Endocrine Drugs - Week 8

Week 8: Endocrine Drugs

Introduction

Week 8 focuses on endocrine drugs, particularly those related to the pancreas and hormones like insulin and glucagon.
Quote from Baroon Sharma highlights the connection between diabetes, hypertension, and kidney failure, a topic to be discussed later.
Etiquette reminder: Keep microphones muted when not speaking and raise hands to ask questions to minimize chaos and confusion.

Dosage Calculation Warm-Up

Converting 2252 to Standard Time: 10:52 PM (including the colon and AM/PM).
Converting 8:41 PM to military time: 2041 (no colon or AM/PM needed).
Metric conversion:
- 3.7g to milligrams: 3700 milligrams (multiply by 1000).
- 120 micrograms to milligrams: 0.12 milligrams (divide by 1000).
Household conversions:
- 12 teaspoons to ounces: 2 oz (12 tsp * 5 mL/tsp = 60 mL, then 60 mL / 30 mL/oz = 2 oz).
- 4. 5 cups to ounces: 36 oz (4.5 cups * 8 oz/cup = 36 oz).
Weight conversion:
- 7 lbs to kilograms: 20.3 kg (44.7 lbs / 2.2 = 20.318… rounded to 20.3).
- 7 lbs 3 oz to kilograms: 3.3 kg (3 oz / 16 oz/lb = 0.1875 lbs, 7.1875 lbs / 2.2 = 3.26… rounded to 3.3).

Drug Label Review

Brand name: Real Met.
Generic name: Metformin.
Formulation: Oral solution.
Dosage: 500 milligrams per 5ML.
Total amount: 473 M LS or 16 ounces.
Prescription only: Yes (Rx only).

Math Problem with Label

Order: Metformin 1500 milligrams poq 12 hours.
Available (H): 500 milligrams.
Quantity (Q): 5ML.
Calculation: $D / H * Q = (1500 \text{ mg} / 500 \text{ mg}) * 5 \text{ mL} = 15 \text{ mL}$ .

Med Rec Detective: Medication Reconciliation Review

Patient: 66-year-old man with congestive heart failure, asthma, and depression.
Goal: Identify any potential issues with the patient's current medication list (Med Rec).

Cyclobenzaprine

Question: Does it make sense for this patient to be on cyclobenzaprine?
Answer: No.
Drug class: Skeletal muscle relaxant.
Typical indications: Muscle spasms, spasticity, chronic pain.
Rationale: No clear indication based on the patient's medical history. Often, patients may be on a medication that has not been discontinued after it was no longer needed.
Common side effect: Drowsiness.

Furosemide

Question: Does it make sense for this patient to be on furosemide?
Answer: Yes.
Drug class: Loop diuretic.
Indication: Congestive heart failure, edema.
Potassium risk: Hypokalemia (F for falling potassium).

Lisinopril

Question: Does it make sense for this patient to be on lisinopril?
Answer: Yes.
Drug class: ACE inhibitor (ends in "pril").
Indication: Congestive heart failure (to decrease cardiac workload by blocking the Ras system).
Potassium risk: Hyperkalemia (ACE inhibitors block Ras, retaining potassium).

Carvedilol

Question: Does it make sense for this patient to be on carvedilol?
Answer: No.
Drug class: Non-selective beta blocker.
Problem: Patient has asthma. Non-selective beta blockers can cause bronchospasm by blocking beta two receptors.
Beta Blocker Indication: Decrease cardiac workload.

Albuterol

Question: Does it make sense for this patient to be on albuterol?
Answer: Yes.
Drug class: Short-acting beta two agonist (Saba).
Indication: Bronchodilator for asthma (rescue inhaler).
Adverse effects: Tremors, tachycardia.

Salmeterol

Question: Does it make sense for this patient to be on salmeterol?
Answer: No.
Drug class: Long-acting beta two agonist (Laba).
Problem: Laba has a box warning for asthma patients. It must be used concurrently with a steroid due to a risk of sudden death.
Adverse effects: Tremors, tachycardia.

Rivaroxaban

Question: Does it make sense for this patient to be on rivaroxaban?
Answer: No.
Drug class: Anticoagulant (factor 10A inhibitor).
Indication: Thrombotic issues (blood clots), atrial fibrillation, DVT.

Sertraline

Question: Does it make sense for this patient to be on sertraline?
Answer: Yes.
Drug class: Antidepressant (SSRI subtype).
Indication: Depression.
Risk: Suicidal behavior/thoughts (especially in patients under 24), serotonin syndrome
Med recs and safety
Nurses must question orders and ensure drugs align with patients' conditions.

