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Flashcards in Endocrine Meds Deck (20):
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Anterior pituitary stimulating drugs

Somatropin (Genotropin, Serostim, Nutropin)

Growth hormone replacement. Indicated for the treatment of growth failure due to growth hormone deficiency, AIDS wasting syndrome and short bowel syndrome.

*Contraindicated for treatment of growth failure after closure of the epiphyseal plates.
* Common Adverse effects include: HA, hyperglycemia, hypothyroidism, and ketosis.

1

Anterior Pituitary Inhibitor Drugs

Octreotide (Sandostatin)

Inhibits growth hormone, promotes fluid and electrolyte reabsorption. Indicated for the treatment of Acromegaly and severe diarrhea and flushing episodes associated with metastatic tumors.

* Common adverse effects include: Dysrhythmias, heart failure, HA, hyper and hypoglycemia, GI complaints, fatigue and dizziness, cholelithiasis

2

Posterior pituitary drugs

Desmopressin (DDAVP), Vasopressin (Pitressin)

Indicated for the treatment of Diabetes Insipidus and nocturnal enuresis, normalizes urinary water excretion.

* Antidiuretic hormone preparation
*Contraindicated in patients with DI that is caused by renal disease as it can worsen fluid retention and overload
* Potent vasoconstrictor, use with caution in patients with known coronary artery disease or hypertension, and in patients at risk for hyponatremia or thrombi
* Monitor for signs and symptoms of water intoxication, ie: HA, listlessness, drowsiness
* Monitor intake and output.

3

Thyroid replacement

T4 Replacement: Levothyroxine (Levothroid, Synthroid),
T3 Replacement:
Liothyronine (Cytomel, Triostat)

Indicated for the treatment of hypothyroidism, myxedema and cretinism.

*Common adverse effects include insomnia and weight loss.
*Serious adverse effects include: hypertension, tachycardia, and cardiovascular collapse.
*Contraindicated with known cardiovascular disease
* Monitor for thyrotoxicosis.
* Replacement for hypothyroidism is life-long.

4

Antithyroid drugs

Methimazole (Tapazole), Propylthiouracil (PTU)

Indicated for the treatment of hyperthyroidism, Graves disease or thyrotoxicosis.

*Most common adverse effects include rash and leucopenia
* Rare but serious adverse effects include agranulocytosis and pancytopenia.
* Monitor CBC with differential and prothrombin time for bone marrow suppression, monitor TSH levels
* Teach patient to report any unusual bruising or bleeding
* Teach patient to avoid shellfish and iodine products.

5

Anti thyroid meds
Iodine

Potassium Iodide (SSKI)

Indicated for the treatment of hyperthyroidism to decrease the vascularity of the thyroid gland.

*Maximum effect after 15 days.
*Dilute and administer through straw after meals to prevent teeth discoloration

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Rapid acting insulin

Common examples: Aspart (NovoLog), Lispro (Humalog), Glulisine (Apidra)



*Onset: 5-15 minutes. Administer with meals. DO NOT administer unless meal is readily available.
* Peak: 1-3 hours, Duration: 3-5 hours.
* Monitor for hypoglycemia, hypokalemia, lipodystrophy.
* Always have oral carbohydrate available.
*May be given as a short-term IV therapy with very close monitoring

7

Short acting/regular insulin

Humulin R, Novolin R,

* Onset: 30 minutes to 1 hour, Peak: 2-4 hours, Duration: 6-8 hours.
* Used for dosing patients with Sliding Scale
* Can be administered IVP or via continuous infusion.
* Monitor for hypoglycemia, hypokalemia, lipodystrophy.
* Always have oral carbohydrate available.

8

Intermediate acting

Isophane suspension (NPH, Humulin N, Novolin N)

* Onset: 1-1.5 hours, Peak: 6-12 hours, Duration: 18-24 hours.
* Cloudy suspension. Can mix with Regular or Rapid Acting Insulin, draw up clear (Regular or Rapid Acting) then cloudy (NPH), “Clear to Cloudy.”
* Monitor for hypoglycemia, hypokalemia, lipodystrophy.
* Always have oral carbohydrate available.

