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Introduction to Pharmacology > Endocrine Drugs > Flashcards

Endocrine Drugs Flashcards

1
Q

Define Endocrine System

A
  • Complements the
    nervous system in
    controlling the body
  • Collection of glands
    and tissues that
    secrete hormones
    into the bloodstream
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2
Q

What is hormones and types of hormones released by the endocrine system

A
  • A chemical substance produced in the body that controls and regulates
    the activity of certain cells or organs.
    – Peptide
    hormones
    – Steroid
    hormones
    – Amine
    hormones
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3
Q

What are the effects of drugs acting on the endocrine glands?

A

= Drugs that mimic or block the endogenous hormones produced by the body
= Peptide: cannot be given orally because of proteolytic enzymes in the GIT
= Steroid: effective when injected
INDICATIONS:
- Provide symptomatic relief
- Diagnostic tool to detect pathophysiological endocrine states

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3
Q

What are the different glands, and hormones it produces, what tissues or organs are targeted by those hormones, and lastly what are the effects it gives to the body?

A
  1. Posterior Pituitary / ADH/Vasopressin / Kidneys and arterioles/ Inhibits urine production; vasoconstriction
  2. Anterior Pituitary / Growth Hormone / Liver, Adipose Tissue / Increases secretion of IGF-I for bone and muscle growth
  3. Thyroid Thyroid Hormone / Various Tissues / Regulation of metabolic rate and promotion of body growth
  4. Adrenal Cortex / Aldosterone / Kidneys / Regulate the body’s sodium balance
  5. Adrenal Cortex / Cortisol / Various tissues; liver / Release of glucose, amino acids, and fatty acids into the blood
  6. Adrenal Medulla / Adrenaline / Various tissues – heart, blood vessels, and bronchioles / Increase in BP, blood glucose, and bronchodilator
  7. Pancreas / Insulin and Glucagon / Various Tissues – liver and fat cells / Regulation of blood glucose
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4
Q

Drugs acting on the anterior pituitary gland

A

= GROWTH HORMONE
= Stimulates growth in tissue and bone
E.g. Somatrem [Protropin], Somatropin [Humatrope]
= Contraindications: Hypersensitivity, Closed Epiphyses (or this marks the end of growth of that particular bone like the femur)
= Adverse Effects: antibody formation, lipoatrophy, diabetogenic, local irritation at the injection site, fluid retention

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5
Q

What are some problems related to the anterior pituitary gland?

A

Over-secretion of growth hormone could lead to gigantism
under secretion of growth hormone could lead to dwarfism

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6
Q

What are some drug/s actions on the anterior pituitary gland?

A

= SOMATOSTATIN AGONISTS
= Growth hormone inhibiting hormone [GHIH]
= Ocreotide [Sandostatin], Somatostatin, Lanreotide
= Contraindication: Hypersensitivity, Pregnancy, Lactation
= Adverse Effects: GI distress, constipation/ diarrhea, flatulence, nausea, acute cholecystitis

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7
Q

What are some drug/s actions on the posterior pituitary gland?

A

= ADH [Vasopressin], Pitressin Synthetic, Desmopressin
= Indication: Diabetes Insipidus [IV, Nasal Spray]; Hemorrhage, Post-operative abdominal distention
= Contraindication: Hypersensitivity, Vascular Disease, Pregnancy, Lactation
= Adverse Effect:
1. Water Intoxication [drowsiness, light-headedness, headache, coma, convulsions]
2. Hangover Effect: tremor, sweating, vertigo, headache

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8
Q

What are your nursing process when administering posterior/anterior pituitary gland medications

A

= OBTAIN BASELINE V/S, I&O, HEIGHT AND WEIGHT
= ASSESS FOR ALLERGIC REACTIONS
= MONITOR PATIENT FLUID VOLUME
= MONITOR NASAL PASSAGES IF GIVEN INTRANASALLY
= MONITOR BLOOD SUGAR

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9
Q

Parts of the adrenal gland and cortex and what hormone it releases?

A

= Adrenal Medulla
- Releases neurotransmitters Norepinephrine and Epinephrine
= Adrenal Cortex
- Produces hormones called CORTICOSTEROIDS
- Corticosteroids: androgens, glucocorticosteroids, mineralocorticoids

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10
Q

DRUGS ACTING ON THE ADRENAL CORTEX

A

= CORTICOID
- Glucocorticoid – Cortisone, Hydrocortisone
- Mineralocorticoid - Aldosterone
- Gonadocorticoids (Sex Hormones) – Androgens

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11
Q

What is a glucocorticoid and what drug action does it do?

