The Endocrine System (Pharm Made Easy 3.0)

Front 1

Drugs for diabetes Mellitus

Back 1

•Oral hypoglycemics

•Injectable hypoglycemic

•Hyperglycemics

Front 2

Oral hypoglycemics

Back 2

•Sulfonylureas

•Meglitinides

•Biguanides

•Thiazolidinediones

•Alpha-glycosidase inhibitors

•Gliptins

Front 3

Sulfonylureas

Back 3

•Treat: type 2 diabetes

•Examples:

-Glipizide

-Tolbutamide

•Stimulate release of insulin (functioning pancreas is required)

•Side effects

-Mild HYPOglycemia (monitor for diaphoresis, tachycardia, fatigue, excessive hunger, tremors)

-Nausea

-Diarrhea

•If HYPOglycemia occurs give 15 to 20 grams of carbohydrate (orange juice, milk or crackers)

•If HYPOglycemic patients becomes UNCONSCIOUS Give I.V glucose (50 grams of glucose)

•If I.V is NOT available give 1 gram of glucagon I.M (check blood sugar every 15 to 20 minutes)

•Give 30 minutes before meals ☆

•Do NOT give to pregnant or lactating moms

•Do NOT give to patients experiencing diabetic keto-acidosis

Front 4

Meglitinides

Back 4

•Treat: type 2 diabetes mellitus

•Examples:

-Repaglinide

-Nateglinide

•Stimulate the release of insulin (functioning pancreas is required)

•Side effects

-HYPOglycemia

-Nausea

-Diarrhea

•If HYPOglycemia occurs give 15 to 20 grams of carbohydrate (orange juice, milk or crackers)

•If HYPOglycemic patients becomes UNCONSCIOUS Give I.V glucose (50 grams of glucose)

•if I.V is NOT available give 1 gram of glucagon I.M (check blood sugar every 15 to 20 minutes)

•Give 30 minutes before meals

•Do NOT give to patients experiencing diabetic keto-acidosis

Front 5

Biguanides

Back 5

•Treats: type 2 diabetes mellitus (commonly used for newly diagnosed diabetics)

•Example

-Metformin

•Lowers blood glucose in 3 ways:

DECREASES absorption of glucose from the intestines

DECREASES synthesis of glucose by the liver

INCREASES sensitivity of insulin receptors in tissues

•Side effects

-Nausea, diarrhea, anorexia

-Vitamin deficiencies (vitamin B 12, folic acid; report weakness, fatigue, pallor or redden tongue which indicate vitamin deficiency)

-Lactic acidosis (rare, but potentially fatal) ☆

•Monitor lactic acidosis by monitoring for weakness, fatigue, lethargy and HYPERventilation

•If lactic acidosis occurs, stop drug

•Lactic acidosis requires hemodialysis

•Avoid alcohol consumption (due to lactic acidosis side effect)

•Do NOT give to patients with these conditions:

-Diabetic keto-acidosis

-Cardiopulmonary, hepatic or renal insufficiency

-Alcoholism

-Heart failure

-Severe infection

-Shock

-Acute myocardial infarction

Front 6

Thiazolidinediones

Back 6

•Treat: type 2 diabetes

•Example:

-Pioglitazone

•Reduces insulin resistance of tissues (insulin must be available and concurrent use of sulfonylurea, metformin, or insulin may be needed)

•Side effects

-Fluid retention

-Hepatotoxicity (monitor liver function test (AST & ALT; assess every 3 to 6 months thereafter; monitor for jaundice, dark urine, abdominal pain, vomiting or fatigue these indicate liver failure)

-Increased serum lipid levels (monitor increase in triglycerides and entire lipid panel)

•Monitor for edema, weight gain, chest pain, dyspnea or indications of heart failure

•Do NOT give to patients with cardiovascular disease (including HYPERtension)

•Do NOT give to patients with heart failure

•Do NOT give to patients with hepatic disease

Front 7

Alpha-glucosidase inhibitors

Back 7

•Treat: type 2 diabetes

•Examples:

-Acarbose

-Miglitol

•Alpha glucosidase is an enzyme that breaks down carbohydrates in the intestines; alpha glucosidase inhibitors BLOCK this enzyme, which SLOWS the absorption of carbohydrates after a meal and REDUCES sudden rise in postprandial (after a meal) blood glucose

•Side effects

-G.I effects (distention, flatus, hyperactive bowel sounds, diarrhea)

-HYPOglycemia (treat with 4 grams of dextrose; retest in 15 minutes after administration of dextrose)

-Liver dysfunction (monitor liver function test (ALT & AST) ☆

-Anemia (iron deficiency secondary to acarbose therapy; monitor CBC, watch for signs of anemia: pallor, fatigue, shortness of breath) recommend iron rich foods)

•Do NOT give to patients with G.I disorders, obstruction or ulceration

Front 8

Gliptins

Back 8

•Treat: type 2 diabetes

•Example:

-Sitagliptin

•Augment naturally occurring incretin hormones by INHIBITING the enzyme that inactivates them (PROMOTE insulin release and DECREASE the secretion of glucagon): Lower post meal glucose levels

•Side effects

-Upper respiratory infections and inflamed nasal passages (monitor temperature and report signs of infections) ☆

-Headache

-Pancreatitis (monitor for G.I effects that signal pancreatitis-vomiting, diarrhea, nausea, abdominal pain) ☆

•Be prepared to monitor blood amylase level to confirm pancreatitis

•Do NOT give to patients with type 1 diabetes

•Do NOT give to patients with lactic acidosis

Front 9

Insulin

Back 9

•Treats: type 1 & 2 diabetes and gestational diabetes

•Rapid:

-Lispro

-Novolog (insulin aspart)

-Humalog

•Short or regular:

-Humulin R

•NPH:

-Humulin N

•Long acting:

Glargine

•Recombinant DNA insulin (acts like human insulin)

•Side effects:

-HYPOglycemia (signs and symptoms: tachycardia, diaphoresis, tremors, weakness and headache; give 15 to 20 grams of glucose such as orange juice, milk, 1 tablespoon of honey

-HYPOkalemia (inverse relationship between insulin and potassium) ☆ (monitor potassium levels and signs and symptoms)

-Lipohypertrophy (to prevent this rotate sites of injection)

•Insulin is given subcutaneously (draw short acting (commonly lispro) FIRST and THEN long acting (commonly NPH)

•Expect dosage adjustments in response to caloric intake, infection, exercise, stress (commonly with surgery), growth spurts and pregnancy (with gestational diabetes)

•Do NOT give to patients allergic to insulin

•Do NOT give to patients that are HYPOglycemic

Front 10

Hyperglycemic

Back 10

•I.V 50% glucose

•Parenteral (I.V, S.C and I.M glucagon)

Front 11

Hyperglycemics

Back 11

•Treat: HYPOglycemia from insulin overdose

•Examples:

-Glucagon

-Glucose

•Converts liver glycogen to glucose (takes 20 minutes)

•Side effects:

-G.I effects (nausea, vomiting)

•Turn unconscious patients on their side to prevent aspiration (this med causes vomiting)

•Provide food after patient regains consciousness

•Be aware that for severe HYPOglycemia, the treatment of choice is I.V 50% glucose because it works faster than glucagon I.M, I.V, S.C

•Do NOT give to patients with HYPOglycemia from starvation

•Do NOT give to patients with pheochromocytoma

Front 12

Drugs that treat thyroid disorders

Back 12

•Thyroid replacements

•Antithyroid drugs

Front 13

Thyroid replacement therapy

Back 13

•Treats: HYPOthyroidism

•Examples:

-Levothyroxine

-Liothyronine

-Liotrix

-Thyroid

•Synthetic form of thyroxine (T4), which is then converted to the active form triiodothyronine (T3) in the body

•Side effect:

-HYPERthyrodism (excessive dose)

•Monitor for HYPERthryodism (anxiety, tachycardia, palpitations, tremors, abdominal cramping, diarrhea, altered appetite, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities)

•Give on an empty stomach

•Monitor vital signs, baseline, weight and height periodically

•Expect lifelong replacement therapy

•Monitor cardiac excitability (angina, chest pain, palpitations, dysrhythmias)

