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2020 Pharmacology I > PME Endocrine System > Flashcards

PME Endocrine System Flashcards

1
Q

sulfonylureas

A
  • oral hypoglycemics
  • first oral hypoglycemic class used to treat Type 2 DM
  • prototype: glipizide
    • 2nd gen
    • stronger than 1st gen
  • other: tolbutamide (1st gen)
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2
Q

sulfonylurea drug mechanism of action

A
  • stimulates release of insulin from pancreatic islet cells
  • pt must have functioning pancreas
  • insulin release related to blood glucose level, so hypoglycemia not usually a problem
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3
Q

side effects of sulfonylureas

A
  • mild hypoglycemia
    • in pts with impaired liver or kidney function
    • slower metabolism and excretion of drug → prolonged action
  • nausea
  • diarrhea
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4
Q

s/sx of hypoglycemia

A
  • diaphoresis
  • tachycardia
  • fatigue
  • excessive hunger
  • tremors
  • BG level < 70
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5
Q

Tx of mild hypoglycemia

A
  • give 15-20 g carbohydrate
  • if conscious, give oral, pill or food
    • 4 oz fruit juice
    • 6 saltines
    • 1 Tbsp honey
  • if unconscious, give parenterally
    • IV glucose if access available
    • 1 mg glucagon SQ or IM
  • check BG every 15 min until
    • level is in reference range
    • Sx resolved
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6
Q

administration of glipizide

A
  • give orally 30 min before selected meals
  • swallow sustained-release form whole
  • pregnancy: stop taking 48 hr before delivery
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7
Q

pt education for hypoglycemia and sulfonylureas

A
  • wear medical alert bracelet
  • watch for a report sx of hypoglycemia and recurrent hypoglycemic episodes
    • test BG to confirm
    • eat 15-20 g carbs
    • retest in 15-20 min
    • repeat Tx if needed
  • carry carb snack at all times
  • nausea: lie down
  • eat adequate carbs
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8
Q

contraindications and precautions for sulfonylureas

A
  • contra
    • pregnancy
    • lactation
    • DKA
  • caution
    • thyroid dz
    • renal or hepatic dysfunction
    • adrenal or pituitary insufficiency
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9
Q

interactions with sulfonylureas

A
  • alcohol
    • N&V
    • palpitations
    • flushing
  • increased effects
    • sulfonamide abx
    • NSAIDs
    • oral anticoagulants
    • salicylates
    • MOAIs
    • cimetidine
  • thiazides counteract
  • beta blockers mask hypoglycemia sx (tachycardia)
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10
Q

meglitinides

A
  • for Type 2 DM
  • prototype: repaglinide
  • other: nateglinide
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11
Q

mechanism of action for meglitinides

A
  • stimulate release of insuline from islet cells
    • must have functioning pancreas
    • insulin release related to BG level
  • wont’ work for pts who don’t respond to sulfonylureas
  • severe hypoglycemia not usually a problem
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12
Q

side effects of meglitinides

A
  • mild hypoglycemia: more common in pts with impaired liver function
  • nausea
  • diarrhea
  • notify provider of persistent nausea, vomiting, or diarrhea
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13
Q

administering repaglinide

A
  • take orally 30 min or less before meal, usually 3x daily
  • skip dose if skipping meal
  • add dose if adding meal
  • do not exceed 4 doses/day
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14
Q

contraindications and precautions for meglitinides

A
  • contra
    • DKA
  • caution
    • older adults
    • renal or hepatic dysfunction
    • systemic infection
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15
Q

interactions with meglitinides

A
  • ↑ hypoglycemic effects
    • gemfibrozil
    • erythromycin
    • ketoconazole
    • grapefruit juice (> 1 L/day)
    • ginseng
    • garlic
  • counteract
    • barbituates
    • carbamazepine
    • rifampin
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16
Q

biguanides

A
  • oral hypoglycemics
  • Tx for Type 2 DM
  • usually 1st drug Rx for newly diagnosed
  • prototype (only drug in class): metformin
  • can be combined with other oral hypoglycemics
    • glipizide
    • repaglinide
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17
Q

mechanism of action for metformin (biguanide)

A
  • lowers BG in 3 ways
    • ↓ absorption from intestines
    • ↓ synthesis of glucose in liver
    • ↑ sensitivity of insulin receptors
  • different MOA from sulfonylureas and meglitinides
    • provides better control in combination therapy
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18
Q

side effects of metformin

A
  • can be severe
    • nausea
    • diarrhea
    • anorexia
  • vitamin deficiencies: can affect absorption; monitor levels
    • B12
    • folic acid
  • lactic acidosis: rare, but potentially fatal
    • r/t effect on mitochondrial oxidation of lactic acid
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19
Q

s/sx of lactic acidosis

A
  • weakness
  • fatigue
  • lethargy
  • hyperventilation
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20
Q

