Pharm Hormones (Endocrine) Meds

Define hormones.

Define steroids.

Define Corticosteroids.

Define Hyperglycemia

Higher than normal blood glucose levels caused by not enough insulin to help glucose enter cells.

Fasting blood glucose should be…

Less than 100 mg/dL, but not below 60 mg/dL.

What is A1C and what is the target range?

A1C is the average blood glucose level over several months. The range should be 4-6%. Diabetics should be at or below 7%.

Type I Diabetes Mellitus

An autoimmune disorder in which the pancreas does not produce insulin. The patient needs to take insulin for the rest of their life. Often diagnosed in childhood.

Type II diabetes mellitus

A disorder in which some insulin is produced, but less is produced over time. It does not bind well to receptors so there is a reduced response. This is known as insulin resistance. Often develops during adulthood.

Classic symptoms of diabetes:

Increased thirst, frequent urination, and excess hunger/eating.

Signs and symptoms of hypoglycemia

Headache, hunger, irritability, difficulty concentrating, nervousness, tremors, sweating, pale or clammy skin, tachycardia, and confusion.

Signs and symptoms of hyperglycemia (Early signs)

Frequent urination, increased thirst, dry mouth, blurred vision, fatigue, and headache.

Signs and symptoms of hyperglycemia (Late signs)

Fruity-smelling breath, abdominal pain, nausea/vomiting, shortness of breath, weakness, confusion, coma.

Define Gestational Diabetes

Occurs during pregnancy and puts the mother at risk for type II diabetes. Blood sugar usually returns to normal soon after delivery.

Describe the following information about insulin administration:

a. Route and timing of administration and method of measurement.

b. Meaning of “sliding scale.”

c. Identify when hypoglycemia is most likely to occur.

a. Time administration before meals so that the onset occurs when they are eating.

b. Sliding scale shows how many units of insulin to give for a blood glucose level. Each patient has their own unique scale.

c. Too much insulin, increased activity, skipping a meal, and illness.

Compare and contrast rapid acting, Short acting, Intermediate, And long acting insulin administration with onset, peak, and duration.

Rapid — 15 min onset and 30 min-3 hr peak.

Short-acting — 30 min onset and 2-4 hr peak.

Intermediate acting– 1.5-4 hr onset and 4-14 hr peak.

Long-acting — 2-4 hr onset and 6-12 hr peak.

Patients may experience hypoglycemia during the peak.

Describe a teaching plan for the diabetic patient and their family r/t insulin, Including adverse effect of hypoglycemia signs and symptoms.

Eat or drink something with real sugar for signs and symptoms of hypoglycemia.

Seek emergency treatment for signs and symptoms of ketoacidosis (Nausea, vomiting and changes in consciousness).

Insulin is good for 1 month at room temperature.

Gently roll insulin. Don’t shake.

More insulin needed when stressed or ill with an infection. Check more frequently.

Carry readily accessible source of sugar when experiencing signs and symptoms of hypoglycemia.

Maintain record of glucose levels to show provider.

Insulin lispro

Class: insulin

Use: Rapid acting: 15 min onset, 30 min-3hr peak.

Action: lowers glucose levels by moving glucose from blood to cells.

Adverse Reactions: Hypoglycemia, lipodystrophy, itching, swelling, erythema (red patches).

Implications: Insulin antagonists: oral contraceptives, corticosteroids, epinephrine, and thiazide diuretics.

Teaching: Avoid anabolic steroids, alcohol, and warfarin, which may increase effect of insulin (Hypoglycemia).

Insulin NPH, Humulin 70/30, NovoLog Mix 70/30

Class: Insulin

Use: Intermediate acting: 1.5-4 hr onset, 4-14 hr peak.

Action: Lowers glucose by moving glucose from blood to cells.

Adverse Reactions:

Implications:

Teaching:

Insulin regular, Humulin

Class: Insulin

Use: Short-acting: 30 min onset, 2-4 hr peak.

Action: Lowers glucose by moving glucose from blood to cells.

Adverse Reactions:

Implications:

Teaching:

Insulin detemir, insulin glargine

Class: Insulin

Use: Long-acting: 2-4 hr onset, 6-12 hr peak.

Action: Lowers glucose by moving glucose from blood to cells.

Adverse Reactions:

Implications: Typically given in the evenings.

Teaching:

glipizide

Class: sulfonylureas (insulin stimulator), first and second generation (non-insulin)

Use: Type II

Action: Lowers glucose by stimulating the release of insulin stored in the beta cells of the pancreas. Must have some functioning beta cells. Also improves the movement of glucose into cells by increasing the amount of receptors or enhancing the action of receptors.

Adverse Reactions: Hypoglycemia, secondary beta cell failure, liver damage, heartburn, nausea, vomiting, abdominal pain, diarrhea, photosensitivity.

Implications: take orally with a meal or no more than 15 minutes before.

Teaching: Skip dose if not eating.

metformin

Class: biguanides (non-insulin)

Use: Type II

Action: Reduces the amount of glucose released by the liver and reduces the rate the intestines absorb the glucose. Also improves how insulin binds to receptors. Not an insulin stimulator, so can’t cause hypoglycemia.

Adverse Reactions: kidney failure, nausea diarrhea, flatulence, weight loss, lactic acidosis.

Implications: Interacts with contrast dye (stop use for 24hrs before using dye and 48hrs after).

Teaching: Avoid alcohol to reduce chance of lactic acidosis.

prednisone

Class:

Use:

Action:

Adverse Reactions:

Implications:

Teaching:

fludrocortisone

Class:

Use:

Action:

Adverse Reactions:

Implications:

Teaching:

levothyroxine

Class:

Use:

Action:

Adverse Reactions:

Implications:

Teaching:

methimazole

Class:

Use:

Action:

Adverse Reactions:

Implications:

Teaching:

pioglitazone

Class: Insulin sensitizer (non-insulin)

Use: Type II

Action: Lower glucose by making insulin receptors more sensitive to insulin. Often used in combination with other meds.

Adverse Reactions: Hypoglycemia and severe cardiovascular side effects.

Implications: Interacts with antihypertensives. Watch for signs of heart failure: Weight gain, shortness of breath, tachycardia, and edema.

Teaching: