Thyroid, Adrenal, and Diabetic Agents

Hyperthyroidism

Graves disease (autoimmune), diarrhea, fatigue, tachycardia, palpitations, irritability, heat intolerance, nervousness, exophthalmos, thyroid storm

Hypothyroidism

Weight gain, hair loss, loss of stamina, edema, dullness of skin, fatigue, goiter, cold intolerance, constipation, myxedema crisis

Myxedema crisis

Thyroid replacement agents

Levothyroxine (Synthroid), liothyronine (Cytomel)

Thyroid replacement agents indications

Hypothyroidism, myxedema

Thyroid replacement agents MOA

Replace what the thyroid gland cannot produce, work in same way as endogenous T3 and T4

Thyroid replacement agents contraindications

Allergy

Thyroid replacement agents adverse effects

Insomnia, tachycardia, palpitations, HTN, N/D, HA, weight loss, heat intolerance, menstrual irregularities, dysrhythmias

Thyroid replacement agents nursing implications

Monitor for therapeutic response (Decrease in hypothyroidism symptoms), adverse reactions (usually due to overshooting and causing more hyperthyroid symptoms), IV for myxedema coma

Anti-thyroid agents

Radioactive Iodine (I-131), Methimazole (Tapazole), Propylthiouracil

Anti-thyroid agents indications

Hyperthyroidism (overproduction of thyroid hormones)

Anti-thyroid agents MOA

Inhibit incorporation of iodine molecules into the amino acid tyrosine which is needed to make T3 and T4

Anti-thyroid agents contraindications

Allergy, hypothyroidism

Anti-thyroid agents adverse effects

Liver toxicities

Anti-thyroid agents nursing implications

Monitor for therapeutic effect (improvement in hyperthyroid symptoms), adverse reactions, take same time each day, avoid foods high in iodine

Glucocorticoids

-sone/–son; Betamethasone, cortisone, dexamethasone, hydrocortisone, prednisone methylprednisolone

Glucocorticoids indications

Any inflammatory condition, COPD exacerbations, asthma, arthritis, rhinitis, sinusitis, meningitis, cerebral edema, collagen diseases, dermatitis, enteritis, post organ transplant

Glucocorticoids MOA

Inhibit or control inflammatory and immune response, stabilize lysosomal membranes, decrease permeability of capillaries to inflammatory cells, decrease migration of WBC to areas, also cause gluconeogenesis

Glucocorticoids contraindications

Allergy, infections

Glucocorticoids adverse effects

Hyperglycemia, salt and water retention, weight gain, electrolyte imbalance, increased infection risk, poor wound healing, menstrual irregularities, ulcers, loss of muscle mass, hirsutism, cushing syndrome

Glucocorticoids nursing implications

Monitor for therapeutic effects (decrease in inflammation), adverse effects, monitor blood glucose (will increase sugar), interferes with wound healing

Type I diabetes

Lack of insulin production or production of defective insulin due to destruction of Beta cells in pancreas

Type II diabetes

Insulin deficiency and Insulin resistance caused by decreased number of insulin receptors and/or insulin receptors that are less responsive to insulin

Gestational diabetes

Hyperglycemia that develops during pregnancy, may need exogenous insulin, usually subsides after pregnancy but increases risk of developing type II diabetes in the future, 30% of patients develop type II diabetes within 10-15 years

Hyperglycemia

Weakness, fatigue, polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased hunger), blurred vision

Hypoglycemia

Diaphoresis, pallor, shakiness, sleepiness, irritability, dizziness, confusion, lack of coordination, hunger

Long-term complications of diabetes

Nephropathy, neuropathy (autonomic and peripheral), diabetic retinopathy, stroke, MI, PAD

Oral anti-diabetic agents

Biguanides (metformin), sulfonylurea (SU), SGLT2 inhibitors (SGLT 2i), dipeptyl peptidase 4 inhibitors (DPP4i)/Gliptins

Biguanides

Metformin (Glucophage), long acting for daily dosing or immediate acting for BID dosing

Biguanides indications

Type II diabetes first line medication

Biguanides MOA

Decreases production of glucose by liver, decreases intestinal absorption of glucose, increases uptake of glucose by tissues (decreases insulin resistance), does not cause hypoglycemia

Biguanides contraindications

Allergy, creatinine clearance less than 30 ml/min

Biguanides adverse effects

Diarrhea, bloating, cramping, low Vit. B 12 levels (may need replacement), lactic acidosis

Biguanides nursing implications

Monitor for therapeutic effects (A1C <7%, fasting glucose 70-130), adverse effects, monitor kidneys, cannot take within 48 hours of contrast dye (because it contains iodine), will lead to renal failure and lactic acidosis, hold day of test and for 48 hours after test that requires contrast media

Sulfonylureas (SU)

Glipizide (Glucotrol), glyburide (Diabeta)

Sulfonylureas (SU) implications

Type II diabetes

Sulfonylureas (SU) MOA

Stimulate insulin secretion from beta cells of the pancreas

Sulfonylureas (SU) contraindications

Allergy, hypoglycemia or conditions that lead to hypoglycemia (ETOH abuse, NPO)

Sulfonylureas (SU) adverse effects

Hypoglycemia, weight gain

Sulfonylureas (SU) nursing implications

Monitor for therapeutic effects (A1C <7%, FBG 70-130), adverse effects (hypoglycemia), do not mix with insulin

Sodium glucose cotransporter inhibitors (SGLT2i)

-gliflozin, empagliflozin (Jardiance)

