Nursing Care of Clients with Endocrine System Drugs PDF

Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote Gland Hormone Targ Function Testes Testosteron Many Male et e characte...

Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote Gland Hormone Targ Function Testes Testosteron Many Male et e characteristics Orga n Pineal Secretes Many Responsible for Pituitary Gland Gland Melatonin the Biological 1. Anterior lobe clock meaning  Aka adenohypophysis they regulate  Secretes the ff hormones that target the sleep and glands and tissues: wake cycle of a  Growth hormone (GH) person  Thyroid stimulating hormone (TSH) Pituita FSH/LH Ovari Both hormones  Adrenocorticotropic hormone (ACTH) ry (follicle es regulate the  Gonadotropins follicle stimulating Gland stimulating Menstrual hormone cycle hormone (FSH) & luteinizing hormone and (LH) luteinizing hormone) ADH Kidne Which is (antidiuretic ys responsible for hormone) the fluid regulation in the body(Osmoregul ation) GH(growth Many Growth & hormone) division Growth hormone Oxytocin Uteru Birth  Regulated by two hypothalamic s contractions hormones: (1) GH releasing hormone (somatropin) and (2)GH inhibiting Prolactin Milk production hormone (somatostatin) Breas  Are given via SUBQ (subcutaneous) or t IM (intramuscular) ONLY tissue  Growth hormone drugs cannot be Thyroi Thyroxin Liver Metabolic rate given orally because they are d inactivated by GI enzymes Gland  Should be administered before the Adren Adrenaline Many Fight or flight al Cortisol Many anti-stress fusion of epiphyses because they act Gland only on newly forming bones Pancr Insulin/gluc Liver Blood sugar  The prolonged use leads to the eas agon levels increase of blood sugar level this is Ovarie Estrogen/ Uteru Menstrual cycle because of the antagonization of s Progesteron s insulin. e  When we say of growth hormone, this talks about the deficiency or the Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote decrease level and the increase level or the extra circulatory growth hormone. Growth Hormone Analogue SOMATROPIN  MOA: stimulates growth of essentially all tissues of the body mostly the bone  Drug of choice for a child with growth failure due to inadequate secretion of endogenous growth hormone & dwarfism Growth Hormone Suppressant Drugs  If a person is deficient with growth  Indications: patients with excess hormone we will be providing growth secretion of growth hormone, hormone analogue. gigantism, acromegaly  Tyrion Lannister, a very famous actor 1. GH receptor antagonist diagnosed with dwarfism 2. Somatostatin analogues  Drug example for growth hormone 3. Dopamine agonists analogue: Somatropin  Contraindicated to pediatric patients with Prader-Willi Syndrome, those with severe respiratory impairment, those patients taking corticosteroids, because this inhibits the effect of somatropin, those patients taking antidiabetic drugs because your somatropin enhances the efficacy of antidiabetic drugs which leads to 1. GH Receptor Antagonist hypogylycemia Pegvisomant  Take note: once final height is  MOA: blocks GH receptor site achieved therapy should be  Side effects (s/e): hyperhydorsis, discontinued cephalgia, fatigue  Side effects (s/e): arthralgia,  Adverse effects(a/e): chest pain, myalgia, peripheral edema, weakness hypertension, elevated hepatic paresthesia, cephalgia transaminase  Adverse effects (a/e): seizures, intracranial hypertension, and leukemia Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote  Growth hormone drugs should not be given orally however for bromocriptine mesylate since it does not entirely focus on the growth hormone and only has an effect on it that is why this medication can be given oral formulation.  Side effects(s/e): nausea, anorexia, dyspepsia, serostomia Growth Hormone Suppressant Drugs  Adverse Effects (a/e): 2. Somatostatin Analogues hypertension, myocardial infarction, stroke seizure Lanreotide Acetate  MOA: prevents pituitary gland secrete growth hormone  The effect is dependent on the dose given  The dose will be calculated by the physicians  Depot formulation (meaning it is a slow release form of medication to permit less frequent administration of medication)  Last for 28 days after deep subcutaneous injection Thyroid-Stmulating Hormone  For the same reason that this  MOA: stimulates thyroid gland to medication is given every 4 weeks. release T3 (triiodothyronine) and T4  Side effects(s/e): Diarrhea, (thyroxine) abdominal pain, nausea & vomiting,  Used as diagnostic agent to constipation, weight loss, and differentiate between primary and flatulence secondary hypothyroidism  Indicated to patients with thyroid cancer  0.9 mg IM (intramuscular) gluteus maximum, and 2nd dose is given after 24 hrs  This medication is given to the patient and then lab works will be done. Growth Hormone Suppressant Drugs  Primary Hypothyroidism: If there is an increase of your TSH level. Dopamine Agonists  Secondary Hypothyroidism: If Bromocriptine mesylate there is still a very low TSH.  