Endocrine Medications Flashcards
1
Q
Pituitary Medications
A
- growth hormones are used to treat pediatric or adult growth hormone deficiency (somatropin, norditropin, mecasermin).
- growth hormone receptor antagonists are used to treat acromegaly (octreotide acetate, lanreotide, pegvisomant).
- growth hormone-releasing factor is used to evaluate anterior pituitary function.
- side and adverse effects: may vary depending on the med; development of antibodies to growth hormone; headache, muscle pain, weakness, vertigo; diarrhea, nausea, abd discomfort; mild hyperglycemia; hypertension; weight gain; allergic reaction (rash, swelling), pain at injection site; elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
- interventions: assess physical growth and compare with standard; annual bone age determinations; monitor VS, blood glucose, AST, ALT levels, and thyroid function tests.
2
Q
Antidiuretic Hormones
A
- desmopressin acetate; vasopressin
- enhance reabsorption of water in the kidneys, promoting an antidiuretic effect and regulating fluid balance; used in diabetes insipidus.
- vasopressin is used less commonly than desmopressin acetate to treat diabetes insipdus; vasopressin is commonly used to treat septic shock
- side and adverse effects: flushing, headache, nausea, abd cramps, water intoxication, hypertension with water intoxication, nasal congestion with nasal adm.
- interventions: monitor weight, intake and output, urine osmolality, electrolyte levels, signs of dehydration or water intoxication.
3
Q
Thyroid Hormones
Levothyroxine sodium; Liothyronine sodium; Liotrix; thyroid, desiccated
A
- control the metabolic rate of tissues and accelerate heat production and oxygen consumption; used to replace deficit in conditions such as hypothyroidism and myxedema coma.
- enhance the action of oral anticoagulants, sympathomimetics, and antidepressants and decrease the action of insulin, oral hypoglycemics, and digitalis preparations; the action of thyroid hormones is decreased by phenytoin and carbamazepine.
- thyroid hormones should be given at least 4h apart from multivitamins, aluminum hydroxide and magnesium hydroxide, simethicone, calcium carbonate, phosphate binders, bile acid sequestrants, iron, and sucralfate, because these meds decrease the absorption of thyroid replacements.
- side and adverse effects: nausea, decreased appetite, abd cramps, diarrhea, weight loss, nervousness, tremors, insomnia, sweating, heat intolerance, tachycardia, dysrhythmias, palpitations, chest pain, hypertension, headache, toxicity (hyperthyroidism).
- take med at the same time each day in the morning without food; avoid over-the-counter meds.
4
Q
Antithyroid Medications
Methimazole; Propylthiouracil; Potassium iodide and strong iodine solution
A
- inhibit the synthesis of thyroid hormone; used for hyperthyroidism, or Graves’ disease.
- side and adverse effects: nausea, vomiting, diarrhea, drowsiness, headache, fever; hypersensitivity with rash; agranulocytosis with leukopenia and thrombocytopenia; alopecia and hyperpigmentation; toxicity (hypothyroidism); iodism (characterized by vomiting, abd pain, metallic or brassy taste in the mouth, rash, and sore gums and salivary glands.
- monitor for signs of thyroid storm and iodism!
- iodism is a concern for clients taking strong iodine solution, also known as Lugol’s solution, because of the risk of iodism, use is limited to about 2 weeks (generally used for hyperthyroidism in preparation for thyroid surgery).
5
Q
Parathyroid Medications
A
- regulates serum calcium levels; low levels of calcium stimulate parathyroid hormone release.
- hyperPT results in high calcium and bone demineralization; hypoPT results in low calcium, which increases neuromuscular excitability (treatment include calcium sup and vit D).
- calcium salts adm with digoxin increase the risk of digoxin toxicity; oral calcium salts reduce the absorption of tetracycline hydrochloride.
- interventions: assess for signs of tetany and renal calculi; instruct the client receiving calcium regulators such as alendronate sodium to swallow the tablet whole with water at least 30 min before breakfast and not to lie down for at least 30 min; instruct to alternate nares when using nasal spray of calcitonin; avoid foods rich in calcium (green, leafy vegetables; dairy products; shellfish; and soy) when using antihypercalcemic agents; instruct not to take other meds within 1h of taking a calcium sup; instruct to increase fluid and fiber in the diet to prevent constipation.
