Endocrine Drugs

Introduction

• The podcast lecture discusses drugs affecting the endocrine system, focusing on:

  • Drugs for diabetes

  • Thyroid medications

  • Corticosteroid drugs

• Encouragement to review lecture notes, ATI texts, and modules for examination preparation.

Drugs Affecting the Endocrine System

Diabetes Medications

General Information

• Mnemonic for Diabetes:

  • D: Diet, weight loss, exercise

  • I: Identifying (medication alert bracelet)

  • A: Alert (risk of hypoglycemia)

  • B: Blood sugar, hemoglobin A1C, urine glucose/ketones

  • E: Educate your patients on medications

  • T: Transcribe medication orders correctly

  • E: Educate on foot care, smoking, stress management

  • S: Signs of hyperglycemia and hypoglycemia

Hypoglycemia Signs and Symptoms

• Use the mnemonic TIRED:

  • T: Tremors

  • I: Irritability, Insomnia

  • R: Restlessness

  • E: Excessive hunger

  • D: Diaphoresis, drowsiness, difficult to concentrate

Hyperglycemia Signs and Symptoms

• Use the mnemonic FLUSHED:

  • F: Flushed skin, fruity breath odor

  • L: Listless, lethargic

  • U: Unusual thirst, increased urine output

  • S: Skin dry

  • H: Hyperventilating

  • E: Elevated respiratory rates, nausea/vomiting

  • D: Drowsiness, decreased appetite

Oral Hypoglycemics

• General Considerations:

  • Primarily administered to type 2 diabetics alongside diet and exercise.

  • Side effects are primarily hypoglycemia.

Specific Classifications

1. Sulfonylureas (e.g., Glyburide)

   • Mechanism: Stimulates insulin release from pancreatic beta cells, reduces hepatic glucose output, increases peripheral insulin sensitivity.

   • Contraindications: Type 1 diabetes, allergies to sulfonylureas.

   • Drug Interactions: Aspirin, alcohol, anticoagulants, etc.

   • Monitoring Requirements: Vital signs, BUN, serum creatinine, liver function, hemoglobin A1C.

   • Administration: Must be taken with food to avoid hypoglycemia.

2. Biguanides (e.g., Metformin/Glucophage)

   • Mechanism: Reduces glucose production in liver, increases uptake in muscles, reduces intestinal absorption.

   • Complications: Nausea, vomiting, diarrhea; potential for lactic acidosis.

   • Monitoring: Regular CBC, hemoglobin A1C; discontinued prior to iodine-based procedures.

   • Client Teaching: Adequate hydration, take with meals.

3. Insulin Sensitizers (e.g., Avandia)

   • Mechanism: Activates insulin receptor sites to lower serum glucose.

   • Side Effects: Headache, hypoglycemia, elevated liver enzymes.

   • Client Monitoring: Signs of anemia, glucose levels, liver function tests.

4. Alpha-Glucosidase Inhibitors (e.g., Precose)

   • Mechanism: Slows carbohydrate absorption.

   • Side Effects: GI symptoms, hepatotoxicity.

   • Monitoring: Serum glucose levels, liver function indicators.

5. Amylin Mimetics (e.g., Symlin)

   • Mechanism: Slows gastric emptying, controls postprandial hyperglycemia.

   • Adverse Effects: Gastrointestinal issues, hypoglycemia.

   • Administration: Injectable, caution regarding dosage.

6. Thiazolidinediones (e.g., Actos)

   • Mechanism: Increase insulin sensitivity and glucose uptake.

   • Adverse Effects: Fluid retention, liver failure, monitor liver function.

7. Meglitinides (e.g., Repaglinide)

   • Mechanism: Increases insulin secretion from pancreatic beta cells.

   • Instructions: Taken 30 minutes before meals.

8. DPP-IV Inhibitors (e.g., Sitagliptin/Januvia)

   • Mechanism: Inhibits enzyme leading to higher levels of incretin hormones.