MOA: inhibits the secretion of GH  This is indicated to patients with caused by tumor in pituitary gland thyroid cancer.  Available in oral formulation Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote Pituitary Gland 2. Posterior Lobe  Aka neurohypophysis Secretes the following hormones:  Antidiuretic hormone(ADH)/ vasopressin Adrenocorticotropic Hormone  Oxytocin  A hormone released by pituitary corticotrophs  Stimulates the release of glucocorticoids (cortisol), Antidiuretic Hormone mineralocorticoids (aldosterone), and  Decrease of your ADH or which with androgen term as the diabetes insipidus as the  Secretion follows a diurnal rhythm disorder or the increase of the ADH or (meaning the secretion is higher in the your SIADH or the syndrome of morning and decreases throughout the inappropriate antidiuretic hormone or day) an increase level of your ADH. 1. Cosyntropin Diabetes Insipidus  A synthetic ACTH  Decreased amount of circulating  MOA: stimulates production of and Antidiuretic Hormone release of cortisol, corticosterone, and  Excessive urination which leads to androgens severe dehydration and electrolyte loss  Used for diagnostic purposes to  Kidney tubules fail to reabsorb water differentiate between pituitary and  S/S: Excretion of large amounts of adrenal cause of adrenal insufficiency dilute urine, polydipsia, dehydration,  Given via IM (intramuscular) or IV inability to concentrate urine which (intravenous) routes again is manifested with dilute urine,  CAUTION: patients receiving diuretics low urine specific gravity Antidiuretic Hormone Therapy Drugs since this medication increases  MOA: promotes water reabsorption from electrolyte loss the renal tubules  S/e: Peripheral edema  Contraindication: Patients with renal  A/e: bradycardia, hypertension, sinus, disease tachycardia  Drug Ex. Vasopressin, Desmopressin acetate 1. Desmopressin Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote  Administered via oral, or intranasal, or by  S/e: thirst, dry mouth, constipation, injection IV or Subcutaneous route hyperglycemia, dizziness, weakness  Given to patients with Hemophilia A or von Willebrand Disease Type 1 2. Vasopressin Nursing Interventions  Administered IM or IV and intranasally  Introduce the release of adrenocorticotropic hormone which increases the serum cortisol level 1. Monitor Vital Signs. 3. Demeclocycline  Increased heart rate and decreased  MOA: induces nephrogenic Diabetes Insipidus with side(?) systolic pressure can indicate fluid  A tetracycline antibiotic volume loss resulting from the  Given orally decrease of your ADH production with  Common complaint: photosensitivity less secretion more water is excreted  S/E: Dental discoloration, enamel decreasing the vascular fluid which hypoplasia leads to hypoglycemia  It induce nephrogenic diabetes insipidus 2. Record urinary output. this only last 5 days starting treatment  Increased output could indicate fluid usually reversed to 2-6 days following the loss caused by the disease of your cessation of treatment ADH. 3. Obtain daily weight using the same Vaptans (Vasopressin Receptor weighing scale and clothing. Antagonist) 4. Assess abdominal girth.  MOA: increase serum sodium and free water clearance  Contraindicated with patients that have 1. Monitor blood glucose. hypovolemia because these further  Because hypoglycemia can occur in decreases the water level in the body high doses of this medication  Ex. Conivaptan and Tolvaptan 2. Monitor serum electrolyte level 1. Conivaptan  Contraindication: patients with corn allergy  Should be administered IV in large veins and rotated every 24 hours  Therefore you need multiple IV site for this medication.  Injections site complications: Phlebitis, pain, edema, pruritus because of the strong potency of the medication.  A/e: Orthostatic hypotension, syncope, hypertension, atrial fibrillation, electrolyte imbalance 2. Tolvaptan  Secretes the following hormones:  Given orally  Triiodothyronine (T3) Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote  Thyroxine (T4)  Calcitonin  A decrease in thyroid hormone Thyroid drugs secretion 1. Levothyroxine sodium  Causes:  MOA : increases T4 meaning it also a. Primary – thyroid gland disorder increases its metabolic rate and its b. Secondary – pituitary gland disorder oxygen consumption, the utilization which results to lack of TSH secretion and mobilization of glycogen source c. Tertiary – hypothalamus disorder which and metabolically is deiodinated to T3 results to lack of TSH secretion  T3 now acts on the target itself.  (Signs and symptoms) s/s:  Also considered to be the drug of fatigues, weight gain, feeling cold, choice (DOC) for replacement therapy itchy and dry skin for the treatment of primary hypothyroidism  Given orally  Contraindication: Thyrotoxicosis, mycocardial Infarction 2. Liothyronine Sodium  A synthetic T3  Biologic half life of 2.5 days with a rapid onset of action  Once hypothyroidism is no longer  Given PO or IV controlled  Used as a replacement or supplemental  Severe hypothyroidism in adult treatment for hypothyroidism and as  S/S: Lethargy, apathy, memory an initial therapy for myxedema this is impairment, emotional changes, slow because of its short half life speech, edema on the eyelids and face,  Unlike Levothyroxine, does not need to dry skin, a deep and coarse voice, cold be deiodinated which increases the intolerance, sloe pulse, constipation, availability for use by the body tissues weight gain and abnormal menses 3. Desiccated Thyroid  Photo below: Women affected by  Contains both Levothyroxine and myxedema. Liothyronine  Given PO (per orem)  Used to treat hyperthyroidism due to thyroid atrophy, hormone deficiency, goiter 4. Liotrix  Mixture of Levothyroxine sodium and Liothyronine, 4:1  Given PO Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote  Congenital hypothyroidism in children  Euthyroid is achieved in 2 to 4 months which causes delayed physical and of treatment mental growth  Preferred due to its lesser side effects compared to PTU 1. Monitor Vital signs 2. Weigh patient daily using the same weighing scale and clothing. 3. Instruct patient to take the medication at  For patients who underwent total the same time each day. thyroidectomy or the removal of 4. Monitor for thyroid function before and the thyroid gland, lifetime treatment after therapy. of thyroid medication is observed. 5. Monitor for adverse reactions.  From the day they were operated until the last day here on earth they should be taking the medication.  This gland secretes parathyroid hormones or parathormone.  Regulates serum calcium levels  Promotes calcium absorption from the GI tract  Promotes calcium reabsorption from the renal tubules  Activated Vitamin D Thiourea Derivatives / Thioamides Propylthiouracil (PTU)  MOA: block thyroid action reducing hormones  Enhances anticoagulant effect when Hypoparathyroidism taken with warfarin  Decrease functioning of the parathyroid gland leading to low level Methimazole of PTH  10 times more potent than PTU  Causes: Damage to parathyroid gland,  Given PO hypomagnesemia, hypocalcemia, renal  Longer half life impairment, diuretic therapy Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote  S/S: Paresthesia, muscle pains, fatigue, twitching of facial muscles Calcitriol  MOA: promotes calcium absorption from the GI tract and secretion of calcium from bone to the bloodstream  Given orally  Contraindication: Hypersensitivity, hypercalcemia, hypevitamosis D  S/e: Fatigue, weakness, somnolence,  MOA: increases bone density cephalgia, nausea, vomiting, diarrhea,  Used primarily to prevent bone loss cramps, drowsiness, dizziness, vertigo, and fractures metallic taste, lethargy, constipation,  Contraindications: patients with fish xerostomia allergy  A/e: anorexia, photophobia,  Given IM or SQ dehydration, cardiac arrhythmias,  S/e: nausea, vomiting dephalgia decreased libido, hypertension,  A/e: Severe hypocalcemia, Tetany, sensory disturbances, hypercalciuria, seizure hypercalcemia, hyperphosphatemia Cinacalcet  Increased circulating parathyroid  MOA: increases the sensitivity of the hormone calcium sensing receptors of the cells  Causes: lung cancer, hyperthyroidism of the thyroid gland, thereby reducing  S/s: Enuresis, polydipsia, muscle PTH weakness, loss of concentration,  This action causes a decrease in serum fatigue, loss of appetite, osteoporosis, calcium and slow the progression of bone and joint pain bone disease  Used for patient with hyperparathyroidism due to chronic renal disease and parathyroid cancer  Given PO Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote 1. Monitor serum calcium level. Normal 8 to 10 mg/dL  Dexamethasone 2.Monitor for hypersensitivity reactions  Given PO, IM or IV 3. Assist activities of daily living.  Given to patients with adrenocortical 4. Instruct patient to adhere to medication insufficiency regimen.  Betamethasone (PO) 5. Monitor for untorward reactions.  Betamethasone sodium phosphate / betamethasone acetate susp (IM) 1. Monitor vital signs 2. Weigh patient daily. 3. Obtain Abdominal girth  Consist of adrenal medulla and adrenal 4. Monitor serum electrolyte level specifically cortex potassium and sodium.  