Endocrinology Pharm Made easy ASN MDC Flashcards
Drug Name: Glipizide
Drug Class: Sulfonylureas (2nd Generation)
what is the indication and MOA?
Hypoglycemic
Indication: Used to treat Type 2 Diabetes Mellitus (T2DM)
Mechanism of Action: Stimulates insulin release from the beta islet cells of the pancreas; requires a functioning pancreas.
Extra info: Another medication in this class is tolbutamide, which is a first-generation sulfonylurea.
Glipizide Side Effects
Common Side Effects: Mild hypoglycemia (especially in clients with liver/kidney impairment), nausea, diarrhea.
Serious Side Effects: Severe hypoglycemia (tremors, fatigue, hunger, diaphoresis).
Glipizide Interventions
Monitor for hypoglycemia symptoms (tremors, tachycardia, fatigue).
Administer carbs if conscious (e.g., 4 oz orange juice, glucose tablets).
Administer IV glucose or glucagon if unconscious; monitor blood glucose every 15-20 min.
Glipizide Administration
Administer 30 minutes before meals, normally once daily.
If dose >15 mg/day, divide into two doses.
Do not crush or chew sustained-release forms.
Contraindications and Precautions for Glipizide
Contraindications: Pregnancy, lactation, diabetic ketoacidosis.
Use with Caution: Renal or hepatic dysfunction, adrenal/pituitary insufficiency.
Glipizide Drug Interactions
Increased Hypoglycemia: Alcohol, NSAIDs, sulfonamide antibiotics, salicylates, anticoagulants, MAO inhibitors.
Counteracts Hypoglycemia: Thiazides.
Masks Hypoglycemia: Beta blockers.
Glipizide Client Instructions
Wear a medical alert bracelet.
Recognize and treat hypoglycemia with carbohydrates.
Avoid alcohol (risk of disulfiram-like reaction and increased hypoglycemia).
Report recurrent hypoglycemia to the provider.
Carry carbohydrate snacks at all times.
Drug Name: Repaglinide
Drug Class: Meglitinides (Glinides)
what is the indication and MOA?
Hypoglycemic
Indication: Used to treat Type 2 Diabetes Mellitus (T2DM)
Mechanism of Action: Stimulates insulin release from the beta islet cells of the pancreas; requires a functioning pancreas.
Extra info: another drug is nateglinide
Repaglinide Side Effects
Common Side Effects: Mild hypoglycemia, nausea, vomiting.
More Likely in: Clients with impaired liver function due to decreased metabolism.
Repaglinide Interventions
Monitor for hypoglycemia (diaphoresis, tachycardia, fatigue).
Administer carbs if conscious (e.g., 4 oz of orange juice, glucose tablets).
Administer IV glucose or glucagon if unconscious; monitor blood glucose every 15-20 min.
Notify the provider if nausea, vomiting, or diarrhea persist.
Repaglinide Administration
Administer orally no more than 30 minutes before meals.
Usual dosing: 3 times a day, skip the dose if skipping a meal.
Maximum dose: No more than 4 doses per day.
Contraindications and Precautions for Repaglinide
Contraindications: Diabetic ketoacidosis.
Caution: Use cautiously in older adults, clients with renal/hepatic dysfunction, and systemic infections.
Repaglinide Drug Interactions
Increases Hypoglycemic Effects: Gemfibrozil, erythromycin, chloramphenicol.
Decreases Hypoglycemic Effects: Alcohol, corticosteroids, rifampin.
Other Interactions: NSAIDs, warfarin, loop diuretics, anabolic steroids.
Repaglinide Client Instructions
Wear a medical alert bracelet.
Recognize and treat hypoglycemia with carbohydrates.
Test blood glucose using a glucometer.
Avoid alcohol (increased hypoglycemia risk).
Carry carbohydrate snacks at all times.
Drug Name: Metformin
Drug Class: Biguanides (Antidiabetic)
what is the indication and MOA?
Indication: First-line treatment for Type 2 Diabetes Mellitus (T2DM).
Mechanism of Action:
Decreases glucose absorption from intestines.
Decreases glucose synthesis in the liver.
Increases insulin sensitivity in tissues.
Metformin Side Effects
Common Side Effects: Nausea, diarrhea, vomiting, metallic taste.
Serious Side Effect: Lactic acidosis (rare but potentially fatal).
Metformin Interventions
Monitor for lactic acidosis (weakness, fatigue, muscle pain, hyperventilation).
Stop medication immediately if lactic acidosis is suspected and assess for acidosis.
Monitor for vitamin B12 and folic acid deficiencies.
Monitor renal function, especially before and after procedures involving iodine contrast media.
Metformin Administration
Administer twice daily with meals (morning and evening) or once daily with extended-release form.
Swallow extended-release tablets whole—do not crush or chew.
Contraindications and Precautions for Metformin
Contraindications: Diabetic ketoacidosis, renal or hepatic insufficiency, heart failure, alcoholism, lactic acidosis.
Use with Caution: Older adults, dehydration, diarrhea, anemia, gastroparesis.
