Pharm 2: Diabetes, Pituitary, Bone, Cushings, Addisons

• Humalin R 
• Novolin R 

• Acute illness ( emergency) ex. DKA, surgery 
• Pregnancy 

Type 2 uncontrolled oral hypoglycemia

Only type of insulin that can be given IV push or IV gtt

• Starts 30 min-1 hr 
• Peak 2-4 hrs 
• Duration 3-6 hrs 
• Max 6-8 hrs

• 30 min before a meal sliding scale 
• Subcut 
• insulin syringe 
• -- eat a snack at peak times ( 2-4 hrs )

• Glargine ( lantus)
• Detemir ( levemir) 

Long term use

• Starts 1-2 hrs
• No Peak
• Lasts 20 hrs

• Dont dilute
• Dont mix
• Normally given at bedtime

NPH insulins 

• Humalin N
• Novolin N 

Long term admin

Hypoglycemia mostly in the mid late afternoon

• Only give Sub Q usually before breakfast or dinner 
• Can be mixed with short-acting ( clear to cloudy) 

• Air into NPH ( cloudy)
• Air into Regular
• Draw up Regular
• Draw up NPH

• Starts 2-4 hrs 
• Peak 8-10 hrs
• Lasts 10-18 hrs
• Max 14-20 hrs

• hypoglycemia= below 70,
• dangerous below 40 
• signs: tachy, palpitations, diaphoresis, headache, weakness) 

• Conscious: 
• foods with 15g carbs, liquid fruit juice
• 4tsps sugar 
• symptoms should go in 5-20 min if not give more carbs 

• Unconscious:
• Dont call MD 1st. treat with 25-50% dextrose IV push 
• or at home Sub Q or IM glucagon

• sufonylureas
• meglitinides
• beta-blockers
• alcohol
• tetracyclines

• thiazide diuretics
• glucocorticoids
• pheynytoin
• levothyroxine
• estrogen/oral contraceptives 
• adrenergics

beta blockers ex propranolol

• Glyburide
• glimepiride
• glipizide

insulin release from the pancreas 

give 30 min before meals 

older adults are sensitive to glyburide

check A1C ( should be less than 7%)

metformin ( glucophage) 

increases the use of glucose by muscle and fat cells, decreases liver glucose production and GI absorption of glucose

- absorbed in the liver

- taken with meals

Least likely to cause hypoglycemia 

can cause lactic acidosis ( hyperventilation, myalgia, sluggishness) -- stop treatment then--> not for people over 80! 

• GI upset  ( lose weight ) 
• B12 + folic acid deficiency

Held at least 24 hrs before tests and 48 hrs after tests with contrast dye to avoid renal failure

acarbose 

miglitol 


Take at the start of each meal 


The med works in the GI and delays the digestion of complex carbs ( glucose lowers after meals)

• Acarbose can decrease digoxin levels 
• and when used with metformin can increase the risk of hypoglycemia and GI effects 

• Works well with sulfonylureas
• (glyburide, glimepiride, glipizide)

• Rosiglitazone
• Pioglitazone 

• Stimulates insulin receptors on muscle, fat, and liver cells
• ( used for insulin resistance) 

• - meds should be taken with meals 
• -can take up to 12 weeks to work

• Hepatotoxicity 
• CHF
• Weight gain ( 2-3 lbs in 2-4 hrs) 

• don't give to people with heart failure 
• monitor liver function

• Repaglinide
• Nateglinide 

• Takes 30 minutes before meals 
• Not commonly prescribed

Pramlintide acetate 

Suppresses postprandial glucagon secretion which slows gastric emptying 

Comes in pen form, given subcut before meals  ( dont admin if skipped meal) 

- associated with weight loss

• sitagliptin phosphate
• linigliptin
• saxagliptin 

balance the release of insulin and limit the release of additional glucose from liver ( helps with insulin resistance) 

take daily with no regard to meals ( po)

• Not for type 1 at all 
• not for heart failure, or renal disease 

can cause upper resp infection, stuffy runny nose

• Exenatide
• Liaglutide 
• Other 2 drugs: albigutide, dulaglutide 

Sub cut BID within 1 hr of breakfast & dinner 

Stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten ( it increases the feeling of fullness/ weight loss)

• Do not lactate 
• C-cell thyroid cancer link 
• -- Make sure to refrigerate and protect from light

Canagliflozin 

Take it with breakfast

Works by inhibiting glucose reabsorption in proximal renal tubules

Assess K+ and blood pressure levels 


Avoid salt substitutes, st johns wort


Check for dehydration, hypotension, syncope, genital mycotic( yeast infection)

thyroxine ( T4), triiodothyronine ( T3), calcitonin ( high blood Ca = more calcitonin)

T4, and T3 depend on the amount of iodine and tyrosine in the thyroid gland 

thyroid hormones are released when its stimulated by TSH from the anterior pituitary gland