Adrenal medulla secretes epinephrine 5. Monitor for glucose level. and norepinephrine 6. Watch signs and symptoms of hypokalemia  Adrenal cortex secretes androgen, 7. Avoid abruptly stopping the medication. estrogen, and steroid hormones: 8. Monitor older adults for signs and glucocorticoids (cortisol), considered to symptoms of osteoporosis. be the most potent natural cortisol and 9. Instruct to avoid large crowds and persons mineralocorticoids (aldosterone), with respiratory infection promotes sodium retention, potassium and hydrogen excretion  Frequently called cortisone  Cortisone Acetate  Usually ends with the suffix-one - Given with foods  MOA: suppresses inflammation,  Hydrocortisone cypionate (PO) humoral immune response and adrenal  Hydrocortisone sodium function phosphate(IM/IV)  May be administered: orally,  Hydrocortisone acetate sodium parenterally, topical and aerosol suspension (IM)  Used to treat Addison’s disease, inflammation, allergic reaction,  A/e: Increased blood glucose, moon debilitating conditions, autoimmune face, buffalo hump, decreased disorders, ulcerative colitis, extremity size, muscle waisting, glomerulonephritis, shock, ocular and edema, sodium and water retention, vascular inflammation, polyarteritis hypertension, euphoria or psychosis, nodosa, hepatitis, organ transplant thinned skin with purpura, glaucoma, recipients to prevent organ rejection peptic ulcers, growth retardation  For the buffalo hump: this is usually situated at the nape. Nursing Care of Clients with Drugs related to the Endocrine System, Women and Men’s Health Mr. Jetier T. Pinote  Drug interactions: - Increases the potency of drugs taken concurrently, including aspirin and NSAIDs, thus increasing the risk of bleeding - Use of K-wasting diuretic increases potassium loss  Administration of glucocorticoid drugs  Indications: Trauma, surgery, inflammation, emotional upsets, anxiety  When therapy is discontinued, the dose should be tapered to allow the adrenal cortex to produce cortisol and other corticosteroids.  Abrupt withdrawal of the drug can result in severe adrenocortical deficiency. Fludrocortisone  MOA: promotes reabsorption of sodium from the renal tubules  Given orally with a glucocorticoids  A/e: fluid overload, hypertension  Mineralocorticoid deficiency usually occurs with glucocorticoid deficiency, called corticosteroid deficiency. Endocrine System, Women and Men’s 4. Gestation  Is because of Health al the increasing Diabetes level of Diabetes Mellitus progesterone, cortisol, and Normally when we eat carbohydrates your human body turns into a sugar called your glucose, placental and sends that to your blood stream. Your lactogen to pancreas releases insulin, it is a hormone check her that helps move glucose from your blood into during the your cell and then the cell uses that glucose second to third for energy. trimester.  The increase of When you have diabetes and don’t get the the hormones proper treatment, your body doesn’t use leads to the insulin like it should. Too much glucose stays inhibition of in your blood a condition called your high insulin usage. blood pressure or your hyperglycemia. To define Diabetes Mellitus simply: Differentiation of a healthy Type 1 DM  Chronic Disease of the pancreas that and type 2 DM results from deficient glucose metabolism.  Caused by insulin secretion insufficiency  Can’t be cured but, it can be controlled Types of Diabetes 1. Type 1 2. Type 2 3. Secondar  Highly y influenced by Diabetes the use of Healthy; the moment the body receives the medications glucose the pancreas secretes insulin; the Example: insulin will now attach itself to the receptor - With the use of glucocorticoids sites opening the gates of the cell for the , cortisol, or glucose to enter. prednisone. Type 1; the pancreases fails to produce - With the use of insulin therefore the cell couldn’t be opened thiazide because the insulin is not present, again, the diuretics, hydrochlorothi insulin receptor sites open the cell with the azide and with use of the insulin. the use of Type 2; There is presence of insulin epinephrine. however, there is a defective insulin receptor site no matter how many insulins are present M.L. it could still not open the cell since the Hemoglobin A1c (HbA1c) or receptor site is defective glycerated hemoglobin test Description & - Measure the preparation amount of glucose attached to hemoglobin - Provides Type 1 Type 2 average Also called- Insulin Also called Non- blood Dependent Insulin Dependent/ glucose level Diabetes/ Juvenile Adult-Onset over the past Onset Diabetes Diabetes two to three months. The pancreas is For the past 20 Normal - Less than damaged and years, the type 2 5.7% doesn’t make DM is more Prediabetes - 5.7 to 6.4% insulin common in children Diabetes - 6.5% and and teens; this is higher because more - Goal for young people are diabetic overweight and patient: obese. N. The regular (R) comes first before the withdraw regular insulin dose. NPH (H) or the Intermediate. 