Drugs that affect the endocrine system
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Drugs that affect the Endocrine System. Pharmacology I. Objective 1: define the term hormone Objective 2: list the endocrine glands Objective 3: identify the hormones that are secreted by the anterior pituitary and describe their main functions in the body.

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Drugs that affect the endocrine system

Drugs that affect the Endocrine System

Pharmacology I


Drugs that affect the endocrine system

  • Objective 1: define the term hormone

  • Objective 2: list the endocrine glands

  • Objective 3: identify the hormones that are secreted by the anterior pituitary and describe their main functions in the body


Drugs that affect the endocrine system

  • Objective 4: identify the hormones that are released by the posterior pituitary and describe their main functions in the body


Drugs that affect the endocrine system

  • Objective 5: identify the two main thyroid hormones

  • Objective 6: describe how the body synthesizes the thyroid hormones


Drugs that affect the endocrine system

  • Objective 7: identify the actions of drugs used to treat hyperthyroidism


Drugs that affect the endocrine system

  • Objective 8: list the anti-thyroid agents used to treat hyperthyroidism

  • Drugs are:

    • Iodine-131 (131I)

    • Propylthiuracil (PTU, Propacil)

    • Methimazole (Tapazole


Drugs that affect the endocrine system

  • Radioactive iodine

    • Taken up by thyroid

    • Destroys hyperactive thyroid tissue

      • Essentially no other tissue is affected

      • Takes 3-6 months for fully assess effect

      • If more than one dose needed, three months between doses is needed


Drugs that affect the endocrine system

  • Dosing is oral

    • Add to water

    • No color

    • No taste

    • Be very careful not to spill (hazardous)

    • Client can not be pregnant


Drugs that affect the endocrine system

  • Side effects

    • Tenderness in thyroid gland

    • Hyperthyroidism in 40%, second dose needed

    • Hypothyroidism


Drugs that affect the endocrine system

  • Drug interactions

    • Lithium carbonate


Drugs that affect the endocrine system

  • PTU and Tapazole

    • Block synthesis of T3 and T4

    • Takes days to 3 weeks to see effect

    • Can use long term

    • Can use short term pre subtotal thyroidectomy


Drugs that affect the endocrine system

  • Side effects

    • Purpuric, maculopapular rash

    • Headaches, salivary and lymph node enlargement

    • Bone marrow suppression

    • Hepatotoxicity

    • Nephrotoxicity


Drugs that affect the endocrine system

  • Objective 9: identify the hypothyroid conditions

  • Hypothyroid condition in adults called myxedema

  • Congenital hypothyroidism called cretinism


Drugs that affect the endocrine system

  • Objective 10: list the thyroid agents

  • Levothyroxine replaces T3 and T4


Drugs that affect the endocrine system

  • Liothyronine synthetic T3

    • Onset of action more rapid than levothyroxine

  • Liotrix synthetic mixture levothyroxine and liothyronine (4 to 1 ratio)

    • Provides consistent levels of T3 and T4


Drugs that affect the endocrine system

  • Thyroid USP

    • From beef, pork, or sheep thyroid glands

    • Oldest form available, cheapest

    • Lacks purity, uniformity, stability


Drugs that affect the endocrine system

  • Side effects

    • Hyperthryoidism

  • Drug interactions

    • Warfarin: larger doses needed

    • Digitalis: smaller doses needed

    • Hyperglycemia can occur early in therapy


Drugs that affect the endocrine system

  • Objective 11: describe the nursing process associated with administering thyroid or anti-thyroid preparations


Drugs that affect the endocrine system

  • Assessment important

    • Clients sensitive to replacement therapy, monitor for adverse effects

    • Levothyroxine started low and dose increased over weeks


Drugs that affect the endocrine system

  • Safe handling, storage and disposal of radioactive materials via institution policy

  • Blood levels need to be monitored

  • Clients need to be alert to side effects and report

  • Clients need to report if no improvement


Drugs that affect the endocrine system

  • Objective 12: name the parts of the adrenal gland

  • Objective 13: list the types of hormones secreted by the adrenal glands


Drugs that affect the endocrine system

  • Two hormones from adrenal gland

    • Mineralcorticoids

    • Glucocorticoids


Drugs that affect the endocrine system

  • Mineralcorticoids

    • Maintain fluid and electrolyte balance

    • Used to treat adrenal insufficiency

      • Fludrocortisone (Florinef)

      • Aldosterone

        • Act on distal tubules, causes water and sodium retention

        • Causes excretion of potassium and hydrogen


Drugs that affect the endocrine system

  • Objective 14: describe the metabolic effects of the glucocorticoids, and the consequences of these effects


Drugs that affect the endocrine system

  • Objective 15: describe how glucocorticoids suppress inflammation

  • Corticosteroids secreted by adrenal cortex of adrenal gland

    Glucocorticoids


Drugs that affect the endocrine system

  • Glucocorticoids include

    • Cortisone, hydrocortisone, prednisone etc.

