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23 Cards in this Set
- Front
- Back
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Somatropin (Humatrope)
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Mechanism of Action:
oPromotes growth (IT IS SYNTHETIC GH) •Used For: oDwarfism; Pediatric: short stature syndrome, Adult: reduced muscle mass (AIDS) •Adverse effects/Interactions: o**Hyperglycemia**, carpal tunnel syndrome, fatality in pts with Prader-Willi syndrome, interacts with glucocorticoids •Nursing Considerations: oMonitor calcium levels and thyroid hormone levels; monitor for stones; Given IM or SQ |
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Octreotide (Sandostatin)
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Mechanism of Action: As a somatostatin, it turns off GH
•Used for: Acromegaly, carcinoid tumors •Nursing Considerations oMonitor hormone levels |
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Drug class: vasopressons
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Act on posterior pituitary to increase reabsorption of water in kidneys, also stimulates contraction of vascular smooth muscle and smooth muscle of GI tract; can cause severe adverse cardiovascular effects: severe vasoconstriction (increased blood flow to heart and brain in person receiving CPR)
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Desmopressin (DDAVP)
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Mechanism of Action: Promotes reabsorption of water by action on the renal tubular epithelium; causes vasoconstriction
•Used for: Diabetes insipidus, bleeding esophageal varices, cardiac arrest, postoperative abdominal distention •Nursing Considerations: Monitor pulse, b/p, intake and output; daily weight, check for edema; |
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Levothyroxine (Synthyroid)
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Mechanism of Action: Increases metabolic rate, increases cardiac output, renal blood flow, oxygen consumption, body temperature, blood volume, growth,
•Used for: Hypothyroidism, myxedema coma •Adverse effects/Interactions: *THYROID STORM* •Nursing Considerations: Onset 3-5 days; increased effect of anticoagulants; monitor: blood pressure, pulse, weight, height, growth, thyroid hormone levels; pt/inr, Give on empty stomach 30-60 minutes before breakfast; don’t switch brands |
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Methimazole (tapazole)
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Mechanism of Action: Inhibits synthesis of thyroid hormones by decreasing iodine use
•Used for: Hyperthyroidism, in preparation for thyroidectomy, thyroid storm •Adverse effects/Interactions: Enlarged thyroid, agranulocytosis, leukopenia, thrombocytopenia •Nursing Considerations: Onset 1 wk- 3 wks; monitor pulse, blood pressure, temp, i/o, weight, T3 T4 levels; **CBC**; Do not discontinue abruptly; don't stay on for long |
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Radioactive iodine
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Mechanism of Action: radioactive isotope of stable iodine; used to destroy thyroid tissue in patients with hyperthyroidism; objective is to produce clinical remission without completely destroying the gland
•Used for: Hyperthyroidism (Grave’s Disease); thyroid cancer Considerations: Low cost, no tissue other than thyroid is injured;May take 2-3 months before full effects develop |
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Nonradioactive iodine
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Mechanism of Action: Used to suppress thyroid function in preparation for thyroidectomy
Used for: Goiter Adverse effects: brassy taste and soreness in mouth and throat |
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Beta Adreneric Blockers
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Used for: Thyroid storm
Mechanism of action: Can suppress tachycardia •Decrease myocardial oxygen demand by reducing HR, BP, and contractility •Benefits derive from beta-adrenergic blockade, NOT from reducing levels of T3 or T4 Nursing considerations: Watch for hypotension, orthostatic hypotension; **Can cause hypoglycemic unawareness so Caution with diabetic patients; Some can be given IV |
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Hydrocortisone (Solu-Cortef)
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Class: Glucocorticoids
•Can be given PO, IM, IV, enema •Therapy should be reserved for diseases in which there is a risk of death or permanent loss of function, and conditions in which short-term therapy is likely to produce remission or recovery •Must weigh the benefits against the risk |
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Goals of steroid therapy
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anti-inflammatory action, Immunosuppression, Maintenance of normal BP, Carbohydrate and protein metabolism
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Fludrocortisone (florinef)
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Class: MIneralcortocoids
•Mechanism of Action: promotes increased reabsorption of sodium and loss of potassium and hydrogen •Used for: adrenal hormone deficiency, Addison’s disease, congenital adrenal hyperplasia •Adverse effects/Interactions: oSodium and water retention: edema, cardiomegaly, htn, heart failure oHypokalemia: nausea, vomiting, prolonged QT, muscle cramps, fatigue •Nursing considerations: oMonitor i/o, weight, blood pressure, oMonitor electrolytes : Potassium (know signs of low K: lethargy, fatigue, weakness, confusion. oEat foods high in potassium |
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General therapeutic considerations for adrenal hormone insufficiency
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oReplacement therapy with glucocorticoids
•Should mimic normal patterns of corticosteroid secretion •2/3 in the morning; ½ in the afternoon •Increase dosage in times of stress oRequire replacement therapy with corticosteroids oGlucocorticoid is always required oSome patients require a mineralocorticoid as well |
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Insulin
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MOA: Stimulates cellular transport (uptake) of glucose and K
Three major groups of insulin •Short duration: can be given prior to meals to control postprandial glucose levels oRapid acting: insulin lispro, insulin aspart, insulin glulisine (effects begin 5-15 minutes, duration is 3-5 hours) oSlower acting: regular insulin (effects begin 15-30 minutes and duration is 3-6 hours) Regular insulin can be given IV •Intermediate duration: not given according to meals injected twice daily to provide glycemic control between meals and during the night (cloudy suspension) oNPH (Neutral Protamine Hagedorn): •Long duration: achieves blood levels that are steady over 24 hours, less risk of hypoglycemia or hyperglycemia, Cannot be mixed with any other insulin oInsulin detemir oInsulin glargine (Lantus) |
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Dawn and Somagyi effects
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•Somogyi effect - insulin before dinner, BS drops at 2am, hypoglycemia causes sympathetic NS activation, causing BS increase!! Need bedtime snack or less insulin before dinner
•Dawn phenomenon - normal cortisol release in the morning causes high BS! Need more morning insulin |
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Metformin (Glucophage)
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•Drug of choice for initial therapy in most type 2 diabetics (also used in prediabetes) Lowers A1C
•Mechanism of Action: lowers blood glucose ;improves glucose tolerance: decreased glucose production in the liver; it reduces glucose absorption in the gut; sensitizes insulin receptors increasing glucose uptake •Used for : type II diabetes •Little risk of hypoglycemia if used alone •Adverse effects: decreased appetite, nausea, and diarrhea; decreases absorption of vitamin B12 and folic acid ; lactic acidosis (alcoholics) ; Must stop this medication 1 day prior to IV contrast and at least 48 hrs after (kidney injury); Watch creatinine levels |
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Glipizide (Glucotrol)
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•Mechanism of action: stimulates release of insulin from beta cells; decreases glycogenosis and gluconeogenesis; enhances cellular sensitivity to insulin; lowers A1c
•Used for: type II diabetes •Adverse effects/interactions: weight gain, hypoglycemia •Nursing considerations: take on an empty stomach |
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Repaglinide (Prandin)
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Class: Megalitinides
•Mechanism of Action: stimulates a rapid and short-lives release of insulin from the pancreas; Lowers A1c •Used for: type II diabetes •Adverse effects/interactions: weight gain, hypoglycemia •Nursing considerations: take before meals |
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Acarbose (Precose)
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Class: Alpha Glucosidase Inhibitors
•Mechanism of Action: delays absorption of glucose from GI tract; Lowers A1c 0.5-1.0% •Used for: type II diabetes •Adverse effects: GI probs |
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Pioglitazone (Actos)
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Class: Thiazoldinediones
•Mechanism of action: increases glucose uptake in muscle; decreases endogenous glucose production; Lowers A1c •Used for : type II diabetes •Adverse effects: weight gain, edema; increased risk for cardiovascular events •Nursing considerations: Black box warning: may cause or worsen CHF, monitor for edema and weight gain. Increased peripheral fracture risk; actos may increase risk of bladder cancer |
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Sitagliptin (Januvia)
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Class: Dipeptidyl Peptidase-4 (DPP-4) Inhibitor
•Mechanism of Action: stimulates release of insulin from pancreatic beta cells, and decreases hepatic glucose production; lowers A1c •Used for: type II diabetes •Nursing considerations: If creatinine elevated give lower dose; no weight gain or hypoglycemia; report signs of pancreatitis |
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Exenatide (Byetta)
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Class: Incretin mimetics
•Mechanism of action: stimulates release of insulin; increases satiety; decreases gastric emptying given, lowers A1C •Used for: type II diabetes •Nursing considerations: Given within 60 minutes before breakfast and dinner; report signs of pancreatitis; Black box warning thyroid c-cell tumor |
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Pramlintide (Symlin)
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Class: Amylin analogs
•Mechanism of Action: decreases gastric emptying; increases satiety; lowers A1c •Used for: type II diabetes Black box: severe hypoglycemic risk 3 hrs post injections |
