ENDOCRINE

SYSTEM
DRUGS
START
DRUGS FOR
PITUITARY
DISORDERS
 GROWTH HORMONES
Treats deficiency of Side effects:
growth hormones Headache
vomiting
Examples: Fatigue
mecasermin Muscle pain
somatropin
 GROWTH HORMONE
RECEPTOR ANTAGONIST

Treats acromegaly Side Effects

Diarrhea
Examples: Nausea
Pegvisomant Blurred Vision
Octerotide
ANTIDIURETIC HORMONES
Treats DIABETES Side Effects:
INSIPIDUS water intoxication
hypertension

Examples: Intervention:
Vasopressin monitor weight
Desmopressin monitor intake
acetate and output
DRUGS FOR
THYROID
DISORDERS
 HYPOTHYROIDISM

DRUGS: INTERVENTIONS
Levohyroixine Monitor T3, T4, and
TSH levels
SIDE EFFECTS take drug in morning
Signs of 30 - 60 minutes
hyperthyroidism before meals
monitor pulse rate
 HYPERTHYROIDISM

DRUGS: SIDE EFFECTS

Propylthiouracil (PTU) Signs of hypothyroidism
Methimazole
Potassium iodide INTERVENTIONS:
Iodine solution (Lugol's Monitor T3, T4 & TSH
Solution) levels
Iodine 131 Monitor weight
Take with meals
FOODS THAT BLOCK THYROID GLAND
FUNCTION
Cruciferous Peaches
vegetables Spinach
Cauliflower Kale
Cabbage Brussels sprouts
Turnips Radish
Strawberries Peas
 PTU
Causes agranulocytosis
monitor for fever and sore
throat
check the CBC with differential
for neutropenia
PARATHYROID
DRUGS
HYPERPARATHYROIDISM
AND
HYPERCALCEMIA
DRUGS
 HYPERPARATHYROIDISM AND
HYPERCALCEMIA
DRUGS:
Gallium nitrate Interventions:
Cinacalcet hydrochloride Foods rich in Calcium
Paricalcitol
Doxercalciferol

SIDE EFFECTS
Nausea
Vomiting
Diarrhea
 HYPERPARATHYROIDISM AND
HYPERCALCEMIA
Vitamin D Function:
enhances absorption of calcium in the
gastrointestinal tract

Calcitonin Function:
Decreases serum calcium and inhibits bone
breakdown (resporption)
MINERALOCOTICOIDS
FLUDOCORTISONE ACETATE
Replaces hormones in Addison's
disease
Side Effects
Signs of Cushing's syndrome
Gastrointestinal bleeding
Interventions
Take drugs with food or milk
High potassium diet
GLUCOCORTICOIDS
GLUCOCORTICOIDS
Fights inflammation
Treats allergy
Helps cope with stress
Examples
Dexamethasone
Prednisone
Hydrocortisone
GLUCOCORTICOIDS
Side Effects
Cushing's syndrome
Hypernatremia
Hypokalemia
Hyperglycemia
Osteoporosis
Weight gain
Mood swings
Cataracts
Acne
GLUCOCORTICOIDS
Interventions:
Monitor blood sugar
High potassium diet
Monitor for
gastrointestinal bleeding
Take drug in the morning
ANDROGENS
METHYLTESTOSTERONE
Replaces androgen hormones
treats certain types of breast cancers
Risk for prostate cancer
Side Effects
Masculinization
Priapism
Acne
METHYLTESTOSTERONE
Interventions
menstrual irregularities
Changes in libido
take with food or snacks
 STEROID DRUGS
Should not be stopped abruptly
Takes a while for adrenal gland to
produce its own steroids after it is shut
down from prolonged steroid use
dose must be tapered to prevent a fatal
adrenal crisis
DRUGS FOR
DIABETES
MELLITUS
 RAPID ACTING
INSULIN

Clear Duration --> 3 - 5 hours

Other Names
Insulin aspart (NovoLog)
Insulin glulisine (Apidra) Implications:
Insulin lispro (Humalog) Given immediately
before meals
Onset --> 15 minutes Given SQ or IV
May mix with NPH
Peak --> 30 - 90 minutes insulin
 SHORT ACTING
INSULIN

Clear Duration --> 5 - 8 hours

Other Names
Insulin regular (Humulin
R, Novolin R) Implications:
Given 30 minutes
Onset --> 30 - 60 minutes before meals
given SQ or IV
Peak --> 2 - 4 hours May mix with NPH
insulin
 INTERMEDIATE ACTING
INSULIN

Cloudy Duration --> 12 - 16 hours

Other Names
Insulin NPH human Implications:
(Humulin N, Novolin N) Lowers blood glucose
elevations when RA
Onset --> 1 - 3 hours insulins stop working
Given SQ
Peak --> 8 hours May mix with RA or SA
insulin
 LONG ACTING
INSULIN

