Pharm Exam 3 Review - Endocrine and Cardiovascular Medications

Pharm Exam 3 - Endocrine

DIABETES

Blood Glucose Modifiers
  • Lowers Blood Glucose:
    • Insulin
    • Metformin
    • Glipizide
    • Glyburide
  • Raises Blood Glucose:
    • Glucagon
INSULIN Types

  1. Rapid-Acting Insulin:

    • Examples:
      • Lispro (Humalog)
      • Aspart (Novolog)
    • Administration Routes: Subcutaneous (SubQ) or infusion pump
    • Onset: 5-15 minutes
    • Peak: 1-2 hours
    • Duration: 3-5 hours
    • Note: Must eat a meal after injection

  2. Short-Acting Insulin:

    • Example: Regular (Humulin R)
    • Administration Routes: Bolus, IV infusion, intramuscular (IM), subcutaneous
    • Onset: 30-60 minutes
    • Peak: 2.5 hours
    • Duration: 6-10 hours
    • IV Route: Immediate onset, duration of 2-6 hours

  3. Intermediate-Acting Insulin:

    • Example: NPH
    • Note: Cloudy, often combined with regular insulin
    • Onset: 1-2 hours
    • Peak: 4-8 hours
    • Duration: 10-18 hours

  4. Long-Acting Insulin:

    • Example: Glargine (Lantus)
    • Characteristics: Clear, colorless, provides a constant level of insulin (basal insulin)
    • Administration: Usually once daily, can be given every 12 hours
    • Onset: 1-2 hours
    • Peak: None
    • Duration: 24 hours
Nursing Implications for All Insulins
  • Check blood glucose before administration
  • Roll vials, do not shake
  • Administer at room temperature
  • Refrigerate unopened vials
  • Opened vials can be stored at room temperature for 28 days
  • Mixing Insulin Procedure:
    1. Inject air into NPH vial
    2. Inject air into regular insulin vial
    3. Draw up regular insulin
    4. Draw up NPH insulin
METFORMIN
  • Indication: Type 2 diabetes
  • Interactions:
    • Iodinated radiologic contrast can lead to acute renal failure and lactic acidosis
    • Recommendation: Discontinue the day of the test for at least 48 hours
GLIPIZIDE
  • Class: Sulfonylureas
  • Mechanism: Stimulates insulin secretion from beta cells of pancreas, improves tissue sensitivity to insulin
  • Patient Teaching:
    • Take 30 minutes before the first meal of the day
    • Avoid alcohol to prevent disulfiram-like reactions (nausea, palpitations, flushing, hypoglycemia)
  • Interactions:
    • Cross allergy with sulfa drugs
GLYBURIDE
  • Class: Sulfonylureas
  • Note: Similar to Glipizide
  • Interactions:
    • Alcohol
    • Cross allergy with sulfa drugs
  • Characteristics: Longer duration than Glipizide but higher risk of hypoglycemia
GLUCAGON
  • Indication for use: Treatment of hypoglycemia caused by insulin overdose, omitting meals, vomiting, over-exercise, or alcohol intake.
  • Early Signs of Hypoglycemia:
    • Sympathetic stimulation, increased epinephrine (inhibits insulin)
    • Symptoms include shakiness, irritability, tachycardia, hunger, pale skin, paresthesia
  • Later Signs of Hypoglycemia:
    • Risks include headache, slurred speech, blurry vision, confusion, lethargy, coma, seizure, and death
  • Treatment Protocols:
    • Treatment depends more on symptoms than blood glucose levels
    • For Mild Cases: Higher protein and lower carbohydrates
    • Drugs:
    1. Oral forms of concentrated glucose (e.g., buccal tablets, semisolid gel)
    2. Glucagon 1 mg IM if there is no IV access
    3. 50% Dextrose IV if the patient is not alert enough to drink
    • Notes: Avoid foods high in carbohydrates
    • Wear medical alert bracelet
THYROID DRUGS
  1. Hypothyroidism Treatment:
    • Example: Levothyroxine
  2. Hyperthyroidism Treatment:
    • Example: Propylthiouracil (PTU)
LEVOTHYROXINE
  • Description: Synthetic thyroid hormone
  • Adverse Effects:
    • Dysrhythmias, tachycardia, palpitations, angina
    • Hypertension, tremors, anxiety, diarrhea, fever, insomnia, headache, nausea, weight loss, sweating, heat intolerance, menstrual irregularities
  • Interactions: Avoid taking with cold medicine, asthma medicine, decongestants
PROPYL THIOURACIL (PTU)
  • Mechanism of Action:
    • Inhibits incorporation of iodine into tyrosine
    • Impedes formation of thyroid hormones (TH)
    • Inhibits conversion of T4 to T3
  • Adverse Effects:
    • Liver and bone marrow toxicity
    • Agranulocytosis, aplastic anemia, may induce hypothyroidism
  • Interactions:
    • Increases activity of anticoagulants
    • Requires adjustments in doses of hypoglycemic medications and serum digoxin levels during concurrent administration
  • Patient Teaching:
    • Short half-life: take every 8 hours for best effect
    • Treatment takes 2 weeks for improved symptoms
    • Teratogenic potential; take with food at the same time each day; do not stop abruptly

