ENDOCRINE SYSTEM.ppt1

8/8/2019 ENDOCRINE SYSTEM.ppt1

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DESCRIPTION:DESCRIPTION:

A polypeptide hormone secreted by the islets ofA polypeptide hormone secreted by the islets of

Langerhans and functioning in the regulation ofLangerhans and functioning in the regulation of

the metabolism of carbohydrates and fats,the metabolism of carbohydrates and fats,

especially the conversion of glucose to glycogen,especially the conversion of glucose to glycogen,

which lowers the blood glucose level.which lowers the blood glucose level.

Any of various pharmaceutical preparationsAny of various pharmaceutical preparations

containing this hormone that are derived from thecontaining this hormone that are derived from the

pancreas of certain animals or produced throughpancreas of certain animals or produced through

genetic engineering and are used in the medicalgenetic engineering and are used in the medicaltreatment and management of diabetes mellitustreatment and management of diabetes mellitus

(type I).(type I).


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ACTION:ACTION:

hormone produced in the beta cells of thehormone produced in the beta cells of the

pancreas and is the key regulator ofpancreas and is the key regulator of

metabolismmetabolism

is required for the entry of the glucose into theis required for the entry of the glucose into theskeletal and heart muscle and fatskeletal and heart muscle and fat

plays a significant role in protein and lipidsplays a significant role in protein and lipids

metabolismmetabolism

deficiency reduces the rate of transportdeficiency reduces the rate of transport

of glucose into the cells, producingof glucose into the cells, producing

hyperglycemiahyperglycemia


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USES:USES:

to maintain normal or nearto maintain normal or near--normal bloodnormal bloodglucose levels in the treatment of type1 andglucose levels in the treatment of type1 and

type2 diabetestype2 diabetes

used in the emergency of DKA and HHNK toused in the emergency of DKA and HHNK to

regulate glucose levels and in treatment ofregulate glucose levels and in treatment ofsevere hyperkalemia to promote thesevere hyperkalemia to promote the

intracellular sgift of potassiumintracellular sgift of potassium

to induce hypoglycemic shock as therapyto induce hypoglycemic shock as therapy

IV as a secretionIV as a secretion--stimulating test for thestimulating test for the

evaluation of pituitary growth hormoneevaluation of pituitary growth hormone


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EXAMPLE OF DRUGS:EXAMPLE OF DRUGS:

Insulin (HUMALOG)Insulin (HUMALOG) insulin aspart (NOVOLOG)insulin aspart (NOVOLOG)

insulin glulisine (APIDRA)insulin glulisine (APIDRA)

insulin injection (REGULAR, HUMILIN R, NOVOLIN R,insulin injection (REGULAR, HUMILIN R, NOVOLIN R,REGULAR ILETIN II)REGULAR ILETIN II)

insulin zinc suspension prompt (SEMILENTE INSULIN)insulin zinc suspension prompt (SEMILENTE INSULIN) insulin glargine (LANTUS R)insulin glargine (LANTUS R)

Insulin Inhalation Powder (EXUBERA)Insulin Inhalation Powder (EXUBERA)

SIDE EFFECTS:SIDE EFFECTS: hyperglycemia, dyspnea, increased cough, reduced pulmonaryhyperglycemia, dyspnea, increased cough, reduced pulmonary

function, RTI, itching, rash, redness, swelling, warmth at thefunction, RTI, itching, rash, redness, swelling, warmth at theinjection site, anaphylaxis, hypersensitivity reactionsinjection site, anaphylaxis, hypersensitivity reactions


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NURSING RESPONSIBILITIES:NURSING RESPONSIBILITIES:

confirm that a blood glucose level wasconfirm that a blood glucose level wasrecently measured and was acceptable for therecently measured and was acceptable for theindividual patientindividual patient

confirm that pulmonary spirometry has beenconfirm that pulmonary spirometry has been

completed before initiating therapy, repeat 6completed before initiating therapy, repeat 6months and then perform annually thereaftermonths and then perform annually thereafter

monitor urine ketone level when glucose levelmonitor urine ketone level when glucose levelis elevatedis elevated

be alert for the adverse reaction and drugbe alert for the adverse reaction and druginteractionsinteractions

monitor injection site for local reactionsmonitor injection site for local reactions


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Description:Description:

Biguanide is a oral antidiabetic agent that decreasesBiguanide is a oral antidiabetic agent that decreases

blood glucose concentration.blood glucose concentration.

Action:Action:

Biguanides increase the binding of insulin atBiguanides increase the binding of insulin at

receptors sites, thereby enhancing the action ofreceptors sites, thereby enhancing the action of

insulin. These agents inhibit hepatic glucoseinsulin. These agents inhibit hepatic glucose

production and reduce glucose absorption inproduction and reduce glucose absorption in

intestine.intestine.

Clinical Therapeutic Uses:Clinical Therapeutic Uses:

Biguanides are used in the treatment of type 2Biguanides are used in the treatment of type 2

diabetes mellitus when diet and exercise program faildiabetes mellitus when diet and exercise program fail

to maintain glycemic control.to maintain glycemic control.


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Drug Examples:Drug Examples:

Metformin (Glucophage, Glucophage XR, Apometformin, Glycon)Metformin (Glucophage, Glucophage XR, Apometformin, Glycon)

Side Effects:Side Effects:

Nausea, Vomiting, Anorexia, Abdominal Cramps, Flatulence, Malaise, Myalgias,Nausea, Vomiting, Anorexia, Abdominal Cramps, Flatulence, Malaise, Myalgias,Respiratory Distress, HypotensionRespiratory Distress, Hypotension

Nursing Responsibilities:Nursing Responsibilities:

Hold metformin for 48 hours before and after diagnostic studies in which theHold metformin for 48 hours before and after diagnostic studies in which thepatient is administered iodinated contrast dye to prevent lactic acidosis or renalpatient is administered iodinated contrast dye to prevent lactic acidosis or renalfailure from occurring.failure from occurring.

Administer metformin with meals to reduce GI side effects.Administer metformin with meals to reduce GI side effects.

Expect the health care provider to reduce the doses of metformin when the patientExpect the health care provider to reduce the doses of metformin when the patient

is undergoing cimetidine therapy.is undergoing cimetidine therapy. Evaluate baseline renal and hepaticfunction tests because the use of metformin isEvaluate baseline renal and hepaticfunction tests because the use of metformin is

contraindicated for patients with renal or hepatic insufficiency.contraindicated for patients with renal or hepatic insufficiency.

