be familial, so screen the family
Signs/Symptoms:
BP is increased, HR is increased, palpitations. Flushing/extremely diaphoretic with a headache.
Diagnosis: Catecholamine levels: VMA and MN test and a 24 hour urine specimen is done and looking for increased levels of epi and norepi. Throw away the first urine and keep the last. KEEP CALM.
Surgery is needed to remove the tumors
Avoid palpating the this client’s abdomen as it will cause severe hypertension with sudden onset
Adrenal Cortex
Produces glucocorticoids, mineral-corticoids and sex hormones ( all are steroids). Even though the body produces these naturally, the adverse effects are going to be more pronounced when the client is receiving oral or IV steroids.
Glucocorticoids
Important for Cushing’s and Addison’s questions.
Changes your mood - presents in lots of different ways
Alter defense mechanisms - Immunosuppression/ High risk for infection
Breakdown Fats and Proteins
Inhibit insulin
Hyperglycemia
(assists in regulating glucose metabolism)
Monitor chem strips q6h even without diabetes diagnosis
Mineralcorticoids
Aldosterone
Makes you retain sodium and water, loses potassium
too much aldosterone: Cushings/Conn’s / FVE and hypokalemia
Too little: Addison’s, FVD and hyperkalemia
Sex Hormones
Testosterone, Estrogen and Progesterone
Too much sex hormone: Hirsutism, acne and irregular menstrual cycle
Too little: Decreased axillary/pubic hair, decreased libido
Adrenal Cortex Issues
Not enough steroids, Shock, Hyperkalemia, hypoglycemia
Addison’s Disease
Adrenocortical insufficiency - not enough steroids - Not enough aldosterone. Lose water and sodium and retain potassium - so hyperkalemia and FVD.
Signs/Symptoms:
Extreme fatigue
N/V/D
Anorexia/Weight loss
Hypotension
Confusion
Decreased sodium, increased potassium and Hypoglycemia
Hyperpigmentation - bronzing color of the skin and mucous membranes
White patchy area of depigmented skin (vitiligo)
Treatment: Combat shock through IV fluids Increase sodium in diet In/outs and daily weights BP monitoring
Medications:
Prednisolone - given twice a day in split doses - 2/3 in the morning and 1/3 at night
Fludrocortisone - is aldosterone
Addisonian Crisis
Can occur with infections , emotional stress, physical exertion or stopping steroids abruptly
Severe hypotension and vascular collapse, hypoglycemia.
Prednisone/Corticosteroids: Uses, contraindications, Onset, MoA, Advantages, Side/Adverse effects, Nursing interventions, Client education
Uses: Used to prevent nausea and vomiting caused by chemotherapy and also to prevent allergic reactions to chemo. Also used Addison’s disease.
Contraindicated in fungal infections, seizure disorder and pregnancy
Onset: 1 hour
MoA: Helpful in treating cancer as well as other illness. Considered chemo drugs. They are anti-inflammatory agents that suppress the inflammatory process that is associated with tumor growth. Blocks steroid specific receptors on the surface of the cel which slows the growth.
Advantages: Gives a sense of well being and euphoria.
Side Effects: Increased appetite, Fluid retention, Hypokalemia, Risk for infection, Hyperglycemia, Increased Fat distributions, Muscle weakness
Adverse effects: Seizures, circulatory collapse, infection
Nursing Interventions: monitor Serum glucose and electrolytes ( especially potassium and calcium), Daily weight and I&O
Client education: Take with food or milk, notify provider if fever of 38 degrees, don’t take aspirin and avoid the SUN
Fludrocortisone/ Mineralocorticoid: Uses, contraindications, Onset, MoA, Advantages, Side/Adverse effects, Nursing interventions, Client education
Used in Addison’s disease and Adrenal insufficiency
Contraindications: Children <2 y/o, hypersensitivity
PO
Interactions: Increased BP with sodium foods or medications, Decreased fludrocortisone action with barbiturates, phenytoin. Decreased potassium with thiazides and loop diuretics.
