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PHARMACOLOGY > Endocrine Drugs > Flashcards

Endocrine Drugs Flashcards

1
Q

System in the body that is made up of organs called glands and tissues that secrete hormones into the bloodstream.

A

Endocrine System

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2
Q

Hormones

A

A chemical substance produced in the body that acts like messenger molecules since it controls and regulates the activity of certain cells or organs

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3
Q

Peptide Hormones

A
  • from proteins
  • has amino acids
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4
Q

Steroid Hormones

A
  • from fats
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5
Q

Amine Hormones

A
  • Collection of amino acid or some protein chain
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6
Q

Peptide can be given rally because of proteolytic enzymes in the GIT
(True or False)

A

False. Peptide cannot be given orally.

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7
Q

Peptide can be given rally because of proteolytic enzymes in the GIT
(True or False)

A

False. Peptide cannot be given orally.

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8
Q

Steroid is effective when injected
(True or False)

A

True

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9
Q

Growth Hormone

A

Stimulates growth in tissue and bone.

Example of growth Hormones are Somatrem (protropin and somatropin (humatrope)

Contraindications: Hypersensitivity, closed epiphyses

Adverse Effects: antibody formation, lipoathrophy, diabetogenic, local irritation at injection site, fluid retention

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10
Q

Somatostatin Agonists

A
  • 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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11
Q

ADH [Vasopressin], Pitressin Synthetic, Desmopressin

A

Indication: Diabetes Insipidus [IV, Nasal Spray]; Hemorrhage, Post-operative abdominal distention
Contraindication: Hypersensitivity, Vascular Disease, Pregnancy, Lactation
Adverse Effect:
- Water Intoxication [drowsiness, light-headnedness, headache, coma, convulsions]
- Hangover Effect: tremor, sweating, vertigo, headache

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12
Q

Oxytocin

A
  • Used to initiate labor, promote delivery of placenta and control post-partum hemorrhage and promotes breastmilk let-down
    ADVERSE EFFECT: hypersensitivity, cardiovascular spasm, hypotension, nausea and vomiting
    CONTRAINDICATION: non-vertex fetal presentation, fetal distress
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13
Q

Nursing Process in Drugs Acting on the Posterior Pituitary Gland

A
  1. Obtain baseline vital signs, input and output, height, and weight
  2. Assess for any allergic reactions
  3. Monitor patient’s fluid volume
  4. Monitor nasal passages if given intranasally and;
  5. Monitor blood sugar
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14
Q

It releases neurotransmitters norepinephrine and epinephrine

A

Adrenal Medulla

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15
Q

It produces hormones called corticosteroids such as androgens, glucocorticosteroids, and mineralocorticoids

A

Adrenal Cortex

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16
Q

Glucocorticoid

A

It increases the availability of glucose, used to promote lung maturation in premature infants, and acts as a potent immunosuppressants used to prevent organ-transplant rejection.

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17
Q

Glucocorticoids Drugs

A
  • “sone”
    1. Hydrocortisone
  • synthetic steroid identical to cortisol
  • Preferred drug for adrenocortical insufficiency
  • Has mineralocorticoid actions and has an oral prep for chronic replacement and parenteral for acute.
    2. Prednisone, Dexamethasone, Cortisone
  • oral therapy for chronic adrenal insufficiency
    3. Dexamethasone
  • this is used o diagnose Cushing’s Syndrome and as a treatment for non-endocrine disorders
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18
Q

Drugs Acting on Endocrine System: Adrenal Glands

A

It acts as an anti-inflammatory since it blocks the arachidonic acid which lessens the formation of prostaglandin and leukotrienes, in return. However, it also acts as immunosuppressive since it impairs the ability of phagocytes and blocks the production of antibodies

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19
Q

Allergy, acute infection, lactation, diabetes mellitus, acute peptic ulcer

A

Contraindications of drugs acting on adrenal glands

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20
Q

Increased blood sugar, abnormal fat deposits, sodium and water retention, increase appetite and weight gain, weakness and muscle atrophy, and high risk for infection are:

A

Adverse effects of drugs acting on adrenal glands

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21
Q

Increased blood sugar, abnormal fat deposits, sodium and water retention, increase appetite and weight gain, weakness and muscle atrophy, and high risk for infection are:

A

Adverse effects of drugs acting on adrenal glands

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22
Q

Glucocorticoids: Nursing Considerations

A
  1. Obtain baseline vital signs, potassium, blood sugar, drugs, and weight
  2. Administer drug daily at 8-9AM
  3. Use of minimal doses for minimal amount of time
  4. Taper doses when discontinuing
  5. Arrange for increase dosage when patient is under stress and;
  6. Protect from infection (do not give live virus)
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23
Q

Mineralocorticoids: Nursing Considerations

A
  1. High or increased dosage can cause stress
  2. Monitor patient for Hypokalemia (weakness, serum electrolytes) and;
  3. Discontinue if signs of overdosage occurs.
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24
Q

A gland that produces Levothyroxine (T4) and triiodothyronine (T3) that regulate the rate of metabolism and helps for growth and development. It is a gland that also produces calcitonin.

