NCM 212 - PHARMACOLOGY IN NURSING

TOPIC: CARDIOVASCULAR DRUGS

CLINICAL INSTRUCTOR:
BY: DESIATA, LYRIZZA LEA BHEA A., SN

DRUGS AFFECTING ENDOCRINE SYSTEM
A. Hypothalamic HormoneAgents
B. Pituitary Agents
C. Posterior Pituitary Hormones
D. Adrenocortical Agents
ADVERSE EFFECTS
● Stimulation or blocking of regular hormone control
● Agonist: can lead to increased release of sex hormones, leading to ovarian
overstimulation, flushing, increased temperature and appetite, and fluid retention
● Antagonist: can lead to a decrease in female sex hormones, leading to lack of
E. Thyroid Agents menstruation, fluid and electrolyte changes, insomnia, and irritability
F. Parathyroid Agents NURSING CONSIDERATIONS FOR PATIENTS
G.Agents to Control Blood Glucose Level ● Monitor for adverse effects
● Periodic radiograph of the long bones
● Monitoring for blood sugar levels and electrolytes

HYPOTHALAMIC HORMONE AGENTS
1. GROWTH HORMONE AGONISTS
THERAPEUTIC ACTIONS AND INDICATIONS
● Hypothalamic agents can inhibit or stimulate the release of hormones from the anterior
pituitary using hormones or factors. However, not all of these hormones are available for
pharmacological use
● Not all of the hypothalamic hormones are used as pharmacological agents.
● Tesamorelin, is used to stimulate GH and its lipolytic effects helping to decrease the
excess abdominal fat in HIV- infected patients with lipodystrophy
● Agonists: Gosselin,Histrelin, Leuprolide, and Nafarelin are analogues of GnRH.
● Antagonists: Degarelix and Ganirelix acetate a
PHARMACOKINETICS
● These drugs are absorbed slowly when given IM , subcutaneously, or in depot form.
● They tend to have very long half-lives of days to weeks.
● Most of these drugs are secreted in the urine.
● Nafarelin is given in a nasal form
CONTRAINDICATIONS AND CAUTIONS
● Known hypersensitivity to any component of the drug
● Pregnancy and Lactation
● Renal Impairment
● Peripheral vascular disorders
● Rhinitis
PITUITARY AGENTS
THERAPEUTIC ACTIONS AND INDICATIONS
● Acceleration of wound healing, activation of immune cells, and action of the central
nervous system. As GHRH might function as a growth factor,we examine effects of
GHRH agonists on tumors.
● GH is responsible for linear skeletal growth, the of internal organs,protein synthesis, and
the stimulation of many other processes that are required for normal growth
● Hypopituitarism is seen in as GH deficiency, may occur as result of developmental
abnormalities or congenital defects of the pituitary, circulatory disturbances like
hemorrhage,infarction,acute or chronic inflammation of the pituitary and pituitary tumors
● GH deficiency in children results in short stature (Dwarfism).
● Somatropin and Somatropin rDNA origin
PHARMACOKINETICS
● Somatropin is injected and reaches peak levels within 7 hours.
● Excretion occurs through the urine and feces
● Patients with liver or renal dysfunction may experience reduced clearance and increased
concentrations of the drug.
 CONTRAINDICATIONS AND CAUTIONS
● Somatropin is contraindicated with any known allergy
● Presence of closed epiphyses or with underlying cranial lesions
● Abdominal surgery and acute illness
● Caution in pregnancy and lactation
ADVERSE EFFECTS
● Development of antibodies to GH
● Sign of inflammation and autoimmune-type reactions: swelling and joint pain
NURSING CONSIDERATIONS FOR PATIENTS
● Assess history of allergy ,height,weight,thyroid function tests,glucose tolerance test and
GH level
● Monitor patient response to the drug, adverse effects, teaching
● Monitor effectiveness of comfort measures and compliance with the regimen
2. GROWTH HORMONE ANTAGONISTS
THERAPEUTIC ACTIONS AND INDICATIONS
● GH antagonists block the action of GH at the GH receptor in the liver. GH is a protein.
The substitution of one amino acid converts endogenous GH into an antagonist.
● Somatostatin is an inhibitory factor released from the hypothalamus.
● It is not used to decrease GH levels
● Analogues of Somatostatin, Ocreotide acetate and Lanreotide are considerably more
potent in inhibitingGHreleasewithless of an inhibitory effect on insulin release
● Bromocriptine, a semisynthetic ergot alkaloid, is a dopamine agonist frequently used to
treat acromegaly.
