081-PP02L022 ELO B_Drugs that Affect the Endocrine System _V 2.0_.pdf

DRUGS THAT AFFECT THE ENDOCRINE SYSTEM 081‐NP02L022 ELO B · Version 2.0 Foundations and Adult Health Nursing, 8th ed., Chapter 51 Introduction to Clinical Pharmacology 10th ed., Chapter 17 & 18 TE...

DRUGS THAT AFFECT THE ENDOCRINE SYSTEM 081‐NP02L022 ELO B · Version 2.0 Foundations and Adult Health Nursing, 8th ed., Chapter 51 Introduction to Clinical Pharmacology 10th ed., Chapter 17 & 18 TERMINAL LEARNING OBJECTIVE Given a patient with a disorder of the pituitary system determine approaches for safe and effective patient care. ENABLING LEARNING OBJECTIVE Given classroom instruction and a patient scenario the care of a patient with endocrine system disorder, select the proper medications that affect the endocrine system. DRUGS THAT AFFECT THE THYROID GLAND Foundations and Adult Health Nursing 8th Ed., Cooper and Gosnell (2019), Chapter 51 p. 1711, [Table 51.2] Introduction to Clinical Pharmacology 10th Ed., Visovsky et al (2022), Chapter 17, pp. 313-317  DRUGS FOR THYROID PROBLEMS Produces Hormones Thyroxine (T₄) Triiodothyronine (T₃) Critical for: Brain Heart and Skeletal Endocrine system Breathing and oxygen  HYPOTHYROIDISM Underactive Thyroid Slows all aspects of metabolism THYROID HORMONE AGONISTS Natural / Synthetic Action: Normal Hormone Balance Contraindications: Allergy Recent MI Adrenal Insufficiency Adverse Effects: Tachycardia, angina, dysrhythmias Tremors, anxiety, insomnia Weight lose, heat intolerance NURSING IMPLICATIONS Check pulse and blood pressure before initial administration Check entire drug list for potential interactions Report use of anticoagulants or NSAIDS Assess for pregnancy  THYROID HORMONE AGONISTS TOP TIP FOR SAFETY Thyroid drugs are not interchangeable, make sure to check the drug name and dose before administering Planning and Implementation Dosage start low Increase slow Absorption Reduced PATIENT AND FAMILY TEACHING TAKE AS Do not stop ER for Chest PRESCRIBED abruptly Pain Take on Warfarin has DO NOT empty increased SKIP stomach effect DO NOT Check Pulse Avoid TAKE AM/PM NSAIDS DOUBLE  ANTITHYROID DRUGS Hypertension Heart Failure Seizures ANTITHYROID DRUGS DRUG: Methimazole (Tapazole) Propylthiouracil (PTU) Radioactive iodine ANTITHYROID DRUGS ACTION AND USE Stop production of hormone ANTITHYROID DRUGS EXPECTED SIDE EFFECTS: Headache Rash Muscle and joint aches ADVERSE EFFECTS: Bone Marrow Suppression Hypothyroidism Kidney damage DRUG INTERACTIONS: Anticoagulants NURSING IMPLICATIONS Nursing Implications ASSESSMENT Assess vital signs Assess lab Assess drug list Assess for bleeding and bruising Planning and Implementation: Carefully check the dose and the specific drug name and prescribed dosage Evaluation: CBC PATIENT AND FAMILY TEACHING CHECK ON LEARNING While discussing thyroid replacement therapy and establishing treatment goals with a patient, the nurse explains that knowing to look for certain adverse effects ahead of time will help her to respond to them before they become serious problems. What are some adverse effects to discuss with her? CHECK ON LEARNING What is the primary treatment for hypothyroidism? a. Levothyroxine b. Radioactive iodine c. Propylthiouracil d. Methimazole CHECK ON LEARNING The nurse is teaching a patient who has a new prescription for the antithyroid drug propylthiouracil (PTU). Which statement by the nurse is correct? a. “There are no food restrictions while on this drug.” b. “You need to avoid foods high in iodine, such as iodized salt, seafood and soy products.” c. “This drug is given to raise the thyroid hormone levels in your blood.” d. “Take with drug in the morning on an empty stomach.” CHECK ON LEARNING When monitoring the lab values of a patient who is taking antithyroid drugs, the nurse know to watch for: a. Increase platelet count b. Decreased WBC count c. Decreased blood urea nitrogen level d. Increase blood glucose level DRUGS THAT AFFECT THE ADRENAL GLAND Introduction to Clinical Pharmacology 10th Ed., Visovsky et al (2022), Chapter 17, pp. 317-318  