A
  • Increase the availability of glucose
    - Potent immunosuppressants used to prevent organ transplant rejection
    - Used to promote lung maturation in premature infants
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12
Q

What are the different Glucocorticoid medications?

A

= Hydrocortisone
- synthetic steroid identical to cortisol
- A preferred drug for adrenocortical insufficiency
- Has mineralocorticoid actions
- Has oral prep for chronic replacement; parenteral for acute
- Prednisone, Dexamethasone,
= Cortisone
- oral therapy for chronic adrenal insufficiency
= Dexamethasone
- Used to diagnose Cushing’s syndrome
- Treatment of non-endocrine disorders

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13
Q

What are the contraindications and adverse effects of medication on adrenal glands?

A

= CONTRAINDICATIONS
- Allergy
- Acute Infection
- Lactation
- Caution: Diabetes Mellitus and Acute Peptic Ulcer
= Adverse Effects
- Increased blood sugar
- Abnormal fat deposits
- Sodium and water retention
- Increased appetite and weight gain
- Weakness and muscle atrophy
- increased risk for infection

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14
Q

What will be your nursing considerations for administering glucocorticoid medications, and what will be the contradictions/cautions and adverse effects will be monitored?

A

= Nursing Considerations:
- Baseline VS, potassium, blood sugar, drugs, weight
- Administer drug daily at 8-9 AM.
- Use minimal doses for a minimal amount of time.
- Taper doses when discontinuing.
- Arrange for ádosage when the patient is under stress.
- Protect from infection.
- Do not give live viruses.
= CI and Cautions
- Allergy, severe hypertension, CHF, cardiac disease, lactation
= Adverse Effects
- áfluid volume (HA, edema, hypertension, CHF, arrhythmias, weakness, hypokalemia

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15
Q

What will be your nursing considerations for administering mineralocorticoid medications?

A

= increase dosage if stressed
= Monitor for HYPOKALEMIA (weakness, serum electrolytes
= Discontinue(D/C) if signs of overdosage occur.

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16
Q

What is the thyroid Gland and what hormone it produces?

A

= Thyroid
1. Produces Levothyroxine (T4) and Triiodothyronine (T3)
- Regulates the rate of metabolism
- Growth and development
2. Produces Calcitonin (a hormone that your thyroid gland makes and releases to help regulate calcium levels in your blood by decreasing it.)

17
Q

What are some problems due to thyroid-related conditions?

A
  1. hyperthyroidism
  2. thyroid edema
  3. Goiter
18
Q

Some drugs that acts on the thyroid gland and what hormone it targets or acts like the hormone itself:

A

= Levothyroxine (Synthroid, Levoxyl, Levothroid)
- Synthetic salt of thyroxine (T4)
= Thyroid desiccated (Armour Thyroid)
- triiodothyronine (T3) and thyroxine (T4)
= Liothyronine (Cytomel)
- triiodothyronine (T3)

18
Q

Drug for thyroid gland: Levothyroxine

A

= Pharmacologic Actions: Thyroid hormones are a synthetic form of thyroxine (T4), a form of liothyronine (T3), or a combination of T3 and T4, that increase metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume, and growth processes.

= Therapeutic Uses:
- Thyroid hormone replacement is used for the treatment of hypothyroidism (all ages, all forms).
- Thyroid hormones are used for the emergency treatment of myxedema coma (IV route).

19
Q

DRUGS ACTING ON THE ENDOCRINE SYSTEM: THYROID

A

= Use:
- Hypothyroidism: Thyroid replacement = ámetabolic rate
= Pharmacokinetics
- Eliminated: bile
- DOES NOT cross the placenta, so it is safe for pregnancy
- Crosses breast milk, so caution with lactating mothers

20
Q

Contraindications and adverse effects of drugs on the thyroid gland

A

= CI and caution
- allergy
- Acute MI
- Caution: lactation, Addison’s disease
= Adverse Effects
- Skin reactions
- Hair loss
- Cardiac stimulation (arrhythmias, hypertension)

