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Flashcards in Endocrine System(Pharm) Deck (91):
1

Glyburdie(Micronase/DiaBeta)

Generica Name: Glyburdie
Trade Name: Micronase/DiaBeta
Sulfonylureas(drugs)
-Second generation
-last longer 12-24hrs
-2.5-20mg dose-

2

Vasopressin(Pitressin)

Generic Name:Vasopressin
Trade Name: Pitressin
Posterior lobe agent
Antidiretic Hormone
-taken 1-2x a day
-5-10u tid, nasal spray,subq,im
-tannate(in oil) last for 48-96hr

3

Levothyroxine(Synthroid)

Generic Name: Levothyroxine
Trade Name: Synthroid
-avg dose:100-125mcg
thyroid replacement drug
-increase metabolic rate by replace t4
-use: hypothyroidism(myxedema), hyposecretion of the thyroid
-interaction with oral coag, epi,antidepressants,antidiabetic agent,cns depressents

4

Propylthiouracil(PTU)

Generic Name: Propylthiouracil
Trade Name:PTU
-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)
-Thiouracil drug
-100-150mg 1-4x a day
-given for 6mos to several years

5

Calcitriol(Rocaltrol)

Generic Name: Calcitrol
Trade Name: Rocaltrol

6

Potassium Iodine(SSKI)

Generic Name: Potassium Iodine
Trade Name: SSKI
-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)

7

Saturated Solution(Lugols Iodine)

Generic Name: Saturated Solution
Trade Name: Lugols Iodine

8

Dempopressin(DDAVP)

Trade Name:Dempopressin
Generic Name: DDAVP
Posterior lobe agent
Antidiretic Hormone
-in posterior pituitary
-hyposecretion results in diabetes insipidus
-used for diabtes insipidus
-post op abdominal disention
-dispel gas interfering with x-ray
-enuresis(bed wetting)
-hemophilia type A

9

Calcitonin(Calcimar)

Generic Name: Calcitonin
Trade Name: Calcimar
-drug for hyperparathyroidism
-synthetic hormone
-turns off secretion of the hormone
-calcitonin-salmon-check allergy to salmon
-sq,im,intranasal
-4-8units 1kg every 6-12hrs

10

Metformin HCL(Glucophage)

Generic Name: Metformin HCL
Trade Name: Glucophage
-oral hypoglycemics
-Biquanides
-500-1000mg 2x a day

11

Acarbose(Precose)

Generic Name: Acarbose
Trade Name: Precose
Acarbose(precose)
Oral Hypoglycemics
-Alpha glucosidase inhibitor drug
-3x a day dose
-must be taken with first bite of meal
-if they do not eat do not take med

12

Chlorpropamide(Diabinese)

Generic Name: Chlorpropamide
Trade Name: Diabinese
-Sulfonylureas(drug First generation)
-titrated(increase slowl)
-avg. dose 150-250mg

13

Glimepiride(Amaryl)

Generic Name: Glimepiride
Trade Name: Amaryl
Sulfonylureas(drugs)
-third generation
-1-2mg once a day
-given with breakfast/main meal of the day

14

Sitagliptin(Januvia)

Generic Name: Sitagliptin
Trade Name: Januvia
oral hypoglycemics
dipeptidyl peptidase
action: inhibit breakdown of incretin hormones, adjuvant to diet and excersie(type 2)
100 mg po daily
side effect:increase resp tract infection
monitor wbc for infection, and monitor resp tract

15

Endocrine glands

ductless glands that empty their secretions directly into the bloody stream

16

Hormones

chemical substances secreted by the endocrine glands

17

Pancreas

Beta cells of the Islet of Langerhans in the pancreas produce the hormone insulin

18

Insulin

hormones that regulate glucose metabolism and the transporting of glucose across the cell membrane

19

Indication

Diabetes Mellitus is a disorder of carbohydrate

20

Classification of Diabetes

Type 1: (IDDM) Insulin dependent diabetes mellitus=little to no insulin produced

Type 2: (NIDDM) non-insulin dependent diabetes mellitus=decrease in production of insulin, decrease in cell sensitivity to insulin, onset insidious, can treat with oral drug and/or insulin

