Endocrine System(Pharm) Flashcards
Glyburdie(Micronase/DiaBeta)
Generica Name: Glyburdie Trade Name: Micronase/DiaBeta Sulfonylureas(drugs) -Second generation -last longer 12-24hrs -2.5-20mg dose-
Vasopressin(Pitressin)
Generic Name:Vasopressin Trade Name: Pitressin Posterior lobe agent Antidiretic Hormone -taken 1-2x a day -5-10u tid, nasal spray,subq,im -tannate(in oil) last for 48-96hr
Levothyroxine(Synthroid)
Generic Name: Levothyroxine
Trade Name: Synthroid
-avg dose:100-125mcg
thyroid replacement drug
-increase metabolic rate by replace t4
-use: hypothyroidism(myxedema), hyposecretion of the thyroid
-interaction with oral coag, epi,antidepressants,antidiabetic agent,cns depressents
Propylthiouracil(PTU)
Generic Name: Propylthiouracil Trade Name:PTU -indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid) -Thiouracil drug -100-150mg 1-4x a day -given for 6mos to several years
Calcitriol(Rocaltrol)
Generic Name: Calcitrol
Trade Name: Rocaltrol
Potassium Iodine(SSKI)
Generic Name: Potassium Iodine
Trade Name: SSKI
-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)
Saturated Solution(Lugols Iodine)
Generic Name: Saturated Solution
Trade Name: Lugols Iodine
Dempopressin(DDAVP)
Trade Name:Dempopressin Generic Name: DDAVP Posterior lobe agent Antidiretic Hormone -in posterior pituitary -hyposecretion results in diabetes insipidus -used for diabtes insipidus -post op abdominal disention -dispel gas interfering with x-ray -enuresis(bed wetting) -hemophilia type A
Calcitonin(Calcimar)
Generic Name: Calcitonin Trade Name: Calcimar -drug for hyperparathyroidism -synthetic hormone -turns off secretion of the hormone -calcitonin-salmon-check allergy to salmon -sq,im,intranasal -4-8units 1kg every 6-12hrs
Metformin HCL(Glucophage)
Generic Name: Metformin HCL Trade Name: Glucophage -oral hypoglycemics -Biquanides -500-1000mg 2x a day
Acarbose(Precose)
Generic Name: Acarbose Trade Name: Precose Acarbose(precose) Oral Hypoglycemics -Alpha glucosidase inhibitor drug -3x a day dose -must be taken with first bite of meal -if they do not eat do not take med
Chlorpropamide(Diabinese)
Generic Name: Chlorpropamide Trade Name: Diabinese -Sulfonylureas(drug First generation) -titrated(increase slowl) -avg. dose 150-250mg
Glimepiride(Amaryl)
Generic Name: Glimepiride Trade Name: Amaryl Sulfonylureas(drugs) -third generation -1-2mg once a day -given with breakfast/main meal of the day
Sitagliptin(Januvia)
Generic Name: Sitagliptin
Trade Name: Januvia
oral hypoglycemics
dipeptidyl peptidase
action: inhibit breakdown of incretin hormones, adjuvant to diet and excersie(type 2)
100 mg po daily
side effect:increase resp tract infection
monitor wbc for infection, and monitor resp tract
Endocrine glands
ductless glands that empty their secretions directly into the bloody stream
Hormones
chemical substances secreted by the endocrine glands
Pancreas
Beta cells of the Islet of Langerhans in the pancreas produce the hormone insulin
Insulin
hormones that regulate glucose metabolism and the transporting of glucose across the cell membrane
Indication
Diabetes Mellitus is a disorder of carbohydrate
Classification of Diabetes
Type 1: (IDDM) Insulin dependent diabetes mellitus=little to no insulin produced
Type 2: (NIDDM) non-insulin dependent diabetes mellitus=decrease in production of insulin, decrease in cell sensitivity to insulin, onset insidious, can treat with oral drug and/or insulin
Forms of Insulin
Animal:
1-Porcine: Pig
2-Bovine: Beef
Human
1-Synthetic: Humulin
2-Semisynthetic: Novolibn
Insulin strength/concentration
u100=every 1ml contains 100u
u500=every 1 ml contains 500u
u30
Insulin routes(SubCu)
1-Abdomen 2-Back of arm 3-Front of thigh 4-upper buttocks
- 90 degree angle