21
Q

Drug interactions of levothyroxine with other drugs

A

= Decreased absorption of Levothyroxine if taken with cholestyramine
= Increased effectiveness of ANTICOAGULANTS with thyroid hormone
= Decreased effectiveness of digitalis glycosides

22
Q

Nursing process for thyroid hormone replacements

A

= Assessment
- Ask the patient about a history of allergy, been diagnosed with Addison’s disease, acute MI
= Take a baseline of vital signs and electrocardiogram
= Diagnosis
- Decrease CO
- Ineffective Tissue Perfusion
= Intervention
- Administer before breakfast: single dose.
- Monitor cardiac response.
- Arrange for periodic blood tests.
- Inform the patient of symptoms of thyrotoxicosis.
= Evaluation
- Monitor the patient’s level of triiodothyronine (T3), thyroxine (T4), thyrotropin-releasing hormone (TRH)

23
Q

Drugs for antithyroid agents:

A
  1. Thioamides
    a. Propylthiouracil (Ptu)
    b. Methimazole (Tapazole)
    = Use: Prevent the formation of thyroid hormone and Inhibit conversion of T4 to T3
    = Symptoms: exophthalmos, profusing perspiration, and high heart rate
    = Pharmacokinetics:
    • PTU(Propylthiouracil): Decreased potential in crossing placenta and breast milk
    • PTU(Propylthiouracil): drug of choice for pregnancy
      = CI and Caution
    • Allergy, pregnancy (benefits vs. risk)
      = Caution: lactation
      = Adverse Effects
    • Thyroid Suppression: Drowsiness, lethargy, bradycardia, nausea, skin rash
    • PTU(Propylthiouracil): N/V, GI complaints
    • Methimazole: bone marrow depression
      = Drug-drug Interactions
    • PTU + Anticoagulants = Increased risk for bleeding
  2. Iodine Solutions
    = decreased doses = formation of thyroid hormone
    = Increased doses = BLOCK THYROID HORMONE
    = RADIOACTIVE IODINE (I131)
    • Destroy thyroid tissue
      = Use
    • Destroy thyroid tissue
      = Pharmacokinetics
    • CATEGORY X
      = Adverse Effect
    • Hypothyroidism
    • Metallic taste, burning in the mouth, sore teeth and gums
    • Staining of teeth, skin rash
      = Nursing Process
      - Assess: allergy, baseline status, current meds
      - Administer PTU(Propylthiouracil) TID (three times a day).
      - Give iodine solution through a STRAW.
      - Mix iodine solution (I131) with juice.
      - Arrange for periodic blood tests.
      - Monitor patient compliance
24
Q

What is diabetes Mellitus? And what are the signs and symptoms of diabetes?

A

Derived from the Greek word for fountain and Latin for honey
Production of large volumes off glucose-rich urine
Diabetes mellitus is a group of metabolic disorders of fat, carbohydrate, and protein metabolism that results from defects in insulin secretion, insulin action (sensitivity), or both
= S/SX:
- Sustained hyperglycemia
- Polyuria
- Polydipsia
- Ketonuria
- Weight loss

25
Q

What are the different Variations of Diabetes?

A
  1. TYPE I
    Name: Insulin-dependent; juvenile
    Age of onset: childhood
    Etiology: Autoimmune process
    Disorder: Loss of beta cells
    Insulin level: Reduced then absent later in life
    Treatment: Insulin replacement
  2. TYPE II
    Name: Non-insulin dependent; adult-onset
    Age of onset: Over 40s
    Etiology: Unknown; heredity
    Disorder: Insulin resistance and inappropriate insulin secretion
    Insulin level: Low [deficiency]; high [resistance]
    Treatment: TLC; oral hypoglycemics and insulin
26
Q

How to be diagnosed with Diabetes?

