23 endo drugs

  1. 4 categories of endocrine system drugs
    • Pituitary hormones
    • Adrenal Corticosteroids
    • Thyroid agents
    • Antidiabetic agents
  2. refers to an internal secretion (hormone) produced by a ductless gland that secretes directly into the bloodstream
  3. _____ is located at the base of the brain and is called the Master Gland
    Pituitary Gland
  4. why is the pituitary gland called the master gland?
    because it regulates the function of other glands
  5. what hormones does the pituitary gland secrete?
    • Thyroid stimulating hormone
    • Adrenocorticotropic Hormone
    • Gonadotropic Hormone
    • Somatotropin Hormone
  6. the anterior pituitary lobe hormone that is called the human growth hormone?
    somatotropin hormone
  7. the hormone that regulates growth
  8. who can only be the one to treat growth abnormalities?
  9. is only available for parenteral use as corticotropin
    adrenocorticotropic hormone
  10. a synthetic peptide of adrenocorticotropic hormone that is used for diagnosis of adrenocortical insufficeincy
    cosyntropin (cortrosyn)
  11. where are the adrenal glands located?
    adjacent to the kidneys (they lay on top)
  12. what type of hormone do the adrenal glands secrete?
  13. ____ act on the immune system to suppress the body's response to infection or trauma. relieves inflammation, reduces swelling, and supresses symptoms
  14. 2 categories of corticosteroids
    • 1. replacement therapy
    • 2. antiinflammatory/immunosupressant
  15. is used as a short term therapy and localized to prevent system effects. is also not a curative, but used as a supportive therapy with other meds
  16. prolong use of this can cause suppresion of the pituitary gland
  17. what can be given if corticosteroids is needed for an extended time period?
    give intermediate acting corticosteroids with alternate day therapy
  18. 1. allergic reactions (poisoning,bites)
    2. acute flare-ups of rheumatic or
    collagen disorders (inflamed joints, decreased crippling)
    3. acute flare ups of severe skin conditions
    4. acute respiratory disorders
    5. malignancies (luekemia, lymphoma, hodgkins disease)
    6. Cerebral edema
    7. organ transplant (to prevent rejection)
    8. life threatening shock
    9. acute flare ups

    are all conditions treated with?
  19. abrupt withdrawal of ______ can lead to acute adrenal insufficiency, shock, death
  20. SE:

    -delayed wound healing, increased susceptibility to infection
    -muscle pain/weakness
    -osteoporosis w/ fractures (esp. in older women)
    -stunted growth in children
    -endocrine disorders
    -gastric/esophageal irritation
    -CNS effects
    -petechiae, bruising, skin thinning
    -fluid & electrolyte imbalances (edema/fluid retention)
  21. CI: -hypothyroidism/cirrhosis
    -emotional instability
  22. PE:
    -take oral meds during/immediately after meals to reduce gastric irritation, but not near bedtime

    -antacids or asprin should be avoided

  23. live virus vaccines/toxoids (inhibits antibody response)
    corticosteroids interaction
  24. thyroid agent medications
    • levothyroxine
    • liothyronine
  25. ____ absorbs all iodine in blood
  26. ______ are released from pituitary gland when levels are low
    TSH (thyroid stimulating hormone)
  27. TSH promotes biosynthesis & secretion of 2 bioactive thyroid hormones called
    • thyroxine (T4)
    • triiodothyronine (T3)
  28. is the major product of the thyroid gland & much is later converted into T3 form
    Thyroxine (T4)
  29. causes slow metabolism w/ symptoms of fatigue, dry skin, thinning hair, weight gain
  30. treatment for hypothyroidism
    replacement therapy
  31. hypothyroid conditions requiring replacement therapy include:
    • *myxedema
    • *Haskimoto's
    • *cretenism
    • *pituitary disorders
    • *thyroid destruction after surgery/radiation
  32. how is hypothyroidism diagnosed?
    through blood tests before medication is given
  33. toxic effects are the result of overdosage of thyroid and are manifested in the signs of ______
  34. toxic effects of ________ include:

    -palpations, cardiac arrhythmias, tachycardia
    -nervousness, insomnia, HA
    -weight loss, diarrhea
    -intolerance to heat, fever, sweating -menstrual irregularities
    -exopthalmos (bulging eyes)
    thyroid medication
  35. CI:
    -cardiovascular disease
    -adrenal insufficiency
    -normal thyroid function (euthyroid)
    thyroid meds
  36. IA:
    -oral coagulants (potentiate)
    -insulin & hypoglycemics (dosage required)
    -adrenergic effects w/ epinephrine (potentiates) WATCH CLOSELY!
    -estrogen, bcp (decrease thyroid response)
    -soy products (decrease response)
    -calcium/iron/magnesium salts (decrease absorption, space several hours apart)
    thyroid meds
  37. PE:
    -meds taken for life
    -take on empty stomach 30-60 mins prior to breakfast
    -periodic lab test to determine effectiveness & dosage
    thyroid meds
  38. hypothyroidism is the reult of the thyroid not making enough _____
  39. hyperthyroidism is when the body makes _____ thyroxine
    too much
  40. _______ used to relieve symptoms of hyperthyroidism in preparation for surgical & radioactive iodine therapy
    • antithyroid agents
    • (Methimazole & propylthiouracil (PTU)
  41. SE (rare):
    -rash, pruritus, urticaria
    -blood dysrasias (esp. agranulocytosis)
    antithyroid agents
  42. CI:
    -prolonged therapy
    -pts who are older than 40 y.o.
    -hepatic disorders
    antithyroid meds
  43. IA:
    -drugs that cause agranulocytosis (potentiate)
    antithyroid meds
  44. PE:
    -inform physician if any signs of illness (chills, rash, sore throat)
    antithyroid agents
  45. used to lower blood glucose levels in those with impaired metabolism of carbs, fats, and proteins
    antidiabetic agents
  46. characterized by destruction of pancreatic beta cells
    DM type 1
  47. characterized by insulin resistance and deficeincy
    DM type 2
  48. ___ was formally described as juvenile diabetes
    DM I
  49. most common form of diabetes (90-95%)
    DM II
  50. DM II is increasing in earlier ages due to?
  51. what is the result of poorly controlled diabetes?
    vascular injury (micro/macrovascular)
  52. microvascular complication includes:
    • retinopathy
    • nephropathy
    • nueropathy
  53. macrovascular complications include:
    • coronary artery disease (MI)
    • cerebrovascular disease (stroke)
    • peripheral vascular disease
  54. why is insulin required for type 1 diabetes?
    for replacement therapy bc of insufficient production of insulin
  55. why is insulin required for type 2 diabetes?
    required for those who have failed to maintain blood glucose
  56. ____ is used in the emergency treatment of diabetic ketoacidosis or coma
    insulin regular
  57. how is insulin administered?
  58. why is insulin administered parenterally?
    bc the GI tract will destroy it
  59. 2 types of injected insulin
    1. biosynthetic insulin - amino acid structure

    2. analog - manmade
  60. types of insulins
    • rapid
    • short
    • intermediate
    • long
    • mixtures
  61. how are biosynthetic adn analog insulins created
    recombinant DNA technology
  62. in a 100 unit ml insulin syringe how much does each line represent
    2 units
  63. in a 50 unit ml insulin syringe how much does each line represent
    1 unit
  64. what type of insulin can ONLY be given intravenously and intramuscularly?
    regular insulin
  65. what types of insulin are clear and ultra rapid acting with a short duration?
    • lispro
    • aspart
    • glulisine
  66. what types of insulins can be given subcutaneously?
    all others EXCEPT regular insulin
  67. what is an intermediate acting insulin?
    isophane (NPH)
  68. what are long acting insulins?
    • glargine (lantus)
    • detemir (levemir)
  69. regular insulin can sometimes be combined with _______ in the same syringe
    isophane (humulin N/novolin N)
  70. if two insulins are ordered at the same time, what must be done first?
    draw up the regular insulin in the syringe first
  71. what types of insulin should no tbe mixed with any other types of insulin?
    glargine and other mixtures
  72. this is sometimes ordered as a corrective action insulin
    regular insulin
  73. what must be done to prevent one of the most common and most dangerous medication error?
    crosscheck physician orders and verify with another caregiver
  74. elevated blood glucose is also known as
  75. undiagnosed diabetes
    insufficient insulin dose
    surgical or other trauma
    emotional stress
    endocrine disorders

    can all be a result of:
  76. Symptoms of _____: polydipsia/polyuria
    excessive sweating
    fruity breath
    weight loss, anorexia
    vision proglems
  77. treatment of acute hyperglycemia
    IV fluids to correct electrolyte imbalance with regular insulin added
  78. lowered blood glucose is also known as
  79. loss of consciousness
    pallor, hunger, N/V

    may result from:
  80. treatment for conscious hypoglycemia
    • 1st – administer 4 oz. oj,candy,honey
    • 2nd – provide protein snack
    • 3rd – recheck blood glucose
  81. treatment for comatose hypoglycemia
    1st – administer 10-30 mL of 50% dextrose IV or -1 unit of glucagon (1mg) IM or IV

    2nd – follow w/ carb snack when pt awakens
  82. what is the somogyi effect?
    a rebound effect of hypoglycemia overdose resulting in hyperglycemia
  83. how are oral anitdiabetic medications administered?
    1. single dose before breakfast


