Endocrine medications

Question 1

mnemonic SRACEE

Answer 1

1. Stimulus
2. Receptor (structure)
3. Afferent (sensory pathway)
4. Control centre (structure)
5. Efferent (sensory pathway)
6. Effector (structure)

Question 2

Medications related to the endocrine system

Answer 2

When parts of the endocrine system are not working properly (overstimulating or underproducing), medications can play a valuable role. Medications related to the endocrine system do not ‘cure’ the condition, but rather they work to correct imbalance and restore physiological homeostasis. Many medications mimic the endogenous hormones (agonists) or block their action (antagonists)

Question 3

Thyroid- and parathyroid-related medications

Answer 3

As you learnt about in the last section, there are two main forms of thyroid imbalances: hypothyroidism (not enough thyroid function) and hyperthyroidism (thyroid function is excessive). The main goals for addressing these imbalances are to relieve symptoms and re-establish homeostasis

Question 4

Thyroid hormone replacement

Answer 4

Example: L- thyroxine

Indication/action

Hypothyroidism;
Replaces the normal role of thyroid hormones.
Nursing considerations

Need to monitor blood thyroid hormone levels when commencing therapy.
The need for replacement therapy is usually life long, vigilance with treatment is required by the patient and healthcare team.
Medication should be taken on an empty stomach before breakfast.
Has interactions and may magnify other medication impact e.g. anticoagulants, digoxin, beta blockers

Question 5

Anti-thyroid drugs (antagonists)

Answer 5

Example: Propylthiouracil, Carbimazole

Indication/action

Hyperthyroidism;
Depresses thyroid hormone synthesis.
Nursing considerations

Need to monitor blood thyroid hormone levels when commencing therapy;
The effects will not be seen for 3-4 weeks, high doses are needed for 4-6 weeks then the lowest dose is used to maintain normal thyroid function;
Hypothyroid function could be an impact of treatment so dose needs to be adjusted

Question 6

Pancreas-related medications

Answer 6

Hyperglycaemic agents, which are used to treat low blood glucose (hypoglycaemia); and
Hypoglycaemic agents, which are used to treat high blood glucose (hyperglycaemia).

Question 7

Hyperglycaemic agent: Glucagon

Answer 7

Glucagon is used to treat low blood sugar when oral glucose can’t be given, like if the person is unconscious. It raises blood sugar by converting stored glycogen into glucose. Blood glucose usually starts to rise 10-15 minutes after an intramuscular injection.

Question 8

Hypoglycasemic agent: Insulin

Answer 8

For Type 1 Diabetes, insulin is the only medication used to lower blood sugar. In Type 2 Diabetes, insulin is used when oral medications and diet changes don’t work. Insulin comes in different forms, chosen based on the patient’s needs. Before giving insulin, nurses must check the patient’s blood glucose level (BGL). Insulin is given by injection under the skin or into a vein, as it would be destroyed by stomach enzymes if taken orally.

Question 9

Ultra-short acting

Answer 9

Example: Novorapid

Onset time: 25min

Duration of effect: 3.5-5 hours

Question 10

Short acting

Answer 10

Example: Actrapid, Humulin R

Onset time: 30 mins to 1 hour

Duration of effect: 6-8 hours

Question 11

Intermediate acting

Answer 11

Example: Protaphane

Onset time: 1-2.5 hours

Duration of effect: 16-24 hours

Question 12

Long acting

Answer 12

Example: Lantus, Levemir

Onset time: 1-2 hours

Duration of effect: 24 hours

Question 13

Premixed versions (have a mix of long and short acting)

Answer 13

Example: Humulin 30/70; Mixtard 30/70

Question 14

What to do when managing the care of a person with diabetes?

Answer 14

he nurse should ensure they assess the patient regularly for both hypoglycaemia and hyperglycaemia. Patients and their family members should also be educated to recognise these conditions, as they are both life-threatening. If the nurse suspects a person is hypoglycaemic, he/she should assess the patient’s BGL. If it is below 4 mmol/L the following steps should be followed depending on the person’s level of consciousness

Question 15

Oral hypoglycaemic agents for diabetes type 2

Answer 15

Sulfonylureas and Biguanide

Question 16

Sulfonylureas

Answer 16

Example: Glibenclamide and Gliclazide (Diamicron)

Indication/action

For Diabetes Types 2
Stimulates the release of insulin from the pancreas;
Inhibits gluconeogenesis;
Increases number of insulin receptors on target cells.
Nursing considerations

Administer with food, as hypoglycaemia may result

Question 17

Biguanide

Answer 17

Example: Metformin

Indication/action

For Diabetes Types 2;
Decreases production of glucose in the liver.
Nursing considerations

May cause nausea;
Should be taken with food to minimise gastric irritation;
Alcohol intake should be minimised

Question 18

True or False? Persons with Diabetes only need to be aware of the symptoms and management of hyperglycaemia, not hypoglycaemia.

