Endocrine Flashcards
Insulin (Onset, peak, duration and side effects)
lispro (Humalog): RAPID-acting
Onset <15 minutes, Peak 30-60 minutes, Duration 3-4hrs
regular (Humulin R): SHORT-acting
Onset 30-60 min, Peak 2-3hrs, Duration 5-7hrs
NPH (Humulin N): INTERMEDIATE-acting
Onset 1-2hrs, Peak 4-12 hrs, Duration 18-24 hrs
insulting glargine (Lantus): LONG-acting Onset 1 hr, Peak none, Duration 24 hrs
INDICATIONS: Diabetes (Type 1 & 2)
SIDE EFFECTS: HYPOGLYCEMIA (symptoms: tachycardia, diaphoresis shakiness, headache, weakness), lipohypertorphy, (rotate inaction sites to prevent!)
Insulin (Key points)
+ insulin dose may need to be increased during illness
+ for hypoglycemia in fully conscious patients, administer 15g glucose (e.g. 4 oz OJ, 8 oz milk). For patients who are not fully conscious, administer IM glucagon.
+ DRAW SHORT-ACTING INSULIN IN SYRINGE FIRST, THEN LONGER-ACTING INSULIN.
+ DO NOT MIX LONG-ACTING INSULINS (INSULIN GLARGINE) WITH OTHER INSULINS.
+ for insulin suspensions, gently rotate vial prior to administration.
+ if a short-acting insulin looks cloudy or discolored, do not administer.
Oral Antidiabetics: Sulfonylureas
glipizide (Glucotrol)
OTHER SULFONYLUREA: Glyburide (Diabeta).
INDICATIONS: Type 2 diabetes; used to control blood sugar levels.
MODE OF ACTION: Increases insulin release from pancreas.
SIDE EFFECTS: HYPOGLYCEMIA, photosensitivity, GI upset.
KEY POINTS: Take 30 minutes before a meal. Do not use alcohol. Wear sunscreen.
Oral Antidiabetecs: Meglitinides
+ repaglinide (Prandin) +
INDICATIONS: Type 2 diabetes; used to control blood sugar levels.
MODE OF ACTION: Increases insulin release from pancreas.
SIDE EFFECTS: HYPOGLYCEMIA, angina.
KEY POINTS: Take 2 times a day, eat within 30 minutes of dose.
Oral Antidiabetics: Biguanides
+ metformin (Glucophage)
INDICATIONS: Type 2 diabetes; used to control blood sugar levels.
MODE OF ACTION: Decreases glucose production in liver and increases glucose uptake.
SIDE EFFECTS: GI upset, B12 deficiency, lactic acidosis, metallic taste.
KEY POINTS: Take with meal. Do not use alcohol. Take B12 supplement if indicated. D/C metformin for procedures requiring NPO or contract dye. Monitor for signs of lactic acidosis (diarrhea, dizziness, hypotension, bradycardia, weakness)>.
Oran Antidiabetics: Thiazolidinediones
+ pioglitazone (Actos)
INDICATIONS: Type 2 diabetes; used to control blood sugar levels.
MODE OF ACTION: Decreases insulin resistance, increases glucose uptake, decreases glucose production.
SIDE EFFECTS: FLUID RETENTION, ELEVATED LDL, hepatotoxicity.
KEY POINTS: Contraindicated for patients with HF. Take one a day, with or without food.
Oral Antidiabetics: Alpha glucosidase inhibitors
+ acarbose (Precose)
INDICATIONS: Type 2 diabetes; used to control blood sugar levels.
MODE OF ACTION: INHIBITS GLUCOSE ABSORPTION IN THE GI TRACT.
SIDE EFFECTS: GI UPSET, hepatotoxicity, anemia.
KEY POINTS: Contraindicated for patients with GI disorders. Take 3 times a day with meals, with the first bit of food.
Hyperglycemic Agent
+ glucagon (GlucaGen)
INDICATIONS: Severe hypoglycemia when patient is unable to take oral glucose.
MODE OF ACTION: Stimulates breakdown of glycogen into glucose in the liver.
SIDE EFFECTS: GI upset.
