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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  • 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






  • Radioactive iodine hyperthyroidism

    • 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


  • Dosing is oral hyperthyroidism

    • Add to water

    • No color

    • No taste

    • Be very careful not to spill (hazardous)

    • Client can not be pregnant


  • Side effects hyperthyroidism

    • Tenderness in thyroid gland

    • Hyperthyroidism in 40%, second dose needed

    • Hypothyroidism



  • PTU and Tapazole hyperthyroidism

    • 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


  • Side effects hyperthyroidism

    • Purpuric, maculopapular rash

    • Headaches, salivary and lymph node enlargement

    • Bone marrow suppression

    • Hepatotoxicity

    • Nephrotoxicity




  • Liothyronine synthetic T3 hyperthyroidism

    • Onset of action more rapid than levothyroxine

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

    • Provides consistent levels of T3 and T4


  • Thyroid USP hyperthyroidism

    • From beef, pork, or sheep thyroid glands

    • Oldest form available, cheapest

    • Lacks purity, uniformity, stability


  • Side effects hyperthyroidism

    • Hyperthryoidism

  • Drug interactions

    • Warfarin: larger doses needed

    • Digitalis: smaller doses needed

    • Hyperglycemia can occur early in therapy



  • Assessment important administering thyroid or anti-thyroid preparations

    • Clients sensitive to replacement therapy, monitor for adverse effects

    • Levothyroxine started low and dose increased over weeks





  • Mineralcorticoids via institution policy

    • 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




  • Glucocorticoids include inflammation

    • Cortisone, hydrocortisone, prednisone etc.

    • Have antiinflammatory, antiallergic activity




  • Use of corticosteroids inflammation

    • Used with caution in those with

      • Diabetes mellitus

      • Heart failure

      • Hypertension

      • Peptic ulcer

      • Mental disturbance

      • Suspected infection




  • Side Effects inflammation

    • Electrolyte imbalance, fluid accumulation

    • Susceptibility to infection

    • Behavioral changes

    • Hyperglycemia

    • Peptic ulcer formation

    • Delayed wound healing


  • Drug interactions inflammation

    • Loop diuretics: can enhance electrolyte loss

    • Warfarin: can have increased or decreased effect

    • Hyperglycemia: diabetics and children need to be monitored




  • Fluocinonide (Lidex) inflammation

  • Hydrocortisone (Cortef, Solu-Cortef)

  • Methlprednisolone (Solu-Medrol, Depo-Medrol)

  • Prednisolone (Delta-Cortef)

  • Prednisone (Deltasone, Apo-Prednisone)

  • Triamcinolone (Aristocort, Kenalog)




  • Objective 23: explain the functions of insulin associated with administering glucocorticoids

    • 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



Rapid acting insulin
Rapid-Acting Insulin of action for rapid, intermediate, long acting and fixed combinations of 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 of action for rapid, intermediate, long acting and fixed combinations of 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 of action for rapid, intermediate, long acting and fixed combinations of 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)


  • Lispro: can be mixed with protamine of action for rapid, intermediate, long acting and fixed combinations of insulin

    • 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 of action for rapid, intermediate, long acting and fixed combinations of insulin

  • Humulin Ultralente

    • Crystalline form of Lente insulin

      • Onset: 4-8 hours

      • Peak: 12-18 hours

      • Duration: 24-28 hours


  • Insulin-Glargine solution (Lantus) of action for rapid, intermediate, long acting and fixed combinations of insulin

    • 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



  • Two problems can occur occur with repeated insulin injections

    • Allergic reactions

      • From proteins in insulin, alcohol, the insulin itself

        • Switch types of insulin

        • Use unscented alcohol

          • Will resolve


  • Lipodystrophies occur with repeated insulin injections

    • Atrophy or hypertrophy of subcutaneous fat

      • Use the area because of anesthesia effect




  • Lethargy occur with repeated insulin injections

  • Decreased coordination

  • General apprehension

  • Sweating

  • Confusion

  • Blurred or double vision

    • Can progress to coma and death



  • Glucagon occur with repeated insulin injections

    • Hormone from alpha cells of pancreas

      • Breaks down stored glycogen to glucose

      • Aids in gluconeogenesis

        • Must have glycogen available or drug will not work




  • Sliding scale insulin insulin administration

    • 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 insulin administration

  • Blood sugar Insulin

  • 0-150 0 units

  • 151-200 2 units

  • 201-300 5 units

  • Over 300, call physician





  • Classifications are antidiabetic agent would be used

    • Biguanide oral hypoglycemic agents

    • Sulfonylurea oral hypoglycemic agents

    • Meglitinide oral hypoglycemic agents

    • Thiazolidinedione oral hypoglycemic agents

    • Antihyperglycemic agents


Biguanide oral hypoglycemics
Biguanide Oral Hypoglycemics antidiabetic agent would be used