    2. 2 divided doses before morning and evening meals
  84. what is a principal therapy for DM II management?
    weight reduction and modified diet
  85. oral hypoglycemic drugs are also known as:
  86. chlorpropamide & tolbutamide are what generation solfonylureas?
  87. glipizide & glyburide are what generation solfonylureas?
  88. ____ work by increasing insulin production from the pancreas and by imporving peripheral insulin activity
  89. major side effect of sulfonylurea
  90. only insulin administered IV, IM and SubQ
  91. side effect of sulfonylureas, biguanides, and alpha-glucosidase inhibitors
    GI Effects
  92. stimulates pancreas beta cells to produce insulin
  93. oral hypoglycemic drugs consisting of first-generation agents
  94. therapy for an allergic reaction to poison ivy
  95. should be done to insulin injection sites
  96. hormone used for diagnosis of adrenocortical insufficiency
  97. if possible, corticosteroids are administered this way
  98. time that opened vials of insulin may be stored without loss of potency
    1 month
  99. adjunctive therapy for clients with type 2 diabetes without glycemic control
  100. side effect of long-term corticosteroid use in children
    stunted growth
  101. decreases hepatic glucose output and enhances insulin sensitivity
  102. common side effect of thiazolidinediones
  103. SE of _____:

    -GI distress
    -dermatological distress
    -pruritus, rash, urticaria
    -hepatic dysfunction including jaundice
    - hypoglycemia in older adults
    - lethargy, vertigo
    -increase of cardiovascular death
  104. CI of ___:

    -debilitated or malnourished Pt's
    -impaired liver and kidney function
    -unstable diabetes
    -major surgery
    -severe infection/trauma
    -water intoxication
  105. which sulfonylurea generation drugs have a higher potency, shorter action duration, better tolerance -& fewer drug interactions
    2nd gen
  106. Pt's recieving/discontinuing sufonylurea agents should be monitored closely for?
    loss of diabetic control
  107. Alpha-glucosidase inhibitor meds
    • acarbose (precose)
    • miglitol (glyset)
  108. often used as part of a combination regimen that includes an oral sulfonylurea
  109. delays digestion of complex carbs & subsequent absorption of glucose after meals
    Alpha-glucosidase inhibitors (carbose)
  110. SE of _____:

    -high rate of GI effects (flatulance, abdominal distention/pain, loose stools) which tend to diminish with time or a reduction in dose; take at the start (first bite) of main meals
    alpha glucosidase inhibitors
  111. drug interactions w/ _____:

    -digestive enzymes
    - digoxin
    -estrogens and oral contraceptives
    alpha glucosidase inhibitor
  112. metformin (glucophage) is an example of a
  113. ____ work by decreasing hepatic glucose output and enhancing insulin sensitivity to muscle
  114. can be used as an initial first-line monotherapy or in combination with sulfonylurea to treat type 2 diabetics
  115. SE of ____:

    -GI effects- Lactic Acidosis (severe dehydration, cardiorespiratory insufficiency, renal dysfunction)-Hypoglycemia-rare
  116. CI of ____:

    - radiocontrast dye
    -heart failure
    -children and older adults
    -impaired kidney adn liver function
  117. DI w/ _____:

    -increased metformin effect seen with alcohol, cephelexin, and cimetidine
    -radiopaque contrast media (hold metformin day of and 48 hrs after)
  118. two naturally occuring hormones that have been identified adn released by cells in the GI tract in response to food
    GIP & GLP-1
  119. _____ activation suppresses the release of glucagon by the pancreas
  120. _____ activation stimulates insulin secretion in order to maintain glucose homeostasis
  121. in type 2 diabetes which enzyme rapidly inactivates GLP-1, which is already reduced in Pt's with impaired glucose intolerance
  122. incretin therapy meds
    • exenatide (Byetta)
    • Sitagliptin (januvia)
  123. given SC BID, mimics action of incretin GLP-1, decreases glucagon secretion, delays gastric emptying time, decreases food intake
    exenatide (byetta)
  124. used as adjunctive therapy for type 2 DM pts who does not have glycemic control & are taking metformin, a sulfonylurea or both
    exenatide (Byetta)
  125. ____ is not recommended for use in Pt's with severe renal disease
    Exenatide (byetta)
  126. given orally once daily, inhibits DPP-4 enzyme, increase GLP-1 & GIP levels, increase insulin secretions
    sitagliptin (januvia)
  127. when recieving januvia Pt's should be monitored with what med
  128. used as monotherapy in type 2 DM pts or combo w/ meformin or thiozolidinedione when adequate glycemic control has not been achieved
    Sitagliptin (januvia)
  129. meglitinide meds
    • nateglinide (starlix)
    • Repaglinide (prandin)
  130. -stimulates pancreatic beta cells to produce insulin
    -used as monotherapy or combo w/ metformin
    • nateglinide (starlix)
    • Repaglinide (prandin)
  131. SE:
    -weight gain, fluid retention, edema
  132. DI:

    -admin prandin before meals to maximize absorption
    -gemfibrozil (lopid) may enhance/prolong effects
  133. Drug IA:
    Azole antifungals
  134. Thiazolidinediones meds
    • pioglitazone (actos)
    • rosiglitazone (avandia)
  135. meds with black box warnings for both meds, potential increase in myocardial ischemia risk
    • pioglitazone (actos)
    • rosiglitazone (avandia)
Card Set
23 endo drugs