pharm 3 Endocrine
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. What would you like to do?
What 2 hormone drugs are contraindicated with Br F?
methimazole & propylthiouracil
What hormone med should pt be taught not to change brands in?
What time of day should pt take somatropin?
in the evening: causes drowsiness
What is somatropin?
synthetic growth hormone
3 uses for somatropin?
- 1. pituitary dwarfism
- 2. growth failure in CH
- 3. Tx wasting ass. with AIDS
Goal of Tx with somatropin for pituitary dwarfism?
produce height of at least 5 ft
Route of admin for somatropin?
any type of injection: SQ, IM, IV
Most common AE of somatropin?
3 serious AE of somatropin?
- 1. insulin resistance
- 2. hyperglycemia
- 3. hypothyroidism
Why does somatropin cause hyperglycemia?
causes energy production to go from carb to fat
Why does insulin resistance occur in somatropin pt?
BG is raised by the hormone and receptors become desensitized
Cautious use with somatropin and what chronic illness?
diabetes - increases insulin resistance and hyperglycemia
Complication that can occur with somatropin use?
slipped capital epiphysis
S/S of slipped capital epiphysis?
- 1. limp
- 2. hip or knee pain (referred)
How often should somatotropin pt be seen?
What will be monitored?
q 3 to 6 mo
- 1. height and weight
- 2. closure of the epiphyseal plate
- 3. thyroid function
- 4. s/s of slipped capital epiphysis
- 5. BG
How is the effectiveness of somatotropin assessed?
if epiphyseal plate has closed
At what time of the day is somatotropin to be given?
give in the evening - mimics natural hormone surge that occurs during sleep and can cause drowsiness
How is it prevented?
disturbance of fat met. - will be flat depression in skin or spongy area
rotate injection sites
Consideration about somatotropin injection?
it is very painful
When will somatotropin therapy be stopped?
when the epiphyseal plates have closed
not effective after that
What should parents of a somatotropin pt report to MD?
limp, hip or knee pain
Education for pt/parents about Creutzfeld-Jakob disease (encephalopathy) caused by human pituitary hormone in the past?
somatotropin is a synthetic hormone & cannot transmit this disease
old drugs were taken from human cadavers
What assessment should be made prior to giving levothyroxine?
>100 don't give
DesmoPressin = ?
Desmopressin drug type?
posterior pituitary hormone regulator
What is desmopressin?
What is the function of ADH?
controls conc of body fluids in body by reabsorption of Na and water in the kidneys
retain water and decreased UO
3 uses for desmopressin?
- 1. DI
- 2. prevent nocturnal enuresis
- 3. comtrol of bleeding in hemophilia A & von Willebrand's disease
What is DI?
absence or low ADH that causes excessive voiding that leads to dehydration
How does desmopressin Tx bleeding?
also increases circulation of clot factor VII
Routes for desmopressin?
Which is most often used?
intranasal, oral, and parenteral - SQ &/or IV
Way to remember what von Willebrand's is?
sounds German - Germans make ppl bleed
Frequency and relief of AE with desmopressin?
usually mild & infrequent & resolved with dosage reduction
4 AE of desmopressin?
- 1. arrhythmias
- 2. decreased CO
- 3. angina
- 4. nasal irritation/congestion with intranasal
Why does desmopressin cause arrhythmias?
retention of Na & water = excretion of K
Why does desmopressin cause decreased CO?
fluid volume excess caused by Na and water retention
Why does desmopressin cause angina?
vasoconstriction of cardiac BV
What minor illness may decrease the effectiveness of intranasal desmopressin?
What does pt need to do?
rhinitis or upper resp infection
blow their nose before admin
Storage of desmopressin?
store nasal and parenteral in the fridge
Why does pt need to count how many sprays are used from intranasal desmopressin?
if used beyond labeled # of sprays will not be effective
Desmopressin pt should be monitored for S/S of _______.
complication of DI
Important assessments/monitoring for desmopressin?
- 1. HR and rhythm
- 2. weight & edema/breath sounds
- 3. S/S of bleeding
Why should desmopressin pt be monitored for bleeding?
if used for hemophilia
2 eval criteria for desmopressin?
- 1. hydration status
- 2. edema
If edema occurs with desmopressin what does it mean?
What needs to be done?
means pt is getting too much effect
What time of day should levothyroxine be givin?
give in the am
thyroid hormones stimulate
2 uses for levothyroxine?