Metformin Drug Interactions
Increased Risk of Lactic Acidosis: Alcohol, cimetidine, iodine contrast media.
Increased Hypoglycemic Effects: Chromium, coenzyme Q10.
Other Interactions: Nifedipine, furosemide, ranitidine, morphine, antifungals.
Metformin Client Instructions
Take medication at the same time each day, preferably with food.
Avoid alcohol (increased risk of lactic acidosis).
Recognize signs of lactic acidosis (weakness, muscle pain, hyperventilation).
Stay hydrated and expect gastrointestinal side effects to decrease over time.
Report symptoms of vitamin B12 or folic acid deficiency (fatigue, pallor).
Drug Name: Pioglitazone
Drug Class: Thiazolidinediones (Glitazones)
what is the indication and MOA?
Hypoglycemic
Indication: Treats Type 2 Diabetes Mellitus (T2DM) with or without concurrent insulin or metformin therapy.
Mechanism of Action: Reduces insulin resistance by activating PPAR gamma receptors, enhancing the cellular response to insulin, allowing glucose to enter skeletal muscle and adipose tissue.
Pioglitazone Side Effects
Common Side Effects: Fluid retention, upper respiratory tract infections, headaches, myalgia.
Serious Side Effects: Increased risk for heart failure, liver injury, bladder cancer, increased fractures in women, elevated LDLs and triglycerides.
Pioglitazone Interventions
Monitor for fluid retention, edema, rapid weight gain, dyspnea (signs of heart failure).
Monitor liver function tests (ALT) periodically and watch for signs of hepatotoxicity.
Check serum lipid levels (HDL, LDL, triglycerides); elevated LDL increases cardiovascular risk.
Pioglitazone Administration
Administer orally once a day, with or without food.
Typical dose: 15-30 mg daily (adjust based on presence of heart disease).
Can be given with metformin, sulfonylureas, or insulin.
Pioglitazone Contraindications and Precautions
Contraindications: Cardiovascular disease (heart failure, hypertension), active hepatic disease, Type 1 DM, diabetic ketoacidosis.
Use with Caution: Mild heart failure, hepatic impairment, history of bladder cancer.
Pioglitazone Drug Interactions
Increased Risk of Heart Failure/Edema: When used with insulin.
Increased Hypoglycemic Effect: Gemfibrozil (Lopid), ketoconazole, chromium, coenzyme Q10.
Reduces Effectiveness of Contraceptives: May interfere with contraceptive effectiveness.
Other Interactions: Glucosamine alters blood glucose control.
Pioglitazone Client Instructions
Report significant swelling, rapid weight gain, or shortness of breath (signs of heart failure).
Report symptoms of liver failure (jaundice, dark urine, abdominal pain).
Watch for bladder cancer signs (hematuria, dysuria).
Expect periodic cholesterol testing due to changes in LDL and triglyceride levels.
Report any chest pain, discomfort, diaphoresis, or fatigue.
Drug Name: Acarbose
Drug Class: Alpha-Glucosidase Inhibitors
what is the indication and MOA?
Hypoglycemic
Indication: Treats Type 2 Diabetes Mellitus (T2DM) with or without insulin, sulfonylurea, or metformin.
Mechanism of Action: Blocks alpha-glucosidase in the small intestine, slowing carbohydrate absorption, reducing postprandial blood glucose spikes.
Extra info: Another medication in this category is miglitol.
Acarbose Side Effects
Common Side Effects: Gastrointestinal issues (distention, flatus, hyperactive bowel sounds, diarrhea).
Serious Side Effects: Hypoglycemia (when combined with insulin/sulfonylurea), liver dysfunction, iron deficiency anemia.
Acarbose Interventions
Monitor for GI discomfort and persistent gastric distress.
Watch for hypoglycemia if combined with insulin/sulfonylureas, and treat with glucose (not carbs).
Monitor liver function tests (every 3 months for the first year).
Monitor for anemia and encourage iron-rich foods or supplements.
Acarbose Administration
Take with the first bite of food at meals (3 times daily).
Initial dosage: 25 mg, which can be increased based on postprandial levels.
Acarbose Contraindications and Precautions
Contraindications: Gastrointestinal disorders (e.g., inflammatory bowel disease, bowel obstruction, ulceration).
Use with Caution: Hepatic impairment, gastrointestinal distress.
Acarbose Drug Interactions
Increased Risk of Hypoglycemia: When combined with insulin or sulfonylureas.
Use glucose tablets (not carbohydrates) to treat hypoglycemia due to the mechanism of action.
Acarbose Client Instructions
Warn clients about the potential GI side effects (may decrease over time).
Instruct clients to carry glucose tablets at all times (especially when combined with insulin/sulfonylureas).
Report symptoms of liver dysfunction (dark urine, abdominal pain) and anemia (pallor, fatigue).
Encourage consumption of iron-rich foods due to risk of iron deficiency anemia.
Drug Name: Sitagliptin
Drug Class: DPP-4 Inhibitors (Gliptins)
what is indication and MOA?
Hypoglycemic
Indication: Treats Type 2 Diabetes Mellitus (T2DM) with or without metformin or glitazones.