Pharm Exam 3 - Endocrine (Continued)

ADRENAL HORMONES

Glucocorticoids and Mineralocorticoids
  • Glucocorticoids:
    • Example: Hydrocortisone
  • Mineralocorticoids:
    • Example: Fludrocortisone
GLUCOCORTICOIDS
  • Forms: Topical, systemic, inhaled, nasal
  • Function: Regulates metabolism
  • Patient Teaching:
    • Caution with gastritis, reflux, ulcers, diabetes, renal, cardiac, or liver disease
    • Never stop abruptly due to adrenal suppression; it can lead to adrenal crisis
  • Adverse Effects:
    • Cardiac: heart failure, edema, HTN due to electrolyte imbalance (hypokalemia, hypernatremia)
    • CNS: Convulsions, headache, vertigo, mood swings, nervousness, insomnia
    • Integumentary: Fragile skin, petechiae, facial erythema, ecchymosis, poor wound healing, hirsutism, urticaria
    • Musculoskeletal: Loss of muscle mass, muscle weakness, osteoporosis
    • Ocular: Increased intraocular pressure, glaucoma, cataracts
    • Other: Weight gain
HYDROCORTISONE
  • Type: Glucocorticoid
  • Function: Regulates metabolism, inhibits inflammatory and immune responses
FLUDROCORTISONE
  • Uses: Addison's disease
  • Adverse Effects:
    • Water retention, heart failure, hypertension, increased intracerebral pressure, skin rash, peptic ulcer, hyperglycemia, hypokalemia, muscle pain, weakness, and compression fractures
    • Excessive amounts lead to Cushing's syndrome
  • Patient Teaching:
    • Take with food or milk
    • Watch for high sodium levels; may have an additive effect with potassium-wasting diuretics
    • Monitor for hypertension
ANTIDIURETIC HORMONE
  • Example: Desmopressin
  • Function: Replaces ADH for diabetes insipidus treatment
  • Properties: Potent vasoconstrictor with intrinsic platelet-activating properties; treats hemophilia A and von Willebrand disease
  • Mechanism of Action: Mimics ADH action by increasing water absorption in distal tubules, concentrating urine, and reducing water excretion by up to 90%
  • Adverse Effects:
    • Water intoxication; notify healthcare provider of weight gain of 2 lbs in 1 day or 5 lbs in 1 week
  • Therapeutic Evaluation: Should reduce thirst and urinary output