- 1. hypothyroidism
- 2. myxedema coma
What is levothyroxine?
replacement for natural thyroid hormones
What is myxedema coma?
complication of hypothyroidism
- 1. hypopyrexia
- 2. hypotension
- 3. bradycardia
- 4. bradypnea
- 5. excess fluid and puffy eyes
- 6. seizures & coma
2 contraindications for levothyroxine?
- 1. recent MI
- 2. thyrotoxicosis
When do AE of levothyroxine usually occur?
with excessive doses
3 CV AE of levothyroxine?
- 1. tachycardia
- 2. arrhythmias
- 3. HTN
3 CNS AE of levothyroxine?
- 1. irritability
- 2. anxiety
- 3. insomnia
2 exocrine AE of levothyroxine?
- 1. excessive sweating
- 2. heat intolerance
Education about how pt should take levothyroxine?
take at same time qd in the morning before breakfast
Food interaction with levothyroxine?
Does levothyroxine cure hypothyroidism?
teach pt that therapy is lifelong
When should dose of levothyroxine be withheld?
if HR is >100
teach pt withhold and call MD
The AE of levothyroxine are all related to _____.
What must be done if a med is withheld?
Can levothyroxine be given with MI?
yes, but monitor closely
What condition is caused by too much thyroid hormone?
thyrotoxic crisis or thyroid storm
Levothyroxine effect on met?
increases met rate & functions
What is the use of methimozole (MMI) & propylthiouracil (PTU)?
Route of admin for methimazole & propylthiouracil?
PTU stands for?
pull thyroid under
MMI stands for?
my my only I time
Difference in admin of methimazole and propylthoiuracil?
methimazole is given 1 X qd usually
propylthiouracil is given 3 equal doses 8 h apart
Onset of methimazole and propylthiouracil?
methimazole has quicker onset
propylthiouracil has longer onset of action - 10 to 21 days
Why must propylthiouracil be given in 3 doses?
keep level therapeutic level to prevent thyrotoxicosis
2 AE of methimazole & propylthiouracil?
hypothyroidism & myxedema coma
What drug will be given to reverse AE of methimazole and propylthiouracil?
Life threatening AE of methimazole & propylthiouracil?
When will this usually occur?
w/in first 3 mo of therapy
Is methimazole or propylthiouracil more likely to cause agranulocytosis?
S/S of agranulocytosis that pt taking methimazole or propylthiouracil should report immediately?
- 1. sore throat
- 2. fever
- 3. rash
Consideration with agranulocytosis and fever?
may not get fever r/t decreased WBC
Before beginning methimazole or propylthiouracil what baseline lab test will be done?
will do baseline CBC & repeated to monitor for hemat. changes
thyroid blood tests will be done periodically also to monitor effectiveness of the drug
2 advantages of methimazole over propylthiouracil?
- 1. faster
- 2. less AE occurrence
2 important things to monitor with methimazole & propylthiouracil?
- 1. thyroid levels
- 2. WBC/CBC
Calcitonin salmon use?
used to decrease serum calcium
Action of calcitonin?
inhibits bone resorption & promotes renal excretion of Ca
resorption- bone B/C & release Ca
3 uses for calcitonin?
- 1. Paget disease/osteitis deformans
- 2. postmenapausal osteoporosis
- 3. hypercalcemia
What is Paget disease?
skel disorder with excessive bone resorption followed by replacement of normal marrow by vascular, fibrous conn tissue and new bone that is larger, disorganized, and weaker
Contraindication for calcitonin?
4 S/S of hypercalcemia?
- 1. confusion
- 2. bradycardia
- 3. kidney stones
- 4. flank pain/deep bone pain
S/S of hypocalcemia?
- 1. tetany
- 2. paresthesia
- 3. muscle twitching
- 4. seizures
- 5. cardiac arrhythmias
- 6. mental confusion
- 7. laryngospasm
What med is used to treat hypocalcemia caused by calcitonin?
What s/s of hypocalcemia means Ca is very low?
What assessment should be done prior to the admin of calcitonin?
apical HR 1 full minute
Life threatening side effect of calcitonin?
anaphylaxis r/t salmon/fish allergy
What testing may be done prior to the admin of calcitonin?
intradermal allergy testing for salmon/fish allergy
What s/s should pt report if taking calcitonin?
s/s of hypercalcemia returning
Assessment for of a pt on calcitonin?
- 1. tetany - chevoskic sign (tap cheek and eye winks), spasms
- 2. parasthesia- ask if tingle/warmth
- 3. HR
- 4. mental state
increases serum Ca in hypocalcemia
2 actions of calcitriol?