Monitor HBC, HbA, C, and renal and hepatic function tests periodically.Monitor HBC, HbA, C, and renal and hepatic function tests periodically.

Instruct the patient to avoid using OTC drugs without consulting with the healthInstruct the patient to avoid using OTC drugs without consulting with the healthcare provider.care provider.

Inform the patient that a bitter or metallic taste may occur but will subside.Inform the patient that a bitter or metallic taste may occur but will subside.


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Definition:Definition:

one of six types of diabetes pills currentlyone of six types of diabetes pills currentlyavailable to treat type 2 diabetes. Theavailable to treat type 2 diabetes. Thecornerstone of diabetes control remainscornerstone of diabetes control remainsunchanged it is important to follow a mealunchanged it is important to follow a mealplan and get plenty of physical activity.plan and get plenty of physical activity.

Diabetes pills are simply another tool to helpDiabetes pills are simply another tool to helpyou manage your blood glucose.you manage your blood glucose.

Actions:Actions:

lower blood glucose by stimulating the releaselower blood glucose by stimulating the releaseof insulin from the beta cells of the pancreas.of insulin from the beta cells of the pancreas.

also diminish glucose production andalso diminish glucose production andmetabolism of insulin by the liver.metabolism of insulin by the liver.


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Therapeutic Uses:Therapeutic Uses:

are effective in type 2 diabetic patients in whom theare effective in type 2 diabetic patients in whom thepancreas still has the capacity to secrete insulin, butpancreas still has the capacity to secrete insulin, butare of no value in the patient with type 1 diabetes,are of no value in the patient with type 1 diabetes,who has no beta cell function.who has no beta cell function.

may be effective in the treatment of type 2 diabetesmay be effective in the treatment of type 2 diabetes

mellitus that cannot be controlled by diet and exercisemellitus that cannot be controlled by diet and exerciseif the patient is not susceptible to developing ketosis,if the patient is not susceptible to developing ketosis,acidosis. Or infections. Patient most likely to benefitacidosis. Or infections. Patient most likely to benefitfrom oral hypoglycemic treatment are those whofrom oral hypoglycemic treatment are those whodevelops signs of diabetes after age 40 and whodevelops signs of diabetes after age 40 and whorequire less than 40 units of insulin per day(indicatingrequire less than 40 units of insulin per day(indicating

that some insulin is still being secreted by the betathat some insulin is still being secreted by the betacells).cells).

may induced hypoglycemic due to overproduction ofmay induced hypoglycemic due to overproduction ofinsulin.insulin.


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Examples of Drug :Examples of Drug :AlphaAlpha--glucoside inhibitors; acardose (Precose ),glucoside inhibitors; acardose (Precose ),

miglitol (Glyset)miglitol (Glyset) Biguanides: metformin (Glucophage, Glucophage XR,Biguanides: metformin (Glucophage, Glucophage XR,Glumetza)Glumetza)

Combination: glyburide andCombination: glyburide andmetformin(Glucovance),rosiglitazone maleate andmetformin(Glucovance),rosiglitazone maleate and

metformin (Metaglip)metformin (Metaglip) Meglitinides : repaglinide(Prandin) nateglinide(Starlix)Meglitinides : repaglinide(Prandin) nateglinide(Starlix)

Sulfonylureas : acetohexamide (Dymelor),Sulfonylureas : acetohexamide (Dymelor),chlorpropamide (Diabinese) ,chlorpropamide (Diabinese) ,

glimepiride (Amaryl), glipizide (Glucotrol, Glucotrolglimepiride (Amaryl), glipizide (Glucotrol, GlucotrolXL),glyburide (DiaXL),glyburide (Dia--Beta,Beta,

Micronase), tolazomide,tolbutamide(Orinase)Micronase), tolazomide,tolbutamide(Orinase)

Thiazolidinediones: rosiglitazone maleate (Avandia),Thiazolidinediones: rosiglitazone maleate (Avandia),pioglitazone hydrochloride (Actos)pioglitazone hydrochloride (Actos)


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Side Effect:Side Effect: Hypoglycemia, nausea, vomiting, heartburn, dizziness,Hypoglycemia, nausea, vomiting, heartburn, dizziness,

drowsiness, headache, photosensitivitydrowsiness, headache, photosensitivity

reactions,(sulfonylureas), lactic acidosis(metformin), flatulencereactions,(sulfonylureas), lactic acidosis(metformin), flatulenceand diarrhea (alphaand diarrhea (alpha-- glucoside inhibitors) upper respiratory tractglucoside inhibitors) upper respiratory tractinfections (meglitinides), edema and heart failureinfections (meglitinides), edema and heart failure

Nursing Responsibilities:Nursing Responsibilities: Instruct the patient to take the alphaInstruct the patient to take the alpha-- glucoside inhibitors withglucoside inhibitors with

first bite food and to take meglinitides within 30 minutes of eachfirst bite food and to take meglinitides within 30 minutes of each

meal.meal. Instruct the patient to contact the practitioner if he cant eat;Instruct the patient to contact the practitioner if he cant eat;

inadequate intake increases the risk of hypoglycemiainadequate intake increases the risk of hypoglycemia

Instruct the patient taking a sulfonylurea to use sunscreen andInstruct the patient taking a sulfonylurea to use sunscreen andprotective clothing to prevent photosensitivity reactions.protective clothing to prevent photosensitivity reactions.

Assess for a signs symptoms of hypoglycemiaAssess for a signs symptoms of hypoglycemia

Advise the patient to consult the practitioner before adjusting theAdvise the patient to consult the practitioner before adjusting thedosage of an oral hypoglycemicdosage of an oral hypoglycemic

Teach the patient how to recognize sign and symptoms ofTeach the patient how to recognize sign and symptoms ofhypoglycemia and hyperglycemiahypoglycemia and hyperglycemia

Provide information about recommended dietary measures,Provide information about recommended dietary measures,exercise, foot care, and sick days rulesexercise, foot care, and sick days rules


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DescriptionDescription akaaka "Glinides" are a class of drugs used treat"Glinides" are a class of drugs used treat diabetes type 2diabetes type 2..

