NCMA 216: Pharmacology Course Unit 11 PDF

NCMA 216: Pharmacology COURSE UNIT 11 Drugs Affecting the Endocrine System Abigael Comson-De Mesa, MAN, RN  LEARNING OBJECTIVES At the end of our lecture, the students will be able to: 1 Review the anatomy and physiology of the endocrine system. 2 Understand hormon...

NCMA 216: Pharmacology COURSE UNIT 11 Drugs Affecting the Endocrine System Abigael Comson-De Mesa, MAN, RN  LEARNING OBJECTIVES At the end of our lecture, the students will be able to: 1 Review the anatomy and physiology of the endocrine system. 2 Understand hormone functions and drug effects. 3 Recognize disorders of the endocrine systems 4 Identify the classifications of drugs affecting the endocrine system. 5 Understand the development of diabetes mellitus. Manifest professionalism in and excellence in safe medication 6 administration.  01 ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM Endocrine System ▪ It provides communication within the body and helps to regulate growth and development, reproduction, energy use, and electrolyte balance. ▪ Closely interconnected with Nervous System – to maintain homeostasis within the body to ensure maximum function and adequate response to various internal and external stressors. GLANDS ▪ Collection of specialized cells that produce hormones that cause an effect at hormone receptor sites. ▪ Hormones are secreted directly into the bloodstream. HORMONE PRODUCED GLAND EFFECTS Adrenal Cortex ▪ Cortisol ▪ Increase glucose levels, suppresses inflammatory and immune reactions. ▪ Aldosterone ▪ Sodium retention, potassium excretion. Intestine ▪ Secretin, Cholecystokinin ▪ Decreased gastric movement, stimulates bile and pancreatic juice secretion. Kidney ▪ Erythropoietin ▪ Increases RBC production. ▪ Renin ▪ Stimulates increase in blood pressure and vascular volume. Ovaries ▪ Estrogen, Progesterone ▪ Promotes secondary sex characteristics, prepares the female body for pregnancy. Pancreas ▪ Insulin, Glucagon, ▪ Regulation of glucose, fat metabolism Somatostatin (Islet of Langerhans) GLANDS HORMONE PRODUCED GLAND EFFECTS Parathyroid Gland ▪ Parathyroid Hormone ▪ Increases the serum calcium levels. Pineal Gland ▪ Melatonin ▪ Affects the secretion of hypothalamic hormones – gonadotropin-releasing hormone. Placenta ▪ Estrogen, Progesterone ▪ Fetal growth and development, prepares the body for delivery. Stomach ▪ Gastrin ▪ Stimulates stomach acid production. Testes ▪ Testosterone ▪ Stimulates secondary sex characteristics of male. Thyroid ▪ Thyroid Hormone ▪ Stimulates the basal metabolic rate. ▪ Calcitonin ▪ Decrease serum calcium levels. HORMONES ▪ Chemicals that are produced in the body and meet a specific criteria. ▪ It is produced in small amounts. ▪ It is secreted directly into the bloodstream. ▪ It act to increase or decrease the normal metabolic cellular processes when they react with their specific receptor sites. ▪ It is immediately broken down. HYPOTHALAMUS ▪ Coordinating center for the nervous and endocrine responses to internal and external stimuli. ▪ It consistently monitors the body’s homeostasis by analyzing input from the periphery and the central nervous system, and coordinating responses through the autonomic, endocrine, and nervous system. ▪ Neurocenter – specific areas sensitive to a stimuli. ▪ Regulates body temperature ▪ Thirst, Hunger ▪ Water Retention ▪ Blood Pressure ▪ Respiration ▪ Reproduction ▪ Emotional Reaction HYPOTHALAMUS ▪ It receives input for processing from ▪ Limbic system ▪ Cerebral cortex ▪ Cranial nerves – smell, sight, tough, taste, and hearing ▪ Emotions and thoughts ▪ It produces and secretes releasing hormones – stimulates the pituitary gland. ▪ Growth hormone ▪ Release-inhibiting factor (Somatostatin) ▪ Prolactin (PRL)-inhibiting factor. ▪ It is connected to the Pituitary Gland by two (2) networks: ▪ Vascular Capillary Network ▪ It carries the hypothalamic-releasing factor directly into the anterior pituitary. ▪ Neurological Network ▪ It delivers antidiuretic hormone (ADH) and oxytocin into the posterior pituitary to be stored. PITUITARY GLAND ▪ Anterior Pituitary Lobe ▪ It produces stimulating hormones in response to hypothalamic stimulation. ▪ It releases hormones essential for the regulation of growth, reproduction, and metabolic process. ANTERIOR PITUITARY HORMONE TARGET ORGAN RESPONSE Adrenocorticotropic Hormone (ACTH) Adrenal corticosteroid hormones Thyroid-Stimulating Hormone (TSH) Thyroid Hormone Growth Hormone (GH) Cell growth Luteinizing Hormone (LH) and Estrogen and Progesterone – Females; Testosterone – Male Follicle Stimulating Hormone (FSH) Prolactin Hormone (PRL) Milk Production Melanocyte Stimulating Hormone (MSH) Melanin stimulation PITUITARY GLAND ▪ Posterior Pituitary Lobe ▪ It stores hormones that are produced by the hypothalamus and deposited in the posterior lobe via the nerve axons. ▪ Two (2) hormones: ▪ Anti-Diuretic Hormone (Vasopressin) ▪ It is directly released in response to plasma osmolarity or decreased blood volume. ▪ Oxytocin ▪ It stimulates uterine smooth muscle contraction in late phases of pregnancy and causes milk release (let-down reflex) in lactating women. ▪ It is associated with labor and lactation. PITUITARY GLAND ▪ Intermediate Pituitary Lobe ▪ It produces hormones to modulate pain perception. ▪ Endorphins and Enkephalins ▪ They are release in response to severe pain or stress. ▪ It occupies specific endorphin receptor sites in the brainstem to block the perception of pain. ▪ They respond to (1) overactivity of pain nerves (2) sympathetic stimulation (3) transcutaneous stimulation (4) guided imagery (5) vigorous exercises. ADRENAL GLAND ▪ Flattened bodies that sit on top of each kidney. ▪ Responds to adrenocorticotropic hormone. ▪ Adrenal Medulla - inner core - part of the Sympathetic Nervous System (SNS) - releases neurotransmitter – epinephrine and norepinephrine - secreted directly to the bloodstream act as hormones ▪ Adrenal Cortex - outer shell - synthesize chemically different types of steroid hormones - produces corticosteroids – affects electrolytes, stimulate protein production and decrease protein breakdown. THYROID GLAND ▪ Located in the middle of the neck, surrounds the trachea ▪ It produces hormones – thyroid hormone and calcitonin ▪ It is a vascular gland made up of cells arranged in circular follicles - Colloid tissues – produced and store Thyroid Hormone - Parafollicular cells – produced Calcitonin ▪ Thyroid Hormone - regulator of growth and development - production and release are regulated by the anterior pituitary hormone – Thyroid Stimulating Hormone (TSH) ▪ Calcitonin - hormones that counteract the effects of the parathyroid hormone to maintain calcium levels. PARATHYROID GLAND ▪ Four small groups of glandular tissues located at the back of the thyroid gland. ▪ It produces Parathyroid hormones – important regulator of serum calcium levels. ▪ Calcitonin – acts to balance the effects of the Parathyroid Hormone ▪ Parathyroid Hormones (1) Stimulation of osteoclasts or bone cells to release calcium from the bone. (2) Increased