   • Adverse Effects: Nausea, can lead to pancreatitis.

9. SGLT2 Inhibitors (e.g., Jardiance, Invokana)

   • Mechanism: Inhibits glucose reabsorption in kidneys, increases glucose excretion in urine.

   • Risks: Increased risk of UTIs, hypotension, and dehydration.

10. Dopamine Agonists (e.g., Cycloset)

    • Mechanism: Increases insulin sensitivity.

    • Side Effects: Dizziness, orthostatic hypotension.

Insulin Therapy

Types of Insulin

1. Rapid-Acting Insulins (e.g., Humalog, NovoLog)

   • Onset: 15-30 minutes

   • Peak: 30 minutes - 3 hours

   • Duration: 3-5 hours

2. Short-Acting Insulin (e.g., Humulin R, Novolin R)

   • Onset: 30 minutes - 1 hour

   • Peak: 2-4 hours

   • Duration: 4-12 hours

   • Administerable via: IV

3. Intermediate Insulin (e.g., NPH)

   • Onset: 1-2 hours

   • Peak: 4-14 hours

   • Duration: 14-24 hours

   • Appearance: Cloudy due to protamine.

4. Long-Acting Insulin (e.g., Lantus, Levemir)

   • Onset: 2-4 hours

   • Peak: Minimal (steady release benefits)

   • Duration: Up to 24 hours

5. Combination Insulins

   • Mixture of short-acting and intermediate insulins (e.g., Humulin 70/30).

Important Considerations for Insulin Therapy

• Patient education on administration techniques, monitoring blood glucose, understanding signs of hypoglycemia, and dietary management.

• Importance of compliance with testing and understanding indications for glucose adjustments.

• Use of medical alert bracelets and emergency glucose sources.

Thyroid Medications

Levothyroxine (Synthroid)

• Mechanism: Synthetic T4 hormone; increases metabolic rate.

• Dosage: Usually 1.6 mcg/kg/day; increases in small increments for elderly.

• Uses: Treat hypothyroidism, myxedema coma, suppress goiter and thyroid cancer.

• Administration: Take on an empty stomach with water, monitoring TSH and T4 levels.

• Adverse Effects: Potential for hyperthyroidism if overdosed; monitor for increased metabolic rate indications.

Thyroid Antagonists (e.g., Methimazole)

• Mechanism: Inhibits thyroid hormone synthesis; used for hyperthyroidism.

• Administration and Monitoring: Taken with food consistently; monitor for adverse effects such as agranulocytosis.

Corticosteroids

General Information

• Examples: Dexamethasone, hydrocortisone, prednisone.

• Uses: Treat adrenal insufficiencies, inflammatory conditions.

• Contraindications: Systemic fungal infections, hypertension, diabetes, ulcers.

• Monitoring: Signs of infection, hyperglycemia, GI bleeding; patient education on dosing and tapering.

Complementary Therapies

1. Saw Palmetto: For BPH, with side effects like headache; discontinue prior to surgery.

2. Valerian Root: Used for insomnia; may cause drowsiness; must be stopped before surgery.

3. St. John's Wort: For depression; potential interactions with medications.

4. Echinacea: Stimulates immune system, can cause anaphylaxis; monitor for fever.

5. Garlic: Lowers cholesterol, interacts with anticoagulants.

6. Ginger Root: For nausea; caution in pregnancy; interacts with NSAIDs and anticoagulants.

7. Melatonin: Treats insomnia; can cause grogginess.

8. Omega-3 Fatty Acids: Cardiac health benefits; may cause GI symptoms.

9. Ginkgo Biloba: Improves circulation; may increase bleeding risk.

10. Glucosamine: Joint health; can affect blood sugar levels.

Preparation for Test

• The exam will cover:

  • Oral and injectable antidiabetic agents

  • Insulin types

  • Thyroid medications

  • Complementary therapies

• Review the posted lecture notes and assigned ATI chapters for comprehensive understanding.