1. increases serum Ca & Ph by increasing absorption in int. & promoting bone->blood
2. reduces renal excretion of Ca & Ph
2 uses for calcitriol?
- 1. Tx & prevent deficiency
- 2. Ca & Ph homeostasis in renal failure
Contraindication for calcitriol?
liver or biliary disease
it is fat-soluble vitamin D - bile is necessary for it's absorption
AE of calcitriol?
Why does calcitriol cause arrhythmias?
if get too much Ca from calcitriol effects can cause arrhythmias
Assessment of pt taking calcitriol?
monitor for s/s of hypo or hyper calcemia
Precautions that need to be taken with a pt taking calcitriol?
- 1. seizure precautions
- 2. fall precautions due to mental confusion
- 3. increase fluid intake to prevent kidney stones
Pt taking what endocrine med needs to be on a monitor?
pt taking calcitriol or calcitonin r/t arrhythmia risk with Ca levels high or low
What group of endocrine meds can cause osteoporosis?
4 glucocorticoid meds?
- 1. prednisone
- 2. dexamethasone
- 3. hydrocortisone
- 4. methylprednisolone
mostly glucocorticoid but some mineralocorticoid effects
3 types of corticosteroids?
glucocorticoid, mineralocorticoid, and androgens
6 uses for glucocorticoids/prednisone?
- 1. anti-inflammatory
- 2. anti-allergenic
- 3. immunosuppresive
- 4. adjunct to cancer meds
- 5. maintain BP during times of stress
- 6. replacement therapy for adrenal insufficiency - Addison's Disease
Why is corticosteroid/prednisone used to maintain BP in stress?
promotes retention of Na & water through actions of aldosterone & causes release of EPI
Life threatening emergency that can occur with glucocorticoid/prednisone therapy?
adrenal insufficiency if abruptly stopped!
Early s/s of adrenal insufficiency?
- 1. general s/s of oncoming illness
- 2. despondency
- 3. hypotension
Late s/s of adrenal insufficiency?
- 1. hypotension
- 2 tachycardia
- 3. dehydration
- 4. hyponatremia
- 5. hyperkalemia
- 6. hypoglycemia
- 7. confusion
3 contraindications/precautions with use of glucocorticoids/prednisone?
- 1. systemic fungal infection
- 2. admin of live virus vaccines: MMR & varicella
- 3. hypertension
Why are glucocorticoids/prednisone contraindicated with systemic fungal infection?
glucocorticoids increase BG & suppress immune system
fungus likes the sugar
Why is glucocorticoid/prenisone contraindicated in HTN?
has mineralocorticoid activity -> aldosterone -> Na & water retention -> increased BP
Admin of glucocorticoids/prednisone?
take in 2 divided doses
take 2/3 of dose in am before 9:00 & 1/3 in pm
mimics normal hormone releases
When may a person taking glucocorticoid/prednisone require a higher dose?
during periods of physical or emotional stress
Glucocorticoid/prednisone teaching to minimize GI AE?
take with food
Pt teaching if pt takes inhaled glucocorticoids/prednisone?
need to rinse mouth/brush teeth following inhalation to prevent fungal infections of mouth, larynx, pharynx
Most important teaching for pt taking glucocorticoids/prednisone?
do not stop abruptly
Pt taking glucocorticoid/prednisone should eat a diet high in _____.
Foods high in K?
- 1. salt substitute - 1 tsp = 2000mg K
- 2. baked potato with skin has most
- 3. bananas
- 4. oranges
- 5. cantaloupes
- 6. honeydew
- 7. grapefruit
- 8. peaches
What lab values need to be monitored with glucocorticoid/prednisone admin?
serum Na & K
Assessments/monitoring of pt taking glucocorticoids/prednisone?
- 1. edema - weight, rales
- 2. HR & rhythm/arrhythmias
- 3. BG
- 4. Na & K
- 5. lipids
- 6. BP
What can 3rd heart sound with glucocorticod/prednisone indicate?
3 meds that may be used with corticosteroids?
- 1. antihypertensive
- 2. acid-reducing drug
- 3. diabetic med
What do AE of corticosteroids depend on?
duration of Tx and dose - usually AE occur with long-term Tx
GI AE of corticosteroids short-term?
- 1. NV
- 2. increased appetite
- 3. dyspepsia
- 4. weight gain
CNS AE of short term corticosteroid use?