intestinal adsorption of calcium. (3) Increased calcium reabsorption from the kidneys. (4) Stimulation of cells in the kidneys to produce calcitriol – active form of vitamin D, stimulates intestinal transport of calcium into the blood. PANCREAS ▪ Endocrine gland – produces hormones ▪ Glucagon - alpha cells - direct response to low blood glucose levels ▪ Insulin - beta cells - direct response to high blood glucose levels - stimulated by the incretins ▪ Somatostatin - delta cells - response to very low blood glucose levels. - blocks the secretion of both insulin and glucagon. ▪ Exocrine gland – release sodium bicarbonate and pancreatic enzymes to neutralize the acid chyme and aid digestion.  02 Drugs Affecting the Endocrine System  Drugs Affecting the Endocrine System Hypothalamic and Pituitary Agents Adrenocortical Agents Thyroid and Parathyroid Agents Glucocorticoids Mineralocorticoids Drugs Affecting Hypothalamic Drugs Affecting Posterior Thyroid Agents Parathyroid Agents Hormones Pituitary Hormones Drugs Affecting Anterior Pituitary Hormones 2.1 Hypothalamic and Pituitary Agents  Hypothalamic and Pituitary Agents Drugs Affecting Drugs Affecting Anterior Drugs Affecting Posterior Hypothalamic Pituitary Hormones Pituitary Hormones Hormones ▪ Desmopressin ▪ Tolvaptan Growth Hormone Growth Hormone ▪ Conivaptan Hypothalamic Hypothalamic Agonists Antagonists Agonists Antagonists ▪ Somatropin ▪ Bromocriptine ▪ Leuprolide ▪ Degarelix ▪ Octreotide ▪ Ganirelix ▪ Pegvisomant Hypothalamic Agents PHARMACODYNAMICS ▪ Hypothalamic Agonists ▪ Stimulate the release of hormone – growth hormone-releasing hormone, thyrotropin-releasing hormone, gonadotropin-releasing hormone (GnRH), corticotropin-releasing hormone, and prolactin-releasing hormone. ▪ Hypothalamic Antagonists ▪ It blocks the effects of hypothalamic releasing hormones. PHARMACOKINETICS ▪ Intramuscular ▪ Subcutaneous ▪ Depot Hypothalamic Agents ADVERSE EFFECTS ▪ Hypothalamic Agonists -⇧release of sex hormones ▪ Ovarian stimulation ▪ Flushing ▪ ⇧body temperature ▪ ⇧appetite ▪ Fluid retention. ▪ Hypothalamic Antagonists - ⇩testosterone levels ▪ loss of energy ▪ ⇩ sperm count and activity ▪ Alteration in secondary sex characteristics ▪ ⇩female sex hormones ▪ lack of menstruation ▪ Changes in fluid and electrolytes ▪ Insomnia ▪ Irritability Hypothalamic Agents DRUG SAMPLES ▪ Hypothalamic Agonists ▪ Leuprolide ▪ Hypothalamic Antagonists ▪ Degarelix ▪ Ganirelix Anterior Pituitary Hormones Drugs PHARMACODYNAMICS ▪ To mimic or antagonize the effects of specific pituitary hormones. ▪ GH (growth hormone) – most commonly use pharmacologic treatment of anterior pituitary hormone. ▪ GH responsible: ▪ Linear Skeletal Growth ▪ Growth of Internal Organs ▪ Protein Synthesis ▪ Other Processes for Normal Growth ▪ Used either as: ▪ For replacement therapy – hypoactive pituitary ▪ For diagnostic purposes ▪ Growth Hormone Agonists ▪ Drugs that are used as a replacement for anterior pituitary hormones acting as Growth Hormone (GH) – somatropin. ▪ Growth Hormone Antagonists ▪ Somatostatin – inhibitory factor released from the hypothalamus. ▪ Inhibits the release of GH. Anterior Pituitary Hormones Drugs DRUG SAMPLES: ▪ Growth Hormone Agonists ▪ Somatotropin ▪ Somatotropin rDNA ▪ Growth Hormone Antagonists ▪ Bromocriptine (Parlodel) – dopamine agonists that inhibits GH oral and effective absorption GI tract ▪ Lanreotide (Somatuline Depot) – subcutaneous administration, slowly release ▪ Octreotide (Sandostatin) – subcutaneous administration, rapidly absorbed and widely distributed ▪ Pegvisomant (Somavert) - subcutaneous administration, slowly absorbed. Anterior Pituitary Hormones Drugs NURSING CONSIDERATIONS ▪ Growth Hormone Agonists ▪ Individual products vary so follow strictly the manufacturer’s direction before use. ▪ Intramuscular or subcutaneous administration for appropriate distribution of the drug. ▪ Monitor closely for response to treatment. ▪ Monitor other hormone function because they ,ay be affected like thyroid function and glucose tolerance. ▪ Monitor closely for adverse effects like hypothyroidism, glucose intolerance, and nutritional imbalance. ▪ Provide health teaching about the drug, prescribed dosage, therapeutic and adverse effects to increase client’s and guardian’s understanding and promote compliance. Anterior Pituitary Hormones Drugs NURSING CONSIDERATIONS ▪ Growth Hormone Antagonists ▪ Follow strictly the manufacturer’s direction for use. ▪ Monitor patient’s response to the drug. ▪ Monitor for adverse effects like hypothyroidism, glucose intolerance, nutritional imbalance, GI disturbance, dizziness, headache, and cholecystitis. ▪ Provide comfort measures. ▪ Health teaching about the drug actions and adverse effects to increase client’s and guardian’s understanding. Posterior Pituitary Hormones Drugs PHARMACODYNAMICS ▪ Blocks the vasopressin or the antidiuretic hormone receptors – leads to ⇧ water excretion resulting to ⇧ serum sodium concentration and return to fluid balance. ▪ It treats clinically significant hypervolemic or euvolemic hyponatremia – same amount of sodium levels but increase total body water, and SIADH – Syndrome of Inappropriate Antidiuretic Hormone. ▪ Loss of water through the urine CONTRAINDICATIONS ▪ Patients with vascular disease – to prevent effects on vascular smooth muscles. ▪ Patients with epilepsy, asthma, and hyponatremia – to avoid exacerbation. ▪ Pregnancy – to inhibit risk of uterine contractions. ▪ Patients who consume large amount of fluids - to prevent risk of electrolyte dilution and hyponatremia. Posterior Pituitary Hormones Drugs ADVERSE EFFECTS ▪ Water intoxication r/t shift to water retention – electrolyte imbalance ▪ Drowsiness ▪ Light headedness ▪ Coma ▪ Convulsions ▪ Tremors ▪ Sweating ▪ Vertigo ▪ Headache r/t water retention (“hang over effect”) ▪ Abdominal cramps ▪ Flatulence ▪ Nausea/ vomiting r/t GIT motility ▪ Local nasal irritation r/t nasal administration ▪ Hypersensitivity – rash or bronchial constriction ▪ Rapid volume shift ▪ Polyuria ▪ Changes in blood pressure ▪ Hyperglycemia ▪ Arrhythmias Posterior Pituitary Hormones Drugs DRUG SAMPLES ▪ Conivaptan (Vaprisol) - continuous intravenous infusion. - half-life: 5 hrs - used with care with digoxin, ACE inhibitors, Angiotensin- receptor blockers, Potassium-sparing diuretics ▪ Tolvaptan (Samsca) - oral - half-life: 12 hrs - should NOT be combined with Telithromycin – risk for severe toxicity ▪ Desmopressin - oral, subcutaneous, nasal administration and intravenous - treatment of choice: Diabetes Insipidus and Hemophilia A - pressor and antidiuretic effects - increases levels of clotting factor VIII. 2.2 Adrenocortical Agents  Adrenocortical Agents Glucocorticoids Mineralocorticoids ▪ Cortisone ▪ Fludrocortisone ▪ Dexamethasone ▪ Cortisone ▪ Budesonide ▪ Hydrocortisone ▪ Beclomethasone ▪ Betamethasone ▪ Hydrocortisone ▪ Methylprednisolone ▪ Prednisone ▪ Prednisolone Adrenocortical Drugs ▪ Widely used to suppress the immune system. ▪ Short-term use to relieve inflammation during acute stage of illness. ▪ Replacement therapy to maintain hormone