    • Have antiinflammatory, antiallergic activity


Drugs that affect the endocrine system

  • Also affect glucose, protein and fat metabolism

    • Glucocorticoids secreted in response to stressors

      • Cause release of epinephrine


Drugs that affect the endocrine system

  • Objective 16: identify therapeutic uses of glucocorticoids

    • Glucocorticoids used for replacement therapy when adrenal gland not functional

    • High doses used for inflammation, allergy, asthma


Drugs that affect the endocrine system

  • Use of corticosteroids

    • Used with caution in those with

      • Diabetes mellitus

      • Heart failure

      • Hypertension

      • Peptic ulcer

      • Mental disturbance

      • Suspected infection


Drugs that affect the endocrine system

  • After one week, discontinue drug slowly (wean off)

  • Abrupt discontinuation

    • Fever; Malaise; Fatigue

    • Weakness; orthostatic dizziness, hypotension

    • Dyspnea; hypoglycemia


Drugs that affect the endocrine system

  • Topical: apply as directed, may use occlusive dressing

  • Alternate –day therapy: give between 6 & 9 AM; give with meals


Drugs that affect the endocrine system

  • Side Effects

    • Electrolyte imbalance, fluid accumulation

    • Susceptibility to infection

    • Behavioral changes

    • Hyperglycemia

    • Peptic ulcer formation

    • Delayed wound healing


Drugs that affect the endocrine system

  • Drug interactions

    • Loop diuretics: can enhance electrolyte loss

    • Warfarin: can have increased or decreased effect

    • Hyperglycemia: diabetics and children need to be monitored


Drugs that affect the endocrine system

  • Objective 17: list the glucocorticoid preparations


Drugs that affect the endocrine system

  • Various drugs for topical, oral, injection, inhalation

    • Cortisone

    • Dexamethasone (Decadron, Dexone)

    • Fludrocortisone (Florinef)-also mineralcorticoid


Drugs that affect the endocrine system

  • Fluocinonide (Lidex)

  • Hydrocortisone (Cortef, Solu-Cortef)

  • Methlprednisolone (Solu-Medrol, Depo-Medrol)

  • Prednisolone (Delta-Cortef)

  • Prednisone (Deltasone, Apo-Prednisone)

  • Triamcinolone (Aristocort, Kenalog)


Drugs that affect the endocrine system

  • Objective 18: describe nursing care responsibilities associated with administering glucocorticoids


Drugs that affect the endocrine system

  • Objective 19: identify the functions of insulin in the body

  • Objective 20: define diabetes mellitus

  • Objective 21: identify the site of insulin production in the body

  • Objective 22: list the types of diabetes


Drugs that affect the endocrine system

  • Objective 23: explain the functions of insulin

    • Hormone from beta cells of the pancreas (islets of Langerhans)

      • Normally: 0.5 – 1 unit per hour secreted

      • Adult: 30-50 units per day

        • Insulin transports glucose into cells; helps metabolize protein and fat.

          • Diabetes is a metabolic disorder: all body systems affected


Drugs that affect the endocrine system

  • Objective 24: identify the onset, the peak, and the duration of action for rapid, intermediate, long acting and fixed combinations of insulin


Rapid acting insulin

Rapid-Acting Insulin

  • Lispro and Aspart

    • Most rapid acting of insulins

    • They are synthetic insulin analogs

      • Give within 10-15 minutes of a meal

        • Onset: 10 minutes

        • Peak: 30 to 60 min

        • Duration: 5 hours


Short acting insulin

Short-Acting Insulin

  • Regular insulin

    • Human regular insulin available, not just animal derivation

      • Give within 30-60 minutes of meals

        • Onset: 30 minutes

        • Peak: 2.5-5 hours

        • Duration: 5-10 hours

          • Administration: subcutaneous or IV


Intermediate acting insulin

Intermediate-Acting Insulin

  • Neutral protamine Hagedorn (NPH)

    • Contains regular insulin and protamine

      • Protamine binds to insulin: slow release

        • Onset: 1-4 hours (pork is 1-1.5 hrs)

