Endocrine Drugs

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Author:
amezm001
ID:
21210
Filename:
Endocrine Drugs
Updated:
2010-05-29 19:10:00
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Endocrine system
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Description:
Drugs of the Endocrine system
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  1. Growth Hormone




    • a.
    • Action: increases cellular size and rate of growth

    • b.
    • Indications for Use: pituitary dwarfism

    • c.
    • Related Drugs: somatrem (Protropin), somatropin (Humatrope, Nutropin), bromcriptine
    • (Parlodel)
  2. Corticotropin – ACTH (Avthar)
    • a.
    • Adrenal gland stimulates secretion of
    • mineralocorticoid cortisol (hydrocortisone), glucocorticoids, and androgens
    • b.
    • Action: controls cortisol release and assists in dealing with stress; causes
    • sodium to be retained and, therefore, water which leads to edema and HTN; also
    • decreases inflammation
    • c.
    • Indications for Use: diagnostic testing of adrenocortical function, treatment of
    • panhypopituitarism.
    • d.
    • Nursing action: monitor VS, electrolytes, blood sugar, CXR, weight, cortisol level;
    • assess for allergy to pork because of cross-sensitivity.
  3. Thyroid-stimulation hormone (TSH)
    • a.
    • Action: Controls functional activity of the
    • thyroid gland and increases production and release of the thyroid hormone.
    • b.
    • Indications for Use: diagnosing hypothyroidism
    • c.
    • Related Drugs: thyrotropin (thytropar), protirelin (Relefact TRH)
  4. Vasopressin:
    Antidiuretic hormone (ADH)
    • a.
    • Action: Vasopressin acts as an antidiuretic
    • by increasing reabsorption of water by renal tubules;
    • concentrates urine and is a potent vasoconstrictor (so… would BP go up or
    • down??)
    • b.
    • Indications for Use: vasopressin treats diabetes insipidus
    • (Diabetes insipidus causes huge amounts of urine output, therefore, when
    • vasopressin is working, urine output decreases.
    • c.
    • Related Drugs: vasopressin (Pitressin), desmopressin acetate (DDAVP) – usually given
    • nasally
    • d. Major
    • Adverse Effects
    • a)
    • Pain at injection site
    • b)
    • Water intoxication and
    • hyponatremia
    • c)
    • Hypertension, anginal pain
    • e.
    • Major
    • Nursing Implications
    • a)
    • Assess/Monitor
    • VS (lying and standing BP
    • since BP goes up)
    • I&O, wt changes-
    • S/S of water intoxication:
    • hyponatremia and decreased urine output
    • b)
    • Give IM deep into muscle
    • c)
    • Avoid IV extravasation (make
    • sure IV is patent in vein)
  5. Oxytocin
    • Action: contract smooth muscle, primarily on the uterus and mammary glands;
    • stimulates ejection of milk
    • b. Indications
    • for Use: induce labor and to control
    • postpartum bleeding; promote milk ejection during lactation
    • c. Prototype: oxytocin (Pitocin)
    • a.
    • Related
    • Drugs: ergonovine maleate
    • (Ergotrate Maleate), ergotamine (Ergostate), methylergonovine (Methergine)
    • b.
    • Common
    • Adverse Effects: N/V, hypertension, ergotism
    • c.
    • Major
    • Nursing Implications
    • a)
    • Assess/Monitor
    • Fetal activity, fetal heart tones, contraction
    • Fluid status, I&O
    • VS and ­BP
    • Ergotism
    • b)
    • Give PO
    • form with food
    • c)
    • Give IV form diluted and via
    • IV pump
    • d) Discontinue
    • infusion if contractions exceed 70-90 seconds, for signs of tetany or abruptio
    • placentae, and fetal distress; turn patient to left side.
  6. Thyroid Agents: no single prototype
    • Action: increases metabolic rate of body tissues
    • (action of thyroid hormones). Stimulates cardiovascular system, increases
    • oxygen consumption, increases body temp., blood volume, growth and overall
    • cellular growth. Euthyroid means normal thyroid function. When a patient has a
    • return to normal thyroid function, the hair will be thick and shiny.
    • b.
    • Indications
    • for Use: replacement of absent
    • or diminished thyroid function
    • c.
    • Related Drugs: desiccated thyroid, thyroglobulin (Proloid), Thyroid, levothyroxine (Synthroid),
    • liothyronine (Cytomel), liotrix (Thyrolar)
    • d.
    • Major Adverse Effects: signs and symptoms of
    • hyperthyroidism: palpitations, tachycardia, angina, nervousness, irritability,
    • insomnia, heat intolerance, wt loss, thyrotoxicosis (or thyroid storm). Elderly
    • patients are more sensitive to thyroid replacement.
    • e. Major
    • Nursing Implications:
    • 1)
    • Assess/Monitor
    • HR, BP, and ECG
    • Wt
    • 2)
    • Give a single morning dose at
    • breakfast to prevent sleep interferences
    • 3)
    • Take apical pulse. Hold if resting
    • HR is more than 100 beats/min
    • 4)
    • Teach S/S of hypo and
    • hyperthyroidism
  7. Antithyroid Agents
    • a.
    • Action: Lower the thyroid level by three
    • mechanism:

    • 1)
    • Block the synthesis of
    • thyroid hormones.

