Drugs for Endocrine Disorders PDF

ENDOCRINE SYSTEM DRUGS START DRUGS FOR PITUITARY DISORDERS  GROWTH HORMONES Treats deficiency of Side effects: growth hormones Headache vomiting Examples: Fatigue mecasermin Muscle pain somatropin  GROWTH...

ENDOCRINE SYSTEM DRUGS START DRUGS FOR PITUITARY DISORDERS  GROWTH HORMONES Treats deficiency of Side effects: growth hormones Headache vomiting Examples: Fatigue mecasermin Muscle pain somatropin  GROWTH HORMONE RECEPTOR ANTAGONIST Treats acromegaly Side Effects Diarrhea Examples: Nausea Pegvisomant Blurred Vision Octerotide ANTIDIURETIC HORMONES Treats DIABETES Side Effects: INSIPIDUS water intoxication hypertension Examples: Intervention: Vasopressin monitor weight Desmopressin monitor intake acetate and output DRUGS FOR THYROID DISORDERS  HYPOTHYROIDISM DRUGS: INTERVENTIONS Levohyroixine Monitor T3, T4, and TSH levels SIDE EFFECTS take drug in morning Signs of 30 - 60 minutes hyperthyroidism before meals monitor pulse rate  HYPERTHYROIDISM DRUGS: SIDE EFFECTS Propylthiouracil (PTU) Signs of hypothyroidism Methimazole Potassium iodide INTERVENTIONS: Iodine solution (Lugol's Monitor T3, T4 & TSH Solution) levels Iodine 131 Monitor weight Take with meals FOODS THAT BLOCK THYROID GLAND FUNCTION Cruciferous Peaches vegetables Spinach Cauliflower Kale Cabbage Brussels sprouts Turnips Radish Strawberries Peas  PTU Causes agranulocytosis monitor for fever and sore throat check the CBC with differential for neutropenia PARATHYROID DRUGS HYPERPARATHYROIDISM AND HYPERCALCEMIA DRUGS  HYPERPARATHYROIDISM AND HYPERCALCEMIA DRUGS: Gallium nitrate Interventions: Cinacalcet hydrochloride Foods rich in Calcium Paricalcitol Doxercalciferol SIDE EFFECTS Nausea Vomiting Diarrhea  HYPERPARATHYROIDISM AND HYPERCALCEMIA Vitamin D Function: enhances absorption of calcium in the gastrointestinal tract Calcitonin Function: Decreases serum calcium and inhibits bone breakdown (resporption) MINERALOCOTICOIDS FLUDOCORTISONE ACETATE Replaces hormones in Addison's disease Side Effects Signs of Cushing's syndrome Gastrointestinal bleeding Interventions Take drugs with food or milk High potassium diet GLUCOCORTICOIDS GLUCOCORTICOIDS Fights inflammation Treats allergy Helps cope with stress Examples Dexamethasone Prednisone Hydrocortisone GLUCOCORTICOIDS Side Effects Cushing's syndrome Hypernatremia Hypokalemia Hyperglycemia Osteoporosis Weight gain Mood swings Cataracts Acne GLUCOCORTICOIDS Interventions: Monitor blood sugar High potassium diet Monitor for gastrointestinal bleeding Take drug in the morning ANDROGENS METHYLTESTOSTERONE Replaces androgen hormones treats certain types of breast cancers Risk for prostate cancer Side Effects Masculinization Priapism Acne METHYLTESTOSTERONE Interventions menstrual irregularities Changes in libido take with food or snacks  STEROID DRUGS Should not be stopped abruptly Takes a while for adrenal gland to produce its own steroids after it is shut down from prolonged steroid use dose must be tapered to prevent a fatal adrenal crisis DRUGS FOR DIABETES MELLITUS  RAPID ACTING INSULIN Clear Duration --> 3 - 5 hours Other Names Insulin aspart (NovoLog) Insulin glulisine (Apidra) Implications: Insulin lispro (Humalog) Given immediately before meals Onset --> 15 minutes Given SQ or IV May mix with NPH Peak --> 30 - 90 minutes insulin  SHORT ACTING INSULIN Clear Duration --> 5 - 8 hours Other Names Insulin regular (Humulin R, Novolin R) Implications: Given 30 minutes Onset --> 30 - 60 minutes before meals given SQ or IV Peak --> 2 - 4 hours May mix with NPH insulin  INTERMEDIATE ACTING INSULIN Cloudy Duration --> 12 - 16 hours Other Names Insulin NPH human Implications: (Humulin N, Novolin N) Lowers blood glucose elevations when RA Onset --> 1 - 3 hours insulins stop working Given