MoA: retains sodium and promotes loss of potassium. water and hydrogen from distal renal tubules.
Disadvantage: Can cause a negative nitrogen balance
Side Effects: Flushing, Headache, HTN, Weight Gain, Hypokalemia, Sweating, Dizziness, Tachycardia, Hyperglycemia
Adverse Effects: Seizures, Circulatory collapse, Embolism, Anaphylaxis
Nursing Interventions: Daily weight, I&O, Assess for edema, V/s q4h, Monitor electrolytes, Administer with food or milk for less GI symptoms
Education: Notify if weight gain > 5 pounds, chest pain, Don’t discontinue abruptly, avoid exposure to disease
Glucocorticoids: Uses, contraindications, Onset, Side/Adverse effects, Nursing interventions, Client education
Uses: Inflammation, allergies, cerebral edema, Septic Shock, Meningitis, Asthma, MS, Irritable bowel syndrome, autoimmune disease and organ transplant
Contraindicated in ulcerative colitis and seizure disorders
Interactions: Increased side effects with ETOH, salicylates, digoxin, diuretics, NSAIDS
Increased dexmethasone action with salicylates, estrogens, indomethacin, NSAIDS
Side Effects: Depression, Sweating, Mood changes, Hypernatremia, Hypokalemia, Flushing, Headache and insomnia
Adverse effects: Seizures, Circulatory collapse, HF, GI bleeding, muscle wasting, osteoporosis, HTN, Cardiomyopathy, thromboembolism, hyperglycemia, Cushings, Delayed wound healing
Interventions: IM injection - avoid the deltoid, Daily Weight, monitor vital signs, I&O, monitor for signs of infection. monitor fluids, electrolytes (potassium and calcium) and glucose. Do not stop abruptly.
Education: Avoid OTC products, DONT STOP ABRUPTLY
Glucocorticoid agents
Betamethasone (Celestone) Dexamethasone (Decadron), prednisone (Deltasone), methylprednisolone (Solu-Medrol) Prenisolone (Prelone)
Mineral corticoid agents
Fludrocortisone
Corticosteroid agents
Prednisone, Methylprednisolone (Solu-Medrol), Dexamethasone (Decadron)
Cushing’s syndrome: Signs + Symptoms, Treatment.
Too many steroids = hypokalemia
Signs and Symptoms:
Growth arrest, thin extremities/skin (lipolysis), increased risk of infection, hyperglycemia, Psychosis to depression, Moon Face ( fat redistribution or fluid retention), Truncal obesity, Buffalo Hump
TOO MANY GLUCOCORTICOIDS
Oily skin/acne, woman with male traits TOO MUCH SEX HORMONES
High BP, CHF, Weight Gain, Fluid volume excess, Hypokalemia, Hypernatremia, Hypocalcemia
Treatment: Adrenalectomy (unilateral or bilateral)/will require lifetime replacement of steroids if both are removed. A quiet environment, avoid infection.
Diet before treatment: Low sugar, High potassium, low sodium, increase protein and increase calcium
Type 1 Diabetes
They have little to no inulin - pancreas is shit
Usually diagnosed in childhood
First sign maybe DKA
Appears abruptly, despite years of beta cell destruction
Polyuria, polydipsia and polyphagia
Oral hypoglycaemic agents will not work with this patient because they don’t have insulin
Type 1 Diabetes Patho
Patho: You need to have insulin to carry glucose out of the blood and into the cell - since there is no insulin, the glucose just builds up in the blood. The blood becomes hypertonic and pulls fluid into the vascular space - the kidneys filter excess glucose and fluids ( polyuria and polydipsia) - the cells are starving so they start breaking down protein and fat for energy - when you break down fat you get KETONES ( an acid) so the client goes into metabolic acidosis with Kussmaul Respirations
Type 2 Diabetes
Pancreas is still working - clients don’t have enough insulin or the insulin they have is no good
These clients are usually overweight as they usually cannot make enough insulin for glucose load that the client is taking in
Usually found by accident or the client keeps coming back to the primary care provider for things like a wound that won’t heal, repeated vaginal infections. Bacteria loves sugar and the immune system in diabetics is compromised as circulation is impaired.