Tx for lactic acidosis

A
  • stop metformin immediately
  • draw labs to test for acidosis
  • hemodialysis may be needed
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21
Q

administering metformin

A
  • monitor
    • fluid I/O
    • for persistent nausea, vomiting, or diarrhea
    • B12 or folic acid levels (recommend supplement)
  • immediate-release: 2x/day with morning and evening meals
  • extended-release: daily with evening meal; swallow whole
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22
Q

pt education for metformin

A
  • lactic acidosis
    • avoid alcohol
    • report weakness, fatigue, lethargy, hyperventilation
    • stop taking and seek medical care if sx develop
  • GI problems
    • expect effects to ↓
    • lie down for nausea
    • ensure adequate carb, clear fluid intake
  • vitamin deficiency
    • report weakness, fatigue, pallor, or red tongue
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23
Q

contraindications and precautions for metformin

A
  • contra: ↑ risk of lactic acidosis
    • DKA
    • cardiopulmonary, hepatic, or renal insufficiency
    • alcoholism
    • heart failure
    • severe infection
    • shock
    • acute MI
    • hypoxemia
    • lactic acidosis
  • caution
    • older adults
    • diarrhea
    • dehydration
    • anemia
    • gastroparesis
    • pituitary insufficiency
    • hypothyroidism
    • GI obstruction
    • PCOS
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24
Q

interactions with metformin

A
  • ↑ risk of lactic acidosis
    • alcohol
    • cimetidine
  • ↑ risk renal failure → lactic acidosis
    • contrast medium with iodine
  • ↑ hypoglycemic effects
    • garlic
    • ginseng
    • captopril
    • nifedipine
    • furosemide
    • morphine
    • ranitidine
    • antifungals
    • many others
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25
Q

thiazolidinediones (glitazones)

A
  • Tx for Type 2 DM
  • with or without insuline or metformin
  • prototype: pioglitazone
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26
Q

mechanism of action for glitazones

A
  • reduce insulin resistance
  • insulin must be available
  • concurrent admin of metformin, a sulfonylurea, or insulin may be needed
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27
Q

side effects of glitazones

A
  • fluid retention
  • hepatotoxicity
  • increased serum lipid levels
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28
Q

administration of glitazones

A
  • monitor
    • edema
    • weight gain
    • indications of heart failure
    • serum ALT levels: baseline, every 3-6 mos after
    • ↑ serum triglyceride, HDL, LDL levels
  • stop drug for indications of liver injury
  • report to provider
    • swelling
    • SOB
    • wt gain > 2-3 kg
    • indications of liver injury
    • ↑ LDLs, triglycerides
  • give orally once daily with or without food
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29
Q

glitazone patient education

A
  • report
    • immediately, significant change
      • SOB
      • wt gain
      • swelling
    • jaundice
    • dark urine
    • abd pain
    • vomiting
    • fatigue
    • chest pain or discomfort
    • diaphoresis
  • expect
    • period cholesterol testing
    • some swelling and wt gain
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30
Q

contraindications and precautions for glitazones

A
  • contra
    • CV dz, including HTN
    • heart failure
    • active hepatic dz
  • caution
    • mild heart failure
    • hx of heart failure
    • hepatic impairment
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31
Q

interactions with pioglitazone

A
  • ↑ risk of heart failure, edema
    • insulin
  • ↑ hypoglycemic effects
    • gemfibrozil
    • ketoconazole
    • green tea
    • ginseng
    • garlic
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32
Q

short name for thiazolidinediones

A

glitazones

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33
Q

alpha-glucosidase inhibitors (AGIs)

A
  • Tx for Type 2 DM
  • with or without insulin, sulfonylurea, or metformin
  • prototype: acarbose
  • other: miglitol
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34
Q

mechanism of action for AGIs

A
  • block action of apha-glucosidase, an enzyme that breaks down carbs in intestine
  • slows absorption of carbs after meal
  • ↓ sudden postprandial BG ↑
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35
Q

side effects of AGIs

A
  • GI: 2/2 fermentation of bacteria from carbs left in colon
    • distention
    • flatus
    • hyperactive BS
    • diarrhea
  • hypoglycemia, in combo with sulfonylurea or insulin
    • Tx difficult because absorption blocked
    • give dextrose parenterally
  • liver dysfunction and iron-deficiency anemia
    • 2/2 long-term or high-dose use with carbose drug
    • liver dysfunction reversible upon D/C of drug
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36
Q

administration of AGIs

A
  • monitor
    • GI sx: hyperactive BS, distention, diarrhea
    • s/sx of hypoglycemia
    • liver enzymes: baseline, every 3 mos for 1 yr, periodically after
    • CBC (hgb), s/sx of anemia (pallor, fatigue)
  • report
    • persistent GI s/sx
    • s/sx of liver injury
  • Tx
    • hypoglycemia: 4g dextrose
    • liver injury: stop drug, report
    • anemia: iron-rich foods, supplements
  • give with first bite of food 3x/day
  • skip dose if skipping meal, only take 1 dose at next meal
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37
Q

pt education for AGIs

A
  • be aware of gastric SE; should ↓ over time
  • follow diet recommended by provider
  • wear medical alert bracelet
  • watch for and report s/sx of hypoglycemia
    • test BG to confirm
    • take 4g of dextrose
    • retest in 15 min
    • repeat Tx if necessary
    • carry dextrose tabs at all times
  • report signs of
    • liver dysfunction
      • dark urine
      • abd pain
      • vomiting
      • fatigue
    • anemia
      • pallor
      • fatigue
      • SOB
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38
Q

contraindications and precautions for acarbose

A
  • contra
    • GI disorders (inflammatory bowel disease)
    • GI obstruction
    • GI ulceration
  • caution
    • hepatic impairment
    • GI distress
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39
Q