KEY POINTS: Administer subcutaneous, IM or IV. PROVIDE FOOD AS SOON AS PATIENT IS ABLE TO SAFELY SWALLOW.
Thyroid medication
+ levothyroxine ( Synthroid)
INDICATIONS: Hypothyroidism.
MODE OF ACTION: Acts as a synthetic form of T3 or T4.
SIDE EFFECTS: (when dose is too high): Hyperthyroidism (symptoms: anxiety, GI upset, sweating, weight loss, heat intolerance).
KEY POINTS: Monitor T4 and TSH levels. TAKE ON EMPTY STOMACH WITH FULL GLASS OF WATER BEFORE BREAKFAST. REQUIRES LIFELONG TREATMENT.
Antithyroid medication #1
+ proprylthiouracil PTU)
INDICATIONS: Gravers disease, and in preparation for thyroidectomy.
MODE OF ACTION: Blocks synthesis of thyroid hormones.
SIDE EFFECTS: Agranulocytosis, GI upset, rash, hepatotoxicity. If dose is too high, signs of hypothyroidism (lethargy, weight gain, cold intolerance, bradycardia, depression).
KEY POINTS: Takes 1-2 weeks for full effect. Monitor CBC levels and liver function.
Antithyroid medication #2
+ Radioactive iodine (RAI)
INDICATIONS: Hyperthyroidism and thyroid cancer,
MODE OF ACTION: Absorbed by thyroid, destroys thyroid-producing cells.
SIDE EFFECTS: Radiation sickness, bone marrow suppression, hypothyroidism.
KEY POINTS: Increase fluid intake and void frequently. Limit contact with others (maintain safe distance from other people, flush twice, do not share utensils for prescribed amount of time).
Antithyroid medication #3
+ Strong iodine solution (Lugol’s solution)
INDICATIONS: Hyperthyroidism/thyrotoxicosis and in preparation for thyroidectomy.
MODE OF ACTION: Inhibits thyroid production and release due to high levels of iodide.
SIDE EFFECTS: Gi upset, IODISM (METALLIC TASTE, STOMATITIS, SORE THROAT/GUMS), hypersensitivity (rash, pruritus).
KEY POINTS: Increase fluid intake. Mix with juice to improve taste. Avoid foods high in iodine (Iodized salt, seafood).
Growth Hormone
+somatropin (Genotropin)
INDICTIONS: Growth hormone deficiencies (pediatric and adult).
MODE OF ACTIONS: Similar to naturally occurring GH; stimulates growth, protein synthesis.
SIDE EFFECTS: Hyperglycemia.
KEY POINTS: Administer via IM or subq; rotate injection sites. STOP TREATMENT PRIOR TO EPIPHYSEAL CLOSURE. Monitor growth rate and bone age frequently.
Antidiuretic Hormone
+ vasopressin (Pitressin Synthetic)
OTHER ANTIDIURETIC HORMONE: Desmopressin.
INDICATIONS: Diabetes Insipidus.
MODE OF ACTION: Mimics ADH (produced by the posterior pituitary), which causes reabsorption of water in the kidneys. DECREASES URINE OUTPUT AND INCREASES URINE OSMOLALITY.
SIDE EFFECTS: Overhydration (pounding headache).
KEY POINTS: Reduce fluid intake during therapy. Monitor I&Os, urine specific gravity. Urine output should be 1.5 -2L/24 hours.
Adrenal Hormone Replacement
+ hydrocortisone
INDICATIONS: Adrenocortical insufficiency in Addison’s disease.
MODE OF ACTION: Mimics naturally occurring cortisol (maintains BP, regulates metabolism and inflammatory response).
SIDE EFFECTS: BONE LOSS, PEPTIC ULCERS, INFECTION, GI UPSET, WEIGHT GAIN, ADRENAL SUPPRESSION, SKIN FRAGILITY.
KEY POINTS: Monitor for signs of peptic ulcer (coffee-ground emesis, tarry stools). Do NOT stop medication suddenly (need to taper slowly). May need increased dose during times of stress. Monitor for signs of INFECTION. Take calcium and vitamin D supplements. Avoid NSAIDS and alcohol.