    • 2)
    • Interfere with the hormone
    • production: iodine must be present in the body for thyroid hormone synthesis. A
    • high dose of iodine (iodism) has a suppressant effect and cause a decrease in
    • the production of thyroid hormone (remember the negative feedback??)

    • 3)
    • Destroys the gland:
    • radioactive preparations destroy the thyroid tissue, thereby decreasing the
    • production of thyroid hormone.



    • b.
    • Indications
    • for Use: management of hyperthyroidism (palpitations, tachycardia,
    • angina, heat intolerance, etc). Thyrotoxicosis (thyroid storm)



    • c. Related
    • Drugs:
    • a)
    • propylthiouracil (PTU)
    • b)
    • methimazole (Tapazole)
    • 2)
    • Iodines
    • a)
    • Strong iodine solution
    • (Lugol’s solution)
    • b)
    • Potassium iodine solution
    • (SSKI), Thyro-block)
    • 3)
    • Radioactive iodine (sodium
    • iodide, Iodine 131 Iodotope)
    • a)
    • Requires avoidance of
    • extended contact with children, spouse, and coworkers for 1 week
    • b)
    • Refrain from coughing or
    • expectoration for the first 24 hours to avoid emitting radioisotopes
    • c)
    • Increase fluids up to 3 to 4
    • L/day for the first 48 hours to help with the excretion of the agent
    • d)
    • Void frequently during
    • initial 48 hours. Flush the toilet twice after each voiding.
    • e)
    • No restriction of the
    • bathroom use is necessary for others in the family.
    • d. Major
    • Adverse Effects:
    • Granulocytopenia,
    • Hypersensitivity, Iodism (increased thirst, burning, brassy taste in the
    • mouth). Hypothyroidism (all body functions decrease except wt increases,
    • lethargy, anorexia, constipation).
    • e.
    • Major Nursing Implication:
    • 1) Assess/monitor VS and body wt
    • 2) Dilute liquid iodine preparations in water
    • and encourage use of a straw to prevent staining of the teeth.
    • 3) Instruct
    • a) S/S of hypo and hyperthyroidism
    • b) Follow-up is needed to evaluate for
    • hypothyroidism
  8. Parathyroid Agents
    • Action: Parathyroid hormone increases renal
    • excretion of phosphorus, stimulates tubular calcium reabsorption, and release
    • of calcium and phosphorus from bone into bloodstream. Calcitonin decreases
    • serum calcium by inhibiting osteoclastic bone resorption and by blocking
    • tubular reabsorption of calcium and phosphorus.
    • b. Related
    • Drugs/Indications for Use:
    • 1)
    • Agents
    • for hypoparathyroidism (a deficiency of parathyroid hormone that cause a low Ca
    • level and high phosphate level): Calcium products and Vitamin D products to
    • treat hypocalcemia



    • 2)
    • Agents
    • for hyperparathyroidism (an excess of parathyroid hormone that cause a high Ca
    • level and low phosphate level): Calcitonin treats Paget’s
    • disease and hypercalcemia.
    • c.
    • Major Adverse Effects:

    • 1)
    • Agents
    • for hypoparathyroidism: Azotemia (excess nitrogenous waste in the blood with
    • elevated BUN level). Hypotension. Hypercalcemia
    • 2)
    • Agents
    • for hyperparathyroidism: N/V, flushing of the face, Hypocalcemia
  9. Major Nursing Implications:
    Agents for
    hypoparathyroidism
    Assess/monitor

    BUN and Creatinine

    S/S of hypercalcemia

    I & O

    BP
  10. Major nursing implications
    Agents
    for hyperparathyroidism
    1) Assess/monitor the S/S of Hypocalcemia

    • 1) Instruct the pt that N/V usually occur with
    • initial therapy and lessens as treatment continues
  11. A patient, 48 years old, has
    been diagnosed as having hypothyroidism. The patient is taking liothyronine
    sodium (Cytomel) 50 micrograms daily. Which side effect may occur?
    • 1. Angina
    • 2. Fatigue
    • 3. Rash
    • 4. Gastritis
  12. The patient is taking
    levothyroxine 75 micrograms po qd. The nurse recognizes the drug is becoming
    effective if which result is found?
    Increased urine output
  13. Insulin analog: insulin
    lispro (Humalog)
    • Rapid onset of action within 15
    • minutes

    • Peak
    • within 30-90 minutes

    • Duration
    • is 6-8 hours

    • Must
    • be given 15 minutes before the meal
  14. Short Acting Insulins: Regular
    insulin, Humulin-R, Novolin R, Semilente
    • Onset
    • in 1/2 to 1 hour
    • Peak
    • in 2 to 4 hours
    • Duration
    • is 8 to 12 hours
  15. Intermediate Acting Insulins:
    NPH, Humulin-N, Lente, Novolin L, Humulin-L
    • Onset in 1 to 3 hours
    • Peak
    • in 4 to 12 hours
    • Duration is 24 hours.
  16. Long Acting Insulins: Protamine
    zinc Insulin (PZI) & Ultra Lente.
    • Onset in 4 to 8 hours
    • Peak
    • in 10 to 30 hours
    • Duration
    • is 36 hours or longer.
    • Rarely given
  17. Glargine (Lantus).
    • Do not mix with other
    • insulins or solutions. This insulin is also clear; however, it is not to be
    • given IV (Remember, only Regular insulin, which is clear, is given IV)

    Onset in 1 hour

    Peak is continuous

    Duration is 24 hours.

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