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Pharmacology > Endocrine System > Flashcards

Endocrine System Flashcards

1
Q

Adverse Effects

Sulfonylureas - glipizide

A

Hypoglycemia

Nausea, diarrhea

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2
Q

Medication Administration

Sulfonylureas - glipizide

A

Give orally 30 minutes before selected meal

Make sure clients swallow the sustained-release form whole and do not crush or chew it

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3
Q

Client Education

Sulfonylureas - glipizide

A

Wear a medical alert bracelet
Watch for and report symptoms of hypoglycemia. Test blood glucose to confirm. Consume a snack of carbohydrates. Retest in 15-20 minutes and repeat if still low. Carry a carbohydrate snack at all times

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4
Q

Interactions

Sulfonylureas - glipizide

A

Alcohol poses a risk for a disulfiram (Antabuse)-like reaction (nausea, palpitations, flushing) and increases hypoglycemic effects
Sulfonamide antibiotics, NSAIDs, oral anticoagulants, salicylates, MAOI, and cimetidine (Tagamet) increases hypoglycemic effects
Thiazides counteract hypoglycemic effects
Beta blockers mask manifestations of hypoglycemia

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5
Q

Client Education

Meglinitides - repaglinide

A

Wear a medical alert bracelet
Watch for and report symptoms of hypoglycemia
Test blood glucose to confirm
If hypoglycemia occurs, advise patient to take a glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water (glucose, not table sugar, if taking miglitol), and notify health care professional
Retest in 15 to 20 minutes and repeat treatment if still low
Carry a carbohydrate snack at all times
Lie down when feeling nauseated
Consume adequate carbohydrates

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6
Q

Nursing Interventions

Meglinitides - repaglinide

A

Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors)
If the client is conscious, give glucose orally in either form, 2-3 tsp of sugar, glass of orange juice, honey, or corn syrup dissolved in a glass of water
If the client is not conscious, give intravenous glucose; give parenteral glucagon if IV not available
Check the clients blood glucose ever 15-20 minutes
Continue treatment until blood glucose has returned to the expected reference range and the client is no longer symptomatic
Monitor for persistent nausea, vomiting, or diarrhea
Monitor CBC levels

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7
Q

Client Education

Biguanides - metformin

A

Avoid drinking alcohol
Report weakness, fatigue, lethargy, or hyperventilation
If these symptoms develop, stop taking the drug and seek medical care immediately
Expect these effects to diminish as drug therapy continues
Lie down when feeling nauseated
Maintain adequate carbohydrate and fluid intake
Report weakness, fatigue, pallor, or reddened tongue

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8
Q

Interactions

Biguanides - metformin

A

Alcohol and cimetidine (Tagamet) increase the risk of lactic acidosis
Any contrast medium containing iodine increases the risk of acute renal failure, thus worsening lactic acidosis. Drug should be stopped 24 hours before dye is used and started 48 hours after test is completed
Nifedipine (Procardia), furosemide (Lasix), morphine, ranitidine (Zantac), antifungals, and many other drugs increase hypoglycemic effects

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9
Q

Nursing Interventions

Thiazolidinedione or Glitazones - pioglitazone

A

Monitor for edema, weight gain, or indications of heart failure. Hepatotoxicity
Obtain serum alanine aminotransferase (ALT) levels: baseline and every 3-6 months thereafter
Stop drug therapy for indications of liver injury
Monitor serum lipid levels
Watch for increases in triglycerides
Watch for increases in both high-density (favorable) and low-density (unfavorable) lipoproteins

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10
Q

Evaluation of Medication Effectiveness

Thiazolidinedione or Glitazones - pioglitazone

A

Pre-prandial glucose levels 90-130 mg/dL and postprandial levels less than 180 mg/dL
HbA1c less than 7%

