ENDOCRINE DRUGS. Endocrine disorders are classified as either an over functioning or under functioning of the endocrine glands.

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1 ENDOCRINE DRUGS Endocrine disorders are classified as either an over functioning or under functioning of the endocrine glands. Drugs that treat endocrine disorders include: a. Natural hormones and their Synthetic Analogues b. Hormone-like substances c. Drugs that stimulate or suppress hormone secretion Drugs affecting endocrine function do not cure the disease but promotes only supportive care to the client. Lifelong therapy is often indicated. ANTI DIABETIC DRUGS AND GLUCAGON ANTIDIABETIC DRUGS AND GLUCAGON Diabetes Mellitus is a condition characterized by elevated blood glucose levels. This may be due to either Insulin deficiency or Insulin Resistance. HOW INSULIN WORKS: Glucose cannot enter the cell without the aid of insulin Insulin binds to the receptors on the surface of the cells. This activates the glucose transport channels in the cells Glucose then is able to move from outside the cell to inside the cell through the Glucose Transport Channels Two types: 1. Type 1: Insulin dependent (body unable to produce enough insulin needed by the body) 2. Type 2: Non-Insulin Dependent (body has sufficient amount of circulating levels of insulin, but this insulin is not utilized because cells are resistant to Insulin) These are drugs that affect Serum Glucose level: a. HYPOGLYCEMIC DRUGS: lowers blood glucose levels (eg., Insulin) b. HYPERGLYCEMIC DRUGS: raises blood glucose levels (e.g., Glucagon) Hyperglycemia vs Hypoglycemia Cold and Clammy needs some Candy and Hot and Dry Sugar is High Hypoglycemia: Restlessness, Yawning, Weakness, Tremors, Pallor, Diaphoresis, Cold and Clammy Skin, Dizziness, Faintness, Slurred Speech Hyperglycemia: Polyuria, Polydipsia, Polyphagia, Warm and Flushed Dry Skin, Soft eyeballs, Kussmaul s breathing, Fruity odor of Breath INSULIN -Usually given to DM Type 1 patients but may at times be given to patients with Type 2 Diabetes -not given orally because it is broken down by gastric juices before it is absorbed in the blood stream -usual route :SUBCUTANEOUS Regular Insulin can be given INTRAVENOUSLY

2 Different Types: a. Rapid Acting: Lispro b. Short Acting: Regular Insulin c. Intermediate Acting: NPH d. Long Acting: Ultra Lente CLASSIFICATION RAPID ACTING EXAMPLES Insulin Lispro (Humalog) Insulin Aspart (Novolog) Insulin Glulisin (Avidra) Indications: a. Type 1 DM b. Type 2 DM when: Other means of controlling DM is ineffective Blood Glucose levels are elevated during periods of emotional and physical stress When Oral Antidiabetics are contraindicated or Hypersensitivity reaction occurs SHORT ACTING Onset: 15 mins or less Duration: 5 to 7 hours Regular Humalin R Novolin R Semilente Semilente Purified Pork Insulin c. Diabetic Ketoacidosis d. Hyperosmolar Non-Ketotic Acidosis e. Severe Hyperkalemia (Potassium moves together with Insulin towards the cells) What You Must Know About the Different Types of Insulin: INTERMEDIATE ACTING LONG ACTING CONSTANT ACTING Onset: mins Duration: 12-16hours Humalin N Novolin N Humalin L Lente Purified Pork Novolin L Onset 1-2 hours Duration: hours Humalin U Ultralente Onset 4-8hours Duration: 36 hours Lantus R Insulin Glargine (do not mix with other insulin) Onset: 4-8 hours Duration: 24hours Mechanism of Action: Mimics the effect of naturally occurring insulin in the body Deceleration of the breakdown of glycogen, proteins and fats and promotes storage of excess glucose as Glycogen Do not give INTERMEDIATE or LONG- ACTING Insulin in cases of coma and other emergency cases that need rapid drug actions. Insulin resistance may occur. In clients with Insulin resistance, you may use REGULAR INSULIN in large doses (500 U) to control symptoms of diabetes. DO NOT SHAKE VIAL when preparing the insulin. This causes the formation of bubbles and creates air in the syringe. Simply SWIRL THE VIAL in your palms. HUMALOG should be given 15 minutes before meals because it is rapid acting. LENTE, ULTRALENTE, and SEMILENTE may be mixed in any proportion. When mixing NPH or Lente with Regular Insulin in the same syringe, give the IMMEDIATELY to avoid loss of potency. REGULAR INSULIN may be given IV or may be incorporated with PNSS. Ensure drop rate as ordered. In mixing 2 insulins, follow the General rule: CLEAR before CLOUDY Clear: Rapid and Short Acting Cloudy: Intermediate and Long Acting

