Drugs Affecting the Endocrine System

Case Scenario C:
Mrs. Bernardo, is 78 year-old, woman with a history of hypertension and adult onset diabetes
mellitus. She has just moved to the area and has come for an initial visit. Mrs. Bernardo has had
hypertension for 20 years and diabetes mellitus for 10 years. Until 8 months ago, the DM was
treated with diet and an oral hypoglycemic agent. However, she began to lose weight , her thirst
and urine output increased, and her blood pressure increased substantially, despite decreasing
doses of the hypoglycemic agent. She was then started with insulin. Mrs. Bernardo monitors her
blood glucose at home twice a day. Five years ago, she had breast cancer and a left radical
mastectomy was performed. She now has metastasis to the bones. Mrs. Bernardo's current
medications are:
- enalapril (Vasotec) 5 mg PO, od
- hydrochlorothiazide 50 mg PO, qd
- tamoxifen 20 mg PO, bid
- NPH insulin 20 IU before breakfast, 5 IU before supper
- Humalog insulin 5 IU before breakfast, 2 IU before supper
1. Hydrochlorothiazide (HCTZ) is one of the drugs ordered for Mrs. Bernardo's
hypertension. Given she has diabetes mellitus, what priority health teaching would be done for
this patient?
a. ________________
b. _______________
c. _______________
2. When is the best time to give your hydrochlorothiazide and why?
a. When? _____________________
b. why? ________________________
3. If Mrs. Bernardo takes her NPH insulin at 7:00am, during what time period should the
drug peak?
a. _________________
4. Mrs. Bernardo is complaining about severe hot flashes. She has a bottle of unused
estrogen in her medicine cabinet and she says she is going to start taking it. How would you
respond?
a. ________________________
b. _______________________
c. ____________________
 5. Mrs. Bernardo's family knows to be alert to a possible hypoglycemic reaction
around supper time related to her NPH insulin, but they are uncertain if they should anticipate a
similar reaction to the Humalog insulin and, if so, when that would be. What do you tell them?
a. _____________________