- 1. anxiety
- 2. mood swings
- 3. insomnia
- 4. HA
Endocrine AE of short term corticosteroid use?
- 1. mentrual irregularities
- 2. hyperglycemia
- 3. suppression of pituitary ACTH (Cushings)
Dermatologic & integumentary short term AE of corticosteroid use?
- 1. acne
- 2. suppression of skin est reactions r/t immunosuppression
- 3. delayed wound healing
11 AE of long term corticosteroid use?
- 1. iatrogenic diabetes mellitus
- 2. peptic ulcer
- 3. cushingoid characteristics
- 4. osteoporosis & vertebral compression fractures
- 5. hyperlipidemia & thrombus formation
- 6. muscle B/D
- 7. cataracts
- 8. glaucoma
- 9. risk for infection
- 10. HTN & cardiac arrhythmias
- 11. growth retardation in CH
Why do corticosteroids cause peptic ulcers?
prednisone/glucocorticoids can augment secretion of gastric acid & pepsid, inhibit production of cytopretective mucus, and reduce gastric mucosal blood flow
these things are usually regulated by prostaglandin which is inhibited by the steroid
3 cushingoid characteristics?
- 1. moon face
- 2. buffalo hump
- 3. truncal obesity
Why does corticosteroid cause osteoporosis/vertebral compression fractures?
decreases activity of osteoblasts (bone forming cells) & decreases GI absorption of Ca -> hypocalcemia-> Ca leaves bone to increase serum Ca
Why does corticosteroid use cause muscle B/D?
suppresses protein synthesis which causes protein catabolism -> negetive nitrogen balance & muscle wasting
Do cataracts and glaucoma go away after stop corticosteroid use?
cataracts require surgery
glaucoma will go away after stopping med
What is the risk for a pt who has had TB & taking corticosteroids?
can reactivate the TB
Why do corticosteroids cause HTN & arrhythmias?
cause Na & water retention and K excretion
Why do corticosteroids cause growth retardation in CH?
reduce DNA synth & decrease cell division
What is Cushing's Syndrome?
decreased adrenal hormones caused by increased corticoids
Skin of a person taking corticosteroids?
will tear easily - thin
mineralocorticoid used in place of aldosterone b/c aldosterone is expensive and must be given IV
2 therapeutic uses for fludrocortisone?
- 1. adrenocortical insufficiency - Addison's
- 2. Tx of adrenogenital syndrome
4 contraindications/precautions with fludrocortisone use?
- 1. hypersensitivity
- 2. systemic fungal infection
- 3. CV disease
- 4. renal disease
AE of fludrocortisone are r/t ?
too much action of the med/too much aldosterone effect
4 AE of fludrocortisone?
- 1. HTN
- 2. heart failure
- 3. cardiomegaly
- 4. hypokalemic alkalosis - hold Na & excrete K
Action of cytadren?
inhibits or suppresses the adrenal cortex blocking synth of glucocorticoids, mineralcorticoids, and androns
2 uses for cytadren?
- 1. temp use to decrease excessive corticosteroid production while waiting for long-term Tx
- 2. off label for advanced breast carcinoma in postmenopausal women who have positive estrogen receptor test
How long will cytadren usually be used temporarily for excessive corticosteroid production?
Why is it only temporary Tx?
no more than 3 months usually
only Tx s/s - need to Tx underlying prob
Why is cytadren used for breast carcinoma with positive estrogen receptor test?
estrogens supplied by adrenals in postmenapausal and oophrectomized women
cytadren lowers estrogen by suppressing adrenal
AE of cytadren?
- 1. myalgia
- 2. measles like rash
- 3. hypotension
- 4. tachycardia
- 5. NV
Life threatening AE of cytadren?
Teaching for a pt taking cytadren?
- 1. change position slowly r/t ortho hypotension
- 2. report sore throat or malaise immediately r/t agranulocytosis
- 3. return to office for CBC
Important monitoring/assessment with cytadren?
- 1. skin for measles-like rash
- 2. BP & HR - causes hypotension, ortho hypotension & tachycardia
- 3. CBC for agranulocytosis
4 types of insulin?
- 1. rapid acting
- 2. short acting
- 3. intermediate acting
- 4. long-acting
2 actions of insulin?
- 1. lowers BG
- 2. stimulates cellular uptake of K, reducing serum K
4 uses for insulin?
- 1. DM I
- 2. DM II when diet and oral meds fail
- 3. gestational diabetes
- 4. hyperkalemia
What pt uses it?