3 Drug Interactions: Some drugs interact with the capability of Insulin in promoting glucose uptake on cells while other drugs directly increase the blood glucose levels in the body: a. INCREASE HYPOGLYCEMIC EFFECT OF INSULIN: Salicylates, Alcohol and Monoamine Oxidase (MAO) Inhibitors b. REDUCE HYPOGLYCEMIC EFFECT OF INSULIN: Thiazide diuretics, Sympathomimetics and Corticosteroids c. Beta Adrenergic Blockers prolong the hypoglycemic effect of insulin Adverse Reactions: a. Hypoglycemia b. Somogyi effect (hypoglycemia followed by rebound hyperglycemia) c. Hypersensitivity reactions d. Lipodystrophy e. Insulin resistance a. Assess patient s blood glucose level before therapy and regularly thereafteespecially during times of stress. b. Monitor patient s uring ketone levels when glucose level is elevated. c. Monitor injection sites for lipodystrophy. d. Assess patient s and family s knowledge regarding insulin therapy. e. Do not give insulin that have granulated and have changed color. f. Check expiration of vial prior to giving insulin. g. Rotate site of injection and avoid rubbing injection site. h. Teach client to follow prescribed dietary modifications, weight reduction techniques and personal hygiene procedures. i. Review timing of injections. j. Have carbohydrates or candy ready on hand when hypoglycemia occurs. ORAL ANTIDIABETIC DRUGS Prototype Drugs: First Generation Sulfonylureas Acetohexamide Chlorpropamide Tolazamide Tolbutamide Second Generation Sulfonylureas Glimepiride Glipizide Glyburide Thiazolidinedione Drugs Pioglitazone Rosiglitazone -indicated for Type II diabetes -absorbed well in the GIT and distributed throughout the bloodstream, metabolized in the liver and excreted via the urine -has extrapancreatic function Mechanism of Action Probably stimulate pancreatic beta cells to release insulin in a patient with a minimally functioning pancreas Prevents gluconeogenesis and glycogenolysis on the liver Increase receptor sites for insuling in the peripheral tissues Indications Type II diabetes if diet and exercise cannot control blood glucose levels Adverse Reactions Sulfonylureas: nausea, epigastric fullness, blood abnormalities, water retention, rash, hyponatremia, photosensitivity

