2024 NCMA213 PHARMA BSN ENDOCRINE MEDICATIONS

Thyroid Medications

1. Hypothyroidism

• Levothyroxine Na

  • Increases T3 and T4 hormone levels

  • Used as a replacement therapy

  • Side Effects:

    • Nausea/Vomiting

    • Diarrhea

    • Cramps

    • Tremors

    • Nervousness/Palpitation

    • Insomnia

    • Headache

    • Weight Loss

    • Tachycardia

    • Hypertension

    • Thyroid Crisis

2. Hyperthyroidism

• Antithyroid Drugs:

  • Propylthiouracil (PTU) & Metimazole (Tapazole)

    • Inhibit secretion of thyroid hormone

    • PTU also inhibits peripheral conversion of T4 to T3

    • Side Effects:

      • Hypothyroidism

      • Weakness

      • Rash

      • Nausea

      • Alopecia

      • Petechiae

      • Agranulocytosis

Glucocorticoids

• Common Drugs:

  • Prednisone, Dexamethasone

• Indications: Used to treat inflammatory conditions, allergies, various debilitating conditions

• Side Effects:

  • Hyperglycemia

  • Fat deposition (face & trunk)

  • Sodium and water retention

  • Glaucoma

  • Osteoporosis

  • Peptic ulcers

  • Growth retardation

Insulin

1. Insulin Types

2. Insulin Administration

• Insulin should be at room temperature before injection

• Roll the vial to redistribute insulin particles

• Inject air into the bottle

• Draw regular insulin first

• Administer at a 45 to 90° angle

• Rotate injection sites

• Store in room temperature, other vials in the refrigerator

3. Complications of Insulin Therapy

• Local allergic reactions

• Lipodystrophy

• Edema

• Hypoglycemia

Oral Hypoglycemic Agents

1. Classes & Actions

• Sulfonylureas: Stimulate beta cells to secrete insulin

  • 1st Gen: Chlorpropamide

  • 2nd Gen: Glipizide

• Biguanides: Increase tissue sensitivity and decrease glucose production by the liver

  • Example: Metformin

• Thiazolidinediones: Increase insulin action (e.g., Rosiglitazone)

• Alpha-Glucosidase Inhibitors: Delay digestion of carbohydrates

  • Example: Acarbose

2. Side Effects

• Common side effects across classes include: Hypoglycemia, gastrointestinal disturbances, and weight gain

Anti-Diuretic Hormones

1. Mechanism and Uses

• Enhance water reabsorption in kidneys

• Therapeutic Indications:

  • Hormonal replacement

  • Control hemorrhage in variceal bleeding

  • Treatment of enuresis

• Drugs: Desmopressin, Lypressin, Pitressin

2. Side Effects

• Flushing, headache, water intoxication, heart block, renal issues

Nursing Responsibilities for Thyroid Medication

1. Monitor weight and vital signs

2. Instruct daily medication intake at the same time without food

3. Monitor blood tests for thyroid activity

4. Report any signs of palpitations or chest pain

5. Avoid foods that inhibit thyroid secretion (e.g., cabbage, spinach)

Corticosteroid Therapy

1. Mechanism of Action

• Regulate metabolism and stress resistance

2. Side Effects

• Include hyperglycemia, immunosuppression, osteoporosis, and mood changes

Diabetes Mellitus Management

1. Pharmacologic Insulin

• Must give exogenous insulin in Type 1 Diabetes

• Type 2 can be managed with oral agents or injectable insulin

• Regular insulin can only be used intravenously

2. Oral Hypoglycemics

• Are not effective during pregnancy and comprise multiple classes to manage blood glucose levels.

3. General Considerations

• Monitor for hypoglycemia, avoid during pregnancy, and educate on managing diabetes effectively.

Reproductive Hormones

1. Types and Uses

• Estrogens and Progestins for females

• Androgens for males

• Clinical Uses: Hormonal replacement, contraception, and treatment of infertility

2. Side Effects

• Risks include thromboembolism, nausea, and headaches

Viagra (Sildenafil)

1. Indication & Mechanism

• Used for erectile dysfunction by inhibiting Phosphodiesterase E and increasing blood flow

2. Side Effects

• Include priapism, headache, and flushing