Endocrine System Flashcards
Adverse Effects
Sulfonylureas - glipizide
Hypoglycemia
Nausea, diarrhea
Medication Administration
Sulfonylureas - glipizide
Give orally 30 minutes before selected meal
Make sure clients swallow the sustained-release form whole and do not crush or chew it
Client Education
Sulfonylureas - glipizide
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
Interactions
Sulfonylureas - glipizide
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
Client Education
Meglinitides - repaglinide
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
Nursing Interventions
Meglinitides - repaglinide
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
Client Education
Biguanides - metformin
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
Interactions
Biguanides - metformin
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
Nursing Interventions
Thiazolidinedione or Glitazones - pioglitazone
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
Evaluation of Medication Effectiveness
Thiazolidinedione or Glitazones - pioglitazone
Pre-prandial glucose levels 90-130 mg/dL and postprandial levels less than 180 mg/dL
HbA1c less than 7%
Adverse Effects
Alpha-glucosidase Inhibitor - acarbose
Gastrointestinal effects (distention, flatus, hyperactive bowel sounds, diarrhea)
Hypoglycemia (combination therapy with insulin or a sulfonylurea)
Liver dysfunction
Anemia
Medication Administration
Alpha-glucosidase Inhibitor - acarbose
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
Therapeutic Effects
Gliptins - sitagliptin
Treats type 2 diabetes alone or in combination with other drugs for diabetes
Contraindications
Gliptins - sitagliptin
Hypersensitivity Type 1 diabetes Diabetic ketoacidosis Hemodialysis Moderate to severe renal dysfunction History of pancreatitis
Therapeutic Effects
Insulin
Diabetes mellitus (type 1, 2, gestational)
Adverse Effects
Insulin
Hypoglycemia
Injection site reactions - lipodystrophy or lipohypertrophy
Hypersensitivity to insulin
Allergic response
Interactions
Insulin
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)
Adverse Effects
Amylin Mimetics - pramlintide
Hypoglycemia (severe) when combined with insulin
Nausea
Injection site reactions
Client Education
Amylin Mimetics - pramlintide
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
Medication Administration
Incretin Mimetics - exenatide
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
Contraindications
Incretion Mimetics - exanatide
Renal impairment Type 1 diabetes mellitus Diabetic ketoacidosis Severe gastrointestinal disease Pregnancy - teratogenic effects Children
Therapeutic Effect
glucagon
Hypoglycemia from an insulin overdose
Evaluation of Medication Effectiveness
gulucagon
Elevation in blood glucose level greater than 70 mg/dL
Medication Administration
Thyroid Replacement - levothyroxine
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
Client Education
Thyroid replacement - levothyroxine
Watch for and report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and chest pain
Contraindications
Thyroid replacement - levothyroxine
Thyrotoxicosis Recent myocardial infarction Cardiovascular disorders (hypertension, angina pectoris, ischemic heart disease) Renal impairment Diabetes mellitus Older adults
Evaluation of Medication Administration
Thyroid replacement - levothyroxine
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)
Therapeutic Effect
Thioamides - propylthiouracil
Hyperthyroidism (Graves’ disease)
Thyrototoxic crisis
Suppression of thyroid hormone production in preparation of thyroid-ectomy
Adverse Effects
Thioamides - propylthiouracil
Hypothyroidism Agranulocytosis Hepatotoxicity Aplastic anemia Rash Arthralgia, headache Vertigo, drowsiness, headache
Evaluation of Medication Effectiveness
Thioamides - propylthiouracil
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)
Client Education
Anti-thyroid drug - Radioactive Iodine
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
Contraindications
Anti-thyroid drug - Radioactive Iodine
Pregnancy - teratogenic effects
Lactation
Children prior to puberty
Interactions
Growth Hormone - somatropin
Glucocorticoids and adrenocorticotropic hormone counteract growth-stimulation effects
Thyroid hormones, estrogens, and androgens promote epiphyseal closure
Evaluation of Medication Effectiveness
Growth Hormone - somatropin
Increased growth (height and weight)
Nursing Interventions
Antidiuretic Hormone - desmopressin
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
Evaluation of Medication Effectiveness
Antidiuretic Hormone - desmopressin
Reduction in the large volumes of urine output associated with diabetes insipidus to normal levels of urine output (1.5 to 2L/24 hours)
Contraindications
Glucocorticoids - hydrocortisone
When given in small doses - none
Large doses - severe infections and live vaccines
Interactions
Glucocorticoids - hydrocortisone
When given in small doses - none
Large doses - oral contraceptives, phenytoin, phenobarbital, and rifampin
Therapeutic Effect
Mineralocorticoids - fludrocortisone
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
Adverse Effects
Mineralocorticoids - fludrocortisone
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
Evaluation of Medication Effectiveness
Mineralocorticoids - fludrocortisone
Relief of effect of adrenocortical deficiency (weakness, hypoglycemia, hyperkalemia, and fatigue) with minimal adverse effects
