Unit 2 - Endocrine Flashcards
What’s your first choice of medication for hyperglycemia in T2D?
Usually Metformin
What is the primary driver of the endocrine system?
Hypothalamus (tells the pituitary to stop or release more of a hormone - negative feedback loop)
The hypothalamus functions on a negative feedback loop with the pituitary gland.
What does antidiuretic hormone (ADH) do?
Prevents urine from being excreted ; tells kidneys to retain water to thin out the blood (increases blood pressure)
Released when blood is too thick.
What is vasopressin and its effects?
Mimics ADH, increases blood volume (thinning out blood and increasing blood pressure) contracts smooth muscle (uterus), and increases clotting factors.
Administered orally, IV, nasal spray, or subcut.
What is Somatropin used for?
Used in pediatric patients (primarily) or adult oncology patients for muscle wasting, dwarfism, or any student growth disorder.
It is the endogenous form of growth hormone.
What are the side effects of Somatropin?
Fatigue, headache, joint pain. Specifically look out for acromegaly and long-term usage effects (diabetes, HIV/AIDs, hypothyroid, cardiovascular issues).
Acromegaly is a significant concern indicating a possible dose reduction.
What is octreotide?
Synthetic form of somatostatin that inhibits the release of growth hormone.
Routes include oral, IV, or subcut.
What are the signs of hypothyroidism vs hyperthyroid?
Hypo: Menstrual dysfunction, fatigue, weight gain
Hyper: hair falling out, anxiety, increased heart-rate, hungry but not gaining any weight (fast metabolism), really thin, bulging eyes.
These symptoms indicate an underactive thyroid.
What is levothyroxine and its administration requirements?
Mimics T4 function (used to treat hypothyroid). Must be taken first thing in the morning at the same time everyday with water; wait at least 30 mins to eat.
What is the mechanism of action for PTU?
Inhibits T3 and T4 production (given for hyperthyroidism / thyroid storms)
What is radioactive iodine used for?
Treats thyroid cancer and iodine deficient hypothyroid
Administered as a one-time dose orally, IV, or liquid.
What is calcitonin’s primary function?
Lower calcium levels in the body by inhibiting breakdown of bone
Administered via nasal spray, subcut, or IM.
What is alendronate (biphosphate) used for?
Prevents bone breakdown (similar to calcitonin).
Administered orally or IV
What are corticosteroids used for?
Autoimmune disorders and adrenal insufficiency
They decrease immune and inflammatory responses.
What are the side effects & adverse effects of corticosteroids?
Side effects: mood swings, muscle weakness, bruising/ ulcers/thinned skin/poor wound healing (skin changes), increased blood sugar (hyperglycemia), and hypokalemia.
Adverse effects: PUD, osteoporosis/ fractures, adrenal crisis (Addison’s), diabetes, cardiovascular disease, immunosuppression, Cushing’s syndrome (excess of corticosteroid)
Monitor for adrenal shutdown with long-term use.
What is Addison’s disease?
Adrenal insufficiency where adrenal glands do not function properly. Can lead to an Addisonian crisis (medical emergency).
Treated with prednisone or methylprednisolone.
What are the hallmark signs of Cushing’s disease?
Moon face and buffalo hump
This syndrome can be reversible.
What is the mechanism of action for aminoglutethimide?
Decreases production of adrenal cortex hormones
What is the primary role of insulin?
Lowers blood sugar
High-risk medication
What are the common signs of hypoglycemia & the severe form?
“Cold and clammy, need some candy”. Shaky, sweaty (cold sweat), hungry, sleepy, confused, headache, blurred vision
Severe form (diabetic coma): unable to eat or drink, seizures or convulsions, unconsciousness.
Severe cases can lead to seizures or unconsciousness.
What are the types of insulin?
Basal insulin - long-acting (Glargine and Detemir) and intermediate-acting (NPH). These will keep blood sugar at a nice, steady state with little to no peaks.