These individuals should be evaluated for metabolic syndrome.
Treatment: Start with diet and exercise and then add oral agents. some clients will take insulin due to non-compliance
GENERAL TREATMENT of DIABETES : Diet
Majority of calories come from complex carbs and then fats and lastly, protein. Carbs should be 45%, Fats 30-40% and protein 15 to 20%.
We are worried about carbs because sugars destroy blood vessels just like fat does.
High fiber slows down glucose absorption in the intestines, therefore, eliminating the sharp rise/fall in blood sugar
GENERAL TREATMENT of DIABETES : Excercise
Wait until the blood sugar normalizes to begin exercise and eat something beforehand in order to meet metabolic demand of body
Exercise when blood sugar is the highest - do the same amount at the same time daily
GENERAL TREATMENT of DIABETES : Oral anti-diabetics and non-insulin injectables
Prescribed for type 2 diabetes, can be given orally or Subcut.
Assists with how the body makes insulin and how the body USES the insulin and glucose.
Works to decreases the amount of circulating glucose
Most widely used is metformin - because of weight control for type 2 and some clients with pre-diabetes. Reduces glucose production and enhances how glucose enters the cells.
Does not stimulate the release of more insulin, so you don’t see hypoglycemia (which also destroys vessels) May be prescribed in PCOS.
Clients undergoing surgery or any radiologic procedure that involves contrast dye should temporarily discontinue metformin. they can resume 48 hours after the procedure if kidney function has returned and creatinine is normal.
GENERAL TREATMENT of DIABETES : INSULIN
Dose is initially is based on weight. 0.4 - 1.0 units/ kg/day
Dose is adjusted until the blood sugar is normal and there is no more glucose or ketones in the urine
Rapid Acting Insulin
Aspart, Lispro and Glulisine
Used in type 1 and 2 diabetes
SubQ and IV
Onset: 5-15 mins
Peak: 1 - 3 hours
Duration: 3 -5 hours
Interactions: Increased hypoglycemic effect with aspirin, oral anticoagulants, alcohol, oral hypoglycemic, beta blockers and MAOIs
MoA: Decreases blood glucose by transporting glucose into cells and the conversion of glucose to glycogen. Promotes use of glucose
by body cells.
Side Effects: Confusion Agitation Tremors Headache Flushing Hunger Weakness Lethargy Fatigue Redness at injection site
Adverse Effects: Tachycardia Palpitations Hypoglycemia Rebound hyperglycemia Lipodystrophy Shock Anaphylaxis
Nursing Interventions:
Administer with meals. DO NOT administer unless meal is readily
available.
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
Client Education:SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
Regular/Short Acting Insulin
Humulin R, Novolin R
Type 1 and 2 Diabetes
Onset: 30 min to 1 hour
Peak: 2 - 4 Hours
Duration: 6 - 8 hours
Interactions: Increased hypoglycemic effect with aspirin, oral anticoagulant, alcohol, oral hypoglycemic, beta blockers MAOIs
Advantages: Used for dosing clients with Sliding
Scale. Can be administered IVP or
continuous IV infusion.
Intermediate Acting Insulin
Isophane suspension
(NPH, Humulin N,
Novolin N)
Uses: Type 1 and 2 Diabetes
Onset of Action: 1 – 1 ½ hour
Peak: 4-12 hours
Duration: 16-24 hrs
Side effects:Confusion Agitation Tremors Headache Flushing Hunger Weakness Lethargy Fatigue Redness at injection site.