21

Forms of Insulin

Animal:
1-Porcine: Pig
2-Bovine: Beef

Human
1-Synthetic: Humulin
2-Semisynthetic: Novolibn

22

Insulin strength/concentration

u100=every 1ml contains 100u
u500=every 1 ml contains 500u
u30

23

Insulin routes(SubCu)

1-Abdomen 2-Back of arm 3-Front of thigh 4-upper buttocks
-90 degree angle
-no massage area
-massage will increase absorbtion rate
-rotate injection site to prevent lipodystrophy

24

Insulin routes(Insulin pump)

-must be able to follow direction
-human insulin in pump
-either rapid acting or short acting
-subCu
-can stay in place for 2-3 days

25

Insulin routes(IV/IVP)

-iv push and bolus dose

26

Classification

1)rapid 2)short 3)intermediate 4)Long acting 5)mixed insulin

properties-
protein-decrease rate of absorption
zinc-modify onset and duration
-dose-determined by HCP
-frequency once or twice a day

27

Rapid Acting Insulin

Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)

onsent: 15mins, novolog 10-20mins
peak:1-2hrs
duration:3-4 hrs
route: SC
hypoglycemia: before lunch

28

Short Acting Insulin
route: SC, only IV route

Insulin Regular(Humulin R, Novolin R)
-onset:30-60mins
-peak:2-4hrs
-duration:5-7hrs
-route:SC
-hypoglycemia before lunch

(IV) Insulin Regular(Humulin R, Novolin R)
route: iv
onset: 10-30min
peak: 15-30min
duration: 30-60min

29

Intermediate insulin

Insulin Isophane(NPH)-Humulin-N, Novolin-N
onset:2-4 hrs
peak:4-10hrs
duration:10-16hrs
route:sc
hypoglycemia: 3pm to supper

30

Long Lasting Insulin

Insulin Detemir(Levemir)
onset:3-4 hrs peak: 3-14hrs duration: 6-24hrs
route:SC

Insulin Glargine(Lantus) onset:3-4 peak:(none) duration: 24hrs route: SC

31

Mixed insulin

NPH and regular(Humulin 70/30, Humulin 50/50, Novolin 70/30) onset: 30min, peak: 2-3hrs, duration: 24hrs, route:sc

aspart protamine and aspart(Novolog 70/30) onset: 15min peak: 1-4hrs, duration:18-24hrs, route: sc

Lispro protamine and lispro(Humalog 75/25,Humalog 50/50) onset: 15-30min, peak: 4-8hrs, duration: 24hrs, route: sc

32

mixing insulin

-intermediate and mixed insulin=cloudy
-rapid, short, long=clear
-rotate in palms of hand to warm
-do not mix levemir/lantus(long acting insulin)
-air goes in cloudy first then clear, clear is withdrawn first then cloudy
-long lasting insulin is design to meet basal needs last for 24hrs period, pt should be educated to take at night, once a day, at the same time

33

storage of insulin

-stored in refrigerator unopened and unused, once open stored at room temp for a month

34

frequency of insulin

fingerstick AC(before meals) HS(hour of sleep)
-q6h if npo
-urine glucose, use fresh urine on second void

35

Hypoglycemia(side effects)

-N/v
-diarrhea, hunger, inability to concentrate
-confusion
-nervousness
-anxiety
-tremors
-tachycardia

36

Hypoglycemia(causes)

insulin reaction/shock
-too much insulin or wrong type
-delay or omission of food
-too much exercise
-illness, diarrhea and vomitting

37

Hypoglycemia(Findings)

-BS=below 60
-urine negative sugar ketones

38

Hypoglycemia(treatment)

10-15grams of simple CHO=to boost it
-6oz fruit juice, non diet soda
-cube sugar, honey or corn syrup
-5-6 life savers
-2-3 glucose tabs or glucose gel

followed by complex CHO within 1hr=to maintain sugar level
-skim milk
-crackers, or meal

39

Hypoglycemia(treatment med)

glucagon 1mg(IM,IV,SQ)
-action: 20min
-increase bs by releasing glucose
-do not use with other meds

50% dw ivp or infusion
-followed by 5-10% to stabilze home care

40

Hyperglycemia(s/s)

-n/v
-ab pain, distention, anorexia, dry mouth
-irritability
-hot flushed skin
-fruity order to breath
-kussmuals resp., increase urinary output

41

Hyperglycemia(cause)