interactions with AGIs

A
  • ↑ risk of hypoglycemia
    • insulin
    • sulfonylureas
    • ginseng
  • ↑ GI effects
    • metformin
  • conteract
    • estrogens
    • thiazides
    • corticosteroids
    • phenothiazines
    • isoniazid (INH)
    • phenytoin
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40
Q

gliptins

A
  • Tx for Type 2 DM
  • with or without metformin or glitazone
  • prototype (only drug, new class): sitagliptin
  • also comes in combo with metformin
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41
Q

mechanism of action of sitagliptin

A
  • augment endogenous incretin hormones by inhibiting enzyme that inactivates them
  • promotes release of insulin
  • ↓ secretion of glucagon
  • ↓ fasting and postprandial BG
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42
Q

side effects of sitagliptin

A
  • trials: small ↑ in
    • URI
    • inflammed nasal passages
    • headache
  • pancreatitis reported in post-release study, possible adverse effect
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43
Q

administration of gliptins

A
  • monitor for
    • respiratory sx
      • body temp
    • headaches (OTC analgesic if persistent)
    • GI effects, s/sx of pancreatitis
      • blood amylase level
  • admin
    • orally alone or as metformin combo
    • with or without food
    • ↓ dose for pts with severe renal impairment and low creatinine clearance
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44
Q

pt education for sitagliptin

A
  • report
    • persistent URI sx or fever
    • persistent or uncontrolled headache
    • severe upper abd pain
    • abd pain that radiates to back and nausea or vomiting
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45
Q

contraindications and precautions for sitagliptin

A
  • contra
    • Type 1 DM
    • lactic acidosis
  • caution
    • hemodialysis
    • mod-severe renal dysfunction
    • Hx of pancreatitis
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46
Q

interactions with sitagliptin

A

↑ digoxin levels (only known interaction)

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47
Q

injectable hypoglycemics

A
  • insulin
  • amylin mimetics
  • incretin mimetics
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48
Q

Type 1 DM

A
  • beta cells of pancreas become damaged and don’t produce insulin
  • thought to be autoimmune
  • oral hypoglycemics don’t work
  • requires injectable hypoglycemics
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49
Q

insulin

A
  • for Tx of
    • DM (1 or 2) that can’t be controlled with oral hypoglycemics and diet
    • gestational DM
  • categorized by duration of action
  • produced recombinant DNA tech
  • prototypes
    • rapid: lispro
    • short: regular insulin (Humulin R)
    • intermediate: NPH
    • long: insulin glargine
  • other
    • rapid: insulin aspart
    • short: regular insulin (Novolin R)
    • intermediate: insulin detemir
  • mixture: eliminates need to mix for pts who need multiple types
    • short and intermediate: NPH 70% and regular 30% (Humulin 70/30)
  • may be used to treat hyperkalemia
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50
Q

onset, peak, and duration times for rapid-acting lispro insulin

A
  • onset: 15-30 min
  • peak: 30 min to 2/5 hr
  • duration: 3-6 hr
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51
Q

onset, peak, and duration times for short-acting regular insulin

A
  • onset: 30 min to 1 hr
  • peak: 1-5 hr
  • duration: 6-10 hr
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52
Q

onset, peak, and duration times for NPH insulin

A
  • onset: 1-2 hr
  • peak: 6-14 hr
  • duration: 16-24 hr
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53
Q

onset, peak, and duration times for insulin glargine

A
  • onset: 70 min
  • peak: none, steady levels
  • duration: 24 hr
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54
Q

insulin produced by recombinant DNA technology

A
  • chemically identical to insulin produced in beta cells
  • promotes cellular uptake and use of glucose
  • converts macronutrients
    • glucose → glycogen
    • amino acids → proteins
    • fatty acids → triglycerides
  • promotes
    • storage of glucose
    • uptake of potassium to cells (hypokalemia can occur)
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55
Q

side effects of insulin

A
  • excess insulin intake
    • hypoglycemia
    • hypokalemia
  • lipohypertrophy
    • injecting in same place too often
    • stimulates synthesis of adipose tissue
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56
Q

things to monitor when giving insulin

A
  • signs of hypoglycemia
    • abrupt onset
      • tachycardia
      • diphoresis
      • shakiness
    • gradual onset
      • headache
      • tremors
      • weakness
  • BG levels
  • signs of lipohypertrophy
  • potassium levels
  • signs of hypokalemia
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57
Q

treating insulin side effects

A
  • hypoglycemia
    • check BG to confirm
    • give 15-20 g carbs
      • 4 oz fruit juice
      • 1 Tbsp honey
      • glucose tabs per instructions
      • for unconscious: parenteral dextrose
    • check BG after 15 min
    • repeat Tx if necessary
  • lipohypertrophy: rotate injection sites
  • hypokalemia: give potassium
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58
Q

administration of insulin

A
  • most often given SQ, but also for IV
  • SQ
    • use insulin syringe marked in units (0.01 mL)
    • for suspensions: rotate gently between palms
    • when mixing, draw up short-acting first, the long
    • do not mix glargine or detemir
    • do not give short-acting if cloudy, discolored
  • short-acting: make sure carbs available in body at onset and peak times
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59
Q

reasons to adjust dosage of insulin

A
  • caloric intake change
  • infection
  • exercise
  • stress
  • growth spurts
  • pregnancy
  • hospitalization, surgery: sliding scale, short-acting
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60
Q

storing insulin

A
  • in use: room temp for one month
  • unopened, single type: refrigerate until expiration date
  • premixed in syringe
    • 1-2 wks in fridge
    • vertical, needles up
    • resuspend with gentle motion before admin
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61
Q