        • Peak: 8-12 hours (pork: 8-12 hrs)

        • Duration: 18-24 hours (pork: 24 hrs)


Drugs that affect the endocrine system

  • Lispro: can be mixed with protamine

    • Humalog mix 75/25

      • 75% Lispro with protamine

      • 25% Lispro

        • Rapid acting insulin with intermediate duration of action (12-24 hours)


Long acting insulin

Long-Acting Insulin

  • Humulin Ultralente

    • Crystalline form of Lente insulin

      • Onset: 4-8 hours

      • Peak: 12-18 hours

      • Duration: 24-28 hours


Drugs that affect the endocrine system

  • Insulin-Glargine solution (Lantus)

    • Biosynthetic

      • Absorbed in a uniform manner-no large fluctuations of insulin levels = reduction in possible hypoglycemia

        Onset: 5 hours

        Peak: no pronounced peak activity

        Duration: 24 hours

        Do NOT mix with other insulins


Drugs that affect the endocrine system

  • Objective 25: describe the local tissue responses that can occur with repeated insulin injections


Drugs that affect the endocrine system

  • Two problems can occur

    • Allergic reactions

      • From proteins in insulin, alcohol, the insulin itself

        • Switch types of insulin

        • Use unscented alcohol

          • Will resolve


Drugs that affect the endocrine system

  • Lipodystrophies

    • Atrophy or hypertrophy of subcutaneous fat

      • Use the area because of anesthesia effect


Drugs that affect the endocrine system

  • Use of the site decreases insulin absorption

  • Causes erratic absorption of insulin

  • Is cosmetic problem


Drugs that affect the endocrine system

  • Objective 26: list the symptoms of insulin shock

  • Hypoglycemia

    • Headache

    • Nausea

    • Weakness

    • Hunger


Drugs that affect the endocrine system

  • Lethargy

  • Decreased coordination

  • General apprehension

  • Sweating

  • Confusion

  • Blurred or double vision

    • Can progress to coma and death


Drugs that affect the endocrine system

  • Objective 27: discuss glucose elevating drugs

    • The drug used to raise blood sugar

      • Glucagon

      • Glucose


Drugs that affect the endocrine system

  • Glucagon

    • Hormone from alpha cells of pancreas

      • Breaks down stored glycogen to glucose

      • Aids in gluconeogenesis

        • Must have glycogen available or drug will not work


Drugs that affect the endocrine system

  • May see 50% glucose administered

  • IV

  • Raises blood sugar

    • Use when no glycogen is stored


Drugs that affect the endocrine system

  • Objective 28: describe what is meant by sliding scale insulin administration


Drugs that affect the endocrine system

  • Sliding scale insulin

    • Physician orders doses of insulin based upon blood glucose level

    • Regular insulin is used

      • Sliding scale is “catch-up”

        • Read the orders carefully


Example

Example

  • Blood sugar Insulin

  • 0-150 0 units

  • 151-200 2 units

  • 201-300 5 units

  • Over 300, call physician


Drugs that affect the endocrine system

  • Objective 29: describe the action of the oral antidiabetic agents

    • Some act on the cells to decrease resistance

    • Some act on the beta cells to increase production

    • Some inhibit glucose absorption


Drugs that affect the endocrine system

  • Objective 30: identify the conditions under which an oral antidiabetic agent would be used

    • Type 2 diabetes

      • No control with diet/exercise


Drugs that affect the endocrine system

  • Objective 31: list the oral antidiabetic agents


Drugs that affect the endocrine system

  • Classifications are

    • Biguanide oral hypoglycemic agents

    • Sulfonylurea oral hypoglycemic agents

    • Meglitinide oral hypoglycemic agents

    • Thiazolidinedione oral hypoglycemic agents

    • Antihyperglycemic agents


Biguanide oral hypoglycemics

Biguanide Oral Hypoglycemics

  • Metformin (Glucophage)

