Endocrine/Diabetes Meds + Treatments

Somatropin

Treats dwarfism
Aka growth hormone

What do you need to monitor when giving somatropin

Glucose
Monthly growth

Octreotide + Bromocriptine

treats gigantism/acromegaly

Thyrotropin

treats TSH deficiency

Cosyntropin and Corticotropin

treats ACTH deficiency

Vasopressin, Desmopressin acetate (DDAVP)

Treats diabetes insipidus

What do you monitor when giving diabetes insipidus meds

Fluids (isotonic fluids and Lactated ringers)

Electrolytes

Demeclocycline, Conivaptan, and Tolvaptan

Treats SIADH

What else to do to treate SIADH

Restrict fluids

Give Hypertonic solution

Levothyroxine sodium (liotrix)

Treats hypothyroidism

Increases metabolism

Liothyronine

Treats hypothyroidism

Increases metabolism

Short acting

Used for myxedema coma (Increases the levels of T4)

Side effects of hypothyroidism meds

Nervousness, headache, insomnia, weight loss

Tremors, GI distress, tachycardia, hypertension

Dysrhythmias, palpitations, angina, thyroid crisis

Interactions of Hypothyroidism meds

May increase blood glucose and effects of anticoagulants

Decrease effects of digitalis

Bone loss and osteoporosis may occur

Prophylthiouracil (PTU) and Methimazole

Treats hyperthyroidism

Kills thyroid cell

Increases T3 hormone

Hyperthyroidism meds interaction side effects

Increases anticoagulants effects

Increases antidiabetics effects

Hyperthyroidism meds nursing considerations

Digoxin and lithium increases action

Give before thyroidectomy

Avoid shellfish (because iodine)

Sodium iodine, Potassium iodine, and Radioactive iodine

Treats hyperthyroidism

Kills overactive thyroid cells

Hyperthyroid management Surgery

Total or subtotal thyroidectomy (can’t send patient into surgery with hyper)

PTU administered prior to surgery until signs of hyperthyroidism have disappeared

We need to bring down metabolism (the medications) first before surgery and then we wean them off to let the

pituitary time to know that it needs to start regulation or else they would go into hypothyroidism

Dexamethosone

Treats symptoms of hyperthyroidism

Decreased inflammation

Beta blockers

Treats symptoms of hyperthyroidism

Slows HR

Calcium gluconate

Treats hypoparathyroidism

Ca replacement

Calcitrol

Treats hypoparathyroidism

Aka parathyroid hormone

Pamidronate, Alendronate, and Zolendronate

Treats hyperparathyroidism

Bone resorption of Ca

Short term

"Drone brings Ca back to the bone"

Calcitonin and Calcimimetic

Treats hyperparathyroidism

Stimulates parathyroid receptors

Long term

Other Hyperparathyroidism treatment

Partial or Full Parathyroidectomy

Bring down serum calcium

Glucocorticoids

Treats Addisons disease

Replace cortisol and aldosterone

Glucocorticoid Examples

Hydrocortisone

Prednisone

Dexamethasone

Glucocorticoids side effects

Tachycardia

HTN

Hyperglycemia

Edema

Glucocorticoids nursing considerations

Wean off

Monitor BS, sodium and water retention

Increase potency of ASA, NSAIDS (increased bleeding)

Increase K+ loss from diuretics

Mineralocorticoids

Treats Addisons disease

Mitronate

Treats Cushing syndrome by inhibiting glucocorticoid synthesis

What does mitrotane do

Decrease glucocorticoid synthesis

Insulin types

Rapid acting - clear

Short acting - clear

Intermediate acting - cloudy

Long acting

Insulin lispro, Insulin aspart, oral inhalation insulin

Examples of (Clear) Rapid acting insulin

Rapid acting insulin onset

5-15 mins

Rapid acting insulin peak

30-60 mins

Rapid acting insulin duration

2-4 hrs

Regular insulin

Example of short-acting insulin

Short acting insulin onset

30-60 mins

Short acting insulin peak

2-3 hrs

Short acting insulin duration

4-6 hrs

Insulin isophane (NPH)