Mechanism of Action: Inhibits DPP-4 enzyme, augmenting incretin hormone, which increases insulin release and decreases glucagon release, helping to control fasting and postprandial blood glucose levels.
Extra info: DDP= Dipeptidyl Peptidase
Other examples: saxagliptin and alogliptin
Sitagliptin Side Effects
Common Side Effects: Upper respiratory infections, headaches, inflamed nasal passages.
Serious Side Effects: Pancreatitis, Stevens-Johnson syndrome, anaphylaxis, angioedema.
Sitagliptin Interventions
Monitor for respiratory infections, fever, or persistent headaches.
Watch for GI effects (signs of pancreatitis), and check blood amylase levels if needed.
Assess for skin reactions (Stevens-Johnson syndrome) and discontinue if signs of anaphylaxis or skin lesions appear.
Sitagliptin Administration
Administer orally, with or without food.
Adjust dose for clients with renal impairment or low creatinine clearance.
Also available in combination with metformin.
Sitagliptin Contraindications and Precautions
Contraindications: Hypersensitivity, Type 1 DM, diabetic ketoacidosis.
Use with Caution: Renal dysfunction, pancreatitis history, clients on hemodialysis.
Sitagliptin Drug Interactions
Increased Digoxin Levels: Sitagliptin may increase digoxin levels.
Increased Risk of Hypoglycemia: When used with insulin or sulfonylureas.
Sitagliptin Client Instructions
Report persistent upper respiratory issues, fever, or unrelieved headaches.
Report signs of pancreatitis (upper abdominal pain radiating to the back, nausea, vomiting).
Review signs of hyper- and hypoglycemia, and proper blood glucose monitoring procedures.
Take medications as prescribed and report missed doses unless it’s close to the next dose.
Drug Name: Empagliflozin
Drug Class: Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i)
what is the indication and MOA?
Hypoglycemic
Indication: Improves blood glucose control in clients with T2DM and reduces cardiovascular mortality in clients with heart failure and T2DM.
Mechanism of Action: Decreases glucose reabsorption in the kidneys, increasing urinary glucose excretion and lowering blood glucose levels. Also provides cardioprotective effects by reducing preload, afterload, and oxidative stress.
Extra info: Other medications in this category are canagliflozin, dapagliflozin, and ertugliflozin.
Empagliflozin Side Effects
Common Side Effects: Genital infections (yeast, UTI), increased urination, upper respiratory infections, joint pain, nausea, constipation, elevated cholesterol and phosphate levels.
Serious Side Effects: Diabetic ketoacidosis, hypoglycemia, dehydration, hypotension, bone fractures, kidney injury.
Empagliflozin Interventions
Monitor fasting blood glucose, pre-meal blood glucose, hemoglobin A1c, LDL cholesterol, and kidney function.
Monitor for dehydration (low BP, low hematocrit) and electrolyte imbalances.
Assess for symptoms of ketoacidosis (nausea, vomiting, abdominal pain, confusion, shortness of breath).
Monitor for urinary tract infections (elevated WBC, cloudy urine, pain with urination).
Empagliflozin Administration
Administer orally once a day in the morning, with or without food.
Initial dose: 10 mg once daily, can be increased to 25 mg once daily.
Empagliflozin Contraindications and Precautions
Contraindications: Type 1 DM, severe kidney disease, kidney failure, clients on dialysis.
Use with Caution: Clients at risk for diabetic ketoacidosis, hypotension, moderate kidney impairment, or on diuretics.
Empagliflozin Drug Interactions
Increased Risk of Hypoglycemia: With insulins and oral sulfonylureas.
Increased Risk of Volume Depletion and Low BP: When used with diuretics.
Other Interactions: Increased effects of loop diuretics, salicylates, and MAO inhibitors.
Empagliflozin Client Instructions
Monitor for and report symptoms of hypoglycemia and hypotension.
Maintain adequate hydration to prevent dehydration.
Report symptoms of genital yeast infections (vaginal discharge, itching) and urinary tract infections (fever, painful urination, cloudy urine).
Monitor blood pressure and blood glucose regularly.
Drug Name: Bromocriptine
Drug Class: Sympatholytic D2-Dopamine Agonist
what is indication and MOA?
Hypoglycemic
Indication: Used to treat Type 2 Diabetes Mellitus (T2DM), Parkinson’s disease, acromegaly, and pituitary prolactinomas. Not a first-line treatment for T2DM.
Mechanism of Action: Stimulates dopamine type 2 receptors in the hypothalamus, improving glucose tolerance, insulin sensitivity, and reducing glucose production.
Bromocriptine Side Effects
Common Side Effects: Nausea, vomiting, dizziness, hypotension, headache, fatigue.
Serious Side Effects: Psychosis, seizures, lung and heart valve fibrosis, cardiovascular events (stroke, myocardial infarction).
Bromocriptine Interventions
Monitor for hypoglycemia, drowsiness, hypotension, seizures, and stroke.
Assess cardiovascular system (heart sounds) and monitor blood pressure, especially during the initial weeks of therapy.
Monitor liver function tests at baseline and periodically for elevated liver enzymes.
