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M6 13-005

Exam 13: Drugs Affecting Endocrine System

Diabetes Mellitus: What it is... A systemic metabolic disorder that involves improper metabolism of carbohydrates, fats, and proteins
Diabetes Mellitus: How it happens... Decrease or absolute lack of insulin production by the beta cells of the islets of Langerhans or by the decreased activity of the insulin that is secreted
Alpha Cells Produce glucagon
Beta cells Produce insulin
Delta cells Produce somatostatin
Insulin use Type I DM management. Type 2 DM when diet and/or oral medications fail to adequately control blood sugar.
Insulin Action Promotes the conversion of glucose to glycogen. Promotes the conversion of amino acids to proteins in muscle. Stimulates triglyceride formation. Inhibits the release of free fatty acids.
Insulin Category antidiabetics, hormones.
The nurse is administering lispro insulin, and should keep in mind that this insulin is: A rapid-acting insulin
Oral Hypoglycemics Use Primarily used for Type 2 DM. Diet therapy alone fails to control blood glucose or symptoms. Patients are not amenable to using insulin. Some oral hypoglycemic may be used with insulin.
Oral Hypoglycemics Action Lower blood glucose by stimulating beta cells of the pancreas. Intact pancreatic function is required.
Alpha-Glucosidase Inhibitors: What it do? delays digestion of ingested carbohydrates. It may be combined with sulfonylureas
Thiazolidinesdiones: What it do? increase insulin sensitivity
Insulins to look at... Novolog, humalog, Regular insulin, NPH, Lantus.
Alpha-Glucosidase Inhibitors: names Acarbase (Precose). Miglitol (Glyset).
Biguanides: names Melformin (Glucophage)
Meglitinides: names Repaglinide(Prandin). Nateglinide (Starlix).
Sulfonylureas (1st Generation: rarely used): names Chloropromide (Diabinese). Tolazamide (Tolinase). Tolbutamide (Orinase).
Sulfonylureas (2nd Generation): names glipizide (Glucotrol). glyburide (DiaBeta, Micronase, Glynase). glimepiride (Amaryl).
Thiazolidinediones: names rosiglitazone (Avandia). pioglitazone (Actos).
Oral Hypoglycemics Contraindications Hypersensitivity. Hypoglycemia. TYPE 1 DM!!! Avoid use in patients with severe kidney, liver, thyroid and other endocrine dysfunction. Avoid use in pregnancy or lactation.
A 48-year-old is diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The purpose of the metformin, in this situation, is to: Decrease insulin resistance.
Slide Scale Insulin may be required for patient exposed to: Stress. Fever. Trauma. Infection. Surgery.
Mixing Insulin... Draw air into syringe. Inject air into "N". Draw air into syringe. Inject air into "R". Invert "R" and draw out amount needed. Invert "N" and draw out amount needed.
Alpha-glucosidase inhibitors are given three times a day with the first bite of the meal because food increases absorption.
Meglitinides are administered 30 minuted before meals.
glipizide (Glucotrol) is given 30 minutes before a meal
glyburide (Micronase) is administered with breakfast or with the first main meal of the day.
Thiazolidinediones are given with or without regard to meals.
When teaching about hypoglycemia, the nurse should make sure that the patient is aware of the early signs of hypoglycemia, which are: Irritability and confusion.
The nurse is teaching a group of patients about self-administration of insulin. What teaching is important to include? When mixing insulins, the clear (such as Regular) insulin should be drawn up into the syringe first.
Thyroid gland Butterfly shaped, with one lobe lying on either side of the trachea. Lies just below the larynx. Lobes are connects by the isthmus. Controls metabolism.
Thyroid gland Secretes Thyroxine (T4). Triiodothyronine (T3). Iodine is essential to the manufacturing of both hormones.
Thyroid gland Function controlled by the release of thyroid-stimulating hormone (TSH) from the pituitary gland.
Calcitonin (hormone) released by the thyroid gland.
Two diseases are related to the hormone-producing activity of the thyroid gland hypothyroidism & hyperthyroidism.
Hypothyroidism a decrease in the amount of thyroid hormones manufactured and secreted
Hyperthyroidism an increase in the amount of thyroid hormones manufactured and secreted
Thyroid Agents: use Replacement/substitution in diminished or absent thyroid function. Thyroid cancer (some forms).
Thyroid Agents Action Promote gluconeogenesis. Increase utilization and mobilization of glycogen stores. Stimulate protein synthesis. Promote cell growth and differentiation. Aid in the development of the brain and CNS.
Thyroid Agents Examples. levothyroxine (Levo-T, Levothroid, Levoxyl, Novothyrox, Synthroid, T4, Unithroid). liothyronine (Cytomel, l-triiodothyronine, T3, Triostat). liotrix (T3/T4, Thyrolar). thyroid (Armour thyroid, Thyrar, Thyroid Strong, Westhroid).
Thyroid Agents Side Effects Central Nervous System Cardiovascular Gastrointestinal Dermatological Endocrine Metabolic
Levothyroxine (Synthroid) may be safely interchanged with other brands without any concern to the patient. False, It is recommended that patients not switch brands to avoid a variance in therapeutic effects and adverse effects.
Thyroid replacement therapy and establishing treatment goals with a Pt, you explains how to look for adverse effects ahead of time will help her to respond to them before they become serious problems. Some of the adverse effects to discuss with her are: Some of the more serious adverse effects of the thyroid drugs include tachycardia, dysrhythmias, weight loss, and fever.