● Lanreotide, which acts like somatostatin, is given as a monthly depot subcutaneous
injection.
● Pegvisomant, is a GH analogue that was approved for the treatment of acromegaly in
patients who do not respond to other therapies.
PHARMACOKINETICS
● Octreotide and Ianreotide must be administered subcutaneously
● Octreotide , rapidly absorbed and widely distributed throughout the body and
metabolized in the tissues with about 30% excreted unchanged in the urine.
● Lanreotide , a depot in the subcutaneous tissue, is slowly released into circulation with
a half-life of 25 to 30 days.
● Bromocriptine - is administered orally and effectively absorbed from the GI tract
● Pegvisomant - is given by subcutaneous injection and is slowly absorbed, reaching
peak effects in 33 to 77 hours.
CONTRAINDICATIONS AND CAUTIONS
● Bromocriptine, should not used during pregnancy or lactation
● Any known allergy
● Cautiously used in the presence of any other endocrine disorders
ADVERSE EFFECTS
● GI complains
● Octreotide and Lanreotide have also been associated with the development of acute
cholecystitis, cholestatic jaundice, biliary tract obstruction and pancreatitis.
● Lanreotide is associated with changes in blood glucose level.
● Bromocriptine is also associated with GI disturbances.
NURSING CONSIDERATIONS FOR PATIENTS
● Assess history of allergy, height, weight, orientation, affect and reflexes, thyroid function
tests,glucose tolerance tests and GH level
● Monitor patient response to the drug, adverse effects,teaching ,
● Monitor effectiveness of comfort measures and compliance with the regimen
HYPOTHALAMIC HORMONE AGENTS
THERAPEUTIC ACTIONS AND INDICATIONS
● The posterior pituitary hormones, oxytocin and vasopressin (also known as antidiuretic
hormone), regulate myometrial and myoepithelial contractions in the female and water
balance in both genders, respectively.
● Vasopressin (also called antidiuretic hormone) regulates the amount of water excreted
by the kidneys and is therefore important in maintaining water balance in the body
● These activities reduce plasma osmolarity and increase blood volume
PHARMACOKINETICS
● Desmopressin -is available for oral ,IV,subcutaneous,and nasal administration
● Tolvaptan-is given orally,is readily absorbed, and has a half-life of 12 hours
● Conivaptan-is given by continuous IV infusion, the half-life of the drug is 5 hours
CONTRAINDICATIONS AND CAUTIONS
● Any known allergy
● With severe renal dysfunction, vascular disease , asthma, and hyponatremia
● Not used during pregnancy and lactation
ADVERSE EFFECTS
● Water intoxication (drowsiness,light-headededness,headache,coma,convulsions)
● Hangover effect: tremor , sweating, vertigo and headache
● Local reaction at injection sites
NURSING CONSIDERATIONS FOR PATIENTS
● Assess history of allergy ,height,weight,orientation,affect and reflexes,skin lesions
● Monitor patient fluid volume and patients with vascular disease for any sign of
exacerbation
 2. MINERALOCORTICOIDS
THERAPEUTIC ACTIONS AND INDICATIONS
ADRENOCORTICAL AGENTS
● Mineralocorticoids are a class of steroid hormones that regulate salt and water
1. GLUCOCORTICOIDS balances
THERAPEUTIC ACTIONS AND INDICATIONS ● Aldosterone is the primary mineralocorticoid
● Glucocorticoids are powerful medicines that fight inflammation and work with your ● Mineralocorticoids promote sodium and potassium transport, usually followed by
immune system to treat a wide range of health problems. Your body actually makes its changes in water balance. This function is essential to life
own glucocorticoids ● These drugs are indicated in combination with glucocorticoid for replacement therapy in
● These hormones have many jobs, such as controlling how your cells use sugar and fat primary and secondary adrenal insufficiency
and curbing inflammation. ● Indicated for the treatment of salt-wasting adrenogenital syndrome
● Hydrocortisone ,Cortisone, and Prednisone PHARMACOKINETICS
● Indicated for the short-term treatment of many inflammatory disorders ● These drugs are absorbed slowly and distributed throughout the body.