pt education for insulin injections

A
  • admin
    • draw up Rx amount
    • have pt demonstrate
    • rotate sites systematically (1 inch apart)
    • do not inject cold; keep vial in use at room temp
  • s/sx, Tx of hypoglycemia
  • medical alert bracelet
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62
Q

contraindications and precautions for insulin

A
  • # of insulins available → pts can usually tolerate one
  • contra
    • hypersensitivity
    • hypoglycemia
  • precautions
    • renal, hepatic dysfunction
    • fever
    • thyroid dz
    • older adults
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63
Q

interactions with insulin

A
  • ↑ hypoglycemic effects
    • sulfonylureas
    • meglitinides
    • beta blockers
    • alcohol
  • counteract: ↑ BG level
    • thiazide and loop diuretics
    • sympathomimetics
    • thyroid hormones
    • glucocorticoids
  • mask hypoglycemia (tachycardia, tremors): beta blockers
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64
Q

amylin mimetics

A
  • Tx of Types 1 and 2 DM
  • for pts who can’t control with oral hypoglycemics and insulin
  • adjunct with insulin or oral hypoglycemic
  • prototype (new class): pramlintide
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65
Q

mechanism of action for amylin mimetics

A
  • mimics peptide hormone amylin from pancreas
  • ↓ postprandial BG levels 3 ways
    • slows gastric emptying
    • inhibits secretion of glucagon
    • ↑ feelings of satiety
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66
Q

side effects of emylin mimetics

A
  • hypoglycemia: severe when in combo with insulin
  • nausea: mostly in Type 1 DM; ↓ dose can help
  • injection site reactions: common
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67
Q

administering amylin mimetics

A

expect ↓ insulin dose

  • monitor for s/sx of hypoglycemia, usually within 3 hr of dose
  • recommend gradual titration of doses
  • monitor for persistent N&V
  • do not mix with insulin
  • give SQ in thigh or abd
  • give AC: ≥ 30 g carbs
  • rotate sites
  • peak: 20 min
  • storage
    • in use: room temp for 28 days
    • unopened: fridge until expired
68
Q

pt education for amylin mimetics

A
  • watch for and report hypoglycemia, especially 3 hr after dose
  • s/sx and Tx of hypoglycemia
  • carry carb snack at all times
  • return demonstrate proper injection
  • wear medical alert bracelet
69
Q

contraindications and precautions for amylin mimetics

A
  • contra
    • renal failure
    • hemodialysis
    • poor insulin regimen adherence
    • HbA1c > 9%
    • gastroparesis
  • caution
    • thyroid dz
    • osteoporosis
    • alcoholism
70
Q

interactions with pramlintide

A
  • ↑ risk of hypoglycemia with insulin
  • take other meds 1-2 hr before or after because of ↓ absorption
  • ↓ gastric emptying, absorption
    • drugs that slow gastric emptying: opioids
    • drugs that delay absorption: acarbose, miglitol
71
Q

incretin mimetics

A
  • for Tx of Type 2 DM
  • adjunct to sulfonylureas or metformin
  • prototype (new class): exenatide
  • synthetic peptide similar to glucagon
72
Q

mechanism of action for incretin mimetics

A
  • activate GLP-1 receptors PC
  • slow gastric emptying
  • stimulate release of insulin in presence of glucose
  • ↓ secretion of glucagon
  • ↑ feelings of satiety
73
Q

side effects of incretin mimetics

A
  • hypoglycemia
    • severe with sulfonylurea, but not with metformin
    • ↓ dose of oral hypoglycemic ↓ risk
  • nausea
  • vomiting
  • diarrhea
  • pancreatitis: usually requires D/C of drug
74
Q

administering incretin mimetics

A
  • initial dose ↓ until effects determined
  • hypoglycemia
    • ↓ dose of oral hypoglycemic
    • most common SE
  • GI symptoms
    • nausea, vomiting, diarrhea
    • monitor fluid and carb intake
    • report if persistent or contribute to hypoglycemic episodes
  • pancreatitis
    • monitor for indications (severe, persistent abd pain)
    • stop drug and report if sx develop
75
Q

giving incretin mimetic injections

A
  • injection
    • give SQ in thigh, abd, upper arm
    • up to 60 min AC morning and evening
    • NOT after meals
    • peak: 2 hr
  • prep
    • follow instructions
    • use appropriate needle size, Rx by provider
    • new needle for each injection
    • do not store with needle attached
76
Q

pt education for incretin mimetics

A
  • s/sx and Tx for hypoglycemia
  • nausea, vomiting, diarrhea
    • nausea: lie down
    • ensure adequate caloric intake
  • pancreatitis
    • report severe, persistent abd pain
    • stop taking exenatide
77
Q

contraindications and precautions for exenatide

A
  • contra
    • renal failure
    • Type 1 DM
    • DKA
    • ulcerative colitis
    • Crohn’s
    • gastroparesis
  • caution
    • older adults
    • thyroid dz
    • renal dysfunction
78
Q

interactions with exenatide

A
  • ↑ risk of hypoglycemia: sulfonylureas
  • give other oral drugs (especially oral contraceptives, abx) 1-2 hr before or after exenatide (slowed absorption)
79
Q

