Week 8 Medications for Endocrine Flashcards
Pituitary drug example
Desmopressin
What is the purpose of desmopressin and how does it work?
Desmopressin manages nocturnal enuresis and it manages diabetes insipidus (large urinary output) by decreasing urinary output and thirst
Adrenal Meds examples
*Glucocorticoids
*Betamethasone
*Budesonide
*Hydrocortisone
*Triamcinolone
*Methlyprednisone
*Prednisone
what are adrenal meds typically used for?
short term tx of inflammatory diseases
Topical adrenal med examples and indication
Topical (Rash- dermatitis -
Triamcinolone, hydrocortisone),
-for little areas
-CAN OD
inhaled/nasal adrenal meds indication and examples
Inhaled/nasal (allergies & Asthma & COPD -
Rhinocort, Pulmicort, Flovent),
-respiratory
injection adrenal meds indication and example
Injection (PN, asthma, COPD-
Methylprednisolone)
oral/systemic adrenal med examples
Oral/systemic (Arthritis, systemic lupus, allergic reactions-prednisone)- long term
what are all the SE and AE of adrenal meds
Delayed wound healing (especially in long term use)
Immunosuppression (immunosuppressant effect)
Risk of peptic ulcers
Rebound affect
Increases blood glucose (not inherently a contraindication of diabetes)
Weight gain (messes with adrenal gland and fluid retention like in cushin’s, the overproduction of the steroid is causing weight gain)
Growth issues in kids, stunted
Insomnia (give AM) will impact the circadian rhythm
Neves, shakiness (restless)
Osteoporosis
Causes thinning of the skin with topical shorter term
reprised what are the SE AE of adrenal meds?
It causes restlessness (shakes, nerves, insomnia)
Causes growth issues including weight because they are steroids
Cushins and water retnetion
Skin irritation with topical uses
Weakens the immune system: nonhealing wounds, peptic ulcers, immunosuppression, infection
Osteoporosis
What is a severe complication of adrenal meds
Adrenal crisis if stopped suddenly due to sudden drop in serum cortisone levels
the adrenal glands of the kidneys will stop production of cortisone levels due to the decreased production
what are the symptoms of adrenal meds?
hyponatremia, hypotension,
loss of consciousness, death
what is a caution of adrenal meds?
diabetes because it can increase sugar levels
what is hypothyroid treated with
levothyroxine
by replacing hormones the thyroid cant produce.
what are the nursing implications of thyroxine?
Take it with water in the mornings on an empty stomach
(about 1 hr before eating)
Make sure not to take it with other meds to avoid interactions
Monitor for adverse effects like tachy, HTN, anxiety (HYPER)
DONT switch brands
safe for pregnancy
it can take 5-8 weeks to regulate
Adrenal meds med administration
make sure to taper prednisone to avoid adrenal crisis
give with food to avoid GI upset
give in the AM
avoid grapefruit juice (increases effect)
infection prevention (immunosupression)
Adrenal meds implications
assess renal disease (affects kidneys)
weight/height (cushins, and stunted growth)
glucose (increases blood sugar)
electrolytes (symptoms of adrenal crisis)
Antithyroid agents
Radioactive iodine 131
-1 dose?
Propylthiouracil PTU
long term
Indication radioactive iodine
Hyperthyroidism
Acute thyrotoxicosis
Graves disease
what is the nursing implication of radioactive iodine
used for candidates who are not eligible candidates
radioactive iodine SE AE
metallic taste
swollen gums and sore teeth
what is the indication for propylthiouracil PTU
hyperthyroidism
Graves
Emergency treatment
Thyrotoxicosis
SEAE of propyliouracil
long term use can become too much causes hypothyroidism
hepatitis
Nursing implication of propylthiouracil
will not cure bulging eyes
parathyroid meds
bisposphonates
calcitonins
bisphosphonates indication
slow normal and abnormal bone resorption
bisphosphonates SE AE
osteonecrosis of the jaw
ocular inflammation
esophagitis
bone pain
bisphosphonate nsg implication
ability to sit up 30 mins!
Calcitonin’s indication and SE AE
stops bone reabsorption
(decrease ca levels)
calcitonin SE AE
flushed face and hands
nasal spray will cause irritation and bleeding
Rapid acting insulin example
Lispro (humolog)
Aspart (novolog)
Onset and peak of rapid acting insulin
Lispro and Aspart
onset 5-15min
peak 1-2 hrs
Short Acting Insulin example
Regular (humulin)
onset and peak of regular (Humulin)
takes longer than rapid
30-60min
2.5h peak
route of regular insulin
SQ IV
REGULAR is the ONLY insulin that is IV!!!
intermediate-acting
example
onset
peak
NPH
1-2 hour onset
4-8 hr peak
Long acting insulin examples
glargine (Lantus)
detemir (Levemir)
glargine
detemir
onset
peak
1-2 hrs
no peak
duration: 24 hrs
Combination insulins:
Humulin 70/30 or
Novolin 70/30 NPH and Rapid
indication of antidiabetic treatments
diabetes
severe hyperkalemia
SE AE of antidiabetic medication INUSULINs
hypoglycemia
lipohypertrophy
Nursing implications of insulin
check the blood glucose levels
evaluate A/C
what should nurses know about insulins
ensure food is available for rapid and short acting insulins
long acting insulin dosing is daily or every 12 hours
Long acting CANNOT be mixed with other types of insulin
med admin insulin
rotating sites
adjusting dose for pt with infections
spike w food
clear then cloudy
pumps are rapid or short acting only (for control)
storage of insulin
unopened can be in the fridge til expiration
room temp insulins can be used for 1month max
oral antidiabetic treatments ex
metformin
metformin indication
Diabetes type II
polycystic ovarian syndrome
metabolic syndrome (due to insulin resistance)
SEAE of metformin
Nausea and Diarrhea
Interactions with metformin
alcohol
why does ETOH intereact w/ metformin?
it inhibits breakdown of lactic acid which can intensify lactic acidosis
to counteract lactic acidosis the body will begin to breath out rapidly
iodine containing contrasts for CT
nursing implications for metformin
tapper up the dose to decrease GI issues
take it with food
hold the med for 48 hours if they will have a CT scan and avoid 48 hours after
hard on the kidneys
-may need to elimiate other nephrotoxic drugs
what should a nurse monitor for a patient on metformin
CREATINE
Sulfonylureas
examples
Glimepiride
Glipizide
Glyburide
Sulfonylureas indication
for type II diabetes
-oral will never be used for type I
SE AE of sulfonylureas
hypoglycemia
weight gain
heartburn
Interactions
beta blockers, alcohol
nursing implications of sulfonyulureas
take in the morning
30 mins before breakfast
piolitazone indication
Thizolidnediones
Diabetes melluitis type II
pigolitazone SE AE
moderate weight gain
edema
mild anemia
hepatic toxicity
nsg implication of pioglitazone
2011 actos causes bladder cancer lawsuit
still used in US
not in other coutnries
Dipeptidyle peptidoase IV inhibitors
Sitagliptin
sitagliptin is used to treat
type II diabetes
either on its own or with metformin
sulfonylurea
but not with INSULIN
SE AE of sitagliptin SE AE
upper respiratory tract infections
headache
diarrhea
nsg implication of sitagliptin
hypoglycemia cann occur especiialy if it is used with sulfonylurea
Glucose elevating med examples
Glucagon
50% dextrose in water
concentrated glucose PO
-chewable tablets, gels
nsg implication of
assess blood glucose before administering glucagon ‘
higher levels of glucoagon are typically not harmful
asses pt ability to swallow
pt education of blood raising meds
keep glucose with you at all times