Prandial insulin - rapid-acting (Lispro) and/or short-acting (Humulin R, Novolin R, any “Regular” insulin). These do peak blood sugar; mimic the action of glucose released when eating.
What is the mechanism of action of biguanides like Metformin?
Decreases hepatic production and intestinal absorption of glucose
Improves insulin sensitivity without causing hypoglycemia.
What is the purpose & MOA of oral contraceptives?
Inhibit ovulation and regulate menstrual cycles by thickening cervical mucus
Can also treat certain cancers and heavy periods.
What are common side effects of oral contraceptives?
Mood swings, weight gain, headache, blurred vision
Increased risk of blood clots is also a concern. Memory hint: thickening cervical mucus -> thickening blood = blood clots
What are the side effects & adverse effects of Octreotide?
GI upset, depression, feeling cold, muscle cramps, etc. Adverse effects: cholelithiasis (gallstones), hypothyroid, pancreatic insufficiency & hyperglycemia (pancreas slows down = less insulin = too much glucose)
Memory hint: SLOWING down growth = slowing down metabolism (thyroid), pancreas, gallbladder, & mood
What are the considerations for octreotide?
Monitor renal/hepatic function in labs before you administer, and also watch for drug interactions (LOTS of drug interactions).
Memory hint: Octreotide causes liver & kidney slides
What are the considerations for levothyroxine?
Monitor patients who are diabetics, are or may become pregnant, have adrenal insufficiency, or cardiac disorders before giving this med.
Memory hint: Levo DPAC -> diabetes, pregnancy, adrenal insufficiency, cardiac disorders
What are the side effects for levothyroxine?
Metabolic increase: GI upset, weight loss, cardiac dysrhythmias (heart palps or tachycardia), hyperthyroidism (adjust the dosage!)
What are the considerations for PTU?
Like a thyroid med, so Very important to take at the same time each day and never double up on a dose. You have to monitor T3 & T4, TSH, and watch for pregnancy (can’t be pregnant while on it).
Memory: PTU -> no pregnancy for you!
What are the side effects & adverse effects of PTU?
Side effects: GI upset, drowsiness, decreased white blood cells (teach patients how to monitor for signs of infection!) , decreased platelets (monitor for bleeding and bruising).
Adverse effects: liver & bone marrow toxicity, black/tarry stools, blood in urine (basically blood anywhere it shouldn’t be - alert doctor right away).
memory hint: PTU causes decreased WBCs and Platelets TOO! Leave it be -> liver & bone marrow toxicity & blood anywhere it shouldn’t be
What are the side effects of radioactive iodine?
Tenderness in neck, GI upset, dry mouth.
What are the considerations for radioactive iodine usage?
Must have a high level of TSH in blood before administering.
Do not give to patients who are allergic to iodine/shellfish/seafood.
Remember isolation rooms or contact exposure precautions & making sure pt. increases fluids.
Also, hormone replacement will be needed after this treatment (they don’t have a thyroid anymore!).
What are the side effects of calcitonin?
GI upset, flushing, redness or swelling at injection site or allergic reaction (more adverse).
Memory: Calicitonin my inflammation up
What are the considerations for calcitonin usage?
Watch for pregnancy
Make sure patients increase vitamin D & calcium in diet or by supplement.
Also must teach them to exercise to keep that bone strong.
What are the side effects & adverse effects for alendronate (biphosphate)?
Side effects: GI upset is extremely common, dizziness, swelling, muscle cramps.
Adverse effects: allergic reaction, bloody stool, coffee-ground emesis, heartburn (precursor to esophageal erosion/rupture), numbness in jaw or difficulty swallowing (notify provider immediately)
Memory hint: Biphosphate (alendrontatE) is very ACIDIC so it can cause allergy, GI upset, PUD, esophageal rupture, or the lock-jaw issue
What are the considerations for alendronate (biphosphate) usage?