ACTION:ACTION: are nonare non--sulfonylurea oral hypoglycemia agentssulfonylurea oral hypoglycemia agents

they lower blood glucose by stimulating the release of insulinthey lower blood glucose by stimulating the release of insulinfrom the beta cells of the pancreas.from the beta cells of the pancreas.

an aan a--phenylalanine derivative, stimulates maximal insulinphenylalanine derivative, stimulates maximal insulinsecretion when taken with a meal, exerting a synergisticsecretion when taken with a meal, exerting a synergisticinteraction with blood glucose levelsinteraction with blood glucose levels

CLINICAL AND THERAPEUTIC USESCLINICAL AND THERAPEUTIC USES are effective in patients with type2 DM in which the pancreasare effective in patients with type2 DM in which the pancreas

still has the capacity to secrete insulin, but are of no value instill has the capacity to secrete insulin, but are of no value inpatients with type1 DM who have no beta cell function.patients with type1 DM who have no beta cell function.

may be effective in the treatment of type2 DM that cannot bemay be effective in the treatment of type2 DM that cannot becontrolled by diet and exercise if the patient is not susceptible tocontrolled by diet and exercise if the patient is not susceptible todeveloping acidosis, ketosis or infectionsdeveloping acidosis, ketosis or infections


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EXAMPLE OF DRUS:EXAMPLE OF DRUS: Repaglinide (pradin)Repaglinide (pradin)

Nateglinide (starlix)Nateglinide (starlix)

SIDE EFFETCS:SIDE EFFETCS:

dizziness, diarrhea, hypoglycemia,dizziness, diarrhea, hypoglycemia,

arthropathy, back pain, bronchitis, coughing,arthropathy, back pain, bronchitis, coughing,

URTI, headache, paresthesia, angina, chestURTI, headache, paresthesia, angina, chestpain, sinusitis, constipation, dyspepsia,pain, sinusitis, constipation, dyspepsia,

nausea and vomitingnausea and vomiting


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monitor glucose level before starting therapy andmonitor glucose level before starting therapy and

regularly thereafter to monitor drug effectivenessregularly thereafter to monitor drug effectiveness

be alert for adverse reactions and drug interactionbe alert for adverse reactions and drug interaction monitor elderly patients and patients taking betamonitor elderly patients and patients taking beta

blockers carefully because HYPOGLYCEMIA mayblockers carefully because HYPOGLYCEMIA may

be difficult to recognize in these patientbe difficult to recognize in these patient

advice patient to maintain the prescribed diet andadvice patient to maintain the prescribed diet and

exercise program to control blood glucose levelsexercise program to control blood glucose levels


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also known asalso known as glitazones, are a classglitazones, are a class

ofofmedicationsmedications used in the treatment ofused in the treatment ofdiabetesdiabetes

mellitus type 2mellitus type 2..

introduced in the late 1990s.introduced in the late 1990s.

A class of drugs forA class of drugs fortype 2 diabetestype 2 diabetes that lower thethat lower the

blood sugar by increasing the sensitivity of cells toblood sugar by increasing the sensitivity of cells to

insulin. Insulin can then move glucose from the bloodinsulin. Insulin can then move glucose from the blood

into cells for energy. These drugs also increase theinto cells for energy. These drugs also increase the

HDL ("good")HDL ("good") cholesterolcholesterol..


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ACTIONS:ACTIONS:

lower blood glucose by increasing the sensitivity of muscle andlower blood glucose by increasing the sensitivity of muscle andfat tissue to insulin, allowing more glucose to enter the cells infat tissue to insulin, allowing more glucose to enter the cells inthe presence of insulin for metabolismthe presence of insulin for metabolism

also may inhibit hepatic gluconeogenesis and decrease hepaticalso may inhibit hepatic gluconeogenesis and decrease hepaticglucose output.glucose output.

unlike meglitinides, TZDs do not stimulate the release of insulinunlike meglitinides, TZDs do not stimulate the release of insulin

from the beta cells of the pancreas, but insulin must be presentfrom the beta cells of the pancreas, but insulin must be presentfor these agents to workfor these agents to work

CLINICAL AND THERAPEUTIC USES:CLINICAL AND THERAPEUTIC USES:

are effective in patients with type2 DM in which the pancreas stillare effective in patients with type2 DM in which the pancreas still

has the capacity to secrete insulin, but are of no value in thehas the capacity to secrete insulin, but are of no value in theperson with type1 DM, who has no beta cell functionperson with type1 DM, who has no beta cell function

May be effective in the treatment of type2 DM that cannot beMay be effective in the treatment of type2 DM that cannot becontrolled by diet and exercise if the patient is not susceptible tocontrolled by diet and exercise if the patient is not susceptible todeveloping acidosis, ketosis or infectionsdeveloping acidosis, ketosis or infections


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pioglitazone (ACTOS)pioglitazone (ACTOS)

rosiglitazone (AVANDIA)rosiglitazone (AVANDIA)

SIDE EFFECTS:SIDE EFFECTS:

headache, edema, heart failure, anemia,headache, edema, heart failure, anemia,pharyngitis, sinusitis, fatigue, back pain,pharyngitis, sinusitis, fatigue, back pain,

hypoglycemia, URT, fluid retention, liverhypoglycemia, URT, fluid retention, liver

injury,injury,


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obtain history of the patients underlyingobtain history of the patients underlyingcondition before starting therapy and regularlycondition before starting therapy and regularly

thereafter to monitor drugs effectivenessthereafter to monitor drugs effectiveness

assess patients for excessive fluid volume,assess patients for excessive fluid volume,

monitor patient with heart failure for increasedmonitor patient with heart failure for increasededemaedema

monitor hemoglobin level and hematocrit,monitor hemoglobin level and hematocrit,

specially during 1st 4specially during 1st 4--12weeks of the therapy12weeks of the therapy

monitor glucose level regularly, speciallymonitor glucose level regularly, specially

during situation of increased stress such asduring situation of increased stress such as

infection, fever, surgery and traumainfection, fever, surgery and trauma


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DESCRIPTION:DESCRIPTION: are oralare oral antianti--diabetic drugsdiabetic drugs used forused fordiabetesdiabetes

mellitus type 2mellitus type 2 that work by preventing thethat work by preventing the

digestion of carbohydrates (such asdigestion of carbohydrates (such as

starchstarch andand table sugartable sugar). Carbohydrates are). Carbohydrates arenormally converted into simple sugarsnormally converted into simple sugars

((monosaccharidesmonosaccharides), which can be absorbed), which can be absorbed

through the intestine. Hence, alphathrough the intestine. Hence, alpha--

glucosidase inhibitors reduce the impact ofglucosidase inhibitors reduce the impact ofcarbohydrates oncarbohydrates on blood sugarblood sugar..


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ACTION:ACTION:

called anticalled anti--hyperglycemia agents. It is an enzyme inhibitor thathyperglycemia agents. It is an enzyme inhibitor thatinhibitor that inhibits pancreatic alpha amylase andinhibitor that inhibits pancreatic alpha amylase andgastrointestinal alpha glucoside hydrolase enzymes used ingastrointestinal alpha glucoside hydrolase enzymes used indigestion of sugars.digestion of sugars.

this enzyme inhibition results in delayed glucose absorption andthis enzyme inhibition results in delayed glucose absorption andlowering of postprandial hyperglycemialowering of postprandial hyperglycemia

USES:USES: as an adjunct to diet to lower blood glucose in patients withas an adjunct to diet to lower blood glucose in patients with

type2 DM whose hyperglycemia cannot be controlled by diettype2 DM whose hyperglycemia cannot be controlled by dietand exercise aloneand exercise alone

has a particular advantage that it will not cause hypoglycemia,has a particular advantage that it will not cause hypoglycemia,

as can occur with insulin and the sulfonylureasas can occur with insulin and the sulfonylureas also may use in combination with the sulfonylureas to loweralso may use in combination with the sulfonylureas to lower

blood glucose because the agents act by different mechanismsblood glucose because the agents act by different mechanisms


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acarbose (PRECOSE)acarbose (PRECOSE) miglitol (GLYSET)miglitol (GLYSET)

SIDE EFFECT:SIDE EFFECT: abdominal pain, diarrhea, flatulence, hypoglycemia, anorexia,abdominal pain, diarrhea, flatulence, hypoglycemia, anorexia,

vomiting, weakness, dizziness, sleepiness, headache, vertigo,vomiting, weakness, dizziness, sleepiness, headache, vertigo,

anemia, increased liver function levelsanemia, increased liver function levelsNURSING RESPONSIBLITIES:NURSING RESPONSIBLITIES:

if the patient is also receiving oral hypoglycemic agent or insulinif the patient is also receiving oral hypoglycemic agent or insulintherapy, ensure that the dosages of these medicines are welltherapy, ensure that the dosages of these medicines are welladjusted before starting acarbose therapyadjusted before starting acarbose therapy

review the patients history to ensure that there is noreview the patients history to ensure that there is nogastrointestinal malabsorption syndrome or obstruction presentgastrointestinal malabsorption syndrome or obstruction present

review the patients medical history to ensure that the liverreview the patients medical history to ensure that the liverabnormalities are presentabnormalities are present

measure glycosylated hemoglobin every 3 monthsmeasure glycosylated hemoglobin every 3 months


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Description:Description: Incretin Mimetic is an injectable antidiabetic agent that increasesIncretin Mimetic is an injectable antidiabetic agent that increases

beta cell responsiveness, enhances insulin secretion,beta cell responsiveness, enhances insulin secretion,suppresses glucagons secretion, slow gastric emptying andsuppresses glucagons secretion, slow gastric emptying andreduces food intake.reduces food intake.

Action:Action:

The incretins help control blood glucose level by:The incretins help control blood glucose level by:

Enhancing insulin secretionEnhancing insulin secretion

Suppressing glucagon secretion from the liver, suppressingSuppressing glucagon secretion from the liver, suppressingglucose output from the liverglucose output from the liver

Delaying gastric emptying, thus slowing carbohydrate & lipidDelaying gastric emptying, thus slowing carbohydrate & lipidabsorption, reducing postprandial hyperglycemiaabsorption, reducing postprandial hyperglycemia

Reducing hyperglycemiaReducing hyperglycemia

Maintaining apetiteMaintaining apetite


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Clinical Therapeutic Uses:Clinical Therapeutic Uses: Exenatide is used to improve glucose controlExenatide is used to improve glucose control

in type @ diabetes mellitus. This agent hasin type @ diabetes mellitus. This agent hassignificantly improved A, C level & weight losssignificantly improved A, C level & weight loss

in many individual.in many individual.Drug Examples:Drug Examples:

Exenatide (Byetta)Exenatide (Byetta)

Side Effect:Side Effect:

Nausea, Vomiting, Diarrhea, HypoglycemiaNausea, Vomiting, Diarrhea, Hypoglycemia


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Nursing Responsibilities:Nursing Responsibilities:When administering an incretin mimeticWhen administering an incretin mimeticagent, the nurse should:agent, the nurse should: Evaluate baseline renal & hepatic function testEvaluate baseline renal & hepatic function test

because the use of exenatide is contraindicated forbecause the use of exenatide is contraindicated for

patients with severe renal dysfunction.patients with severe renal dysfunction.

Monitor CBC, HbA, C & renal function test periodicallyMonitor CBC, HbA, C & renal function test periodically

Instruct the patient to avoid using OTC drugs withoutInstruct the patient to avoid using OTC drugs withoutconsulting with the health provider.consulting with the health provider.

Administer exenatide with the injectable prefilled penAdminister exenatide with the injectable prefilled penin twicein twice--aa--day dosingday dosing


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Description:Description:

Amylinomimetic Pramlintide is a synthetic analog ofAmylinomimetic Pramlintide is a synthetic analog ofamylin. Amylin is a protein secreted from pancreaticamylin. Amylin is a protein secreted from pancreatic

beta cells with insulin in response to food intake.beta cells with insulin in response to food intake.

Action:Action:

Amylin and Pramlintide reduce postprandialAmylin and Pramlintide reduce postprandialglucose levels by:glucose levels by:

Suppressing glucagons secretion from the liver,Suppressing glucagons secretion from the liver,

suppressing glucose output from the liver.suppressing glucose output from the liver.

