Endocrine Medications Flashcards
Metformin (Glucophage)
- Used for Type II Diabetes Management
- Side effects: Headache, dizzy, drowsy, N/V/D, agitation, weakness, Lactic Acidosis
- Report s/s of lactic acidosis to HCP immediately
- Metformin is used in addition to other antiDM agents
- XR Tablets must be swallowed whole, don’t chew or crush tablets
Insulin Need to Knows
- Given SQ route (lateral thigh, abdomen or outer arm)
- Rapid Acting Insulin/Novalog given 15 mins before meals
Rapid Acting-Insulin
Glulisine (Apidra) Remember GAL
Aspart (Novolog) *Onset: 5-15 mins
Lispro (Humalog) *Peak: 30-60 mins
- Used to tx DM.
- s/e: hypoglycemia, bronchospasm with inhaled insulin, anaphylaxis, lipodystrophy
- Watch for hyperglycemia/hypoglycemia s/s
- Normal is 70-120 mg/dL - Check type, dose, and exp date
Regular Insulin
Humulin R, Humulin R-500 (5x stronger)
- Onset: 30m
- Peak: 2-4hr
- Used for tx of DM; can be used to tx DKA
- s/e: hypoglycemia, lipodystrophy
- Correct administration @ correct time
- Check type, dose, exp date (U-500 is color coded)
- Recognize hypo/hyperglycemia s/s
Intermediate Acting Insulin
Neutral Protamine Hagedorn (NPH)
-Humulin N, Novolin N
- Used to tx DM; not for acute treatment of DKA due to prolonged duration
- Onset: 1-2 hr, Peak: 4-12 hr
- s/e: hypoglycemia, lipodystrophy
- Carb Counting is important to diet plan
- Recognize s/s of hypo/hyperglycemia
- Memorize peak time-hypoglycemia occurs then
Long-Acting Insulin
Insulin Detemir (levemir) Insulin Glargine (lantus)
- Used to tx DM, not for acute tx
- onset: 1-2 hr
- s/e: hypoglycemia, lipodystrophy
*Recognize s/s of hypo/hyperglycemia
Pramlintide
- Treatment of DM 1 & 2 used with other anti-DM medications
- Pen-filled Insulin (Prime as directed)
- s/e: seizures, coma, cool/pale skin, depression, confusion, muscle/joint pain
- Don’t drink alcohol
- Recognize s/s of hypo/hyperglycemia
- HbA1C and Postprandial are the best indicators of control
Glucagon-like Peptide-1 Receptor Agonist
Exenatide (byetta), Dulaglutide (trulicity), Albiglutide (tanzeum), Liraglutide (victoza)
- Antidiabetic Agent
- Used for treatment of type II diabetes uncontrolled by metformin or sulfonylurea.
- s/e: dizziness, jitters, weakness, N/V/D
-Given 1 hour before meals (DO NOT TAKE AFTER)
Dipeptidyl Peptidase-4 Inhibitors
Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
- Antidiabetic Agent
- Used (in addition to diet and exercise) to improve glycemic control in type II diabetics.
- s/e: headache
- Often used in combination with other antidiabetic medications (metformin, thiazolidinedione)
Meglitinides
Repaglinide (Prandin)
- Used to tx type II diabetes (with exercise and diet)
- s/e: angina, hypo/hyperglycemia
- Used in combination with other antidiabetic meds (metformine, rosiglitazone, pioglitazone)
- Taken 30 mins before each meal
- Test BS before meals and before bed
Alpha-Glucosidase Inhibitors
Acarbose (precose), Miglitol (glyset)
- Used to manage diabetes with diet therapy. Can be used with insulin or other hypoglycemic agents
- S/e: abdominal pain, diarrhea, flatulence, inc in transaminases
- Carry an oral form of glucose for hypoglycemia.
- Sucrose is not digested-
- Admin with first bite of each meal 3x/day
Sodium-Glucose Co-Transporter 2 Inhibitors
Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
- Used to tx type II diabetes with diet and exercise.
- s/e: hypotension, female mycotic infections, hypoglycemia, hyperkalemia
- Take as directed, don’t double dose
- May cause yeast infections, contact HCP if occurs
- Notify HCP of rash, hives, swelling of face/lips/throat
Sulfonylureas
Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (DiaBeta)
- Used to tx type II diabetes (with diet therapy or insulin resistance cases)
- s/e: aplastic anemia, cramps, inc appetite
*Monitor glucose levels ac and qhs
Thiazolidinediones
Rosiglitazone (avandia), Pioglitazone (actos)
- Used for tx of type II diabetes (with diet and exercise). Used alone or with other DM meds
- s/e: edema, inc cholesterol/LDL/HDL levels, weight gain
- Doesn’t cause hypoglycemia
- Can be taken without food
- Lab studies required to assess levels
Pancreatic (Antihypoglycemic)
Glucagon
- Used to manage acute cases of severe hypoglycemia
- s/e: transient inc in HR/BP, N/V, anaphylaxis
Thyroid Hormones
Levothyroxine (synthroid)
Liothyronine (Cytomel, triostate)
Thyroid (Armour Thyroid, Westhroid)
- Used as a replacement therapy for clients without a thyroid or to diminish thyroid use.