    • Does not stimulate insulin release

    • Will not cause hypoglycemia

    • Can be used in combination with sulfonylureas

    • Decreases serum triglycerides and LDL

    • Slightly increases HDL


Drugs that affect the endocrine system

  • Initial dose: 500 mg BID

    • Can go up to 2500 mg daily

      • Use divided doses

      • If blood sugar not controlled, add another agent


Drugs that affect the endocrine system

  • Side effects to expect

    • N/V

    • Anorexia

    • Abdominal cramps

    • Flatulence

      • Will resolve

      • Take with meals to decrease SE


Drugs that affect the endocrine system

  • SE to report

    • Malaise

    • Myalgias

    • Respiratory distress

    • Hypotension

      • Lactic acidosis can occur

        • More if renal failure or excess alcohol intake


Drugs that affect the endocrine system

  • Drug interactions

    • Drugs that depend upon kidney for excretion can block metformin excretion

      • Can have lactic acidosis develop


Drugs that affect the endocrine system

  • Drugs that cause hyperglycemia with metformin

    • OBC

    • Corticosteroids

    • Phenothiazines

    • Diuretics

    • Thyroid replacement


Sulfonylurea oral hypoglycemic agents

Sulfonylurea Oral Hypoglycemic Agents

  • Stimulate release of insulin

  • Use when pancreas can still secrete insulin


Drugs that affect the endocrine system

  • Two generations

    • First generation

      • Example: Dymelor (500 mg daily)

    • Second generation

      • Example: Glucotrol (2.5-5 mg daily)


Drugs that affect the endocrine system

  • Allergy: if allergic to sulfonamides, probably allergic to sulfonylureas

    • Do not administer


Drugs that affect the endocrine system

  • SE to expect

    • N/V

    • Anorexia

    • Abdominal cramps

      • Usually mild

      • Decrease with continued therapy


Drugs that affect the endocrine system

  • SE to report

    • Hypoglycemia

      • Monitor blood sugar

        • Treat with glucose source

    • Hepatotoxicity

      • Anorexia, N/V, jaundice, increased liver function tests


Drugs that affect the endocrine system

  • Blood dyscrasias

    • RBC, WBC

    • Monitor for sore throat, fever, purpura, jaundice

  • Dermatologic reactions

    • Rash or pruritus

    • If occurs: hold drug, call MD


Drugs that affect the endocrine system

  • Drug interactions

    • Various drugs can cause hypoglycemia such as Warfarin, ethanol


Drugs that affect the endocrine system

  • Hyperglycemia with corticosteroids, phenothiazines and others

  • Beta-adrenergic blockers: cause hypoglycemia or mask the symptoms

  • Alcohol: Antabuse-like reaction


Meglitinide oral hypoglycemics

Meglitinide Oral Hypoglycemics

  • Stimulate release of insulin from pancreas

  • Can be used alone or in combination

    • Have short duration of action

    • Must take up to QID


Drugs that affect the endocrine system

  • Examples of drugs

    • Repaglinide (Prandin)

    • Nateglinide (Starlix)


Drugs that affect the endocrine system

  • Dosing

    • Can take 1-30 minutes before a meal

    • Must take up to QID: compliance

    • If skip meal, skip dose


Drugs that affect the endocrine system

  • SE to expect and report

    • Hypoglycemia

      • Dose adjustments may be needed

      • Monitoring of blood glucose important


Drugs that affect the endocrine system

  • Drug interactions

    • Hypoglycemia

      • Ethanol, NSAIDs, Warfarin, MAOIs

    • Hyperglycemia

      • Corticosteroids, phenothiazines, estrogens


Drugs that affect the endocrine system

  • B-blockers: cause hypoglycemia or mask symptoms

  • Tegretol and others: increase repaglinide metabolism

  • Some macrolides and antifungals can inhibit repaglinide metabolism


Thiazolidinedione oha

Thiazolidinedione OHA

  • Increase sensitivity of muscle and fat tissue to insulin

    • Allows more glucose to enter cells

    • Inhibit gluconeogenesis

      • Decreases hepatic output of glucose

    • Do not increase insulin output


Drugs that affect the endocrine system

  • Can be used alone or in combination with other OHA’s or insulin

  • Examples

    • Pioglitazone (Actos)

    • Rosiglitazone (Avandia)


Nursing process for tzd s

Nursing Process for TZD’s

  • Baseline labs: liver function and alkaline phosphatase, CBC, WBC, HDL, LDL, triglycerides

  • Premenopausal, anovulatory females

    • Ovulation may resume


Drugs that affect the endocrine system

  • SE to expect

    • N/V

    • Anorexia

    • Abdominal cramps

      • Mild

      • Resolve with continued therapy


Drugs that affect the endocrine system

  • SE to report

    • Hypoglycemia

    • Hepatotoxicity

    • Weight gain


Drugs that affect the endocrine system

  • Drug interactions

    • Various drugs can cause an increase in hypoglycemia or hyperglycemia

    • B-adrenergics can mask hypoglycemia or cause it

    • Pioglitazone can enhance metabolism of ethinyl estradiol and norethindrone

      • Ovulate, become pregnant


Antihyperglycemic agents

Antihyperglycemic Agents

  • Two drugs

    • Acarbose (Precose)