Hyperglycemia can lead to diabetic coma/ketoacidosis
-too little insulin, missed dose
-unregulated or extra meals
-stress
-increase alcohol
-injection
-n/v or diarrhea

42

Hyperglycemia(Findings & Tx)

-bs-over 150
-urine: positive sugar and ketones
-glucose cannot be used then fats are used for metabolism-ketones occur
-fluid and electrolyte imbalance
tx: regular insulin subQ or IV

43

Lipodystrophy

-destruction of fat tissue
-rotate site and store at room temp to prevent

44

allergic recation

local or systemic
-risk greater in animal insulin and cold insulin
-insulin resistance rare
-interaction:
-alcohol,steriods,NSAIDS,ASA,betablockers,diuretics,MAOI

45

Nursing considerations

-assess FS AC/HS
-FS 1/2 hr AC/HS
-weight change may indicate need for medication adjustment
-objective coordinate blood sugar testing, drug administration, diet and exercise
-exercise increases rate of absorption in insulin
-limit activity 30-60min after
-determine-onset,peak,and duration of insulin
-double check insulin type and dose
-absorption varies based on site,technique,formulation and excersice
-exercise limit 30-40min after meals
-prefilled

46

Oral Hypoglycemics

-type 2 diabetes mellitus
-monotherapy
-multitherapy

47

Sulfonylureas

-Oral Hypoglycemics
-action: stimulate the beta cella to release insulin
-must have functional beta cells for the drug to work
-effective decreases over time

48

Chlorpropamide(Diabinese)

-Sulfonylureas(drugs)
-first generation
-titrated(increase slowl)
-avg. dose 150-250mg

49

Glyburide(Micronase0(Diabeta)

Sulfonylureas(drugs)
-Second generation
-last longer 12-24hrs
-2.5-20mg dose-

50

Glimepiride(Amaryl)

-Sulfonylureas(drugs)
-third generation
-1-2mg once a day
-given with breakfast/main meal of the day

51

Sulfonylureas(Side effects)

-hypoglycemia(common)
-anorexia,n&v,heartburn,weight gain
-weakness,numbness in extremities
-heart and blood vessels disease
-antabuse like reaction
-hepatoxicity
-photosensitivity

52

Sulfonylureas(Nursing consideration)

-30min before breakfast/main meal of the day
-check allergy to sulfa
-long acting glipizide-shell in stool
-recognize hypoglycemia and treatment
-not for use during pregnany

53

Alpha Glucosidase Inhibitor

-Oral Hypoglycemics
-action delays carbohydrate and absorption
-effecting post crandial-after you eat
-slows the breakdown of meal

54

Alpha Glucosidase Inhibitor Drug

Acarbose(precose)
Oral Hypoglycemics
-Alpha glucosidase inhibitor drug
-3x a day dose
-must be taken with first bite of meal
-if they do not eat do not take med

55

Alpha Glucosidase Inhibitor(side effect)

-gi: upset,flatulence,abdominal pain,diarrhea,hypoglycemia
-contraindicated: liver/bowel disease

56

Biquanides

-Oral Hypoglycemics
-reduce hepatic glucose production
-increase insulin sentitivity to muscle and fat cell
-reduce insulin resistance
-decrease weight
-improve lipid levels

57

Biquanides drug

Metformi(Glucophage)
-oral hypoglycemics
-Biquanides
-500-1000mg 2x a day

58

Biquanides(side effects)

-gi:upset,bloating,n/v,flatulance,weight loss,cramping,diarrhea,metallic taste(common)
-hypoglycemia and lactic acidosis(rare)
-caustion: liver,kidney disease and excressive alcohol

59

Meglititinides(glinide)

oral hypoglycemics
-Meglititinides(glinide)
-stimulate insulin release from the pancreas
-drug: Repaglinide(Prandin)
-side effect: hypoglycemia, urti,rhinitis,bronchitis,back pain,headache,hepatoxic,monitor liver profile

60

Thiazolidinediones

oral hypoglycemics
action: decrease insulin resistance, increase insulin sensitivity
drug: rosiglitazone
-black box warning=drug causes serous AVE commonly CHF
-side effect: increase urti,sinusitis,headache,back pain,diarrhea,
-caution in chf and decrease effectiveness of contraceptive pills

