Endocrine Medications PDF

1 Endocrine Medications Diabetes Mellitus CLASSIFICATION THERAPEUTIC MECHANISM OF ACTION ADVERSE EFFECTS DRUG USES...

1 Endocrine Medications Diabetes Mellitus CLASSIFICATION THERAPEUTIC MECHANISM OF ACTION ADVERSE EFFECTS DRUG USES EXEMPLARS Sulfonylureas Used in Stimulates pancreas beta cells to secrete Hypoglycemia, weight gain, photosensitivity. glipizide conjunction with insulin GI upset, CNS effect, erythema, multiform, (Glucotrol) diet & exercise in aplastic anemia glyburide the treatment of (Micronase) PT: Take 30 minutes before a meal. Do not T2DM consume alcohol. Wear protective clothing and Sunscreen. Contraindication: known sulfa allergy Biguanides SA Suppresses gluconeogenesis in the liver. Metallic taste, GI upset, lactic acidosis metformin Increases muscle glucose uptake (S/s.: diarrhea, dizziness, hypotension, (Glucophage) Increases intestinal glucose uptake bradycardia, muscle pain, weakness) Hold metformin prior to procedures requiring contrast dye and for 48 hours after the procedure. Monitor for signs of lactic acidosis. Take it with a meal. Do not consume alcohol. Thiazolidinediones SA Decreases insulin resistance. Fluid retention, edema, liver failure pioglitazone (Glitazones) Increases muscle glucose uptake (hepatotoxicity) elevated LDLs, elevated (Actos) Decreases gluconeogenesis liver enzymes. Contraindication: Congestive heart failure Alpha-Glucosidase SA Slows carbohydrate absorption & Gi upset, abdominal pain, diarrhea, acarbose Inhibitors digestion flatulence, hepatotoxicity, flatus (Precose) Contraindication: GI disorders  2 Take 3 times day with meals w/ the first bite of food Meglitinides SA Stimulates pancreas beta cells to secrete Hypoglycemia, angina, CNS, Gi repaglinide insulin (dyspepsia, pancreatitis, hemolytic (Prandin) anemia, leukopenia, allergic reaction) Take 3 times a day, eat within 30 minutes of dose Quick acting. Client should eat 15-30 minutes of taking medication DPP-4 Inhibitors SA Promotes incretin secretion to increase Pancreatitis, acute renal failure, sitagliptin (Gliptins) insulin secretion and decrease glucagon anaphylaxis, SJS, angioedema, headache, (Juvenia) secretion hypoglycemia, GI, peripheral edma Sodium-Glucose SA Enhances glucose excretion through the Urosepsis, female myotic inefections, canagliflozin Co-Transporter 2 urine ketoacidosis, hyperkalemia, (Invokana) (SGLT-S Inhibitors) hypersensitivity reactions Incretin Mimetics SA Mimics action of incretin Pancreatitis, diarrhea, nausea, vomiting, exenatide Increases insulin secretion thyroid C-cell tumors (Byetta) Decreases glucagon secretion Slows gastric emptying Decreases appetite Amylin Mimetics SA Mimics action of amylin CNS (Headache), GI (N/V, anorexia), pramlintide Decreases gastric emptying time cough, systemic allergy (Symlin) Decreases glucagon secretion Increases satiety thereby decreasing calorie intake Emergency treatment for Increases gluconeogenesis Hypotension, Nausea/vomiting, glucagon hypoglycemia anaphylaxis  3 SubQ, IM, IV. Provide an oral carbohydrate as soon as the patient is able to safely swallow. Mainly for treatment of T1DM Also used for gestational diabetes Some people with T2DM require insulin Classification Drug Onset Peak Duration RAPID lispro ( 15-30 minutes 30 mins to MOST DEADLY 15 ONSET 3 to 6 hours Humalog) 2.5 hrs SHORT regular 30 min to 1 hour 1 to 5 hours READY TO GO IV ONLY 6-10 hours (HUMALIN R) INTERMEDIATE NPH (Humulin 1 to 2 hours 6-14 hours Never IV, Mix clear to cloudy, 2x a day 16-24 hours N) LONG Insulin glargine 70 minutes None NO Mix 24 hours (Lantus) Pituitary and Adrenal Gland CLASSIFICATION THERAPEUTIC MECHANISM OF ACTION ADVERSE EFFECTS DRUG USES EXEMPLARS Anterior Pituitary Used mainly to mimic or antagonize effects of specific pituitary hormones Growth hormone Treatment of Stimulate overall growth and Injection site reactions Somapacitan-bec (GH) agonists children with production of protein Edema o (Sogroya), growth failure Bind to GH receptors on target tissues Myalgia Somatropin d/t lack of GH Arthralgia (Genotropin, Development of antibodies that Norditropin, Replacement of inactivate the hormone replacement Flexpro) endogenous GH Hypoadrenalism, hypothyroidism, in adults with pancreatitis GH deficiency.  