Delaying gastric emptying, thus slowing carbohydrateDelaying gastric emptying, thus slowing carbohydrate& lipid absorption, reducing postprandial& lipid absorption, reducing postprandial

hyperglycemiahyperglycemia


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Clinical Therapeutic Uses:Clinical Therapeutic Uses:

Pramlintide is used as additional therapy to reducePramlintide is used as additional therapy to reduce

elevated postprandial hyperglycemia in patients withelevated postprandial hyperglycemia in patients with

type 1 or type 2 diabetes mellitus who are taking mealtype 1 or type 2 diabetes mellitus who are taking meal

time insulin or a combination of metformin & atime insulin or a combination of metformin & a

sulfonylurea but who have not achieved adequatesulfonylurea but who have not achieved adequateglycemic control.glycemic control.

Drug Examples:Drug Examples:

Pramlintide (Symlin)Pramlintide (Symlin)

Side Effects:Side Effects: Nausea, Vomiting, Indigestion, HypoglycemiaNausea, Vomiting, Indigestion, Hypoglycemia


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Nursing Responsibilities:Nursing Responsibilities: To give drug, use a UTo give drug, use a U--100 insulin syringe, preferably100 insulin syringe, preferably

a 0.3 ml Size.a 0.3 ml Size.

Dont mix drug with any type of insulin, & give it as aDont mix drug with any type of insulin, & give it as a

separate injection.separate injection. Before pramlintide therapy starts, make sure patientsBefore pramlintide therapy starts, make sure patients

prepre--meal insulin dosage has been reduced by 50%.meal insulin dosage has been reduced by 50%.

Give pramlintide immediately before meals.Give pramlintide immediately before meals.

Monitor patients pre & postMonitor patients pre & post--meal blood glucose levelsmeal blood glucose levels

regularly to determine effectiveness of pramlintide &regularly to determine effectiveness of pramlintide &insulin therapy & to defect hypoglycemia.insulin therapy & to defect hypoglycemia.


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Description:Description: Glucagon is a hormone secreted by the alphaGlucagon is a hormone secreted by the alpha--cellscells

of the pancreas that breaks down stored glycogen.of the pancreas that breaks down stored glycogen.

Side Effects:Side Effects: Nausea, Vomiting, WarfarinNausea, Vomiting, Warfarin

Actions:Actions: It has no essentially no action in cases of starvation,It has no essentially no action in cases of starvation,

adrenal insufficiency, or chronic hypoglycemia.adrenal insufficiency, or chronic hypoglycemia.

Uses:Uses: Glucagon is used to treat hypoglycemic reactions inGlucagon is used to treat hypoglycemic reactions in

patients with diabetes mellitus.patients with diabetes mellitus.


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Drug Examples:Drug Examples: GlucagonGlucagon

Dextrose ( Glucose, Glutose, InstaDextrose ( Glucose, Glutose, Insta--glucose)glucose)

Diazoxide (Proglycem)Diazoxide (Proglycem)

Glucagon (Glucogen, Glucagon)Glucagon (Glucogen, Glucagon)

Octreotide (Sanclostatin)Octreotide (Sanclostatin)

Nursing Responsibilities:Nursing Responsibilities: Rouse patient as quickly as possible because prolonged hypoglycemiaRouse patient as quickly as possible because prolonged hypoglycemia

cab cause cerebral damage.cab cause cerebral damage. Before injecting glucagons, place unconscious patient on his side toBefore injecting glucagons, place unconscious patient on his side to

prevent aspiration of vomitus when he regains conciousness.prevent aspiration of vomitus when he regains conciousness.

Administer by slow I.V. injectin to decrease the risk of adverseAdminister by slow I.V. injectin to decrease the risk of adversereactions, such as tachycardia & vomiting.reactions, such as tachycardia & vomiting.

If patient doesnt respond to glucagons, expect to administer I.V.If patient doesnt respond to glucagons, expect to administer I.V.dextrose.dextrose.

When patient has regained conciousness or as soon as diagnosticWhen patient has regained conciousness or as soon as diagnosticprocedure is completed, give him oral carbohydrate to restore hepaticprocedure is completed, give him oral carbohydrate to restore hepaticglycogen stores & prevent secondary hypoglycemia.glycogen stores & prevent secondary hypoglycemia.


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thyroxine (T4) and triiodothyronine (T3), arethyroxine (T4) and triiodothyronine (T3), are

tyrosinetyrosine--based hormones produced by thebased hormones produced by thethyroid gland primarily responsible forthyroid gland primarily responsible for

regulation of metabolismregulation of metabolism


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ACTIONACTION

Thyroid drugs contain natural andThyroid drugs contain natural and

synthetic thyroid hormones that controlsynthetic thyroid hormones that control

the rate of metabolism and thusthe rate of metabolism and thus

significantly influence all bodilysignificantly influence all bodily

functions. Heart, skeletal muscle, liverfunctions. Heart, skeletal muscle, liver

and kidneys are especially sensitive toand kidneys are especially sensitive to

the stimulating effects of thesethe stimulating effects of these

substances. These hormones aresubstances. These hormones are

essential for normal growth andessential for normal growth anddevelopment. Thyroid hormones aredevelopment. Thyroid hormones are

also critical for brain and skeletalalso critical for brain and skeletal

maturation. Thyroid hormones increasematuration. Thyroid hormones increase

metabolic rate of body tissues, therebymetabolic rate of body tissues, thereby

increasing oxygen utilization.increasing oxygen utilization.


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Side Effects:Side Effects:

With appropriate dosaging for replacementWith appropriate dosaging for replacement

therpy, adverse effects of thyroid hormonestherpy, adverse effects of thyroid hormones

are few. Adverse effects of thyroid hormonesare few. Adverse effects of thyroid hormones

include cardiac dysrhythmia, anxiety,include cardiac dysrhythmia, anxiety,headache, and sleeplessness. Loss of hairheadache, and sleeplessness. Loss of hair

and skin reactions may occur, particularly inand skin reactions may occur, particularly in

children during the first months of treatment.children during the first months of treatment.


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Monitor the patients response to thyroid drugs and any adverse cardiac effect,Monitor the patients response to thyroid drugs and any adverse cardiac effect,hypertension, tachycardia, anxiety, or skin rash. The patients metabolism shouldhypertension, tachycardia, anxiety, or skin rash. The patients metabolism shouldgradually increase to a more normal state.gradually increase to a more normal state.

Instruct the patient taking a thyroid hormone replacement drug to a notify theInstruct the patient taking a thyroid hormone replacement drug to a notify thehealth care provider immediately if adverse signs appear.health care provider immediately if adverse signs appear.