6
Q
Corticosteroids: Mineralocorticoids
A
- fludrocortisone acetate
- enhance reabsorption of sodium and chloride and promote the excretion of potassium and hydrogen from the renal tubules, thereby helping maintain fluid and electrolyte balance.
- used for replacement therapy in primary and secondary adrenal insufficiency in Addison’s disease.
- side and adverse effects: sodium and water retention, edema, hypertension, hypokalemia, hypocalcemia, osteoporosis (compression fractures), weight gain, heart failure.
- interventions: instruct to take med with food or milk; consume high-potassium diet; not to stop the med abruptly because could result in adrenal insufficiency; notify PHCP if low BP, weakness, cramping, palpitations, or changes in mental status occur.
7
Q
Corticosteroids: Glucocorticoids
(Betamethasone, Cortisone acetate, Dexamethasone, Hydrocortisone, Methylprenisolone, Prednisolone, Prednisone, Triamcinolone).
- description, side and adverse effects
A
- affect glucose, protein, and bone metabolism; alter the normal immune response and suppress inflammation; and produce antiinflammatory, antiallergic, and antistress effects; may be used as a replacement in adrenocortical insufficiency.
- used for their antiinflammatory and immunosuppressant effects both short-term and long-term in the treatment of several nonendocrine disorders.
- side and adverse effects: adrenal insufficiency, hyperglycemia, hypokalemia, hypocalcemia, osteoporosis, sodium and fluid retention, weight gain and edema, moon face, buffalo hump, truncal obesity, increased susceptibility to infection (and masking symptoms of infection), cataracts, hirsutism, acne, fragile skin, bruising, growth retardation in children, GI irritation, peptic ulcer, pancreatitis, seizures, psychosis.
8
Q
Corticosteroids: Glucocorticoids
- contraindications and interventions
A
- contraindicated in clients with hypersensitivity, psychosis, and fungal infections.
- should be used with caution in clients with DM.
- should be used with extreme caution in clients with infections because they may mask the signs.
- they can increase the potency of meds taken concurrently, such as aspirin and nonsteroidal antiinflammatory drugs, thus increasing the risk of GI bleeding and ulceration.
- use of potassium-losing diuretics increases potassium loss, resulting in hypokalemia.
- dexamethasone decreases the effects of orally adm anticoagulants and antidiabetic agents.
- barbiturates, phenytoin, and rifampin decrease the effect of prednisone.
- instruct client to take early morning with food or milk; advise to eat foods high in potassium.
- notify if signs of Cushing’s syndrome, not to stop the med abruptly because can result in severe adrenal insufficiency.
- consult PHCP before receiving vaccines.
- note that the client may need additional doses during periods of stress, such as surgery.
9
Q
Androgens
A
- used to replace deficient hormones or to treat hormone-sensitive disorders.
- can cause bleeding if the client is taking oral anticoagulants (increase effect).
- can cause decreased glucose, thereby reducing insulin requirements in clients with DM.
- hepatotoxic meds are avoided with the use of androgens because of the risk of additive damage to the liver.
- androgens are usually avoided in men with known prostate or breast carcinoma, because it often stimulate growth of these tumors.
- side and adverse effects: masculine secondary sexual characteristics; bladder irritation and UTI; breast tenderness; gynecomastia; priapism; menstrual irregulatities; virilism; sodium and water retention with edema; nausea, vomiting, or diarrhea; acne; changes in libido; hepatotoxicity, jaundice; hypercalcemia.
- instruct the client to take med with meals or a snack; instruct women to use a non-hormonal contraceptive while on therapy.
10
Q
Estrogens and Progestins: description and contraindications
A
- estrogens are steroids that stimulate female reproductive tissue; progestins are steroids that specifically stimulate the uterine lining.
- both may be used to stimulate the endogenous hormones to restore hormonal balance or to treat hormone-sensitive tumors (suppress tumor growth) or for contraception.