8. Without adding more air to NPH vial, carefully withdraw NPH dose taking care not to push fluid back into container as this will contaminate NPH insulin with regular insulin. Storage of Insulin  Should not be placed inside the freezer, nor under direct sunlight.  Unopened vials are refrigerated until needed.  Unopened vials are refrigerated until needed. Insulin Administration Example 2:  Administered via Subcutaneous route in the abdominal area. They are administered in the abdominal area because they are absorbed faster than those at other body sites and have been found to be more consistent. M.L.   Using insulin syringe in a 90-degree 1. 8 day rotation schedule angle. 2. Insulin be injected daily at a chosen  Only regular insulin can be injected site for 1 week. intravenously - 1.5 inches apart  Increases subcutaneous absorption; heat and massage. Insulin Syringe  Slows down absorption; cooling or - injected subcutaneously in a 90- application of cold packs. degree angle. -disadvantages; painful, injection site reactions. - Insulin site should be rotated to Insulin Pen prevent lipodystrophy - resembles a fountain pen but contains a disposable needle and disposable insulin-filled cartridge. - -injected subcutaneously in a 90- degree angle. - allows more simple, accurate, and convenient delivery than using a vial syringe.  Lipodystrophy; this involves your - Types: prefilled and reusable lipoatrophy it is depression under - Capacity: 150-300 units skin surfaces that primarily affect women and children Insulin Pumps  Lipohypertrophy, on the other hand erase lump or not on skin - used in association with blood surface that is more common in men, glucose monitoring and carbohydrate but in general lipodystrophy is caused counting. by the repeated injection into the - this device has an insulin reservoir same site. and programming capacity to deliver continuous rapid-acting insulin in  To prevent this complication, varying amounts at different times we have Insulin Rotation throughout a 24-hour period. Program: Insulin Jet Injectors - Shoots insulin without a needle directly through the skin into the fatty tissue. - s/e; stinging, pain, burning, bruising- since insulin is delivered in high pressure. M.L.  result being that the liver rapidly Insulin Syringe breaks down fat into ketones to employ as a fuel sources. - S/s; extreme thirst, polyuria, fruity breath odor, kussmaul breathing, rapid and thready pulse, blood Insulin Jet Injector glucose > 250 mg/dl.  These are given to patients with Type 2 diabetes Insulin Pump Sulfonylureas MOA: stimulate pancreatic beta cells to secrete insulin; because of this, it increases the insulin receptor cells which increases the ability of the cell to bind insulin for Adverse Reactions glucose metabolism. Insulin Shock  chemically related to sulfonamides but lack antibacterial activity - occurs when too much insulin is  Types: 1.) 1st Generation administered. 2.) 2nd Generation - -s/s; nervousness, trembling, lack of 1st Generation coordination, cold and clammy skin, Short acting Sulfonylureas headache. - -provide orally or IV Tolbutamide  Administered PO Somogyi Effect  s/e: headache, dysgeusia, pyrosis, hypoglycemia, weight gain, - a hypoglycemic effect that occurs weakness, dizziness, fatigue, between 2:00am to 4:00am blurred vision. - reducing bed time insulin dosage. - S/s; early morning headache, night Long Acting Sulfonylureas sweats and nightmares. Chlopropamide Dawn Phenomena  administered PO with breakfast  avoid administering to older adults. - hyperglycemia on awakening.  Because long half-life and duration - increase bedtime dose of insulin. of action and its increased risk of prolonged and serious Diabetic Ketoacidosis hypoglycemia with symptoms - occurs when absolute or relative including tachycardia, palpitation, irritability, headache hypothermia insulin deficiency inhibits the ability visual disturbances and lethargy. of glucose to enter cells for  Chlorpropamide is sold under utilization as metabolic fuel, the brand name DIABINESE. M.L.   Ex. Metformin Taken with meals Does not produce hypolycemia or 2nd Generation hyperglycemia  greater hypoglycemic potency Absorbed in the small than first generation intestine  longer duration of action and Does not undergo fewer side effects hepatic metabolicm  Effective doses are lowered and eliminated compared to first generation unchanged in the urine  Less displacement potential Most effective in from protein binding sites monatherapy  Contraindicated to patients with Useful to oral liver or kidney dysfunction antidiabetic resistant patients if combines with sulfonylureas S/e: Dizziness, headache, flushing, 2ND Generation weakness Glipizide, Glyburide, Glimepiride  S/e: Hypoglycemia  A/e: Aplastic anemia, 2. Alpha-Glucosidase Inhibitors leukopenia, thrombocytopenia,  MOA: inhibits