What is it for?
What meds may be used with it?
What is the normal parameter for an additional dose of insulin?
ill or hospitalized pt
correct elevations r/t illness or food
may use short or rapid acting insulin
continuous secretion that maintains glucose homeostasis - baseline insulin
insulin secretion stimulated in response to meals
Which type of insulin has a rigid meal schedule in which pt must eat w/in 45 minutes of admin?
Sliding scale covers the pt basal/prandial insulin dose?
When should it be given?
with a meal or hs
Rotation method for injection of insulin?
intrasite rotation - rotate within the locale with about 2 inch b/t sites of injection
How often should each site be used for insulin injectin?
ideally each site should be used only once per month
Order of absorption of injection sites for insulin?
- 1. abd 2 inches from umbilicus
- 2. arm
- 3. thigh
- 4. butt
How long is insulin good in RA?
How long is insulin good when refrigerated?
How should prefilled insulin syringes be stored?
in refrigerator with capped needle pointing up
will keep for 1 month
What should pt do before admin prefilled insulin?
roll to resuspend and warm
AE of insulin?
hypoglycemia - BG <50
S/S of hypoglycemia?
- 1. hunger
- 2. N
- 3. nervousness
- 4. trembling
- 5. HA
- 6. tachycardia
- 7. sweating
- 8. confusion
- 9. convulsions
- 10. coma
- 11. death
How to prevent hypoglycemia when giving regular insulin?
assess current BG before giving
Which oral hypoglycemic med is suitable for use in elderly?
has minimal renal excretion
When should insulin dose be withheld?
if BG is less than 70
What should always be done before admin dose of insulin?
have it double checked by another nurse
How can you prevent local irritation at site of insulin injection?
- 1. avoid injecting cold insulin
- 2. rotation of sites
Why is it important to know the peak action time of insulins?
need to monitor pt for hypoglycemia esp around this time
Teaching for pt that can help avoid dosing errors?
use same type/brand of syringe
What type of medication is recommended for Tx of diabetes during pregnancy?
human like insulin
Follow-up assessment after admin of insulin?
- 1. assess for hypoglycemia esp around peak action time
- 2. assess for hypotension
- 3. make sure pt eats after admin
Use for rapid-acting insulin?
used for prandial/supplemental insulin coverage
3 rapid-acting insulins?
- Glulisine /apidra
What 3 insulins may be given IV?
- 1. Aspart/novolog
- 2. Apidra/glulisine
- 3. regular insulins
AA - alcoholics anonymous - need IV fluids
Peak of action for rapid-acting insulins?
30 min - 11/2 h
Which insulin cannot be used during pregnancy?
pregnant ppl p alot so they can't take apidra
When are rapid-acting insulins admin?
15 before or after a meal
allows for greater flexibility in eating schedule
What type of insulins are best for use in implantable insulin pumps?
mimics endogenous insulin response
What is required to give Aspart and Apidra IV?
What oral hypoglycemic causes digoxin toxicity?
Mixing rapid-acting insulins?
can mix with NPH/intermediate insulins
- cannot mix with R/short-acting insulins
- short and rapid don't mix because short ppl can't go fast
Teaching for pt taking glyburide?
wear sunscreen & protective clothing r/t photosensitivity
Rapid-acting insulin in children and pregnancy?
can be used in CH
pregnancy category C
2 types of short-acting insulins?
Humulin R & Novolin R
What is R insulin used for?
prandial and supplemental insulin coverage
Imp consideration when giving insulin IV?
must run some out first r/t binding to tubing
What type of insulin is safest during pregnancy?
Peak of R insulins?
What oral hypoglycemic drug decreases oral contraceptive effectiveness?
AE of R insulin?
Why does this occur?
causes weight gain
insulin converts excess glucose to glycogen & promotes storage of fat
3 things that can affect the peak time of an insulin?
- 1. site
- 2. type of insulin
- 3. individual pt response
What type of insulins are cloudy?
intermediate acting/NPH/N insulins
Use of intermediate-acting/NPH insulins?
provides basal insulin coverage
What is intermediate-acting insulin?
isophane insulin suspenction NPH
3 types of intermediate-acting insulin?
Peak of intermediate-acting insulins?
If give am dose when will it usually peak?
4 - 12 h
during mid to late afternoon
Long-acting insulin use?
basal insulin coverage
2 types of long-acting insulins?