Adverse Effects: Tachycardia Palpitations Hypoglycemia Rebound hyperglycemia Lipodystrophy Shock Anaphylaxis
Nursing Interventions: Cloudy suspension. Can mix with Regular or Rapid acting insulin:
Draw up clear (Regular or Rapid acting), then cloudy (NPH), “Clear
to cloudy”.
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available
Client Education: SubQ medication administration.
Glucose self-monitoring.
Signs/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
Long Acting Insulin
Glargine
Onset: 2-4 hours
Peak: none
Duration: 24 hours
Once daily SubQ injection provides
24-hour coverage. No peak, insulin
delivered at steady level, less risk of
hypoglycemia
Interventions:Do NOT mix with any other insulin.
Monitor for hypoglycemia, hypokalemia, lipodystrophy.
Always have oral carbohydrate available.
HbA1c
Blood test that gives an average of what blood sugar has been for 3 to 4 months.
4-6%
Diabetic goal <7%
What happens to blood sugar when you are stressed or sick?
When you are sick, you become hyperglycaemic because usually the normal pancreas can handle these fluctuations. An increase in the blood sugar when sick or stressed, is a normal reaction to help us fight the illness or stressor. Illness = DKA.
Insulin Infusion Pumps
Alternative to daily injections. Only rapid insulin is used in these pumps. Obtains a better control, as receiving a basal level of insulin from the pump and boluses of additional insulin as needed with meals or if they have elevated blood sugars
Hypoglycemia: Signs and Symptoms
Cold and Clammy, Confusion, Shakey, Headache, Nervous, Nausea, Hunger, Increased pulse, Coma-like
Hypoglycemia treatment
Eat 15 g of a simple sugar, wait 15 minutes and re-assess. Once the blood sugar is up, eat a complex carb and a protein.
If you enter the room and pt is unconscious, treat as hypoglycemia. Use D50W in a large bore IV because it is a hypertonic solution.
Prevention: Eat, take ya insulin, know hypoglycemia s/s and monitor chem strips
Alpha-Glucosidase Inhibitors
Acarbose and Ligitol
Used in Type 2 diabetes
Contraindications: DKA, Type 1, Cirrhosis and intestinal obstruction
PO
Interactions: Decreases levels of digoxin and propranolol
MoA: Delays absorption of glucose from the GI tract
Advantages: Less likely to cause hypoglycaemic
Disadvantages: Can be Hepatotoxic
Side Effects: Flatulence, Abd Cramps and diarrhea
Adverse Effects : Hepatotoxicity
Interventions: Monitor liver functions every 3 months for the first year of therapy and periodically after
Monitor for hypoglycemia if also taking a sulfonyurea
FSBS
Client Education: Importance of diet and exercise.
Signs/Symptoms of hypoglycemia and hyperglycemia
Take with food at the same time each day.
Self-monitoring blood glucose
Amylin Analog
Pramlintide
Adjunct therapy for Type 1 and 2 who have failed to achieve optimal glucose control with insulin alone
Contraindications: Gastroparesis
SubQ
Onset 20 minutes
Interactions: Increases effect of Tylenol.
Increases hypoglycemia with ACE inhibitors, alcohol, corticosteroids and insulin
MoA: Augments the effects of insulin. Decreases post meal glucagon and glucose. Slows stomach emptying. Decreases appetite,
leads to decreased caloric intake and weight loss.
Advantages: Can assist with weight loss
Side Effects: Headache Fatigue
Dizziness Blurred vision
Nausea/vomiting Anorexia
Abdominal pain
Adverse Effects; Hypoglycemia
Nursing Interventions: Administer immediately prior to meals.
Give SubQ in abdomen or thigh. DO NOT administer in arm as
absorption is unpredictable.
Monitor for hypoglycemia/hyperglycemia
Always have oral carbohydrate available.
Client education:Medication administration.
Give SubQ in abdomen or thigh. DO NOT administer in arm as absorption is unpredictable.
