Endocrine Medications

1
Endocrine Medications

• Julie Balk
• Nursing 220
• March 21, 2005

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Diabetes Mellitus

• Types of DM
• Complications
• Short Term
• Long Term
• Diagnosis and Monitoring
• Treatment Overview

3
Diabetes Mellitus

• Type 1 Diabetes
• Type 2 Diabetes

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Complications of Diabetes

• Short Term
• Hyperglycemia
• Hypoglycemia
• Ketoacidosis
• Long Term
• Macrovascular Disease
• Microvascular Disease
• Pathys retinopathy, nephropathy, neuropathy
• Others
• Amputations, Inpotence, Gastroparesis

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Diagnosis

• FPG
• Casual (Random) Blood glucose
• Oral Glucose Tolerance Test

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Type 1 Treatment

• Goal is to maintain normal glucose levels
• Diet
• Self-monitoring (SMBG)
• Exercise
• Insulin replacement

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Type 2 Treatment

• Maintain Normal blood glucose
• Diet
• Exercise
• Oral hypoglycemic agents
• Insulin

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Insulin

• Seven Types of Insulin
• Natural (1)
• Modified Insulin (6 )
• Lispro
• Insulin Aspart (NovoLog)
• Neutral Protamine Hagedorn (NPH)
• Lente
• Ultralente
• Insulin Glargine (Lantus)

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Sources of Insulin

• Recombinant DNA Technology
• Human Insulin Analogs
• Lispro, aspart, glargine
• Pork Pancreas
• Beef Pancreas

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Insulin Concentrations

• 100U/ml (U-100)
• 500 U/ml (U-500) Manufacturer Request

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Insulin Pearls

• Routes of Administration
• Preparing the Injection
• Sites of Injection
• Mixing
• Storage
• Alternative Methods of Insulin Delivery
• Jet Injectors, Pen Injectors, Portable Insulin
  Pumps, Implantable Insulin Pumps, Intranasal

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Dosing Schedules

• Conventional Therapy
• Intensive conventional therapy
• Continuous Subcutaneous Insulin Infusion

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Insulin Treatment Complications

• Hypoglycemia
• Lipdystrophies
• Allergic Rxn

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Oral Hypoglycemics

• Sufonylureas
• Mechanism of Action
• Adverse Effects
• Hypoglycemia
• Use in Pregnancy and Lactation
• Cardiovascular Toxicity
• Drug Interactions
• Alcohol, Beta Blockers, other drugs that can
  cause hypoglycemia

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Meglitinides

• Mechanism of Action
• Adverse Effects
• hypoglycemia

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Biguanides

• Mechanism of Action
• Indications
• Side Effects
• Decreased appetite, N/V, diarrhea
• Toxicity
• Lactic Acidosis
• Drug Interactions

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Rosiglitazones

• Mechanism of Action
• Side Effects
• Fluid retention, edema, lipid effects
• Monitoring
• LFTs

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Alpha-Glucosidase Inhibitors

• Mechanism of Action
• Indications
• Side Effects
• Flatulence, cramps, abd distention, diarrhea,
  borborygmus
• Hypoglycemia
• Liver dysfunction

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Combination Products

• Glyburide/Metformin
• Glipizide/Metformin
• Rosiglitazone/Metformin

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Thyroid Disorders

• Hypothyroidism
• Hyperthyroidism

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Hypothyroidsim

• Requires replacement with thyroid hormones
• Thyroid Hormone Preparations
• Pure, synthetic compounds
• Extracts of animal thyroid glands

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Thyroid Supplements

• Routes of Administration
• Evaluation
• Nursing Implications

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Hyperthyroidism

• Propylthiouracil
• Mechanism of Action
• Indications
• Adverse Effects
• Agranulocytosis, Hypothyroidism, Pregnancy and
  Lactations
• Rash, Nausea, arthralgia, headache, dizziness,
  parathesias

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Hyperthyroidism (cont)

• 131 I
• Indications
• Advantages and disadvantages

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Hypothalamic and Pituitary Rx

• Growth Hormone
• Prolactin
• Thyrotropin
• Corticotropin
• Gonadotropins
• Antidiuretic Hormone
• Oxytocin

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Adrenal Cortex Medications

• Glucocorticoids
• Mineralocorticoids
• Adrenal Androgens

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Replacement Therapy

• Hydrocortisone
• Cortisone
• Fludrocortisone

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Corticosteroid Synthesis Inhibitors

• Ketoconazole
• Aminogluthethimide

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Drugs Affecting Uterine Function

• Uterine Relaxants
• MgSO4
• Beta 2 Adrenergic Agonists
• Calcium channel blockers
• Indomethacin

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Uterine Stimulants

• Oxytocin
• Ergot Alkaloids

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Drugs for Cervical Ripening

• Dinoprostone
• Misoprostol