Part 1 Endocrine System Drugs – Insulin
Part 2 NCLEX Endocrine Medications Oral Hypoglycemics
For Insulin Overdose
The Drug: Glucagon
Expected Action: Increases glycogenolysis, Decreases glycogenesis, Increases gluconeogenesis
Therapeutic Uses: Hypoglycemia 2º insulin overdose, ò GI motility while undergoing radiological procedures of stomach / intestines
Adverse Effects: GI distress (turn on left side to ò risk of aspiration)
Contraindications/Precautions:
Pregnancy: ?
Pheochromocytoma d/t catecholamine stimulating effects
Ineffective for starvation-related hypoglycemia because depleted glycogen stores.
Education: Provide food as soon as patient is able to eat.
Thyroid Hormones
Drug: levothyroxine (Synthroid) Others: liothyronine, liotrix
Expected Action:
Synthetic thyroxine leads to increased metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume, and growth processes.
Therapeutic Uses:
Hypothyroidism (all forms), Emergency treatment of myxedema coma by IV
Adverse Effects: Hyperthyroidism (anxiety, tachycardia, palpitations, increased appetite, heat intolerance, fever, diaphoresis, and weight loss)
Contraindications/Precautions: Pregnancy (A), Thyrotoxicosis and MI, CAUTION with Cardiovascular problems and pregnancy
Interactions:
Levothyroxine breaks down vitamin K ñ Warfarin effects
Many antiseizure and antidepressant meds like carbamazepine, phenytoin, phenobarbital, sertraline ñ levothyroxine metabolism
Binding agents (iron, calcium, antacids, cholestyramine)and sucralfate ò levothyroxine absorption
Antithyroid Medication
Drug: propylthiouracil — Others: methimazole (Tapazole)
Expected Action: Block thyroid hormone synthesis // Prevent oxidation of Iodine // V T4 leads to T3
Therapeutic Uses: Grave’s disease, Adjunct to thyroid irradiation, Produce euthyroid state prior to thyroid removal, Emergency thyrotoxicosis treatment
Adverse Effects:
Overmedication leads to hypothyroidism which can cause (drowsiness, weight gain, edema, bradycardia, cold intolerance, dry skin)
Agranulocytosis Monitor for early signs (fever, pharyngitis) Tx: Neupogen
Contraindications/Precautions: Pregnancy (D), USE CAUTION: Marrow depression or immunosuppression
Interactions: increased anticoagulant effects
Education: Take at consistent time and with meals (decreases GI distress), Hyperthyroidism may get β-adrenergic blocker (propranolol) to decrease tremors
Radioactive Iodine (I131)
Drug: Radioactive iodine
Expected Action: Destroys thyroid cells at high doses
Therapeutic Uses: Hyperthyroidism (ñ dose), Thyroid cancer (ñ dose), ò doses: Thyroid function studies
Adverse Effects: Marrow suppression (anemia, leukopenia, thrombocytopenia), Radiation sickness: Hematemesis, epistaxis, intense nausea, vomiting
Contraindications/Precautions: Pregnancy (X), childbearing age, lactation
Interactions: Reduced uptake with antithyroid meds
Education: Take on empty stomach, Void frequently // Limit contact to ½ hr/day/person // ñ fluids, dispose of body wastes per protocol, avoid coughing and expectorating
Nonradioactive Iodine
Drug: strong iodine solution (Lugol’s solution) — Others: sodium iodide, potassium iodide
Expected Action: increases iodide levels leads to decreased uptake (by thyroid), V thyroid hormone production, and block release of thyroid hormones into blood stream.
Therapeutic Uses: Development of euthyroid state and ò size prior to removal, Emergency treatment of thyrotoxicosis
Adverse Effects: Iodism symptoms d/t corrosive property (metallic taste, stomatitis, sore teeth and gums, gastric distress). – drink through straw // take ĉ food // OD prevention
Contraindications/Precautions: Pregnancy (D)
Interactions: Foods high in iodine (fish, salt) leads to Risk for iodism
Education: Dilute Lugol’s solution with juice to improve taste.
Growth Hormones (Anterior Pituitary)
Drug: Somatropin — Others: Somatrem (Protropin)
Expected Action Stimulate overall growth, production of proteins, and ò use of glucose
Therapeutic Uses: Growth hormone deficiencies, Bulking up so you can hit the long ball…
Adverse Effects: Hyperglycemia (polyphagia, polydipsia, polyuria)
Contraindications/Precautions: Pregnancy(C), Caution: Diabetes leads Risk for hyperglycemia, D/c Tx before epiphyseal closure
Interactions: Glucocorticoids can counteract growth-promoting effects
Education: IM or SC (less painful)
Antidiuretic Hormone
Drug: vasopressin (Pitressin) — Others: desmopressin (DDAVP)
Expected Action: Promote H2O reabsorption in kidneys (desmopressin preferred), Vasoconstriction due to smooth muscle contraction (vasopressin)
Therapeutic Uses: Diabetes insipidus, Cardiac arrest
Contraindications/Precautions: Pregnancy (X), CAD or decreased peripheral circulation (risk for gangrene)
Education: Monitor site carefully; extravasation can cause gangrene.