- no massage area
- massage will increase absorbtion rate
- rotate injection site to prevent lipodystrophy
Insulin routes(Insulin pump)
- must be able to follow direction
- human insulin in pump
- either rapid acting or short acting
- subCu
- can stay in place for 2-3 days
Insulin routes(IV/IVP)
-iv push and bolus dose
Classification
1)rapid 2)short 3)intermediate 4)Long acting 5)mixed insulin
properties- protein-decrease rate of absorption zinc-modify onset and duration -dose-determined by HCP -frequency once or twice a day
Rapid Acting Insulin
Insulin Lispro (Humalog) Insulin Aspart (Novolog) Insulin Glulisine (Apidra)
onsent: 15mins, novolog 10-20mins
peak: 1-2hrs
duration: 3-4 hrs
route: SC
hypoglycemia: before lunch
Short Acting Insulin
route: SC, only IV route
Insulin Regular(Humulin R, Novolin R)
- onset:30-60mins
- peak:2-4hrs
- duration:5-7hrs
- route:SC
- hypoglycemia before lunch
(IV) Insulin Regular(Humulin R, Novolin R)
route: iv
onset: 10-30min
peak: 15-30min
duration: 30-60min
Intermediate insulin
Insulin Isophane(NPH)-Humulin-N, Novolin-N
onset: 2-4 hrs
peak: 4-10hrs
duration: 10-16hrs
route: sc
hypoglycemia: 3pm to supper
Long Lasting Insulin
Insulin Detemir(Levemir)
onset: 3-4 hrs peak: 3-14hrs duration: 6-24hrs
route: SC
Insulin Glargine(Lantus) onset:3-4 peak:(none) duration: 24hrs route: SC
Mixed insulin
NPH and regular(Humulin 70/30, Humulin 50/50, Novolin 70/30) onset: 30min, peak: 2-3hrs, duration: 24hrs, route:sc
aspart protamine and aspart(Novolog 70/30) onset: 15min peak: 1-4hrs, duration:18-24hrs, route: sc
Lispro protamine and lispro(Humalog 75/25,Humalog 50/50) onset: 15-30min, peak: 4-8hrs, duration: 24hrs, route: sc
mixing insulin
- intermediate and mixed insulin=cloudy
- rapid, short, long=clear
- rotate in palms of hand to warm
- do not mix levemir/lantus(long acting insulin)
- air goes in cloudy first then clear, clear is withdrawn first then cloudy
- long lasting insulin is design to meet basal needs last for 24hrs period, pt should be educated to take at night, once a day, at the same time
storage of insulin
-stored in refrigerator unopened and unused, once open stored at room temp for a month
frequency of insulin
fingerstick AC(before meals) HS(hour of sleep)
- q6h if npo
- urine glucose, use fresh urine on second void
Hypoglycemia(side effects)
- N/v
- diarrhea, hunger, inability to concentrate
- confusion
- nervousness
- anxiety
- tremors
- tachycardia
Hypoglycemia(causes)
insulin reaction/shock
- too much insulin or wrong type
- delay or omission of food
- too much exercise
- illness, diarrhea and vomitting
Hypoglycemia(Findings)
- BS=below 60
- urine negative sugar ketones
Hypoglycemia(treatment)
10-15grams of simple CHO=to boost it
- 6oz fruit juice, non diet soda
- cube sugar, honey or corn syrup
- 5-6 life savers
- 2-3 glucose tabs or glucose gel
followed by complex CHO within 1hr=to maintain sugar level
- skim milk
- crackers, or meal
Hypoglycemia(treatment med)
glucagon 1mg(IM,IV,SQ)
- action: 20min
- increase bs by releasing glucose
- do not use with other meds
50% dw ivp or infusion
-followed by 5-10% to stabilze home care
Hyperglycemia(s/s)
- n/v
- ab pain, distention, anorexia, dry mouth
- irritability
- hot flushed skin
- fruity order to breath
- kussmuals resp., increase urinary output
Hyperglycemia(cause)
Hyperglycemia can lead to diabetic coma/ketoacidosis
- too little insulin, missed dose
- unregulated or extra meals
- stress
- increase alcohol
- injection
- n/v or diarrhea
Hyperglycemia(Findings & Tx)
- bs-over 150
- urine: positive sugar and ketones
- glucose cannot be used then fats are used for metabolism-ketones occur
- fluid and electrolyte imbalance
tx: regular insulin subQ or IV
Lipodystrophy
- destruction of fat tissue