Clear Duration --> 20 - 24 hours

Other Names
Insulin glargine (Lantus, Implications:
Toujeo) Lowers blood glucose
Insulin detemir (Levemir) elevations when RA
insulins stop working
Onset --> 1 hour Given SQ
Peak Usually taken once a day
Lantus - NO PEAK May mix with RA or SA
Levemir - 6 - 8 hours insulin
 MIXED
INSULIN

Cloudy Duration --> 24 hours

Other Names
Humulin 70/30 Implications:
novolin 70/30 Usually taken once
Relion 70/30 daily
Given SQ
Onset --> 30 minutes Do not mix with other
insulins
Peak --> 2 - 12 hours
 TIPS
Always know the peak times of insulin
medications
Rationale:
It is the period where clients most
likely develop hypoglycemic or insulin
reactions
 FAQS
Why is insulin not given orally?
it is destroyed by gastric secretions
What are the sites for insulin injections?
Abdomen (preferred), posterior arm, anterior
thigh, and hips
Why rotate injection sites?
To prevent lipodystrophy that will result into
erratic insulin absorption
 FAQS
What is the needle gauge for insulin injection?
guare 27 - 29 needle, 1/2 inch
Why do we roll the insulin vial between the palms
before preparation?
to properly dissolve the insulin solution and
restores appearance
Can a insulin vial be shaken?
No, bubbles will expand insulin volume
 FAQS
How to draw insulin?
draw insulin from clear vial first the cloudy to
maintain the purity and clarity of the clear
solution
 FAQS
What insulins are not compatible for mixing with
other types of insulin (even though they are clear)
Glargine (Lantus)
Insulin detemir (Levemir)
How is insulin injected?
Give subcutaneously at 45-90 degree angle;
45 - 60 degrees in thin clients
 FAQS
Is aspiration needed when insulin injected?
NO
What insulins can be given IV?
Rapid acting insulin
Short acting insulin
 COMPLICATIONS

DAWN PHENOMENON SOMOGYI PHENOMENON

"DOWN INSULIN" "SO MUCH INSULIN"
Due to decreased effect of A "rebound hyperglycemia" in
bedtime insulin dose response to low blood glucose
Hyperglycemia occurs at night
between 2:00 & 8:00 AM May need to decrease the
(early morning) insulin dose or provide snacks
May need to increase the at bedtime
insulin dose
 TIPS
Check blood sugar level between 2:00 -
3:00 AM
Hypoglycemia consistently present
Somogyi phenomenon
Blood glucose level usually high or
normal
Suspect Dawn Phenomenon
 ORAL
HYPOGLYCEMIC
AGENTS
NON-INSULIN
DRUGS
FOR
DIABETES
MELLITUS
AMYLINOMIMETIC
Reduces glucagon secretion after meals
Example:
Prmlintide
Side Effects
Anorexia
Weight loss
Hypoglycemia
Interventions
Avoid drinking alcohol
DPP-4 INHIBITORS
Reduces glucagon
Risk for pancreatitis
Examples:
ogliptin
Saxagliptin
Sitagliptin
Linagliptin
DPP-4 INHIBITORS
Side Effects
headache
Runny nose
Chills
Interventions
Report severe abdominal pain
(pancreatitis)
 GLUCAGON-LIKE PEPTIDES
(GLP-1 RECEPTOR AGONISTS)
Increases insulin and decreases
glucagon
all are injectibles (subcutaneous)
Incretins
Hormones that stimulate insulin
secretion after eating, before blood
glucose become elevated
 GLUCAGON-LIKE PEPTIDES
(GLP-1 RECEPTOR AGONISTS)

Examples
Albiglutide
Exenatide
Liraglutide
Dulaglutide
 GLUCAGON-LIKE PEPTIDES
(GLP-1 RECEPTOR AGONISTS)
Side Effects:
Nausea and vomiting
Diarrhea
Dizziness
Interventions
Report severe abdominal pain
(pancreatitis)
SODIUM GLUCOSE TRANSPORTER 2
(SGLT2) INHIBITORS
Prevents the kidney from retaining
glucose
Examples
Dapagliflozin (Farxiga)
Empagliflozin
Canagliflozin
SODIUM GLUCOSE TRANSPORTER 2
(SGLT2) INHIBITORS
Side Effects:
Hypotension
Dehydration
Glycosuria
Weight Loss
Interventions
Monitor for dehydration
 INHALED INSULIN
Ultra-rapid acting insulin (faster than
rapid acting insulins)
Example
Afrezza
Side effects
Hypoglycemia, cough, sore throat
Avoid in clients with asthma and COPD