Sign/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
Anterior Pituitary Inhibitor drugs
Octreotide
Common uses: Acromegaly Severe diarrhea Flushing episodes associated with metastatic tumors Variceal bleeding
Route: SubQ, IM, IV
Onset: 30 minutes
Interactions: decreased absorption of dietary fat, Vit B12 Levels
MoA: Inhibits growth hormone, promotes fluid and electrolyte reabsorption.
Side Effects: Headache GI complaints Fatigue Dizziness Flatulence Constipation UTI
Adverse Effects: Dysrhythmias Heart failure Hyperglycemia Hypoglycemia Cholelithiasis Seizure
Interventions: Assess growth hormone antibodies.
Monitor thyroid function studies.
Monitor blood glucose
Education: Sub Q self injection and Blood glucose monitoring
Anterior Pituitary Stimulant Drugs
Somatropin
Common Uses: Growth HormoneL Growth failure die to growth hormone deficiency, AIDS wasting syndrome and short bowel syndrome
Contraindications: Growth failure after closure of the epiphyseal plates
SubQ and IM
Onset: 15 minutes
Interactions: Increases epiphyseal closure with androgens, thyroid hormones
Decreased growth with glucocorticoids
Decrease insulin, anti-diabetic effect
MoA: Stimulates growth
Side Effects:
Headache, Fever, N/V, Joint and Muscle Pain
Adverse Effects: Hyperglycemia, Hypothyroidism, Ketosis
Interventions: Inject deeply into a large muscle. Aspirate before injection. Rotate injection sites daily. Assess for signs/symptoms of diabetes. Thyroid function tests.
Education:
Treatment may continue for years.
Maintain a growth record.
Report knee/hip pain or limping.
Anti-Hypoglycemic
Glucagon
used for Hypoglycemia
Contraindicated in Pheochromocytoma
Route: SubQ, IM and IV
Onset is 10 mins
Interactions: Increased bleeding risk with anticoagulants
MoA: Increases blood sugar by stimulating glycogenolysis (glycogen breakdown) in the liver. It protects the body cells, especially in the
brain and retina, by providing the nutrients and energy needed to maintain body function
Side effects: Dizziness
Headache
Hypotension
Nausea/vomiting
Adverse Effects: Hyperglycemia
Interventions: Monitor Glucose levels
Education: How to use product.
Glucose self-monitoring.
Sign/symptoms of hypoglycemia/hyperglycemia.
Always have oral carbohydrate available.
Carry a glucose source to treat hypoglycemia
Anti- Thyroid Drugs
Methimazole and Propylthiouracil
Common uses: Hyperthyroidism, Graves disease, Thyrotoxicosis, Pre-op to stun the thyroid prior to thyroidectomy
Contraindications: Pregnancy, Breastfeeding
PO
Onset is Rapid
Interactions: Increase response to digoxin.
Decrease effectiveness of warfarin
Increase PT, AST, ALT, alkaline phosphate.
Side Effects:
Rash, Drowsiness, Headache, Vertigo, Nausea/Vomiting, Diarrhea
Adverse: Leukopenia, agranulocytosis, Pancytopenia, Hepatitis
Interventions: Monitor CBC with differential and PT time for bone marrow
suppression.
Monitor TSH levels.
Assess for s/s of hypothyroidism as well as hyperthyroidism.
I&O
Daily weight
Increase fluids to 3-4 L/day unless contraindicated
Client Education: Report unusual bruising or bleeding.
Avoid shellfish and iodine products.
Teach client how to monitor pulse daily.
Report redness, swelling, sore throat, fever.
Do not discontinue medication abruptly because thyroid crisis
can occur.
Radioactive Iodine
Used for Hyperthyroidism
Contraindicated in Pregnancy
PO
Side effects: Hypothyroidism Headache Confusion Paresthesia Metallic taste Stomatitis Nausea/Vomiting Diarrhea
Adverse Effects : Hyperthyroidism: rebound effect post radioactive iodine
Interventions: Watch for thyroid storm.