- rotate site and store at room temp to prevent
allergic recation
local or systemic
- risk greater in animal insulin and cold insulin
- insulin resistance rare
- interaction:
- alcohol,steriods,NSAIDS,ASA,betablockers,diuretics,MAOI
Nursing considerations
- assess FS AC/HS
- FS 1/2 hr AC/HS
- weight change may indicate need for medication adjustment
- objective coordinate blood sugar testing, drug administration, diet and exercise
- exercise increases rate of absorption in insulin
- limit activity 30-60min after
- determine-onset,peak,and duration of insulin
- double check insulin type and dose
- absorption varies based on site,technique,formulation and excersice
- exercise limit 30-40min after meals
- prefilled
Oral Hypoglycemics
- type 2 diabetes mellitus
- monotherapy
- multitherapy
Sulfonylureas
- Oral Hypoglycemics
- action: stimulate the beta cella to release insulin
- must have functional beta cells for the drug to work
- effective decreases over time
Chlorpropamide(Diabinese)
- Sulfonylureas(drugs)
- first generation
- titrated(increase slowl)
- avg. dose 150-250mg
Glyburide(Micronase0(Diabeta)
Sulfonylureas(drugs)
- Second generation
- last longer 12-24hrs
- 2.5-20mg dose-
Glimepiride(Amaryl)
- Sulfonylureas(drugs)
- third generation
- 1-2mg once a day
- given with breakfast/main meal of the day
Sulfonylureas(Side effects)
- hypoglycemia(common)
- anorexia,n&v,heartburn,weight gain
- weakness,numbness in extremities
- heart and blood vessels disease
- antabuse like reaction
- hepatoxicity
- photosensitivity
Sulfonylureas(Nursing consideration)
- 30min before breakfast/main meal of the day
- check allergy to sulfa
- long acting glipizide-shell in stool
- recognize hypoglycemia and treatment
- not for use during pregnany
Alpha Glucosidase Inhibitor
- Oral Hypoglycemics
- action delays carbohydrate and absorption
- effecting post crandial-after you eat
- slows the breakdown of meal
Alpha Glucosidase Inhibitor Drug
Acarbose(precose) Oral Hypoglycemics -Alpha glucosidase inhibitor drug -3x a day dose -must be taken with first bite of meal -if they do not eat do not take med
Alpha Glucosidase Inhibitor(side effect)
- gi: upset,flatulence,abdominal pain,diarrhea,hypoglycemia
- contraindicated: liver/bowel disease
Biquanides
- Oral Hypoglycemics
- reduce hepatic glucose production
- increase insulin sentitivity to muscle and fat cell
- reduce insulin resistance
- decrease weight
- improve lipid levels
Biquanides drug
Metformi(Glucophage)
- oral hypoglycemics
- Biquanides
- 500-1000mg 2x a day
Biquanides(side effects)
- gi:upset,bloating,n/v,flatulance,weight loss,cramping,diarrhea,metallic taste(common)
- hypoglycemia and lactic acidosis(rare)
- caustion: liver,kidney disease and excressive alcohol
Meglititinides(glinide)
oral hypoglycemics
- Meglititinides(glinide)
- stimulate insulin release from the pancreas
- drug: Repaglinide(Prandin)
- side effect: hypoglycemia, urti,rhinitis,bronchitis,back pain,headache,hepatoxic,monitor liver profile
Thiazolidinediones
oral hypoglycemics
action: decrease insulin resistance, increase insulin sensitivity
drug: rosiglitazone
- black box warning=drug causes serous AVE commonly CHF
- side effect: increase urti,sinusitis,headache,back pain,diarrhea,
- caution in chf and decrease effectiveness of contraceptive pills
Incretin Mimetic
oral hypoglycemics
- mimic hormone incretin
- increase insulin secretion from beta cells=more hypoglycemia
- supress glucagon secretion
- slows gastic emptying
- indication: adjuvant to improve glycemic control post meal
- drug:Exenatide(Byetta)-sq-1hr before breakfast 1hr before dinner-pre-filled syring
- side effect:gastrotoxic
Dipeptidyl Peptidase-4 inhibitor
oral hypoglycemics
