Endocrine Meds Flashcards
What are the indications for Desmopressin?
-PO: SL: SC: IV: Intranasal: Treatment of central diabetes insipidus caused by a deficiency of vasopressin.
-IV: Intranasal: Controls bleeding in certain types of hemophilia and von Willebrand’s disease.
Intranasal: Nocturia due to nocturnal polyuria in patients who awaken ≥2 times per night to void (Noctiva only)
-SL: Nocturia in adults with ≤4 nocturnal voids (Noctdurna only)
-PO: SL: Primary nocturnal enuresis.
What are the indications for Conivaptan
To increase serum sodium in hospitalized patients with euvolemic or hypervolemic hyponatremia.
What are the indications for Tolvaptan?
Treatment of significant hypervolemic and euvolemic hyponatremia (serum sodium <125 mEq/L or less marked symptomatic hyponatremia that has resisted correction by fluid restriction), including patients with heart failure and syndrome of inappropriate antidiuretic hormone (SIADH)
What are the indications for glucocorticoids?
Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity.
Replacement therapy in adrenal insufficiency.
What are the indications for Mineralocorticoids?
Sodium loss and hypotension associated with adrenocortical insufficiency (given with hydrocortisone or cortisone).
Management of sodium loss due to congenital adrenogenital syndrome (congenital adrenal hyperplasia).
What are two common Thionamide Medications?
Tapazole, Propylthiouracil
What are the indications for Thionamide medications?
Palliative treatment of hyperthyroidism.
Used as an adjunct to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
What are the indications for Synthroid (levothyroxine)?
- Thyroid supplementation in hypothyroidism.
- Treatment or suppression of euthyroid goiters.
- Adjunctive treatment for thyrotropin-dependent thyroid cancer.
What are the indications for radioactive iodine (I-131)
Imaging for thyroid assessment
What is the MOA for Desmopressin?
An analogue of naturally occurring vasopressin (antidiuretic hormone). Primary action is enhanced reabsorption of water in the kidneys.
What is the MOA for Conivaptan?
Antagonizes vasopressin at V2 receptor sites in renal collecting ducts, resulting in excretion of free water.
Therapeutic Effect(s):
Increased serum sodium concentrations.
Improved fluid status.
What is the MOA of Tolvaptan?
Acts as a selective vasopressin V2-receptor antagonist, resulting in increased renal water excretion and increased serum sodium.
Therapeutic Effect(s):
Correction of hyponatremia.
What is the MOA of Glucocorticoids?
- Suppression of inflammation and modification of the normal immune response.
- Replacement therapy in adrenal insufficiency
What is the MOA for mineralocorticoids?
Causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule.
Therapeutic Effect(s):
Maintenance of sodium balance and BP in patients with adrenocortical insufficiency.
What is the MOA for Tapazole?
Inhibits the synthesis of thyroid hormones.
Therapeutic Effect(s):
Decreased signs and symptoms of hyperthyroidism
What is the MOA for Propylthiouracil?
Inhibits the synthesis of thyroid hormones.
Therapeutic Effect(s):
Decreased signs and symptoms of hyperthyroidism.
What is the moa of Synthroid?
Replacement of or supplementation to endogenous thyroid hormones.
-Principal effect is increasing metabolic rate of body tissues:
-Promote gluconeogenesis,
-Increase utilization and mobilization of glycogen stores,
-Stimulate protein synthesis,
Promote cell growth and differentiation,
-Aid in the development of the brain and CNS.
Therapeutic Effect(s):
Replacement in hypothyroidism to restore normal hormonal balance.
Suppression of thyroid cancer.
What is the MOA of Radioactive Iodine (I-131)?
Binds to CD20 antigens on the surface of specific lymphocytes producing antibody-mediated cytotoxicity and cell death due to ionizing radiation.
What are the side/adverse effects of desmopressin?
CNS: SEIZURES, dizziness, drowsiness, headache, listlessness.
EENT: intranasal: epistaxis, nasal congestion, nasal discomfort, rhinitis, sneezing
Resp: dyspnea
CV: hypertension, hypotension, tachycardia (large IV doses only)
GI: mild abdominal cramps, nausea
GU: vulval pain
Derm: flushing
F and E: fluid retention, hyponatremia
MS: back pain
Local: phlebitis at IV site
What are the side/adverse effects of conivaptan?
CNS: headache, confusion, insomnia
CV: hypertension, hypotension
GI: diarrhea
GU: ↓ fertility (females), polyuria
F and E: dehydration, hypokalemia, hypomagnesemia, hyponatremia
Local: infusion reactions
Misc: fever, thirst
What are the side/adverse effects of Tolvaptan?
