pharm non diabetic endocrine pharm

major points

If it’s hypo – replace the missing hormone

◦ If it’s hyper – block the release of excess hormone

If it’s replacing missing hormones in excess – you can get signs of hyper________

◦ If it’s blocking the hormone too much – you can get signs of hypo_______

pituitary disorders

what is the treatment for growth hormone deficiency?

somatropin

what is the therapeutic use of somatropin?

pediatric or adult GH deficiency

what do we monitor when a patient is taking somatropin?

• Height and weight monthly

• bone growth annually

describe the pharmacology of somatropin

• stimulates growth by REPLACING human GH

WHat is the administration routes for Somatropin?

• SubQ or IM

What are the adverse effects of somatropin

• Hyperglycemia

• Hypothyroidism

• neutralizing antibodies

when do we stop giving somatropin?

• until epiphyseal closure until satisfactory adult height or no longer seen responses

What is the treatment of excessive GH

• Surgery or radiation

What drug treatment do you do for excessive GH

octreotide (reotide)

What is the MOA for octreotide

stops growth by BLOCKING GH release by mimicking somatostatin

• hypothalamus signs GH and somatostatin to be released. SST is the body’s natural stop for producing GH

• when we have octreotide, it mimics SST (somatostatin) by making Gh to stop producing

What are the adverse effects of octreotide?

• Nausea, bloating, gas

• expensive

What is the treatment for ADH deficiency>

VASOPRESSIN

what is the therapeutic use of Vasopressin

DI

what is the MOA vasopressin?

mimic effects of antidiuretic hormone

• it reabsorbs water into the kidneys

• it also contracts vascular smooth muscle and Gi smooth muscle

what are the adverse effects of vasopressin?

water intoxication

• angina - chest pain

• myocardial infraction

• gangrene - necrosis of the tissue

what is the nursing interventions of vasopressin ?

• LIMIT FLUID INTAKE

• Educate patient to report dizziness, headache, muscle weakness, drowsiness, nv and abdominal bloating

thyroid disorders

how does thyroid hormone work?

iodine gets taken up and makes t3 and t4. tsh tells the thyroid gland to make thyroid hormone

What is the treatment for hypothyroidism

levothyroxine

What is the therapeutic use of levothyroxine

• Drug of choice

• LOW THYROID

• When this drug is used, we have an increase of energy, weight loss, and increased HR to return to normal ranges

what is the MOA of levothyroxine

• replaces thyroid hormone t4 but it converts to t3

what are the adverse effects of levothyroxine

• Hyperthyroidism because the therapeutic range is smaller

• Overdose – signs of high levels

  ◦ Tachycardia

  ◦ Angina

  ◦ Tremor

  ◦ Nervousness

  ◦ Insomnia

  ◦ Heat intolerance

  ◦ Sweating

why do we monitor tsh and not t3 and t4

levothyroxine is mimicking t3 and t4

• if you draw t3 and t4 labs in a patient that is taking levothyroxine then you are really looking at how the body is responding to t3 and t4

• tsh is RESPONDING to t3 and t4

what medications can levothyroxine CANNOT be taken with

Acid reflux medications, bile acid sequestrants, iron supplements, magnesium salts, calcium supplements

what are other considerations for levothyroxine

• do not eat before taking the medication at least 30-60 mins before a meal

• adjust warfarin effects (decrease)

• use catecholamines with caution

what is the treatment for hyperthyroidism

methimazole

what is the preferred in hyperthyroidism in pregancy

propylthiouracil

what is the therapeutic use of methimazole

first line for hyperthyrodism

• short and long term use

what is the MOA for methimazole?

reduces thyroid hormone (T3 and t4) by blocking peroxidase enzymes

3-12 weeks

what do you expect to see in a patient taking methimazole?

reduced nervous system energy, weight gain, reduced heart rate, and thyroid lab levels to normal ranges

what are the adverse effects of methimazole

• not safe during pregnancy

• agranulocytosis - report sore throat and fever should

  • monitor WBC <5000 leukopenia

  • can be treated with filgrastim

what is the overdose for methimazole

signs of low levels (can become hypothyroidism)

• bradycardia

• fatigue

• cold intolerance

• monitor t3 and t4 levels

What is the therapeutic use for hyperthyroidism - radioactive iodine

• hyperthyrodism

• lowe cost

• cheaper than surgery

• not lifelong

what is the MOA of radioactive iodine

• reduces thyroid hormone by destroying the thyroid tissues through gamma and beta radiation particles

  • the radioactive means it has a lot of energy. it kills of the the thyroid tissue

what are the adverse effects of radioactive iodine

• DELAYED hypothyroidism

• effects from radiation

  • neck swelling

  • swollen salivary gland

  • loss/change of taste

  • dry mouth, dry eyes, excessive tearing

  • may need to take precautions for exposure for love ones

• NOT SAFE IN PREGNANCY

adrenal disorders

what is the treatment for adrenal hormone deficiency

ADD adrenal hormones

• Hydrocortisone - DOC

  • serves both glucocorticoid and mineralocorticoid

• Fludrocortisone - mineralocorticoids

what is a consideration for the treatment of adrenal hormones

• times of stress- dose increase

• lifelong - dosing schedule should follow natural hormone release

what is a treatment for adrenal hormone excess

• cushing syndrome

• treat the cause

  • remove the adrenal glands