digestive weight gain, seizure enzymes in the small intestine  Ex. Acarbose Is not absorbed in the GI tract Non-sulfonylureas Intended for patients 1. Biguanides who do not achieve 2. Alpha-Glucosidase Inhibitors results with diet 3. Thiazolidenidiones (Insulin  Miglitor Enhancing Agents) Absorbed in the GI 4. Meglitinides tract 5. Incretin Modifiers/ Dipeptidyl 3. Meglitinides Peptidase 4 Inhibitors/ Gliptins  MOA: stimulate beta cells to releaase insulin  Contraindicared to patients with liver dysfunction because of a 1. Biguanides possible decreased liver  MOA: increase binding to metabolism rate insulin to receptors and Ex. Repaglinide, nateglinide improved tissue to sensitivity to  S/e: headache, diarrhea, back insulin pain, dizziness, infection M.L. 4. Gliptins emptying, modulate appetite by  MOA: increase the level of inducing satiety incretin hormones, increase  Administered via SubQ before insulin secretions, and decrease meals in either abdomen or glucagon production thigh  Used as an adjunct therapy  Can be given to patients with treatment with exercise and diet Type 1 and Type 2 DM  Ex. Sitagliptin phosphate,  Ex. Pramlintide linapliptin, aloglipton,  S/e: dizziness, nausea, vomiting saxagliptin fatigue  S/e: headache, nasopharyngitis, arthralgia, peripheral edema Guidelines: 1. Onset of Diabetes Mellitus at age 40 years or older Glucagon 2. Diagnosis of diabetes within the past  MOA: increases blood glucose 5 years by stimulating glycogenolysis 3. Normal or overweight  Used to treat insulin-induced – 4. Fasting blood sugar of 200 mg/dL or hypoglycemia when other less means of providing glucose are 5. Fewer than 40 units of insulin not available required per day  Administered via SubQ, IM and 6. Normal renal and hepatic function IV oroute Incretin Mimetics/ Glucagon-like Peptide  MOA: acts on beta cell to improve its responsiveness  Given via subcutaneous route  NOT SUBSTITUTE FOR INSULIN  Ex. Exenatide, Liraglutide, Dulaglatide, Albiglutide  S/e: Headache, restlessness, fatigue, GI distress, injection site reactions Amylin Analogues  MOA: suppress glucagon secretions, slows gastruc M.L. NCM 106: Pharmacology Module 4M: Endocrine System Progestin MOA (Mechanism of Action) → Suppresses the LH surge WOMEN’S REPRODUCTIVE → Ovulation is prevented when LH surge is suppressed. Pregnancy will HEALTH not occur Combined Hormonal Progestin Effects Contraceptives (endometrial changes which (CHCs) creates a less favorable place for → Contains synthetic version of implantation) ❖ Endometrial changes estrogen and progestin ❖ Creates thick and hostile → Causes drug-induced cervical mucus anovulatory cycles - prevents the sperm to - A cycle which ovulation swim through and does not occur survive → Can be given orally, ❖ Alters movement of the transvaginally, transdermally, fallopian tube and cilia intramuscularly - impeding the movement of the ovum Estrogen MOA through the tube (Mechanism of Action) → Inhibits ovulation by preventing the formation of a dominant follicle Examples of Estrogens: → When a dominant follicle does not mature, estrogen remains at a 1. Esterified Estrogens consistent level and is unable to 2. Estradiol reach the peak level needed to stimulate the luteinizing hormone 3. Conjugated estrogens Estrogen Effects: 4. Ethinyl Estradiol ❖ Stabilize uterine endometrium Examples of Progestins: ❖ Inhibits proliferation and secretory changes 1. Norethindrone ❖ Decreases the occurrence of 2. Norethindrone acetate heavy or irregular bleeding 3. Ethynodiol diacetate 4. Norgestrel 5. Levonorgestrel 6. Desogestrel 7. Norgestimate 8. Drospirenone Yuson, Drea NCM 106: Pharmacology Side Effects Withdrawal Bleeding ❖ Nausea ❖ Vomiting → Aka pseudomenstruation → Scheduled monthly to mimic ❖ Menstrual changes normal 28-day menstrual cycle ❖ Breast tenderness ❖ Malaise Guidelines for Missed Dose ❖ Weight gain (missed taking your CHCs) One Tablet Adverse Effects ❖ Breakthrough bleeding ► Take the tablet as soon as the - Episode of bleeding that missed dose is realized occurs during the active ► Take the next tablet as pill cycle of CHC scheduled ❖ Excessive cervical mucus Two Tablets formation ❖ Hypertension ► Take 2 tablets as soon as the CHCs are available in 21 days missed dose is realized 2 tablet pack and 28 days tablet tablets the next day pack ► Use a back up contraception → In the 21-day active box, 21 plan for the rest of the cycle days active pills that contain Three Tablets estrogen and progestin are followed by a seven day pill-free ► Discontinue the present pack period and allow for withdrawal → In a 28-day tablet pack, 21 days bleeding of active pills are followed by ► Start a new package of tablets seven days of inert pills or for 7 days after last tablet is coldure (?) counters taken → You can identify there the ► Use another form