Endocrine Drugs Flashcards
Somatropin
GH deficiency
Indication:
- dwarfism (before epiphyseal closure)
Side effects:
- DM (↓ insulin secretion)
- Hypothyroidism
Route:
- IM & SubQ
Contraindication:
- Other types of dwarfism unrelated to GH
- Obesity
- Respiratory disease (sleep apnea)
Octreotide
GH excess
Indication:
- Gigantism / acromegaly
- Severe diarrhea**
- Esophageal varices & bleed**
Side effects:
- Pancreatitis
- Hypothyroidism
Route:
- IV, PO & SubQ
Monitor:
- Kidney
- Liver
Oreo & lactose intolerance –> so you’re poop & throw up & pancreas is secreting a lot of insulin so pancreatitis
Levothyroxine Sodium (T4)
MOA:
- Synthetic thyroid hormones
Indication:
- PO: hypothyroidism
- IV: myxedema coma (severe hypothyroidism)
Side effects:
- S/S of hyperthyroidism (OD)
- S/S of hypothyroidism (under-dosed)
- Hyperglycemia
- Tachypnea
- Highly protein-bound toxicity with hypoproteinemia or when taken with other protein-bound drugs i.e. oral AC
Adverse effects:
- Tachydysrhythmias (A-fib)
- Chest pain
- HTN
- Seizure
Contraindication:
- MI
Patient education:
- Requires lifelong replacement
do not discontinue, change brand, or change dose without checking with endocrinologist
- Slow absorption & onset of action, long half-life (one week)
- Full therapeutic effect in 6-8 weeks
Nursing:
- Only on empty stomach (one hour before BF)
- Check levels frequently (TSH and T4, T3)
Methimazole & Propylthiouracil (PTU)
Antithyroid Drug
MOA:
- Inhibits TH synthesis
- Full therapeutic effect in 3-12 weeks
- Does not destroy existing TH
Indication:
- Hyperthyroidism (Graves’ disease)
- Thyrotoxicosis (thyroid storm)
- Adjunct to irradiation
Side effects
- S/S of hypothyroidism (OD)
- S/S of hyperthyroidism (under-dosed)
- GI distress (take with meal)
Contraindication
- Pregnancy & lactation
Patient education
- Take same time daily
- Take with meals
- Do not discontinue abruptly (risk of thyrotoxicosis)
- Avoid foods high in iodine (seafood)
- Many drug interactions (oral AC, insulin, digoxin, lithium, phenytoin)
Meth Heads wear PLAID: Phenytoin, lithium, ACs, insulin, digoxin
Hyperthyroidism S/S
- Tachycardia, palpitation
- Diaphoresis, heat intolerance
- Nervousness, anxiety, irritability
- Exophthalmos
- Weight loss
- Amenorrhea
Thyroid storm (thyrotoxicosis):
- Severe hyperthyroidism
- May result in death
- Medical emergency
Hypothyroidism
- Bradycardia
- Cold intolerance
- Apathy, depression, lethargy
- Dry skin, facial edema
- Weight gain
- Menorrhagia
- Goiter
Myxedema coma or myxedema crisis:
- Severe hypothyroidism
- May result in death
- Medical emergency
Corticotropin
- Synthetic ACTH
- Must be given parenterally (IV/IM/SubQ)
- Repository or depot injection (slow absorption)
Indications:
1) Secondary adrenal insufficiency (pituitary insufficiency => low ACTH)
2) Diagnosing secondary vs. primary adrenal insufficiency
(ACTH stimulation test: checking cortisol level pre & q30 min post corticotropin)
3) Acute severe exacerbation of inflammatory disorders
(Lupus, multiple sclerosis (MS), systemic dermatomyositis, systemic sarcoidosis, psoriatic arthritis, RA, etc.…)
Contraindication:
- Contraindication: primary adrenal insufficiency (Addison’s disease)
Side Effects:
- Fluid & Na retention –> edema
- RF
- Increased BG (so watch in DM pts)
- Monitor BP trend for HTN
Nursing:
- Monitor cortisol levels
- Taper the dose
- Do not abruptly discontinue
Glucocorticoids
Drugs:
- Methylprednisolone IV/PO
- Prednisone PO
- Dexamethasone PO/IM/IV
- Hydrocortisone PO, IV, joint injection, topical
Indications:
- Primary adrenocortical insufficiency
- Addison’s disease
- Adrenal crisis (see next slide)
- Many inflammatory, autoimmune, & allergic diseases
- RA, MS, MG, UC, glomerulonephritis, shock, hepatitis, asthma/COPD, drug reactions, contact dermatitis, anaphylaxis
Contraindications:
- Fungal/viral infections
- Live virus vaccine
Side effects
- Hyperglycemia (in diabetic patients)
- Leukocytosis
- Immunosuppressant anti-inflammatory mechanism (higher risk of infection)
- Water/Na retention (worsening of HF, edema, HTN) => hypokalemia (dysrhythmia)
- Water/Na retention => increased IOP (worsening of glaucoma)
- SubQ tissue loss with chronic use => “paper-skin” or “steroid skin”
- Adrenal suppression (never stop abruptly to avoid adrenal crisis) requires weaning
- Osteoporosis (take Vitamin D, Ca++ & exercise)
Desmopressin & Lypressin
MOA:
- ↓ urine output
- ↑osmolality of urine
- Little vasoconstrictive effect
- Long duration of action (20 hours)
Indication:
- DI
- Routes: nasal spray, PO, IV, subQ
Side effects:
- Fluid overload => worsening HF
- AMS (water intoxication)
- Vasoconstriction
Nursing:
- Monitor for angina & MI, dysrhythmia, HTN
- Monitor: I/O, daily weight, CMP (electrolyte changes),
Vasopressin (ADH)
MOA:
- Peripheral vasoconstriction
Indication:
- Emergency drug (for severe hypotension as in shock) - NOT indicated for DI
Side effects:
- Fluid overload => worsening HF
- AMS (water intoxication)
- Vasoconstriction
- Short duration of action (30-60 min)
- Only given IV (vesicant)
Tolvaptan
MOA:
- aquaresis (excretion of water without electrolyte loss)
Indication:
- SIADH
Side-effects:
- Hypovolemia
- ↑K
- ↑BG
Calcitriol
MOA:
- Hypoparathyroidism & hypocalcemia
- Increases Ca++ absorption in the GI tract
- Increases Ca++ resorption (increases activity of osteoclasts) ↑ release from bone
Indications:
- Hypoparathyroidism only PO
- Vitamin D deficiency PO
- Renal hormone replacement ESRD on HD PO/IV**
Side effects:
- Dizziness
- Vertigo
- Falls
- Metallic taste
“Cows Don’t Feel Very Motivated Ever”
Calcitonin-Salmon
Routes:
- IM, SubQ, nasal spray
MOA:
- Calcitonin receptor agonist (mimics the effect of thyroid hormone, calcitonin)
- Deposit Ca into the bones => hence, it is indicated for osteoporosis
- Increase renal excretion
Indication:
- Hypercalcemia
- Hyperparathyroidism: malignancies of parathyroid, ectopic PTH secretion from lung CA
- Drug-induced by: thiazide, Vit A/D, milk-alkali syndrome
- Prolonged immobility
Side effects: (hypocalcemia)
- Numbness or tingly feeling around the mouth
- Tachycardia, muscle spasms, hyperactive deep tendon reflexes (DTR), seizure
- Nasal spray causes nasal dryness (alternate nostrils and use NS nasal spray)