  • 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


  • Initial dose: 500 mg BID antidiabetic agent would be used

    • Can go up to 2500 mg daily

      • Use divided doses

      • If blood sugar not controlled, add another agent


  • Side effects to expect antidiabetic agent would be used

    • N/V

    • Anorexia

    • Abdominal cramps

    • Flatulence

      • Will resolve

      • Take with meals to decrease SE


  • SE to report antidiabetic agent would be used

    • Malaise

    • Myalgias

    • Respiratory distress

    • Hypotension

      • Lactic acidosis can occur

        • More if renal failure or excess alcohol intake


  • Drug interactions antidiabetic agent would be used

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

      • Can have lactic acidosis develop



Sulfonylurea oral hypoglycemic agents
Sulfonylurea Oral Hypoglycemic Agents antidiabetic agent would be used

  • Stimulate release of insulin

  • Use when pancreas can still secrete insulin


  • Two generations antidiabetic agent would be used

    • First generation

      • Example: Dymelor (500 mg daily)

    • Second generation

      • Example: Glucotrol (2.5-5 mg daily)



  • SE to expect sulfonylureas

    • N/V

    • Anorexia

    • Abdominal cramps

      • Usually mild

      • Decrease with continued therapy


  • SE to report sulfonylureas

    • Hypoglycemia

      • Monitor blood sugar

        • Treat with glucose source

    • Hepatotoxicity

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


  • Blood dyscrasias sulfonylureas

    • RBC, WBC

    • Monitor for sore throat, fever, purpura, jaundice

  • Dermatologic reactions

    • Rash or pruritus

    • If occurs: hold drug, call MD


  • Drug interactions sulfonylureas

    • Various drugs can cause hypoglycemia such as Warfarin, ethanol



Meglitinide oral hypoglycemics
Meglitinide Oral Hypoglycemics others

  • Stimulate release of insulin from pancreas

  • Can be used alone or in combination

    • Have short duration of action

    • Must take up to QID



  • Dosing others

    • Can take 1-30 minutes before a meal

    • Must take up to QID: compliance

    • If skip meal, skip dose



  • Drug interactions others

    • Hypoglycemia

      • Ethanol, NSAIDs, Warfarin, MAOIs

    • Hyperglycemia

      • Corticosteroids, phenothiazines, estrogens



Thiazolidinedione oha
Thiazolidinedione OHA others

  • 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



Nursing process for tzd s
Nursing Process for TZD’s insulin

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

  • Premenopausal, anovulatory females

    • Ovulation may resume


  • SE to expect insulin

    • N/V

    • Anorexia

    • Abdominal cramps

      • Mild

      • Resolve with continued therapy


  • SE to report insulin

    • Hypoglycemia

    • Hepatotoxicity

    • Weight gain


  • Drug interactions insulin

    • 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 insulin

  • Two drugs

    • Acarbose (Precose)

    • Miglitol (Glyset)

    • They inhibit pancreatic and GI enzymes from digesting sugars

      • This delays glucose absorption and decreases postprandial hyperglycemia


  • Acarbose insulin

    • Does not cause hypoglycemia

    • Can be used with sulfonylureas or metformin

    • Dosing

      • TID at start of main meals


  • SE to expect insulin

    • Abdominal cramps

    • Diarrhea

    • Flatulence

      • Caused by metabolism of carbohydrates in gut

      • Usually mild, resolve


  • SE to report insulin

    • Hypoglycemia

    • Hepatotoxicity

      • Can cause increased AST, ALT

      • Has caused hyperbilirubinemia



  • Miglitol (Glyset) corticosteroids, phenothiazines, OBC, thyroid

    • Used alone or with sulfonylureas

    • Check liver function before treatment

    • Assess for malabsorption syndrome or obstruction in gut


  • Dosing corticosteroids, phenothiazines, OBC, thyroid

    • Take with first bite of food

    • Start with 25 mg TID


  • SE to expect corticosteroids, phenothiazines, OBC, thyroid

    • Abdominal cramps

    • Diarrhea

    • Flatulence


  • SE to report corticosteroids, phenothiazines, OBC, thyroid

    • Hypoglycemia


  • Drug interactions corticosteroids, phenothiazines, OBC, thyroid

    • Hyperglycemia with various agents such as cortisone, phenothiazines

    • Propranolol, Ranitidine not absorbed with concurrent miglitol

    • Digestive enzymes, intestinal adsorbents reduce effect of miglitol







  • 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





  • Various drugs can decrease effect of OBC yeast infections

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

  • Drugs enhance effect and toxic effects

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



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