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Medications that

Affect the
Endocrine System
Thyroid and
Adrenocortical drugs
Anti-diabetic drugs
Created by Amanda McBride

Diabetes

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2 Types of Diabetes

CONFIDENTIAL

Created by Amanda McBride

CONFIDENTIAL

Created by Amanda McBride

Anti-diabetic
Insulin
Oral Antidiabetic drugs
Created by Amanda McBride

Insulin
Hormone manufactured by the beta cells of the
pancreas
Beta cells are located in the pancreas in
clusters known as the islets of Langerhans.
Insulin is a small protein
Required for the proper use of carbohydrates
Controls the storage and utilization of amino
acids and fatty acids.
Lowers blood glucose levels by inhibiting
glucose production by the liver

Created by Amanda McBride

Action of Insulin

Insulin molecules circulate throughout the blood stream until


they bind to their associated (insulin) receptors.
Insulin receptors promote the uptake of glucose into various
tissues that contain type 4 glucose transporters (GLUT4). Such
tissues include skeletal muscles (which burn glucose for energy)
and fat tissues (which convert glucose to triglycerides for
storage).
The initial binding of insulin to its receptor initiates a signal
transduction cascade that communicates the message
delivered by insulin: remove glucose from blood plasma .
By the facilitative transport of glucose into the cells, the
glucose transporters effectively remove glucose from the blood
stream.
These changes can last from minutes to hours.

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Human Insulin
Less allergic reactions than
animal insulin
Structurally similar to human
insulin

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Action
Activate a process that helps

Activate a process that helps


glucose molecules enter the cells of
striated muscle and adipose tissue
Stimulates the synthesis of glycogen
by the liver.
Promotes protein synthesis and
helps the body store fat by
preventing its breakdown for energy.

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Onset, Peak,
Duration
Onset
When insulin first begins to act in the
body
Peak
When the insulin is exerting max action
Duration
The length of time the insulin remains
in effect

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Uses

Diabetes type 1
Diabetes type 2 when
uncontrolled by diet, exercise or
weight reduction
Treat severe DKA or diabetic coma
Treat hypokalemia in combination
with glucose

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Adverse
Reactions

Hypoglycemia
Too little food
Too much Insulin
Increased demand
Hyperglycemia
Too much food
Too little Insulin
Emotional stress, infection, surgery, pregnancy or
acute illness
Increased Insulin resistance
Antibodies develop against Insulin

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Precautions
Hepatic impairment
Renal impairment
Pregnancy
Lactation
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Interactions
Drug that affect
effectiveness

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Nursing
Process

Assessment
Skin
v/s
Diet
Type and duration of symptoms
Blood work
S&S hypo/hyper glycemia
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Implementation

Doses highly individualized


Daily dose
Sliding scale based on glucometer reading
Mixing Insulins
Mix in the same syringe
Clear to cloudy
Insulin syringe
Check date opened
Second checker/co-signer
Rotate suspension to mix insulin
Rotate sites to prevent lipodystrophy
Hypoglycemic reaction
Orange juice
Honey hard candy
Commercial gluoose products
Glucagon
Glucose IV
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Evalution
Coping
Education
Effectiveness
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Diabetic Ketoacidosis

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Oral Anti-diabetic
drugs
Sulfonylureas
Biguanides
Alpha inhibitors
Meglitinides
Thiazolidinediones
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Use
Only in the treatment of type 2
diabetes
May be used with Insulin
Some can be used together
when one antidiabetic drug and
diet do not control blood
glucose
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Adverse
reaction,
Contraindicati
ons,
Precautions
and
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Sulfonylureas
Action
Stimulate beta cells
Not effective unless beta cells work
DiaBeta/ glyburide
Side effects
Hypoglcemia, anorexia, nausea, vomiting, wt gain,
weakness numbness
Contraindicated
CAD, liver renal dysfunction
Sulpha drug allergy
Drug- drug interactions

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Biguanides
Action
Decreasing hepatic glucose production
Increasing insulin sensitivity in muscle and fat cells
Sensitizes the liver to circulating Insulin levels
Glucophage / metformin
Side effects
GI upset, lactic acidosis
weight loss

