Endocrine Disorders Flashcards
Propylthiouracil (PTU)
Thyroid hormone antagonists
Inhibit the synthesis of thyroid hormones T3 and T4
Indication of use:
Palliative treatment and prevention of hyperthyroidism
Adjunct prior to thyroidectomy
Management of thyrotoxicosis
Contraindicated:
Pregnancy (category D) & allergy
Thyroid hormones increase anticoagulant effect of Coumadin
Thyroid hormones decrease effects of digoxin
Reproductive/gynecologic history
Adverse Effects of Antithyroid drugs (PTU)
Most damaging and serious are liver and bone marrow toxicity
N&V Altered taste sensation Joint swelling, althralgias Vertigo, drowsiness Hematologic complications- agranulocytosis
Patient Teaching for Thyroid Medication Therapy
Never discontinue abruptly – life long
Emphasize importance of follow up care; lab values evaluation
Do not switch brands of medications
Report chest pain, weight loss, tremors, insomnia
Take with meals or snack; given at the same time every day
Metabolic Changes Occurring When Insufficient Insulin is Released
Hyperglycemia: Increased blood sugar
Glycosuria: Sugar is spilled into the urine
Polyphagia: Increased hunger
Polydipsia: Increased thirst
Lipolysis: Fat breakdown
Ketosis: elevated ketones in the blood. Liver converts fats into fatty acids & ketone bodies
Acidosis: Liver cannot remove all of the waste products
Types of insulin
1.) “natural” insulin and four modified insulins
Regular (Natural) – unmodified, clear solution, generally rapid acting with shorter duration; Only one that can be given IV
2.) lispro (Humalog) or aspart (Novolog): newer – more rapid acting –
Humalog: onset within 25 min
Novolog: onset in 5-10 min
Usually given right before meals
Only by prescription; Clear
3.) NPH insulin – regular mixed with protamine (large protein) delays absorption. Roll in hands; Intermediate-acting; Cloudy appearance
4.) Lente – mixed with zinc: longer acting. Ultra-lente: longest acting
Insulins: Regular Insulin
Treatment for type 1 and type 2 diabetes whose hyperglycemia cannot be controlled by diet, exercise, weight reduction, oral anti-antidiabetic drugs or combination
Treatment of patients with hyperkalemia
Also converts excess glucose into glycogen; and storage of fat by converting fat into triglycerides
Adverse Effects of Regular Insulin
Hypoglycemia
Fatigue and malaise, trembling, irritability, headache, nausea, paresthesias, blurred vision
Increased sympathetic activity: hunger, tachycardia, sweating, nervousness
Lipodystrophy
Sulfonylureas
Sulfonylureas increase endogenous insulin secretion from pancreatic beta cells
Reduces glycogenolysis & gluconeogenesis
Effects: Hypoglycemia, Weight gain Generally the least expensive class of medication
Contraindicated in patients with sulfa allergy
Example Drug: glyburide
Biguanides
Biguanides do not increase insulin secretion from the pancreas and thus do not cause hypoglycemia
Decreases the production of glucose by the liver, decreases intestinal absorption of glucose and improves insulin receptor sensitivity
Lowers triglycerides & LDL
Promotes weight loss
Drug: Metformin
Biguanides Adverse Effects/Interactions
Adverse Effects:
Primarily affects the GI tract: anorexia, N/V/D, cramping, flatulence, diarrhea, metallic taste
Serious adverse effect: lactic acidosis (look at creatinine levels)
Interactions:
Hypoglycemia when given w/ sulfonyureas
Metformin therapy should be stopped at least 48 hours before any contrast/radiological contrast medias are given (renal toxic)
Thiazolidinediones
Thiazolidinediones decrease insulin resistance by making muscle and adipose cells more sensitive to insulin.
They also suppress hepatic glucose production.
Do not promote weight loss.
Improves HDL cholesterol and plasma triglycerides
Alpha-glucosidase Inhibitors
Alpha-glucosidase inhibitors block the enzymes that digest starches in the small intestine
***Alpha glycosidase are always to be taken with the first bite of each main meal
Other Effects
Flatulence, diarrhea, abdominal discomfort
No specific effect on lipids or blood pressure
Contraindicated in patients with inflammatory bowel disease, hiatal hernias
***If hypoglycemic, use oral glucose tablets instead of table sugar products.
Hypoglycemia Signs/Symptoms
Headache, confusion, irritability
Blurred vision, diplopia (double vision)
Drowsiness, tremor, weakness, twitching progressing to seizures (late symptom)
Hunger, nausea
Diaphoresis, cool clammy skin
Sudden onset: patient appears anxious, drunk; associated with overdose of insulin, missing a meal, or increased stress
Types of Glucose Elevating Drugs
Glutose, Insta-Glucose
oral glucose tablets for moderate hypoglycemic episodes
50% Dextrose (D50)
Given intravenously in hospital setting - emergent
***Glucagon and Diazoxide can cause hypertension
Glucocorticoid Medication Therapy
Drugs ending in “-sone”
Corticosteroids are used in replacement therapy to maintain adequate levels of hormones in patients with inadequate adrenal function
Also used as:
Anti-inflammatory
Immunosuppressive effects
Must not be abruptly discontinued
Dose is weaned or slowly tapered down
Abrupt withdrawal can lead to Adrenal insufficiency
Drug: ***Prednisone, or Dexamethasone (Decadron)