hyperglycemics

A
  • Tx for hypoglycemia 2/2 insulin overdose
  • other: IV 50% glucose
    • immediate onset
    • preferred
  • prototype: glucagon
    • IV, SQ, IM
    • slower onset
80
Q

mechanism of action for glucagon

A
  • converts glycogen from liver to glucose
  • onset: about 20 min
81
Q

side effects of glucagon

A
  • high incidence of GI effects: nausea, vomiting
  • may persist after admin
  • monitor for persistence
  • monitor fluid and carb intake
  • turn unconscious pts on side to prevent aspiration
82
Q

administering glucagon

A
  • give IM, SQ, or IV
  • unconscious pts
    • expect consciousness about 20 min after IV admin
    • give food after consciousness, swallowing regained
  • IV glucose still Tx of choice
83
Q

pt education for glucagon

A
  • emergency admin
    • teach pt and fam how/when to inject
    • carry at all times
  • N&V
    • warn about probable vomiting
    • keep pt on their side
    • encourage oral intake when tolerated
84
Q

contraindications and precautions for glucagon

A
  • contra
    • hypoglycemia from starvation (depleted glycogen)
    • pheochromocytoma (adrenal tumor)
  • caution
    • CV disorders
    • adrenal insufficiency
85
Q

interactions with glucagon

A

↑ effects of oral anticoagulants

86
Q

2 types of thyroid drugs

A
  • thyroid replacements (for hypothyroid)
  • antithyroid (for hyperthyroid)
87
Q

thyroid replacement

A
  • oral: for Tx of hypothyroidism
  • IV: for myxedema coma
  • prototype: levothyroxine (synth; T4)
  • other
    • liothyronine (synth; T3)
    • liotrix (synth; T4 and T3)
    • thyroid (natural; animal-sourced)
88
Q

levothyroxine mechanism of action

A

synthetic form of T4 which is converted to T3 in the body

89
Q

side effect of thyroid replacements

A

hyperthyroidism

90
Q

s/sx of hyperthyroidism

A
  • anxiety
  • tachycardia
  • palpitations
  • tremors
  • altered appetite
  • abd cramping
  • diarrhea
  • heat intolerance
  • fever
  • diaphoresis
  • wt loss
  • menstrual irregularities
91
Q

myxedema coma

A
  • severe or prolonged hypothyroidism
  • body basically shuts down
92
Q

administering thyroid replacements

A
  • oral
    • daily on empty stomach
  • get baseline and monitor VS, wt, height
  • monitor for cardiac excitability
    • angina
    • chest pain
    • palpitations
    • dysrhythmias
  • monitor thyroxine and TSH levels
  • thyroxine formulations not interchangeable
  • therapy is life-long
93
Q

pt education for thyroid replacements

A
  • formulations not interchangeable: notify pharmacy if different product dispensed
  • expect lifelong therapy
  • take daily
  • watch for and report s/sx of hyperthyroidism
94
Q

contraindications and precautions for thyroid replacements

A
  • contra
    • thyrotoxicosis
    • recent MI
  • caution
    • older adults
    • renal impairment
    • DM
    • CV disorders
      • HTN
      • angina pectoris
      • ischemic heart dz
95
Q

interactions with thyroid replacements

A
  • ↓ absorption of levothyroxine: don’t take within 4 hr
    • food
    • cholestyramine
    • antacids
    • iron
    • calcium
    • sucralfate
  • ↓ levo levels: antiseizure and antidepressant drugs
    • phenytoin
    • phenobarbitol
    • sertraline
    • carbamazepine
  • ↑ anticoagulant effects of warfarin
  • ↑ cardiac reponse to catecholamines
96
Q

antithyroid drugs

A
  • Tx hyperthyroidism (Graves’ dz)
  • alone or with radiation
  • supression of thyroid hormone
    • in prep for thyroidectomy
    • in thyrotoxic crisis
  • prototype: propylthiouracil (PTU)
  • other: methimazole
97
Q

thyrotoxic crisis

A
  • 2/2 to
    • uncontrolled hyperthyroidism
    • exposure to stressor: surgery, pregnancy
  • sx
    • tachycardia
    • HTN
    • fever
98
Q

mechanism of action of antithyroid drugs

A
  • blocks synthesis of thyroid hormone
  • blocks iodine integration into tyrosine
  • blocks conversion of T4 to T3
99
Q

side effects of antithyroid drugs

A
  • hypothyroidism
  • agranulocytosis
    • uncommon
    • during initial therapy
    • reversible
  • rash
  • arthralgia
  • myalgia
  • headache
100
Q

administering propylthiouracil

A
  • hypothyroidism
    • monitor thyroid function
    • get baseline and monitor T3 and T4
    • ↓ dose if hypo
  • agranulocytosis
    • get baseline and monitor CBC
    • monitor for s/sx
    • stop and notify if ↓ leukocytes and neutrophils
  • rash, joint or muscle pain, headache
    • mild analgesic for pain
  • orally at regular intervals (usually 8 hr)
  • get baseline and monitor VS, wt
  • 3-12 wks for euthyroid state
  • 6-12 mos to stabilize
  • do not D/C abruptly
101
Q

s/sx of hypothyroidism

A
  • drowsiness
  • depression
  • wt gain
  • edema
  • bradycardia
  • anorexia
  • cold intolerance
  • dry skin
  • menorrhagia
102
Q

