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Endocrine Medications

PITUITARY MEDICATIONS
• THE ANTERIOR PG secretes GH, TSH, ACTH, prolactin, MSH and gonadotropins • The posterior PG secretes antidiuretic hormone and oxytocin

GROWTH HORMONES
Medication Somatrem Uses Growth Failure Side Effects Development of antibodies to GH

Somatropin

Growth failure

Headache, muscle pain, weakness, mild hyperglycemia, hypertension, allergic reaction, pain at injection site

Interventions: • Assess child’s physical growth and compare growth with standards • Recommend annual bone age determinations for children receiving growth hormones • Monitor blood glucose levels and thyroid function test • Teach the client and family about the clinical manifestations of hyperglycemia and the importance of follow up regarding periodic blood test .

promoting an antidiuretic effect and regulating fluid balance • Used in diabetes insipidus .ANTIDIURETIC HORMONES • Enhance reabsorpton of water in the kidney.

Side effects: • • • • • • Flushing Headache Nausea and abdominal cramps Water intoxication HPN with water intoxication Nasal congestion with nasal administration .

Examples: • Desmopressin acetate • Lypresin • Vasopressin .

indicating need to increase dosage • Monitor BP • Instruct client how to use intranasal meds • Weigh daily .Interventions: • • • • • Monitor weight Monitor I&O and urine osmolality Monitor electrolyte levels Monitor for signs of water intoxication Monitor for signs of DHN.

calcium carbonate. bile acid sequestrants. sympathomimetics and antidepressants and decrease the action of insulin. simethicone.THYROID HORMONES • Control the metabolic rate of tissues and accelerate heat production and oxygen consumption • Used to replace the thyroid hormone deficit in condition such as hypothyroidism and myexedema • Enhance the action of oral anticoagulant. iron and sucralfate . aluminum hydroxide and magnesium hydroxide. oral hypoglycemic and digitalis preparations • Should be given at least 4 hours apart from multivitamins.

Examples: • Levothyroxine sodium • Liothyronine sodium • Liotrix .

Levothyroxine Sodium(Synthroid) 6th day 6th dose 4th day 4th dose 1st day 1st dose Watch for: Irritability Palpations Tachycardia Diarrhea Arrhythmias Missed dose 1st day Missed dose 4th day Missed dose 6th day Dose is too low Dose is too high .

palpitations. chestpain HPN Headache Toxicity: hyperthyroidism .Side Effects: • • • • • • • • • • Nausea and decreased appetite Abdominal cramps and diarrhea Weight loss Nervousness and tremors Insomnia Sweating and heat intolerance Tachycardia. dysrhythmias.

Interventions: • Assess client for history of meds currently being taken • Monitor VS • Monitor weight • Monitor triidothyronine. thyroxine and TSH levels • Instruct client to take meds at the same time each day preferably in the morning without food • Monitor pulse rate • Report symptoms of hyperthyroidism • Avoid foods that inhibit thyroid secretions • Avoid OTC meds .

ANTITHYROID HORMONES • Inhibit the synthesis of Thyroid hormones • Used for hyperthyroidism or Grave’s disease .

Examples: • • • • Methimazole Propylthiouracil Potassium iodide Radioactive iodine .

the protype of this class. Warning: When in use. watch for: -Paresthesia -Dyspepsia -Hepatitis -GI mobility This medication helps control hyperthyroidism and thyrotoxicosis (thyroid storm).Methimazole (Tapazole) Tapazole is 10 times more potent thatn propythiourical (PTU). especially prior to surgery or radioactive iodine treatment. .

abdominal pain.Side effects • • • • • N/V Diarrhea Drowsiness. fever Hypersensitivity with skin rash Agranulocytosis with leucopenia and thrombocytopenia • Alopecia and hyperpigmentation • Toxicity: hypothyroidism • Iodism: vomiting. rash and sore gums and salivary glands . metallic or brassy taste in the mouth. headache.

thyroxine and TSH levels Monitor weight Take meds with meals Monitor pulse rate Report fever or sore throat Instruct the client regarding the importance of med compliance and that abruptly stopping could cause thyroid storm • Monitor for signs of iodism • Consult physician before eating iodize salt and iodine rich foods • Avoid aspirin and meds containing iodine .Interventions • • • • • • • Monitor VS Monitor triidothyronine.