levels. Glucocorticoid Drugs PHARMACODYNAMICS ▪ Stimulate an increase in glucose levels for energy. ▪ Increase rate of protein breakdown. ▪ Decrease rate of protein formation from amino acids – energy preservation ▪ Lipogenesis – formation and storage of fat. ▪ It enters the target cells and bind to cytoplasmic receptors – anti-inflammatory and immunosuppressive effects. ▪ Short-term treatment of many inflammatory disorders – to relieve discomfort and to give the body a chance to heal from effects of inflammation. ▪ It blocks the actions of arachidonic acid – decrease in the formation of prostaglandins and leukotrienes. ▪ Impair the ability of phagocytes to leave the bloodstream and move to injured tissues, and inhibit the ability of lymphocytes to act in the immune system. ▪ Treat local inflammation – topical agents, intranasal or inhaled agents, intra-articular, and ophthalmic agents. Glucocorticoid Drugs DRUG SAMPLES ▪ Beclomethasone - respiratory inhalant and nasal spray - blocking inflammation in the respiratory tract. ▪ Flunisolide ▪ Betamethasone - long-acting steroid available for systemic. - parenteral, oral, and topical use in acute situations. ▪ Budesonide - intranasal use - relief of symptoms of seasonal and allergic rhinitis ▪ Cortisone - oral and parenteral - replacement therapy in adrenal insufficiency. ▪ Dexamethasone - multiple forms for dermatological, ophthalmological, intra-articular, parenteral, and inhalational uses. - peak quickly and effects lasts for 2-3 days. Glucocorticoid Drugs DRUG SAMPLES ▪ Methylprednisolone - multiple forms: oral, parenteral, intra-articular, retention enema preparations. ▪ Prednisolone - intermediate-acting corticosteroid - effects last only a day - intralesional and intra-articular injection. - oral and topical forms. ▪ Prednisone - available only as an oral agent. ▪ Hydrocortisone - with mineralocorticoid effect. - topical or ophthalmic agent. Mineralocorticoid Drugs PHARMACODYNAMICS ▪ It affect the electrolyte levels and homeostasis. ▪ Aldosterone - classic mineralocorticoids and holds the sodium and water causes excretion of potassium by acting on the renal tubule. - no longer available for pharmacological use. ▪ Increases sodium reabsorption in renal tubules – sodium and water retention, increase potassium excretion. DRUG-DRUG INTERACTIONS ▪ Decrease effectiveness ▪ Salicylates ▪ Barbiturates ▪ Hydantoins ▪ Rifampin ▪ Anticholinesterase Glucocorticoids and Mineralocorticoid Drugs NURSING CONSIDERATIONS ▪ Avoid sudden withdrawal of steroids to prevent Addisonian crisis. Taper dose if there is a need to discontinue. ▪ Monitor glucose, sodium, potassium levels. ▪ Monitor vital signs especially blood pressure. ▪ Follow the regimen and administer following the natural release of hormones. ▪ Avoid exposure to infection. ▪ Do not give live virus vaccines because the client is immunosuppressed. ▪ Monitor CBC. ▪ Provide health teaching about the drugs, therapeutic and adverse effects to increase client’s or guardian’s understanding. 