Examples of (Cloudy) Intermediate acting insulin

Intermediate acting insulin onset

2-4 hrs

Intermediate acting insulin peak

4-12 hrs

Intermediate acting duration

16-20 hrs

Insulin glargine

Example of Long acting insulin

Long acting insulin onset

1 hr

Long acting insulin peak

No peak

Long acting insulin duration

24 hrs

When do you give long acting insulin

At bedtime

Insulin combinations

Short acting and intermediate OR Rapid acting and intermediate

NPH 70 and regular 30

NPH 50 and regular 50

How do you store insulin

In fridge until opened

Avoid direct sunlight and high temperatures

Sliding scale insulin

Adjusted dose based on individual glucose levels

Rapid or short acting used

When do you monitor blood glucose when pt is using sliding scale insulin

Before meals

Before bedtime

Side effects / adverse effects of insulin

Hypoglycemia

Insulin shock coma

Somagyi effect

Dawn phenomenon

DKA

Lipodystrophy

Hypoglycemia manifestations

Cool/clammy skin

Decreased LOC

Irritated behavior

Nervousness

Somogyi effect

Low blood glucose episode during nights causing glycogen release

Dawn phenomenon

Low blood glucose episode at night then high blood glucose episode in morning

DKA

Diabetic keto acidosis

A metabolic acidosis due to high ketones in the body

Only effects type 1 diabetes

Lipodystrophy

Scar tissue replacing subcutaneous fat due to repeated injection of insulin

Decreases insulin absorption

Use knuckle strategy

How often should insulin injection sites be changed

Every week

What insulin can be given IV

Only regular insulin can be given IV

What insulins are commonly used for sliding scale

Regular and lispro

What insulin do you draw up first when mixing

Clear (rapid acting)

Then cloudy second (intermediate acting)

What insulin do you never mix

Glargine (long acting)

Oral antidiabetics

Sulfaonylureas

Nonsulfonylureas/biguanide

Thiazolidinediones

Meglitinides

Sulfonylureas Examples

Glipizide

Glyburide

Glimepiride

What do sulfonylureas do

Treats type 2 DM

Stimulates pancreatic beta cells to secrete insulin

Increases tissue response to insulin

Decreases glucose production

Sulfonylureas side effects

Gi upset

Weight gain

Hypoglycemia

Nonsulfonylurea Examples

Metformin

What do nonsulfonylureas do

Decrease hepatic production of glucose from stored glycogen

Diminish increase in serum glucose after meals

Decrease glucose absorption from small intestine

Increase insulin receptor sensitivity

Nonsulfonylureas side effects

Hepatotoxicity

Nephrotoxicity

Dizziness

HA

Dyspepsia

Lactic Acidosis,

Metallic taste

What do you NOT have with nonsulfonylureas

Hypoglycemia

What do you need to do before giving nonsulfonylureas

Check liver function

Thiazolidinediones Examples

Pioglitazone

Rosiglitazone

What do thiazolidinediones do

Decrease insulin resistance

When is thiazolidinediones contraindicated on

Contraindicated in Class III and IV heart failure

Thiazolidinediones nursing consideration

Do not cause hypoglycemia

Make sure your doing good lung assessments and watch for SOB

Used in combination with another medication not usually alone

thiazolidinediones side effects

Headache

Dizziness

Blurred vision

Fluid retention

Weight gain

Pulmonary and peripheral edema

Meglitinides Examples

Relaglinide

Nateglinide

What do meglitinides do

Stimulate beta cells to release insulin

Short term acting

Meglitinides side effects

Hypoglycemia

Headache

Back pain

Diarrhea

Elevated hepatic enzymes

What are meglitinides contraindicated in

Liver dysfunction

Give an example of the treatment options for a hypoglycemic episode

Glucagon

Glucagon

Hyperglycemic hormone secreted by the alpha cells of the islets of Langerhans in the pancreas

Glucagon Action

Increase blood glucose by stimulating glycogenolysis in the liver

Glucagon Route

SQ, IM, and IV

Glucagon Use

Insulin-induced hypoglycemia when other methods are not available

Glucagon nursing considerations

Can give orange juice but make sure you know it contains Potassium or maybe even honey works (ANY SIMPLE CARB

WORKS), we can also give IV dextrose