- 1. Lantus/detemir
- 2. Levemir/glargine
2 advantages of long-acting insulin?
- 1. less weight gain
- 2. less somogyi
Peak of action for long-acting insulins?
Levemir = 3 to 14 hours
Lantus has no peak
How long does Lantus remain constant after admin?
When is Levemir given?
with evening meal or hs
Mixing long-acting insulins?
do not mix with any other insulins
How are longer acting insulins formulated?
have additives that increase their lenght of action:
- 1. protamine
- 2. zinc
- 3. isophan
How do additives in long-acting insulins work?
delay absorption = later onset, peak, & duration of action
How is the strength of long acting insulin set up?
long acting part will be listed first (mix of insulin and additive)
short acting part will be just the insulin and will be listed last
Glucose reading <___ = hold insulin.
How is a regular insulin syringe calibrated?
What should you do if you need an even # amnt?
in increments of 2u up to 100u/1mL
use a low-dose syringe calibrating in 1 u increments up to 50u/.5mL
How many times may a pt reuse a needle?
What should they monitor for?
3 to 4 times
monitor for s/s of site infection: red, warmth, edema, etc
What are sulfonylureas?
oral hypoglycemic agents
- 1. glyburide
- 2. repaglinide
What must pt have in order for glyburide to act?
must have functioning pancreas b/c glyburide increases effects of insulin and receptors
What is glyburide used for?
lower BG in DM II
Contraindications for sulfonylureas/glyburide/repaglinide?
known hypersensitivity to sulfa drugs
AE of glyburide?
- 1. hypoglycemia
- 2. photosensitivity (glyburide - tan your hide)
Class of repaglinide?
Action of repaglinide?
stim pancreas to prod more insulin
Repaglinide is good for use in _____ & causes AE of ______ _______.
fat-hag-linide - fat old person - use in old ppl and makes them fat
What med may be used if a person is allergic to sulfa in glyburide?
Can repaglinide be taken with sulfa allergies?
Admin schedule of repaglinide?
take dose 15 to 30 min before each meal - # of meals matches doses for the day
gives flexibility for ppl who don't eat on same schedule qd
Action of repaglinide that allows it to be taken directly before meals?
has short half life - effects wear off before next meal and insulin levels return to normal
3 types of nonsulfonylureas?
- 1. Biguanide
- 2. Thiazolidinediones
- 3. Alpha-glucosidase inhibitors
Class of metformin?
George Formin is big
metformin is biguanide
2 complications of metformin?
Which is rare?
- 1. lactic acidosis
- 2. blood dyscrasias - rare
S/S of lactic acidosis?
- 1. malaise
- 2. myalgia
- 3. resp distress
- 4. increasing somnolence
- 5. nonspecific abd distress
- 6. hypothermia
- 7. hypotension
- 8. bradyarrhythmias
What pH imbalance is caused by the drug fludrocortisone?
Contraindications for metformin?
renal and hepatic impairment
Advantage of metformin use?
causes weight loss
Teaching to decrease GI effects of metformin?
take with food
When should pt take metformin?
at same time each day
When should metformin ALWAYS be withheld?
24 h before & 48 h after use of iodinated contrast dye b/c both metformin and dye can be toxic to kidneys
What will be done if creatinine/BUN shows decreased kidney functioning with use of metformin & pt needs contrast dye?
will give fluids to increase BF to kidney before giving contrast dye
When may metformin cause hypoglycemia?
when used with other hypoglycemic meds
when used as monotherapy metformin cannot cause hypoglycemia
Class of acarbose?
alpha-glucosidase inhibitor AKA starch blocker
Actions of acarbase?
delays absorption of dietary carbs -> reduces rise in BG after meals
acarbase - decreased carb absorption
What is the action of alpha-glucosidase enzyme that is inhibited by acarbase?
B/D carbs in the int -> carb absorption
AE of acarbase?
GI: flatulence, cramps, abd distention, borbormus, and diarrhea
all r/t carbs remaining in GI longer than usual and fermenting -> forms gas
acarbose - bose is a speaker and acarbose causes stomach sounds
Complication of acarbose?
liver dysfunction with long-term high dose therapy
Contraindications of acarbose?
diseases of the bowel: IBD, absorptive disorders, colonic ulceration, and Hx of bowel obstruction
If a pt taking acarbose exp a hypoglycemic event what should they do?
take oral glucose tabs not table sugar r/t decreased absorption of carbs
3 AE of rosiglitazone?
- 1. fluid retention and weight gain
- 2. increased blood lipids
- 3. HA
Fluid retention from rosiglitazone can cause what other AE>
Contraindications for rosiglitazone?
liver disease or increased ALT or AST to more than 2.5 times upper limits of normal
Cautious use of rosiglitazone?