A

Thyroid

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25
Q

Drugs Acting on Endocrine System: Thyroid

A
  1. Levothyroxine (Synthroid, Levoxyl, Levothroid)
    - synthetic salt of T4
  2. Thyroid desiccated (Armour Thyroid)
    - T3 and T4
  3. Liothyronine (Cytomel)
    - T3
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26
Q

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 treatment of hypothyroidism (all ages, all forms).
- Thyroid hormones are used for the emergency treatment of myxedema coma (IV route).

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27
Q

Use of Drugs acting on endocrine system specifically in thyroid

A

Hypothyroidism: Thyroid replacement = increases metabolic rate

28
Q

Pharmacokinetics of Drugs acting on endocrine system specifically in thyroid

A
  1. Eliminates bile
  2. Does not cross placenta hence, safe to be used by pregnant women;
  3. However, it crosses breast milk hence, caution in lactation.
29
Q

Contraindications and cautions of Drugs acting on endocrine system specifically in thyroid

A
  • allergy
  • acute myocardial infarction
  • lactation, Addison’s disease
30
Q

Adverse Effects of Drugs acting on endocrine system specifically in thyroid

A
  • skin reactions. hair loss. and cardiac stimulation (arrythmias hypertension)
31
Q

Nursing Process in Thyroid Replacement

A

Assess for history of allergy, Addison’s disease, acute myocardial infarction, and obtain baseline vital signs and ECG

Diagnose for decrease CO and ineffective tissue perfusion

Intervention:
Administer before breakfast in single dose, monitor for cardiac response, arrange for periodic blood test, and inform patients for possible symptoms of thyrotoxicosis

32
Q

Antithyroid Agents

A
  1. Thioamides
    - example drugs includes Propylthiouracil (Ptu) and Methimazole (Tapazole)
    - used to prevent formation of thyroid hormone and inhibits conversion of T4 and T3
33
Q

Propylthiouracils (PTU) has a lower risk of crossing placenta and breast milk hence, a drug of choice when the patient is pregnant
(True or False)

A

True

34
Q

Thioamides has an adverse effects such as thyroid suppression that can caused drowsiness, lethargy, bradycardia, nausea, and skin rash. PTU can also cause nausea and vomiting and GI complaints and Methimazole can cause bone marrow depression to he patient.
(True or False)

A

True

35
Q

Antithyroid Agents

A
  1. Iodine Solutions
    - low dosage can inhibits formation of thyroid hormone
    - high dosage can block thyroid hormone
36
Q

Radioactive Iodine (I131)

A

Use:
- destroys 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 TID
- Give iodine solution through a STRAW
- Mix iodine solution (I131) with juice
- Arrange for periodic blood tests
- Compliance

37
Q

It is derived from the Greek word for fountain and Latin for Honey. A metabolic disorder of fat, carbohydrates, and protein metabolism that results from defects in insulin secretion, insulin action (sensitivity), or both, and produces large volume of glucose-rich urine. It has a signs and symptoms of sustained hyperglycemia, polyuria, polydipsia, ketonuria, and weight loss.

A

Diabetes Mellitus

38
Q

Type I

A

Names: 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

39
Q

Type II

A

Names: non-insulin dependent; adult-onset
Age of Onset: over 40’s
Etiology: unknown, heredity
Disorder: Insulin resistance and inappropriate insulin secretion
Insulin Level: Low [deficiency]; high [resistance]
Treatment: TLC; oral hypoglycemics and insulin

40
Q

Three criteria of diagnosis of diabetes

A
  • 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
41
Q

It is one of the principal fuels used by our body (broken down to ATP) and when absorbed in the intestines, it is routed to the liver and converts by hepatocytes into glycogen for storage.

A

Glucose

42
Q

It secretes digestive enzymes and releases insulin and glucagon from the Islets of Langerhans

A

Pancreas

43
Q

Use of Drugs for Diabetes

A

Promotes cellular uptake of glucose (decreases glucose levels), converts glucose into glycogen, and moves potassium into cells (along with glucose)

44
Q

Insulin

A

Used for glycemic control of diabetes mellitus (type 1, type 22, gestational) to prevent complications

45
Q

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

A
  • 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.
46
Q

Humalog

A

Rapid acting, 5-15 minutes onset, 30 minutes to 1 hour peak, and 2-4 hours duration

