23 endo drugs

4 categories of endocrine system drugs

refers to an internal secretion (hormone) produced by a ductless gland that secretes directly into the bloodstream

_____ is located at the base of the brain and is called the Master Gland

why is the pituitary gland called the master gland?

what hormones does the pituitary gland secrete?

the anterior pituitary lobe hormone that is called the human growth hormone?

the hormone that regulates growth

who can only be the one to treat growth abnormalities?

is only available for parenteral use as corticotropin

a synthetic peptide of adrenocorticotropic hormone that is used for diagnosis of adrenocortical insufficeincy

where are the adrenal glands located?

what type of hormone do the adrenal glands secrete?

____ act on the immune system to suppress the body's response to infection or trauma. relieves inflammation, reduces swelling, and supresses symptoms

2 categories of corticosteroids

is used as a short term therapy and localized to prevent system effects. is also not a curative, but used as a supportive therapy with other meds

prolong use of this can cause suppresion of the pituitary gland

what can be given if corticosteroids is needed for an extended time period?

1. allergic reactions (poisoning,bites)
2. acute flare-ups of rheumatic or
collagen disorders (inflamed joints, decreased crippling)
3. acute flare ups of severe skin conditions
4. acute respiratory disorders
5. malignancies (luekemia, lymphoma, hodgkins disease)
6. Cerebral edema
7. organ transplant (to prevent rejection)
8. life threatening shock
9. acute flare ups

are all conditions treated with?

abrupt withdrawal of ______ can lead to acute adrenal insufficiency, shock, death

SE:

-delayed wound healing, increased susceptibility to infection
-muscle pain/weakness
-osteoporosis w/ fractures (esp. in older women)
-stunted growth in children
-endocrine disorders
-gastric/esophageal irritation
-CNS effects
-petechiae, bruising, skin thinning
-fluid & electrolyte imbalances (edema/fluid retention)

CI: -hypothyroidism/cirrhosis
-emotional instability
-glaucoma
-HTN/DM

PE:
-take oral meds during/immediately after meals to reduce gastric irritation, but not near bedtime

-antacids or asprin should be avoided

-

live virus vaccines/toxoids (inhibits antibody response)

thyroid agent medications

____ absorbs all iodine in blood

______ are released from pituitary gland when levels are low

TSH promotes biosynthesis & secretion of 2 bioactive thyroid hormones called

is the major product of the thyroid gland & much is later converted into T3 form

causes slow metabolism w/ symptoms of fatigue, dry skin, thinning hair, weight gain

treatment for hypothyroidism

hypothyroid conditions requiring replacement therapy include:

how is hypothyroidism diagnosed?

toxic effects are the result of overdosage of thyroid and are manifested in the signs of ______

toxic effects of ________ include:

-palpations, cardiac arrhythmias, tachycardia
-nervousness, insomnia, HA
-weight loss, diarrhea
-intolerance to heat, fever, sweating -menstrual irregularities
-exopthalmos (bulging eyes)

CI:
-cardiovascular disease
-elderly
-adrenal insufficiency
-DM
-normal thyroid function (euthyroid)

IA:
-oral coagulants (potentiate)
-insulin & hypoglycemics (dosage required)
-adrenergic effects w/ epinephrine (potentiates) WATCH CLOSELY!
-estrogen, bcp (decrease thyroid response)
-soy products (decrease response)
-calcium/iron/magnesium salts (decrease absorption, space several hours apart)

PE:
-meds taken for life
-take on empty stomach 30-60 mins prior to breakfast
-periodic lab test to determine effectiveness & dosage

hypothyroidism is the reult of the thyroid not making enough _____

hyperthyroidism is when the body makes _____ thyroxine

_______ used to relieve symptoms of hyperthyroidism in preparation for surgical & radioactive iodine therapy

SE (rare):
-rash, pruritus, urticaria
-blood dysrasias (esp. agranulocytosis)

CI:
-prolonged therapy
-pts who are older than 40 y.o.
-hepatic disorders

IA:
-drugs that cause agranulocytosis (potentiate)

PE:
-inform physician if any signs of illness (chills, rash, sore throat)

used to lower blood glucose levels in those with impaired metabolism of carbs, fats, and proteins

characterized by destruction of pancreatic beta cells

characterized by insulin resistance and deficeincy

___ was formally described as juvenile diabetes

most common form of diabetes (90-95%)

DM II is increasing in earlier ages due to?

what is the result of poorly controlled diabetes?

microvascular complication includes:

macrovascular complications include:

why is insulin required for type 1 diabetes?

why is insulin required for type 2 diabetes?

____ is used in the emergency treatment of diabetic ketoacidosis or coma

how is insulin administered?

why is insulin administered parenterally?