PHARMACOKINETICS ● They undergo hepatic metabolism to inactive forms
● Glucocorticoids inhibit many inflammation-associated molecules such as cytokines, CONTRAINDICATIONS AND CAUTIONS
chemokines, arachidonic acid metabolites, and adhesion molecules. In contrast, ● Any known allergy
anti-inflammatory mediators often are up-regulated by glucocorticoids. ● With severe hypertension,heart failure, or cardiac disease
● Beclomethasone and Flunisolide ● Lactation and pregnancy
● Betamethasone ● Presence of any infection
● Budesonide ● With high sodium intake
● Cortisone ADVERSE EFFECTS
CONTRAINDICATIONS AND CAUTIONS ● Increased fluid volume seen with sodium and water retention
● Any known allergy ● Possible hypokalemia
● Presence of acute infection and lactation NURSING CONSIDERATIONS FOR PATIENTS
● Caution should be used in patients with diabetes, acute peptic ulcers, and with other ● Assess history of allergy ,height,weight,orientation-use only in conjunction with
endocrine disorders appropriate glucocorticoid- increase dose in times of stress
ADVERSE EFFECTS ● Monitor for hypokalemia
● Methylprednisolone is associated with increased toxicity ● Discontinue if signs of overdose (like excessive weight
● Children are at risk for growth retardation gain,edema,hypertension,cardiomegaly)
● Local inflammations and infections as well as burning and stinging sensations
NURSING CONSIDERATIONS FOR PATIENTS
● Assess history of allergy ,height,weight,orientation
● Use the minimal dose for the minimal amount of time
● Taper doses when discontinuing from high doses or from long-term therapy
● Arrange for increased dose when the patient is under stress
● Use alternate day maintenance therapy with short-acting drugs whenever possible
 2. ANTITHYROID HORMONES
THERAPEUTIC ACTIONS AND INDICATIONS
THYROID AGENTS
● Antithyroid medications inhibit the formation and coupling of iodotyrosine in
1. THYROID HORMONES thyroglobulin. Because These processes are necessary for thyroid hormone synthesis,
THERAPEUTIC ACTIONS AND INDICATIONS this inhibition induces a gradual reduction in thyroid hormone levels over 2-8 weeks or
● Thyroid hormone, in the form of triiodothyronine (T3), acts by modifying gene longer
transcription in virtually all tissues to alterrates of protein synthesis and substrate ● Thioamides - lower thyroid hormone levels by preventing the formation of thyroid
turnover. hormone in the thyroid cells. These drugs are indicated for the treatment of
● These actions are the net result of the presence of T3 and of multiple other factors that hyperthyroidism.
amplify or reduce its action ● Iodine Solutions- Low doses of iodine are needed in the body for the formation of
● These hormones replace the low or absent levels of natural thyroid hormone and thyroid hormone. High Doses block thyroid function.This drug is used to treat
suppress the overproduction of TSH by the pituitary hyperthyroidism.
● Levothyroxine (Synthroid,Levoxyl,Levothyroid) -a synthetic salt of T4, is the most PHARMACOKINETICS
frequently used replacement hormone ● Antithyroid agents comprise a diverse group of substances used to reduce thyroid
● Desiccated thyroid (Armour thyroid,and others) is prepared from dried animal thyroid hormone synthesis and/or secretion in treating hyperthyroidism, the most common
glands and contains bothT3andT4 cause of which is Graves' disease.
PHARMACOKINETICS ● Thioamides- these drugs are well absorbed from the GI tract and are then concentrated
● Oral absorption of thyroid hormone can be erratic (T4 up to 80%; T3 up to 95%) and in the thyroid gland.
decreases with age. ● Methimazole has an onset of action of 30 and 40 minutes and peaks in about 60
● The time for peak serum levels is 2-4 hours. minutes.
● The onset of action for oral administration is 3-5 days and 6-8 hours for IV ● Iodine solution- these drugs are rapidly absorbed from the GI tract and widely
administration. distributed throughout the body fluids.
● These drugs are well absorbed from the GI tract and bound to serum proteins CONTRAINDICATIONS AND CAUTIONS
● Thyroid replacement therapy should not be discontinued during pregnancy ● Any known allergy
CONTRAINDICATIONS AND CAUTIONS ● During Pregnancy and lactation
● Any known allergy ● Pulmonary and edema tuberculosis
● During acute thyrotoxicosis ADVERSE EFFECTS
● During acute myocardial infarction ● Thioamides: most commonly seen are drowsiness,lethargy,bradycardia,nausea,skin rash
● Pregnancy and lactation so on.
