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Flashcards in Endocrine Meds Deck (20):

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.


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


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.


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.


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.


Anti thyroid meds

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


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


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.


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.


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


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.


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



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.


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.


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).



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


**Fixed Combination Products

Glucovance (Glyburide and Metformin)

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


Incretin Modifiers

Sitagliptin (Januvia) , Saxagliptin (Onglyza)

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


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


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.