4 Metformin: metallic taste, nausea, vomiting, abdominal discomfort Nursing Interventions: Assess blood glucose of patient regularly Patients transferring from insulin therapy to oral antidiabetic medications may need to have blood glucose checking TID Know when to give oral antidiabetics: SULFONYLUREAS: 30 mins.before morning meal (once dose), or 30 minutes before morning and evening meals (double-dose) METFORMIN: give together with morning and evening meals ALPHA-GLUCOSIDASE: given together with first bite of each main meal TID Inform client that therapy treats symptoms but not the disease itself Know s/sx of hyper and hypoglycemia Treat hypoglycemic episodes with a fast acting carbohydrate GLUCAGON -A hyperglycemic drug that raises blood glucose levels. A hormone produced by the alpha cells of the pancreas -glucagon causes GLYCOGENOLYSIS, a process where stored glycogen on the liver are metabolized to produce glucose, thus increasing serum glucose levels. Mechanism of Action: Glycogenolysis Gluconeogenesis by mobilizing free fatty acids from fats causing lipolysis Severe hypoglycemia Nursing Interventions: Assess patient s blood glucose regularly In giving glucagon IV, use a dextrose solution together with a medication hence precipitate forms when used together with chloride solutions. Arouse lethargic patients immediately and offer fast acting carbohydrates If patient does not respond to glucaon, IV dextrose 50% may be given The pituitary gland is divided into: a. Anterior Pituitary Gland: responsible for growth &development & functioning of other endocrine glands b. Posterior Pituitary Gland: responsible for the production of hormones oxytocin and ADH ANTERIOR PITUITARY MEDICATIONS Prototype Medications: Somatotropin (Humatrope) Somatrem (Protropin) Corticotropin (ACTH) Cosyntropin (Cortrosyn) SOMATROPIN AND SOMATREM -growth hormone-like drugs Mechanism of Action -facilitates transport of Amino acids across cell membrane thus, encouraging the growth of the epiphyseal plates of long bones Indications: Dwarfism PITUITARY MEDICATIONS Drug Interactions: Oral anticoagulants: inc d risk for bleeding Should not be given to immunocompromised clients (AIDS, TB) Do not give to clients with Peptic Ulcer Disease, may cause further bleeding

5 Do not give to clients with systemic fungal infections Give with precaution to hypertensive clients (release of aldosterone causes Na retention) Note: In large amounts it may cause increased peristaltic movement, oxytocic effects and vasoconstriction leading to increased BP Drug Interactions: Note: Estrogen and oral contraceptives block the effect of cotricotropin Salicylates may increase risk of bleeding on GI if given together with corticotrophin Has the capacity to increase thyroid activity. WOF signs of hyperthyroidism WOF hypernatremia and possible HPN Hypersensitivity to pork and pork products, hence medication is a pork derivative Nursing responsibilities: Check electrolyte levels; WOF signs of hypernatremia Instruct patient of possibility of immunosuppression (e.g., sore throat, fever) Decrease sodium on diet. Avoid immunization using live vaccines POSTERIOR PITUITARY MEDICATIONS Prototype Medications: Desmopressin acetate Lypressin Vasopressin Mechanism of Action Increases water reabsorption on the distal convoluted tubules, thus decreasing urine formation Mimics the effects f ADH on the body DI Epistaxis (nasal aerosols of vasopressin) Hypersensitivity to pork and pork products Adverse Reactions Diarrhea Nausea and Vomiting HPN Uterine Cramping Nursing Responsibilities Avoid giving oral forms of vasopressin hence proteolyti enzymes of the stomach can digest medication WOF signs of fluid volume overload (e.g., increased weight gain, edema formation, crackles on lungs upon auscultation) Monitor hepatic and renal condition In giving nasal desmopressin, load medication using a straw with your mouth, flex the other tip of the straw to your nose and gently blow to spray medication on nose. No more than 3 blows at a time. ADRENAL MEDICATIONS Adrenal gland is an organ located superiorly at each kidneys. Divided into: a. Adrenal Cortex: releases glucocorticoids, mineralocorticoids, and androgens b. Adrenal Medulla: releases norepinephrine and epinephrine