9

Long acting insulin

Glargine (Lantus)

* Onset: 2-4 hours. No Peak, Duration: 24 hours.
* Once daily Subq injection provides 24 hour coverage.
* No peak, insulin delivered at steady level, less risk of hypoglycemia.
* Monitor for hypoglycemia, hypokalemia, lipodystrophy
* Always have oral carbohydrate available.
*DO NOT mix with any other insulin

10

Combination insulin

Humulin 70/30, NovoLog Mix 70/30 Humalog Mix 75/25, Humalog Mix 50/50,

* Intermediate Acting Insulin combined with either Rapid Acting or Short Acting (Regular) Insulin.
* Onset and Peak dependent on whether combined with a Rapid Acting or Short Acting Insulin. All provide 24 hour duration.
* Monitor for hypoglycemia, hypokalemia, lipodystrophy.
* Always have oral carbohydrate available.

11

Antidiabetic sulfonyureas

1st Generation: Tolbutamide (Orinase), Chlorpropamide (Diabinese)
2nd generation: Glipizide (Glucotrol), Glyburide (Diabeta, Glynase), Glimepride (Amaryl)

* Stimulates the release of insulin from the pancreas.
*Monitor for hypoglycemia. Second generation Sulfonyureas have a higher hypoglycemic potency.
*Adverse effects include: cholestatic jaundice, blood dyscrasias, GI complaints, HA, dizziness

12

Antidiabetic
Biguanides

Metformin (Glucophage, Glucophage XR)

* Decreases the rate of hepatic glucose production and lowers the glucose uptake by the tissues.
*Less likely to cause hypoglycemia.
*Adverse effects include: multiple GI complaints. GI disturbances may limit its usefulness in certain patients.
* Rare Adverse Effect: Lactic Acidosis. Not recommended in patients with renal insufficiency.

13

Alpha-Glucosidase Inhibitors

Acarbose (Precose), Miglitol (Glyset)

* Delays absorption of glucose from the GI tract.
* Less likely to cause hypoglycemia.
* Adverse effects include: flatulence, abdominal cramps, diarrhea.
* Can be hepatotoxic. Monitor liver functions every 3 months for the first year of therapy and periodically thereafter.
*May be used in combination with a Sulfonyurea.

14

Thiazolidineodiones “Glitazones”

Rosiglitazone (Avandia), Pioglitazone (Actos)

* Improves glucose uptake in the muscles, decreases endogenous glucose production.
* Monitor for hypoglycemia.
*Should be avoided in patients with symptomatic heart disease. May cause heart failure or MI.
*Can be hepatotoxic, monitor ALT level.
* Added benefit: lowers triglyceride level.
* Effect on cholesterol: may raise LDL (bad thing) and raise HDL (good thing).

15

Meglitinides

Nateglinide (Starlix), Repaglinide (Prandin)

* Stimulates the release of insulin from the pancreas.
*Should be avoided in patients with liver dysfunction due to possible decreased liver metabolism.
* Monitor for hypoglycemia.
*May be used alone or in combination with Metformin

16

**Fixed Combination Products

Glucovance (Glyburide and Metformin)

* Monitor for hypoglycemia.
*Contraindicated for patients with renal insufficiency due to possible risk of developing Lactic Acidosis

17

Incretin Modifiers

Sitagliptin (Januvia) , Saxagliptin (Onglyza)

*Increases insulin secretion, decreases glucagon secretion * Monitor for hypoglycemia.

18

Incretin mimetic

Exenatide (Byetta)

Suppresses Glucagon secretion. Adjunctive therapy for Type II diabetics who are inadequately managed by Metformin or a Sulfonyurea.

* Subq injection administered within 1 hour of morning and evening meals.
* Monitor for hypoglycemia. Always have oral carbohydrate available.

Liraglutide (Victoza)

Stimulates insulin release. Used for management of type two diabetes

*Not recommended for first-line therapy
*Risk of thyroid C-cell tumors including medullary thyroid cancer
* Monitor for hypoglycemia. Always have oral carbohydrate available. *Monitor for pancreatitis

19

Amylin analog

Pramlintide (Symlin)

Adjunctive therapy for Type I and Type II diabetics who have failed to achieve optimal glucose control with insulin alone. Symlin augments the effects of insulin.

* Subq injection administered immediately prior to meals.
*Give Subq in abdomen or thigh. DO NOT administer in arm as abasorption is unpredictable
* Monitor for hypoglycemia. Always have oral carbohydrate available.