Antithyroid Agents: Use Palliative treatment of hyperthyroidism. Adjunct to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
Antithyroid Agents: Action Inhibits the synthesis of thyroid hormones. Therapeutic Effects: decreased signs and symptoms of hyperthyroidism.
Antithyroid Agents: Examples Methimazole (Tapazole). Propylthiouracil (PTU).
Antithyroid Agents: Side Effects CNS: drowsiness, headache, vertigo. GI: diarrhea, drug-induced hepatitis, loss of taste, nausea, parotitis, vomiting. Derm: rash, skin discoloration, urticaria. Hemat: agranulocytosis, anemia, leukopenia, thrombocytopenia.
Propylthioruracil (PTU) is used for: hyperthyroidism.
Iodine Containing Agents Use Adjunct with other antithyroid drugs in preparation for thyroidectomy. Treatment of thyrotoxic crisis. Radiation protectant following radiation emergencies or administration of radioactive iodine. Iodine replacement.
Iodine Agents Action Rapidly inhibits the release and synthesis of thyroid hormones. Decreases the vascularity of the thyroid gland. Decreases thyroidal uptake of radioactive iodine following radiation emergencies or administration of radioactive isotopes of iodine.
Iodine Agents; examples potassium iodide (Pima, SSKI, Thyro-Block, Thyrosafe). sodium iodide (Iodopen). strong iodine solution (Lugol's solution).
Iodine Agents: Precautions TB. Bronchitis. Hyperkalemia. Impaired renal function. Pregnancy. Lactation.
Radioactive iodine isotopes will Destroy hyperactive thyroid tissue.
Antithyroid Agents may cause Agranulocytosis (decreased WBC count, immune system decreased). May cause increased AST, ALT, LDH, alkaline phosphatase, serum bilirubin and prothrombin time.
Which nursing diagnosis may appear on a hyperthyroid patient’s care plan? Disturbed sleep pattern.
The primary treatment for hypothyroidism is: Levothyroxine.
Hormones Treatment of severe diarrhea and flushing episodes in patients with GI endocrine tumors, including metastatic carcinoid tumors and vasoactive intestinal peptide tumors (VIPomas).
Hormones Actions Suppresses secretion of serotonin and gastroenterohepatic peptides. Increases absorption of fluid and electrolytes from the GI tract and increases transit time. Decreases levels of serotonin metabolites.
Hormones Therapeutic Effects control of severe flushing and diarrhea associated with GI endocrine tumors.
Hormone Precautions Gallbladder disease (increased risk of stone formation). Renal impairment (dosage reduction may be necessary). Hyperglycemia or hypoglycemia (changes in blood glucose may occur). Fat malabsorption (may be aggravated).
Hormone Side Effects CNS: dizziness, drowsiness, fatigue, headache, weakness. EENT: visual disturbances. CV: edema, orthostatic hypotension, palpitations. GI: abdominal pain, cholelithiasis, diarrhea, fat malabsorption, nausea, vomiting.
Electrolyte Replacement Actions Essential for nervous, muscular, and skeletal systems. Maintain cell membrane and capillary permeability. Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Electrolyte Replacement Examples calcium chloride (27% Ca or 13.6 mEq/g). calcium citrate (21% Ca or 12 mEq/g): Cal-Citrate 250, Citrical, Citrical Liquitab. calcium gluconate (9% Ca or 4.5 mEq/g): Kalcinate. calcium lactate (13% Ca or 6.5 mEq/g): Cal-Lac.
Electrolyte Replacement Contraindications Hypercalcemia. Renal calculi. Ventricular fibrillation.
Electrolyte Replacement Side Effects CNS: syncope (IV only), tingling. CV: cardiac arrest (IV only), arrhythmias, bradycardia. GI: constipation, nausea, vomiting. GU: calculi, hypercalciuria. Local: phlebitis (IV only).
The health care provider orders calcium chloride in 5% dextrose and 0.45% sodium chloride (D5 1/2 NS). What effect may saline solution have on calcium chloride? Calcium for IV use should be mixed with D5W, not a saline solution. Sodium encourages calcium loss.
Which vitamin promotes calcium absorption from the GI tract? Vitamin D
Pheochromocytoma Agents IV: control of blood pressure during surgical removal of a pheochromocytoma. IV Infiltration: prevention and treatment of dermal necrosis and sloughing following extravasation of norepinephrine, phenylephrine, or dopamine.
Pheochromocytoma Agents Actions Produces incomplete and short-lived blockade of alpha-adrenergic receptors located primarily in smooth muscle and exocrine glands. Induces hypotension by direct relaxation of vascular smooth muscle and by alpha blockade.
Pheochromocytoma Agents Therapeutic Effects Reduction of blood pressure in situations in which hypertension is due to adrenergic (sympathetic) excess. When infiltrated locally, reverses vasoconstriction caused by norepinephrine or dopamine. phentolamine (Regitine).
Pheochromocytoma Agents Side Effects CNS: cerebrovascular spasm, dizziness, weakness. EENT: nasal stuffiness. CV: hypotension, MI, angina, arrhythmias, tachycardia. GI: abdominal pain, diarrhea, nausea, vomiting, aggravation of peptic ulcer. Derm: flushing.
Pheochromocytoma Agents Nursing Implications Monitor blood pressure, pulse, and ECG every 2 min until stable during IV administration. If hypotensive crisis occurs, epinephrine is contraindicated and may cause paradoxic further decrease in blood pressure; norepinephrine may be used.
Created by: jtzuetrong