Endocrine Meds

Question 1

What are the indications for Desmopressin?

Answer 1

-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.

Question 2

What are the indications for Conivaptan

Answer 2

To increase serum sodium in hospitalized patients with euvolemic or hypervolemic hyponatremia.

Question 3

What are the indications for Tolvaptan?

Answer 3

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)

Question 4

What are the indications for glucocorticoids?

Answer 4

Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity.
Replacement therapy in adrenal insufficiency.

Question 5

What are the indications for Mineralocorticoids?

Answer 5

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).

Question 6

What are two common Thionamide Medications?

Answer 6

Tapazole, Propylthiouracil

Question 7

What are the indications for Thionamide medications?

Answer 7

Palliative treatment of hyperthyroidism.

Used as an adjunct to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.

Question 8

What are the indications for Synthroid (levothyroxine)?

Answer 8

• Thyroid supplementation in hypothyroidism.
• Treatment or suppression of euthyroid goiters.
• Adjunctive treatment for thyrotropin-dependent thyroid cancer.

Question 9

What are the indications for radioactive iodine (I-131)

Answer 9

Imaging for thyroid assessment

Question 10

What is the MOA for Desmopressin?

Answer 10

An analogue of naturally occurring vasopressin (antidiuretic hormone). Primary action is enhanced reabsorption of water in the kidneys.

Question 11

What is the MOA for Conivaptan?

Answer 11

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.

Question 12

What is the MOA of Tolvaptan?

Answer 12

Acts as a selective vasopressin V2-receptor antagonist, resulting in increased renal water excretion and increased serum sodium.

Therapeutic Effect(s):

Correction of hyponatremia.

Question 13

What is the MOA of Glucocorticoids?

Answer 13

• Suppression of inflammation and modification of the normal immune response.
• Replacement therapy in adrenal insufficiency

Question 14

What is the MOA for mineralocorticoids?

Answer 14

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.

Question 15

What is the MOA for Tapazole?

Answer 15

Inhibits the synthesis of thyroid hormones.

Therapeutic Effect(s):

Decreased signs and symptoms of hyperthyroidism

Question 16

What is the MOA for Propylthiouracil?

Answer 16

Inhibits the synthesis of thyroid hormones.

Therapeutic Effect(s):

Decreased signs and symptoms of hyperthyroidism.

Question 17

What is the moa of Synthroid?

Answer 17

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.

Question 18

What is the MOA of Radioactive Iodine (I-131)?

Answer 18

Binds to CD20 antigens on the surface of specific lymphocytes producing antibody-mediated cytotoxicity and cell death due to ionizing radiation.

Question 19

What are the side/adverse effects of desmopressin?

Answer 19

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

Question 20

What are the side/adverse effects of conivaptan?

Answer 20

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

Question 21

What are the side/adverse effects of Tolvaptan?

Answer 21

CNS: weakness

GI: HEPATOTOXICITY, constipation, dry mouth

GU: polyuria

F and E: thirst

Metabolic: hyperglycemia

Neuro: osmotic demyelination

Misc: ANAPHYLAXIS

Question 22

What are the side/adverse effects of Gulcocorticoids?

Answer 22

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

Question 23

What are the side/adverse effects of mineralcorticoids?

Answer 23

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

Question 24

What are the side/adverse effects for Tapazole?

Answer 24

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

Question 25

What are the side/adverse effects of Propylthiouracil?

Answer 25

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

Question 26

What are the side/adverse effects of synthroid?

Answer 26

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

Question 27

What are the side/adverse effects of Radioactive Iodine?

Answer 27

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

Question 28

What are the nursing considerations for Desmopressin

Answer 28

-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

Question 29

What are the nursing considerations for Conivaptan?

Answer 29

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.

Question 30

What are the nursing considerations for Tolvaptan?

Answer 30

• 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.