•Do NOT give to patients with thyrotoxicosis

•Do NOT give to a patient with recent myocardial infarction

Front 14

Antithyroid drugs

Back 14

•Treats: HYPERthyrodism (Graves’ disease), suppression of thyroid hormone production for thyroidectomy and thyrotoxic crisis

•Examples:

-Propylthiouracil (PTU)

-Methimazole (Tapazole)

•BLOCK synthesis of thyroid hormone, which blocks iodine from being integrated into tyrosine and blocks conversion of thyroxine (T4) into triiodothyronine (T3)

•Side effects

-HYPOthyroidism (monitor for signs and symptoms: drowsiness, depression, weight gain, edema, bradycardia, cold intolerance, dry skin, menorrhagia or heavy bleeding)

-Agranulocytosis (monitor CBC, if agranulocytosis occurs stop the drug; report sore throat & fever)

-Rash

-Arthralgia, myalgia & headache

•Monitor T3 & T4 levels, vital signs, weight (periodically)

•Expect 3 to 12 weeks for therapeutic effects

•Do NOT discontinue abruptly

•Do NOT give to pregnant women (category D)

Front 15

Antithyroid drugs (radioactive iodine)

Back 15

•Treat: HYPERthyroidism (Graves’ disease) & thyroid cancer

•Examples:

-Iodine 131

-Sodium iodide

-Potassium iodide

•Radioactive iodine is absorbed by the thyroid gland and it gradually destroys thyroid tissue and decreases function of thyroid gland

•Side effects

-HYPOthyroidism (monitor for signs and symptoms: drowsiness, depression, weight gain, edema, bradycardia, cold intolerance, dry skin, menorrhagia or heavy bleeding)

-Bone marrow suppression (rare) (monitor CBC; monitor for anemia, leukopenia, thrombocytopenia (report fever or sore throat)

-Radiation sickness (rare) (monitor hematemesis or bloody vomit, epistaxis or nosebleed,intense nausea & vomiting

•Take radiation precautions with large dosages (limit contact, increase fluid and dispose of patient body waste appropriately per protocol)

•Expect effects you take days or weeks; full effects starts in 2 to 3 months

•Do NOT give to pregnant women

•Do NOT give to lactating moms

Front 16

Drugs Therapy for hypothalamic disorders

Back 16

•Growth hormone

•Antidiuretic hormone

Front 17

Growth hormone

Back 17

•Treat: growth hormone deficiencies (Turner's syndrome in children), growth deficiencies in adults and AIDs wasting syndrome

•Examples:

-Somatropin

•Stimulates release of insulin-like growth factor-1 (IGF-1) from liver/other tissues

•Somastatin (inhibits the release of growth hormone from the pituitary)

•Side effects

-HYPERglycemia

-Myalgia (give analgesia if prescribed)

-HYPERcalciuria (monitor urine calcium levels and renal stones; report flank pain, urinary frequency or blood in the urine

•Dosage is based on weight

•Obtain weight, thyroid function, growth hormone levels and monitor monthly and yearly x-ray of long bones

•Do NOT give to patients with severe obesity

•Do NOT give to patients with respiratory impairment

•Do NOT give to children with closed epiphyses plates

•Do NOT give to patients with a critical illness

Front 18

Antidiuretic hormone

Back 18

•Treats: diabetes insipidus

•Examples:

-Desmopressin

-Vasopressin

•INCREASES reabsorption of water and DECREASES urine volume

•Side effects

-Fluid retention (monitor for water intoxication: sleepiness, headache, confusion, weight gain and edema)

-Vasoconstriction (only with vasopressin, not desmopressin

•Monitor I & O

•Monitor sodium levels

•Restrict fluids when appropriate

•Recommend diuretic therapy to treat fluid retention

•Monitor for myocardial infarction, angina, cardiac insufficiency (report chest pain or pressure in the chest)

•Do NOT give vasopressin for these conditions:

-Coronary artery disease

-Poor peripheral circulation

-Chronic nephritis

•Do NOT give desmopressin with these conditions:

-Renal failure

-Nephrogenic diabetes insipidus

-Electrolytes imbalances (P.O route)