Endocrine-Thyroid-Adrenal Gland Medications:

NSG 349

Levothyroxine (Synthroid)

Thyroid-replacement agent
Indication: Hypothyroidism, myxedema
MOA: Replacing what thyroid can’t produce
Contraindications: Allergy
Adverse Effects: Insomnia, HTN, Menstrual irregularities, dysrhythmias
Nursing Implication: IV for myxedema coma, monitor adverse effects + therapeutiic Effects

High Point —> Thyroid Replacement Agents

Cardiac dysrythmia, take in morning before breakfast

Prednisone

Gluco-Corticoids
Indication: any inflammatory condition
MOA: inhibit or control immune response
Contraindication: allergy, infections
Adverse Reaction: hyperglycemia, increased infection risk, Salt and water retention, poor wound healing, hirsutism
Nursing Implication: monitor blood glucose (increae blood sugar), interferes with wound healing

High Points for Gluco-corticoid

Increased risk for infection, interfers with wound healing, monitor glucose, NEVER STOP ABRUBTLY (could lead to adrenal crisis)

Metformin

Biguanides: long acting insulin for daily dosing or immediate acting
Indication: Type II diabetes
MOA: decreases production of glucose by liver
Contraindications: allergy, creatinine clearance less than 30ml/min

Adverse Effects: diarrhea, bloating, cramping, lactic acidosis, low b12 levels
Nursing Implications: monitor kidneys, cannot take within 48 hours of contrast dye (iodine) —> leads to renal failure

Januvia (Dipeptidyl Peptidase IV Inhibitors)

Indication: Type II Diabetes
MOA: inhbits breakdown of glucose
Contraindicatiion: allergy
Adverse Effects: hypoglycemia —> if combined with insulin
Nursing Implications: may be combo med (januvia + metformin)

High points for oral Anti-diabetic medications

Metformin —> first line, good kidneys
Lactic acidosis —> deadly

Insulin Lispro (humalog)

Rapid Acting Insulin
Indication: Type I + Type II diabetes, gestational diabetes
MOA: Restores ability to metabolize CHO, coverts glycogen to fat stores after a meal
Contraindications: drug allergy, hypoglycemia
Adverse Effects: hypoglycemia, weight gain
Nursing Implications: adverse effects (symptoms of hypoglycemia), works 15 mins after administration

Regular Insulin (Humulin R)

Short Acting Insulin

Indication: Type I + Type II diabetes, gestational diabetes
Contraindications: drug allergy, hypoglycemia
Adverse effects: hypoglycemia
Nursing Implications: only insulin that can be given IV
Onset: 30-60 mins
Peak: 2.5 hours
Duration of action: 6-10 hours

Insulin Isophane Suspension (NPH)

Intermediate Acting Insulin

Indication: Type I + Type II Diabetes
Contraindication: allergy
Adverse Effect: hypoglycemia
MOA: Keeps sugar level constant
Onset: 1-2 hours
Peak: 4-8 hours
Duration of action: 10-18 hours

Insulin Glargine (Lantus), Insulin detemir (levemir)

Long Acting Insulin
MOA: prolonged, consistent glucose level
Adverse Effects: less risk of hypoglycemia, lipodystrophy, weight gain
Onset: 1-2 hours
NO PEAK
Duration of action: 24 hours

Insulin High Point

Hypoglycemia, weight gain, ALWAYS Sub Q injection (unless regular insulin), always use Insulin syringe (units not ml)
NPH cloudy —> regular/rapid acting is clear —> regular before NPH —> clear before cloudy