Pharm Exam 3 - Cardiovascular

BP MEDS

RAAS Modulators and Sympathetic Blockers
  • ACE Inhibitors:
    • Example: -pril class drugs
  • Beta Blockers:
    • Example: Carvedilol, Clonidine, Doxazosin
ACE INHIBITORS
  • Function: Inhibits ACE (renin-angiotensin-aldosterone system, RAAS)
  • Indications:
    • Hypertension
    • Heart failure
    • Cardiac and renal protective
  • Adverse Effects:
    • Fatigue, headache, dizziness, dry cough, metallic taste, hyperkalemia, neutropenia, angioedema (may be fatal), hypotensive effect
BETA BLOCKERS
  • Indications:
    • For angina, myocardial infarction (MI), hypertension, dysrhythmias
  • Nursing Implications:
    • Hold for heart rate <60 BPM or blood pressure <90/60 mmHg
    • Taper dosage slowly to avoid withdrawal effects
  • Patient Teaching:
    • Take with food at the same time every day and educate how to monitor pulse
  • Adverse Effects:
    • Bradycardia, hypotension, heart failure, rebound hypertension
CARVEDILOL
  • Type: Dual action alpha-1 and beta receptor blocker
  • Indications:
    • Hypertension, mild to moderate heart failure in conjunction with digoxin, diuretics, ACE inhibitors
  • Contraindications:
    • Known allergy, cardiogenic shock, severe bradycardia, heart failure, bronchospastic conditions (asthma), and conduction issues
CLONIDINE
  • Type: Alpha-2 receptor agonist
  • Function: Lowers blood pressure and heart rate
  • Patient Teaching:
    • Available in several forms, including a topical patch
    • Taper slowly to prevent rebound hypertension crisis
  • Adverse Effects:
    • Orthostatic hypotension, dizziness, fatigue, xerostomia (dry mouth)
    • Caution with hazardous activities due to risk of hypotension and syncope
DOXAZOSIN
  • Type: Alpha-1 receptor blocker (-zosin)
  • Mechanism: Blocks alpha-1 receptors resulting in venous and arterial dilation
  • Adverse Effects:
    • Orthostatic hypotension, reflex tachycardia, frequent headaches, dizziness

HEART FUNCTION MEDS

DIGOXIN
  • Type: Cardiac glycoside used in heart failure and to control ventricular response to atrial fibrillation
  • Mechanism:
    • Positive inotropic effect (increases contractility)
    • Negative chronotropic effect (decreases heart rate)
    • Negative dromotropic effect (decreases conduction speed)
  • Adverse Effects:
    • Cardiac: Dysrhythmia, bradycardia or tachycardia
    • CNS: Headache, fatigue, malaise, confusion, convulsions
    • Eyes: Colored vision (seeing green, yellow, purple), halo vision, flickering lights
    • GI: Anorexia, nausea/vomiting, diarrhea
  • Patient Teaching:
    • Avoid high fiber foods as they can affect absorption
    • Hold medication if heart rate is <60 BPM
VASODILATION MEDS
NITRATES
  • Use: Treatment for angina
  • Mechanism of Action: Potent vasodilation to relieve myocardial ischemia
  • Emergency Treatment for Angina:
    1. Place the patient in an upright position
    2. Check pulse and respiratory rate
    3. Administer oxygen if needed
    4. Order of Nitroglycerin administration:
    • Rest first
    • Sublingual nitroglycerin - wait for it to dissolve, do not chew or swallow
    • After 5 minutes, if pain persists, take a second dose, and call EMS if still in pain after a third dose taken after another 5 minutes
  • Nursing Implications/Patient Teaching:
    • Caution with hypotension
    • A burning sensation with sublingual forms indicates potency
    • Potency lost 3 months after opening; store in airtight, dark glass bottle with a metal cap
    • Special tubing needed for IV forms; discard parenteral solutions that are blue, green, or dark red

EMERGENCY/CARDIAC SUPPORT MEDS

EPINEPHRINE
  • Type: Adrenergic agonist
  • Function: Mimics effects of sympathetic nervous system neurotransmitters (catecholamines)
  • Indications: Emergency situations, cardiac and respiratory support
DOPAMINE
  • Type: Adrenergic agonist
  • Function: Mimics sympathetic neurotransmitters
  • Mechanism:
    • Low doses dilate blood vessels in the brain, heart, kidneys, and mesentery, increasing blood flow to these areas
    • High doses lead to vasoconstriction (alpha-1 adrenergic receptor activity)

Pharm Exam 3 - Cardiovascular (Continued)