Bromocriptine Administration
Administer once daily in the morning with food (within 2 hours of waking) to reduce GI effects.
Dosage may be increased until the desired blood glucose goal is reached.
Bromocriptine Contraindications and Precautions
Contraindications: Hypersensitivity, Type 1 DM, uncontrolled hypertension, severe psychotic disorders, diabetic ketoacidosis, severe liver disorders, pregnancy/postpartum, lactating.
Use with Caution: History of cardiovascular disorders (stroke, myocardial infarction, hypertension, dysrhythmias).
Bromocriptine Drug Interactions
CYP3A4 Inhibitors: Ergot alkaloids, levodopa, antihypertensives, macrolide antibiotics may increase effects and risk of hypoglycemia.
CYP3A4 Inducers: Antipsychotics, tricyclic antidepressants, dopamine antagonists (e.g., metoclopramide) may reduce effectiveness.
Dopamine Antagonists: Phenothiazines can reduce the effectiveness of bromocriptine.
Bromocriptine Client Instructions
Report dizziness, drowsiness, or syncope; use caution when driving.
Avoid or limit alcohol consumption.
Monitor blood glucose and blood pressure regularly.
Avoid grapefruit juice as it can increase bromocriptine levels and effects.
Review symptoms of hyper- and hypoglycemia with the client.
Drug Name: Lispro (Rapid-Acting), Regular Insulin (Short-Acting), NPH (Intermediate-Acting), Glargine (Long-Acting)
Drug Class: Injectable Hypoglycemics
what is the indication and MOA?
Indication: Used to treat T1DM, T2DM not controlled by diet or oral hypoglycemics, and gestational diabetes.
Mechanism of Action: Promotes cellular uptake of glucose, converts glucose to glycogen, and helps store glucose in the liver and muscles. Also helps potassium uptake into cells.
Insulin Onset, Peak, and Duration
Rapid-Acting (Lispro)
Onset: 15-30 min
Peak: 30 min - 3 hr
Duration: 3-5 hr
Extra info: Other rapid-acting insulins include aspart and glulisine.
Insulin Onset, Peak, and Duration
Short-Acting (Regular)
Onset: 30 min - 1 hr
Peak: 2-4 hr
Duration: 4-12 hr
Insulin Onset, Peak, and Duration
Intermediate-Acting (NPH)
Onset: 1-2 hr
Peak: 4-12 hr
Duration: 14-24 hr
Insulin Onset, Peak, and Duration
Long-Acting (Glargine):
Onset: 2-4 hr
Peak: Minimal
Duration: Up to 24 hr
Extra info: Another long-acting insulin is detemir.
Insulin Side Effects
Common Side Effects: Hypoglycemia, hypokalemia, lipodystrophy, lipohypertrophy.
Serious Side Effects: Allergic reactions (urticaria, rash, breathing difficulties).
Insulin Interventions
Monitor for signs of hypoglycemia (tachycardia, diaphoresis, shakiness).
Monitor potassium levels for hypokalemia (muscle weakness, palpitations).
Rotate injection sites to prevent lipohypertrophy.
Administer glucagon or glucose if hypoglycemia occurs.
Insulin Administration
Administer subcutaneously (using insulin syringe or pen) or intravenously (Regular insulin only).
Gently roll vials of insulin suspensions before administering.
Draw up short-acting (clear) insulin before longer-acting (cloudy) insulin if mixing.
Do not mix Glargine or Detemir with other insulins.
Insulin Client Instructions
Instruct clients to rotate injection sites.
Teach them how to test blood glucose and treat hypoglycemia with a carbohydrate snack.
Ensure clients always carry a carbohydrate snack and wear a medical alert bracelet.
Teach them to store insulin at room temperature for 30 days (or refrigerate unopened vials).
Insulin Contraindications and Precautions
Contraindications: Hypersensitivity to insulin, hypoglycemia.
Precautions: Use cautiously in clients with fever, stress, or altered nutrition.
Insulin Drug Interactions
Increased Hypoglycemic Effects: Sulfonylureas, meglitinides, beta blockers, salicylates, alcohol.
Increased Blood Glucose (Counteracts Insulin): Thiazide diuretics, sympathomimetics, glucocorticoids, thyroid hormones.
Beta Blockers: Mask signs of hypoglycemia (tachycardia, tremors).
Drug Name: Pramlintide
Drug Class: Amylin Mimetics (Antidiabetic)
what is the indication and MOA?
Hypoglycemic
Indication: Used as an adjunct therapy for T1DM and T2DM when oral hypoglycemics or insulin alone do not control blood glucose levels.
Mechanism of Action: Mimics amylin to reduce postprandial blood glucose by slowing gastric emptying, inhibiting glucagon secretion, and increasing satiety.
Pramlintide Side Effects
Common Side Effects: Nausea, especially in clients with T1DM; injection site reactions (redness, swelling, itching).
Serious Side Effect: Severe hypoglycemia when combined with insulin.
Pramlintide Interventions
Reduce insulin dosage when initiating pramlintide to minimize hypoglycemia.
Monitor for hypoglycemia, especially within 3 hours of dosing.