2.3 Thyroid and Parathyroid Agents  Thyroid and Parathyroid Agents Thyroid Drugs Parathyroid Drugs Thyroid Hormones Antithyroid Agents Antihypocalcemic Antihypercalcemic ▪ Calcitriol ▪ Levothyroxine (Rocaltrol) (Synthroid, Levoxyl) Parathyroid Biphosphonate Calcitonin Thioamides Iodine Solutions ▪ ▪ Liothyronine Hormone (Cytomel, Triostat) ▪ Teriparatide ▪ Liotrix ▪ Alendronate (Thyrolar) ▪ Methimazole ▪ Sodium Iodide ▪ Etidronate ▪ Propylthiouracil ▪ Strong Iodine Solution ▪ Ibandronate ▪ Pamidronate ▪ Residronate Thyroid Replacement Hormones PHARMACODYNAMICS ▪ Treatment for cases of Hypothyroidism, myxedema coma, suppression of TSH, prevention of goiter, and management of thyroid cancer ▪ Management for thyroid toxicity and thyroid overstimulation. ▪ It replaces low or absent levels of natural thyroid hormone and suppress the overproduction of TSH by the pituitary. ▪ It contains natural and synthetic thyroid hormones. ▪ It increases the metabolic rate of body tissues, increasing oxygen consumption, respiration, heart rate, growth and maturation, metabolism of fats, carbohydrates, and proteins. DRUG-DRUG INTERACTIONS ▪ Decreased absorption if taken concurrently with Cholestyramine. ▪ If this combination needed, drugs should be administered 2 hours apart. ▪ Oral anticoagulants – increase effectiveness if taken with thyroid hormone. ▪ Decreased effectiveness if taken concurrently with Digitalis Glycosides. ▪ Decreased clearance of Theophylline if take with thyroid hormone. Thyroid Replacement Hormones ADVERSE EFFECTS ▪ Skin reactions and loss of hair ▪ Symptoms of hyperthyroidism ▪ Cardiac stimulation ▪ Arrhythmia ▪ Hypertension ▪ CNS effects ▪ Anxiety ▪ Sleeplessness ▪ Headache ▪ Difficulty swallowing ▪ Esophageal Atresia – take drugs with full glass of water to alleviate the effect. Thyroid Replacement Hormones DRUG SAMPLES ▪ Levothyroxine - Replacement therapy in hypothyroidism - Suppression of TSH release - Increases the metabolic rate of body tissues , increasing oxygen consumption, respiration and heart rate. ▪ Liothyronine ▪ Liotrix Thyroid Replacement Hormones NURSING CONSIDERATIONS ▪ Administer before breakfast to ensure consistent therapeutic levels. ▪ Advise periodic blood tests to assess levels of thyroid hormones and TSH. ▪ Monitor for signs of primary adverse effect of hyperthyroidism. ▪ Monitor vital signs. ▪ Monitor cardiac response. ▪ Assess for possible adverse effects – anxiety, skin rash,, tachycardia, and hypertension Antithyroid Drugs ▪ It blocks the production of thyroid hormone and to treat hyperthyroidism. THIOAMIDES ▪ It lowers the thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells – lowers the serum level of thyroid hormone. ▪ It partially inhibit the conversion of T4 and T3 at the cellular level. ▪ Indicated for the treatment of hyperthyroidism. IODINE SOLUTIONS ▪ Use to treat hyperthyroidism. ▪ It causes the thyroid cells to become oversaturated with iodine and stop producing thyroid hormone. ▪ Radioactive Iodine – taken up into the thyroid cells, which are then destroyed by the beta-radiation given off by the radioactive iodine. Antithyroid Drugs PHARMACOKINETICS THIOAMIDES ▪ Absorbed well in the GIT ▪ Concentrated in the thyroid gland ▪ Methimazole - onset of action: 30 to 40 mins IODINE SOLUTIONS ▪ Rapidly absorbed in the GIT ▪ Widely distributed throughout the body fluids ▪ Oral – strong iodine products, potassium iodide, sodium iodide - effects: 24hrs, short-lived - peak: 10 to 15 days Antithyroid Drugs ADVERSE EFFECTS THIOAMIDES ▪ Drowsiness ▪ Lethargy ▪ Bradycardia ▪ Skin Rash ▪ Nausea/ Vomiting ▪ Severe Liver Toxicity IODINE SOLUTIONS ▪ Hypothyroidism ▪ Iodism – metallic taste and burning in the mouth, sore teeth and gum ▪ Staining of teeth ▪ Goiter development Antithyroid Drugs DRUG SAMPLES THIOAMIDES ▪ Methimazole (Tapazole) ▪ Propylthiouracil (PTU) IODINE SOLUTIONS ▪ Sodium Iodide ▪ Strong Iodine Solution ▪ Potassium Iodide Antithyroid Drugs NURSING CONSIDERATION ▪ Monitor thyroid hormone levels regularly. ▪ Monitor for symptoms of hypothyroidism – primary adverse effects. ▪ Administer PTU round the clock as ordered to ensure consistent therapeutic levels. ▪ Administer iodine solution using straw – to prevent staining of the teeth. Tablets may be crushed. ▪ Monitor client’s response to the drug. ▪ Provide health teaching about the drug, therapeutic action and adverse effect. ▪ Provide measure to promote good client’s compliance. Parathyroid Drugs ▪ To treat disorders associated with parathyroid function are drugs that affect serum calcium levels. ▪ Parathyroid replacement hormone ▪ Affects the calcium levels. Parathyroid Drugs ANTIHYPOCALCEMIC DRUGS ▪ Stimulates new bone formation – increasing the skeletal mass ▪ It increases serum calcium and decreases serum phosphorus ▪ Management of hypocalcemia and hypoparathyroidism ANTIHYPERCALCEMIC DRUGS ▪ Use to treat parathyroid hormone excess or hypercalcemia ▪ It act on the serum levels of calcium and do not suppress the parathyroid gland CALCITONIN DRUGS ▪ It inhibits bone resorption, lowers serum calcium levels in children and in patient’s with Paget’s disease – chronic bone disease that causes the bones to grow larger and weaker. BIPHOSPHONATES ▪ It slow or block bone resorption. ▪ It helps to lower serum calcium levels. ▪ It doesn’t inhibit normal bone formation and mineralization Parathyroid Drugs DRUG SAMPLE ANTIHYPOCALCEMIC DRUGS ▪ Calcitriol (Rocaltrol) - well absorbed GIT, widely distributed in the body - stored in the liver, muscle, fat, skin, and bone - half-life: 5 to 8 hrs - duration of action: 3 to 5 days - management of hypocalcemia and reduction of parathormone levels - Associated with hypercalcemia in the baby ▪ Parathyroid Hormone (Naptara) - administer daily subcutaneous injection - half-life: 3 hrs - peak levels: 5 to 30 mins - metabolized in the liver and excreted through the kidneys ▪ Teriparatide - given daily subcutaneous injection every day. - rapidly absorbed from the subcutaneous tissues - half-life: 1 hr - peak concentration: 3 hrs - metabolized in the liver and excreted through the kidneys Parathyroid Drugs DRUG SAMPLE ANTIHYPERCALCEMIC DRUGS ▪ Biphosphonates ▪ Alendronate ▪ Etidronate ▪ Ibandronate ▪ Pamidronate ▪ Risedronate ▪ Calcitonin ▪ Calcitonin Parathyroid Drugs NURSING CONSIDERATIONS ▪ Antihypocalcemic Drugs ▪ Monitor serum calcium levels before treatment and periodically during the treatment. ▪ Provide supportive measures to help the patient deal with GI and CNS effects. ▪ Encourage to eat calcium rich food. ▪ Provide health teaching about the name of drug, prescribed dose, therapeutic and adverse effects. ▪ Antihypercalcemic Drugs ▪ Monitor serum calcium level periodically. ▪ Biphosphonates should be given with an empty stomach because it may cause GERD. ▪ Ensure adequate hydration to reduce risk of renal complications. ▪ Reduce injection sites and monitor inflammation with use of calcitonin. ▪ Provide comfort measures. ▪ Provide health teaching about the medicine, prescribed dosage, drug action and adverse effects.  03 ANTI-DIABETIC DRUGS Insulin - helps the glucose to enter the blood. - Effect: To decrease the level of glucose in the blood. Glucose - used by the cell to produce energy. DIABETES MELLITUS - metabolic disease characterized by hyperglycemia, most commonly due to insulin dysfunction. - Classification of DM: TYPE I DM – lack of insulin production TYPE II DM – insulin produced but ineffective or slow release GESTATIONAL DM – happens during pregnancy DM Associated with Other Conditions  Diabetes Mellitus Drug Therapy Focus Replace insulin