● Hypoadrenal conditions ● Iodine solution: most common adverse effect is hypothyroidism,iodism(metallic taste
ADVERSE EFFECTS and burning in the mouth,sore teeth and gums,diarrhea,cold symptoms and stomach
● These side effects include rash, itching, abnormal hair loss, and fever. upset, staining of teeth, skin rash , and the development of goiter.)
● Less common side effects include nausea, swelling, heartburn, muscle and joint NURSING CONSIDERATIONS FOR PATIENTS
aches, numbness, and headache ● Assess history of allergy ,height,weight,orientation
NURSING CONSIDERATIONS FOR PATIENTS ● Administer propylthiouracil 3 times a day, around the clock
● Assess history of allergy ,height,weight,orientation ● Give iodine solution through a straw
● Administer a single daily dose before breakfast each day ● Monitorpatient receiving iodine solution for any of iodism
● Administer with a full glass of water
● Monitor periodically of the blood test of thyroid functions
 2. ANTIHYPERCALCEMIC AGENTS
PARATHYROID AGENTS
THERAPEUTIC ACTIONS AND INDICATIONS
1. ANTIHYPOCALCEMIC AGENTS ● Antihypercalcemic agents are drugs used to treat PRH excess or hypercalcemia
THERAPEUTIC ACTIONS AND INDICATIONS ● These agents include bisphosphonates and calcitonin salmon.
● Antihypocalcemic agents are indicated for the following medical conditions: ● These drugs act on the serum levels of calcium and do not suppress the parathyroid
Management of hypocalcemia in patients on chronic renal dialysis. Management of gland PTH.
hypocalcemia associated with hypoparathyroidism and with sustained systemic ● Bisphosphonates, act to slow or block bone resorption by doing this they help to lower
glucocorticoids therapy. serum calcium levels but they do not inhibit normal bone formation and mineralization
● Vitamin D compounds regulate the absorption of calcium and phosphate from the small ● Bisphosphonates drugs are used to treat Piaget’s disease and of postmenopausal
intestine,mineral resorption in bone , and reabsorption of phosphate from the renal osteoporosis in women and Alendronate is also used to treat osteoporosis in men.
tubules. ● Calcitonin, are hormones secreted by the thyroid gland to balance the effects of PTH.
PHARMACOKINETICS This Hormone inhibits bone resorption.
● Calcitriol , is well absorbed from the GI tract and widely distributed throughout the body. PHARMACOKINETICS
It is stored in the liver, fat, muscle,skin, and bones. It has a half-life of approximately 5 to ● Bisphosphonates-these drugs are well absorbed from the small intestine and do not
8 hours and a duration of action of 3 to 5 days. undergo metabolism
● Parathyroid hormone is given as a daily subcutaneous injection ● Calcitonin- these drugs are metabolized in the body tissue to inactive fragments, which
CONTRAINDICATIONS AND CAUTIONS are excreted by the kidney
● Any known allergy CONTRAINDICATIONS AND CAUTIONS
● Hypercalcemia or vitamin D toxicity ● Bisphosphonates - not be used in the presence of hypocalcemia,history of
● History of renal stone allergy,during pregnancy lactation
ADVERSE EFFECTS ● Calcitonin-can be used in pregnancy only if benefits to the mother clearly out weights,
● Related to GI Effects: metallic taste, nausea, vomiting, dry mouth, constipation and not be used in lactation,known allergy,renal dysfunction or pernicious anemia
anorexia. ADVERSE EFFECTS
● CNS Effect ● Bisphosphonates: Commonly seen are headache,nausea,and diarrhea
NURSING CONSIDERATIONS FOR PATIENTS ● Calcitonin: Commonly seen are flushing of the face and hands, skin rash,nausea and
● Assess history of allergy ,height,weight,orientation vomiting, urinary frequency and local inflammation
● Assess for hypercalcemia, vitamin toxicity, renal stone and pregnancy and lactation. NURSING CONSIDERATIONS FOR PATIENTS
● Monitor serum calcium concentration ● Assess history of allergy ,height,weight,orientation
● Arrange nutritional consultation of GI effects ● Ensure adequate hydration
● Arrange for concomitant vitamin D, calcium supplements, and hormone replacement
therapy
● Rotate injection sites
 2. SULFONYLUREAS
THERAPEUTIC ACTIONS AND INDICATIONS
AGENTS TO CONTROL BLOOD GLUCOSE LEVEL
● These drugs exert their hypoglycemic effects by stimulating insulin secretion from the
1. INSULIN pancreatic beta-cell.
THERAPEUTIC ACTIONS AND INDICATIONS ● Their primary mechanism of action is to close ATP-sensitiveK-channels in the beta-cell
● Insulin therapy is indicated in patients with newly diagnosed diabetes and severe plasma membrane, and so initiate a chain of events which results in insulin release.
hyperglycemia(plasma glucose level greater than 250 mg per dL), recent significant ● Type II diabetes, a drug of choice for patients where metformin is contraindicated (or
weight loss, and ketonuria who cannot tolerate metformin) can be added in combination with other hypoglycemic
PHARMACOKINETICS drugs or insulin.