Gradually titrate dose to reduce nausea and hypoglycemia risk.
Use proper injection techniques to reduce site reactions.
Pramlintide Administration
Do not mix with insulin in the same syringe.
Administer subcutaneously before meals (thigh or abdomen) containing at least 30g of carbohydrates.
Rotate injection sites and avoid injecting near insulin sites.
Peak action occurs 20 min after dosing; hypoglycemia risk occurs 3 hours post-dosing.
Store at room temperature for 28 days; refrigerate unopened vials.
Pramlintide Contraindications and Precautions
Contraindications: Poor insulin regimen adherence, gastroparesis, medications affecting GI motility.
Precautions: Clients with poor hypoglycemic awareness or inconsistent insulin use should not take pramlintide.
Pramlintide Drug Interactions
Increased Hypoglycemia Risk: When combined with insulin.
Slows absorption of oral medications—take 1 hour before or 2 hours after pramlintide.
Medications that slow gastric emptying (e.g., opioids, acarbose, miglitol) should be administered separately.
Pramlintide Client Instructions
Monitor for hypoglycemia 3 hours post-dosing and report symptoms.
Test blood glucose before treating hypoglycemia with a carbohydrate snack.
Retest glucose 15-20 minutes after treatment and repeat if necessary.
Wear a medical alert bracelet and always carry a carbohydrate snack.
Drug Name: Exenatide
Drug Class: Incretin Mimetics (Antidiabetic)
what is the indication and MOA?
Indication: Used to treat T2DM, either alone or as a supplement to sulfonylureas or metformin.
Mechanism of Action: Mimics GLP-1 to reduce postprandial blood glucose by slowing gastric emptying, stimulating insulin release, decreasing glucagon secretion, and increasing satiety.
Extra info: Additional incretin mimetics include liraglutide, dulaglutide, semaglutide, and tirzepatide.
Exenatide Side Effects
Common Side Effects: Nausea, vomiting, diarrhea.
Serious Side Effects: Hypoglycemia (with sulfonylureas), pancreatitis, renal failure, severe hypersensitivity reactions.
Exenatide Interventions
Reduce the dose of oral hypoglycemics to minimize the risk of hypoglycemia.
Monitor for hypoglycemia, especially 2 hr post-dosing.
Monitor for persistent nausea, vomiting, or diarrhea, and ensure adequate fluid and carbohydrate intake.
Watch for signs of pancreatitis (severe abdominal pain) and discontinue if these symptoms appear.
Exenatide Administration
Administer subcutaneously in the thigh, abdomen, or upper arm, 60 min before morning and evening meals (not after meals).
Rotate injection sites and use a new needle for each injection.
Exenatide pens come in 5-10 mcg doses; follow manufacturer instructions for setup.
Keep pens at room temperature for up to 30 days; refrigerate unused pens until their expiration date.
Exenatide Contraindications and Precautions
Contraindications: Severe renal impairment, T1DM, diabetic ketoacidosis, severe GI disorders.
Use with Caution: History of thyroid carcinoma, pancreatitis, moderate renal impairment, or use with insulin.
Exenatide Drug Interactions
Increased Risk of Hypoglycemia: When combined with sulfonylureas.
Slows Absorption of Oral Medications: Take oral contraceptives, antibiotics 1 hr before or 2 hr after exenatide.
Exenatide Client Instructions
Watch for signs of hypoglycemia, especially 2 hr post-dosing, and report them.
Test blood glucose to confirm hypoglycemia and treat with carbohydrates, retesting after 15-20 min.
Wear a medical alert bracelet and always carry a carbohydrate snack.
Report signs of pancreatitis (severe abdominal pain) and stop medication if these occur.
Follow proper injection technique using the pen.
Drug Name: Glucagon
Drug Class: Pancreatics (Hormone)
what is the indication and MOA?
Indication: Used to treat insulin-induced hypoglycemia, especially when severe.
Mechanism of Action: Raises blood glucose by stimulating glycogen breakdown (glycogenolysis) in the liver and reducing glycogen synthesis.
Extra info: Glucose, which is given intravenously, is another form of hyperglycemic.
Glucagon Side Effects
Common Side Effects: Nausea, vomiting.
Serious Side Effects: Hypersensitivity reactions, including anaphylaxis.
Glucagon Interventions
Monitor for signs of hypoglycemia before and during treatment.
Monitor neurologic status and fluid intake if nausea persists.
Turn unconscious clients on their side to prevent aspiration from vomiting.
Be ready with suction equipment in case of emesis.
Glucagon Administration
Administer glucagon via IV, IM, or subcutaneously.
Unconscious clients typically regain consciousness within 20 min after IV administration.
Provide food once the client regains consciousness and can swallow.
IV glucose is the preferred treatment for severe hypoglycemia due to faster action.
Glucagon Contraindications and Precautions
Contraindications: Hypoglycemia from starvation (no glycogen stores), pheochromocytoma.
Use with Caution: Cardiovascular disorders, adrenal insufficiency.
Glucagon Drug Interactions
Increased Effects of Anticoagulants: Glucagon increases the effects of warfarin.
