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MODULE 3.4 - ENDOCRINE, Lecture notes of Pharmacology

Don Mariano Marcos Memorial State University (DMMMSU)Pharmacology

MODULE 3.4 - ENDOCRINE LECTURE NOTES

Typology: Lecture notes

2021/2022

Available from 10/25/2022

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NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
LESSON 5
ENDOCRINE DRUGS
ANTIDIABETIC AGENTS
A. Description
1. Used to manage/treat diabetes mellitus
2. Classified into two types: insulin for parenteral use and oral antidiabetics
3. Insulin
a. Acts to facilitate the transport of glucose across the cell membrane
and to promote glycogenesis.
b. Available in three forms: human, beef, and pork
--human and purified pork insulins are less antigenic;
--administered parenterally
--brands and forms should not be substituted without medical supervision.
c. Available in rapid-acting, intermediate-acting, and long-acting forms
--rapid-acting and intermediate-acting forms are available in mixed preparations (e.g.,
Humulin 70/30, which contains 70% NPH and 30% regular insulin).
4. Oral antidiabetics
a. Require some functioning beta cells.
b. Lowers serum glucose in variety of ways depending on the drug.
B. Examples
1. Insulin: regular (Humulin R, Novolin R);
isophane suspension (Humulin N, Novolin N);
insulin zinc suspension (Humulin L, Novolin N).
2. Oral antidiabetics
a. Sulfonylureas: stimulate pancreatic beta cells to produce insulin: glipizide (Glucotrol);
chlorpropamide (diabenese); glyburide (Micronase).
b. Other: acarbose (Precose); delays digestion of carbohydrates; metformin (Glucophage)
and troglitazone (Rezulin); increase sensitivity to insulin and inhibit hepatic glucose
production.
C. Major side effects
1. Insulin: irritability, tremor (hypoglycemia); headache; confusion,
convulsion (hypoglycemia); tachycardia (hypoglycemia); moist skin
(hypoglycemia); hunger (hypoglycemia).
2. Oral antidiabetics: hypoglycemia; skin rash, allergic reactions, pruritus
(hypersensitivity); jaundice (hepatic alterations); thrombocytopenia (glucophage).
D. Nursing care
1. Assess client for signs of hypoglycemia.
2. Instruct client to:
a. Use proper medication administration procedure.
b. Comply with dietary program, including snacks.
c. Avoid alcohol, especially when taking Diabenese and Glucophage.
d. Perform blood glucose solution, hard candy, orange juice, glucagon)
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LESSON 5

ENDOCRINE DRUGS

ANTIDIABETIC AGENTS

A. Description

1. Used to manage/treat diabetes mellitus 2. Classified into two types: insulin for parenteral use and oral antidiabetics 3. Insulin a. Acts to facilitate the transport of glucose across the cell membrane and to promote glycogenesis. b. Available in three forms: human, beef, and pork --human and purified pork insulins are less antigenic; --administered parenterally --brands and forms should not be substituted without medical supervision. c. Available in rapid-acting, intermediate-acting, and long-acting forms --rapid-acting and intermediate-acting forms are available in mixed preparations (e.g., Humulin 70/30, which contains 70% NPH and 30% regular insulin). 4. Oral antidiabetics a. Require some functioning beta cells. b. Lowers serum glucose in variety of ways depending on the drug. **B. Examples

  1. Insulin:** regular (Humulin R, Novolin R); isophane suspension (Humulin N, Novolin N); insulin zinc suspension (Humulin L, Novolin N). 2. Oral antidiabetics a. Sulfonylureas: stimulate pancreatic beta cells to produce insulin: glipizide (Glucotrol); chlorpropamide (diabenese); glyburide (Micronase). b. Other: acarbose (Precose); delays digestion of carbohydrates; metformin (Glucophage) and troglitazone (Rezulin); increase sensitivity to insulin and inhibit hepatic glucose production. **C. Major side effects
  2. Insulin:** irritability, tremor (hypoglycemia); headache; confusion, convulsion (hypoglycemia); tachycardia (hypoglycemia); moist skin (hypoglycemia); hunger (hypoglycemia). 2. Oral antidiabetics: hypoglycemia; skin rash, allergic reactions, pruritus (hypersensitivity); jaundice (hepatic alterations); thrombocytopenia (glucophage). D. Nursing care
  3. Assess client for signs of hypoglycemia.
  4. Instruct client to: a. Use proper medication administration procedure. b. Comply with dietary program, including snacks. c. Avoid alcohol, especially when taking Diabenese and Glucophage. d. Perform blood glucose solution, hard candy, orange juice, glucagon)
  1. Administer insulin a. Administer all forms of insulin subcutaneously. b. Use only regular insulin for IV administration. c. If premixed insulin is not prescribed and two forms are to be mixed, draw up regular insulin first. d. Abdomen is preferred site because it is not influenced by exercise. e. Slight dosage adjustment may be necessary when switching from one form of insulin to another because of different pharmacokinetics.
  2. Offer emotional support to client; therapy is lifelong. Common Types of Insulin Onset Peak Duration
  • Rapid-acting Insulin (Lispro, Humalog) 10 - 15 mins 1 hour 3 hours
  • Short acting insulin (Humulin Regular) 1 hour 2 - 3 hours 4 - 6 hours
  • Intermediate-acting Insulin (Humulin NPH, Humulin Lente) 3 - 4 hours 4 - 12 hours 16 - 20 hours
  • Long-acting Insulin (Humulin Ultralente) 6 - 8 hours 12 - 16 hours 20 - 30 hours Premixed Insulin (70%NPH + 30% regular) 1 hour 2 - 12 hours 18 - 14 hours *1st^ generation Sulfonyllureas *2nd^ Generation Sulfonylureas Glipizide (Glucotrol, Glucotrol XL) Glyburide (Dia Beta, Micronase, Glynase) Glimeperide (Amaryl)
  • Short Acting Tolbutamide (Orinase)
  • Intermediate Acting Acetohexamide (Dymelor) Tolazamide (Tolinase) Non Sulfonylureas Meiformin (Glucophage) Acarpos (Precose) Miglitol (Glysey) Troglitazone (Kezulin) Rosiglitazone (Aranida) Rapaglinide (Prandin) *Long Acting Chlorpropamide (Diabenase)