Evaluate specific drugs interactions, particulary those related to cholestyramine,Evaluate specific drugs interactions, particulary those related to cholestyramine,digoxin, and theophylline. Monitor digoxin levels; thus adjustments in the dosedigoxin, and theophylline. Monitor digoxin levels; thus adjustments in the dosecan be made appropriatelycan be made appropriately

Monitor periodic thyroid function blood tests to evaluate effectiveness.Monitor periodic thyroid function blood tests to evaluate effectiveness.Recognize that as thyroid function returns to normal. The dose of theophyllineRecognize that as thyroid function returns to normal. The dose of theophyllineshould be altered accordingly.should be altered accordingly.

Realize that thyroid hormones increase cellular metabolism, thus also increasingRealize that thyroid hormones increase cellular metabolism, thus also increasingheart production.heart production.

Warn the patient to avoid discontinuing thyroid hormones without checking withWarn the patient to avoid discontinuing thyroid hormones without checking withthe health care provider.the health care provider.

Advise the patient than in most instances thyroid hormone replacement therapyAdvise the patient than in most instances thyroid hormone replacement therapyis lifelong.is lifelong.


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Definition:Definition: (also called thionamides) are most often used to treat(also called thionamides) are most often used to treat

an overactive thyroid (hyperthyroidism) caused byan overactive thyroid (hyperthyroidism) caused by

Graves' disease. These drugs block the formation ofGraves' disease. These drugs block the formation ofthyroid hormone by the thyroid gland.thyroid hormone by the thyroid gland.

Action:Action:Antithyroid drugs are pharmacologic preparation usedAntithyroid drugs are pharmacologic preparation used

to treat hyperthyroidism. Hyperthyroidism resultsto treat hyperthyroidism. Hyperthyroidism results

when an over secretion of thyroid hormone is present.when an over secretion of thyroid hormone is present.The abundance of this hormone greatly increasesThe abundance of this hormone greatly increasesmetabolism and may induce a toxic state. Antithyroidmetabolism and may induce a toxic state. Antithyroiddrugs decrease the production or release of thyroiddrugs decrease the production or release of thyroidhormone. Thioureylene drugs such ashormone. Thioureylene drugs such aspropylthiouracil, methimazole, and iodine solutionspropylthiouracil, methimazole, and iodine solutionsare used to inhibit the production or secretion ofare used to inhibit the production or secretion ofthyroid hormone. These drugs are not chemicallythyroid hormone. These drugs are not chemicallyrelated but both help decrease the blood levels ofrelated but both help decrease the blood levels ofthyroid hormone.thyroid hormone.


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Example of drug:Example of drug:

Therapeutic Uses:Therapeutic Uses:

Antithyroid drugs are used to treat theAntithyroid drugs are used to treat the

oversecretion of thyroid hormoneoversecretion of thyroid hormone(hyperthyroidism); thus they may given in(hyperthyroidism); thus they may given inpreparation for a thyroid, in conjunctionwithpreparation for a thyroid, in conjunctionwithradioactive iodine therapy, and in these caseradioactive iodine therapy, and in these case

of thyroid storm or thyrotoxic crisis. Antithyroidof thyroid storm or thyrotoxic crisis. Antithyroiddrug therapy is usually continued until thedrug therapy is usually continued until thepatient is euthyroid for 6 to 12 months.patient is euthyroid for 6 to 12 months.


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Side Effects:Side Effects: Adverse effects of antithyroid drugs areAdverse effects of antithyroid drugs are

those associated with thyroidthose associated with thyroidsuppression (e.g., lethargy, bradycardia,suppression (e.g., lethargy, bradycardia,

nausea, skin rash).nausea, skin rash). Propylthiouracil in particular isPropylthiouracil in particular is

associated with GI disturbances.associated with GI disturbances.

Adverse reaction of the iodine solutions,Adverse reaction of the iodine solutions,in addition to hypothyroidism includein addition to hypothyroidism includeiodism (e.g., metallic taste, stomachiodism (e.g., metallic taste, stomachupset, diarrhea, discomfort of the mouth,upset, diarrhea, discomfort of the mouth,teeth, and gums). Staining of the teeth,teeth, and gums). Staining of the teeth,skin rash, and goiter may also occur.skin rash, and goiter may also occur.


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Evaluate patients for allergy to any antithyroid drug.Evaluate patients for allergy to any antithyroid drug.Instruct the patient who are receiving propylthiouracil to divide the doseInstruct the patient who are receiving propylthiouracil to divide the doseand take the drug around the clock to ensure consists levels.and take the drug around the clock to ensure consists levels.

Monitor patients who are receiving iodine solutions for signs of iodismMonitor patients who are receiving iodine solutions for signs of iodismand immediately report these signs to the health care provider whenand immediately report these signs to the health care provider whenthey occur.they occur.

Teach patients who are undergoing iodine solution therapy to take theTeach patients who are undergoing iodine solution therapy to take the

medicine orally through a straw to prevent staining of teeth.medicine orally through a straw to prevent staining of teeth.Inform patients that they will undergo laboratory test to evaluate theInform patients that they will undergo laboratory test to evaluate theeffectiveness of the antithyroid drug.effectiveness of the antithyroid drug.

Monitor patients for signs of adverse effects, such as anxienty,Monitor patients for signs of adverse effects, such as anxienty,decreased cardiac output, ECG abnormalities, blood dyscrasias anddecreased cardiac output, ECG abnormalities, blood dyscrasias andskin rash.skin rash.

Withdraw antithyroid drud gradually, and perform frequent evaluationsWithdraw antithyroid drud gradually, and perform frequent evaluationsto determine the likelihood of the patient remaining euthyroid.to determine the likelihood of the patient remaining euthyroid.


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Definition:Definition: are a class of steroid hormones characterized by their similarity toare a class of steroid hormones characterized by their similarity to

aldosterone and their influence on salt and water balances.aldosterone and their influence on salt and water balances.Action:Action:

Mineralcorticoid drugs are any of group from the adrenal cortex, thusMineralcorticoid drugs are any of group from the adrenal cortex, thusnamed because of their effects on sodium, chloride, and potassiumnamed because of their effects on sodium, chloride, and potassiumconcentrations in extracellular fluid. The primary mineralcorticoidsconcentrations in extracellular fluid. The primary mineralcorticoidshormonehormonealdosteronaldosteronis essential to the maintenance of extracellularis essential to the maintenance of extracellularand intracellular fluid volume, normal cardiac output, and adequateand intracellular fluid volume, normal cardiac output, and adequatelevels of blood pressure. Without mineralcorticoids, diminished cardiaclevels of blood pressure. Without mineralcorticoids, diminished cardiacoutput and fatal shock can quickly occur.output and fatal shock can quickly occur.