Opposes Insulin Effects: Glucagon negates insulin’s effects.
Inhibited by Phenytoin: Glucagon’s effects can be reduced by phenytoin.
Glucagon Client Instructions
Teach clients and families how to administer glucagon using injection kits or prefilled pens.
Carry a glucagon kit at all times for severe hypoglycemia.
Warn that vomiting is common post-administration, and instruct families to keep clients on their side.
After regaining consciousness, eat a small meal to prevent another hypoglycemic episode.
Encourage carrying a small sugar source to prevent severe hypoglycemia.
Drug Name: Levothyroxine
Drug Class: Thyroid Preparations (Hormone)
what is the indication and MOA?
Indication: Used for thyroid replacement therapy in clients with hypothyroidism.
Mechanism of Action: Synthetic T4 (thyroxine) that converts to T3 (triiodothyronine) in the body, aiding in thyroid hormone replacement.
Extra info: Other medications in this category are liothyronine, which is a synthetic preparation of T3
Levothyroxine Side Effects
Common Side Effects: Hyperthyroidism symptoms if overdosed (e.g., tachycardia, nervousness, tremor, sweating).
Serious Side Effects: Thyrotoxicosis (severe overdose) with angina, hyperthermia, and cardiac symptoms.
Levothyroxine Interventions
Monitor thyroid function tests (T4, TSH) regularly, especially during therapy initiation.
Watch for signs of hyperthyroidism (tachycardia, weight loss, nervousness, tremors).
Adjust dosage as needed and monitor cardiac status, especially in clients with cardiovascular disease.
Levothyroxine Administration
Take orally once daily on an empty stomach, at least 30 min before breakfast.
IV form used for severe hypothyroidism (myxedema coma).
Monitor baseline vital signs and weight, and check medication consistency (formulations not interchangeable).
Levothyroxine Contraindications and Precautions
Contraindications: Thyrotoxicosis, recent myocardial infarction.
Use with Caution: In older adults, clients with renal impairment, DM, and cardiovascular disorders (e.g., hypertension, angina).
Levothyroxine Drug Interactions
Reduced Absorption: Cholestyramine, antacids, iron, calcium supplements, sucralfate (take 4 hr apart).
Decreased Effectiveness: Anti-seizure and antidepressant medications (e.g., carbamazepine, phenytoin).
Increased Effects: Levothyroxine increases the effects of warfarin and catecholamines (e.g., epinephrine).
Levothyroxine Client Instructions
Take daily for life, preferably on an empty stomach.
Report signs of hyperthyroidism (nervousness, sweating, weight loss, rapid heart rate).
Monitor for cardiac symptoms (chest pain, palpitations).
Avoid switching between different formulations without consulting the provider.
Myxedema Coma Safety Alert
Myxedema coma is a medical emergency from untreated hypothyroidism or sudden withdrawal from thyroid therapy.
Symptoms include decreased cardiac output, organ failure, hyponatremia, and hypoglycemia.
Treatment involves IV levothyroxine, glucocorticoids, and respiratory support.
Drug Name: Propylthiouracil (PTU)
Drug Class: Thioamides (Antithyroid Agent)
what is indication and MOA?
Indication: Used to treat hyperthyroidism (Graves’ disease), thyrotoxic crisis, or as preparation for thyroidectomy.
Mechanism of Action: Blocks iodine from integrating into tyrosine and prevents the conversion of T4 to T3, limiting thyroid hormone synthesis.
Extra info: Another medication with similar effects is methimazole.
Propylthiouracil Side Effects
Common Side Effects: Rash, nausea, vomiting, arthralgia, headache.
Serious Side Effects: Hypothyroidism, agranulocytosis (decreased leukocytes), aplastic anemia, hepatotoxicity.
Propylthiouracil Interventions
Monitor for signs of hypothyroidism (fatigue, weight gain, cold intolerance).
Obtain baseline CBC and watch for agranulocytosis (fever, sore throat).
Monitor skin for rashes and joints for pain; treat with mild analgesics.
Monitor thyroid function regularly to adjust dosage.
Propylthiouracil Administration
Administer orally every 8 hr due to short half-life.
Expect therapy to take 3-12 weeks to produce a euthyroid state and 6-12 months to stabilize.
Measure baseline T3, T4, vital signs, and weight before starting therapy.
Propylthiouracil Contraindications and Precautions
Contraindications: Hypersensitivity.
Use with Caution: Pregnant clients, clients with immunosuppression, bone marrow depression, infection, or liver dysfunction.
Propylthiouracil Drug Interactions
Additive Bone Marrow Suppression: With antineoplastics or radiation therapy.
Increased Antithyroid Effects: When taken with lithium or potassium iodide.
Increased Agranulocytosis Risk: With phenothiazines.
Propylthiouracil Client Instructions
Take the medication regularly to maintain thyroid hormone balance.
Watch for signs of both hyperthyroidism and hypothyroidism and report them.
Report fever, sore throat, or persistent rash, joint pain, and headache.
Inform providers about any OTC medications or supplements being taken.