PARATHYROID MEDICATIONS • Regulates serum calcium levels • Low serum levels of calcium stimulate parathyroid hormone release • Hyperparathyroidism results in high serum calcium level and bone demineralization. which increases neuromuscular excitability. treatment includes calcium and vit D supplements • Calcium salts administered with digoxin increase the risk of digoxin toxicity • Oral calcium salts reduce the absorption of tetracycline hydrochloride . meds is used to lower the serum calcium levels • Hypothyroidism results in low serum calcium level.

doxercalciferol . etidronate disodium. calcitonin salmon.Examples: • • • • • • Calcium carbonate Calcium citrate Dibasic calcium phosphate Calcium lactate Vit D supplements – calcitriol. risedronate sodium • Antihypercalcemics – cinacalcet hydrochloride. ergocalciferol Calcium regulators – alendronate sodium.

Interventions: • • • • • • • • • • Monitor electrolyte and calcium levels Assess for S/Sx of hypocalcemia and hypercalcemia Assess for signs or tetany in client with hypocalcemia Assess for renal calculi in client with hypercalcemia Check OTC meds labels for the possibility of calcium content Instruct the client receiving oral calcium supplements to maintain adequate intake of Vit D Instruct the client receiving calcium regulators to swallow the tablet whole with water at least 30 mins before breakfast and not to lie down for at least 30 mins Clients using antihypercalcemic agents should avoid foods rich in calcium Not to take other meds within 1 hour of taking calcium salt Increase fluid and fiber in diet .

Fludrocortisone acetate .CORTICOSTEROID MINERALOCORTITICOIDS • Mineralocorticoids are steroid hormones that enhance the reabsorption of sodium and chloride and promote the excretion of potassium and hydrogen from the renal tubules. thereby helping maintain fluid and electrolyte balance • Used for replacement therapy in primary and secondary adrenal insufficiency in Addison’s disease • Ex.

Side effects  Sodium and water retention .

weakness.Interventions • • • • • • • • Monitor VS Monitor I&O and weight and for edema Monitor electrolyte and calcium levels Take meds with food or milk Consume a high potassium diet Do not stop the med abruptly Report illness. palpitation or changes in mental status occur . cramping. fever Notify physician if low BP. severe diarrhea. vomiting.

antiallergic and antistress effects • May be used as replacement for adrenocortical insufficiency .GLUCOCORTICOIDS • Affect glucose. and bone metabolism. alter normal immune response and suppress inflammation and produce anti inflammatory. protein.

Examples • • • • • • Dexamethasone Hydrocortisone Methylprednisolone Prednisolone Prednisone Triamcinolone .

Corticosteroids Methylprednisolone Sodium Succinate (SoluMedrol) Dexamethasone (Decadron) Prednisone (Deltasone) The Good  These drugs stop. or reduce the inflammatory response (local or systemic) in any part of the body by suppressing the immune system. The Bad  Although there is a slow internal and external deterioration of the body. peptic ulcers. Watch for edema. delayed wound healing. control. the trade off is that the steroid in a chronic or autoimmune disorder will usually keep the body alive longer than if the inflammatory process was left unchecked. The dose amount and duration of use dictate the extent of dependency and damage to the body. osteoporosis & infections .

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fragile skin. truncal obesity Increased susceptibility to infection and masking of the s/Sx of infection Cataracts Hirsutism.Side Effects • • • • • • • • • • • • • Hyperglycemia Hypokalemia Hypocalcemia. acne. osteoporosis Sodium and fluid retention Weight gain Mood swings Moon face. buffalo hump. peptic ulcer pancreatitis Seizures. psychosis . bruising Growth retardation in children GI irritation.

Interventions: • • • • • • Monitor VS Monitor serum electrolyte and blood glucose levels Monitor for hypokalemia and hyperglycemia Monitor I&O and weight and for edema Monitor for HPN Assess medical hx for glaucoma. cataracts. mental health disorder or DM • Monitor older clients for S/Sx of increased osteoporosis • Assess for changes in muscle strength . peptic ulcer.

• • • • It is best to take med in the early morning Eat foods high in potassium Avoid individuals with respiratory infections Report S/Sx of medication overdose or Cushing’s Syndrome • Client may need additional doses during periods of stress • Do not stop the med abruptly .

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CAUSED BY A DEFIECIENCY OF INSULIN . PROTEIN & LIPID METABOLISM.DIABETES MELLITUS A CHRONIC DISORDER OF IMPAIRED GLUCOSE INTOLERANCE AND CARBOHYDRATE.

• Cause: Unknown • Predisposing Factors • • • • • • Stress Heredity Obesity Viral infection Autoimmune Disorder Women • Multigravida with Large babies 34 .