Has to be taken first thing in the morning on empty stomach (like a thyroid med) with full glass of water & they have to remain upright for 30 mins after to decrease GI upset. Also patients must increase vitamin D & calcium in their diet or by supplement while on it and maintain good oral hygiene.
What are the considerations for taking corticosteroids?
Patient CANNOT abruptly stop them or it may lead to an adrenal crisis.
Avoid NSAID use (Can cause PUD)
Avoid caffeine & alcohol use
Increase Vitamin D & calcium while on it to prevent osteoporosis
What are treatment & consideration options for patients with Addison’s disease?
Treatment: combination of corticosteroids & mineralocorticoids like prednisone AND fludrocortisone
Considerations: make sure patients are maintaining potassium and sodium levels because steroids can cause hypokalemia ; take CT’s to check adrenals.
What are treatment & consideration options for patients with Cushing’s syndrome?
Treatment: taper them off steroids, but there are also medications available to help (aminoglutethimide).
Considerations: monitor cortisol (midnight plasma; 24 hr) and blood glucose levels.
What is the route for Aminoglutethimide?
PO (by mouth) 4x/day
What are the side effects & adverse effects for Aminoglutethimide?
Side effects: dizziness, itching, GI upset, low RBCs and low WBCs (teach pt to monitor for bruising and signs of infection).
Adverse effects: blood in urine or stools (or anywhere it shouldn’t be.. PUD), yellowing of eyes or skin (liver!), fevers or chills.
Memory hint: Aminoglutethimide breaks down your aminos (RBCs and WBCs), can cause an amine allergy (itching, GI upset) and can cause jaundice, fever, or PUD
What are the considerations for taking Aminoglutethimide?
Monitoring cortisol levels & titrating. Also lots of drug interactions.
What is Ketoconazole?
A drug used to inhibit adrenal steroid synthesis (lower levels of adrenal steroid/hormones) ; prevents rise in ACTH secretion
What are the side effects & adverse effects of Ketoconazole?
Side effects: just GI upset.
Adverse effects: headache, vision changes, menstrual changes, decreased libido, enlarged/tender breasts in men, mood changes, weight loss.
Memory hint:
Side & Adverse effects of a keto diet like headache, GI upset, vision changes, mood changes, weight loss
And because it’s a conazole -> corticosteroid decreaser -> can lead to libido changes, menstrual changes, and gynacomastia
What is Spironolactone?
A drug used to block aldosterone (works as a diuretic & lowers blood pressure!).
What are the side effects for Spironolactone?
hyperkalemia (too much potassium), hyponatremia (too little sodium), tinnitus, rash.
Memory hint: Spiro - sodium too low and potassium to high. LacTONE like the tone in your ears with tinnitus.
What are the considerations for Spironolactone usage?
Monitoring renal/hepatic function and I&O’s (input and output). Educating patients to avoid salt substitutes with potassium (to prevent hyperkalemia!) in them and watch their daily weight.
Spiro -> like spirulina -> watch those salt subs with potassium to prevent hyperkalemia. Watch daily weight because it’s a hormone med
Lactone -> like I’m lacking I’s & O’s and liver/hepatic function.
What are the common signs of hyperglycemia & the severe form?
“Hot and dry? Sugar’s high.”
Increased thirst, dry mouth, but headache & blurred vision will be there just like hypoglycemic.
Severe (diabetic ketoacidosis): vomiting, diarrhea, dehydration, fruity smelling breath, Kussmaul’s breathing (rapid & shallow), confusion/disorientation but not comatose like a diabetic coma.
What are sliding scales for insulin dosing?
Sliding scales are scales only used for Short or Rapid-acting insulins that tell you how much to dose based on the pt’s blood sugar & sensitivity or resistance to insulin.
What is an important piece of patient education for insulin injections?
Always rotate injection site! You can use any subcutaneous injection site, so, for the abdomen - rotate through the four quadrants, or use the back of the arm or thigh.