2 types of injected insulin

types of insulins

how are biosynthetic adn analog insulins created

in a 100 unit ml insulin syringe how much does each line represent

in a 50 unit ml insulin syringe how much does each line represent

what type of insulin can ONLY be given intravenously and intramuscularly?

what types of insulin are clear and ultra rapid acting with a short duration?

what types of insulins can be given subcutaneously?

what is an intermediate acting insulin?

what are long acting insulins?

regular insulin can sometimes be combined with _______ in the same syringe

if two insulins are ordered at the same time, what must be done first?

what types of insulin should no tbe mixed with any other types of insulin?

this is sometimes ordered as a corrective action insulin

what must be done to prevent one of the most common and most dangerous medication error?

elevated blood glucose is also known as

undiagnosed diabetes
insufficient insulin dose
infections
surgical or other trauma
emotional stress
endocrine disorders
pregnancy

can all be a result of:

Symptoms of _____: polydipsia/polyuria
excessive sweating
fruity breath
weight loss, anorexia
lethargy
vision proglems
ketoacidosis

treatment of acute hyperglycemia

lowered blood glucose is also known as

loss of consciousness
irritability
tachycardia
pallor, hunger, N/V

may result from:

treatment for conscious hypoglycemia

treatment for comatose hypoglycemia

what is the somogyi effect?

how are oral anitdiabetic medications administered?

what is a principal therapy for DM II management?

oral hypoglycemic drugs are also known as:

chlorpropamide & tolbutamide are what generation solfonylureas?

glipizide & glyburide are what generation solfonylureas?

____ work by increasing insulin production from the pancreas and by imporving peripheral insulin activity

major side effect of sulfonylurea

only insulin administered IV, IM and SubQ

side effect of sulfonylureas, biguanides, and alpha-glucosidase inhibitors

stimulates pancreas beta cells to produce insulin

oral hypoglycemic drugs consisting of first-generation agents

therapy for an allergic reaction to poison ivy

should be done to insulin injection sites

hormone used for diagnosis of adrenocortical insufficiency

if possible, corticosteroids are administered this way

time that opened vials of insulin may be stored without loss of potency

adjunctive therapy for clients with type 2 diabetes without glycemic control

side effect of long-term corticosteroid use in children

decreases hepatic glucose output and enhances insulin sensitivity

common side effect of thiazolidinediones

SE of _____:

-GI distress
-dermatological distress
-pruritus, rash, urticaria
-photosensitivity
-hepatic dysfunction including jaundice
- hypoglycemia in older adults
- lethargy, vertigo
-increase of cardiovascular death

CI of ___:

-debilitated or malnourished Pt's
-impaired liver and kidney function
-unstable diabetes
-major surgery
-severe infection/trauma
-water intoxication

which sulfonylurea generation drugs have a higher potency, shorter action duration, better tolerance -& fewer drug interactions

Pt's recieving/discontinuing sufonylurea agents should be monitored closely for?

Alpha-glucosidase inhibitor meds

often used as part of a combination regimen that includes an oral sulfonylurea

delays digestion of complex carbs & subsequent absorption of glucose after meals

SE of _____:

-high rate of GI effects (flatulance, abdominal distention/pain, loose stools) which tend to diminish with time or a reduction in dose; take at the start (first bite) of main meals
-

drug interactions w/ _____:

-digestive enzymes
- digoxin
-estrogens and oral contraceptives

metformin (glucophage) is an example of a

____ work by decreasing hepatic glucose output and enhancing insulin sensitivity to muscle

can be used as an initial first-line monotherapy or in combination with sulfonylurea to treat type 2 diabetics

SE of ____:

-GI effects- Lactic Acidosis (severe dehydration, cardiorespiratory insufficiency, renal dysfunction)-Hypoglycemia-rare

CI of ____:

- radiocontrast dye
-heart failure
-children and older adults
-impaired kidney adn liver function

DI w/ _____:

-increased metformin effect seen with alcohol, cephelexin, and cimetidine
-radiopaque contrast media (hold metformin day of and 48 hrs after)

two naturally occuring hormones that have been identified adn released by cells in the GI tract in response to food

_____ activation suppresses the release of glucagon by the pancreas

_____ activation stimulates insulin secretion in order to maintain glucose homeostasis

in type 2 diabetes which enzyme rapidly inactivates GLP-1, which is already reduced in Pt's with impaired glucose intolerance

incretin therapy meds

given SC BID, mimics action of incretin GLP-1, decreases glucagon secretion, delays gastric emptying time, decreases food intake

used as adjunctive therapy for type 2 DM pts who does not have glycemic control & are taking metformin, a sulfonylurea or both

____ is not recommended for use in Pt's with severe renal disease

given orally once daily, inhibits DPP-4 enzyme, increase GLP-1 & GIP levels, increase insulin secretions

when recieving januvia Pt's should be monitored with what med

used as monotherapy in type 2 DM pts or combo w/ meformin or thiozolidinedione when adequate glycemic control has not been achieved

meglitinide meds

-stimulates pancreatic beta cells to produce insulin
-used as monotherapy or combo w/ metformin

SE:
-weight gain, fluid retention, edema
-URI
-myalgia
-hypoglycemia

DI:

-admin prandin before meals to maximize absorption
-gemfibrozil (lopid) may enhance/prolong effects

Drug IA:
BCP
Nitrates
Azole antifungals

Thiazolidinediones meds

meds with black box warnings for both meds, potential increase in myocardial ischemia risk