2024 NCMA213 PHARMA BSN ENDOCRINE MEDICATIONS

HYPOTHYROIDISM

ENDOCRINE DRUGS NCMA213 PHARMA BSN 1ST SEM 2024-2025 DR SONNIE P TALAVERA

  • Levothyroxine Na

    • Increases T3 and T4 levels

    • Used as replacement therapy

    • Side Effects: nausea, vomiting, diarrhea, cramps, tremors, nervousness, palpitations, insomnia, headache, weight loss, tachycardia, hypertension, and potential thyroid crisis

HYPERTHYROIDISM

  • Anti-Thyroid Drugs: Propylthiouracil (PTU) & Methimazole (Tapazole)

    • Inhibit secretion of thyroid hormone

    • PTU also inhibits the peripheral conversion of T4 to T3

    • Side Effects: hypothyroidism, weakness, rash, nausea, alopecia, petechiae, agranulocytosis

GLUCOCORTICOIDS

  • Prednisone, Dexamethasone

    • Used to treat various diseases, including inflammatory conditions and allergies

    • Side Effects: hyperglycemia, fat deposition in face/trunk, sodium and water retention, glaucoma, osteoporosis, peptic ulcer, growth retardation

INSULIN

  • Types and Administration:

    • Types:

      • Rapid-acting (Humalog): Onset 5 min, Peak 30-60 min, Duration 2-4 hrs

      • Short-acting (Regular, Humulin R): Onset 30-60 min, Peak 2-4 hrs, Duration 6-8 hrs

      • Intermediate-acting (NPH, Humulin N, Lente): Onset 1-2 hrs, Peak 6-12 hrs, Duration 18-24 hrs

    • Administration Guidelines:

      • Insulin should be at room temperature before injection

      • Roll vial to redistribute insulin

      • Inject air into vial, draw regular insulin first

      • Store opened vials at room temperature, others in fridge

COMPLICATIONS OF INSULIN THERAPY

  • Local allergic reactions

  • Lipodystrophy

  • Edema

  • Hypoglycemia

ORAL HYPOGLYCEMIC AGENTS

  • Classes and Actions:

    • 1st Generation Sulfonylureas (e.g., Chlorpropamide): Stimulate insulin production; side effects include hypoglycemia and weight gain

    • 2nd Generation Sulfonylureas (e.g., Glipizide): Increase tissue sensitivity and decrease liver glucose production

    • Biguanides (e.g., Metformin): Increased tissue sensitivity, decreased hepatic glucose production, and gastrointestinal side effects

    • Thiazolidinediones (e.g., Rosiglitazone): Increase insulin action at receptors; caution with other agents

    • Alpha-glucosidase inhibitors (e.g., Acarbose): Delay digestion of carbohydrates; side effects involve gastrointestinal discomfort

ANTI-DIURETIC HORMONES

  • Mechanism:

    • Enhance water reabsorption in the kidneys

    • Increase water permeability in renal collecting ducts

    • Stimulate vasoconstriction, increasing blood pressure

  • Side Effects: flushing, headache, water intoxication, cardiovascular issues, and renal effects

  • Medications Used in Diabetes Insipidus:

    • Desmopressin, Lypressin (intranasal)

    • Pitressin (intramuscular)

THYROID MEDICATIONS

  • Levothyroxine (Synthroid), Liothyronine (Cytomel), etc.:

    • Used to treat hypothyroidism, replacing hormonal deficits

    • Actions: Increase metabolic rate; enhance O2 consumption and heart rate

    • Side Effects: nausea, vomiting, signs of increased metabolism (tachycardia, hypertension)

    • Nursing Responsibilities: Monitor vital signs, instruct consistent daily intake without food, and educate about avoiding foods that inhibit thyroid secretions

STEROID MEDICATIONS

  • Corticosteroids:

    • Examples include Cortisol, Prednisone; used for anti-inflammatory effects

    • Side Effects: Hyperglycemia, increased infection risk, osteoporosis, and growth retardation for high-dose treatments

CLINICAL NOTES FOR STEROIDS

  • Monitor vital signs, electrolytes, weight

  • Ensure medications are taken with meals to prevent gastric irritation

  • Taper drugs gradually to allow adrenal recovery

DIABETES MELLITUS MANAGEMENT

  • Insulin Therapy:

    • Type 1 requires lifelong exogenous insulin

    • Type 2 may utilize oral agents to stimulate insulin production, especially if insulin resistance is present

  • Pharmacological insulin categories: based on onset, duration, and source

    • Only regular insulin can be administered intravenously

ORAL HYPOGLYCEMIC AGENTS

  • General Considerations:

    • Monitor for hypoglycemia, allergic reactions; educate to take medications consistently

    • Never use these medications during pregnancy

REPRODUCTIVE HORMONES

  • Indications for use: Hormonal replacement, menstrual regulation, treatment of infertility

  • Types of agents: Estrogens, Progestins, Androgens, Oral contraceptives

    • Oral contraceptives: Inhibit ovulation, regulate menstrual cycles, with various potential side effects including thromboembolic risks

CLINICAL CONSIDERATIONS FOR REPRODUCTIVE HORMONES

  • Assess for risk factors, teach about the side effects, and the importance of compliance