Pharmacology 1950 Unit 8 1. 1. define hormone ◦ Maintain homeostasis within the blood system ...
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Pharmacology 1950 Unit 8 1. 1. define hormone ◦ Maintain homeostasis within the blood system Example: 2. List the endocrine glands ◦ Pinealhypothalmuspituitary
1. define hormone Maintain homeostasis within the blood system
Example: 2. List the endocrine glands Pinealhypothalmuspituitary
Parathyroidthyroidthymus Adrenalpancreasgonad 2
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ACTH TSH GH Prolactin FSH LH 3
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ADH Oxytocin 5. Identify main thyroid hormones Calcitonin
thyroid 4
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Thyroid gland Regulates BMR Iodine is essential for synthesis
of T3 and T4 Negative feedback mechanism to limit secretion as
needed. Thyroid hormone attaches to a carrier pro-TBG When it
reaches the tissue level thyroxin converts to T3 where it enters
the cell level. 5
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Objective 7: identify the actions of drugs used to treat
hyperthyroidism Interferes with synthesis of T3 T4 and prevents
conversion to target tissues Delayed action from several days to
weeks. 6
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7
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Objective 8: list the anti-thyroid agents used to treat
hyperthyroidism (Graves Disease) S/S: increased BMR, tachycardia,
wt loss, 4-8x more common in women Drugs are: Iodine-131 ( 131 I)
Propylthiuracil (PTU, Propacil) prototype Methimazole (Tapazole
8
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Radioactive iodine Taken up by thyroid Destroys hyperactive
thyroid tissue Essentially no other tissue is affected Takes 3-6
months for fully assess effect If more than one dose needed, three
months between doses is needed 9
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Dosing is oral Add to water No color No taste Be very careful
not to spill (hazardous) Client can not be pregnant Becomes
euthyroid state Avoid children/preg women for 1 week..others for
few days 10
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Side effects Tenderness in thyroid gland Hyperthyroidism in
40%, second dose needed Hypothyroidism 11
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Drug interactions Lithium carbonate Hypothyroidism develops
12
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PTU and Tapazole Block synthesis of T3 and T4 Takes days to 3
weeks to see effect Can use long term Can use short term pre
subtotal thyroidectomy 13
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Side effects Purpuric, maculopapular rash Headaches, salivary
and lymph node enlargement Bone marrow suppression Hepatotoxicity
Nephrotoxicity 14
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Hypothyroid condition in adults called myxedema General s/s
Weakness, muscle cramping, slurred speech, intolerance to cold
Congenital hypothyroidism called cretinism 15
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16
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Objective 10: list the thyroid agents Levothyroxine replaces T3
and T4 prototype 17
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Liothyronine synthetic T3 Onset of action more rapid than
levothyroxine Liotrix synthetic mixture levothyroxine and
liothyronine (4 to 1 ratio) Provides consistent levels of T3 and T4
18
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Thyroid USP From beef, pork, or sheep thyroid glands Oldest
form available, cheapest Lacks purity, uniformity, stability
Clients should avoid changing agents 19
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Side effects Hyperthryoidism Drug interactions Warfarin: larger
doses needed Digitalis: smaller doses needed Hyperglycemia can
occur early in therapy 20
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Objective 11: describe the nursing process associated with
administering thyroid or anti- thyroid preparations 21
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Assessment important Clients sensitive to replacement therapy,
monitor for adverse effects Levothyroxine started low and dose
increased over weeks 22
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Safe handling, storage and disposal of radioactive materials
via institution policy Blood levels need to be monitored Clients
need to be alert to side effects and report Clients need to report
if no improvement 23
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Objective 12: name the parts of the adrenal gland Medulla
cortex Objective 13: list the types of hormones secreted by the
adrenal glands 24
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Two hormones from adrenal gland Mineralcorticoids
Glucocorticoids 25
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Mineralcorticoids Maintain fluid and electrolyte balance Used
to treat adrenal insufficiency Fludrocortisone (Florinef)
Aldosterone(prototype) Act on distal tubules, causes water and
sodium retention Causes excretion of potassium and hydrogen 26
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Objective 14: describe the metabolic effects of the
glucocorticoids, and the consequences of these effects 27
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Increase blood sugar Increase protein breakdown Suppress immune
responses Increase sensitivity of smooth muscle to norepinephrine
Affects mood and brain excitability 28
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Objective 15: describe how glucocorticoids suppress
inflammation Corticosteroids secreted by adrenal cortex of adrenal
gland Glucocorticoids 29
Slide 30
Glucocorticoids include Cortisone, hydrocortisone, prednisone
etc. Have antiinflammatory, antiallergic activity 30