Autonomic Nervous System Review

This review covers the sympathetic and parasympathetic nervous systems.

Sympathetic Nervous System

Receptors: Adrenergic (alpha and beta receptors).
Drivers: Epinephrine (adrenaline) and norepinephrine (noradrenaline).
Effects: Fast and dry, increased heart rate, increased blood pressure, increased respiratory rate, open airways, dilated pupils, diaphoresis (sweating).

Parasympathetic Nervous System

Receptors: Cholinergic (muscarinic and nicotinic).
Driver: Acetylcholine (ACH).
Effects: Slow and leaky, decreased heart rate, decreased blood pressure, decreased respiratory rate, increased GI tract activity, increased salivation and lacrimation (but not diaphoresis).

Anticholinergic Drugs

Effect: Sympathetic response (block cholinergic receptors).
Also known as: Parasympatholytics, anti-muscarinics.
Toxicity Signs: "Can't see, can't pee, can't spit, can't poop" (fast and dry).

Cholinergic Drugs

Effect: Parasympathetic effects (pro-acetylcholine).
Also known as: Parasympathomimetics, muscarinics.
Toxicity Signs: Dumbbells (slow and leaky).

Sympathomimetics

Effect: Sympathetic effects (mimic sympathetic nervous system).
Also known as: Adrenergic agonists.
Toxicity Signs: Fast (hypertension, tachycardia, tachypnea, bronchodilation, pupil dilation).

Sympatholytics

Effect: Parasympathetic effects (inhibit sympathetic nervous system).
Also known as: Adrenergic antagonists.
Toxicity Signs: Slow (decreased blood pressure, heart rate, and respiratory rate, constricted airways).

Clinical Application

Low blood pressure: Give a sympathomimetic.
High blood pressure: Give a sympatholytic (e.g., beta blocker).

Upcoming Drug Classes

Anti-diabetic agents (hypoglycemics): Injectable and oral.
Hyperglycemics (e.g., Glucagon).
Thyroid disease drugs.
Synthetic hormones (growth hormone, antidiuretic hormone).
Note: Cortical steroids will not be covered again as they were discussed in Week 6.

Organizing Drug Information

Use a consistent system (e.g., drug card or main template) to organize drug information for study purposes.
Focus on actions, indications, and nursing considerations for each drug class.

Insulin

Types

Rapid-acting: Lispro, glulisine, aspart.
Short-acting: Regular human insulin (R).
Intermediate-acting: NPH (neutral protamine Hagedorn).
Long-acting: Glargine, detemir.

Mechanism of Action

Insulin is produced by the beta cells of the pancreas.
Its job is to decrease blood sugar by pushing glucose into cells (liver, muscle, fat).
It promotes glycogenesis (creation of glycogen from glucose).
Fun fact: Bodybuilders use insulin for its anabolic effects to promote muscle growth (though this is not a safe practice and not recommended).

Circulating Insulin Levels

Basal insulin: Baseline level of insulin always in the blood.
Prandial spike: Increase in insulin levels after eating a meal to control blood sugar.

Indications

Diabetes mellitus: "Large discharge of sweet urine" (glycosuria due to excess sugar peeing out).

Type One Diabetes vs Type Two Diabetes

Type 1: autoimmune disease where the body destroys beta cells. Treatment required insulin due to total lack of insulin.
Type 2: Initially insulin resistance, then reduced insulin secretion over time. Treatment: lifestyle, oral drugs, potentially insulin.
Met in medical charting iddm that stands for insulin and dependent diabetes mellitus.
You'll see this abbreviation on type 2 diabetics and medical charting in iddm that stands for noninsulin dependent diabetes mellitus.

Contraindications and Cautions

Hypoglycemia.
Hypokalemia.
Hepatic and renal dysfunction.

Interactions

Increased insulin dosing needed due to antagonism:
- Diuretics
- Glucocorticoids (corticosteroids).
- Levothyroxine.
- Physiologic stress.
Decreased insulin dosing due to additive/synergistic effects:
- Lifestyle modifications.
- Oral hypoglycemic drugs and non insulin injectables
- Alcohol impair glycogen release from liver
  . Non-drug action of glucagon and beta blocker. Glucagon is opposite of insulin and blocks effect of beta blockers.
  *Beta Blockers can mask the signs of hypoglycemia

Administration and Assessment

Physiologic Insulin Regimens: Basal Bolus regimens follow the built-in mechanism of the body. You must take any longer acting insulin as the basal, or take the faster actings as the bolus. Bolus can be used any time, and insulin dose in units. Sliding scales are a non-fixed dosing that help the fixed system operate.
Physiologic Insulin Regimens: Non- designed to mimic the natural basal process.
The most important slide that's gonna include all the rapid/short/long and intermediate action and characteristics.

