Endocrine Medications

Question 1

Oral Hypoglycemics

alpha-glucosidase inhibitors: acarbase, miglitol
Biguanides: metformin
Gliptins: sitagliptin
Meglitinides: repaglinide, nateglinide
Sulfonylureas: glipizide, glyburide
Thiazolidinedione’s: rosiglitazone, pioglitazone

Answer 1

Uses:
-in conjunction with diet and exercise to control glucose levels in clients with type two DM

Precautions/interactions:

• caution in clients with renal, hepatic, or cardiac disorders
• generally avoided during pregnancy & lactation; consult provider
• Alpha-glucosidase inhibitors:
  
  • contraindicated in clients with intestinal disease due to increase gas formation
• Biguanides
  
  • Withhold 48 hr. prior to and 48 hr. after a test with contrast media
  • contraindicated in clients with severe infection, shock, hypoxic conditions
• Gliptins
  
  • Caution with impaired renal function- dose will be reduced
• Meglitinides:
  
  • short-acting; administer before each meal; risk of hypoglycemia
• Sulfonylureas:
  
  • Extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders; can cause disulfiram-like reaction with alcohol ingestion
• Thiazolidinediones:
  
  • exacerbation of heat failure

Nursing interventions/education:

• teach signs and management for hypoglycemia, especially with sulfonylureas
• encourage diet and exercise to follow American Diabetes Association
• monitor glycosylated hemoglobin (HbA1c)
• refer to diabetic nurse educator

Question 2

Insulin

Rapid acting: lispro
Short-acting: regular
intermediate: NPH
Long acting: glargine

Answer 2

Uses:

• glycemic control of DM (type 1, 2, gestational) to prevent complications
• clients taking oral hypoglycemic agents may require insulin therapy when
  
  • undergoing diagnostic tests; NPO status
  • pregnant
  • severe kidney or liver disease is present
  • oral agents are inefficient
  • Treatment of hyperkalemia

Precautions/interactions:

• When mixing regular with NPH, draw up regular first (clear to cloudy)
• do not mix other insulin with lispro, glargine, or combination 70/30
• only regular insulin is given IV (only in normal saline)
• administer glargine at bedtime

side/adverse effects:

• hypoglycemia/hyperglycemia
• lipodystrophy

nursing interventions/education:

• Monitor serum glucose levels before meals and at bedtime or patterned scheduled-specific to client
• roll vial insulin (except regular) to mix; do not shake
• instruct client to rotate injection sites to prevent lipodystrophy
• teach signs and management for hypo/hyperglycemia
• encourage diet and exercise to follow ADA recommendations
• monitor HbA1c
• refer to diabetic nurse educator

Question 3

Glycemic agent

Glucagon

Answer 3

Uses:
-emergency treatment of severe hypoglycemia

Precautions/interactions:
-do not mix with sodium chloride or dextrose solutions

Side/adverse effects:

• nausea/vomiting
• rebound hypoglycemia

Nursing interventions/education:

• Administer to unresponsive patient
• monitor BG levels
• Instruct client to self-monitor for early signs of hypoglycemia
• instruct client to wear medical alert ID
• advise client to teach family members how to administer medication
• provide carbohydrates when client awakes from hypoglycemic reaction

Question 4

Thyroid medications

Levothyroxine/T4

Answer 4

Uses:

• hypothyroidism
• emergency treatment of myxedema coma

Precautions/interactions:
-over medication can result in signs of hyperthyroidism

side/adverse effects:

• tachycardia
• restlessness
• diarrhea
• weight loss
• decreased bone density
• heat intolerance
• insomnia

Nursing interventions/education:

• monitor cardiac system
• therapy initiated with low doses; advance to higher doses while monitoring lab values
• monitor T4 and TSH levels
• take in early AM

Question 5

Thyroid Hormone Antagonist

Methimazole

Answer 5

Uses:

• hyperthyroidism
• perioperative thyroidectomy
• thyrotoxic crisis
• thyroid storm

precautions/interactions:

• administer with caution to clients who have bone marrow depression, hepatic disease, or bleeding disorders
• discontinue prior to radioactive iodine uptake testing
• contraindicated with breastfeeding

side/adverse effects:

• skin rash, pruritus
• abnormal hair loss
• GI upset
• paresthesia
• periorbital edema
• joint and muscle pain
• jaundice
• agranulocytosis
• thrombocytopenia

Nursing interventions/education:

• Administer with food at the same time each day
• increase fluids to 3/L a day
• instruct client to avoid OTC products that contain iodine
• instruct client to take medication as prescribed
• if d/c, dose must be tapered
• monitor for therapeutic response: weight gain, decreased pulse, BP and T4 levels
• monitor client for signs of overdose and signs of hypothyroid: periorbital edema, cold intolerance, mental depression

Question 6

Anterior pituitary/growth hormones

Somatropin

Answer 6

Use:

• treat growth hormone deficiencies
• Turner’s syndrome

Precautions/interactions:

• contraindicated in clients who are severely obese
• therapy must be d/c prior to epiphyseal closure
• avoid concurrent use of glucocorticoids

side/adverse effects:

• hyperglycemia
• hypothyroidism

nursing interventions/education:

• monitor growth patterns
• reconstitute medication per manufacturer instructions
• administer subcutaneous per protocol
• dose is individualized

Question 7

Posterior pituitary hormones/antidiuretic hormones

Desmopressin (DDVAP): oral, intranasal, subq, IV
Vasopressin: intranasal, subq, IV

Answer 7

Uses:

• diabetes insipidus
• cardiac arrest
• nocturnal enuresis
• hemophilia (desmopressin)

Precautions/interactions:
-contraindicated in clients with chronic nephritis or high risk for myocardial infarction

Side/adverse effects:

• Hyponatremia
• seizures
• coma

Nursing interventions/education:

• monitor urine specific gravity
• monitor BP
• monitor urine output
• prevent Hyponatremia d/t water intoxication
• instruct for use of nasal spray

Question 8

Adrenal Hormone Replacement

-sone

dexamethasone
hydrocortisone sodium succinate
fludrocortisone acetate
prednisone

Answer 8

Uses:

• acute and chronic replacement for adrenocortical insufficiency (Addison’s disease)
• inflammation, allergic reactions, cancer

precautions/interactions:

• contraindicated in clients who have systemic fungal infection
• caution in clients who have HTN, gastric ulcers, diabetes, osteoporosis
• requires higher doses in acute illness or extreme stress

side/adverse effects:

• adrenal suppression when administered for inflammation, allergic reactions
• infection
• hyperglycemia
• osteoporosis
• GI bleeding
• fluid retention

nursing interventions/education:

• do not skip doses
• monitor BP
• monitor F&E balance, weight, and output
• monitor for signs of bleeding & GI discomfort
• teach clients to take calcium supplements and maintain vitamin D levels
• give with food
• taper off dose regimen when when discontinuing medication
• provide immunosuppression