CV disease esp CHF & HTN b/c can be exacerbated by fluid retention with rosiglitazone
Drug interaction with rosiglitazone?
What testing will be done with rosiglitazone?
will have liver function test q 2 mo X 1 yr and periodically thereafter to monitor for hepatotoxicity
Hypoglycemia in rosiglitazone?
cannot cause hypoglycemia with monotherapy
Action of januvia/DDP-4 inhibitors?
inhibit the enzyme DDP-4 that metabolizes incretin hormones
incretin hormones increase insulin release therefor inhibiting DDP-4 that breaks them down will allow the hormones to have their antihyperglycemic effects
Patho of DDP-4 inhibition by Januvia?
inhibits DDP-4 -> slowing of incretin metabolism (increase incretin hypoglycemic effect) -> increase insulin release or synth & decrease glucagon secretion -> decreased BG
2 AE of Januvia?
- 1. upper resp infection
- 2. nasopharyngitis
unvia - in Jan
uary alot of upper resp infections & pipes freeze so have to dig
oxin them up (also causes digoxin toxicity)
Drug interaction with januvia?
raises digoxin levels
Rosiglitazone memory story?
will be pushing up roses b/c causes fluid retention, HTN, CV probs, increased lipids, & liver probs & your kid will bring roses to your grave b/c you got pregnant b/c the med interfered with your oral contraceptive
glucose elevating agent
2 actions of glucagon?
- 1. stimulates hepatic prod. of glucose from glycogen stores
- 2. relaxes musculature of GI tract within 15 min of admin and temp inhibits mvmt. for about 30 min
2 uses for glucagon?
- 1. hypoglycemic event in unconcious person
- 2. relaxes GI for examination
Onset & duration of action for glucagon?
increases glucose in 30 min and lasts for 1 to 2 h
What should be done prior to the admin of glucagon for hypoglycemic event?
put pt on side b/c they will throw up
What should pt do after they wake up from hypoglycemic event that was Tx with glucagon?
eat a meal that contains protein to prevent BG from dropping again
Contraindiction of glucagon?
glucagon causes release of catecholamines & exacerbates extreme HTN ass. with this illness
2 nursing intervention to prevent hypoglycemic unconcious pt from aspirating after glucagon admin?
- 1. position on side before admin
- 2. have suction equipment available
In what pt will glucagon be ineffective?
How will they be Tx?
pt with no glycogen stores: malnutrition, chronic hypoglycemia, adrenal insufficiency
will be given glucose instead
Actions of exanatide?
regulates prod of glucose and insulin
slows down rate at which glucose enters BF by decreasing gastric emptying
Who may use exanatide?
only adults with type II DM
not for CH
Admin of exanatide?
taken bid by SQ injection 60 min before morning and evening meal
DO NOT take after meal
AE of exenatide?
- 1. NV
- 2. anorexia
- 3. weight loss
N will subside over time
Contraindications for exenatide?
- 1. preg - cat C
- 2. children
- 3. DM I
- 4. severe GI disease (gastroparesis)
What should pt do if they miss a dose of exenatide?
skip the dose
Storage of exenatide?
do not store with needle attached - can cause leaking and air bubbles
Why does pt need to keep up with the day they start exenatide pen?
use for 30 days then throw away
New pen set up?
How many doses in the pen?
do only 1 time or will run out of med
Teaching pt about drug interactions with exenatide?
pt should take meds that require GI absorption 1 h before exenatide inj - contraceptives, tylenol, ABX
What type of pt would not be suitable for exenatide injections?
pt who is not able to comply with rigid schedule or not able to follow directions
tumor that has extreme HTN
2 actions of testosterone?
- 1. normal growth and dev of male sex organs
- 2. maintenance of male secondary sex characteristics
3 uses for testosterone?
- 1. male hypogonadism
- 2. to initiate male puberty
- 3. suppression of tumor growth in breast cancers that are estrogen dependent (testosterone lowers estrogen levels)
AE of testosterone in women?
- 1. amenorrhea
- 2. deepening of voice
- 3. change in libido
- 4. clitoral enlargement that is permenant
- 5. decreased breast size
AE of testosterone in men?