    • Miglitol (Glyset)

    • They inhibit pancreatic and GI enzymes from digesting sugars

      • This delays glucose absorption and decreases postprandial hyperglycemia


Drugs that affect the endocrine system

  • Acarbose

    • Does not cause hypoglycemia

    • Can be used with sulfonylureas or metformin

    • Dosing

      • TID at start of main meals


Drugs that affect the endocrine system

  • SE to expect

    • Abdominal cramps

    • Diarrhea

    • Flatulence

      • Caused by metabolism of carbohydrates in gut

      • Usually mild, resolve


Drugs that affect the endocrine system

  • SE to report

    • Hypoglycemia

    • Hepatotoxicity

      • Can cause increased AST, ALT

      • Has caused hyperbilirubinemia


Drugs that affect the endocrine system

  • Hyperglycemia can occur with some drugs such as corticosteroids, phenothiazines, OBC, thyroid

  • Digestive enzymes and intestinal adsorbents reduce effect of acarbose

  • Acarbose can decrease absorption of digoxin


Drugs that affect the endocrine system

  • Miglitol (Glyset)

    • Used alone or with sulfonylureas

    • Check liver function before treatment

    • Assess for malabsorption syndrome or obstruction in gut


Drugs that affect the endocrine system

  • Dosing

    • Take with first bite of food

    • Start with 25 mg TID


Drugs that affect the endocrine system

  • SE to expect

    • Abdominal cramps

    • Diarrhea

    • Flatulence


Drugs that affect the endocrine system

  • SE to report

    • Hypoglycemia


Drugs that affect the endocrine system

  • Drug interactions

    • Hyperglycemia with various agents such as cortisone, phenothiazines

    • Propranolol, Ranitidine not absorbed with concurrent miglitol

    • Digestive enzymes, intestinal adsorbents reduce effect of miglitol


Drugs that affect the endocrine system

  • Objective 32: describe the nursing interventions associated with teaching the diabetic about the treatment


Drugs that affect the endocrine system

  • Objective 33: list the therapeutic uses of estrogen and progesterone

    • Stimulate maturation of female sex organs

    • Responsible for menstrual cycle

    • Drugs used for replacement, birth control, control of prostate cancer, breast cancer, osteoporosis (controversial use)


Drugs that affect the endocrine system

  • Objective 34: name the estrogen preparations

    • Various estrogens

      • Conjugated estrogen (Premarin)

      • Esterified estrogens (Estratab)

      • Estradiol (Estrace)

      • Estropipate (Ogen)

      • Ethinyl estradiol (Estinyl)


Drugs that affect the endocrine system

  • Objective 35: name the progesterone preparations

    • Progestins inhibit ovulation

      • Norethindrone

      • Ethynodiol diacetate

      • Desogestrel

      • Levonorgestrel


Drugs that affect the endocrine system

  • Objective 36: identify the most commonly used ovulatory agents

  • Clomiphene citrate (Clomid)

    • Structurally similar to natural estrogens

      • Stimulates ovaries to release ova

        • Used for women with reduced circulating estrogen


Drugs that affect the endocrine system

  • Objective 37: describe the actions of the oral contraceptives

    • Estrogens and progestins induce contraception by inhibiting ovulation

      • Estrogen blocks pituitary release of FSH

      • Progestin inhibits LH

        • Both alter cervical mucus

        • May change endometrial wall


Drugs that affect the endocrine system

  • Minipill is progestin-only

    • Must take every day

  • Combination pill

    • Take in 21 day cycle


Drugs that affect the endocrine system

  • Complete physical needed before therapy

  • SE expected: nausea, weight gain, spotting, changed menstrual flow, missed periods, depression, mood changes, chloasma, headaches


Drugs that affect the endocrine system

  • SE to report: vaginal discharge, breakthrough bleeding, yeast infections

  • Blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain


Drugs that affect the endocrine system

  • Various drugs can decrease effect of OBC

    • Barbiturates, Tegretol, St. John’s Wort, antibacterial agents

  • Drugs enhance effect and toxic effects

    • Some antifungals, Warfain, phenytoin, thyroid hormones, benzodiazepines


Drugs that affect the endocrine system

  • Objective 38: identify the nursing process for clients with conditions for which female hormones are used


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