Endocrine Meds

Question 1

Insulins

Answer 1

Rapid Acting: Lispro
- Onset: 15-30 mins
- Peak: 0.5-2.5 hrs
-Duration: 3-6 hrs

Short Acting: Regular
- Onset: 0.5-1 hr
-Peak: 1-5 hrs
- Duration: 6-10 hrs

Intermediate Acting: NPH
-Onset: 1-2 hrs
-Peak: 6-14 hrs
-Duration: 16-24 hrs

Long Acting: Glargine/Lantis
-Onset: 70 mins
-Peak: none
-Duration: 24 hrs

Facts:
- “Listen Read Not Glarine” fastest to slowest
- air in NPH, air in R, draw R, draw NPH
- 70/30 rule with 70% lispro or glargine + 30% regular
-take 15-30 mins before meal (depending on how fast it works)
- keep unopened bottles in fridge, open ones room temp

Question 1

Oral Hypoglycemics

Answer 1

• Metformin
• Sitagliptin
• Repaglinide
• Nateglinide
• Glyburide

Facts:
- avoid during pregnancy and lactation
- Drink 2-3 L of water daily
- withold 48 hours prior to and 48 hours after a test with contrast dye (metformin)
- contraindicated for clients with severe infection, shock, or hypoxic conditions (metformin)
-take metformin with food
- metformin not for alcoholics

Question 2

Thyroid Hormones

Answer 2

Hypothyroidism:
-Levothyroxine

Facts:
-treats hypothyroidism
-can cause: tachycardia, restlessness, diarrhea, weight loss, decreased bone density, insomnia
- take in early morning
- Do not take with calcium

Hyperthyroidism:
- Methimazole
-Propylthiouracil

Facts:
- treats hyperthyroidism and thryoid storm
- discontinue prior to radioactive iodine testing
- do not take while breastfeeding
- Can cause rash, hair loss, Gi upset, parasthesias, periorbital edema, joint and muscle pain, juandice, agranulocytosis (low neutrophils), thrombocytopenia
-administer with food at same time each day
- 3L of fluid daily
- taper off medicine
- increase in ability to focus means that the med is working/effective

Question 3

Pituitary/Growth Hormones

Answer 3

Anterior Pituitary
- Somatropin

Facts:
- treats growth hormone deficiencies and Turner’s syndrome (short height)
- do not use with glucocorticoids
- do not give to clients who are obese
- discontinue prior to epiphyseal closure
-can cause hyperglycemia and hypothyroidism
-subcutaneous only
-dose is individualized

Posterior Pituitary:
- Desmopressin
- Vasopressin

Facts:
- used for diabetes insipidus (low ADH), cardiac arrest, hemophilia
- do not give to clients with chronic nephritis or MI risk
- can cause hyponatremia, seizures, and coma

Question 4

Adrenal Hormone Replacement

Answer 4

• Dexamethasone
• Hydrocortisone
• Fludocortisone acetate (can cause thinning of skin)
• Prednisone

Facts:
-used for replacement of cortisol in addison’s disease, allergic reaction, cancer, inflammation
-do not give to clients with systemic fungal infection, hypertension, hyperglycemia, osteoporosis
- can cause GI bleed, fluid retention, osteoporosis, infection, hyperglycemia
- do not skip doses, give with food, provide immunoprotection