Endocrine and Gastrointestinal Pharmacology Lecture Review

A complete set of vocabulary practice flashcards detailing pharmacology and nursing care for endocrine and gastrointestinal disorders.

I-131 Radioactive Iodine Therapy (RAI)

The treatment of choice for non-pregnant adults with hyperthyroidism that permanently destroys thyroid tissue, takes $2$-$3\,\text{months}$ for onset, and results in lifelong hypothyroidism requiring hormone replacement.

Time, Distance, and Shielding

Radiation safety precautions mandated for clients receiving radioactive iodine ($I-131$), including limiting direct contact to $30\,\text{minutes}$ during care, keeping a distance of $6\,\text{feet}$, and utilizing lead aprons and lead containers.

Somatropin

A synthetic human growth hormone replacement indicated for pituitary deficiency, AIDS wasting, and cachexia; adverse effects include hyperglycemia and renal calculi.

Vasopressin and Desmopressin

Synthetic antidiuretic hormone preparations are indicated for diabetes insipidus, severe hypotension, and nocturnal enuresis, which carry risks of coronary artery constriction (heart attack), water intoxication (Seizures from low Na+), and dilutional hyponatremia (herniation in the brain).

Glucocorticoids (Steroids)

Synthetic analogues of cortisol used to suppress inflammation and the immune response; long-term therapy ($10+\,\text{days}$) suppresses adrenal gland function and necessitates gradual tapering to prevent adrenal crisis.

Calcium Carbonate (TUMS)

An alkaline over-the-counter antacid indicated for peptic ulcers, GERD, and chronic kidney disease ($\text{CKD}$), which can cause hypercalcemia and constipation.

Aluminum Hydroxide (Amphojel)

An over-the-counter antacid that binds dietary phosphate to reduce serum phosphorus levels in end-stage renal disease ($\text{ESRD}$); adverse effects include constipation and hypophosphatemia.

Magnesium Hydroxide (Milk of Magnesia)

An antacid and osmotic laxative that neutralizes stomach acid and stimulates bowel evacuation, with adverse effects of diarrhea and risk of severe magnesium toxicity in clients with renal failure.

H2 Receptor Antagonists

Gastric antisecretory drugs (such as cimetidine, famotidine, ranitidine and nizatidine) that block histamine $H_2$ receptors to suppress stomach acid output, used for GERD, peptic ulcer disease, and Zollinger-Ellison syndrome ($\text{ZES}$). (THINK 2 DINE WITHOUT PAIN)

Bismuth Subsalicylate

A mucosal protective drug that coats ulcer beds and increases intestinal fluid absorption; it turns the tongue and stool grayish-black and is contraindicated in children due to its aspirin component and the danger of Reye's syndrome. (MUST CHEW TABS - DO NOT SWALLOW WHOLE)

Misoprostol

A synthetic prostaglandin $E_1$ analogue that decreases gastric acid production and enhances mucosal bicarbonate secretion to prevent NSAID-induced ulcers; classified as Category $X$ and contraindicated in pregnancy due to uterine stimulation. (DO PREGNANCY TEST)

Metoclopramide

A dopamine antagonist and prokinetic agent that accelerates upper gastrointestinal motility to treat constipation and emesis, with adverse effects of extrapyramidal symptoms ($\text{EPS}$), tardive dyskinesia, and neuroleptic malignant syndrome ($\text{NMS}$).
CONTRAINDICATED in patients with GI obstruction, seizure hx, GI Bleed, Pheochromocytoma (benign tumor of the kidney), and Parkinson's disease. (USE WITH CAUTION) .

Diphenoxylate with Atropine

An antidiarrheal combination medication containing subtherapeutic atropine to discourage overdose and substance abuse, indicated to decrease stool frequency and liquid content. CONTRAINDICATED WITH DEHYDRATION, INFECTION, ELECTROLYTE IMBALANCE

Scopolamine

An anticholinergic antiemetic agent prescribed to prevent motion sickness and postoperative nausea and vomiting ($\text{PONV}$), contraindicated in clients with glaucoma or benign prostatic hyperplasia ($\text{BPH}$).

Dimenhydrinate

An $H_1$ antihistamine antiemetic administered $30$-$60\,\text{minutes}$ prior to triggers to manage motion sickness, carrying anticholinergic adverse effects. CONTRAINDICATED WITH GLAUCOMA AND BPH

Dronabinol

A cannabinoid antiemetic indicated for chemotherapy-induced nausea and vomiting ($\text{CINV}$) and postoperative nausea, contraindicated or cautioned in clients with psychiatric and mental health disorders.

Ondansetron

A serotonin ($5\text{-HT}_3$) antagonist antiemetic that carries risks of headache, dizziness, and prolonged $QT$ intervals, and contains aspartame, making orally disintegrating forms contraindicated in phenylketonuria ($\text{PKU}$).

Banana Bag

An intravenous infusion formula containing multivitamins, B vitamins, folic acid, thiamine, and magnesium, administered in alcohol use disorder to manage or prevent Wernicke's encephalopathy and Korsakoff syndrome.

Lispro Insulin (Humalog)

A rapid-acting correctional insulin with an onset of $15\,\text{minutes}$, peak of $60$-$90\,\text{minutes}$, and duration of $3$-$4\,\text{hours}$, requiring food consumption within $15\,\text{minutes}$ of injection.

Regular Insulin (Humulin R)

A short-acting insulin with an onset of $30\,\text{minutes}$ to $1\,\text{hour}$, peak of $2$-$3\,\text{hours}$, and duration of $4$-$6\,\text{hours}$; the specific formulation approved for intravenous infusion in severe hyperglycemia and DKA.

NPH Insulin (Humulin N)

An intermediate-acting insulin preparation with an onset of $1$-$2\,\text{hours}$, a peak effect between $6$-$14\,\text{hours}$, and an overall duration of action of $16$-$24\,\text{hours}$.

Insulin Glargine (Lantus)

A long-acting basal insulin possessing an onset of $1$-$2\,\text{hours}$, no pronounced peak, and a steady duration extending for $24+\,\text{hours}$.

Metformin (Glucophage)

A first-line oral biguanide that reduces intestinal glucose absorption, enhances cellular insulin sensitivity, and reduces hepatic glucagon release; carries a risk of lactic acidosis and must be held for $48\,\text{hours}$ after iodinated contrast media. CONTRAINDICATIONS ETOH, RENAL IMPAIRMENT

Sulfonylureas

Oral antidiabetic agents (glipizide, glyburide, glimepiride) that trigger pancreatic beta cells to release insulin; administered once daily $30\,\text{minutes}$ before meals and strictly contraindicated with alcohol.

Meglitinides

Oral antidiabetic medications (repaglinide, nateglinide) that stimulate pancreatic insulin secretion and must be ingested within $15\,\text{minutes}$ before meals.

Gliptins (DPP-4 Inhibitors)

Oral antidiabetic drugs (sitagliptin, linagliptin) that prevent the enzymatic breakdown of incretin hormones to increase insulin release; adverse risks include pancreatitis and Stevens-Johnson syndrome ($\text{SJS}$). TAKE REGARDLESS OF FOOD

Incretin and Amylin Mimetics

Injectable non-insulin antidiabetic agents (semaglutide, pramlintide, exenatide) that increase satiety, slow gastric emptying, and promote insulin release; they carry a black box warning for thyroid tumors. BEFORE BREAKFAST OR DINNER AND DO NOT MIX WITH INSULIN

Acarbose

An oral alpha-glucosidase inhibitor that delays the enzymatic digestion and absorption of carbohydrates in the small intestine; adverse effects include flatulence, abdominal bloating, and iron deficiency anemia.

Thiazolidinediones

Oral antidiabetic agents (rosiglitazone, pioglitazone) that improve peripheral insulin sensitivity; adverse effects include hepatotoxicity, elevated serum lipids, and fluid retention that can precipitate congestive heart failure. ADVERSE EFFECTS ARE FLUID RETENTION

Total Parenteral Nutrition (TPN)

Hypertonic nutritional support containing $60\%$ to $70\%$ dextrose infused via a central line using an inline $0.2\,\mu\text{m}$ filter ($1.2\,\mu\text{m}$ for co-infused lipids) for clients unable to take enteral nutrition for greater than $7\,\text{days}$.
CAN KILL YOU BY HYPOGLYCEMIA (if abruptly stopped), INFECTION (make sure TPN has filter)

Loperamide

A non-controlled oral antidiarrheal that inhibits intestinal motility to decrease stool output in diarrhea and ileostomies; adverse effects include $QT$ prolongation and Stevens-Johnson syndrome. DO NOT DRINK ETOH, COFFEE, TONIC WATER, GRAPEFRUIT JUICE

Psyllium Husks (Metamucil)

A bulk-forming laxative that absorbs fluids in the gastrointestinal tract to enlarge stool bulk and trigger peristalsis; requires administration with at least $8\,\text{oz}$ of fluid to avoid obstruction.

Docusate Sodium (Colace)

A surfactant laxative (stool softener) that reduces surface tension of the fecal mass to facilitate fluid and fat penetration, used to prevent straining post-myocardial infarction or surgery.