Answer 18

False - Correct. Persons with Diabetes (and their loved ones) must be aware of the symptoms and management of both hyperglycaemia and hypoglycaemia, as both can arise from the condition itself and/or from related medication.

Question 19

True or False? If left untreated, hyperglycaemia can progress to diabetic ketoacidosis in a person with Diabetes.

Answer 19

True - Correct. Diabetic Ketoacidosis can result form untreated and severe hyperglycaemia in persons with Diabetes.

Question 20

True or False? Oral hypoglycaemics are commonly used to treat persons with Diabetes Type 1.

Answer 20

False - Correct. Oral hypoglycaemics are commonly used to treat persons with Diabetes Type 2. Persons with Diabetes Type 1 require insulin.

Question 21

True or False? Insulin types are categorised based on the speed of onset.

Answer 21

True - True: The speed at which insulin acts (onset time) is how different forms of insulin are categorised.

Question 22

Adrenal-related medications

Answer 22

Corticosteroids, medications related to the adrenal cortex, are commonly used as anti-inflammatory agents and immunosuppressants. They help manage autoimmune diseases, inflammation, and can treat conditions like Addison’s disease, asthma, rheumatoid arthritis, ulcerative colitis, and prevent organ rejection after transplants. However, corticosteroids have side effects, including rapid heart rate, high blood pressure, swelling, slow growth in children, osteoporosis, slow wound healing, higher infection risk, glaucoma, and depression.

Question 23

Oral corticosteroids

Answer 23

Examples: Prednisone, Prednisolone, Methylprednisolone, Dexamethasone

Indication/action

Used as anti-inflammatory treatment for a range of conditions (i.e. allergic disorders, skin conditions, arthritis, lupus, etc.)
Nursing considerations

When administered for more than 2 weeks, should not be abruptly stopped because this may result in an adrenal crisis;
Should be gradually reduced in dose over a period of time (using a dose tapering regime)

Question 24

Topical corticosteroids

Answer 24

Example: Betamethasone (Betnovate)

Indication/action

Used a ointment, cream or lotion for itchy dry skin (e.g. eczema, contact dermatitis, psoriasis)
Nursing considerations

Encourage use only on affected areas;
Withdrawal side effects can occur if using for greater than 12 months (including redness or changes in skin colour, burning, stinging, itching)

Question 25

Inhalation corticosteroids

Answer 25

Example: Budesonide (Pulmicort)

Indication/action

Used as an inhaler for asthma and chronic obstructive pulmonary disease.
Nursing considerations

Advise person to rinse mouth after each use;
Should be gradually reduced in dose over a period of time (using a dose tapering regime)

Question 26

Nasal inhalation corticosteroids

Answer 26

Example: Beclomethasone (Beconase)

Indication/action

Reduces swelling in nasal passage;
Used as a nasal spray for hay fever

Question 27

Mineralocorticoids

Answer 27

Example: Fludrocortisone (Florinef)

Indication/action

Impact sodium and water retention and increases blood volume and blood pressure
Nursing considerations

Should be gradually reduced in dose over a period of time (using a dose tapering regime)
Note: the medication spironolactone suppresses mineralocorticoid aldosterone (it is a mineralocorticoid antagonist) and is a useful diuretic, reducing oedema and blood pressure

Question 28

Pituitary-related medications

Answer 28

Medications in this category affect one of the six hormones secreted from the anterior pituitary or the two hormones secreted from the posterior pituitary.

Question 29

Somatropin

Answer 29

Indication/action

Stimulates skeletal and cellular growth;
Used for children with a deficiency of growth hormone and therefore short stature

Question 30

Oxytocin

Answer 30

Indication/action

Stimulates the smooth muscle of the uterus, producing rhythmic contractions;
Used for bringing on labour

Question 31

Vasopressin

Answer 31

Indication/action

Also known as Antidiuretic hormone (ADH);
Used for persons in shock to increase the blood pressure when other therapies are ineffective

Question 32

Tetracosactrin

Answer 32

Indication/action

Stimulates the adrenal cortex to release corticosteroids;
Used to diagnose impaired adrenal function and treat inflammatory conditions

Question 33

Desmopressin (DDAVP)

Answer 33

Indication/action

Synthetic form of vasopressin;
An anti-diuretic that decreases the amount of water excreted in the urine;
Used to support treatment of diabetes insipidus, nocturia and bleeding disorders