4 Growth hormone Treatment of Dependent on medication Bromocriptine Mesylate: dizziness, Bromocriptine antagonists acromegaly fatigue, light-headedness, nasal mesylate Bromocriptine Mesylate: Acts directly on congestion, drowsiness, nausea, (Parlodel), Adjunctive postsynaptic dopamine receptors in the vomiting, abdominal cramps, Lanreotide treatment for brain and as a dopamine agonist. constipation, diarrhea, HA (Somatuline Parkinson’s Depot) Posterior Pituitary Antidiuretic Treatment of Produces antidiuretic activity in the HA, dry mouth, facial flushing, nausea, Conivaptan Hormone (ADH) neurogenic kidneys, increases water reabsorption and fluid retention, slight increase in BP, local (Vaprisol), diabetes decreases urine formation. reaction at injection site, water Desmopressin insipidus Increases levels of clotting factor VIII. intoxication at high doses. (DDAVP, Stimate) Adrenal Gland Glucocorticoid Replacement Enter target cells and bind to cytoplasmic Vertigo, HA, Hypotension, shock, Prednisone therapy in receptors sodium and fluid retention, adrenal cortical Initiate many complex reactions amenorrhea, increased appetite, insufficiency, responsible for anti-inflammatory and weight gain, immunosuppression, management of immunosuppressive effects masking of infections, impaired various wound healing, mood disturbances, inflammatory delirium. and allergic disorders, ulcerative colitis, COPD exacerbations Mineralocorticoids Partial Increases sodium reabsorption in the Frontal and occipital HA, arthralgia, Fludrocortisone replacement renal tubules and increases potassium weakness, increased blood volume, therapy in and hydrogen excretion, leading to water edema, HTN, HF, rash, anaphylaxis. cortical and sodium retention. insufficiency conditions (Addison’s), treatment of salt-losing adrenogenital syndrome  5 Thyroid CLASSIFICATION THERAPEUTIC MECHANISM OF ACTION DRUG EXEMPLARS USES Thyroid Hormone Hypothyroidism Synthetic form of thyroxine When dose is too high, hypothyroidism levothyroxine Replacement (T4,T3, or both) (s/s: anxiety, Gi upset, sweating, weight (Synthroid) loss, heat intolerance) Headache, insomnia, arrhythmias, tachycardia, abdominal cramps, diarrhea, vomiting, menstrual irregularities, accelerated bone maturation in children. Monitor T3. T4, and TSH levels. Take on an empty stomach with a full glass of water before breakfast. Requires lifelong treatment. Antithyroid Agents Hyperthyroidism Blocks synthesis of thyroid hormones Agranulocytosis, GI upset, rash. When propylthiouracil (Graves)- the dose is too high, hypothyroidism (PTU) preparation for a (S/S: lethargy, weight gain, cold thyroidectomy intolerance, bradycardia, depression) Monitor CBC levels and liver function Thyroid cancer Destroys thyroid producing cells fatigue, nausea, dry mouth, sore throat, Radioactive headache, infertility, bone marrow Iodine suppression, leukemia (RAI) Before giving med: -Neg. pregnancy test -remove jewelry and dentures -5-7 days before (hold antithyroid meds) -Awake- no anesthesia or conscious sedation  6 Thyrotoxic Inhibits thyroid production & hormone GI upset, hypothyroidism, Iodism (s/s: Strong Iodine crisis/storm release d/t high levels of iodide metallic taste, stomatitis, severe GI Solution (Lugol’s) Pre-Thyroidecto upset), hypersensitivity (rash, pruritus). my Mix the solution with juice to improve the bitter taste. Radioactive iodine ca also be used, which can cause radion sickness; contact with others should be limited.