Endocrine+System+Drugs+new+PPT copy.pdf

Endocrine System Drugs Cynthia Bartlau, RN, PHN, MSN Endocrine System Collection of glands that produce hormones Regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood, among other things. Made up of the pituitary gland, th...

Endocrine System Drugs Cynthia Bartlau, RN, PHN, MSN Endocrine System Collection of glands that produce hormones Regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood, among other things. Made up of the pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pancreas, ovaries (in females) and testicles (in males) Endocrine *Hormones: insulin thyroid adrenocortical male/female hormones *Hormones are secretions formed by body tissue & carried via bloodstream to act on some other organ/tissue Diabetes mellitus Type 1 – absolute insulin deficiency Type 2 – insulin resistance & insulin deficiency Islets of Langerhans in Pancreas Basal insulin Bolus insulin Type-1 Diabetes (IDDM): Insulin Insulin is a hormone manufactured by beta cells of the pancreas. It is the principal hormone required for the proper use of glucose (Carbohydrate) by the body. When deficient in this hormone, diabetics must receive “exogenous source of insulin” so the body can process sugars/carbohydrates and turn it into energy needs for the body Blood Values/Diagnosis Normal Blood Glucose: 70-115 mg/dL Random Glucose > 200 mg/dL Fasting Glucose > 126 mg/dL Blood Glucose < 140 mg/dL 2 hours Glycated (Glycosylated) Hemoglobin (A1C, GHb) Insulin 4-grps of insulin +: rapid acting short-acting intermediate long-acting +pre-mixed (usually R & NPH) Synthetic “human insulin” is biologically engineered in labs: few allergies if any to the insulin Insulin: Bolus vs. Basal Insulins Bolus Insulin: rapid acting and short acting Rapid- Acting Insulin: newest fast acting/ultra-rapid **Insulin Analog: aspart (Novolog) & lispro (Humalog), glulisine (Apidra), Onset=5-15 min; Peak=1-1 ½ hr.; Duration=3-4 hrs Short-Acting insulin:®Regular insulin Onset = ½ -1 hr; Peak = 2-4 hr; Duration = 6-8 hrs *Give insulin before meals *Make sure they eat! Look for s/s of hypoglycemia both rapid + short acting insulin is a clear solution ! Continued: Insulin Basal insulins: intermediate & long acting Intermediate Acting:(Cloudy)*NPH Onset = 1-3 hr; Peak = 5-7 hrs; Duration =10-16hr Long Acting:*new long-acting basal analog: glargine (Lantus), detemir (Levemir) 1 shot lasts 24 hrs; usually given at bedtime *NEVER mix w/other insulin same syringe Onset = 1hr; no Peak; Duration = up to 24 hrs Fixed Combinations:* Humulin 70/30; or Novulin70/30: they are combination of (regular & intermed) thus no need to mix insulin S/S of :hyper/hypoglycemia* Hyperglycemia: Hypoglycemia: BGM >200mg/dl. BGM80yo, PG Thiazolidinediones α-Glucosidase Inhibitors Biguanides pioglitazone (Actos) acarbose (Precose) metformin (Glucophage) rosiglitazone (Avandia) Delay digestion of CHO ↓hepatic glucose ↓ insulin resistance & absorption in intestines production ↑insulin sensitivity Lactic acidosis = URI, sinusitis, malaise, abd pain, HA, pharyngitis AE: GI upset (take ↑resp, musc pain, myalgia, diarrhea, with meals) wt loss back pain - DC for surgery alters effect of OC Non-Sulfonylureas/Miscellaneous: Biguanides = metformin (Glucophage) S/E: GI, lactic acidosis, generally no hypoglycemia, weight loss, dec. triglyceride and LDL Thiazolidinediones = pioglitazone (*Actos), rosiglitazone (Avandia) S/E: CV effects, hypoglycemia Alpha-glucosidase inhibitors = acarbose (Precose), miglitol (Glyset) S/E: GI, hypoglycemia Non-Sulfonylureas/Miscellaneous: Incretin mimetic agents SQ for Type 2 diabetics uncontrolled with oral agents Combination * glyburide/metformin Glucovance) rosiglitazone/glimepiride (Avandaryl) S/E: same as for individual ingredient Generally: Used cautiously: renal, liver, cardiovasc dz Give 1/2 hr before meals - usually breakfast Make sure they eat their meals! Observe for s/s of ** hypoglycemia  Thyroid Hormones:(thyroxin-T3&T4) hyper/hypothyroidism Hyper:Drugs blocks T3&T4 Graves Dz: Drugs: *Tapazole (methimazole), propylthiouracil (PTU) “slow things down” metabolism Thyroid Hormones:(T3&T4) hyper/hypothyroidism (cont.) Hypo- drugs mimic thyroxin hormone levothyroxine or *(Synthroid) *check pulse daily “will speed things up” h.r., energy, inc. basal metabolic rate, etc.! Check serum bld level Adrenal Hormones: Adrenal Cortex (glucocorticoids & mineralcorticoids) Referred to: as “steroids, corticosteroids, cortisone, adreno-corticosteroids” Cortisol =endogenous glucocorticoid and Aldosterone =endogenous mineralcorticoid Adrenal Cortex: produces sex steroids too! Frequently “cortisol” or steroids meds given for inflammatory & immune disorders since they dec the inflammatory response. Administered po, IV, ,topical preps, eye gtts, inhalation, ungts, into joints, rectal, etc. Gluco-corticoids: Steroids (Cortisol) Common Drugs: dexamethasone (Decadron) hydrocortisone (Cortisol or Cortef), methylprednisolone (Medrol or Solu-Medrol),* prednisone, prednisolone, triamcinolone (Aristocort) S/E: redistribution of fat “buffalo hump”, s/s/of Cushing’s syndrome, moon face, oily skin/acne,* serious weight gain, depression, insomnia, "mask s/s of infections", depressed immune response*(prone to infections) Pt. Teaching: Glucocorticoids or “Steroids” Further s/e: ulcer formations,* “Poor wound healing”(d/t depressed immune response) Never d/c drug abruptly! (→Adrenal-crisis) Taper the drug down gradually, if given daily, give between 6-9 am (mimics natural cortisol secretion). Monitor *BGM for those with Diabetes Take drug w/food to avoid GI irritation Avoid ETOH/Nicotine which inc. steroids effect Avoid people w/infections, flu Report mild sore throat! Mineralcorticoids: aldosterone used to maintain Na+ balance (b/p & bld vol) Florinef (fludrocortisone acetate): most common drug used for adrenocortical insufficiency (Addison’s Dz) Also used to increase b/p when needed Florinef: has both mineral & glucocorticoid activity. Has many of same s/e of glucocorticoids or steroids Monitor b/p freq, daily weights, note any edema in the body. Both Florinef & steroids contraindicated w/ dx of fungal infections Sex Hormones males= androgens (testosterone & its derivatives) females=estrogen and progesterone Androgens- Male Sex Hormones Synthetic form called “anabolic steroids” muscle bldg, athletes (abused) C-III Natural (bio-identical) androgens include testosterone given IM, SQ, transdermal; no PO form. Some synthetic androgens given orally Primary action is to devlp and maintain male reprod. system, including sperm Used to “masculinize”, and often used in cancer tx of female tumors (negate female hormones) Testosterones: (fluoxymesterone) Tesamone, (nandrolone decanoate) Nandrolone, (oxandrolone) Oxandrin Andro-Inhibitor: Proscar (finasteride) tx baldness & shrink prostate * blocks testosterone Estrogen/progesterone- Female Sex Hormones Endogenous (prod. by the body) *estradiol & estrone, estriol Progestins-natural/synth (Premarin) estrogen: menopause (HRT), birth control, and female surgery, prostatic cancer men (Prometrium) progesterone: female problems/ also comb: estrogen: BCP Premarin, Estratabs or Estraderm (estrogen) Provera, Megace (progestins) – wear gloves when administering s/e: weight gain, H20 retention, breakthrough bleeding, bloating, discoloration of skin, High risk of uterine cancer & CV( stroke) espec. if smoking. Patient teaching: Estrogen Estrogen used cautiously in pt. with Gall Bladder Dz, Cardiovascular Dz & Liver Dz Estrogen also contra-indicated for some types of breast cancer (makes tumor grow) Stop smoking, esp if >30 yrs of age=high risk for bld. clots, strokes, heart attacks (CV) Use sunblocks if skin discoloration occurs Report suspected pregnancy immediately Breast/pap smears yearly Note any changes in moods/depression ASAP Questions?