A

Diagnosis of diabetes is made by three criteria:
- fasting plasma glucose ≥126 mg/dL
- 2-hour value from a 75-g oral glucose tolerance test ≥200 mg/dL
- casual plasma glucose level of ≥200 mg/dL with symptoms of diabetes;
- with results confirmed by any of the three criteria on a separate day

27
Q

What are the targeted normal parameters of a person without diabetes

A

PARAMETER VALUE
Pre-meal Plasma Glucose 90-130 mg/dL
hemoglobin A1c (HbA1c) <7%
Blood pressure (BP) <130/<80 mmHg
low-density lipoprotein <100 mg/dL
triglycerides test <150 mg/dL

28
Q

The Physiology of Insulin in the body:

A

PANCREAS
- Secretes digestive enzymes
- Release insulin and glucagon
-from the Islets of Langerhans
- Glucose is one of the principal fuels used by our body [broken down to ATP]
- After absorption in the intestines, routed to the liver
- Hepatocytes converts it to GLYCOGEN for storage

29
Q

Drugs for Diabetes

A
  • Expected Pharmacological Action Promotes cellular uptake of glucose (decreases glucose levels) Converts glucose into glycogen Moves potassium into cells (along with glucose)
30
Q

Different types of Insulin:

A

Types of Insulin / Onset(hr) / Peak(Hr) / Duration(Hr) / Max duration(Hr) / Appearance
Rapid Acting
- Aspart / 15-30 min / 1-2 / 3-5 / 5-6 / Clear
- Lispro / 15-30 min / 1-2 / 3-5 / 5-6 / Clear
- Glulisine^a / 15-30 min / 1-2 / 3-5 / 5-6 / Clear
Short Acting
- Regular insulin /30 min - 1 Hr/ 2-3 / / 3-6 / / 6-8 / Clear
Intermediate-Acting
- neutral protamine hagedorn (NPH) / 2-4 / 4-6 / 8-12 / 14-18 / Cloudy
- Lente / 3-4 / 6-12 / 12-18 / 20 / Cloudy
Long Acting
- Ultralente / 6-10 / 10-16 / 18-20 / 24 / Cloudy
- Glargine / 4-5 / —– / 22-24 / 24 / Clear

31
Q

The Therapeutic usage of Insulin

A

Insulin is used for glycemic control of diabetes mellitus (type 1, type 2, gestational) to prevent complications.

Clients who have type 2 diabetes mellitus may require insulin when:

  • Oral antidiabetic medications, diet, and exercise are unable to control blood glucose levels.
  • Severe renal or liver disease is present.
  • Painful neuropathy is present.
  • Undergoing surgery or diagnostic tests.
  • Experiencing severe stress such as infection and trauma.
  • Undergoing emergency treatment of diabetes ketoacidosis (DKA) and hyperosmolar
  • hyperglycemic nonketotic syndrome (HHNS).
  • Requiring treatment of hyperkalemia.
31
Q

Reminders when administering Insulin

A
  • Not all insulins available as clear solutions are short-acting and can be administered through IV
  • Not all can be mixed with other insulins
  • ONLY NPH is appropriate for mixing with short-acting insulin
  • Withdraw short-acting first
  • Mixtures are stable til the 28th day
  • Make sure to be aware of lipodystrophy (when the fatty tissues within our skin get damage and causes a spot to sink because of the sudden lost of fatty tissue at the injection site)
32
Q

How to Store away Insulin medication:

A
  • Unopened vials – refrigerated; not frozen
  • The vial in use – can be at room temp for up to 1 month
  • No direct sunlight and extreme heat
  • Mixtures stable at room temp for 1 month; 3 months under refrigeration
33
Q

Nursing Interventions for insulin administration

A
  • Adjust the client’s insulin dosage to meet insulin needs.
  • Ensure adequate glucose is available at the time of onset of insulin and during all peak times.
  • When mixing short-acting insulin with a longer-acting insulin, draw the short-acting insulin up into the syringe first, then the longer-acting insulin.
  • Do not administer short-acting insulins if they appear cloudy or discolored.
  • Instruct clients to administer subcutaneous insulin in one general area to have consistent rates of absorption.
34
Q

What could be a possible complication for insulin administration?

A

= Hypoglycemia
- Monitor clients for signs of hypoglycemia. If abrupt onset, the client will experience SNS symptoms, such as tachycardia, palpitations, diaphoresis, and shakiness. If gradual onset, the client will experience PNS symptoms, such as headache, tremors, and weakness.
* Instruct clients to self-administer a snack of 15 g of carbohydrates (4 oz orange juice, 2 oz grape juice, 8 oz milk,
glucose tablets per the manufacturer’s suggestion to equal 15 g).
* Instruct clients to notify the provider if there is a recurrent problem.
* If severe hypoglycemia occurs, IV glucose may be needed.
* Encourage clients to wear a medical alert bracelet.