What is important to tell patients in regards to pre-filled insulin pens?
They must be inverted prior to injecting.
As a nurse, if you are required to mix two types of insulin in a syringe, what are the steps to take?
- Make sure you have the right insulins.
- Match the syringe to the vials (U-100 syringe to U-100 vial for example).
- Clean off the tops of each vial.
**Note: if you’re using NPH, you have to mix the vial by rolling it in your palms at this step. - Add air to each vial, starting with N & then going to R.
- Draw UP R before N!
Which kind of insulin goes in an IV?
ONLY Regular (short-acting)
What is the treatment for hypoglycemia?
Give glucagon and/or carbohydrates (juice, candy). Routes: Injection (subcutaneous, IM, or by IV). It peaks in 15-30 mins, so it is very rapid-acting.
D50W is given as IV rescue if glucagon doesn’t work
What is the treatment for hyperglycemia &
what do these medications do?
T1D: Insulin
T2D: Diet/exercise mods first -> then Oral Antihyperglycemics/antidiabetics, which are meant to Decrease A1c - we want A1c at 5.7 or below.
Sulfonylureas (-Ide ending drugs) mechanism of action:
stimulates beta cells to secrete insulin
What are the side effects & adverse of sulfonylureas?
Side effects: GI upset, dizziness/drowsiness (not enough sun), weight gain (not enough sun), skin changes (Skin changes because of the sulfa sun)
Adverse effects: hypoglycemia potential
What are the considerations for sulfonylureas?
Can cause hypoglycemia so you’re always going to have to check blood glucose prior to administration & be cautious with NSAIDs/other protein bound drugs because they contribute to that
Monitor for hemolytic reactions (result of a genetic deficiency)
Don’t use alcohol with it (can cause a lot of nausea & vomiting) -> disULFAN reaction
Sunscreen education due to photosensitivity (sulfa -> SUN)
What are some side effects & adverse effects of biguanides like Metformin?
Side effects: GI upset, weakness, headache, metallic taste in mouth (METformin)
Adverse effects: lactic acidosis (excessively low pH in blood stream.. Remember the metal foreman), renal/hepatic disease
What are the signs and symptoms of lactic acidosis?
Extreme exhaustion & fatigue, fast breathing, GI upset, muscle cramps & body aches.
What are the considerations for taking biguanides like Metformin?
The patient will have to stop taking it 24-48 hrs before any diagnostic test with contrast (CT/MRI… Metformin -> Metallic -> contrast)
It is contraindicated in renal or hepatic disease so you have to monitor for that
Patient must be aware of the risk & signs for metabolic acidosis (the lactic acidosis adverse effect)
What are DPP-4 inhibitors (-liptin ending drugs like Saxagliptin) and what is their MOA?
Antihypergylcemics. They basically slow the inactivation of hormones that regulate glucose, increase insulin release, and decrease circulating glucagon levels.
(DPP-4 check for allergy before ; increase insulin and decrease the glucagon some more)
What is the benefit of taking DPP-4 inhibitors over another oral antihyperglycemic?
Lower risk of hypoglycemia, and not associated with cardiovascular or weight gain events.
What are the side effects of taking DPP-4 inhibitors?
GI upset, allergic reactions, skin reactions
(DPP-4 - check for allergy before)
What are Alpha-glucosidase inhibitors (like acarbose) and what is their MOA?
Antihyperglycemics. These inhibit alpha glucoside (enzyme) that breaks down food, thus delaying digestion of carbs & slowing glucose absorption. They reduce postprandial (post eating) glucose levels
What are the side effects of taking alpha-glucosidase inhibitors?
GI upset (specifically bloating and feeling fuller)
(Glucosidase -> only causes gastric malaise)
What are the considerations for taking alpha-glucosidase inhibitors?
They must always be taken with food
Considerations: they can cause hepatic impairment, intestinal disorder flare ups like IBD, colonic ulceration, and intestinal obstruction.