Increase sensitivity of cells to insulin Increase entry of Decrease absorption glucose into the cells of glucose in the GIT INSULIN ▪ Administer subcutaneously. ▪ Primary treatment of Type 1 DM. ▪ It does not cross the placenta and destroyed by the digestive enzyme – safe to use by pregnant and lactating women. ▪ Drug of Choice – Gestational DM. TYPE EXAMPLE ONSET PEAK DURATION VERY SHORT ▪ ASPART 15 min 30-60 min 2-4 hrs ACTING ▪ LISPRO SHORT ACTING ▪ Regular Insulin 30-60 min 2-4 hrs 4-6 hrs INTERMEDIATE ▪ NPH 2-4 hrs 6-8 hrs 16-20 hrs (Neutral Protamine Hagedorn Insulin) Isophane Insulin INSULIN TYPE EXAMPLE ONSET PEAK DURATION LONG ACTING ▪ Ultralente 6-8 hrs 12-16 hrs 20-30 hrs VERY LONG ▪ Glargine 1 hr No Peak 24 hrs ACTING ▪ Lantus INSULIN NURSING CONSIDERATIONS ▪ Monitor vital signs, tachycardia can occur during insulin reaction. ▪ Rotate injection sits to prevent lipodystrophy. ▪ Monitor blood sugar level daily. ▪ Monitor for glucose control by determining glycosylated hemoglobin test (HBA1c) periodically. ▪ Provide health teaching on symptoms of hypoglycemia – tremors, palpitation, dizziness, pallor, tachycardia, syncope. Oral Hypoglycemic Agents (OHA) CLASSIFICATION EXAMPLE MECHANISM OF ACTION SULFONYLUREAS First Generation Sulfonylureas ▪ Tolbutamide Potentiate insulin action. ▪ Tolazamide ▪ Chlorpropamide Second Generation Sulfonylureas ▪ Glimepiride Potentiate insulin action ▪ Glipizide ▪ Glyburide NON-SULFONYLUREAS (Other Antidiabetic Agents) Alpha-Glucosidase Inhibitors ▪ Acarbose Decreases absorption of ▪ Miglitol glucose in the small intestine. Biguanides ▪ Metformin Decrease hepatic production of glucose and decrease glucose absorption in the small intestine. Oral Hypoglycemic Agents (OHA) CLASSIFICATION EXAMPLE MECHANISM OF ACTION NON-SULFONYLUREAS (Other Antidiabetic Agents) Thiazolidinediones ▪ Pioglitazone Insulin enhancing agents ▪ Rosiglitazone IMPT: Increase risk of heart attack and death Meglitinides ▪ Nateglinide Stimulate beta cells to release insulin. ▪ Repaglinide IMPT: Hepatotoxicity effects DDP-4 Inhibitors ▪ Sitagliptin Increase the level of incretin hormones. ▪ Linagliptin Increase insulin secretion. Decrease glucagon secretion to reduce glucose production. Oral Hypoglycemic Agents (OHA) ▪ Used for patients with Type II DM. ▪ It may cause harmful effects to pregnant and nursing infants. ▪ May combine with Insulin or different OHA types – to control sugar in the blood. ▪ Sulfonylureas ▪ First generation is less potent than second generation. ▪ Both potentiate insulin action. ▪ Hypoglycemia – primary adverse effects. ▪ Non-sulfonylureas ▪ Act more on decreasing level of glucose – decreasing its production or inhibiting its absorption. ▪ Main action is in the GIT. ▪ GI symptoms – most common adverse effects. Oral Hypoglycemic Agents (OHA) NURSING CONSIDERATIONS ▪ Determine vital signs. Oral antidiabetic drugs may increase cardiac function and oxygen consumption which can cause cardiac dysrhythmias. ▪ Administer non-sulfonylureas with food to minimize GI effects. ▪ Sulfonylureas are taken before meals. ▪ Monitor blood glucose level. ▪ Monitor glycosylated hemoglobin test (HBA1c) for glucose control. ▪ Provide health teaching about the drug, the name, the prescribed dose, therapeutic and adverse effect to increase client’s knowledge, lessen anxiety and promote good compliance.  THANKS! DO YOU HAVE ANY QUESTIONS? [email protected] CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon, and infographics & images by Freepik Please keep this slide for attribution