35
Q

Anti-diabetic drugs for type II diabetes Mellitus

A
  • SULPHONYLUREAS
    - Short acting – gliclazide and tolbutamide
    - Longer acting – chlorpropamide, glibenclamide, glipizide
    - Works by opening Ca+ channels of the beta cells stimulating release of insulin
36
Q

Anti-betic drugs

A
  • BIGUANIDES
    - Metformin HCl
    - Decreases glucose production by the liver; increases tissue response to insulin
    - Diarrhea, GI s/sx, decreased appetite
  • ALPHA-GLUCOSIDASE INHIBITORS
    - Acarbose; Miglitol
    - Reduces rate starches are broken down and absorbed; decreases post-prandial rise in blood glucose
    - Side effect flatulence
  • THIAZOLIDINEDIONES
    - Rosiglitazone, Pioglitazone
    - Decrease insulin resistance, increase glucose uptake and decrease glucose production in the liver
    - Causes hypoglycemia
  • GLIPTINS
    - Sitagliptin
    - Increases insulin release, reduces glucagon release
37
Q

What will be your Nursing administration for the patient and procedure for the different anti-diabetic drugs?

A
  • Encourage clients to exercise consistently and to follow appropriate dietary guidelines.
  • Encourage clients to maintain a log of glucose levels and to note patterns that affect glucose levels (increased dietary intake, infection).
  • Consider referring clients to a registered dietician and/or diabetic nurse educator.
  • Instruct clients that formulations may combine two medications.
  • Instruct clients who are also taking insulin to monitor for signs of hypoglycemia.
  • Administer medications orally and at appropriate times:
    - Glipizide – Best taken 30 min prior to the meal.
    - Repaglinide – Instruct clients to eat within 30 min of taking a dose of the medication, 3 times/day.
    - Metformin HCl – Instruct clients to take immediate-release tablets two times per day with breakfast and dinner and to take sustained-release tablets once daily with dinner.
    - Pioglitazone – Instruct clients to take once a day, with or without food.
    - Acarbose – Instruct clients to take it with the first bite of food, three times per day. If a dose is missed, take the dose at the next meal but do not take two doses.
    - Sitagliptin – Instruct clients to take once a day with or without food.
38
Q

How to distinguish Hypoglycemia and Hyperglycemia? And what can we tell to the patient to do when they feel these symptoms

A

You can distinguish them by knowing the signs and symptoms of the different conditions

  • Hypoglycemia (low blood glucose)
    - Shaky
    - fast heart rate
    - Profuse Perspiration
    - Dizzy
    - Anxious
    - Increase Appetite
    - Blurry Vision
    - Weakness or Fatigue
    - Headache
    - feel easily irritable
    What he or she can do?
    - Check blood glucose level
    - Eat and drink candy and orange juice
    - and then monitor blood glucose level again and if symptoms persist, go to the hospital
  • Hyperglycemia (high blood glucose level)
    - Extreme thirst or polydipsia
    - Dysuria or frequent urination
    - Dry skin
    - Increase appetite
    - BLurry Vision
    - Drowsy
    - Slow healing wounds
    What he or she can do?
    - Check blood glucose level
    - If confirm high blood glucose level and don’t know why. contact your a health care provider or go to the hospital
39
Q

HYPERGLYCEMIC AGENT: GLUCAGON

A

= Pharmacologic Action: Increases blood glucose levels by increasing the breakdown of glycogen into glucose, decreasing glycogen synthesis enhances the synthesis of glucose
= Therapeutic Uses:
* Emergency management of hypoglycemic reactions, such as insulin overdose in clients who are unable to take an oral glucose
* Decrease in gastrointestinal motility in clients undergoing radiological
= Adverse Effects: GI Distress (turn the clients on their side to prevent aspiration during emesis)
= Contraindicated: ineffective for hypoglycemia from inadequate glycogen stores, Pregnancy Category B, used in caution for patients with cardiovascular disease
= Nursing Management:
* Administer glucagon subcutaneously, IM, or IV immediately following reconstitution parameters.
* Provide food as soon as the client regains full consciousness and is able to swallow.
* Instruct clients to maintain access to a source of glucose and glucagon kit at all times.

Introduction to Pharmacology (6 decks)

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