(8) Endocrine Lecture 4 Endocrine Meds

Pituitary Medications

• Cabergoline

  • Side effects: nausea, headache, constipation.

• Somatostatin analogs (e.g. octreotide)

  • Inhibit growth hormone secretion.

  • Side effects: nausea, diarrhea, abdominal pain, headache, injection site pain, hyper/hypoglycemia.

• Octreotide

  • Routes: subcutaneous or intramuscular injection.

  • Common side effects: nausea, cramps, diarrhea, flatulence.

  • Recommended to be injected at bedtime to minimize side effects.

• Lanreotide

  • Route: subcutaneous injection.

  • Side effects: abdominal pain, nausea, vomiting, diarrhea, flatulence, cholecystitis.

• Pegvisomant

  • Route: subcutaneous injection.

  • Side effects: nausea, diarrhea, liver injury, chest pain, flu-like symptoms.

  • Monitor blood sugar levels for hyper/hypoglycemia.

Growth Hormones

• Somatropin

  • Stimulates overall growth.

  • Used for treating growth hormone deficiencies.

  • Routes: intramuscular or subcutaneous.

  • Complications: hyperglycemia, hypercalcemia, renal calculi.

  • Monitor for polyphagia, polydipsia, polyuria, back pain, fever, diarrhea, and growth patterns.

Diabetes Insipidus Medications

• Vasopressin and Desmopressin

  • Both are synthetic ADH preparations promoting water reabsorption in kidneys.

  • Vasopressin: stimulates ADH action; used in CPR.

  • Desmopressin: less vasoconstriction; preferred for diabetes insipidus; available orally, intranasally, subcutaneously, intravenously.

  • Monitor for overhydration.

  • Contraindicated in coronary artery disease patients.

SIADH Medications

• Demeclocycline

  • A tetracycline derivative causing water diuresis; treats hyponatremia in SIADH.

  • Side effects: diarrhea, nausea, vomiting, changes in skin/mouth color, excessive thirst, frequent urination, weakness.

• Lithium Carbonate

  • Interferes with ADH action, causing polyuria.

Thyroid Medications

• Levothyroxine

  • Hormone replacement for hypothyroidism; used in emergency myxedema coma treatment.

  • Monitor Thyroid-stimulating Hormone (TSH) annually for potential overmedication.

  • Symptoms of hyperthyroidism indicate overmedication: anxiety, rapid heart rate, weight loss, etc.

• Thionamides (e.g. PTU, Methimazole)

  • Block T4 conversion into T3; treat Graves’ disease.

  • Side effects include serious conditions like agranulocytosis; monitor for sore throat, fever, fatigue.

• Radioactive Iodine

  • Destroys thyroid cells; used in thyroid cancer.

  • Risks: radiation sickness, bone marrow depression, hypothyroidism; maintain distance from others during treatment.

• Iodine Products (potassium/sodium iodide)

  • Reduce iodine uptake; side effects include metallic taste and rash; contraindicated with potassium-sparing diuretics or ACE inhibitors.

Parathyroid Medications

• Hyperparathyroidism Treatment

  • Surgical removal of abnormal tissue; monitor intake/output; furosemide to reduce serum calcium.

• Hypoparathyroidism Treatment

  • IV calcium gluconate/chloride administration; monitor magnesium levels; ECG monitoring advised.

Adrenal Medications

• Glucocorticoids (e.g. hydrocortisone, prednisone, dexamethasone)

  • Mimic steroid hormones; used for adrenal insufficiency (Addison’s disease).

  • Side effects: osteoporosis, adrenal suppression, GI discomfort, immunosuppression; monitor for infection.

• Fludrocortisone

  • Causes sodium and water retention; monitor for weight, blood pressure, potassium levels.

• Mitotane

  • Alters cortisol metabolism; used in Cushing's disease; caution in driving; monitor for side effects like nausea, lethargy.

Diabetes Mellitus

• Chronic disease due to deficient glucose metabolism; type 1 is insulin-dependent, type 2 is non-insulin-dependent.

• Insulin

  • Promotes glucose uptake; manufactured by DNA technology; classified by type (rapid, short, intermediate, long).

• Only regular insulin can be given IV mixed with normal saline. Sliding scales for hyperglycemia management; premixed insulins exist.

• Pramlintide

  • Subcutaneous adjunct to insulin therapy; decreases gastric emptying.

  • Nursing interventions include monitoring vitals, glucose levels, and patient education on self-care.

Oral Anti-diabetic Agents

• Refer to pages 1775-1776 for classifications and examples:

  • Sulfonylureas (e.g. glipizide, glyburide): lower blood glucose.

  • Meglitinides (e.g. repaglinide, nateglinide): stimulate insulin release.

  • Alpha-glucosidase inhibitors (e.g. acarbose, miglitol): delay carbohydrate absorption.

  • Thiazolidinediones (e.g. rosiglitazone, pioglitazone): increase insulin sensitivity.

  • Biguanides (e.g. metformin): reduce hepatic glucose production.

• Guidelines for oral diabetic therapy include specific patient criteria and conditions for use.