Endocrine Pharm Maps

What should you assess and verify before administering Insulin

Assess blood sugar; verify dose in syringe with another nurse

What are the signs and symptoms of hypoglycemia

Confusion, lethargy, tremors, diaphoretic

Insulin—reason for taking

All types of diabetes (mostly type 1)

Insulin—action

helps remove glucose from the bloodstream into the cells

Insulin—adverse reaction/side effects

Hypoglycemia

Insulin—contraindications

• vomiting and/or diarrhea

• Surgical patients (NPO)

• Low blood sugar (hypoglycemic)

Insulin—Rapid acting (name, onset, lasts)

• Insulin aspart (humalog) and Insulin lispro (Novolog)

• Onset: within 15 minutes, give right before a meal

• Lasts: 3-5 hours

Insulin—Short acting (name, onset, lasts)

• Regular insulin (Humulin R and Novolin R)

• Onset: 30 to 60 minutes

• Lasts 6-10 hours

Insulin—Intermediate (name, onset, lasts)

• NPH insulin (Humulin N)

• Onset: 1-2 hours

• Lasts: 10-18 hours

Insulin—Long acting (name, onset)

• Insulin detemir (Levemir) and Insulin giargine (Lantus)

• Onset 1-2 hours

What should patients taking insulin avoid

avoid sugars and starches

Symptoms of hypoglycemia

slow to respond, tremors, diaphoretic

What do you do if you suspect a patient is hypoglycemic

• If conscious—administer snack (protein, milk)

• If lethargic or NPO—give glucagon SQ or D50W IV

Metformin (Glucophage)—reason for taking

Diabetes

Metformin (Glucophage)—action

Decreases hepatic glucose production (stops the breakdown of glycogen in the liver)

Metformin (Glucophage)—Contraindications

Any procedures that use contrast (dye)

Metformin (Glucophage)—Adverse reactions/side effects

• Nausea

• Vomiting

• Diarrhea

When should you take Metformin (Glucophage)

On a regular schedule 3o minutes before meals

What is the importance of holding Metformin (Glucophage) if having a procedure that uses contrast (dye)

IV contrast slows GFR—increases metformin in blood stream—increase risk of lactic acidosis (because metformin blocks a certain enzyme from breaking down glucagon, blocking this enzyme also causes lactic acid buildup in the body)

Glucagon—reason for taking

hypoglycemia

Glucagon—action

Hormone that triggers the liver to break down glycogen into glucose

Glucagon—contraindications

Hyperglycemia

Glucagon—adverse reactions/side effects

• Nausea

• Vomiting

• Swelling (edema) at injection site

When would glucagon be given

• Hypoglycemia and cannot eat

• Unconscious

• NPO for procedure

• Seizure

Hypertonic solution (50% dextrose)—reason for taking

hypoglycemia

Hypertonic solution (50% dextrose)—action

Replaces sugar in the bloodstream

Hypertonic solution (50% dextrose)—contraindications

Hyperglycemia

Hypertonic solution (50% dextrose)—adverse reactions/side effects

Rebound hypoglycemia

When is Hypertonic solution (50% dextrose) used?

Emergency use for hypoglycemia (lethargic, unconscious, NPO)

How is Hypertonic solution (50% dextrose) given

• Pre-filled syringe

• Large bore IV

Glucocorticoid—drug names

• -solone

• Methylprednisolone (Solumedrol)

Glucocorticoid—reason for taking

• Inflammatory disorders

  • Asthma

  • COPD exacerbation

  • PNA

  • But also IBS or skin disorders

Glucocorticoid—action

• blocks the inflammatory response

• Inhibits certain proteins (leukocytes, etc.) that set off the inflammatory chain

Glucocorticoid—Contrindications

• Liver or renal disease (decreases metabolism or excretion)

• Diabetics (increases blood sugar)(steroids stop glucose being used up by muscle, sits in blood stream)

• Immunosuppressed (pts with current infection)

Glucocorticoid—Adverse reactions/side effects

• Edema d/t fluid retention

• High blood sugar or low potassium

• Weight gain—major concern for pts

• Jitteriness or shakiness

• immunosuppression

What should you avoid when taking Glucocorticoid

Live vaccines and alcohol

What should you teach your patient about Glucocorticoid

• Report leg cramps, edema to MD

• Avoid crowds or the sick (immunosuppression)

What should you take with Glucocorticoid

food or milk

Levothyroxine (Synthroid)—reason for taking

Hypothyroidism (usually caused by Hashimoto’s Disease

Levothyroxine (Synthroid)—Action

Replaces the hormone thyroxine (T4—main hormone of the thyroid gland) that the thyroid is unable to produce

Levothyroxine (Synthroid)—Contraindications

elevated T4 levels

Levothyroxine (Synthroid)—Adverse reactions/side effects

• Cardiac arrhythmias

  • chest pain

  • dyspnea

  • Palpitations

What levels do you monitor when taking Levothyroxine (Synthroid)

Routine TSH. T4, and T3 levels

How do you direct patients to take Levothyroxine (Synthroid)

• Take in the morning on an empty stomach or with full glass of water

• Do not interchange brands

• Avoid foods high in iodine (shellfish, table salts, dairy, green beans

• Never stop abruptly

How does the thyroid work

Butterfly shape, produces 3 hormones (T3, T4, calcitonin) used to regulate metabolism, growth, and development, and maintain temperature, mood, menstruation, etc.