61

Incretin Mimetic

oral hypoglycemics
-mimic hormone incretin
-increase insulin secretion from beta cells=more hypoglycemia
-supress glucagon secretion
-slows gastic emptying
-indication: adjuvant to improve glycemic control post meal
-drug:Exenatide(Byetta)-sq-1hr before breakfast 1hr before dinner-pre-filled syring
-side effect:gastrotoxic

62

Dipeptidyl Peptidase-4 inhibitor

oral hypoglycemics
action: inhibit breakdown of incretin hormones
indication: adjuvant to diet and excersise(type 2 dm)
-drug: sitagliptin(Januvia), 100mg po daily
side effect: increase resp tract infection
-monitor wbc for infection, lung sound

63

Amylin Analogue

-action:slows movement of food through the stomach
-indication:type 1/2 diabetes that need blood sugar control
-side effect:n/v,severe hypoglycemia(3hrs after pt has eating)
nursing implication: sq,abdomen or upper thigh,given before major meal,store upopened pen in fridge,dose may based on BS

64

Pituitary/Hypophysis agent
Anterior Lobe Agent
Adrenocorticotropic Hormone(ACTH)

-anterior lobe
-stimulate the adrenal cortex to produce glucocorticoids
-used to diagnose adrenocortical function, multiple sclerosis,thyroidits,hypercalcemia related to cancer
-route:parental,measured in units

65

Pituitary/Hypophysis agent
Anterior Lobe Agent
Adrenocorticotropic Hormone(ACTH)
Side Effects:

Electrolute imbalance
dcrease wbc increase rbc(thrombi)
-increase appetite,thinning mucosa,peptic ulcer
-decrease would healing,
-water and na retention
-weight gain, moon face,buffalo hump,retarded growth in children
-muscle/skeletal weakness,atrophy,osteoporosis
-glucose intolerance
-mood swings
-abrupte withdrawal leads to crissi
-suppress immune response
-suppresses inflammation

66

Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)

-increase size and number of skeletal muscles
-increaase lean body mass in adults
-increase production in Aids
-replace GH in children who fail to grow

67

Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
(side effects)

-hypothyroids
- cause insulin resistance-hyperglycemia
-drop in Bp: hypotension
-decrease in body fat
-tachycardia
-nephrotoxic
-increase sugar levels
-acromegaly
-monitor vs

68

Pituitary/Hypophysis agent
Anterior Lobe Agent
Growth Hormone(Somatotropin)
(Nursing implication)

-route: subq/Im
-1x-7x/week for 6months - 2yr
-dose based on BSA(monitor daily weight)
-teach how to give injection
-monitor ADR@injection site
-glycouria
-stadio-meter measurements
-antibody production against GH
-follow up doctor q3-6mos

69

Posterior lobe agent
Antidiretic Hormone

-in posterior pituitary
-hyposecretion results in diabetes insipidus
-used for diabtes insipidus
-post op abdominal disention
-dispel gas interfering with x-ray
-enuresis(bed wetting)
-hemophilia type A

70

Posterior lobe agent
Antidiretic Hormone
Vasopressin(Pitressin)

-taken 1-2x a day
-5-10u tid, nasal spray,subq,im
-tannate(in oil) last for 48-96hr
-in posterior pituitary
-hyposecretion results in diabetes insipidus
-used for diabtes insipidus
-post op abdominal disention
-dispel gas interfering with x-ray
-enuresis(bed wetting)
-hemophilia type A

71

Posterior lobe agent
Antidiretic Hormone
DDAVP(Desmopressin)

-nasal spray solution(via rhinal tube)
-in posterior pituitary
-hyposecretion results in diabetes insipidus
-used for diabtes insipidus
-post op abdominal disention
-dispel gas interfering with x-ray
-enuresis(bed wetting)
-hemophilia type A

72

Posterior lobe agent
Antidiretic Hormone
(Side effect)

-hypersensitivity
-termors,vertigo,sweating
-belching,n/v,diarrhea
-water intoxication
-spasm in uterus and coronary artery
-thrombosis
-watch for water intox=n/v,headache,drowsy,confusion,weight gain,seizures,coma,
contraiindicated for children aged, children under 11mos

73

Posterior lobe agent
Antidiretic Hormone
(nursing implication)