Rapid Acting:

Onset is 15 to 30 minutes, 30 min peak, duration 3 - 5 Hours.

Short Acting

Onset 30-60 mins
Peak 2 - 4 Hours
Duration 4-12 Hours
Only one you can give via IV

Intermediate Acting 1-2 Hour

Peak 4 - 12 Hours, 14 to 24 Duration. That a Protein they add to extend the life called protamine and when about to administer always mix. In the bottle rolling to not damage structure

Long Acting 2-4 Hours

, QHS for timing and always 24 Hours. Cannot mix with others.
Important table for future reference (for more test questions in the future other than farm)

Pre-Mix Instructions for Combining. Humologs is only brand Name and Numbers mean percentages and which is bigger is always intermediate is larger % than the first fraction. Know what they look like and how to integrate. The non-complex for low disease is a good option

Delivery is usually violin injections. Which are affordable and easy but have inaccurate dosing levels. Insulin pins are easy but must inject daily, and Jet Injectors is No needle but not used in US. And the Insulin pump works through continuous infusion to prevent complications

Storage:

Storage: anytime you talk about ins, so we always got to cover this how to store. The reason is. Insulin is a protein, so it does have special storage consideration so that it maintains its potency and effectiveness, something you. Don't want to freeze it, But refrigeration is good for it til expiration or take it out of the fridge for 86 degree angle is less irritating on the skin. Always is good til 28 Day or month, the syringe has been open. They are great pre-filleds but can ruin needles if used at an agle that is to steep.
Insulin comes at concentration levels of U100, U300 and 500. To administer these make sure you check BG(Blood Pressure) as priority assessment to avoid tank outs.

High Alert Requires A2 Nurse sign off verification

And to make sure of Lypodisrophy you keep rotating for no fat traumatized. Th effects you would hope to observe is a improvement and more well regulated levels of blood glucose levels and that can avoid potential air way complication.

Adverse Effects: Hypoglycemia

(less than 70)and can affect your cardio, muscle, and even your brain so always take with a carbohydrate snack to mitigate. In the hospital we check for potassium abnormalities and also to correct we administer to cells and therefore lower blood levels which effects lead to potential heart life threatening desrhymias.

Weight Gain and Lipidistrophy is also possible but take precautions. To avoide somgyi and phenomena all these lead to hyperglucima. So it is important to be aware of levels as it also will increase blood volume and weight .

What it would look like if you start at levels with out insulin for therapy .

Monitor sugar, storage, cary snack, education for sliding scale, monitor diet, signs and symptoms to keep in check. If you don't understand medical speak seek out someone that can break it for you. If you have all that than life has been made a lot easier.
So now we move on to the non- insulininjectables to inject meds when insulin isn't applicable.

Non- INsulin Injectibles

Amynlin Mimeitics (one drug called promeline and it has created GLP which is created by food intake. The effects are hunger satisfaction but the problems all due. And over times it becomes very deficient
Cautions of acute ilmess for procedire, renal disfuctions . box warning for medimetics and that has contraindications of thyroid cancer increase that works on cell increase and inflammation. All these effects decrease G1
With medication make sure to gradually take food to avoid GI/ stomach side or reactions. Make sure to be constantly doing it with clean administrations and other potential medicines.
actions. Inhibit, and. And increase

Always inject to rotate and take meds an hour apart with clean levels

Oralhypoglycemic is is. So that is what we are going to cover for other drugs for our system. Biganides for drug to treat the most and metformin. And Sulfonreas and then and alpha gluco and GLPTs. Sympto drug. Bromo

And it decreases glucose absorption with sensitivity, increase release, decrease, increate release with pancrease secretion glucode and the types are for type two diabetes.. Metrormine is the number drug and its prescription only for any reason . . Contraindications are acute stress, with food, lack of calorie. Liver are high renal problems with pregnancy. Interaction with increase liver problems with synergy , alcohol which is very significant, iodinated contract .
MAslow's needs to be accounted for and take meds that do not crush to have time released properties. That food reduce by taking stomach , and to drink water with gum as well. Diuresis means drink alcohol, lower level will be to make a good habit that helps with the best way.
You also have to be aware of the abcd and what has to be watch about what the patient says. The key point is that it can harm by lacticacid , this also causes deficiency of with B1