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11
Q

Adverse Effects

Alpha-glucosidase Inhibitor - acarbose

A

Gastrointestinal effects (distention, flatus, hyperactive bowel sounds, diarrhea)
Hypoglycemia (combination therapy with insulin or a sulfonylurea)
Liver dysfunction
Anemia

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12
Q

Medication Administration

Alpha-glucosidase Inhibitor - acarbose

A

Give with the first bite of food, three times a day
Tell clients who skip a meal to also skip the dose usually taken with that meal ad to take only one dose at the next meal

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13
Q

Therapeutic Effects

Gliptins - sitagliptin

A

Treats type 2 diabetes alone or in combination with other drugs for diabetes

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14
Q

Contraindications

Gliptins - sitagliptin

A 
Hypersensitivity
Type 1 diabetes
Diabetic ketoacidosis
Hemodialysis
Moderate to severe renal dysfunction
History of pancreatitis
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15
Q

Therapeutic Effects

Insulin

A

Diabetes mellitus (type 1, 2, gestational)

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16
Q

Adverse Effects

Insulin

A

Hypoglycemia
Injection site reactions - lipodystrophy or lipohypertrophy
Hypersensitivity to insulin
Allergic response

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17
Q

Interactions

Insulin

A

Sulfonylureas, meglitinides, beta blockers, salicylates, and alcohol increase hypoglycemic effects
Thiazide and loop diuretics, sympathomimetics, thyroid hormones, and glucocorticoids increase blood glucose levels, thus counteracting hypoglycemic effects
Beta blockers mask manifestations of hypoglycemia (tachycardia, tremors)

18
Q

Adverse Effects

Amylin Mimetics - pramlintide

A

Hypoglycemia (severe) when combined with insulin
Nausea
Injection site reactions

19
Q

Client Education

Amylin Mimetics - pramlintide

A 
Wear a medical alert bracelet
Watch for and report symptoms of hypoglycemia, especially 3 hr after dosing. Test blood glucose to confirm, then consume a snack of carbohydrates, and retest in 15-20 minutes and repeat if still low
Carry a carbohydrate snack at all times
Lie down when feeling nauseated
Instruct on proper injection technique
20
Q

Medication Administration

Incretin Mimetics - exenatide

A

Injection considerations - give subcutaneously into the thigh, abdomen, or upper arm up to 60 minutes prior to the morning and evening meals, not after meals. Rotate injection sites. Expect the peak action 2 hours after dosing
Preparation and care of the injection pen - Available in 5 mcg and 10 mcg doses. Follow manufacturer’s instructions for “new pen setup”. Use needle size prescribed by provider. Use new needle each time injection pen is used. Keep pens in use at room temperature up to 30 days. Do not store pens with needle attached. Refrigerate unused injector pens until their expiration date

21
Q

Contraindications

Incretion Mimetics - exanatide

A 
Renal impairment
Type 1 diabetes mellitus
Diabetic ketoacidosis
Severe gastrointestinal disease
Pregnancy - teratogenic effects
Children
22
Q

Therapeutic Effect

glucagon

A

Hypoglycemia from an insulin overdose

23
Q

Evaluation of Medication Effectiveness

gulucagon

A

Elevation in blood glucose level greater than 70 mg/dL

24
Q

Medication Administration

Thyroid Replacement - levothyroxine

A

Give orally to treat hypothyroidism and IV to treat myxedema coma
Give daily (usually in the morning) on an empty stomach (at least 30-60 minutes before breakfast with a full glass of water)
Measure baseline vital signs, weight, and height, and monitor periodically thereafter
Monitor for cardiac excitability (angina, chest pain, palpitations, dysrhythmias)
Monitor T4 and TSH levels
Be aware that the various formulations of thyroxine are not interchangeable; instruct client to notify the provider of a pharmacy dispenses a different levothyroxine product
Expect life-long replacement therapy

25
Q

Client Education

Thyroid replacement - levothyroxine

A

Watch for and report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and chest pain