TherapeuticUses:TherapeuticUses: Mineralcorticoids are used primarily as a replacement therapy forMineralcorticoids are used primarily as a replacement therapy for

patients with adrenal insufficiency and with saltpatients with adrenal insufficiency and with salt--losing forms oflosing forms ofcongenital adrenal hyperplasia. Flucortisone is the drug of choice forcongenital adrenal hyperplasia. Flucortisone is the drug of choice forchronic mineralcorticoid therapy. However, in most cases, achronic mineralcorticoid therapy. However, in most cases, aglucocorticosteroid must also be administered for adequate control.glucocorticosteroid must also be administered for adequate control.Cortisone and hydrocortisone are drug of choice for replacementCortisone and hydrocortisone are drug of choice for replacementbecause they promote both mineralcorticoid and glucocorticoid activity.because they promote both mineralcorticoid and glucocorticoid activity.


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Drug examples:Drug examples: Aminoglutethimide, carbamazepine,Phenobarbital,phenytoin,Aminoglutethimide, carbamazepine,Phenobarbital,phenytoin,

and rifampin increase the metabolism of the mineralcorticoidsand rifampin increase the metabolism of the mineralcorticoids

when given concurrently. Fludrocortisones decreases thewhen given concurrently. Fludrocortisones decreases theeffectiveness of diuretics and potassium supplements.effectiveness of diuretics and potassium supplements.Fludrocortisoone increases the metabolism of isoniazid andFludrocortisoone increases the metabolism of isoniazid andsalicylates when given together.salicylates when given together.

Side Effects:Side Effects: At normal physiologic levels, themineralcocorticoids have noAt normal physiologic levels, themineralcocorticoids have no

adverse effects or contraindications. When the dose isadverse effects or contraindications. When the dose isexcessive, sodium and water are retained, potassium is lost. Theexcessive, sodium and water are retained, potassium is lost. Theeffects on water and sodium result in expansion of fluid volume,effects on water and sodium result in expansion of fluid volume,hypertension, edema, cardiac enlargement, and hypokalemia.hypertension, edema, cardiac enlargement, and hypokalemia.B

ruising, sweating, hives, and an allergic rash have beenB

ruising, sweating, hives, and an allergic rash have beenreported. Desoxycorticosterone (DOCA) may producereported. Desoxycorticosterone (DOCA) may producehypertensive changes in mental functioning and permanent brainhypertensive changes in mental functioning and permanent braindamage in susceptible patients.damage in susceptible patients.


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Monitor the patient for significant weight gain, edema,Monitor the patient for significant weight gain, edema,hypertension, or severe headache.hypertension, or severe headache.Realize that fludrocortisones therapy increases serumRealize that fludrocortisones therapy increases serumsodium levels and decreases potassium levels.sodium levels and decreases potassium levels.

Teach the patient to recognize the signs andTeach the patient to recognize the signs andsymptoms of electrolyte imbalance (e.g., musclesymptoms of electrolyte imbalance (e.g., muscleweakness, paresthesia, numbness, fatigue, anorexia,weakness, paresthesia, numbness, fatigue, anorexia,nausea.)nausea.)

Instruct the patient to report altered heart rhythm,Instruct the patient to report altered heart rhythm,mental status, increase urination, severe ormental status, increase urination, severe orcontinuing headaches, unusual weight gain, andcontinuing headaches, unusual weight gain, andswelling of the feet to the health care providerswelling of the feet to the health care provider


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Definition:Definition: GlucocorticoidsGlucocorticoids (GC) are a class of(GC) are a class ofsteroidsteroid

hormoneshormones that bind to thethat bind to the glucocorticoid receptorglucocorticoid receptor(GR), which is present in almost every(GR), which is present in almost every vertebratevertebrateanimal cell.animal cell.

ACTIONS:ACTIONS: The major glucocorticoids of the adrenal cortex isThe major glucocorticoids of the adrenal cortex is

cortisol. The hypothalamic pituitary gland axiscortisol. The hypothalamic pituitary gland axisregulates the secretion of cortisol by increasing orregulates the secretion of cortisol by increasing ordecreasing the output of corticotrophin releasingdecreasing the output of corticotrophin releasingfactor (CRF) from the hypothalamus.factor (CRF) from the hypothalamus.

USES:

USES: Glucocorticoids are usually given because of heirGlucocorticoids are usually given because of heir

antianti--inflammatory and antiallergenic properties.inflammatory and antiallergenic properties.


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EXAMPLE OF DRUGS:EXAMPLE OF DRUGS: beclomethasone (beclovent)beclomethasone (beclovent)

Betamethasone (celestone)Betamethasone (celestone)

Dexamehasone (decadron)Dexamehasone (decadron)

Hydrocortisone ( cortef)Hydrocortisone ( cortef)

Mehylprednisolone ( medrol)Mehylprednisolone ( medrol)

Prednisolone (deltaPrednisolone (delta--cortef)cortef)

Prednisone (deltasone)Prednisone (deltasone) Triamcinolone (aristocort)Triamcinolone (aristocort)


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SIDE EFFECT:SIDE EFFECT: Muscle wasting and weakness, facial redness, impaired woundMuscle wasting and weakness, facial redness, impaired wound

healing, hypertension, menstrual irregularities, cushingshealing, hypertension, menstrual irregularities, cushings

syndrome, cataract formation,GI bleeding, pancreatitis, pelvicsyndrome, cataract formation,GI bleeding, pancreatitis, pelviculcer diseaseulcer disease

NURSING RESPONSIBILITIES:NURSING RESPONSIBILITIES: Administer drug daily at 8 to 9AMAdminister drug daily at 8 to 9AM

Space multiple does evenly throughout the daySpace multiple does evenly throughout the day

Use minimal dose for minimal amount of timeUse minimal dose for minimal amount of time Taper doses when discontinuing from high doses or from longTaper doses when discontinuing from high doses or from long

term therapyarrange for increased dosage when the patient isterm therapyarrange for increased dosage when the patient isunder stressunder stress

Use alternate day maintenance therapy with short acting drugsUse alternate day maintenance therapy with short acting drugswhenever possiblewhenever possible

Do not give live from virus vaccines when the patient isDo not give live from virus vaccines when the patient isimmunosuppressedimmunosuppressed

Protect the patient from unnecessary exposureProtect the patient from unnecessary exposure


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DescriptionDescription

are a group ofare a group ofsteroidsteroid compounds, named for theircompounds, named for their

importance in theimportance in the estrous cycleestrous cycle, and functioning as, and functioning as

the primarythe primary femalefemale sex hormonessex hormones..