Monitor for fever, rash, metallic taste, mouth sores, sore throat, GI
distress.
Education:Stay away from babies for 1 week Don’t kiss anybody for 1 week. Avoid crowds and people who are ill. Report darkening of urine or jaundice. Monitor for weight gain.
Biguanides
Metformin
Used for Hyperglycemia in Type 2 Diabetes
Contraindications: Ketoacidosis Renal impairment Hepatic dysfunction Cardiopulmonary insufficiency Alcoholism
PO
Interactions: May potentiate hypoglycemia when used with ACE inhibitors, ARBS, calcium channel blockers, beta-blockers, procainamide, digoxin, furosemide, alcohol, cimetidine
MoA: Decreases hepatic production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine.
Advantages:Does not stimulate the release of
more insulin, so less likely to cause
hypoglycemia
Disadvantages: Clients undergoing surgery or any
radiologic procedure that involves contrast
dye should temporarily discontinue
metformin. They can resume 48 hours
after the procedure if kidney function has
returned and the creatinine is normal.
Side Effects: Dizziness Fatigue Headache Anorexia Nausea/Vomiting Diarrhea Weight loss
Adverse Effects : Lactic Acidosis
Interventions: Assess for hypoglycemia/hyperglycemia
Monitor CBC, renal and studies every 3 months
Administer with meals
Education:Glucose self-monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol.
Glucophage XR tab may appear in stool.
Carry emergency ID and glucagon emergency kit.
Fixed Combination Products
Glucovance
Used for Type 2 Diabetes
Contraindications: Renal insufficiency, Type one Diabetes, DKA
PO
Onset is 15 to 30 minutes
Interactions: Thiazides and other diuretics, corticosteroids,
phenothiazines, estrogens, oral contraceptives,
phenytoin, calcium channel blockings, and
isoniazid may cause hyperglycemia.
The hypoglycemic action of sulfonylureas
may be potentiated by NSAIDS, salicylates,
sulfonamides, MAOIs, and beta-adrenergic
blocking agents
MoA: GLUCOVANCE combines glyburide and metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action,
to improve glycemic control in patients with type 2 diabetes. Gluburide directly stimulates the beta cells to secrete insulin, thus decreasing
the blood glucose level. Increases the tissue response to insulin and decreases glucose production by the liver. Metformin decreases hepatic
production of glucose from stored glycogen. Lowers the glucose absorption of glucose from the small intestine.
Disadvantages: Contraindicated for clients with renal insufficiency due to possible risk of developing lactic acidosis
Side Effect: UTI, Headache, N/V, Abd Pain, Diarrhea, Dizziness
Adverse Effects: Lactic acidosis and Hypoglycemia
Interventions: Assess for hypoglycemia/hyperglycemia
Monitor CBC, renal and studies every 3 months
Administer with meals
Education:Glucose self-monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia.
Avoid OTC medications, alcohol.
Glucophage XR tab may appear in stool.
Carry emergency ID and glucagon emergency kit.
Use sunscreen and wear protective clothing when outside for more than a
short time.
Iodine Compounds
Potassium Iodine
Used for hyperthyroidism, Pre-op to decrease the chance of bleeding
Contraindications: Pregnancy
Pulmonary edema
TB
Bronchitis
PO
Onset: 24- 48 hours Interactions: Increase: hypothyroidism – lithium Increase: hyperkalemia ACE inhibitors, potassium sparing diuretics.
MoA: Decreases the size and vascularity of the thyroid gland. Inhibits secretion of thyroid hormone.
Side Effects: Headache Confusion Paresthesia Metallic taste Stomatitis Nausea/Vomiting Diarrhea
Adverse Effects:
Angioneurotic edema
Interventions: Dilute in milk or juice and administer through a straw to prevent teeth discoloration. Administer after meals to prevent GI upset. Assess Vital signs Monitor potassium level Daily weight I&O Monitor thyroid levels
Education:
Keep of graph of weight, pulse, mood
Avoid seafood and other iodine products.