of counter pills which is at the contraception until tablets have bottom part since they are the been taken for 7 contraceptive only ones that are in color days green. The active pills are in Ethinyl Estradiol and color white Norelgestromin Transdermal → During the hormone-free Patch periods or the counter days or → Another example of CHC the 7-day pill-free for the 21 → It is a weekly form of CHC patch days tablet pack, this result of given transdermally the decreased level of estrogen → It delivers 20 mcg of your ethinyl and progestin which allows estrogen and 150 mcg of your breakdowns of endometrial norelgestromin every 24 hours or 35 lining. So this is somehow mcg of EE and 150 mcg of N every called your withdrawal bleeding 24 hours → Placed on a clean and dry skin, once a week for 3 weeks in a row → 4th week is patch-free to allow withdrawal bleeding Yuson, Drea NCM 106: Pharmacology Sites of Patch Application: 3. Once inserted, keep the ring in ❖ Buttocks place as long as checked by your ❖ Abdomen healthcare provider ❖ Upper arm or upper torso → For this case, that should be left there for 3 weeks NURSING INTERVENTIONS 1. Monitor vital signs and weight 2. Instruct the client in the administration of the medication. Ethinyl Estradiol and Etonogestrel Transvaginal Contraception → It may take up to 1 week for full → In a form of a 2-inch flexible contraceptive effect to occur indwelling vaginal ring when medication is begun → Non-biodegradable, transparent, 3. Assist the client with DM in colorless → Releases 15 mcg of EE (ethinyl monitoring blood glucose level estradiol) and 120 mcg of E 4. Instruct the client to contact (etonogestrel) healthcare provider if vaginal bleeding → The vaginal ring is placed during or menstrual irregularities occur or if the first 5 days of menstruation and pregnancy is suspected left in place for 3 weeks and removed for 1 week to allow 5. Advise the client to use an withdrawal bleeding alternative method of birth control when taking antibiotics because these may decrease absorption of oral contraceptives Specific to Contraceptive Patches: 1. Instruct the client to peel away half of the backing on a patch, apply the How to Insert the Vaginal Ring: sticky surface to the skin, remove the other half of the backing, and then press down on the patch with the palm for 10 seconds. 2. Encourage the client to change the patch weekly, using a new location for 1. Hold the ring between your thumb each patch. and index finger and press the opposite sides of the ring together. 3. If the patch falls off and remains off 2. Gently push the folded ring up into for less than 24 hours, it can be the vagina as far as possible. Don’t reapplied if still sticky, or it can be worry that you will push the ring so replaced with a new patch that it will not get lost. Yuson, Drea NCM 106: Pharmacology 4. If the patch is off for more than 24 Disadvantages: hours, a new 4-week cycle must be Higher incidence of irregular started immediately. bleeding and spotting Specific to Vaginal Ring: Mood changes Depression 1. Instruct client that a back up contraception is needed during the first Decreased libido seven days after the ring is placed. Start Date and Dosing Schedule When are you supposed to start taking 2. Insert the ring into the middle or the medications? upper third of vagina. 3. Instruct the client that the ring First-day Start Method remains in place during sex, tampon → Initiated on the first day a use or administration of intravaginal woman experiences bleeding drugs → Days are counted then 4. If the ring slips out for less than 3 2,3,4,5,6 and so on until the first-day bleeding begins again hours, instruct the client to rinse with → So, if you started your lukewarm water and should be reinserted. menstruation or your bleeding on September 22, then you will 5. If the ring slips out for more than 3 be taking your pill on hours, reinsert ring and have an September 22 as well additional contraceptive for 7 days. Sunday Start Method 6. Removed rings should be wrapped → Starts the tablet or patch on a in a foil pouch and discarded, not flushed down the toilet. Sunday after the first day of menstruation PROGESTIN CONTRACEPTIVES → If menstruation starts on a → Contains only progestin Sunday, the woman starts her → Available in oral, intramuscular tablet/patch on that day (IM), subcutaneous and → It aids a woman in remembering implantable routes the first days of her contraception Advantages: → For example, the bleeding Relatively safe started on September 17, you Easy to use will be taking or applying the Spontaneity of sexual patch, taking the tablet and intercourse but less effective applying the patch on a Sunday than CHCs on September 19 - since they do not → If the woman starts suppress the release of contraception later than 5 days