What are GLP-1 Meds (-tide meds like Dulaglutide & Liraglutide and ozempic) and their MOA?
Antihyperglycemics specifically created for T2D with insulin resistance. MOA: stimulate beta cells to release insulin; decreases glucagon secretion and gastric emptying (feeling fuller faster). These also help people with metabolic syndrome or obesity to lose weight and get things like blood pressure under control.
What are the considerations for taking oral contraceptives?
Can cause hepatic impairment or MI (heart attack), so definitely monitor for those.
Also Antibiotics render these useless - you need to be on a second contraceptive.
Patients cannot smoke on these (increased risk of blood clots).
What are the side effects for vasopressin?
Side effects: based on the route. Nosebleeds for nasal, hypertension for oral/IV, GI upset.
What is a potential side effect of insulin use?
Hypokalemia
Insulin gets blood sugar AND potassium HYPOO LOWWW
What HgbA1C target do providers aim for to indicate good insulin administration & glycemic control in diabetic patients?
Providers typically aim to maintain an HgbA1C target of around 7% or less
What are the tell-tale signs of Addison’s Disease?
Weakness, fatigue, nausea, and abdominal pain
The nurse is caring for a client diagnosed with Addison disease. Which of the following medications would the nurse expect to be prescribed to replace aldosterone in this client?
Fludrocortisone, as it has more potent sodium-retaining effects than prednisone and is more often used for adrenal insufficiency (Fludro -> flooding the adrenals with hormones & sodium)
A nurse is giving discharge instructions a patient who is taking levothyroxine. The nurse instruct the patient to notify the physician if which of the following occurs?
Tremors
What are some considerations for prednisone specifically?
Avoid individuals with respiratory infections
Avoid caffeinated drinks
A patient is taking insulin glargine injection daily. The onset of action is seen at:
3-4 hours after administration
What is glucagon used for?
to treat severe hypoglycemia (low blood sugar) in diabetes patients treated with insulin who have passed out or cannot take some form of sugar by mouth
Are there any side effects to glucagon?
Yes, but they’re usually just minor GI upset.
True or False: Glucocorticoids should be avoided in patients with peptic ulcer disease (PUD).
True. They can cause an increased risk of peptic ulcers (side effects of coffee-ground emesis, blood in stools - are signs of this)
Onset, peak, & duration times for different insulin types:
Rapid-acting (Lispro/humalog) - Onset: 15 mins. Peak: 30-90 minutes. Duration: 4 hours.
Short-acting (Regular) - Onset: 30 mins. Peak: 2-3 hours. Duration: 6-8 hours.
Intermediate-acting (NPH) - Onset: varies on site of injection. Peak: 4 hours. Duration: 12-18 hours.
Long-acting (Glargine, Detemir) - Onset: 2 hours. Peak: Does not peak. Duration: 24-36 hours.
Do T1D patients ever receive oral antidiabetics?
NO. T1D’s are insulin dependent - they only receive insulin.
Which oral antidiabetic can cause photosensitivity?
Sulfonylureas! Therefore, educate your patients to wear sunscreen when on these
What is an important piece of patient education in regards to growth hormone administration?
Rotate injection sites just like insulin, since this medication is only given via injection (Subcut or IM)
Which type of steroids treat which conditions?
Glucocorticoids (prednisone, methylprednisolone, etc) typically treat allergies & autoimmune issues
Mineralocorticoids (fludrocortisone) usually treat adrenal insufficiency (Addison’s)
Corticosteroids routes of admin:
Prednisone - by mouth
Methylpred - mouth, injection, or IV
Fluticasone - nasal spray or topical
Which thyroid drugs are given by mouth?
Levo, PTU & Even Radioactive iodine (although it can also be given by IV)
Which hormones can be given by mouth?
Vasopressin, Octreotide
What foods should you avoid with hyperthyroidism?
Foods high in soy (because they’re high in iodine!)