Do not discontinue abruptly as thyroid crisis may occur.
Incretin Mimetic
Exenatide and Liraglutide
Type 2 Diabetes
Contraindications: Type one diabetes, DKA, severe renal dsyfunction and severe GI disease
SUBQ, Onset 1 hour
Interactions:Increase hypoglycemia
with ACE inhibitors,
sulfonylureas, alcohol.
Increase hyperglycemia with corticosteroids.
MoA: Suppresses glucagon secretion and stimulates insulin release
Advantages: Exenatide added to type 2 diabetic
therapy when inadequately managed by
Metformin or a Sulfonylurea
Disadvantage: Liraglutide not recommended for firstline therapy. Risk of thyroid C-cell tumors
including medullary thyroid cancer
Side Effects: Headache Dizziness Jitteriness Nausea/Vomiting Diarrhea
Adverse Effects: Hypoglycemia
Pancreatitis
Angioedema
Anaphylaxis
Interventions: Administer exenatide SQ within 1 hour of morning and evening meals.
Monitor for hypoglycemia
Always have oral carbohydrate available.
Monitor for pancreatitis.
Client Education: SubQ medication administration. Glucose self-monitoring. Signs/Symptoms of hypoglycemia/hyperglycemia. Avoid OTC medications, alcohol. Always have oral carbohydrate available. Notify PHCP or severe abdominal pain.
Thyroid Hormone Replacements
T4: Levothyroxine
T3: Liothyronine
Common uses : Hypothyroidism. Myxedema and Cretinisim
Contraindications: Adrenal insufficiency, Recent MI and Thyrotoxicosis
PO/IV
Onset is 24 hours
Interactions: Increase cardiac insufficiency risk with epinephrine products. Decrease levothyroxine absorption/effect with ferrous sulfate, estrogens, antacids, sucralfate
MoA:
Increases metabolic rate; increases cardiac output, renal blood flow, oxygen consumption, body temperature, blood volume,
growth, development at cellular level via action on thyroid hormone receptors
Side Effects: Insomnia Weight loss Anxiety Insomnia Headache Nausea Anorexia
Adverse Effects: Hypertension Tachycardia Chest pain Cardiovascular collapse Thyrotoxicosis
Interventions: Monitor Vital Signs Monitor for thyrotoxicosis. Daily weight Monitor thyroid hormone levels Monitor cardiac status
Education
Life-long replacement with medication is necessary.
Do not switch brands
Avoid OTC preparations with iodine.
Avoid iodine-rich foods (Iodized salt, soybeans, tofu, turnips,
seafood).
Pituitary Gland
The hormones of the pituitary gland help regulate the functions of other endocrine glands.
The pituitary gland has two parts—the anterior lobe and posterior lobe—that have two very separate functions.
The hypothalamus sends signals to the pituitary to release or inhibit pituitary hormone production.
The pituitary gland is often dubbed the “master gland” because its hormones control other parts of the endocrine system, namely the thyroid gland, adrenal glands, ovaries, and testes. However, the pituitary doesn’t entirely run the show.
In some cases, the hypothalamus signals the pituitary gland to stimulate or inhibit hormone production. Essentially, the pituitary acts after the hypothalamus prompts it.
Anterior Pituitary Hormones
Adrenocorticotropic hormone (ACTH): ACTH stimulates the adrenal glands to produce hormones.
Follicle-stimulating hormone (FSH): FSH works with LH to ensure normal functioning of the ovaries and testes.
Growth hormone (GH): GH is essential in early years to maintaining a healthy body composition and for growth in children. In adults, it aids healthy bone and muscle mass and affects fat distribution.
Luteinizing hormone (LH): LH works with FSH to ensure normal functioning of the ovaries and testes.
Prolactin: Prolactin stimulates breast milk production.
