Pharm Week 12 Endocrine

Hypothyroidism

A condition characterized by diminished production of thyroid hormones

Primary hypothyroidism

problem with thyroid gland (T3 & T4 release)

Secondary hypothyroidism

problem with pituitary gland and results from decreased TSH which decreases release of T3 and T4

Tertiary hypothyroidism

reduced thyrotropin-releasing hormones from the hypothalamus which reduces TSH, T3 & T4

Hypo vs. Hyperthyroidism

Hypo: cold intolerance, weight gain, depression, constipation, bradycardia

Hyper: heat intolerance, weight loss, anxiety, diarrhea, tachycardia

levothyroxine mechanism

Synthetic thyroid hormone. Levothyroxine is the preferred. Increases the levels of T4 which is metabolically changed to T3

levothyroxine uses

Replacement; prevention or treatment of goiters; replacement whose thyroid glands have been surgically removed or destroyed

levothyroxine routes

PO, IV

levothyroxine SE

(HYPER) Tachycardia, palpitations, dysrhythmias, Insomnia, anxiety, Nausea, sweating, heat intolerance

levothyroxine nursing interventions & pt. education

Given at the same time every day:   In the morning, empty stomach, 30 minutes before breakfast.  Give at the same time every day (early am).

Taking in the afternoon/evening will lead to increase in energy level and sleeplessness. 

Avoid with OTC iodine, antacids, vitamins, or supplements containing iron and/or calcium within a 4-hour time frame of giving. 

Different brands are not interchangeable.

Parathyroid hormone

Enhances calcium release from bones

Enhances calcium reabsorption in renal tubules

Enhances calcium absorption in intestines by increasing production of vitamin D

Function of vitamin D

Regulates calcium & Needed for intestinal calcium absorption

helps your body absorb and hold onto calcium to raise calcium levels in the blood

Hypocalcemia

S&S of hypocalcemia:  Tetany, muscle cramps/spasms, paresthesia, circumoral numbness, seizures & overtime osteoporosis which leads to bone fractures.

Calcitriol

active form of vitamin D

Use: treat hypoparathyroidism and hypocalcemia

Action: promote Ca+ absorption from the GI tract, promote secretion of calcium from bone to blood

Type 1 diabetes

Lack of insulin production or by the production of defective insulin

Type 2 diabetes

Caused by both insulin resistance and insulin deficiency

Gestational diabetes

A type of hyperglycemia that develops during pregnancy

A1C

an indicator of glycemic control over 2 to 3 months

A1C target goal

normal is below 5.7%

prediabetes between 5.7 and 6.4%

diabetes 6.5% or below

Fasting blood sugar goal

Non-diabetic adults: 70-99 mg/dL

Pre-diabetic adults: 100-125 mg/dL

Diabetic adults: 80-130 mg/dL (depending on type of diabetes and individual goals)

Hyperglycemia causes

stress, medications, sickness

metformin (Glucophage) mechanism

First-line treatment type II. Monotherapy or in combination with other type II PO meds. 

Decreases glucose production by the liver, intestinal absorption of glucose, and improves insulin receptor sensitivity

results in increased peripheral glucose uptake and use, and decreased hepatic production of triglycerides and cholesterol

metformin (Glucophage) route

PO

metformin (Glucophage) SE

abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea, especially at the start of therapy, Metallic taste, Hypoglycemia

metformin (Glucophage) nursing interventions and pt. education

GI Side Effects lessened if taken with food, usually goes away after first few months

Contraindicated with renal disease

Monitor creatinine

Hold for iodine contrast studies (may be up to 48 hours before and after test) or until creatinine returns to normal

glipizide, glyburide (Diabeta) mechanism

Sulfonylureas 2nd gen

Used in conjunction with Biguanide or Glitazones, use early in type II

Bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin

Appear to secondarily decrease the secretion of glucagon

glipizide, glyburide (Diabeta) routes

PO

glipizide, glyburide (Diabeta) SE

hypoglycemia, weight gain

glipizide, glyburide (Diabeta) nursing interventions & pt. education

patient must still have functioning beta cells in the pancreas, check for sulfa allergy

Rapid acting insulin

lispro (Humalog), aspart (Novolog)

lispro (Humalog), apsart (Novolog)

Peak time: average 1 hour

Routes: SQ, insulin pump

SE: hypoglycemia, SQ=lipodystrophy

Give 15 minutes before meals

Rapid acting insulin nursing considerations & pt. education

eat at the same time as the injection

use sliding scale

combine with longer-acting insulin for basil-bolus dosing

Short acting insulin

Regular

Regular insulin

Peak: average 2.5 hours

Route: SQ, insulin pump, IV

SE: hypoglycemia, SQ=lipodystrophy

Give 30 min before meals

Short acting insulin nursing considerations & pt. education

eat within 30 minutes

use IV during DKA

Intermediate acting insulin

NPH

NPH insulin

Peak time: average 8 hours

Routes: SQ, insulin pump

SE: hypoglycemia, SQ=lipodystrophy

Has cloudy appearance

Intermediate acting insulin nursing considerations & pt. education

covers insulin needs for about ½ a day or overnight

often combined with rapid or short acting

Long acting insulin

glargine (Lantus), detemir (Levemir)

glargine (Lantus), detemir (Levemir)

Peak time: no peak (glargine)

Route: SQ

SE: hypoglycemia, SQ=lipodystrophy

Usually taken in evening, but sometimes required twice a day

cannot be mixed with other insulins

Long acting insulin nursing considerations & pt. education

covers insulin needs for up to 24 hours

combine with rapid acting for basil-bolus dosing

do not mix with other insulins

Pre-mixed insulins

Humulin- 70/30 (NPH/Reg)

Novolin- 70/30 (NPH/Reg)

Humulin- 50/50 (NPH/Reg)

Basil-bolus insulin therapy

mimics healthy pancreas

basil=long-acting, bolus=rapid

Basil insulin

suppresses glucose production between meals and overnight

50% of daily needs

Bolus insulin

Given at mealtimes

limits hyperglycemia after meals

Immediate rise and sharp peak at 1 hour

10% to 20% of total daily insulin needs

Hypoglycemia

Blood glucose levels below 70 mg/dL

S&S: confusion, irritability, tremors, feeling hungry, sweating, hypothermia, seizures

Hypoglycemia treatment

juics, IV D50 or IM glucagon

Insulin storage

never freeze

store for up to 1 month at room temp and up to 3 months in the fridge

do not use insulin that does not have proper clarity or color

store prefilled insulin syringes in the fridge for up to 1 month

always check expiration dates

Insulin administration

roll the vial between hands without shaking to avoid bubble formation in the vial

give freshly mixed insulins within 5 minutes

only use insulin syringes

rotate sites