DIURETICS

LOOP DIURETICS
  • Class: -semide
  • Effects:
    • Potent diuresis leading to rapid loss of fluid
    • Reduces fluid volume affecting blood pressure and systemic vascular resistance
    • Causes potassium and sodium depletion
  • Indications:
    • Edema associated with heart failure, renal, or hepatic disease
    • Controls hypertension
    • Promotes renal excretion of calcium in hypercalcemia
    • Useful in heart failure from diastolic dysfunction
  • Interactions:
    • Contraindicated with sulfa drugs but acceptable in most cases; caution with neurotoxic, nephrotoxic agents, NSAIDs
  • Adverse Effects:
    • CNS: Dizziness, headache, tinnitus, blurred vision, photosensitivity
    • GI: Nausea/Vomiting, diarrhea
    • Integumentary: Steven-Johnson syndrome (with torsemide)
    • Hematologic: Agranulocytosis, neutropenia, thrombocytopenia
    • Metabolic: Hypokalemia, hyperglycemia, hyperuricemia
SPIRONOLACTONE
  • Class: Potassium-sparing diuretic, aldosterone antagonist
  • Adverse Effects:
    • CNS: Dizziness, headache
    • GI: Cramps, nausea/vomiting, diarrhea, gynecomastia, amenorrhea, irregular menses, postmenopausal bleeding, testicular atrophy
  • Patient Teaching:
    • Do not take with NSAIDs
    • Be alert for signs of hyperkalemia (high potassium levels)

ANTICOAGULATION + BLEEDING MEDS

Anticoagulants
  • Prevent Clots:
    • Heparin
    • Warfarin
    • Rivaroxaban
  • Stop Bleeding Drugs:
    • Aminocaproic acid
HEPARIN
  • Indications: Prevent clot formation for unstable angina, atrial fibrillation, indwelling devices, major orthopedic surgery
  • Adverse Effects:
    • Hematuria, melena, petechiae, ecchymosis, bleeding at gums/mucous membranes
    • Heparin-induced thrombocytopenia/thromboembolic (HITT)
  • Antidote: IV protamine sulfate
  • Monitoring Labs:
    • aPTT/Anti Xa levels
  • Patient Teaching:
    • Mild bruising and redness at injection site are normal
    • Avoid aspirin and NSAIDs
    • Watch for signs of occult bleeding
    • Regular lab testing is essential
    • Medical alert bracelet is recommended
WARFARIN
  • Antidote: Vitamin K (phytonadione)
  • Monitoring Labs:
    • PT/INR levels
    • Normal INR = 1; therapeutic INR with warfarin is between 2-3.5
  • Indications: Prevent clot formation
  • Adverse Effects: Life-threatening bleeding
ATORVASTATIN
  • Class: HMG-CoA reductase inhibitor
  • Function: Potent LDL reducer; used by the liver to produce lipids
  • Adverse Effects:
    • GI: Nausea/Vomiting, cramping
    • Thrombocytopenia, risk of anaphylaxis
  • Administration: Dilute and give over 30 minutes
RIVAROXABAN
  • Type: Selective Factor Xa inhibitor
  • Indications: Treats blood clots, stroke prevention in A-fib, post-operative clot prevention in hip and knee
  • Adverse Effects:
    • GI disturbance, rash, headache, myopathy, rhabdomyolysis (monitor CPK levels)
    • Elevated liver enzymes or liver disease contraindicates use
  • Patient Teaching:
    • Black Box Warning regarding spinal hematomas and thrombosis risk
    • Do not administer with other anticoagulants
    • Be aware of insurance issues since it is a newer drug
AMINOCAPROIC ACID
  • Type: Thrombolytic reversal agent
  • Function: Helps clot and control bleeding
  • Patient Monitoring: Report signs of toxicity (muscle soreness or changes in urine color) indicating potential rhabdomyolysis; risk of bleeding increases when taken with anticoagulants
  • Dietary Considerations: Avoid grapefruit juice
ATROPINE
  • Function: Inhibits the action of ACh in the parasympathetic nervous system
  • Indication: Symptomatic bradycardia, 2nd degree AV block
  • Use: Antidote for anticholinesterase inhibitor toxicity or poisoning

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