INSULIN-DEPENDENT DIABETES 2.1. NON-INSULIN DEPENDENT DIABETES .

5% young Slow development Prevalence 5-10% adult .Characteristics of Type 1 and Type 2 Diabetes Type 1 Type 2 Fast onset of disease Prevalence 0.

 demands Obesed Prone to HHNC (Ketosis – resistant) 37 .Type I      IDDM Juvenile – onset Unstable DM  30 yrs. Absolute Insulin deficiency  Thin  Prone to DKA Type II        NIDDM Maturity – onset Stable DM  40 yrs.. With insulin sec.

Pathophysiology of Type 2 Diabetes: 2 Defects Genes Genes Impaired Insulin Secretion Insulin Resistance ± Environment IGT ± Environmen t IGT Type 2 Diabetes IGT = Impaired Glucose Tolerance .

Main Problem 39 .

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Triad of Manifestations:

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Deficient insulin production  Hyperglycemia


Inc. concemtration of blood glucose  Glucosuria  Excess glucose excreted in urine 

Excess fluid loss
 Polyuria / Polydipsia

Insulin deficiency  Impaired metabolism of CHON and fats  Weight loss  Decreased storage of calories  Polyphagia .

ASSESSMENT • POLYPHAGIA • POLYDIPSIA • POLYURIA • HYPERGLYCEMIA • WEIGHT LOSS • BLURRED VISION • SLOW WOUND HEALING • VAGINAL INFECTIONS • WEAKNESS & PARESTHESIAS • SIGNS OF INADEQUATE FEET CIRCULATION .

MEDICATIONS FOR DM .

or delay intestinal absorption of glucose. decreasing serum glucose levels • Oral hypoglycemic agents stimulate the pancreas to produce more insulin. decrease hepatic glucose output. increase the sensitivity of peripheral receptors to insulin.INSULIN AND ORAL HYPOGLYCEMIC MEDICATIONS • Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen. thus decreasing serum glucose levels .

jaundice. nausea and heartburn • Anemia . photosensitivity .ORAL HYPOGLYCEMIC MEDICATIONS  Prescribed for clients with type 2 DM Adverse effects • Hypoglycemia • Diarrhea.

glimepiridine . chlorpropamide.Sulfonylureas • Stimulate the beta cells to produce more insulin • Ex: acetohexamide.

Glipizide (Glucotrol) Watch for: Epigastric fullness Diarrhea Constipation  hypoglycemia Heartburn priritus .

lactic acidosis • Ex: metformin .Biguanides • Suppress hepatic production of glucose and increases insulin sensitivity • Side effects: diarrhea.

• Second generation drugs have shorter duration with metabolism in the kidney and liver and are the choice for elderly patients. .Nursing Considerations • Chlorpropamide has a long duration of action and produces a disulfiram-like reaction when taken with alcohol.

: acarbose.Alpha-glucosidase inhibitors • Delay absorption of ingested carbohydrates. resulting in smaller increase in blood glucose level after meals • Do not increase insulin production • Can be given alone or in combination with sulfonylureas • Will not cause hypoglycemia when given alone • Given with first bite of meal • Ex. migitol .

I can work with insulin. I go in with the first bites of each meal. or I can work on my own. metformin or a sulfonylurea.Acarbose (precose) I am acarbose (precose). so I can interfere with absorption of carbohydrates. Watch for: diarrhea Flatulence Abdominal distention .

Thiazolidinediones • Insulin sensitizing agents that lower blood glucose by decreasing hepatic glucose production and improving target cell response to insulin • May cause liver toxicity • Ex. rosiglitazone .: ploglitazone.

Meglitinides • Stimulate pancreatic insulin secretion • Quicker and shorter duration of action therefore. Repaglinide . less chance of hypoglycemia • Very fast onset of action allows client to take the med with meals and skip a dose when meal is skipped • Ex: Nateglinide.

sugery or infection .Interventions: • Assess the client’s knowledge of DM and the use of oral antidiabetic agents • Obtain a med hx regarding the meds that the client is taking currently • Assess VS and blood glucose levels • Avoid OTC meds • Do not ingest alcohol with sulfonylureas • Insulin maybe needed during stress.

peak and duration of action depends on the insulin type • The main areas for injections are the abdomen. massage and exercise of the injected area can increase absorption rates and may result in hypoglycemia . arms. potassium and magnesium • Prescribed for clients with type 1 DM and type 2 DM in client whose blood glucose level is not controlled with oral hypoglycemic agents • The onset. muscle and adipose tissue by attaching to receptors on cellular membranes and facilitating the passage of glucose. thighs and hips • Insulin injected into the abdomen may absorb more evenly and rapidly than other sites • Heat.INSULIN • Primarily acts on the liver.

ANTI-DIABETIC DRUGS Insulin Type Example Onset 15 minutes 1 hour PEAK 1 hour 2-4 hrs ULTRA-acting RAPID-acting INTERMEDIATE acting Lispro Regular Insulin NPH and Lente 1 ½ to 2 hrs LONG-Acting Ultra-lente 4-8 hrs 6-8 hrs Up to 12 hrs 10-20 hrs .

. The fastest acting insulin (lispro) is closest to the plunger.Insulin Peaks L I S P R O N S H O Regular T U L E N I N T N S = R = Rapid E T R M E D I A T E E The slower acting insulins are closest to the needle.

Nursing Considerations • Insulin is administered at home subcutaneously ( only Regular insulin can be used INTRAVENOUSLY) • Instruct the client to rotate the areas of injection. but exhaust all available sites in one area first before moving into another area .

• • • • • Route : SC slow absorption less painful Angle: 90 Needle: • • thin: 3/8” obesed: ½”. 5/8” • • IV – DKA Don’t massage site of injection 62 .

• Refrigerate unused insulin • Never shake the vial • Prevent lipodystrophy 63 .

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• • Side – effects: Localized • • • • • Induration or Redness Swelling Lesion at the site Lipodystrophy Generalized • Edema • Hypoglycemia • Somogyi phenomenon 65 .

Diabetes Mellitus The four main areas for insulin injection areABDOMEN. THIGHS and HIPS . UPPER ARMS.

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Exubera • Short acting inhaled insulin indicated for treatment of types 1 and 2 DM • Consists of fine dry powder insulin that enters the bloodstream more rapidly than the SQ injection • Inhaled 10 mins before meals • Causes a decrease in pulmonary function • Contraindicated in clients who smokes. chest discomfort. starts smoking or quits smoking less than 6 mos prior to initiation of treatment • Side effects include cough. dry mouth. hypoglycemia .

lowers the production of glucagons after meals. abdomen or upper arm within 60 min before morning and evening meals.Exanatide • A synthetic hormone classified as an incretin mimetic that is administered SQ • Use for type 2 DM • Restores first phase insulin response. slows gastric emptying. resulting in weight loss • Administered as SQ injection in the thigh. reduces fasting and postprandial blood glucose levels and reduces caloric intake. not taken after meals • Can cause mild to moderate nausea that abates with use .

a naturally occurring hormone secreted by the pancreas • Used for clients with types 1 and 2 DM who use insulin • Given before meals • Associated with increased risk on insulin induced severe hypoglycemia.Pramlintide • Synthetic form of amylin.particularly in clients with type 1 DM • GI side effects including nausea can occur .

Glucagon • Hormone secreted by alpha cells of the islet of Langerhans in the pancreas • Increases blood glucose level by stimulating glycogenolysis in the liver • Can be administered SQ or IV • Used to treat insulin induced hypoglycemia when the client is semiconscious or unconscious and is unable to ingest liquids • The blood glucose level begins to increase within 5 to 20 mins after administration .

Diazoxide • Increase blood glucose level by inhibiting insulin release from the beta cells and stimulating the release of epinephrine from the adrenal medulla • Used to treat chronic hypoglycemia cause by hyperinsulinism resulting from islet cell cancer or hyperplasia .

REPRODUCTIVE HORMONES • • Female hormones include ESTROGENS. PROGESTINS and ovarian hormones Male hormones include ANDROGENS and anabolic steroids .

Therapeutic Uses • FEMALE: Hormonal replacement therapy. oral contraception. treatment of infertility and management of some tumors .

Levonorgestrel (Norplant). Diethylstilbesterol (DES). Clomiphene Progestins-Medroxyprogesterone (Provera). Norethindrone. Estradiol. Ethinyl estradiol. Norgestrel .Eg: Conjugated estrogen.

. Fluoxymesterone. Methyltestosterone. Aqueous testosterone . metabolic stimulators and treatment of some tumors Eg: Testosterone cypionate.• MALE: replacement therapy.

hypertension. . thromboemoblic or CVA disease • Contraindicated in pregnancy • WARN the client to avoid smoking because this will increase the risk for embolic episodes.Nursing Considerations • Not to be used in patients with history of.