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Also affect glucose, protein and fat metabolism Glucocorticoids
secreted in response to stressors Cause release of epinephrine
31
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Objective 16: identify therapeutic uses of glucocorticoids
Glucocorticoids used for replacement therapy when adrenal gland not
functional High doses used for inflammation, allergy, asthma
32
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Use of corticosteroids Used with caution in those with Diabetes
mellitus Heart failure Hypertension Peptic ulcer Mental disturbance
Suspected infection 33
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After one week, discontinue drug slowly (wean off) Interacts
with many drugs May need to administer every other day Abrupt
discontinuation Fever; Malaise; Fatigue Weakness; orthostatic
dizziness, hypotension Dyspnea; hypoglycemia 34
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Topical: apply as directed, may use occlusive dressing
Alternate day therapy: give between 6 & 9 AM; give with meals
35
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Side Effects Electrolyte imbalance, fluid accumulation
Susceptibility to infection Behavioral changes Hyperglycemia Peptic
ulcer formation Delayed wound healing 36
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Drug interactions Loop diuretics: can enhance electrolyte loss
Warfarin: can have increased or decreased effect Hyperglycemia:
diabetics and children need to be monitored 37
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Objective 17: list the glucocorticoid preparations 38
Slide 39
Various drugs for topical, oral, injection, inhalation
Cortisone Dexamethasone (Decadron, Dexone) Fludrocortisone
(Florinef)-also mineralcorticoid 39
Objective 18: describe nursing care responsibilities associated
with administering glucocorticoids Provide education, VS, glucose
levels, long term use may lead to osteoporosis, Cushing syndrome
41
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Objective 19: identify the functions of insulin in the body
Glucose transport Affects carbohydrate, lipid and pro metabolism
Objective 20: define diabetes mellitus Group of metabolic diseases
with decreased insulin production or decrease in receptor cells
42
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Objective 21: identify the site of insulin production in the
body pancreas Objective 22: list the types of diabetes Insulin
dependent Type I 10% of population; onset 11-13 years of age
Insuline dependent Type 2 Deficient amounts of insulin production
or insulin resistant cells Gestational Associated with pregnancy
43
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Objective 23: explain the functions of insulin Hormone from
beta cells of the pancreas (islets of Langerhans) Normally: 0.5 1
unit per hour secreted Adult: 30-50 units per day Insulin
transports glucose into cells; helps metabolize protein and fat.
Diabetes is a metabolic disorder: all body systems affected 44
Slide 45
Objective 24: identify the onset, the peak, and the duration of
action for rapid, intermediate, long acting and fixed combinations
of insulin 45
Slide 46
Lispro and Aspart Most rapid acting of insulins They are
synthetic insulin analogs Give within 10-15 minutes of a meal
Onset: 10 minutes Peak: 30 to 60 min Duration: 5 hours 46
Slide 47
Regular insulin Human regular insulin available, not just
animal derivation Give within 30-60 minutes of meals Onset: 30
minutes Peak: 2.5-5 hours Duration: 5-10 hours Administration:
subcutaneous or IV 47
Lispro: can be mixed with protamine Humalog mix 75/25 75%
Lispro with protamine 25% Lispro Rapid acting insulin with
intermediate duration of action (12-24 hours) 49
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50
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Humulin Ultralente Crystalline form of Lente insulin Onset: 4-8
hours Peak: 12-18 hours Duration: 24-28 hours 51
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Insulin-Glargine solution (Lantus) Biosynthetic Absorbed in a
uniform manner-no large fluctuations of insulin levels = reduction
in possible hypoglycemia Onset: 5 hours Peak: no pronounced peak
activity Duration: 24 hours Do NOT mix with other insulins 52
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55
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Objective 25: describe the local tissue responses that can
occur with repeated insulin injections 59
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Two problems can occur Allergic reactions From proteins in
insulin, alcohol, the insulin itself Switch types of insulin Use
unscented alcohol Will resolve 60
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Lipodystrophies Atrophy or hypertrophy of subcutaneous fat Use
the area because of anesthesia effect 61
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62
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Use of the site decreases insulin absorption Causes erratic
absorption of insulin Is cosmetic problem 63
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Objective 26: list the symptoms of insulin shock Hypoglycemia
Headache Nausea Weakness Hunger 64
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Lethargy Decreased coordination General apprehension Sweating
Confusion Blurred or double vision Can progress to coma and death
65
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Objective 27: discuss glucose elevating drugs The drug used to
raise blood sugar Glucagon Glucose 66
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Glucagon Hormone from alpha cells of pancreas Breaks down
stored glycogen to glucose Aids in gluconeogenesis Must have
glycogen available or drug will not work 67
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May see 50% glucose administered IV Raises blood sugar Use when