ACTION:ACTION:

Estrogen are responsible for the development of theEstrogen are responsible for the development of the

sex organs during growth in the uterus and forsex organs during growth in the uterus and for

maturation at puberty.maturation at puberty.

USES:USES:

Estrogen products are used for relieving the hot flashEstrogen products are used for relieving the hot flash

symptoms of menopause, for contraception; forsymptoms of menopause, for contraception; for

hormone replacement therapy after an oophorectomy;hormone replacement therapy after an oophorectomy;

in conjunction with appropriate diet; calcium andin conjunction with appropriate diet; calcium and

physical therapy in the treatment of osteoporosisphysical therapy in the treatment of osteoporosis


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EXAMPLE OF DRUGS:EXAMPLE OF DRUGS: Est radiol (estrace)Est radiol (estrace)

Estrogen, conjugated (premarin)Estrogen, conjugated (premarin)

Esrogen, esterified (estraab, menest)Esrogen, esterified (estraab, menest)

Estropipate (orthoEstropipate (ortho--est, ogen)est, ogen)

SIDE EFFECT:SIDE EFFECT: Weight Gain, Edema, Breast Tenderness andWeight Gain, Edema, Breast Tenderness and

nausea.nausea.NURSING RESPONSIBILITIES:NURSING RESPONSIBILITIES:

Administer drug as prescribed,Administer drug as prescribed,

Provide analgesics for relief of headache asProvide analgesics for relief of headache asappropriate.appropriate.

Monitor liver function periodically for the patient onMonitor liver function periodically for the patient onlong term therapy.long term therapy.

Provide support and reassurance to deal with theProvide support and reassurance to deal with thedrug and drug effectsdrug and drug effects


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ACTION:ACTION: Progesterone and its derivatives (theprogestins) inhibit theProgesterone and its derivatives (theprogestins) inhibit the

secretion of pituitary gonadotropins, preventing maturation ofsecretion of pituitary gonadotropins, preventing maturation of

ovarian follicles and thus inhibiting ovulation.ovarian follicles and thus inhibiting ovulation.USESUSES

Progestin are use primarily to treat secondary amenorrhea,Progestin are use primarily to treat secondary amenorrhea,break through uterine bleeding, and endometriosis, but they maybreak through uterine bleeding, and endometriosis, but they mayalso be used in combination with estrogen as contraceptives.also be used in combination with estrogen as contraceptives.

EXAMPLE OF DRUGS:EXAMPLE OF DRUGS: Medroxyprogesterone (amen, curretab)Medroxyprogesterone (amen, curretab)

Nonethindrone (aygestine)Nonethindrone (aygestine)

Norgestrel(ovrette)Norgestrel(ovrette)

Progesterone (progestasert)Progesterone (progestasert)

SIDE EFFECT:SIDE EFFECT: WeightGain, Edema, Nausea, Vomiting, Diarrhea, Tiredness,WeightGain, Edema, Nausea, Vomiting, Diarrhea, Tiredness,

Oily scalp, and Acne.Oily scalp, and Acne.


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Description:Description: AndrogenAndrogen, also called, also called androgenic hormonesandrogenic hormones oror

testoidstestoids, is the generic term for any natural or, is the generic term for any natural orsynthetic compound, usually asynthetic compound, usually a steroid hormonesteroid hormone, that, thatstimulates or controls the development andstimulates or controls the development andmaintenance of male characteristics inmaintenance of male characteristics in vertebratesvertebrates bybybinding tobinding to androgen receptorsandrogen receptors..

ACTION:ACTION:Androgen are responsible for the normal growth andAndrogen are responsible for the normal growth and

development of male sex organs and for maintenancedevelopment of male sex organs and for maintenanceof secondary sex characteristics.of secondary sex characteristics.

USES:USES:Androgens are used to treat hypogonadism,Androgens are used to treat hypogonadism,

eunuchism, androgen deficiency, and palliation ofeunuchism, androgen deficiency, and palliation ofbreast cancer in post menopausal women with certainbreast cancer in post menopausal women with certaincell types of cancer.cell types of cancer.


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EXAMPLE OF DRUGS:EXAMPLE OF DRUGS: Danasol (danocrine)Danasol (danocrine)

fluoxymesterone (halotestin)fluoxymesterone (halotestin)

Testolactone (testacy)Testolactone (testacy)

Testostorone (duratest, testoderm)Testostorone (duratest, testoderm)

SIDE EFFECT:SIDE EFFECT: Dizziness, Headache, Sleep disorders, Fatigue, Rash,Dizziness, Headache, Sleep disorders, Fatigue, Rash,

androgenic effects (acne, deepening voice, oily skin),androgenic effects (acne, deepening voice, oily skin),hypoestrogenic effects (flushing, sweating, vaginitis),hypoestrogenic effects (flushing, sweating, vaginitis),polycythemia, nausea, hepatopolycythemia, nausea, hepato--cellular carcinoma.cellular carcinoma.

NURSING RESPONSIBILITIES:NURSING RESPONSIBILITIES: Reconstitute the drug according to the manufacturers directionReconstitute the drug according to the manufacturers direction

Remove old dermal system before applying new system toRemove old dermal system before applying new system to

clean, dry, intact skinclean, dry, intact skin Monitor response carefully when beginning therapyMonitor response carefully when beginning therapy

Monitor liver function periodically with long term therapy andMonitor liver function periodically with long term therapy andarrange to discontinue he drug at any sign of hepatic dysfunctionarrange to discontinue he drug at any sign of hepatic dysfunction

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ENDOCRINE SYSTEM.ppt1