action: inhibit breakdown of incretin hormones
indication: adjuvant to diet and excersise(type 2 dm)
-drug: sitagliptin(Januvia), 100mg po daily
side effect: increase resp tract infection
-monitor wbc for infection, lung sound
Amylin Analogue
-action:slows movement of food through the stomach
-indication:type 1/2 diabetes that need blood sugar control
-side effect:n/v,severe hypoglycemia(3hrs after pt has eating)
nursing implication: sq,abdomen or upper thigh,given before major meal,store upopened pen in fridge,dose may based on BS
Pituitary/Hypophysis agent
Anterior Lobe Agent
Adrenocorticotropic Hormone(ACTH)
- anterior lobe
- stimulate the adrenal cortex to produce glucocorticoids
- used to diagnose adrenocortical function, multiple sclerosis,thyroidits,hypercalcemia related to cancer
- route:parental,measured in units
Pituitary/Hypophysis agent
Anterior Lobe Agent
Adrenocorticotropic Hormone(ACTH)
Side Effects:
Electrolute imbalance dcrease wbc increase rbc(thrombi) -increase appetite,thinning mucosa,peptic ulcer -decrease would healing, -water and na retention -weight gain, moon face,buffalo hump,retarded growth in children -muscle/skeletal weakness,atrophy,osteoporosis -glucose intolerance -mood swings -abrupte withdrawal leads to crissi -suppress immune response -suppresses inflammation
Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
- increase size and number of skeletal muscles
- increaase lean body mass in adults
- increase production in Aids
- replace GH in children who fail to grow
Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
(side effects)
- hypothyroids
- cause insulin resistance-hyperglycemia
- drop in Bp: hypotension
- decrease in body fat
- tachycardia
- nephrotoxic
- increase sugar levels
- acromegaly
- monitor vs
Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
(Nursing implication)
- route: subq/Im
- 1x-7x/week for 6months - 2yr
- dose based on BSA(monitor daily weight)
- teach how to give injection
- monitor ADR@injection site
- glycouria
- stadio-meter measurements
- antibody production against GH
- follow up doctor q3-6mos
Posterior lobe agent
Antidiretic Hormone
- in posterior pituitary
- hyposecretion results in diabetes insipidus
- used for diabtes insipidus
- post op abdominal disention
- dispel gas interfering with x-ray
- enuresis(bed wetting)
- hemophilia type A
Posterior lobe agent
Antidiretic Hormone
Vasopressin(Pitressin)
- taken 1-2x a day
- 5-10u tid, nasal spray,subq,im
- tannate(in oil) last for 48-96hr
- in posterior pituitary
- hyposecretion results in diabetes insipidus
- used for diabtes insipidus
- post op abdominal disention
- dispel gas interfering with x-ray
- enuresis(bed wetting)
- hemophilia type A
Posterior lobe agent
Antidiretic Hormone
DDAVP(Desmopressin)
- nasal spray solution(via rhinal tube)
- in posterior pituitary
- hyposecretion results in diabetes insipidus
- used for diabtes insipidus
- post op abdominal disention
- dispel gas interfering with x-ray
- enuresis(bed wetting)
- hemophilia type A
Posterior lobe agent
Antidiretic Hormone
(Side effect)
-hypersensitivity
-termors,vertigo,sweating
-belching,n/v,diarrhea
-water intoxication
-spasm in uterus and coronary artery
-thrombosis
-watch for water intox=n/v,headache,drowsy,confusion,weight gain,seizures,coma,
contraiindicated for children aged, children under 11mos
Posterior lobe agent
Antidiretic Hormone
(nursing implication)
- monitor s/s of dehydration
- record I&O
- urine SG
- skin tugor
- weight
- BP,HR,EKG
- have NTG(Nitroglycerin) available=treat angina
- labs-electrolytes/coags
- check for changes in nasal mucosa
- switching from nasal to oral forms-give first tab within 12hr of last nasal dose
- rinse bottle tip in hot water,dry with tissue and recap