Agranulocytosis Risk Safety Alert
Monitor for agranulocytosis in clients with immunosuppression or bone marrow depression.
Watch for signs of infection due to the reduced number of leukocytes and neutrophils.
Stop therapy and notify the provider if fever or sore throat develops.
Drug Name: Radioactive Iodine (Iodine-131)
Drug Class: Antithyroid
Indication: Treats hyperthyroidism (Graves’ disease) and thyroid cancer.
Mechanism of Action: Destroys thyroid tissue by being absorbed by the thyroid gland, reducing its function over time.
Radioactive Iodine Side Effects
Expected Effect: Hypothyroidism (requires lifelong hormone replacement).
Serious Side Effects: Bone marrow depression, radiation sickness (in large doses).
Radioactive Iodine Interventions
Monitor for hypothyroidism (weight gain, fatigue, cold intolerance).
Watch CBC and platelets for bone marrow suppression signs (anemia, leukopenia, thrombocytopenia).
Monitor for radiation sickness (vomiting blood, nosebleeds, intense nausea).
Radioactive Iodine Administration
Administered orally (capsule or solution).
Obtain a negative pregnancy test before administration.
Expect full therapeutic effects in 2-3 months.
Use radiation precautions for clients receiving high doses for thyroid cancer.
Radioactive Iodine Contraindications and Precautions
Contraindicated: Pregnancy, breastfeeding (teratogenic and passes through breast milk).
Use with Caution: Children before puberty.
Radioactive Iodine Drug Interactions
Do not use with other antithyroid medications as they reduce radioactive iodine uptake.
Radioactive Iodine Client Instructions
Watch for hypothyroidism signs (fatigue, weight gain, dry skin).
Report bone marrow suppression signs (fever, sore throat, bruising).
Follow radiation precautions for up to 2 weeks: limit contact with others, especially pregnant women and children, use a separate bathroom, flush 3 times, wash utensils and linens separately.
Radiation Safety Alert
High doses for thyroid cancer require strict radiation precautions: avoid close contact, sleep alone, use separate bathroom, avoid sexual contact, and dispose of waste carefully to prevent radiation exposure to others.
Drug Name: Somatropin
Drug Class: Growth Hormone
what is the indication and MOA?
Indication: Treats growth hormone deficiency (e.g., Turner’s syndrome) and wasting syndrome in AIDS. Used in children for growth and in adults to increase lean muscle mass.
Mechanism of Action: Stimulates the release of IGF-1 from the liver and other tissues, promoting normal growth and height in children and muscle mass in adults.
Somatropin Side Effects
Common Side Effects: Hyperglycemia, especially in clients with diabetes.
Serious Side Effects: Development of antibodies against GH, increased risk of fatalities in Prader-Willi Syndrome (PWS) with respiratory issues or obesity.
Somatropin Interventions
Periodically check blood glucose levels to monitor for hyperglycemia.
Monitor thyroid function regularly as GH may suppress thyroid hormone.
Obtain baseline height, weight, and thyroid function before starting therapy and monitor monthly.
Somatropin Administration
Administer subcutaneously (less painful) or intramuscularly; rotate injection sites to avoid tissue atrophy.
Dosage is based on weight, and therapy typically lasts several years.
For pediatric clients, monitor growth monthly and perform annual x-rays to assess epiphyseal plate closure.
Somatropin Contraindications and Precautions
Contraindications: Severe obesity, respiratory impairment, closed epiphyseal plates, critical illness.
Caution: DM, hypothyroidism, chronic renal failure, Prader-Willi Syndrome (watch for hyperglycemia and weight gain).
Somatropin Drug Interactions
Counteracting Effects: Glucocorticoids and ACTH reduce growth stimulation.
Epiphyseal Plate Closure: Thyroid hormones, estrogens, and androgens promote closure, stopping growth in children.
Somatropin Client Instructions
Report signs of hyperglycemia (polyphagia, polydipsia, polyuria).
Rotate injection sites to prevent tissue atrophy.
Inform caregivers on how to administer injections and monitor for side effects.
Prader-Willi Syndrome Safety Alert
Clients with Prader-Willi Syndrome and obesity, respiratory obstruction, or sleep apnea are at increased risk for fatalities with GH therapy.
Emphasize the importance of rotating injection sites to avoid tissue atrophy.
Drug Name: Desmopressin
Drug Class: Antidiuretic Hormone (ADH)
what is indication and MOA?
Indication: Treats diabetes insipidus by reducing excessive urine output and helping maintain fluid balance.
Mechanism of Action: Promotes water reabsorption in the kidneys, decreasing urine output and increasing water retention.
Extra info: Treatment may also include vasopressin, but its short duration of action and need to be administered parenterally makes desmopressin the preferred choice.
Desmopressin Side Effects
Common Side Effects: Fluid retention, hyponatremia, water intoxication.
Serious Side Effects: Seizures, especially related to water intoxication.
Desmopressin Interventions
Monitor for water intoxication (headache, confusion, weight gain).
Check fluid intake and output.
Monitor serum sodium levels for signs of hyponatremia.
Desmopressin Administration
Administer orally, intranasally, subcutaneously, sublingually, or IV.
