Endocrine Drugs - Exam 3 Flashcards
Somatropin
(Humatrope)
Mech: Identical to GH, stim protein synthesis by increasing amino acid uptake
Reduces carb use by cells
Use: In children, stop use when epiphyseal plates close
SE: hyperglycemia, careful w/ DM !
Notes: Corticosteriods can oppose effects of GH!
Vasopressin
(Pitressin)
Synthetic ADH
Mech: Increases collecting duct perm to water causing increased reabsoprtion of water in to bloodstream -> Increased BP.
Use: Given IV, used for DI & Cardiac arrest
SE: Water intox!! Neurologic signs of drowsiness, headache, convulsions, coma
Desmopressin
(DDAVP)
Synthetic ADH
Mech: Increases perm in collecting duct to water causing increased reabsoprtion of water in to bloodstream -> Increased BP. less vascular activity
Use: Main Tx in DI! NOT USED FOR CARDIAC RESUSCITATION!
SE: Water intox!
Levothyroxine
(Levothroid, Synthroid)
Hypothyroid drug
Mech: Synthetic version of thyroxine (T4)
Use: HIGHLY PROTEIN BOUND!
-Half life of 7 days
-Levels stay steady, just takes a while to get there
-Edu pt that taken for life.
MUST BE TAKEN ON EMPTY STOMACH
SE: Thyrotoxicosis
-Tachy
-Angina
-Tremor
-Hyperthermia
-Heatintolerance
Notes: Monitored by checking TSH levels.
TSH 0.5- 2.0mu/mL is desired!
Low TSH = decrease dose , High TSH = increase dose
Radioactive Iodine
Hyperthyroid drug
Mech: Emits beta particles & gamma rays
Destroys thyroid tissue with minimal damage to surrounding tissues
Use: Given outpt! Concerned about their body fluids!
-Private toilet or flush 2-3x
-Launder bed linens separately!
-Avoid close contact w/ preg women or child for 7 days after therapy
SE: Risk for delayed HYPOthyroidism
Notes: Should NOT be used in preg or lactating women!
Methimazole
(Tapazole)
Antithyroid drug
Mech: Inhibits peroxidase (enzyme responsible for the synthesis of thyroid hormone) Does not destroy TH already in existence !
Use: 1st line drug for hyperthyroidism
SE: AGRANULOCYTOSIS!! Will NOT see increased WBC w/ infection!
Too much can cause hypothyroidism
Notes: Contraindicated in PREGNANCY
Should not be used in 1st trimester, can cross placenta and interfere w/ thyroid synthesis.
If given can cause cretinism
Propylthiouracil (PTU)
Antithyroid drug
“Protect The Unborn”
Mech: inhibits oxidation of iodide by peroxidase
Use: short half life, has to be admin 2-3x/day
SE: Agranulocytosis
Hypothyroidism
Liver injury!!! Watch for jaundice or urine changes
Notes: Can use in 1st Trimester ONLY then switch to methimazole for rest of pregnancy
Lugol’s Solution
(Non-Radiactive Iodine)
Antithyroid drug
Mech: High concentration causes paradoxical effect on thyroid.
-reduces iodine uptake by thyroid
-results in decreased t3/t4 production
Use: Rarely used on its own, typically used with another anti-thyroid med
SE: Iodism = brassy taste, burning sensation on throat, frontal headache, salivation
-Corrosion of GI tract
Hydrocortisone
(Solu-Cortef)
Glucocorticoid
Adrenal hormone insufficiency drug
Mech: Mimics cortisol! Also has small mineralcorticoid effect
Use: Used for allergic reactions, inflammation, cancer, organ transplant
-Admin PO or IV
If PO, give 2/3 in morning, 1/3 in evening
(mimics body’s natural release)
SE: CHAOS =
Cushing syndrome Hyperglycemia Adrenal insufficiency Osteoporosis Suppressed immune system
Notes: Edu pt to NOT withdraw rapidly from high dose
Dose must be increased in times of stress
Fludrocortisone
(Florinef)
Mineralcorticoid
Adrenal hormone insufficiency drug
Mech: Mimics aldosterone (possess small glucocorticoid effect)
SE: HTN, Hypokalemia
Cosyntropin
(Cortrosyn)
Adrenal diagnostic drug
Mech: Synthetic version of ACTH
Stim adrenal gland to secrete cortisol
Use: 1.Plasma cortisol level is checked
2. Cosyntropin is injected
3. Plasma cortisol level is checked again, after 30-60 mins
Normal person = rise in cortisol level
Dexamethasone
(Decadron)
Adrenal diagnostic drug
Mech: Mimic’s cortisol
Use: Used to diagnose Cushing’s syndrome!