- s/e: hyperthyroidism, menstrual irregularities, irritability, insomnia
- Levothyroxine is given 30 mins-1 hour before breakfast (on an empty stomach)
- Monitor T3/T4/TSH levels
*Take medication
Antithyroids
Propylthiouracil (PTU)
- Used as a palliative tx of hyperthyroidism
- s/e: drowsiness, headache, loss of taste, agranulocytosis
- Monitor weight 2-3x/week
- Medication may cause drowsiness
- Report Sore Throat, Unusual Bleeding, Bruising, Pallor, SOB, or extreme fatigue STAT
- Frequent lab tests to determine effectiveness
*Watch for thyroid storm (tachycardia, palps, nervousness, insomnia, fever, sweating, heat intolerance, tremors, wt loss)
Corticosteroids
Cortisone, Hydrocortisone, Methylprednisolone, Prednisone
- Used as a systemic and local tx of inflammatory diseases. Replacement therapy for adrenal insufficiency.
- s/e: peptic ulceration, dec wound healing, depression, psychoses, fluid retention
- Don’t stop abruptly
- Don’t use grape juice and limit caffeine for PO meds
Fludrocortisone
- Used for tx of Na loss and hypotension asso. with adrenal insufficiency.
- s/e: dizziness, adrenal suppression, wt gain, edema, headache
- Avoid abrupt d/c (leads to addisonian crisis)
Oxytocic
Oxytocin (Pitocin)
-Used for labor induction. Can be used for abortions. Postpartum bleeding control after expulsion of placenta.
-s/e: coma, seizures, hypotension (maternal)
intracranial hemorrhage, asphyxia, arrhythmias (fetal)
- Expect contractions to be more severe and last longer.
- Assess uterine contractions and fetal HR
Antidiuretic Hormones (ADH)
Desmopressin, Vasopressin
- Used to manage primary nocturnal enuresis unresponsive to other txs. Tx of pulseless VT, V Fib, GI Hemorrhage, vasodilatory shock of Diabetes insipidus caused by deficiency.
- s/e: drowsiness, nasal congestion (DDAVP), HTN/HypoTN, tachycardia, water intoxication/hyponatremia
- Avoid Alcohol (decs ASH effects)
Growth Hormone
Somatropin (Genotropin)
- Used to tx growth hormone deficiency in adults from pituitary disease, hypothalamic disease, surgery, radiation, trauma, or childhood onset.
- s/e: edema of hands and feet, hypothyroidism, hyperglycemia, insulin resistance
*F/U with endocrinologist as recommended
Hormones
Octreotide (Sandostatin)
Lanreotide (Somatuline Depot)
- Used to treat severe diarrhea and flushing episodes with GI tumors. Tx diarrhea in AIDS clients or clients with fistulas.
- s/e: drowsiness, cholethiasis, diarrhea, fat malabsorption, orthostatic hypotension
- May cause dizziness, drowsiness, or visual disturbances
- Slow position changes (Ortho hypoTN)
- Keep a record of number/characteristics of BMs
Progestin
Megestrol (Megace)
- Used in palliative treatment of endometrial and breast carcinoma, either alone or with surgery/radiation. Tx of anorexia, wt loss and cachexia asso with AIDS (oral suspension only)
- s/e: thromboembolism, GI Irritation, Alopecia
- Take medicine exactly, no skipped or double doses
- Report HCP of unusual vaginal bleeding or signs of DVT
- Use contraception during therapy
- Possible hair loss can occur
- Assess client for swelling, pain, or tenderness in legs or armpits. (DVT s/s)
Vasopressin Antagonists
Conivaptan (Vaprisol), Tolvaptan (Samsca)
- Used to inc serum sodium in hospital pts with euvolemic or hypervolemic hyponatremia.
- s/e: headache, confusion, hypo/HTN, dehydration, hypokalemia, fever, thirst
- Do not drink grapefruit juice or take herbals
- Report to HCP about pain/redness at site, dehydration signs, dark urine or stools, yellowing eyes
*Monitor for liver injury