SQ Peak --> 8 hours May mix with RA or SA insulin  LONG ACTING INSULIN Clear Duration --> 20 - 24 hours Other Names Insulin glargine (Lantus, Implications: Toujeo) Lowers blood glucose Insulin detemir (Levemir) elevations when RA insulins stop working Onset --> 1 hour Given SQ Peak Usually taken once a day Lantus - NO PEAK May mix with RA or SA Levemir - 6 - 8 hours insulin  MIXED INSULIN Cloudy Duration --> 24 hours Other Names Humulin 70/30 Implications: novolin 70/30 Usually taken once Relion 70/30 daily Given SQ Onset --> 30 minutes Do not mix with other insulins Peak --> 2 - 12 hours  TIPS Always know the peak times of insulin medications Rationale: It is the period where clients most likely develop hypoglycemic or insulin reactions  FAQS Why is insulin not given orally? it is destroyed by gastric secretions What are the sites for insulin injections? Abdomen (preferred), posterior arm, anterior thigh, and hips Why rotate injection sites? To prevent lipodystrophy that will result into erratic insulin absorption  FAQS What is the needle gauge for insulin injection? guare 27 - 29 needle, 1/2 inch Why do we roll the insulin vial between the palms before preparation? to properly dissolve the insulin solution and restores appearance Can a insulin vial be shaken? No, bubbles will expand insulin volume  FAQS How to draw insulin? draw insulin from clear vial first the cloudy to maintain the purity and clarity of the clear solution  FAQS What insulins are not compatible for mixing with other types of insulin (even though they are clear) Glargine (Lantus) Insulin detemir (Levemir) How is insulin injected? Give subcutaneously at 45-90 degree angle; 45 - 60 degrees in thin clients  FAQS Is aspiration needed when insulin injected? NO What insulins can be given IV? Rapid acting insulin Short acting insulin  COMPLICATIONS DAWN PHENOMENON SOMOGYI PHENOMENON "DOWN INSULIN" "SO MUCH INSULIN" Due to decreased effect of A "rebound hyperglycemia" in bedtime insulin dose response to low blood glucose Hyperglycemia occurs at night between 2:00 & 8:00 AM May need to decrease the (early morning) insulin dose or provide snacks May need to increase the at bedtime insulin dose  TIPS Check blood sugar level between 2:00 - 3:00 AM Hypoglycemia consistently present Somogyi phenomenon Blood glucose level usually high or normal Suspect Dawn Phenomenon  ORAL HYPOGLYCEMIC AGENTS NON-INSULIN DRUGS FOR DIABETES MELLITUS AMYLINOMIMETIC Reduces glucagon secretion after meals Example: Prmlintide Side Effects Anorexia Weight loss Hypoglycemia Interventions Avoid drinking alcohol DPP-4 INHIBITORS Reduces glucagon Risk for pancreatitis Examples: ogliptin Saxagliptin Sitagliptin Linagliptin DPP-4 INHIBITORS Side Effects headache Runny nose Chills Interventions Report severe abdominal pain (pancreatitis)  GLUCAGON-LIKE PEPTIDES (GLP-1 RECEPTOR AGONISTS) Increases insulin and decreases glucagon all are injectibles (subcutaneous) Incretins Hormones that stimulate insulin secretion after eating, before blood glucose become elevated  GLUCAGON-LIKE PEPTIDES (GLP-1 RECEPTOR AGONISTS) Examples Albiglutide Exenatide Liraglutide Dulaglutide  GLUCAGON-LIKE PEPTIDES (GLP-1 RECEPTOR AGONISTS) Side Effects: Nausea and vomiting Diarrhea Dizziness Interventions Report severe abdominal pain (pancreatitis) SODIUM GLUCOSE TRANSPORTER 2 (SGLT2) INHIBITORS Prevents the kidney from retaining glucose Examples Dapagliflozin (Farxiga) Empagliflozin Canagliflozin SODIUM GLUCOSE TRANSPORTER 2 (SGLT2) INHIBITORS Side Effects: Hypotension Dehydration Glycosuria Weight Loss Interventions Monitor for dehydration  INHALED INSULIN Ultra-rapid acting insulin (faster than rapid acting insulins) Example Afrezza Side effects Hypoglycemia, cough, sore throat Avoid in clients with asthma and COPD