Contraindicated
Heart failure, renal disease, metabolic acidosis,
pregnancy

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Action

a-Glucosidase
Inhibitors

Delay the digestion and absorption of carbs


Prandase

Side effects
GI disturbances

Contraindications
Type 1 diabetes
Pregnancy
Renal impairment
Preexisting GI problems

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Meglitinides
Action
Stimulate the release of Insulin from pancreas
More rapid acting, shorter duration
Prandin
Side effects
Hypoglycemia, URI, headache, bronchitis, back pain
Contraindications
Type 1 diabetes
Pregnancy
Renal hepatic impairment
Drug- drug interactions

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Thiazolidinediones
Action
Decrease Insulin resistance
Increase Insulin sensitivity
Avandia
Side effects
Aggravated diabetes
URI
Sinusitis
Headache
Diarrhea
Contraindications

Severe heart failure


Edema
CV disease
Liver kidney disease
Decrease the effect of oral contraceptives

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Use Avandia with caution if you have a problem with


fluid retention or swelling. The drug has been known to
cause this problem ,which in turn can lead to heart
failure. Avandia should be avoided by anyone who has
been diagnosed with heart failure, and it should be
discontinued by anyone who develops it. Make sure
doctor is aware of any heart problems you may have.
Alert him immediately if you develop symptoms of
heart failure such as fatigue and shortness of breath.

* You should be aware that people taking Avandia tend to gain a


weight, typically around 5 to 10 pounds. The cause is thought to
be a combination of fluid retention and fat accumulation

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Nursing
Baseline
assessment including
Process
wt
Integumentary
Blood work
Glycosylated hemoglobin
Monitor initially for hypoglycemia

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Education

Take as prescribed
Avoid alcohol
Avoid strenuous exercise
Maintain good foot care
Medic alert
Know the symptoms of
hypo/hyper
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Posterior and Anterior


Pituitary Hormones
Posterior Hormones
Vasopressin
Oxytocin
Anterior Hormones
Prolactin
LH
FSH
TSH
ACTH
GH
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Vasopressin

Used in the treatment of diabetes


insipidus
Diabetes Insipidus results from a
decreased production of antidiuretic
hormone ( vasopressin) , the hormone
that normally prevents the kidney
from producing too much urine.
Helps the body to conserve water when
dehydrated.
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Created by Amanda McBride

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Adrenocorticol
Hormones

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System

Effects
Glucocorticoids on Body
Systems
Effect
ofofGlucocorticoids,
Cortisol

CNS

Euphoria and behavioural changes


Lower Seizure Threshold

Resp

Opens airways. Stabilize mast cells, to inhibit release of


bronchoconstrictive and inflammatory substances, eg histamine

GI

Facilitation of fat absorption


Increased acid, pepsin, and trypsin

Skeletal Muscle

Weakness (excess and deficiency)


Muscle atrophy (chronic excess)

Skin

Atrophy and thinning (chronic excess)

Hematopeoietic
system

Decrease in peripheral lymphocytes, monocytes, eosinophils,


clotting time
Increase in peripheral neutrophils, platelets, RBCs
Decreased phagocyte competence

CVS

Increased blood pressure (increased blood volume)

Kidneys

Increased reabsorption of water, sodium, chloride


Increased excretion of potassium, calcium

Bone

Inhibition of collagen synthesis by fibroblasts


Antagonism of Vitamin D

Inflammatory and Decrease inflammatory response, decrease capillary


permeability, decrease immune response, decrease
Immune response
antibodies, anti-allergic actions

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Uses

Adrenocortical insufficiency
Allergic reactions
Cancer
Lupus
Ulcerative colitis
Dermatologic conditions
Rheumatic disorders
Shock
Asthma
COPD
Spinal cord injury
Organ transplantation