Monitor blood pressure, intake and output, and creatinine clearance.
Intranasal form: Spray high into nasal cavity.
Vasopressin Safety Alert
Vasopressin (a related medication) is a potent vasoconstrictor. Monitor IV sites for extravasation, which can cause tissue damage.
Use a central line for administration when possible.
Desmopressin Contraindications and Precautions
Contraindications: Renal failure, nephrogenic diabetes insipidus, and electrolyte imbalances (for oral form).
Caution: Older adults, cardiovascular disease, history of hyponatremia, severe heart failure.
Desmopressin Interactions
Increased Effects: Carbamazepine, chlorpropamide.
Decreased Effects: Lithium, other vasopressors.
Increased Risk of Hyponatremia: Loop diuretics, SSRIs, NSAIDs, thiazide diuretics.
Drug Name: Hydrocortisone
Drug Class: Corticosteroid (Glucocorticoid)
what is indication and MOA?
Indication: Replacement therapy for acute and chronic adrenocortical insufficiency (Addison’s disease).
Mechanism of Action: Hydrocortisone acts as a synthetic replacement for cortisol, essential for maintaining glucose levels, blood pressure, and response to stress.
Extra info: Other medications in this category include prednisone and dexamethasone.
Desmopressin Client Instructions
Report confusion, headache, weight gain, and difficulty urinating (signs of water intoxication).
Monitor fluid intake and output.
Lifelong therapy may be required for diabetes insipidus.
Hydrocortisone Interventions
Monitor for weight loss, hypotension, and signs of adrenal insufficiency.
Check blood glucose levels for hyperglycemia and electrolyte imbalances (hypokalemia, hypernatremia).
Monitor for edema and high blood pressure at high doses.
Hydrocortisone Side Effects
Low-dose Therapy: Few side effects.
High-dose Therapy: Adrenal suppression, Cushing’s syndrome, hyperglycemia, hypokalemia, hypernatremia.
Glucocorticoid Expected Action
Cortisol Effects: Promotes glucose synthesis, breakdown of proteins and lipids, and enhances body’s stress response by regulating blood pressure and glucose.
Hydrocortisone Administration
Give orally with meals to reduce GI upset.
Divide doses: Two-thirds in the morning, one-third in the afternoon to mimic normal cortisol secretion.
Administer IV in acute situations.
Taper the dose gradually when discontinuing.
Safety Alert for Hydrocortisone
Increase dosage during periods of stress to prevent hypoglycemia and circulatory collapse.
Monitor for signs of adrenal insufficiency during physical or emotional stress.
Hydrocortisone Client Instructions
Take medication daily, lifelong in most cases.
Report increased stress as doses may need to be adjusted.
Eat a diet high in protein, calcium, vitamin D, potassium, and low in sodium and carbohydrates.
Watch for signs of infection and avoid live vaccines while on high doses.
Hydrocortisone Contraindications
Contraindications: Serious infections, live vaccines (for high doses).
Precautions: High doses can lead to immunosuppression, hyperglycemia, and muscle wasting.
Hydrocortisone Interactions
Interactions at High Doses: Oral contraceptives, phenytoin, phenobarbital, and rifampin may interact with hydrocortisone.
Drug Name: Fludrocortisone
Drug Class: Corticosteroid (Mineralocorticoid)
what is indication and MOA?
Indication: Replacement therapy for acute and chronic adrenocortical insufficiencies (Addison’s disease, primary hypoaldosteronism, congenital adrenal hyperplasia).
Mechanism of Action: Promotes sodium and water reabsorption and potassium excretion in the kidneys.
Fludrocortisone Expected Action
Aldosterone Effect: Regulates sodium, potassium, and water levels by promoting sodium and water reabsorption and potassium excretion through the kidneys.
Fludrocortisone Side Effects
Low Doses: Few side effects.
Excessive Doses: Hypertension, edema, heart failure, hypokalemia, fluid retention.
Fludrocortisone Interventions
Monitor for weight gain, fluid retention, increased blood pressure, and hypokalemia for excess dosing.
Monitor for weight loss, fatigue, muscle weakness, and hypotension for inadequate dosing.
Fludrocortisone Administration
Give orally once daily or three times a week.
Monitor CBC and electrolytes at baseline and periodically.
Lifelong therapy with a medical alert band is required.
Fludrocortisone Client Instructions
Report weight gain, swelling (high sodium levels), weakness, or heart palpitations (low potassium levels).
Regularly monitor blood pressure and follow a high-potassium diet.
Fludrocortisone Contraindications
Contraindications: Hypersensitivity to fludrocortisone.
Precautions: Addison’s disease, heart failure.
Fludrocortisone Interactions
Rifampin and phenobarbital reduce effectiveness.
Potassium-depleting diuretics (e.g., furosemide) increase the risk of hypokalemia.
High-sodium foods can worsen sodium retention and potassium loss.
Fludrocortisone Safety Alert
Avoid loop and thiazide diuretics to reduce the risk of hypokalemia.
Recommend potassium-sparing diuretics like spironolactone to manage fluid retention safely.