Sodium glucose cotransporter inhibitors (SGLT2i) indications

Type II diabetes

Sodium glucose cotransporter inhibitors (SGLT2i) MOA

Inhibit glucose reabsorption in the renal tubules

Sodium glucose cotransporter inhibitors (SGLT2i) contraindications

Allergy

Sodium glucose cotransporter inhibitors (SGLT2i) adverse effects

Genital yeast infections, UTI’s and increased urination

Sodium glucose cotransporter inhibitors (SGLT2i) nursing implications

Monitor for therapeutic effects, adverse effects (yeast infections)

Dipeptidyl peptidase IV inhibitors (DPP4i)

-Glipitin; Sitagliptin (Januvia), Linagliptin (Tradjenta)

Dipeptidyl peptidase IV inhibitors (DPP4i) indications

Type II diabetes

Dipeptidyl peptidase IV inhibitors (DPP4i) MOA

Inhibits breakdown of endogenous incretin hormones by inhibiting the enzyme DPP4 that works to break them down

Dipeptidyl peptidase IV inhibitors (DPP4i) contraindications

Allergy

Dipeptidyl peptidase IV inhibitors (DPP4i) adverse effects

Hypoglycemia if combined with SU or insulin

Dipeptidyl peptidase IV inhibitors (DPP4i) nursing implications

Monitor for therapeutic response (A1C <7%, FBG 70-130), adverse effect, may be in a combo medication: Janumet (Januvia and Metformin)

GLP-1 receptor agonists

Semaglutide (Ozempic, Wegovy), liraglutide (Victoza), dulaglutide (Trulicity)

GLP-1 receptor agonists indications

Type 2 Diabetes, weight management (some formulations)

GLP-1 receptor agonists MOA

Increased insulin secretion (only when glucose is high), decreased glucagon secretion, slows gastric emptying, increased satiety (leads to weight loss)

GLP-1 receptor agonists adverse effects

Nausea (most common), V/D, decreased appetite, pancreatitis, gallbladder disease

GLP-1 receptor agonists nursing implications

Monitor for GI side effects, signs of pancreatitis (severe abdominal pain), teach small meals to reduce nausea, weight loss is expected, usually injection (weekly or daily)

Basal insulin

Long acting or intermediate acting insulin, keeps glucose levels consistent throughout the day

Bolus insulin

Immediate acting or short acting, helps to control glucose spikes with meals

Types of insulin

Rapid-acting insulin, short-acting insulin, intermediate-acting insulin, fixed-combination insulin, long-acting insulin

Rapid-acting insulin

Insulin lispro (Humalog), insulin aspart (Novolog)

Rapid-acting insulin indications

Type I Diabetes, type II diabetes, gestational diabetes

Rapid-acting insulin MOA

Restores ability to metabolize CHO, stores glucose in liver, converts glycogen to fat stores after a meal

Rapid-acting insulin contraindications

Allergy, hypoglycemia

Rapid-acting insulin adverse effects

Hypoglycemia (especially if does not eat or only eats a small amount after administration), weight gain, lipodystrophy at site

Rapid-acting insulin nursing implications

Monitor for therapeutic effects, adverse effects (hypoglycemia), begins working 15 minutes after administration (when they may become hypoglycemic) onset: 15 minutes, peaks: 1-2 hr, duration of action: 3-5 hours

Short-acting insulin

Regular insulin (Humalin R, Novolin R)

Short-acting insulin indications

Type I diabetes, type II diabetes, gestational diabetes, DKA, HHNS – only regular insulin can be given IV

Short-acting insulin MOA

Restores ability to metabolize CHO, stores glucose in liver, converts glycogen to fat stores

Short-acting insulin contraindications

Allergy, hypoglycemia

Short-acting insulin adverse effects

Hypoglycemia (especially if does not eat – or only eats a small amount after administration)

Short-acting insulin nursing implications

Monitor for therapeutic effects, adverse effects (hypoglycemia), only insulin that can be given IV, onset: 30-60 minutes, peak: 2.5 hours, duration of action: 6-10 hours

Intermediate-acting insulin (NPH)

Insulin isophane suspension (NPH)

Intermediate-acting insulin (NPH) indications

Type I diabetes, type II diabetes

Intermediate-acting insulin (NPH) MOA

Restores ability to metabolize CHO, stores glucose in liver, converts glycogen to fat stores, intermediate acting helps to keep sugar levels constant

Intermediate-acting insulin (NPH) contraindications

Allergy, hypoglycemia

Intermediate-acting insulin (NPH) adverse effects

Hypoglycemia (especially if does not eat or only eats a small amount after admin)

Intermediate-acting insulin (NPH) nursing implications

Monitor for therapeutic effects, adverse effects (hypoglycemia), onset: 1-2 hours, peak: 4-8 hours, duration of action: 10-18 hours

Long-acting insulin

Insulin Glargine (Lantus), Insulin detemir (Levemir), QD, BID dosing

Long-acting insulin indications

Type I diabetes, type II diabetes, gestational diabetes

Long-acting insulin MOA

Restores ability to metabolize CHO, Stores glucose in liver, Converts glycogen to fat stores, helps to keep sugar levels constant, provides a prolonged, consistent blood glucose level

Long-acting insulin contraindications

Allergy, contraindications

Long-acting insulin adverse effects

Less risk of hypoglycemia, lipodystrophy, weight gain

Long-acting insulin nursing implications

Monitor for therapeutic effects, adverse effects, onset: 1-2 hours, no peak, duration of action: 24 hours