CNS: weakness
GI: HEPATOTOXICITY, constipation, dry mouth
GU: polyuria
F and E: thirst
Metabolic: hyperglycemia
Neuro: osmotic demyelination
Misc: ANAPHYLAXIS
What are the side/adverse effects of Gulcocorticoids?
CNS: depression, euphoria, headache, ↑ intracranial pressure (children only), personality changes, psychoses, restlessness
EENT: cataracts, ↑ intraocular pressure
CV: hypertension
GI: PEPTIC ULCERATION, anorexia, nausea, vomiting
Derm: acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae
Endo: adrenal suppression, hyperglycemia
F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis
Hemat: THROMBOEMBOLISM, thrombophlebitis
Metabolic: weight gain, weight loss
MS: avascular necrosis of joints, muscle wasting, osteoporosis, muscle pain
Misc: cushingoid appearance (moon face, buffalo hump), ↑ susceptibility to infection
What are the side/adverse effects of mineralcorticoids?
CNS: dizziness, headache
CV: HF, arrhythmias, edema, hypertension
GI: anorexia, nausea
Endo: adrenal suppression, weight gain
F and E: hypokalemia, hypokalemic alkalosis
MS: arthralgia, muscular weakness, tendon contractures
Neuro: ascending paralysis
Misc: hypersensitivity reactions
What are the side/adverse effects for Tapazole?
CNS: drowsiness, headache, vertigo
GI: HEPATOTOXICITY, diarrhea, loss of taste, nausea, parotitis, vomiting
Derm: rash, skin discoloration, urticaria
Hemat: AGRANULOCYTOSIS, anemia, leukopenia, thrombocytopenia
MS: arthralgia
Misc: fever, lymphadenopathy
What are the side/adverse effects of Propylthiouracil?
CNS: drowsiness, headache, paresthesia, vertigo
CV: edema, vasculitis
GI: HEPATOTOXICITY, nausea, vomiting, diarrhea, loss of taste
Derm: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, exfoliative dermatitis, hair loss, skin discoloration, urticaria
Endo: hypothyroidism
GU: glomerulonephritis
Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, BLEEDING, leukopenia, thrombocytopenia
MS: arthralgia, myalgia
Resp: interstitial pneumonitis
Misc: fever, lymphadenopathy, parotitis, splenomegaly
What are the side/adverse effects of synthroid?
CNS: headache, insomnia, irritability
CV: angina pectoris, arrhythmias, tachycardia
GI: abdominal cramps, diarrhea, vomiting
Derm: sweating
Endo: hyperthyroidism, menstrual irregularities
Metabolic: heat intolerance, weight loss
MS: accelerated bone maturation in children
What are the side/adverse effects of Radioactive Iodine?
CNS: dizziness, drowsiness, headache, weakness
CV: edema, hypotension
GI: abdominal pain, diarrhea, nausea, vomiting
Endo: hypothyroidism
Hemat: NEUTROPENIA, THROMBOCYTOPENIA, anemia
Metabolic: weight loss
MS: arthralgia, back pain, myalgia, neck pain
Misc: HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS, infusional toxicity, fever, pain, secondary malignancies
What are the nursing considerations for Desmopressin
-Use cautiously in patients at risk for water intoxication with hyponatremia.
Monitor urine and plasma osmolality and urine volume frequently.
Assess patient for symptoms of dehydration
Weigh patient daily and assess for edema.
Monitor intake and output and adjust fluid intake (especially in children and elderly) to avoid overhydration
What are the nursing considerations for Conivaptan?
May cause hyperglycemia, hypoglycemia, hypokalemia, hypomagnesemia, and hyponatremia.
Frequently causes erythema, pain, swelling and phlebitis.
Monitor vital signs frequently during therapy. Discontinue therapy if patient becomes hypovolemic and hypotensive.
Assess neurologic status during administration. Overly rapid rise in serum sodium may cause neurologic sequelae.
What are the nursing considerations for Tolvaptan?
- Monitor neurologic status and assess for signs and symptoms of osmotic demyelination syndrome (trouble speaking, dysphagia, drowsiness, confusion, mood changes, involuntary movements, weakness, seizures)
- Monitor fluid balance. If hypovolemia occurs interrupt or discontinue tolvaptan and provide supportive care (monitor vital signs, balance fluid and electrolytes).
-Monitor for signs and symptoms of liver injury (fatigue, anorexia, right upper abdominal discomfort, dark urine, jaundice) periodically during therapy. If symptoms occur, discontinue therapy.