Endocrine medications Flashcards
mnemonic SRACEE
- Stimulus
- Receptor (structure)
- Afferent (sensory pathway)
- Control centre (structure)
- Efferent (sensory pathway)
- Effector (structure)
Medications related to the endocrine system
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)
Thyroid- and parathyroid-related medications
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
Thyroid hormone replacement
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
Anti-thyroid drugs (antagonists)
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
Pancreas-related medications
Hyperglycaemic agents, which are used to treat low blood glucose (hypoglycaemia); and
Hypoglycaemic agents, which are used to treat high blood glucose (hyperglycaemia).
Hyperglycaemic agent: Glucagon
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.
Hypoglycasemic agent: Insulin
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.
Ultra-short acting
Example: Novorapid
Onset time: 25min
Duration of effect: 3.5-5 hours
Short acting
Example: Actrapid, Humulin R
Onset time: 30 mins to 1 hour
Duration of effect: 6-8 hours
Intermediate acting
Example: Protaphane
Onset time: 1-2.5 hours
Duration of effect: 16-24 hours
Long acting
Example: Lantus, Levemir
Onset time: 1-2 hours
Duration of effect: 24 hours
Premixed versions (have a mix of long and short acting)
Example: Humulin 30/70; Mixtard 30/70
What to do when managing the care of a person with diabetes?
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
Oral hypoglycaemic agents for diabetes type 2
Sulfonylureas and Biguanide
Sulfonylureas
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
Biguanide
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
True or False? Persons with Diabetes only need to be aware of the symptoms and management of hyperglycaemia, not hypoglycaemia.
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.
True or False? If left untreated, hyperglycaemia can progress to diabetic ketoacidosis in a person with Diabetes.
True - Correct. Diabetic Ketoacidosis can result form untreated and severe hyperglycaemia in persons with Diabetes.
True or False? Oral hypoglycaemics are commonly used to treat persons with Diabetes Type 1.
False - Correct. Oral hypoglycaemics are commonly used to treat persons with Diabetes Type 2. Persons with Diabetes Type 1 require insulin.
True or False? Insulin types are categorised based on the speed of onset.
True - True: The speed at which insulin acts (onset time) is how different forms of insulin are categorised.
Adrenal-related medications
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.
Oral corticosteroids
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)
Topical corticosteroids
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)
Inhalation corticosteroids
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)
Nasal inhalation corticosteroids
Example: Beclomethasone (Beconase)
Indication/action
Reduces swelling in nasal passage;
Used as a nasal spray for hay fever
Mineralocorticoids
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
Pituitary-related medications
Medications in this category affect one of the six hormones secreted from the anterior pituitary or the two hormones secreted from the posterior pituitary.
Somatropin
Indication/action
Stimulates skeletal and cellular growth;
Used for children with a deficiency of growth hormone and therefore short stature
Oxytocin
Indication/action
Stimulates the smooth muscle of the uterus, producing rhythmic contractions;
Used for bringing on labour
Vasopressin
Indication/action
Also known as Antidiuretic hormone (ADH);
Used for persons in shock to increase the blood pressure when other therapies are ineffective
Tetracosactrin
Indication/action
Stimulates the adrenal cortex to release corticosteroids;
Used to diagnose impaired adrenal function and treat inflammatory conditions
Desmopressin (DDAVP)
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