ADRENAL GLAND: HYPOFUNCTION (ADDISON’S DISEASE) Adrenal Gland Sits on top of kidneys Cortex Aldosterone Cortisol Medulla DRUG REPLACEMENT: Prednisone Fludrocortisone ADRENAL GLAND: HYPOFUNCTION (ADDISON’S DISEASE) ACTION AND USES: Glucocorticoid drugs Natural Cortisol Fludrocortisone Natural Aldosterone EXPECTED SIDE EFFECTS: Fludrocortisone HTN Edema Hypokalemia Hypernatremia ADVERSE EFFECTS: Heart Failure  ADRENAL GLAND: HYPOFUNCTION (ADDISON’S DISEASE) Nursing Implications and Patient Teaching: Same time daily Monitor weight Report edema Report weight gain of 2 lbs. in a day or 3 lbs. in a week Fluid retention Heart Failure CHECK ON LEARNING During long‐term corticosteroid therapy, the nurse will monitor the patient for Cushing’s syndrome. Which is manifested by? a. Weight Loss b. Moon face c. Hypotension d. Thickened hair growth  ADRENAL GLAND: HYPERFUNCTION (CUSHING’S SYNDROME) Excessive secretion of Cortisol Drug Therapy Corticosteroid Receptor Blocker Steroid Production Inhibitors Surgery ADRENAL GLAND: HYPERFUNCTION (CUSHING’S SYNDROME) ACTION: Corticosteroid Receptor Blocker Steroid Production Inhibitor  ADRENAL GLAND: HYPERFUNCTION (CUSHING’S SYNDROME) EXPECTED SIDE EFFECTS: Nausea Vomiting Rash Dizziness Mitotane Hematuria Menstrual Irregularities  ADRENAL GLAND: HYPERFUNCTION (CUSHING’S SYNDROME) ADVERSE EFFECTS Allergic Reaction Adrenal Insufficiency  ADRENAL GLAND: HYPERFUNCTION (CUSHING’S SYNDROME) NURSING IMPICATION: Signs and Symptoms of Adrenal Insufficiency  ADRENAL GLAND: HYPERFUNCTION (CUSHING’S SYNDROME) PATIENT AND FAMILY TEACHING Keep all appointments Laboratory Report symptoms Take with food Women Use 2 forms of birth control  PHEOCRHOMOCYTOMA Rare Tumor Drugs: Calcium Channel Blockers Alpha‐adrenergic Blocking Agents Phenoxybenzamine Hydrochloride Beta Blockers Metyrosine CHECK ON LEARNING Which drug therapy for an endocrine problem drug can cause pregnancy loss? a. 1. liothyronine sodium (Cytomel) b. 2. spironolactone (Aldactone) c. 3. mifepristone (Korlym) d. 4. mitotane (Lysodren) DRUGS THAT AFFECT THE PANCREAS Foundations and Adult Health Nursing 8th Ed., Cooper and Gosnell (2019), Chapter 51 p. 1728-1733; 1740-1742 Introduction to Clinical Pharmacology 10th Ed., Visovsky et al (2022), Chapter 18, pp. 327-345  BLOOD GLUCOSE CONTROL Diabetes Mellitus Glucose important for energy Insulin Hormone Binds to receptors which open the cell to allow glucose to enter the cell BLOOD GLUCOSE CONTROL Pancreas Insulin Hormone of Plenty Glucagon Hormone of Starvation Incretin LOSS OF GLUCOSE CONTROL Main feature of DM is chronic hyperglycemia EARLY SIGNS LATE SIGNS Frequent urination Fruity‐smelling breath Increased thirst Abdominal pain Increased hunger Nausea and vomiting Blurred vision Shortness of breath Fatigue Weakness Headache Confusion Coma DRUG MANAGEMENT FOR DM Non‐Insulin Antidiabetic Drugs Used in addition to Diet and Exercise INSULIN STIMULATORS ACTION: Stimulate release Insulin Must have function beta cells DRUGS: Sulfonylurease 1st generation = lots of adverse effects 2nd generation = more potent with fewer adverse effects Meglitinide analogs INSULIN STIMULATORS EXPECTED SIDE EFFECTS: SULFONYLUREAS Heartburn, nausea, vomiting, abdominal pain, diarrhea, and severe sunburns MEGLINITIDES Upper respiratory infections, back, joint pain, and dizziness ADVERSE EFFECTS: Hypoglycemia Secondary Beta Cell Failure Increase Liver enzymes INSULIN STIMULATORS DRUG INTERACTIONS: Sulfonylureas and meglitinides NSAIDS (aspirin) Angiotensin II receptor agonists (ARBs) angiotensin‐converting enzyme inhibitors (ACEIs) beta blockers, warfarin, azole antifungal drugs, and many antibiotics. Increase Blood Glucose Corticosteroid Furosemide Isoniazid Pseudoephedrine Antiretroviral protease inhibitors Thiazide diuretics INSULIN STIMULATORS NURSING IMPLICATIONS: Assess for hypoglycemia before giving insulin stimulators Do not give at the same time as other drugs known to increase hypoglycemic effect Give with meal no more than 15 minutes prior Wait till tray is in the room Do not give if NPO Not