• TSH goes down 
• T3, T3 is high

Caused by graves disease: where thyrotropin receptor antibodies simulate TSH 

thyroid storm ( severe): extreme symp, heart fail, coma

other signs: goiters, thyroditis, thyroid carcinoma, pituitary adenoma, thyroid storm

A beta blocker for hyperthyroidism 

taken around the clock q8hr 

PTU may increase the effects of anticoagulants = risk of bleeding goes up 

Monitor live functions tests 

If the HR is 100+ the dose isnt high enough

hyperthyroidism

take a pregnancy test before starting

Hyperthyroidism

Higher at the start because of a rapid metabolism 

need to restrict seafood/salt

some OTC have iodine : cough syrup, asthma meds, and multivit

TSH is high ( trying to compensate): T3, T4 normal 

Cause: cretinism ( child born without a thyroid gland) 

myxedema ( low basal temp, and low hr, card dysrh)

Hashimoto ( autoimmune)

Goiter radiation

Need a low dose for pain and anesthesia

• Increase the effects of levothyroxine: 
• Antidepressants
• asthmatic agents
• nasal decongestants 

• Decrease the effects..
• antacids, iron
• antihypertensives, proppranolol 
• estrogen, oral contraceptives

If the pts has Addisons treat that first

Levothyroxine/synthroid 

Give PO empty stomach 30 minutes before meals or IV ( IV dose in half)

GH/Somatropin

Dwarfism= not enough GH

Acomegaly= too much GH

Stimulates GH ( skeletal, linear, muscle and organ growth) 

• Subcut or IM
• 2 nurses must check dose calculation

Hyperglycemia, mild edema 

Monitor serum and urine calcium, glucose, and thyroid function

Avoid if Prader Willi syndrome

ADH/Vasopressin : to regulate water 

-- Diabetes inspidus: is a ADH deficiency kidneys are filtering but not reabsorbing water 

Oxytocin: childbirth, lactation

• Desmopressin acetate 
• Vasopressin

synthetic ADH: increases water permeability, and osmolality and decreases urine volume 

• Desmopressin: oral, intranasal, subcut, IV
• Vasopressin: subcut, IM, IV

Monitor IV sites== necrosis

hyponatremia: lethary, confusion, seizures


fluid volume shift = dysrhythmia 

Assess for signs of rehydration

Carbamazepine and chloropropamide , tricyclic antidepressants

selective serotonin

alcohol ( decreases the diuretic effect), heparin, lithium, phenytonin

Octreotide acetate 

Deep IM ( not the deltoid) 

between meals to prevent fat malabsorption 

Med has to be withdrawn for 4 weeks out of the year

prolonged QT interval 

• Monitor sugar levels and for gallbladder disease 
• IV gtt may be used for GI bleed

• oral calcium products ex. GERD 
• IV : calcium chloride, calcium gluconate for acute hypocalcemia 
•  

• Slow IV push
• PO 2 hrs apart from other meds

Increases risks of digoxin toxicity 

Calcium citrate is better absorbed 

Iv calcium gluconate is the antidote for calcium channel blocker overdose

thiazide diuretics 

vitamin D

calcitonin

corticosteroids 

phosphates

Bisphosphonates  ( end in -dronate)

Main drug: Alendronate 

PO: must take with a full glass of water 30 minutes before breakfast with no other meds

should sit or stand for 30 minutes after or esophagus erodes

Supresses osteoclast activity to gain bone mass 

Dont take calcitonin with salmon allergy

Aspirin/NSAID: increase the risk of GI adverse effects 

Antacids decrease the effectiveness

loss of sodium, water and chloride 

cardiac output, dehydration, hyperkalemia, hypoglycemia

Acute adrenal crisis: othostatic, muscle weakenss, bronze, body hair changes

Adrenocorticoids : bind to receptors to decrease inflammation and increase sodium retention for addisons disease 

• Hydrocortisone cypionate
• hydrocortison sodium succinate 

PO with food to decrease GI upset 

Never stop randomly , and increase calcium intake , and montior blood sugar ( it can cause hyperglycemia)

No live viruses if on hydrocortisone 

assess for htn, chf , and decreased cardiac output

Sodium retention and potassium excretion to increase BP

for addisions taken lifelong 

limit salt intake, and assess sodium potassium levels, bp, weight

• Too much adrenocortico 
• (from tumors or long term glucocorticoid uses) 

moon face, facial hair , buffalo hump , thin skin

• Ketoconazole 
• used to help cushings 

Take with fluids to decrease stomach acid, and food

• Dont take with antacids 
• can cause hepatotoxicity 

monitor liver enzymes

Miotane decreases production of cortisol

used for cushings disease 

its a high alert med, hold if trauma ( its just pallative not a cure)

used for inoperable adrenocorticol carcinomas

causes lethargy