s/sx of agranulocytosis

A
  • ↓ leukocytes and neutrophiles
  • fever
  • sore throat
103
Q

pt education for propylthiouracil

A
  • regimens
    • sometimes lifelong
    • adjunct with radiation
    • in prep for thyroidectomy
  • report
    • s/sx of hypothyroidism
    • s/sx of agranulocytosis
    • joint/muscle pain, headache
      • take OTC analgesic
104
Q

contraindications and precautions for propylthiouracil

A
  • contra
    • pregnancy category D: neonatal hypothyroidism and goiter
  • caution
    • immunosuppression
    • bone marrow depression
    • infection
    • liver dysfunction
105
Q

interactions with propylthiouracil

A
  • ↑ effects of anticoagulants
  • food alters absorption rates
  • counteracted by
    • potassium iodide
    • sodium iodide
    • amiodarone
106
Q

radioactive iodine

A
  • Tx for hyperthyroidism (Graves’ dz)
  • thyroid cancer
  • prototype: iodine-131
  • other
    • sodium iodide
    • potassium iodide
107
Q

mechanism of action of radioactive iodine

A
  • absorbed by thyroid gland
  • gradually destroys thyroid tissue
  • gradually decreases thyroid function
108
Q

side effects of radioactive iodine

A
  • hypothyroidism
    • expected for most
    • requires hormone therapy
  • bone marrow depression (rare)
  • radiation sickness (rare)
109
Q

administering radioactive iodine

A
  • labs
    • TSH
    • T4
    • T3
    • CBC: baseline and after
  • s/sx of
    • hypothyroidism
    • anemia
    • leukopenia
    • thrombocytopenia
    • radiation sickness
  • give once, subsequently for some pt
  • get negative hCG before
  • VS and wt: baseline and after
  • onset: effects in few days or wks; full effect in 2-3 mos
  • radiation precautions for large doses
    • limit contact
    • increase fluids
    • body waste disposal per protocol
110
Q

s/sx of radiation sickness

A
  • hematemesis
  • epistaxis
  • intense nausea, vomiting
111
Q

pt education for radioactive iodine

A
  • info about goal of therapy
  • watch for and report s/sx of
    • hypothyroidism
    • bone marrow depression
    • radiation sickness
112
Q

contraindications and precautions for radioactive iodine

A
  • contra
    • pregnancy category X: damage to fetus and fetal thyroid
    • lactation: damage to baby’s thyroid
  • caution: prepubescent children
113
Q

interactions with radioactive iodine

A

antithyroid drugs ↓ uptake

114
Q

drugs for hypothalamic disorders

A
  • growth hormone
  • antidiuretic hormone (ADH)
115
Q

growth hormone

A
  • Tx for
    • deficiency in children: Turner’s syndrome
    • deficiency in adults: to increase lean muscle mass
    • AIDS wasting syndrome
  • prototype: somatropin
116
Q

mechanism of action for growth hormone

A

stimulates release of insulin-like growth factor-1 (IGF-1) from liver and other tissues

117
Q

mechanism of action of somatostatin

A

inhibits release of growth hormone from pituitary

118
Q

imbalance in growth hormone

A
  • children
    • inadequate: short stature
  • adolescents
    • excessive: gigantism
  • adults
    • excessive: acromegaly
119
Q

acromegaly

A
  • caused by excessive growth hormone in adults, especially middle-aged
  • big bones
  • notable in hands, face, feet
120
Q

side effects of somatropin

A
  • hyperglycemia
  • myalgia
  • hypercalciuria
121
Q

administering somatropin

A
  • monitor
    • BG levels
    • muscle pain (mild analgesic)
    • urine calcium
    • renal stones
  • IM or SQ (preferred)
    • dosage wt-based
    • daily or multiple/wk
    • very costly
  • baseline and monitor
    • VS
    • wt
    • thyroid function
    • growth hormone levels
    • annual X-rays of long bones
  • reconstituting: rotate gently, do not shake
  • inject into abd and thighs
  • rotate sites
122
Q

pt education for somatropin

A
  • watch for and report
    • hyperglycemia
      • polyphagia (hunger)
      • polydipsia (thirst)
      • polyuria
    • myalgia
    • hypercalcemia
      • flank pain
      • urinary frequency
      • hematuria
  • proper injection technique
123
Q

contraindications and precautions for somatropin

A
  • contra
    • severe obesity
    • severe respiratory impairment
    • closed epiphyses in children
    • critical illness
  • caution
    • DM
    • chronic renal failure
    • hypothyroidism
    • Prader-Willi syndrome (PWS)
124
Q

interactions with somatropin

A
  • counteracted by
    • glucocorticoids
    • adrenocorticotropic hormone
  • promote epiphyseal closure
    • thyroid hormones
    • estrogens
    • androgens
125
Q

antidiuretic hormone (ADH)