-monitor s/s of dehydration
-record I&O
-urine SG
-skin tugor
-weight
-BP,HR,EKG
-have NTG(Nitroglycerin) available=treat angina
-labs-electrolytes/coags
-check for changes in nasal mucosa
-switching from nasal to oral forms-give first tab within 12hr of last nasal dose
-rinse bottle tip in hot water,dry with tissue and recap
-iv-use pump,check for infiltration and tissue necrosis

74

Thyroid gland

regulation of metabolism of carb,protein,lipids by the secretion of t3 and t4

75

thyroid replacement drug

-increase metabolic rate by replacing thyroid hormone t3/t4
used for hyposecretion of thyroid hormone/hypothyroidism(myxedema in adults
-euthyroid state-return to normal

76

thyroid replacement drug(side effect)

-hyperthyroid/increase bmr
-tachycardia,palp,htn(monitor apical)
-nervousness,headache,insomnia
-diarrhea,decrease weight
-intolerance to heat, sweating

77

thyroid replacement drug
Levothyroxine(synthroid)

-avg dose:100-125mcg
-interaction with oral coag, epi,antidepressants,antidiabetic agent,cns depressents

78

thyroid replacement drug(nursing implicaiton)

-start with low dose
-take at same time each day
-early am before breakfast to prevent insomnia
-record apical pulse=hold if bp above 100
-see improvement within 10-14days
-life long therapy
-keep in dark bottle
-replace q3mos
-avoid iodine salt, iodoine
-children monitor bone growth and development

79

Antithyroid drug

-indication: treat hyperthyroidism(grave disease,exopthalmos, hypersecretion of the thyroid)

80

Antithyroid drugs used

thiouracil
iodides
radioactive isotopes

81

Thiouracils

-inhibit synthesis and release of the thyroid hormone
-prevent the conversion of t3/t4 in the peripheral circulation
-indication:hyperthyroidism
-return to euthyroid state

82

Thiouracil(drug)

-propylthiouracils(PTU)
-100-150mg 1-4x a day
-given for 6mos to several years

83

Thiouracil(side effects)

-s/s of hypothyroidism
-lupus like symptoms(butterfly rash,joint pain,photosensitivity)
-hepatotoxic-jaundice up to 10wks even after md discontinues
-arganulocytosis(monitor blood)
-n/v
-hay fever,sore throat,skin rash,puritis,headache,paresthesia

84

Thiouracil(Nursing implication)

-given at the same time w/meals
-sudden stop=thyroid storm(agitation,change in LOC,tachycardia,shaking,fever,sweating,diarrhea)
-available suppository or enema
-instruct pt to report chills,fever,skin rash,sore throat,malaise,enlarged lymph node,jaundice,monitor cbc,pt,no vaccine w/ permission

85

Iodides(Antithyroid drug)

-reduce the size and vascularity of the thyroid gland

86

Iodides(Antithyroid drug)(Indication)

-use 7-10days before surgery so the thyroid is more sturdy
-mild to severe thyroid hyperactivity in the young
-onset-24hr peak:10-15 days

87

Iodides(drugs)

-potassium iodide(sski)
-130mg/day child is hald 65
-side effects: iodism=toxicity of iodine=metallic taste in the mouth,fever,rash,on the skin or mucous membrane,parotits,increase salivation,and allergic reaction

nursing implication:
-check for drug allergy to seafood,iodine
-dilute in milke,cola,fruit juice
-improves taste
-prevents staining of teeth

88

Radioactive iodine(RAI)(antithyroid drug)

-action:emit beta rays which DESTROY hyperactive thyroid cells
use: hyperthyroidism, thyroid cancer, diagnostic testing
drug :radiactive iodine(RAI), sodium iodide
-if destroying going to need thyroid replacement

side effect: hypothyrodism
-thyroidits swelling of the neck,back,sore throat,cough, and pain on swallowing,n&v,bone marrow suppresion-monitor cbc,wbc

contrainticated in pregnacy

89

Parathyroid agents

-hormones working in opposite direction
-not functioning levels go in same direction
-parathyroid glands regulate calcium metabolism and secretes its hormone when blood calcium levels drops to promote reabsorption of calcium from the bones

90

Hyperparathyroidism

hypersecretion of parathyroid hormone causing increase in calcium levels
use for osteoporosis and hypercalciema

91

Calcitonin(calcimar)

-synthetic hormone
-turns off secretion of the hormone
-calcitonin-salmon-check allergy to salmon
-sq,im,intranasal
-4-8units 1kg every 6-12hrs