- estrogen contraindications: clients with breast cancer, endometrial hyperplasia, endometrial cancer, history of thromboembolism, known or suspected pregnancy, or lactation; with caution in clients with hypertension, gallbladder disease, or liver or kidney dysfunction; estrogens increase the risk of toxicity when used with hepatotoxic meds; barbiturates, phenytoin, and rifampin decrease the effectiveness of estrogen.
- progestins contraindications: clients with thromboembolic disorders and should be avoided in clients with breast tumors or hepatic disease.
11
Q
Estrogens and Progestins: side and adverse effects; interventions
A
- side and adverse effects: breast tenderness, menstrual changes; nausea, vomiting, and diarrhea; malaise, depression, excessive irritability; weight gain; edema and fluid retention; atherosclerosis; hypertension, stroke, myocardial infarction; thromboembolism (estrogen); migraine headaches and vomiting (estrogen).
- interventions: monitor VS, assess for edema and weight gain; advise client not to smoke and to undergo routine breast and pelvic examinations.
12
Q
Medications for DM: insulin and oral antidiabetic meds
A
- insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose level.
- oral antidiabetic agents act in a number of ways: stimulate the pancreas to produce more insulin, increase the sensitivity of peripheral receptors to insulin, decrease hepatic glucose output, delay intestinal absorption of glucose, enhance the activity of incretins, and promote glucose loss through the kidney.
- contraindications and concerns: oral agents, except the sodium-glucose cotransporter 2 (SGLT-2) inhibitors, are contraindicated in type 1 DM; B-adrenergic blocking agents may mask signs and symptoms of hypoglycemia associated with hypoglycemia-producing meds; anticoagulants, chloramphenicol, salicylates, proponolol, monoamine oxidase inhibitors, pentamidine, and sulfonamides may cause hypoglycemia; corticosteroids, sympathomimetics, thiazide diuretics, phenytoin, thyroid preparations, oral contraceptives, and estrogen compounds may cause hyperglycemia.
- side and adverse effects of the sulfoylureas include GI symptoms and dermatological reactions; hypoglycemia can occur when excessive dose is adm or when meals are omitted or delayed, food intake is decreased, or activity is increased. Can also cause a disulfiram type of reaction when alcohol is ingested.
13
Q
Medications for DM: insulin
A
- acts primarily in the liver, muscle, and adipose tissue by attaching to receptors on cellular membranes and facilitating the passage of glucose, potassium, and magnesium.
- avoid exposing insulin to extreme temperatures; should not be frozen or kept in direct sunlight or a hot car; before injection, insulin should be at room temp; if a vial of insulin will be used up in 1 month, it may be kept at room temp, otherwise, the vial should be refrigerated.
14
Q
Insulin injection
A
- the main areas for injections are the abdomen, arms, (posterior surface), thighs (anterior surface), and hips.
- insulin injected into the abd may absorb more evenly and rapidly than at other sites.
- systemic rotation within 1 anatomical area is recommended to prevent lipodystrophy and to promote more even absorption; clients should be instructed not to use the same site more than oncec in a 2-3 week period.
- injections should be 1 to 1.5 inches (2.5-3.8cm) apart within the anatomical area.
- heat, massage, and exercise of the injected area can increase absorption rates and may result in hypoglycemia; injection into scar tissue may delay absorption.
15
Q
Administering insulin
A
- insulin glargine cannot be mixed with any other types of insulin.
- most insulin syringes have a 27-29 gauge needle that is about 0.5-inch long (1.3cm).
- NPH is a insulin suspension; the appearance is cloudy; all other insulin types are solutions, appearance is clear.
- before use, NPH must be rotated, or rolled, between the palms to ensure that the insulin suspension is mixed well; vigorously shaking the bottle will cause bubbles to form. It is not necessary to rotate or roll clear insulins before use.
- when mixing insulins, draw up the shortest-acting insulin first.
- short-duration (regular, lispro, aspart, and glusine) insulin may be mixed with NPH.
- adm a mixed dose within 5-15 min of preparation; after this time, the short-acting insulin binds with the NPH and its action is reduced.