- 1. acne
- 2. facial hair
- 3. gynecomastia
- 4. impotence
- 5. oligospermia
- 6. priapism
AE of testosterone that occur in men & women?
- 1. hypercalcemia esp in immobile pt and those with metastitic breast cancer
- 2 edema from Na & water retention
3 s/s of hypercalcemia?
- 1. decreased LOC
- 2. arrhythmias
- 3. HR
3 complications of testosterone therapy?
- 1. hepatitis
- 2. hepatocellular carcinoma with prolonged use of high doses
- 3. premature closing of long bones
Test that should be done with prepubescent boys on testosterone therapy?
radiographs q 6 mo to det rate of bone maturation and effects on epiphyseal closure
Admin of testosterone?
inject deep IM to prevent inflammation and pain at injection site
Assessment/monitoring for pt on testosterone?
- 1. weight daily
- 2. assess for fluid volume excess
- 3. monitor hepatic function tests & serum Ca levels
3 actions of premarin/estrogen?
- 1. promote growth and dev of F sex organs
- 2. reduces chol.
- 3. conserves Ca and Ph & has a positive effect on bone mass
Therapeutic uses for premarin?
- 1. restore hormone balance in deficiency states
- 2. Tx of hormone-sensitive tumors
- 3. part of HRT to Tx vasomotor s/s of menopause (hot flashes)
- 4. reduce bone loss & improv bone density in postmenopausal women
- 5. Tx abn uterine bleeding from hormonal imbalance with no organic pathology
- 6. palliative therapy in advanced prostatic cancer, men with metastatic breast cancer who don't have estrogen-dependent tumor
AE of estrogen therapy/premarin?
- 2. edema
- 3. N
- 4. weight changes
- 5. amenorrhea
- 6. breakthrough bleeding
- 7. dysmenorrheal
- 8. breast tenderness
- 9. impotence
- 10. testicular atrophy
- 11. gynecomastia
- 12. acne
- 13. chloasma - dark patchy pigmentation to the skin
Complications of premarin?
- 1. MI
- 2. thromboembolism
- 3. Br cancer
- 4. endometrial cancer
- 5. acute pancreatitis
4 contraindications for estrogen therapy?
- 1. breast cancer
- 2. thromboembolic disease
- 3. estrogen-dependent neoplastic diseases
- 4. pregnancy - category X
What should be assessed before and periodically throughout estrogen therapy?
Teaching for estrogen therapy?
- 1. instruct to use sunscreen and protective clothing to prevent chloasma & due to photosensitivity
- 2. undergo pelvic exam and pa test to rule out cervical cancer
- 3. undergo physical to rule out Br cancer, genital bleeding, and thrombophlebitis
Long-bone growth and estrogen?
during estrogen therapy need to assess long-bone growth to prevent premature closing of epiphyses in prepubescent pt
2 actions of prometrium?
- 1. prod secretory changes in the endometrium
- 2. prod histologic changes in vaginal epithelium
4 uses for prometrium?
- 1. restoration of hormonal balance with control of uterine bleeding
- 2. Tx amenorrhea & prod normal cycles
- 3. add to postmenopausal HRT to decrease risk of endometrial cancer from estrogen therapy
- 4. used in combo with estrogen in oral contraceptives to prevent preg
Contraindications of prometrium?
- 1. thrombophlebitis
- 2. cerebral hemorrhage
- 3. carcinoma of the breast or genital organs
- 4. pregnancy
- 5. severe liver disease
AE of prometrium?
- 1. breakthrough bleeding
- 2. change in menstrual flow
- 3. breast tenderness
- 4. fluid retention
- 5. pulmonary embolism
- 6. thromboembolism
- 7. increased risk of breast cancer
- 8. increased risk of endometrial cancer
Action of fosamax?
inhibits resorption of bone by inhibiting osteoclast activity
2 uses for fosamax?
- 1. reversal of progression of osteoporosis in postmenopausal women
- 2. decreased progression of Paget's
Contraindications for fosamax?
AE of fosamax?
- 1. esophageal irritation & acid reflux
- 2. other GI upset
How can a pt prevent esophageal irritation with fosamax?
take with plain water only at least 6 to 8 oz. & remain upright for 30 min after admin
Fosamax and other meds/food?
should take at least 30 min before eating, drinking, or other meds b/c has many drug interactions
When should pt d/c use of fosamax and call MD?
- 1. pain or difficulty swallowing
- 2. retrosternal pain
- 3. new/worsening heartburn
What would you like to do?
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