Low dose tests are done first
If low dose is abnormal, a high dose test is done to
identify the source
Low dose = 1mg before bed, cortisol lvl check next AM. Cortisol should drop If not, do high dose
High dose = 8mg before bed, cortisol lvl check next AM
drop in cortisol = pituitary cause
No drop = paraneoplastic or adrenal cause
Insulin lispro (humalog)
Insulin aspart (NovoLog)
Insulin glutilisine (Apidra)
Rapid Acting Insulin
Onset: 10-30min
Peak: 30min-3hrs
Duration: 3-6
Give with
meals!!
Can Give with
intermediate
or long acting
insulin
May be given
IV, but rare
Regular insulin
(Humulin R, Novolin R)
Short acting insulin
Onset: 30-60mins
Peak: 1-5hrs
Duration: 6-10hrs
May be given IV!
NPH insulin
(Humulin N, Novolin N
Intermediate Insulin
Onset: 60-120mins
Peak: 6-14hrs
Duration: 16-24hrs
Cloudy!! May be given with regular or rapid insulin
Insulin glargine (Lantus)
Long acting insulin
Onset: 70mins
Peak: None
Duration: 18-24hrs
Metformin
(Glucophage)
Biguanide
Mech: Inhibits glucose prod by liver
Reduces glucose absorption in gut SLIGHTLY
Sensitizes insulin receptors
DOES NOT STIM INSULIN RELEASE
Use: Drug of choice for initial therapy for Type 2 Diabetes!
SE: -GI disturb
-Reduced B12 & folate absorption (anemia)
-Weight Loss !
-Lactic acidosis, rare!
Contraindicated in renal fl pts!
Notes: Weight loss from Metformin also helps increase insulin sensitivity
IV contrast + met can cause renal impairment!
met must be held 48HRS before procedure, switched to SQ insulin
Hydrate pt after to flush out contrast
Glipizide (Glucotrol)
Glyburide (Diabeta)
Glimepiride (Amaryl)
Sulfonylureas
Mech: Stim release of insulin from pancreatic B-cells!
Pancreas MUST be able to synthesize insulin for this drug to work!!
Use: Type 2 diabetes
SE: Hypoglycemia – sulfonylureas will ALWAYS reduce
glucose levels, regardless of where they start
– Higher doses associated with lower glucose levels
Possibly teratogenic in humans
Notes: Contraindicated in Pregnancy and lactation – due to it’s teratogenic nature
Nateglinide (Starlix)
Repaglinide (Prandin)
Meglitinides (-glinide)
Mech: Stim release of insulin from pancreatic B-cells
Shorter half life than Sulfonylureas!
Use: Type 2 diabetes
SE: Hypoglycemia!
PT MUST EAT WITHIN 30MINS OF ADMIN
Pioglitazone
(Actos)
Thiazolidinediones or TZDs (-glitazone)
Mech: Reduces insulin resistance = Cellular response to insulin increases relies on good insulin prod by pancreas
Use: Type 2 diabetes
SE: Promotes fluid retention careful with HF!!
Liver failure ! Monitor LFTs
Acarbose (Precose)
Miglitol (Glyset)
Alpha-glucosidase inhibitors
Mech: Inhibits the action of alpha-glycosides = Blocks absorption of carbs
Use: Type 2 diabetes
SE: GI disturb most common!
Glucose stays in intestines, brings water with it, increased risk of diarrhea!
Notes: Take with first bite of meal!!
Sitagliptin (Januvia)
Alogliptin (Nesina)
DPP-4 Inhibitors (-gliptin)
Mech: Inhibits DPP-4 So enhances the action of incretin hormones (GLP-1)
Use: Type 2 diabetes
SE: Pancreatitis (Rare)
Notes: Pt should report any flank pain!
Exenatide (Byetta)
Semaglutide (Ozempic)
Glucagon-like Peptide 1 Receptor Agonists
Mech: Synthetic analog of GLP-1
-Activates receptors to slow gastric emptying
-Stimulates release of insulin
-Reduces glucose prod by liver
Use: Type 2 diabetes
SE: GI, nausea
-Rare pancreatitis & renal impairment
-Hypoglycemia if combined w/ Sulfonylureas
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Sodium Glucose Co-transporter 2 (SGLT-2)
Mech: Blocks SGLT-2 in the nephron
Results in glucosuria (voiding glucose instead of retaining)
Use: Type 2 diabetes
SE: -Genital Fungal infection
-UTI
-Freq urination
-Postural hypotension
Notes: Benefits for HF pts! Works almost like a diuretic!