Thyroid-stimulating hormone (TSH): TSH stimulates the thyroid gland to produce hormones.
Posterior Pituitary Hormones
Posterior Lobe Hormones:
Anti-diuretic hormone (ADH): This hormone prompts the kidneys to increase water absorption in the blood.
Oxytocin: Oxytocin is involved in a variety of processes, such as contracting the uterus during childbirth and stimulating breast milk production.
Thiazolidinediones
Rosiglitazone
(Avandia),
Pioglitazone (Actos)
Commonly used for type 2 diabetes
Contraindications: Symptomatic heart disease Class 3 / 4 Heart failure DKA Type 1 diabetes
PO
Interactions:
avoid concurrent use with insulin, nitrates
Increased anti-diabetic effect with garlic
MoA: Improves glucose uptake in the muscle and decreases endogenous glucose production. decreases insulin resistance and improve blood glucose control.
Advantages: Does not induce hypoglycemic reactions
if taken alone. Lowers triglyceride level.
May raise HDL cholesterol
Disadvantages: May cause HF or MI, can be hepatotoxic, may raise LDL cholesterol
Side Effects: Fatigue Headache Weight gain Diarrhea UTI
Adverse Effects:
MI CHF Hepatotoxicity anaphylaxis
Interventions; Monitor for hypoglycemia. Monitor ALT level Monitor glucose Use effective contraception
Education:
Monitor blood glucose
Signs/Symptoms of hyperglycemia / hypoglycemia
Daily weight
Report edema
Report SOB, chest pain
Report symptoms of hepatic dysfunction – Nausea/
Vomiting, abdominal pain, dark urine, jaundice, anorexia
Meglitinides
Nateglinide (Starlix),
Repaglinide (Prandin)
Type 2 Diabetes
Don’t use with Type one or DKA
PO/30 minutes
Stimulates the release of insulin from the pancreas
Advantages: Maybe used alone or in combination with Metfrmin
Disadvantages: Should be avoided in clients with liver dysfunction due to possible decreased liver metabolism.
Side Effects: Headache Weakness Tinnitus Sinusitis Nausea/vomiting Diarrhea Constipation Dyspepsia Angina URI
Adverse Effects: Hypoglycemia Pancreatitis Hemolytic anemia Leukopenia
Intervention:
Administer 15-30 minutes before meals.
Skip dose if meal skipped.
Monitor for hypoglycemia.
Education:
Blood glucose monitoring.
Signs/Symptoms of hypoglycemia/hyperglycemia
Eat after taking medication to prevent hypoglycemia.
Sulfonylureas
stimulate insulin release via the pancreas and carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended by the Beers Criteria. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin)
Acromegaly
is an uncommon condition caused by an overproduction of growth hormone (GH). It is usually due to pituitary adenoma, and onset in adult clients generally occurs at age 40-45. In an adult, increased GH results in overgrowth of soft tissues of the face, hands, feet, and organs. Additional heart sounds (S3, S4) require further assessment for cardiac conditions (eg, heart failure).
Local tumor effect :Pituitary enlargement, visual field defects, headache
Musculoskeletal/skin :Gigantism, maloccluded jaw, arthralgias/arthritis, hyperhidrosis, skin tags
Cardiovascular: Hypertension, heart failure
Enlarged organs : Tongue, thyroid, salivary glands, liver, spleen, kidney, prostate
Endocrine : Galactorrhea, decreased libido, diabetes mellitus
Lactate normal levels
1-1.8 mmol/L
TSH normal levels
0.4-5.0 mU/L
Free T4 and
Free T3 normal levels
13-27 pmol/L and
3.5-6.5 pmol/L
Uric Acid normal levels
120-420 μmol/L
Lipase normal levels
<160
Myoglobin normal levels
30 - 90ug/ml
Ammonia normal levels
9 - 33 µmol/L
Iron normal levels
13-31 μmol/L (male)
5-29 μmol/L (female)