26
Q

Contraindications

Thyroid replacement - levothyroxine

A 
Thyrotoxicosis
Recent myocardial infarction
Cardiovascular disorders (hypertension, angina pectoris, ischemic heart disease)
Renal impairment
Diabetes mellitus
Older adults
27
Q

Evaluation of Medication Administration

Thyroid replacement - levothyroxine

A

Decreased TSH levels. Evaluation of TSH should not be done until 6 to 8 weeks following the start of treatment
T4 levels within expected reference range
Absence of hypothyroidism manifestations (depression, weight gain, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia)

28
Q

Therapeutic Effect

Thioamides - propylthiouracil

A

Hyperthyroidism (Graves’ disease)
Thyrototoxic crisis
Suppression of thyroid hormone production in preparation of thyroid-ectomy

29
Q

Adverse Effects

Thioamides - propylthiouracil

A 
Hypothyroidism
Agranulocytosis
Hepatotoxicity
Aplastic anemia
Rash
Arthralgia, headache
Vertigo, drowsiness, headache
30
Q

Evaluation of Medication Effectiveness

Thioamides - propylthiouracil

A

Weight gain
Vital signs within expected reference range
Decreased T4 levels
Absence of manifestations of hyperthyroidism (anxiety, tachycardia, palpitations, increased appetite, abdominal cramping, health intolerance, fever, diaphoresis, weight loss, menstrual irregularities)

31
Q

Client Education

Anti-thyroid drug - Radioactive Iodine

A

Watch for and report anxiety, drowsiness, depression, weight gain, swelling, slow heart rate, appetite loss, cold intolerance, dry skin
Report fever, sore throat, weakness, or fatigue
Report bloody vomit, nosebleeds, or severe nausea and vomiting

32
Q

Contraindications

Anti-thyroid drug - Radioactive Iodine

A

Pregnancy - teratogenic effects
Lactation
Children prior to puberty

33
Q

Interactions

Growth Hormone - somatropin

A

Glucocorticoids and adrenocorticotropic hormone counteract growth-stimulation effects
Thyroid hormones, estrogens, and androgens promote epiphyseal closure

34
Q

Evaluation of Medication Effectiveness

Growth Hormone - somatropin

A

Increased growth (height and weight)

35
Q

Nursing Interventions

Antidiuretic Hormone - desmopressin

A

Monitor for headache, confusion, or other signs of water intoxication
Monitor fluid intake and output
Monitor serum and sodium levels
Restrict fluid intake when appropriate
Recommend diuretic therapy for moderate and severe fluid retention

36
Q

Evaluation of Medication Effectiveness

Antidiuretic Hormone - desmopressin

A

Reduction in the large volumes of urine output associated with diabetes insipidus to normal levels of urine output (1.5 to 2L/24 hours)

37
Q

Contraindications

Glucocorticoids - hydrocortisone

A

When given in small doses - none

Large doses - severe infections and live vaccines

38
Q

Interactions

Glucocorticoids - hydrocortisone

A

When given in small doses - none

Large doses - oral contraceptives, phenytoin, phenobarbital, and rifampin

39
Q

Therapeutic Effect

Mineralocorticoids - fludrocortisone

A

Replacement therapy for acute and chronic adrenocortical insufficiency (Addison’s disease - use caution as clients with Addison’s may have an exaggerated response, primary hyperaldosteronism, congenital adrenal hyperplasia), usually along with hydrocortisone

40
Q

Adverse Effects

Mineralocorticoids - fludrocortisone

A

Few at low, therapeutic levels
At levels above that which is therapeutic, fluid and electrolyte imbalances that can lead to hypertension, edema, heart failure, hypokalemia

41
Q

Evaluation of Medication Effectiveness

Mineralocorticoids - fludrocortisone

A

Relief of effect of adrenocortical deficiency (weakness, hypoglycemia, hyperkalemia, and fatigue) with minimal adverse effects

Pharmacology (9 decks)

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