eating INSULIN STIMULATORS PATIENT AND FAMILY TEACHING: Take with or just before meals Skip meal = skip drug dose S/S of hypoglycemia Consume sugar Glucose tab or gel ½ cup juice or regular soda 1 tablespoon honey or sugar Common expected side effects Nausea Headache Weight gain BIGUANIDES ACTION: Reduce the amount of glucose the liver releases Reduces how much and how quickly the intestines absorb the glucose from food Improve insulin binding to cellular receptor site DRUG: Metformin BIGUANIDES EXPECTED SIDE EFFECTS: Nausea Diarrhea Flatulence Weight loss ADVERSE REACTIONS: Risk of lactic acidosis Nausea Vomiting Rapid and deep breathing Weakness BIGUANIDES DRUG INTERACTIONS: Radioactive dye (contrast medium) NURSING IMPLICATIONS: Assess kidney function Assess for lactic acidosis Check blood glucose level as ordered Assess for s/s of hypoglycemia BIGUANIDES PATIENT AND FAMILY TEACHING: Avoid alcohol Common side effects Stop drug 24 hours before tests using radioactive dye Increased risk for cardiovascular disease INSULIN SENSITIZERS ACTION: Increase sensitivity of insulin receptors DRUGS: Thiazolidinediones (TZDs) Also called glitazones  INSULIN SENSITIZERS ACTION: DRUGS: Increase sensitivity Thiazolidinediones (TZDs) Also called glitazones of insulin receptors  INSULIN SENSITIZERS EXPECTED SIDE EFFECTS: Hypoglycemia Headache Sneezing Sore throat ADVERSE REACTIONS: TZDs = Severe Cardiovascular Rosiglitazone Fluid retention Liver problems Macular edema  INSULIN SENSITIZERS DRUG INTERACTIONS: Rosiglitazone Gembibrozil Rifampin Drugs to treat HTN NURSING IMPLICATIONS: Assess for allergic reaction Assess for signs of heart failure Assess for signs of hypoglycemia  INSULIN SENSITIZERS PATIENT AND FAMILY TEACHING: Take as prescribed Do not double up Report s/s of reaction Report changes in vision, feet or ankle swelling Avoid alcohol S/S of hypoglycemia Monitor blood sugar frequently ALPHA‐GLUCOSIDASE INHIBITORS ACTION: Prevent enzymes in the intestinal tract from breaking down starches and more complex sugars into glucose (slows glucose absorption). Work independently from insulin Can be used in type 1 & 2 DM DRUG: ALPHA‐GLUCOSIDASE INHIBITORS EXPECTED SIDE EFFECTS: Flatulence Bloating Diarrhea ADVERSE REACTION: Increased bowel inflammation Colitis Crohn's Intestinal obstruction Hypoglycemia Liver impairment ALPHA‐GLUCOSIDASE INHIBITORS DRUG INTERACTIONS: Risk of hypoglycemia Combined with other drugs NURSING IMPLICATIONS: Assess for allergic reaction Monitor s/s of hypoglycemia Monitor for GI discomfort ALPHA‐GLUCOSIDASE INHIBITORS PATIENT AND FAMILY TEACHING: Drugs work best in conjunction with proper diet and exercise Take at the start of the meal Drug effects depend on the amount of complex carbohydrates in the meal Avoid alcohol Report s/s of allergic reactions  INCRETIN MIMETICS ACTION: Injectable Weekly dosing Act like hormones Satiety  INCRETIN MIMETICS EXPECTED SIDE EFFECTS: Nausea Vomiting Diarrhea Upper respiratory tract symptoms Weight loss ADVERSE REACTIONS: Allergic reaction Pancreatitis Increased risk of Thyroid Cancer  INCRETIN MIMETICS DRUG INTERACTIONS: Sulfonylureas Increase hypoglycemia Decrease absorption of other drugs NURSING IMPLICATIONS: Assess for s/s of allergic reaction Monitor for abdominal pain, bloating, and nausea Monitor blood glucose Evaluate for thyroid cancer  INCRETIN MIMETICS PATIENT AND FAMILY TEACHING: Report s/s of allergic reaction Avoid alcohol Monitor blood glucose Seek immediate help for: Severe abdominal pain and nausea Do not double up injections Give subcutaneous 60 minutes before meal Refrigerate unused pens AMYLIN ANALOGS ACTION: Injectable antidiabetic drug Delays gastric emptying Used with Type 1 and 2 DM Type 1 is deficient in amylin DRUG: Pramlintide AMYLIN ANALOGS EXPECTED SIDE EFFECTS: Nausea Vomiting Headache Abdominal pain Weight loss Fatigue ADVERSE REACTIONS: severe hypoglycemia Dizziness AMYLIN ANALOGS DRUG INTERACTIONS: Aspirin Fluoxetine Blood pressure drugs Cholesterol drugs Birth control antibiotics NURSING IMPLICATIONS: Assess for allergic