THYROID INHIBITORS

A. Description

  1. Interfere with the synthesis and release of thyroid hormone; inhibit oxidation of iodides to prevent their combination with tyrosine in formation of thyroxine.
  2. Treat hyperthyroidism.
  3. Available in oral and parenteral (IV) preparations. B. Examples: iodine (Lugol’s solution) methimazole (Tapazole); Propylthiouracil (PTU) C. Major side effects: agranuclocytosis (decreased WBCs); skin disturbances (hypersensitivity); nausea, vomiting (irritation of gastric mucosa); decreased metabolism (decreased production of serum T3, T4); iodine: (bitter taste, stains teeth because of local oral effect on mucosa and teeth). **D. Nursing care
  4. Instruct client to:** a. Report the occurrence of any side effects to physician, especially sore throat and fever. b. Avoid crowded places and potentially infectious situations.
  5. Administer liquid iodine preparations diluted in beverages of choice; use a straw.
  6. Assess client for signs of hypothyroidism.

ADRENOCORTICOIDS

A. Description

  1. Interfere with the release of factors important in producing the normal inflammatory auditory immune responses.
  2. Increase glucose and fat formation and promote protein breakdown.
  3. Used for hormonal replacement therapy.
  4. Available in oral, parenteral (IM, IV), inhalation, intraarticular, and topical, including ophthalmic, preparations.

B. Examples: dexamethasone (Decadron); hydrocortisone succinate (Solu-Cortef); prednisone (Deltasone). C. Major side effects

  1. Cushing-like symptoms (increased glucocorticoid activity)
  2. Hypertension (promotion of sodium and water retention)
  3. Hyperglycemia (increased carbohydrate catabolism; gluconeogenesis)
  4. Mood changes (CNS effect)
  5. GI irritation and ulcer formation (local GI effect)
  6. Cataracts (hyperglycemia)
  7. Hypokalemia (promotion of potassium excretion) D. Nursing care
  8. Administer oral preparations with food milk or antacid.
  9. Monitor client’s weight, blood pressure, and serum electrolytes during therapy.
  10. Avoid placing client in potentially infectious situations.
  11. Assess for GI bleeding; monitor blood glucose in people with diabetes.
  12. In addition to carrying a medical alert card, instruct client to: a. Avoid exposure to infections; notify physician if fever or sore throat occurs; avoid immunizations during therapy. b. Avoid using salt; encourage foods high in potassium. c. Avoid missing changing, or withdrawing drug suddenly.
  13. Withdraw drug therapy gradually to permit adrenal recovery.

ANTIDIURETIC HORMONE

A. Description

  1. Promotes water reabsorption by the distal renal tubules and causes vasoconstriction and increased muscle tone of the bladder, GI tract, uterus, and blood vessels.
  2. treatment for diabetes insipidus
  3. Available in parenteral (IM, SC) or nasal preparation B. Examples:
  4. Lypressin (Diapid) for intranasal administration
  5. vasopressin (Pitressin) C. Major side effects
  6. Increased intestinal activity (direct peristaltic stimulant)
  7. Hyponatremia (promotion of water reabsorption)
  8. Pallor (hemodilution)
  9. Water intoxication (promotion of water reabsorption)
  10. Cardiac disturbances (Fluid/electrolyte imbalance)
  11. Nasal irritation (lypressin has local effect on nasal mucosa) D. Nursing care
  12. Assess client for signs of dehydration during therapy, monitor intake and output.
  13. Assess vital signs, especially blood pressure
  14. If drug is administered to improve bladder or bowel for continence or passage.