47
Q

Humulin R

A

Short-acting, 30-69 minutes onset, 2-3 hours peak, and 3-4 hours duration

48
Q

Neutral Protamine Hagedorn (NPH), Lente

A

Intermediate - Acting, 2-4 hours onset, 4-8 hours peak, and 16-24 hours duration

49
Q

Humulin U, Lantus, Ultralente

A

4-8 hours onset, 14-20 hours peak, and 24-36 hours duration

50
Q

Insulin Reminders

A
  1. Not all insulins available as clear solutions are short-acting and can be admit through IV
  2. Not all can be mixed with other insulins
    - Only neutral protamine hagedorn (NPH) is appropriate for mixing with short-acting insulin
    - Withdraw short-acting first
    - Mixtures are stable until 28th day
51
Q

Lipodystrophy

A

Abnormal distribution of fat or partial loss of fat tissue

52
Q

Storage of drugs for diabetes: Insulin

A
  1. Unopened vials –refrigerated; not frozen
  2. Vial in use –can be at room temp for up to 1 month
  3. No direct sunlight and extreme heat
  4. Mixtures stable at room temp for 1 month; 3 months under refrigeration
53
Q

Nursing Intervention (Drugs for Diabetes: Insulin)

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 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.
54
Q

Hypoglycemia

A
  • an insulin complications
  • needs to monitor client for sign and symptoms such as tachycardia, palpitations, diaphoresis, and shakiness for abrupt onset (SNS symptoms). Headache, tremors, and weakness for gradual onset (PNS symptoms)
  • instruct the patient to self-administer of 15g of carbohydrate ( 4oz orange juice, 2 oz grape juice, 8 oz milk, glucose tablets per manufacturer’s suggestion equal to 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.
55
Q

It is an anti-diabetic drug for for type II diabetes mellitus that has a short-acting drugs which are gliclazide and tolbutamide, longer-acting drugs which are chlorpropamide, glibenclamide, and glipizide, and works by opening Ca+ channels of the beta cells stimulating release of insulin.

A

Sulphonylureas

56
Q

Antidiabetic Drugs

A

a. BIGUANIDES
- Metformin HCl
- Decreases glucose production by the liver; increase tissue response to insulin
- Diarrhea, GI s/sx, decreased appetite

57
Q

Antidiabetic Drugs

A

b. ALPHA-GLUCOSIDAE INHIBITORS
- acarbose; Miglitol
- reduces rate starches are broken down and absorbed; decreases post-prandial rise in blood glucose
- side effect flatulence

58
Q

Antidiabetic Drugs

A

c. THIAZOLIDINEDIONES
- Rosiglitazone, Pioglitazone
- Decrease insulin resistance, increase glucose uptake and decrease glucose production in liver
- Causes hypoglycemia

59
Q

Antidiabetic Drugs

A

d. GLIPTINS
- sitagliptin
- increases insulin release, reduces glucagon release

60
Q

Nursing Administration of Antidiabetic Drugs

A
  1. Encourage clients to exercise consistently and to follow appropriate dietary guidelines.
  2. Encourage clients to maintain a log of glucose levels and to note patterns that affect glucose levels (increased dietary intake, infection).
  3. Consider referring clients to a registered dietician and/or diabetic nurse educator.
  4. Instruct clients that formulations may combine two medications. ¡Instruct clients who are also taking insulin to monitor for signs of hypoglycemia.
61
Q

Nursing Administration of Antidiabetic Drugs

A
  • Administer medications orally and at appropriate times:
    a. Glipizide –Best taken 30 min prior to meal.
    b. Repaglinide –Instruct clients to eat within 30 min of taking a dose of the medication, 3 times/day.
    c. 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.
    d. Pioglitazone –Instruct clients to take once a day, with or without food.
    e. Acarbose –Instruct clients to take 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.
    f. Sitagliptin –Instruct clients to take once a day with or without food.
62
Q

Metformin: PCOS (Polycystic Ovary Syndrome)

A
  • combined endocrine/metabolic disorder characterized by androgen excess and insulin resistance
  • has a signs and symptoms of irregular periods, anovulation, infertility, acne and hirsutism
  • increase insulin sensitivity and decreases insulin levels which results in lowering androgen levels
  • improved glucose tolerance, ovulation and pregnancy rates
63
Q

It is a hyperglycemic agent that increases blood glucose levels by increasing the breakdown of glycogen into glucose, decreasing glycogen synthesis enhances the synthesis of glucose. It is used for emergency management of hypoglycemic reactions, such as insulin overdose in clients who are unable to take oral glucose and decrease in gastrointestinal motility in clients undergoing radiological procedures of the stomach and intestines.

A

Glucagon

64
Q

Glucagon’s assessment, contraindications, and nursing management.

A

Assessment:
- GI Distress (turn the clients on the side to prevent aspiration during emesis)
Contraindication:
- 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.

65
Q

Glucagon’s assessment, contraindications, and nursing management.

A

Assessment:
- GI Distress (turn the clients on the side to prevent aspiration during emesis)
Contraindication:
- 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.

PHARMACOLOGY (7 decks)

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