reaction Monitor for dizziness, notify healthcare provider AMYLIN ANALOGS PATIENT AND FAMILY TEACHING: Injected into thigh or stomach (rotate sites) Keep opened vials and pens Unrefrigerated items must be used in 28 days then discard Room temp before injection Never mix with insulin Do not double dose Do not drink alcohol Monitor blood glucose regularly Do not operate machinery until effects are known Report symptoms of hypoglycemia DPP‐4 Inhibitors ACTION: NON‐INSULIN ANTIDIABETIC Reduces enzyme dipeptidyl peptidase‐4 which activates gut hormones, glucagon‐like peptide, and gastric inhibitory polypeptide. ONLY FOR Type 2 DM DRUG: Alogliptin Linagliptin Saxagliptin sitagliptin DPP‐4 Inhibitors EXPECTED SIDE EFFECTS: Nasopharyngitis Diarrhea ADVERSE REACTION: Hypoglycemia Allergic reaction Fatal pancreatitis Heart failure Severe arthralgia Bullous pemphigoid DPP‐4 INHIBITORS DRUG INTERACTIONS: P‐glycoprotein inducer (erythromycin) CYP3A4 inducer (ketoconazole) NURSING IMPLICATIONS: Allergic reaction Angioedema Monitor blood glucose Monitor for s/s heart failure DPP‐4 INHIBITORS PATIENT AND FAMILY TEACHING: Take drug as ordered Check blood glucose regularly Saxagliptin and alogliptin Monitor weight Report gain 2 lbs. or more in a day or inset of SOB Report allergic response or angioedema Report symptoms of pancreatitis Report pregnancy or breastfeeding SODIUM‐GLUCOSE COTRANSPORT INHIBITORS ACTION: Prevent kidneys from reabsorbing glucose that was filtered from the blood into the urine Only Type 2 DM DRUG: Canagliflozin Dapagliflozin empagliflozin SODIUM‐GLUCOSE COTRANSPORT INHIBITORS EXPECTED SIDE EFFECTS: Increased need to urinate Positive for urine glucose Weight loss ADVERSE REACTION: Vaginal yeast infections Kidney failure Allergic reaction hypoglycemia SODIUM‐GLUCOSE COTRANSPORT INHIBITORS DRUG INTERACTIONS: Combined with insulin Increases risk of dehydration Combined with diuretics Increases risk of dehydration NURSING IMPLICATIONS: assess for allergic reaction Monitor blood glucose Check weight Monitor for UTI Monitor for vaginal yeast infection Assess for dehydration Monitor serum potassium SODIUM‐GLUCOSE COTRANSPORT INHIBITORS PATIENT AND FAMILY TEACHING: Notify s/s of allergic reaction Weight once per week Report s/s of UTI/Vaginal yeast infection CHECK ON LEARNING A 48‐year‐old is diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The purpose of the metformin, in this situation, is to: a. Increase the pancreatic secretion of insulin. b. Decrease insulin resistance. c. Increase blood glucose levels. d. Decrease the pancreatic secretion of insulin INSULIN ACTION: Beta cells Binds to receptor sites allowing glucose into the cell DRUG: HIGH ALERT DRUG Rapid‐acting Intermediate‐acting Long‐acting INSULIN EXPECTED SIDE EFFECTS: Mild allergic reactions Lipodystrophy ADVERSE REACTIONS: Hypoglycemia DRUG INTERACTIONS: Insulin antagonists Oral contraceptives Corticosteroids Epinephrine Thiazide diuretics Alcohol Betablockers INSULIN NURSING IMPLICATIONS: Monitor blood glucose before every injection Double verify with another licensed nurse Right syringe Check vial Clear to cloudy Roll do not shake vial Select injection site Meal tray at bedside Monitor for hypoglycemia INSULIN PATIENT AND FAMILY TEACHING: S/s of hypoglycemia Seek Emergency care for ketoacidosis Procedure for monitoring blood glucose and insulin injection Store vial in refrigerator Outside refrigerator for 1 month Warm to room temp before injection Check expiration date Avoid alcohol Carry source of sugar CHECK ON LEARNING The nurse is teaching a group of patients about self‐administration of insulin. What teaching is important to include? a. Patients should use the injection site that is the most accessible. b. During times of illness, patients should increase their insulin dosage by 25%. c. When mixing insulins, the cloudy (such as NPH) insulin should be drawn up into the syringe first. d. When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first. SUMMARY Drugs that Affect the: a. Thyroid b. Adrenal Gland c. Pancreas QUESTIONS?