6 GLUCOCORTICOIDS Mechanism of Action: Increase breakdown of proteins to amino acids, oxidize and mobilize fatty acids Increase gluconeogenesis and glycogenolysis Decrease inflammatory response in the body by inhibiting the release of histamines, prostaglandis and leukotrienes Chronic inflammatory conditions Rheumatoid arthritis Systemic lupus Erythematosus Asthma Organ transplantation Urticaria Other inflammatory conditions Systemic fungal infections Immunosuppression Use cautiously on: DM and PUD caused by H. pylori Adverse Effects: Muscle wasting and weakness Impaired wound healing HPN Menstrual irregularities Cushing syndrome GI bleeding-pud Administer the lowest possible dose for glucocorticoids at a shortest possible time Mimic the normal body surge of hormones when giving glucocorticoids: Give 2/3 on AM and 1/3 on PM Monitor serum glucose levels frequently Instruct client to take drug with food Teach patient to withdraw medication slowly and not abruptly. May cause withdrawal symptoms of exhaustion, fever and diffuse muscle pain MINERALOCORTICOID Prototype drug Fludrocortizone- drug of choice Desoxycorticosterone Mechanism of action: Promote reabsorption of sodium and secondarily water on the distal convoluted tubules of the kidneys. Note: Usually given together with glucocorticoids to mimic the normal surge of hormones on the body Cortisone and Hydrocortisone use is more preferred since they have both glucocorticoid and mineralocorticoid properties. Immunosuppression: Systemic Fungal Infection Adverse Reactions: Hypokalemia HPN Monitor for excessive water retention: presence of excessive weight gain, edema and audible crackles Monitor for HPN Monitor electrolyte levels for hypernatremia and hypokalemia ADRENAL HORMONE INHIBITING MEDICATIONS Prototype Drugs: Aminogluthemide (Cytadron) Mitotane (Lysodren) Metyrapone (Metoprione)

7 Mechanism of Action: Inhibits the ability of the adrenal gland to secrete its G-M-A hormones Used as a temporary treatment in cases where the adrenal glands overly secretes G-M-A hormones. A permanent solution (e.g., surgery) is preferred Monitor for signs of Addison-like disorder Monitor for feelings of weakness Monitor for Hyponatremia and Hyperkalemia Sexual Disturbances may occur during therapy THYROID MEDICATIONS Thyroid gland is a gland located anteriorly to the trachea responsible for releasing hormone T3 (triidothyronine) and T4 (thyroxine). These hormones are responsible for regulating body metabolic processes. THYROID HORMONE REPLACEMENT DRUGS Prototype Drugs: Levothyroxine (Synthroid) Liothyronine (Cytomel) Liotrix (Thyrolar) Mechanism of Action: Mimics the effects of naturally occurring T3 and T4 hormones in the body: a. Controls the rate of metabolism of the body b. Increase fat and carbohydrate metabolism Replacement therapy for hypothyroidism Treatment for Myxedema Coma and Thyroid cancer Contraindicated: Hypersensitivity to pork and pork derivatives Avoid using during MI and on hypoadrenal attacks Adverse Effects: Development of cardiac dysrhythmia Anxiety Sleeplessness Nursing Responsibilities Give medication 30 minutes before breakfast on empty stomach Monitor for hyperthyroidism-like effects Monitor periodic thyroid function tests Advise patient that T3 and T4 hormonal therapy could be life long ANTITHYROID MEDICATIONS Prototype Medications: Propylthiouracil (PTU) Methimazole Strong Iodine Solution Potassium Iodine Solution Mechanism of Action Increase the production or release of thyroid hormones Inhibit the production or secretion of thyroid hormones Indication Hyperthyroid state Note: Euthyroid state must last for 6-12 months before medication can be withdrawn Contraindicated during pregnancy Iodine solution hypersensitivity Drug Interactions Lithium causes increased hypothyroidism effect Potassium containing antithyroid medication can cause hyperkalemia if

8 given with other potassium carrying medications Adverse Effects HYPOTHYROID-LIKE EFFECTS: Lethargy, bradycardia, diarrhea, abdominal discomforts Monitor signs for Iodism Instruct clients that iodine solutions may cause staining of teeth. Drink medications using a straw. Monitor for serum potassium level for those clients taking potassium carrying antithyroid drugs. WOF cardiac dysrhythmias. Avoid abrupt withdrawal of medication. Achieve euthyroid state for 3 to 6 months to withdrawal.