ENDOCRINE DISORDER MEDS

LEVOTHYROXINE

• thyroid replacement / therapeutic use → hypothyroidism 

• you can OVERSHOOT (give too much of this med and bringing the levels too high) and can cause thyrotoxicosis (too much thyroid T4 & T3), hyperthyroidism (overactive thyroid, speeds up)

• and eventually cause tachycardia

• monitor thyroid function - labs every 6 - 8 weeks

• monitor signs/symptoms of hyperthyroid (losing weight, sweating a lot, feeling palpitations) → means you’ve overdone and need to adjust dosing

• take in the morning on empty stomach (30 mins before breakfast at LEAST) → for max absorption

• TAPER → (if they stop abruptly, they could have a rebound effect) → if you want to stop, reach out to provider FIRST

• formulations are not interchangeable (can’t switch from brand med to genetic med - don’t change types)

• STORY →  roxine

PROPYLTHIOURACIL or PTU

• antithyroid drug / therapeutic use → hyperthyroidism (grave’s disease)

• risk of OVERSHOOTING → can cause hypothyroidism

• can cause agranulocytosis → not making enough cells to take care of regular infection

• REPORT FEVER & SORE THROAT → IMPORTANT and then check CBC

• monitor thyroid function (labs every 6 - 8 weeks)

• TAPER → could have rebound, and then get into thyroid storm

• take every 8h → short half life

• can take 3 - 12 weeks to normalize / see improvement 

• get a good history (taking anything else? radiation?) and then see how to teach then about agranulocytosis 

• STORY → 

IODINE - radioactive iodine

• most often administered in hospital - strong but can also take in outpatient (be careful who you’re around after taking this medication at home)

• can cause hypothyroidism (OVERSHOOT)

• can cause bone marrow depression (RARE)

• can cause radiation sickness (RARE)

• limit exposure to others (radiation) especially CHILDREN & PREGNANT women after taking this med (sweat, saliva, sharing food) - 6 ft away

• after 3 weeks, its safe to be around

• report bloody nose

• report signs/symptoms of agranulocytosis (high risk for infection)

• DO NOT give other antithyroid → it reduces uptake, its not gonna take as much iodine

• takes 2 - 3 weeks for it to respond and see improvement

• STORY → 

HYDROCORTISONE

• can cause adrenal insufficiency (if you give a lot, you can tamp down the body’s ability to do it itself)

• can cause cushing’s syndrome (OVERSHOOT → too much = hypo state, addison’s & too much = hyper state)

• both are RARE is doses are titrated well

• avoid live vaccines → because immunosuppression

• monitor weight changes

• minimize carbohydrates → more complex carbs, proteins & fats to slow down absorption

• avoid birth control → if large dosing

• avoid phenobarb → if large dosing (manages seizures)

• STORY →

FLUDROCORTISONE

• can cause hypokalemia (hypo K) → report weakness or heart changes, check BP

• monitor fluid/electrolyte imbalance

• report weight gain → could indicate big fluid imbalance

• take with milk

• TAPER

• avoid potassium depleting diuretics (brosmide)

• STORY → 

GLIPIZIDE  

• hypoglycemia (safety alert)

• monitors for signs/symptoms of hypoglycemia 

• always cary snacks 

• if feeling hypoglycemic check blood glucose

• take orally 30 mins prior to meals 

• AVOID alcohol → may experience nausea, vomiting, palpitations, flushing 

• STORY →

REPAGLINIDE

• hypoglycemia (safety alert)

• monitor signs/symptoms of hypoglycemia 

• if feeling hypoglycemic, check blood glucose

• take orally 30 MINS OR LESS PRIOR TO MEALS (fast acting) - dont take med until you have food stray in front of you 

METFORMIN

• metallic taste

• vitamin deficiencies → folic acid & B12

• monitor for lactic acidosis

• AVOID alcohol

• report weakness, hperventilation

• take TWICE a day am/pm

• if ER form, take ONCE a day → dont chew pr crush

• CONTRAST must stop 2 days before procedure and DO NOT resume until 48 hr after

• STORY →

PIOGLITAZONE

• fluid retention

• hepatotoxicity → increased serum lipid levels

• monitor serum lipids/triglycerides

• can be given in combination with metformin, sulfonylureas or insulin

• STORY → 

SITAGLIPTIN

• upper respiratory infection

• pancreatitis

• Steven Johnson Syndrome (rare)

• angioedema → STOP if swelling of head, neck, throat

• monitors for respiratory infection

• report signs/symptoms of pancreatitis 

• STORY → 

SEMAGLUTIDE (ozempic)

• hypoglycemia 

• pancreatitis 

• STORY → 

GLUCAGON 

• nausea/vomiting → very common

• headache 

• rotate unconscious patients

• put on side if vomiting 

• STORY → 

INSULIN - injectable hypoglycemics

• can cause hypoglycemia (IMPORTANT)

• hypo K

• plan meals and snacks based on onset/peaks

• rotate sides !!

• STORY →

LISPRO

• rapid acting

• used to correct elevated blood glucose

• used to cover snacks or meals

• make sure food is present

REGULAR

• short acting

• clear appearance

• can be mixed with intermediate acting

• onset is around 30 min

• most appropiate for DKA →

• IV insulin is always regular insulin

NPH

• intermediate acting

• cloudy appearance

• can be mixed with short acting

• peak is 2 - 4 hr → often around 8 hr

• plan snacks according to peak

GLARGINE

• long acting 

• can last 24 hr 

• no defined peak

• is not mixed with others