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Adverse
Reactions

S&S Cushings
syndrome

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immunosuppression
hyperglycemia due to increased gluconeogenesis , insulin resistance and impaired
glucose tolerance ("steroid diabetes "); caution in those with diabetes mellitus
increased skin fragility, easy bruising
reduced bone density (osteoporosis, higher fracture risk, slower fracture repair)
weight gain due to increased visceral and truncal fat deposition (central obesity)
and appetite stimulation
adrenal insufficiency (if used for long time and stopped suddenly without a taper)
muscle breakdown (proteolysis), weakness; reduced muscle mass and repair
expansion of malar fat pads and dilation of small blood vessels in skin
anovulation, irregularity of menstrual periods
growth failure, pubertal delay
increased plasma amino acids, increased urea formation; negative nitrogen
balance
excitatory effect on central nervous system

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Cushingoid

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Contraindications,
Precautions,
Interactions
Containdicated
with serious infections

Renal hepatic impairment


Hypothyroidism
Ulcerative colitis
Peptic ulcer disease
HTN
Convulsive disorders
Diabetes
Multiple drug-drug interactions
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Mineralocorticoids-Aldosterone

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Aldosterone

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Action and
Use
Conserves salt

and water
Replacement for
Addisons disease
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Adverse
Reactions
If dosage
to high of withdrawal too
rapid
Edema, HTN, CHF, enlargement of
the heart
Increased sweating, allergic skin
reaction
Hypokalemia, muscle weakness,
headache
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Contraindications,
Precautions,
Interactions

Fungal infection
Use cautiously with Addisons
Infection
Decreased effects of
hydantoins, rifampin, barbs,
salicylates
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Thyroid Drugs

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System

Effects of thyroid hormone

Metabolis
m

Lipid metabolism: Increased thyroid hormone levels stimulate fat


mobilization, leading to increased concentrations of fatty acids in
plasma. They also enhance oxidation of fatty acids in many
tissues. Finally, plasma concentrations of cholesterol and
triglycerides are inversely correlated with thyroid hormone levels
- one diagnostic indiction of hypothyroidism is increased blood
cholesterol concentration.
Carbohydrate metabolism: Thyroid hormones stimulate almost
all aspects of carbohydrate metabolism, including enhancement
of insulin-dependent entry of glucose into cells and increased
gluconeogenesis and glycogenolysis to generate free glucose.

Growth

Growth hormones

CVS

Increases heart rate, cardiac contractility and cardiac output.


They also promote vasodilation, which leads to enhanced blood
flow to many organs.

CNS

Both decreased and increased concentrations of thyroid


hormones lead to alterations in mental state. Too little thyroid
hormone, and the individual tends to feel mentally sluggish,
while too much induces anxiety and nervousness
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Thyroid Drugs
Synthetic replacement with
exogenous source of thyroid
hormone.

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Anti-thyroid Drugs
Act by decreasing production or
release of thyroid hormones.

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Nursing Process
Assessment
Weight
I/O
Baseline v/s
Head to toe assessment
Blood levels of thyroid hormones
Sign and symptoms
Adverse effects especially with glucocorticoids
Implementation
Administered IM, SC, IV, PO, topically, Inhalant

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Special
Considerations

Diabetics
May require frequent
adjustments of Insulin
More frequent monitoring
May precipitate latent
diabetes
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Adrenal insufficiency
Use of glucocorticoids can cause
shutting off of the pituitary release
of ACTH
Situations producing stress may
precipitate the need for an
increase in dosage, until the crisis
is over.

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Risk of infection
Report any signs of
infection, sore throat,
fever
Protect pt against
isolation

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Risk for injury


Signs of compression
fractures, pathological
fractures
Skin injuries
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Acute pain
Coffee grounds
emesis, tarry stools,
epigastric pain

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Excess fluid volume


Check for edema
I/O
Daily weight
Restrict sodium intake
Electrolyte Imbalance

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Education
GI upset, take with food

Do not stop abruptly


Follow taper instructions
Weight weekly
Excessive glucocorticoid levels resulting from
administration as a drug or hyperadrenocorticism
have effects on many systems. Some examples
include inhibition of bone formation, suppression of
calcium absorption (both of which can lead to
osteoporosis), delayed wound healing, muscle
weakness and increased risk of infection.

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