HFHS Orientation - Hormonal Agents PDF

# Hormonal Agents ## A. Insulin Products Used at HFH - **Rapid acting** (will be discussed with the glycemic protocol) - Insulin Lispro (Humalog) - Give when the food tray arrives and not before - **Short acting** - Human regular insulin (Novolin R) - ONLY insulin that can be given...

# Hormonal Agents ## A. Insulin Products Used at HFH - **Rapid acting** (will be discussed with the glycemic protocol) - Insulin Lispro (Humalog) - Give when the food tray arrives and not before - **Short acting** - Human regular insulin (Novolin R) - ONLY insulin that can be given IV - Hypoglycemia likely prior to lunch - May be mixed with NPH or Lente - draw regular insulin (clear) up first - **Intermediate** - NPH (Novolin N) - Hypoglycemia most likely to occur between 3pm and dinner - **Long acting** - Insulin Glargine (Lantus) - Glargine (Lantus) is a long-acting insulin with NO peak. It is clear and CANNOT be mixed with any other insulin. - Ultralente (Humulin U) - Detemir (Levemir) - **Combination** - NPH 70%/Human regular 30% mixture (Novolin 70/30) - Usually given 15-30 minutes before breakfast and supper - Ultralente (Humulin U) - **Concentrated Insulin** - U500 insulin ## Insulin Pharmacodynamics | Insulin | Onset (hr) | Peak (hr) | Duration (hr) | Appearance | Route of Admin. | |---|---|---|---|---|---| | Insulin aspart (Novolog) | 5-10 minutes | 1-3 | 3-5 | Clear | SQ | | Human Regular | 1/2-1 | 2-4 | 5-7 | Clear | IV or SQ | | NPH | 1-2 | 6-14 | 24+ | Cloudy | SQ | | Ultralente | 6 | 18-24 | 36+ | Cloudy | SQ | | Insulin glargine (Lantus, Levemir) | 1 | None | 24 | Clear | SQ | | U500 | 30min | 2-4 | 8 or longer | Clear | SQ | # B. Oral Hypoglycemic Agents - Chlorpropamide (Diabinese)*, Glipizide (Glucotrol)**, Glyburide (Diabeta, Glynase, PresTab, Micronase), Tolbutamide (Orinase), Metformin (Glucophage), Tolazamide (Tolinase), Sitagliptin (Januvia), Canagliflozin (Invokana), Empagliflozin (Jardiance) ## General Information - Stimulates insulin release from pancreatic beta cells and reduces glucose output by the liver and/or enhances excretion of glucose by the kidneys - Onset 1 hour, peak 3-4 hours, duration 60 hours - Common side effects: anorexia, nausea, vomiting, epigastric discomfort, heartburn, hypoglycemia - Give drug before breakfast. If severe GI upset, divide dose - one before breakfast and one before evening meal - IV glucose for severe hypoglycemia - Not to be used for type I diabetes, in pregnancy, or lactation - Avoid alcohol and take at the same time each day - *Diabinese NOT recommended for the elderly* - **Glipizide (Glucotrol) has very few drug-to-drug interactions and IS recommended for the elderly** - Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, or celery # C. Corticosteroids: Prednisone, prednisolone, hydrocortisone (Cortisol) 1. **Indications:** Treatment of a variety of diseases including: - Adrenocortical insufficiency - Hypercalcemia - Rheumatic and collagen disorders - Dermatologic, respiratory, gastrointestinal, and neoplastic disease - Organ transplantation - A variety of diseases including those of hematologic, allergic, inflammatory, and autoimmune in origin. 2. **Adverse Reactions:** - Chronic, long-term use may result in Cushingoid appearance, osteoporosis, muscle weakness, and suppression of the adrenal-hypothalamic-pituitary axis. - Insomnia - Nervousness - Increased appetite - Indigestion - Headache - Diabetes mellitus - Cataracts - Glaucoma - Hirsutism 3. **Nursing Considerations:** - Monitor patient for weight gain and fluid retention - Withdraw therapy with gradual tapering of dose - Administer oral dose with food or after meals to reduce GI irritation - Prednisone may decrease response and increase potential infections - Prednisone may increase blood glucose levels 4. **Patient Education:** - Take exactly as directed. Do not take more than prescribed. - Do not discontinue abruptly. - Take with meals or after meals. - If diabetic, monitor serum glucose closely and notify physician of changes - Notify physician if experiencing higher than normal levels of stress as medication may need to be adjusted. - Periodic ophthalmic examinations will be necessary with long-term use. - Monitor for signs and symptoms of infections and avoid crowds or infectious people with contagious diseases. - Report weakness, change in menstrual pattern, vision changes, signs of hyperglycemia, signs of infection or worsening of condition.