FSH and LH as same as of her menstrual cycle, a degree as CHCs backup contraception should be used for 7 days Yuson, Drea NCM 106: Pharmacology Quick Start Method Natural Androgens: → Starts on the day the patient ❖ Testosterone Nasal receives the prescription ❖ Transdermal testosterone patch regardless where she might be ❖ Testosterone topical gel in her menstrual cycle ❖ Buccal testosterone → Increases adherence and ❖ Testosterone pellet resolves risk for becoming ❖ Testosterone cypionate pregnant while waiting for Synthetic Androgens: menstruation to start the contraceptive ❖ Fluoxymesterone → So, if you receive your ❖ Methyltestosterone prescription on September 20, MOA: binds to androgen receptors, you will also be staring to take producing multiple anabolic and the prescribed medication on androgenic effects September 20. → If used after the first 5 days of Antiandrogens/Androgen menstruation, a backup Antagonist contraception is needed for 7 → Drugs used to treat BPH, advanced days prostatic cancer, hormonal therapy for patients with endometriosis MEN’S REPRODUCTIVE HEALTH DRUG EXAMPLES: ANDROGENS Goserelin Acetate and Leuprolide → Male sex hormones Acetate → Control the development and maintenance of sexual process, → MOA: elevates GnRH accessory organs, cellular Ketoconazole metabolism, and bone & muscle growth → An antifungal drug but with → Used to replace deficient testosterone suppressing hormones such as your effects hypogonadism → MOA: inhibits testosterone release Side Effects: → Given at higher doses 400 mg Masculine secondary sexual PO q8h as opposed to its 200 to characteristics: 400 mg daily for the treatment of fungal infection ❖ Body hair growth ❖ Lowered voice Flutamide, ❖ Muscle growth Bicalutmide/Bicalutamide ❖ Breast tenderness → MOA: inhibits receptor sites ❖ Gynecomastia → It competes with androgens at ❖ Priapism receptor sites in the prostate gland blocking the conversion of testosterone to dihydrotestosterone Yuson, Drea NCM 106: Pharmacology → By doing so, this prevents the Depot Medroxyprogesterone androgens from stimulating the Acetate (DMPA) prostate cancer cells to grow [Progestin Contraceptive] → Also highly effective, long acting Spironolactone injectable progestin → A weak Potassium-Sparing (K- → MOA: thickens cervical mucus, thins uterine endometrium, sparing) diuretics decreases fallopian tube motility → MOA: inhibits androgen → Administration Dose: 150 mg/mL receptor sites deep IM ventral gluteus or deltoid Finasteride every 1 to 13 weeks → Causes anovulation and → MOA: Blocks conversion of amenorrhea because it inhibits both testosterone to FSH and LH secretion dihydrotestosterone → Higher circulating level than CHCs and POPs NURSING INTERVENTIONS Specific to DMPA: Progestin Implant 1. Instruct the client that the injection → A single-rod device that contains site should not be massaged after 68 mg of estonogestrel / administration. etonogestrel → Implanted in the inner side of the 2. Document the injection site and the upper non-dominant arm injection site reaction. → Should be removed not later than 3. Instruct the client to return within 11 3 years after date of implantation to 13 weeks. though it may be replaced with a new implant at the time of removal → If the client fails to return after → Contains barium, a radio peak 13 weeks, for example three substance that can help locate the weeks and one day, pregnancy device on a 2-dimensional should be ruled out first before radiography ultrasound, MRI and CT the client receives another scan, may not be effective in women injection with a BMI greater than 30 or your obese women 4. Include calcium and vitamin D How Progestin Implant is Placed: supplements in the diet. → Because bone resorption exceeds bone formation Yuson, Drea NCM 106: Pharmacology Progestin Only Oral Contraceptive Pills (POPs) → Also called minipill → MOA: 1. Alters cervical mucus making it thick and viscous blocking sperm penetration 2. Interferes endometrial lining making implantation difficult 3. Decreases fallopian tube peristalsis slowing down the transport of ovum 4. Interferes with LH surge which inhibits ovulation → Unlike CHCs, all 28 pills contain active hormone with 0.35 mg of norethidone / norethindrone each → Should be taken continuously without a break within a 3-hour window → Because it takes 4 to 6 hours for progestin to thicken the cervical mucus to prevent penetration → The duration of the progestin and cervical mucus lasts for just 24 hours → If the minipill is taken more than 3 hours late, a back-up contraceptive method should be used for 48 hours GUIDELINES FOR MISSED DOSE: One or More Tablets ❖ Take the tablet as soon as the missed dose is realized, and follow with the next tablet at a regular time ❖ Use a backup method of contraception for 48 hours Yuson, Drea