Bisacodyl

A stimulant laxative that chemically irritates the colonic mucosal lining to stimulate peristaltic waves; administration within $1\,\text{hour}$ of milk or antacids must be avoided.

Osmotic Laxatives

Potent laxatives (including lactulose, polyethylene glycol, and magnesium salts) that pull water into the colonic lumen via osmotic gradient, distending the bowel and inducing rapid evacuation.

Proton Pump Inhibitors (PPIs)

Antisecretory agents (omeprazole, pantoprazole, lansoprazole) that irreversibly block the parietal cell $H^+/K^+$ ATPase pump, increasing client susceptibility to pneumonia, osteoporosis, and hypomagnesemia.

Sucralfate

A mucosal protective drug that reacts with hydrochloric acid to produce a viscous adherent barrier over gastric ulcer craters; must be administered on an empty stomach $1\,\text{hour}$ before meals and separated by $2\,\text{hours}$ from other medications. (INCREASE FLUIDS AND FIBER)

H. Pylori Eradication Regimen

A multi-drug therapeutic combination consisting of two to three antibiotics (such as clarithromycin, amoxicillin, metronidazole, or tetracycline) combined with a PPI, H2 antagonist, or bismuth subsalicylate taken for $2\,\text{weeks}$.

Methimazole and Propylthiouracil (PTU)

Thionamide antithyroid medications that suppress thyroid hormone production in hyperthyroidism

Lugol's Solution (SSKI)

A concentrated iodine solution that rapidly inhibits synthesis and release of $T_3$ and $T_4$ and diminishes thyroid gland vascularity before surgery; can induce iodinism and stain dentition unless taken diluted through a straw.

Levothyroxine (Synthroid)

A synthetic levorotatory isomer of thyroxine ($T_4$) indicated for lifelong treatment of hypothyroidism; must be taken once daily in the morning on an empty stomach $30$-$60\,\text{minutes}$ prior to food and held if heart rate exceeds $110\,\text{bpm}$.

What are adverse reactions of Synthroid/Levothyroxine

Possible adverse reactions include hyperthyroidism symptoms such as Nervousness, increased HR, Seizures, Dysrhythmias, Tremors, Insomnia, Diaphoresis, Irritability, and weight loss.

Things to know with Synthroid/Levothyroxine

Take consistently, monitor TSH (high T3/T4 levels - HYPER and visa versa) levels regularly, take for the rest of life, and allow 1 month for therapeutic effect

What to have next to patient while taking Lugol’s Solution (In hospital setting)

IVP form of Calcium and a trach kit in case of acute respiratory distress.

Hyperthyroidism

Also known as Graves ' disease. A condition characterized by excessively high levels of thyroid hormones in the bloodstream, leading to symptoms such as weight loss, rapid heartbeat, and nervousness.

Adverse Effects of Radioactive Iodine with Hyperthyroidism

Radioactive iodine treatment can cause side effects such as hypothyroidism, BONE MARROW SUPRESSION, sore throat, radiation sickness (hematemesis, epistaxis), Dysgeusia (distorted sense of taste)

Adverse Reactions for Methimazole, PTU (Prophylthiouracil)

Agranulocytosis, Pancytopenia, Hypothyroidism (think everything down except the weight) and Liver Toxicity.

Hypotonic solutions

0.45% NaCl, 0.225% NaCl, Water

Isotonic Solutions

D5 ¼ NS, NS, LR, D5W

Hypertonic Solutions

D10W, D20W, 3-5% NaCl, D5 ½ NS, D5LR, and D5 NS

How can steroids kill you

1. Suppresses adrenal gland function (adrenal crisis, increased risk of infections, cardiovascular issues, or gastrointestinal complications)

2. Hypokalemia (can occur due to immunosuppression, leading to opportunistic infections or exacerbation of existing conditions)

3. Infection (can result from immunosuppression, increasing the risk of serious illnesses due to a weakened immune response. Chronic usage may also lead to gastrointestinal perforation and increased susceptibility to cardiovascular diseases.)

Sulfasalazine

1st line medication for IBS

DO NOT GIVE IF ASA SENSITIVITY OR SULFA ALLERGY

ALSO CAUSES LIGHT SENSITIVITY - USE SUNSCREEN

Hypoglycemia S/S

Tachycardia, diaphoresis, tremors, FSBG <70
USE D50W or GLUCAGON FOR TX

Hyperglycemia S/S

3 P’s
THINK HIGH AND DRY

Hypokalemia S/S

Palpitations, muscle weakness