A
  • Tx for
    • diabetes insipidus
    • hemophilia
  • prototype: desmopressin (DDAVP)
    • preferred because of short DOA, parenteral route
  • other: vasopressin
  • ADH produced by hypothalamus, stored in posterior pituitary
126
Q

mechanism of action for ADH

A
  • produces effects on kidneys
    • ↑ reabsorption of water
    • ↓ urine volume
127
Q

side effects of ADH

A
  • fluid retention → water intoxication
  • hyponatremia
  • vasoconstriction (vasopressin only)
128
Q

nursing actions when giving ADH

A
  • fluid retention
    • headache, confusion, other signs of water intoxication
    • monitor I/O
    • monitor serum Na levels
    • restrict fluid intake if needed
    • recommend diuretic therapy if mod-severe
  • monitor for s/sx of
    • MI
    • angina
    • cardiac insufficiency
129
Q

administering desmopressin

A
  • oral, intranasal, SQ, or IV
  • intranasally
    • high into nasal cavity
    • not into throat
  • monitor
    • BP
    • I/O
    • urine and plasma osmolality
    • creatinine clearance
130
Q

administering IV vasopressin

A
  • monitor IV site
  • extravasation → gangrene
131
Q

pt education for ADH

A
  • report water intoxication Sx
    • pounding headache
    • sleepiness
    • fluid retention
    • weight gain
    • edema
  • record fluid I/O daily
  • limit fluid intake during therapy
  • report chest pain or pressure
  • expect lifelong therapy
132
Q

contraindications for vasopressin

A
  • coronary artery disease
  • poor peripheral circulation
  • chronic nephritis
133
Q

contraindications and precautions for desmopressin

A
  • contra
    • renal failure
    • nephrogenic diabetes insipidus
    • electrolyte imbalances (oral form)
  • precautions
    • older adults
    • CV disease
    • HTN
    • Hx of hyponatremia
    • Hx of thromboembolic events
    • severe heart failure
134
Q

interactions with vasopressin and desmopressin

A
  • ↑ antidiuretic action
    • carbamazepine
    • chlorpropamide
  • ↓ antidiuretic action
    • other vasopressors
    • lithium
135
Q

drug classes to treat adrenal disorders

A
  • glucocorticoids
  • mineralocorticoids
  • androgens
136
Q

glucocorticoids for adrenal disorders

A
  • replacement therapy for acute and chronic adrenocortical insufficiency (Addison’s disease)
  • prototype: hydrocortisone
  • other: prednisone, dexamethasone
137
Q

mechanism of action for glucocorticoids in Tx of adrenal disorders

A
  • synth of cortisol in adrenal gland stimulated by adrenocorticotropic hormone (ACTH)
  • pituitary gland stimulated to release ACTH in response to the release of corticotropin releasing hormone by the hypothalamus.
  • cortisol: primary glucocorticoid the body needs
    • makes glucose available
    • promotes breakdown of proteins and lipids → glucose
    • production increased during stress to support BP and BG
138
Q

side/adverse effects of glucocorticoid replacement therapy

A
  • few effects at low, therapeutic levels
  • multiple effects at high levels to suppress inflammation and immune system
      • hypercortisolism
    • hyperglycemia
    • fat redistribution
    • osteoporosis
  • hypocortisolism
    • fatigue
    • wt loss
    • hypoglycemia
139
Q

administering glucocorticoids for adrenal disorders

A
  • labs (baseline and monitor)
    • CBC
    • electrolyte
    • glucose
    • glucocorticoid
  • oral for chronic insufficiency
    • total daily dose HS or
    • divided: 2/3 morning, 1/3 early afternoon
  • IV for acute situations
  • taper slowly and establish minimum therapeutic dose
  • supplemental doses PRN during stress
140
Q

pt education for glucocorticoids for Tx of adrenal disorders

A
  • wear medical alert bracelet
  • carry emergency dose
  • report increased physical/emotional stress
    • ↑ dose needed to prevent hypocortisolism
  • expect lifelong therapy
141
Q

contraindications and precautions for glucocorticoids

A
  • low doses: none
  • high doses: SE can complicate current or previous disorders (e.g. DM)
142
Q

interactions with glucocorticoids

A
  • small doses: none
  • high doses: multiple
143
Q

mineralocorticoids

A
  • replacement therapy for acute and chronic adrenocortical insufficiency
    • Addison’s disease
    • primary hypoaldosteronism
    • congenital adrenal hyperplasia
  • usually along with hydrocortisone
  • prototype (only): fludrocortisone
144
Q

mechanism of action of fludrocortisone

A
  • replaces insufficient aldosterone
    • synthesis stimulated by the renin-angiotensin-aldosterone system (RAAS)
    • regulates sodium, potassium, and water levels in the body
    • promotes sodium and water reabsorption by the kidneys
    • promotes excretion of potassium by the kidneys
  • deficiency → dangerous fluid-electrolyte imbalances
145
Q

side effects of fludrocortisone

A
  • low, therapeutic dose: few
  • inadequate dose
    • wt loss
    • poor appetite
    • fatigue
    • muscle weakness
    • hypotension
  • excess dose
    • wt gain
    • fluid retention
    • ↑ BP
    • hypokalemia
  • high dose: fluid and electrolyte imbalances → HTN, edema, heart failure, hypokalemia
146
Q

administering fludrocortisone

A
  • orally daily or 3x/wk
  • get baseline and monitor CBC and electrolyte levels
147
Q

pt education for fludrocortisone

A
  • medical alert bracelet
  • report Sx of ↑ Na
    • wt gain
    • swelling
  • report Sx of low potassium (life-threatening)
    • weakness
    • heart palpitations
  • have BP checked regularly
148
Q

contraindications and precautions for fludrocortisone

A
  • contra
    • potassium-depleting diuretics
    • acute glomerulohephritis
    • hypercortisolism
    • viral or bacterial skin dz uncontrolled by abx
  • caution
    • heart failure
    • systemic fungal infection
    • thromboembolic disorder
    • DM
    • HTN
    • renal dysfunction
149
Q

interactions with fludrocortisone

A
  • ↓ fludrocortisone levels: rifampin
  • ↓ anti-diabetes effects of insulin and sulfonylureas
  • ↑ risk of hypokalemia: potassium-depleting diuretics such as furosemide
150
Q

You are caring for a pt taking exenatide to treat Type 2 DM. Pt reports severe abd pain. You suspect what adverse reaction to this drug?