- iv-use pump,check for infiltration and tissue necrosis
Thyroid gland
regulation of metabolism of carb,protein,lipids by the secretion of t3 and t4
thyroid replacement drug
-increase metabolic rate by replacing thyroid hormone t3/t4
used for hyposecretion of thyroid hormone/hypothyroidism(myxedema in adults
-euthyroid state-return to normal
thyroid replacement drug(side effect)
- hyperthyroid/increase bmr
- tachycardia,palp,htn(monitor apical)
- nervousness,headache,insomnia
- diarrhea,decrease weight
- intolerance to heat, sweating
thyroid replacement drug
Levothyroxine(synthroid)
- avg dose:100-125mcg
- interaction with oral coag, epi,antidepressants,antidiabetic agent,cns depressents
thyroid replacement drug(nursing implicaiton)
- start with low dose
- take at same time each day
- early am before breakfast to prevent insomnia
- record apical pulse=hold if bp above 100
- see improvement within 10-14days
- life long therapy
- keep in dark bottle
- replace q3mos
- avoid iodine salt, iodoine
- children monitor bone growth and development
Antithyroid drug
-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)
Antithyroid drugs used
thiouracil
iodides
radioactive isotopes
Thiouracils
- inhibit synthesis and release of the thyroid hormone
- prevent the conversion of t3/t4 in the peripheral circulation
- indication:hyperthyroidism
- return to euthyroid state
Thiouracil(drug)
- propylthiouracils(PTU)
- 100-150mg 1-4x a day
- given for 6mos to several years
Thiouracil(side effects)
- s/s of hypothyroidism
- lupus like symptoms(butterfly rash,joint pain,photosensitivity)
- hepatotoxic-jaundice up to 10wks even after md discontinues
- arganulocytosis(monitor blood)
- n/v
- hay fever,sore throat,skin rash,puritis,headache,paresthesia
Thiouracil(Nursing implication)
- given at the same time w/meals
- sudden stop=thyroid storm(agitation,change in LOC,tachycardia,shaking,fever,sweating,diarrhea)
- available suppository or enema
- instruct pt to report chills,fever,skin rash,sore throat,malaise,enlarged lymph node,jaundice,monitor cbc,pt,no vaccine w/ permission
Iodides(Antithyroid drug)
-reduce the size and vascularity of the thyroid gland
Iodides(Antithyroid drug)(Indication)
- use 7-10days before surgery so the thyroid is more sturdy
- mild to severe thyroid hyperactivity in the young
- onset-24hr peak:10-15 days
Iodides(drugs)
- potassium iodide(sski)
- 130mg/day child is hald 65
- side effects: iodism=toxicity of iodine=metallic taste in the mouth,fever,rash,on the skin or mucous membrane,parotits,increase salivation,and allergic reaction
nursing implication:
- check for drug allergy to seafood,iodine
- dilute in milke,cola,fruit juice
- improves taste
- prevents staining of teeth
Radioactive iodine(RAI)(antithyroid drug)
-action:emit beta rays which DESTROY hyperactive thyroid cells
use: hyperthyroidism, thyroid cancer, diagnostic testing
drug :radiactive iodine(RAI), sodium iodide
-if destroying going to need thyroid replacement
side effect: hypothyrodism
-thyroidits swelling of the neck,back,sore throat,cough, and pain on swallowing,n&v,bone marrow suppresion-monitor cbc,wbc
contrainticated in pregnacy
Parathyroid agents
- hormones working in opposite direction
- not functioning levels go in same direction
- parathyroid glands regulate calcium metabolism and secretes its hormone when blood calcium levels drops to promote reabsorption of calcium from the bones
Hyperparathyroidism
hypersecretion of parathyroid hormone causing increase in calcium levels
use for osteoporosis and hypercalciema
Calcitonin(calcimar)
- synthetic hormone
- turns off secretion of the hormone
- calcitonin-salmon-check allergy to salmon
- sq,im,intranasal
- 4-8units 1kg every 6-12hrs