● The pharmacokinetics of insulin comprise the absorption process, the distribution ● Chlorpropamide
including binding to circulating insulin antibodies, if present, and to insulin receptors, PHARMACOKINETICS
and its ultimate degradation and excretion ● Sulfonylureas are structurally related to sulfonamide antimicrobials.
● The distribution and metabolism of absorbed insulin follow that of endogenous insulin ● They are absorbed rapidly (although the rate of absorption is reduced when taken with
● At a cellular level in most tissues, insulin degradation is initiated by the hormone binding food), are highly protein-bound and are metabolised
to specific receptors CONTRAINDICATIONS AND CAUTIONS
● The hormone-receptor complex is processed, including internalization and degradation ● Contraindications to the use of sulfonylureas include hypersensitivity to sulfonylureas
of at least some of the hormone-receptor complexes. and drugs that have similar structures and pregnancy.
CONTRAINDICATIONS AND CAUTIONS ● Caution should be exercised in cases of reduced renal or hepatic function.
● Episodes of hypoglycemia ● Patients with ketoacidosis should receive insulin, not an oral antihyperglycemic agent.
● Insulin does not cross the placenta THESE DRUGS ARE NOT FOR USE DURING PREGNANCY AND LACTATION
● Insulin does not enter breast milk ADVERSE EFFECTS
ADVERSE EFFECTS ● Major Adverse Effect
● Initial weight gain as the cells start to take in glucose ,blood sugar that drops too low , ○ Hypoglycemia and Ketoacidosis
or hypoglycemia, rashes, bumps, or swelling at an injection site. ● Most Common Side Effect
● Hypoglycemia and Ketoacidosis ○ hypoglycemia, more common with long-acting sulfonylureas such as
● Lipodystrophy chlorpropamide and glibenclamide. However, all sulfonylureas may cause
● Cough and throat pain or irritations hypoglycemia, usually due to an excessive dosage.
NURSING CONSIDERATIONS FOR PATIENTS
● Assessfor contraindications or cautions
● Any known allergy
● Assess history of asthma and COPD
● Assess for any sign of skin lesions and nutritional intake
● Obtain blood glucose levels as ordered and monitor results
● Ensure patient is following a dietary and exercise regimen
● Monitor for sign of hypoglycemia
● Use or sign of hypoglycemia
● Store insulin in a cool place away from the direct sunlight
● Monitor patient sensory loss
3. OTHER ANTIDIABETIC AGENTS
COMMON ANTIDIABETIC AGENTS INCLUDE
● Alpha-glucosidase inhibitors (Acarbose, Miglitol)
● Amylin analogs (pramlintide)
● dipeptidyl peptidase 4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin)
● incretin mimetics (albiglutide, dulaglutide, exenatide, liraglutide,lixisenatide)
● insulin

4. GLUCOSE-ELEVATING AGENTS
THERAPEUTIC ACTIONS AND INDICATIONS
● Glucose-elevating agents are indicated for the following medical conditions:Diazoxide is
an oral management of hypoglycemia; intravenous use for management of severe
hypertension.
● Glucagon is used to counteract severe hypoglycemic reactions.
PHARMACOKINETICS
● Glucose-elevating agents raise blood level of glucose when severe hypoglycemia occurs
at <40 mg/dL.
● The desired and beneficial action of glucose-elevating agents is increasing blood
glucose by decreasing insulin release and accelerating the breakdown of glycogen in the
liver to release glucose.
CONTRAINDICATIONS AND CAUTIONS
● Diazoxide is contraindicated with known allergies to sulfonamides or thiazides.
● Pregnancy and lactation.
ADVERSE EFFECTS
● Glucagon is associated with GI upset, nausea, and vomiting
● Diazoxide is associated with vascular effects, including hypotension, headache, cerebral
ischemia, weakness, heart failure, and arrhythmias.