A

pancreatitis

151
Q

You are caring for a pt on acarbose and a sulfonylurea to treat Type 2 DM. Which of the following is an indication of an adverse reaction to this drug combination?

  • polyuria
  • tremors
  • bradycardia
  • thirst
A

tremors

152
Q

Name the therapeutic uses of each.

  1. desmopressin
  2. glucagon
  3. glipizide
  4. radioactive iodine-131
A
  1. diabetes insipidus
  2. hypoglycemia
  3. Type 2 DM
  4. thyroid cancer
153
Q

A pt is about to start taking sustained-release glipizide (Glucotrol) to treat Type 2 DM. Which of the following instructions should you include when talking with the patient about taking this drug?

  • chew tab completely before swallowing
  • take once a day, 30 min before selected meals
  • take in the evening before bed
  • drink 16 oz of water after taking
A

take once a day, 30 min before selected meals

154
Q

You are caring for a pt taking levothyroxine for hypothyroidism. The patient reports palpitations, wt loss, diarrhea. You suspect which adverse effect?

  • hyperthyroidism
  • Addison’s dz
  • myxedema
  • hyperglycemia
A

hyperthyroidism

155
Q

A pt is about to start taking somatropin. You evaluate the effectiveness with which of the following assessments?

  • LOC
  • ECG
  • ht and wt
  • breath sounds and RR
A

ht and wt

156
Q

A patient is about to start taking hydrocortisone to treat adrenocortical insufficiency. You instruct the patient to do which of the following to help reduce her risk for adverse effects? (Select all that apply.)

  • expect lifelong therapy
  • carry extra doses
  • expect periodic blood tests
  • urinate every 4 hr
  • report increased stress
A
  • expect lifelong therapy
  • carry extra doses
  • expect periodic blood tests
  • report increased stress
157
Q

Name therapeutic uses for each.

  1. hydrocortisone
  2. somatropin
  3. propylthiouracil (PTU)
  4. levothyroxine
A
  1. Addison’s dz
  2. Turner’s syndrome
  3. thyrotoxic crisis
  4. hypothyroidism
158
Q

When talking with a patient about self-administering regular insulin (Humulin R), you should include which of the following instructions?

  • shake vial vigorously
  • expect cloudy appearance
  • store unopened vials at room temp
  • inject insulin SQ
A

inject insulin SQ

159
Q

When talking with a 30-year-old woman who will receive radioactive iodine-131 (Iodotope) to treat Graves’ disease, you should include which of the following instructions? (Select all that apply.)

  • report wt gain, edema
  • use effective contraception
  • allow 2-3 mos for full effect
  • expect periodic labs
  • get regular eye exams
A
  • report wt gain, edema
  • use effective contraception
  • allow 2-3 mos for full effect
  • expect periodic labs
160
Q

What Dx do you expect with the following Sx and lab results for a 19-year-old woman who hasn’t eaten in > 12 hr?

  • N&V
  • polyuria
  • nocturia
  • persistent thirst
  • BG: 185 mg/dL
  • glucose and ketones in urine
A

Type 1 DM

161
Q

The patient will self-inject 8 units of NPH insulin and 4 units of regular insulin each day before breakfast. As you show the patient how to self-administer insulin, you should include which of the following instructions? (Select all that apply.)

  • draw regular insulin first, then NPH
  • inject in large muscle
  • discard unused premix within 5 days
  • use 5-mL syrine when mixing
  • use one syringe to ↓ injections
A
  • draw regular insulin first, then NPH
  • use one syringe to ↓ injections
162
Q

You instruct the patient to watch for and report which of the following indications of an adverse reaction to insulin?

  • palpitations
  • wt gain
  • low UOP
  • constipation
A

palpitations

163
Q

As you continue to talk with the patient about managing her diabetes with regular insulin (Humulin R), you should include which of the following instructions? (Select all that apply.)

  • Self-inject chilled insulin.
  • Carry a carbohydrate snack.
  • Rotate injection sites.
  • Wear a medical alert bracelet.
  • Expect to adjust the dosage during illness.
A
  • Carry a carbohydrate snack.
  • Rotate injection sites.
  • Wear a medical alert bracelet.
  • Expect to adjust the dosage during illness.
164
Q

You give the patient 5 units of lispro insulin (Humalog) and 10 units of insulin glargine SQ at 1400. Based on your instructions, the patient should expect her blood glucose level to be the lowest at which of the following times?

  • 1430
  • 1530
  • 1630
  • 1730
A

1430

165
Q

The next day, two hours after self-administering regular insulin SQ, the patient contacts you at the provider’s office to report that she is sweating, shaky, and has a rapid pulse. Which of the following actions should you advise her to take?

  • Drink 4 oz of orange juice.
  • Check her blood glucose level.
  • Take an oral hypoglycemic.
  • Measure her urine output.
  • Self-administer a long-acting insulin.
A
  • Drink 4 oz of orange juice.
  • Check her blood glucose level.

2020 Pharmacology I (21 decks)

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