Endocrine Meds Flashcards
Anterior Pituitary Inhibitor Drugs
Octreotide (Sandostatin)
Inhibits growth hormone, promotes fluid and electrolyte reabsorption. Indicated for the treatment of Acromegaly and severe diarrhea and flushing episodes associated with metastatic tumors.
- Common adverse effects include: Dysrhythmias, heart failure, HA, hyper and hypoglycemia, GI complaints, fatigue and dizziness, cholelithiasis
Anterior pituitary stimulating drugs
Somatropin (Genotropin, Serostim, Nutropin)
Growth hormone replacement. Indicated for the treatment of growth failure due to growth hormone deficiency, AIDS wasting syndrome and short bowel syndrome.
- Contraindicated for treatment of growth failure after closure of the epiphyseal plates.
- Common Adverse effects include: HA, hyperglycemia, hypothyroidism, and ketosis.
Posterior pituitary drugs
Desmopressin (DDAVP), Vasopressin (Pitressin)
Indicated for the treatment of Diabetes Insipidus and nocturnal enuresis, normalizes urinary water excretion.
- Antidiuretic hormone preparation
- Contraindicated in patients with DI that is caused by renal disease as it can worsen fluid retention and overload
- Potent vasoconstrictor, use with caution in patients with known coronary artery disease or hypertension, and in patients at risk for hyponatremia or thrombi
- Monitor for signs and symptoms of water intoxication, ie: HA, listlessness, drowsiness
- Monitor intake and output.
Thyroid replacement
T4 Replacement: Levothyroxine (Levothroid, Synthroid),
T3 Replacement:
Liothyronine (Cytomel, Triostat)
Indicated for the treatment of hypothyroidism, myxedema and cretinism.
- Common adverse effects include insomnia and weight loss.
- Serious adverse effects include: hypertension, tachycardia, and cardiovascular collapse.
- Contraindicated with known cardiovascular disease
- Monitor for thyrotoxicosis.
- Replacement for hypothyroidism is life-long.
Antithyroid drugs
Methimazole (Tapazole), Propylthiouracil (PTU)
Indicated for the treatment of hyperthyroidism, Graves disease or thyrotoxicosis.
- Most common adverse effects include rash and leucopenia
- Rare but serious adverse effects include agranulocytosis and pancytopenia.
- Monitor CBC with differential and prothrombin time for bone marrow suppression, monitor TSH levels
- Teach patient to report any unusual bruising or bleeding
- Teach patient to avoid shellfish and iodine products.
Anti thyroid meds
Iodine
Potassium Iodide (SSKI)
Indicated for the treatment of hyperthyroidism to decrease the vascularity of the thyroid gland.
- Maximum effect after 15 days.
- Dilute and administer through straw after meals to prevent teeth discoloration
Rapid acting insulin
Common examples: Aspart (NovoLog), Lispro (Humalog), Glulisine (Apidra)
- Onset: 5-15 minutes. Administer with meals. DO NOT administer unless meal is readily available.
- Peak: 1-3 hours, Duration: 3-5 hours.
- Monitor for hypoglycemia, hypokalemia, lipodystrophy.
- Always have oral carbohydrate available.
- May be given as a short-term IV therapy with very close monitoring
Short acting/regular insulin
Humulin R, Novolin R,
- Onset: 30 minutes to 1 hour, Peak: 2-4 hours, Duration: 6-8 hours.
- Used for dosing patients with Sliding Scale
- Can be administered IVP or via continuous infusion.
- Monitor for hypoglycemia, hypokalemia, lipodystrophy.
- Always have oral carbohydrate available.
Intermediate acting
Isophane suspension (NPH, Humulin N, Novolin N)
- Onset: 1-1.5 hours, Peak: 6-12 hours, Duration: 18-24 hours.
- Cloudy suspension. Can mix with Regular or Rapid Acting Insulin, draw up clear (Regular or Rapid Acting) then cloudy (NPH), “Clear to Cloudy.”
- Monitor for hypoglycemia, hypokalemia, lipodystrophy.
- Always have oral carbohydrate available.
Long acting insulin
Glargine (Lantus)
- Onset: 2-4 hours. No Peak, Duration: 24 hours.
- Once daily Subq injection provides 24 hour coverage.
- No peak, insulin delivered at steady level, less risk of hypoglycemia.
- Monitor for hypoglycemia, hypokalemia, lipodystrophy
- Always have oral carbohydrate available.
- DO NOT mix with any other insulin
Combination insulin
Humulin 70/30, NovoLog Mix 70/30 Humalog Mix 75/25, Humalog Mix 50/50,
- Intermediate Acting Insulin combined with either Rapid Acting or Short Acting (Regular) Insulin.
- Onset and Peak dependent on whether combined with a Rapid Acting or Short Acting Insulin. All provide 24 hour duration.
- Monitor for hypoglycemia, hypokalemia, lipodystrophy.
- Always have oral carbohydrate available.
Antidiabetic sulfonyureas
1st Generation: Tolbutamide (Orinase), Chlorpropamide (Diabinese)
2nd generation: Glipizide (Glucotrol), Glyburide (Diabeta, Glynase), Glimepride (Amaryl)
- Stimulates the release of insulin from the pancreas.
- Monitor for hypoglycemia. Second generation Sulfonyureas have a higher hypoglycemic potency.
- Adverse effects include: cholestatic jaundice, blood dyscrasias, GI complaints, HA, dizziness
Antidiabetic
Biguanides
Metformin (Glucophage, Glucophage XR)
- Decreases the rate of hepatic glucose production and lowers the glucose uptake by the tissues.
- Less likely to cause hypoglycemia.
- Adverse effects include: multiple GI complaints. GI disturbances may limit its usefulness in certain patients.
- Rare Adverse Effect: Lactic Acidosis. Not recommended in patients with renal insufficiency.
Alpha-Glucosidase Inhibitors
Acarbose (Precose), Miglitol (Glyset)
- Delays absorption of glucose from the GI tract.
- Less likely to cause hypoglycemia.
- Adverse effects include: flatulence, abdominal cramps, diarrhea.
- Can be hepatotoxic. Monitor liver functions every 3 months for the first year of therapy and periodically thereafter.
- May be used in combination with a Sulfonyurea.
Thiazolidineodiones “Glitazones”
Rosiglitazone (Avandia), Pioglitazone (Actos)
- Improves glucose uptake in the muscles, decreases endogenous glucose production.
- Monitor for hypoglycemia.
- Should be avoided in patients with symptomatic heart disease. May cause heart failure or MI.
- Can be hepatotoxic, monitor ALT level.
- Added benefit: lowers triglyceride level.
- Effect on cholesterol: may raise LDL (bad thing) and raise HDL (good thing).