no glycogen is stored 68
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Objective 28: describe what is meant by sliding scale insulin
administration 69
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Sliding scale insulin Physician orders doses of insulin based
upon blood glucose level Regular insulin is used Sliding scale is
catch-up Read the orders carefully 70
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Blood sugar Insulin 0-150 0 units 151-200 2 units 201-300 5
units Over 300, call physician 71
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Objective 29: describe the action of the oral antidiabetic
agents Some act on the cells to decrease resistance Some act on the
beta cells to increase production Some inhibit glucose absorption
72
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Objective 30: identify the conditions under which an oral
antidiabetic agent would be used Type 2 diabetes No control with
diet/exercise 73
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Objective 31: list the oral antidiabetic agents 74
Metformin (Glucophage) Does not stimulate insulin release Will
not cause hypoglycemia Can be used in combination with
sulfonylureas Decreases serum triglycerides and LDL Slightly
increases HDL 76
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Initial dose: 500 mg BID Can go up to 2500 mg daily Use divided
doses If blood sugar not controlled, add another agent 77
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Side effects to expect N/V Anorexia Abdominal cramps Flatulence
Will resolve Take with meals to decrease SE 78
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SE to report Malaise Myalgias Respiratory distress Hypotension
Lactic acidosis can occur More if renal failure or excess alcohol
intake 79
Slide 80
Drug interactions Drugs that depend upon kidney for excretion
can block metformin excretion Can have lactic acidosis develop
80
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Drugs that cause hyperglycemia with metformin OBC
Corticosteroids Phenothiazines Diuretics Thyroid replacement
81
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Stimulate release of insulin Use when pancreas can still
secrete insulin 82
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Two generations First generation Example: Dymelor (500 mg
daily) Second generation Example: Glucotrol (2.5-5 mg daily)
Prototype 83
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Allergy: if allergic to sulfonamides, probably allergic to
sulfonylureas Do not administer 84
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SE to expect N/V Anorexia Abdominal cramps Usually mild
Decrease with continued therapy 85
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SE to report Hypoglycemia Monitor blood sugar Treat with
glucose source Hepatotoxicity Anorexia, N/V, jaundice, increased
liver function tests 86
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Blood dyscrasias RBC, WBC Monitor for sore throat, fever,
purpura, jaundice Dermatologic reactions Rash or pruritus If
occurs: hold drug, call MD 87
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Drug interactions Various drugs can cause hypoglycemia such as
Warfarin, ethanol 88
Slide 89
Hyperglycemia with corticosteroids, phenothiazines and others
Beta-adrenergic blockers: cause hypoglycemia or mask the symptoms
Alcohol: Antabuse-like reaction 89
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Stimulate release of insulin from pancreas Can be used alone or
in combination Have short duration of action Must take up to QID
90
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Examples of drugs Repaglinide (Prandin) Nateglinide (Starlix)
91
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Dosing Can take 1-30 minutes before a meal Must take up to QID:
compliance If skip meal, skip dose 92
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SE to expect and report Hypoglycemia Dose adjustments may be
needed Monitoring of blood glucose important 93
B-blockers: cause hypoglycemia or mask symptoms Tegretol and
others: increase repaglinide metabolism Some macrolides and
antifungals can inhibit repaglinide metabolism 95
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Increase sensitivity of muscle and fat tissue to insulin Allows
more glucose to enter cells Inhibit gluconeogenesis Decreases
hepatic output of glucose Do not increase insulin output 96
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Can be used alone or in combination with other OHAs or insulin
Examples Pioglitazone (Actos) Rosiglitazone (Avandia) 97
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Baseline labs: liver function and alkaline phosphatase, CBC,
WBC, HDL, LDL, triglycerides Premenopausal, anovulatory females
Ovulation may resume 98
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SE to expect N/V Anorexia Abdominal cramps Mild Resolve with
continued therapy 99
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SE to report Hypoglycemia Hepatotoxicity Weight gain 100
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Drug interactions Various drugs can cause an increase in
hypoglycemia or hyperglycemia B-adrenergics can mask hypoglycemia
or cause it Pioglitazone can enhance metabolism of ethinyl
estradiol and norethindrone Ovulate, become pregnant 101
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Two drugs Acarbose (Precose) Miglitol (Glyset) They inhibit
pancreatic and GI enzymes from digesting sugars This delays glucose
absorption and decreases postprandial hyperglycemia 102
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Acarbose Does not cause hypoglycemia Can be used with
sulfonylureas or metformin Dosing TID at start of main meals
103
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SE to expect Abdominal cramps Diarrhea Flatulence Caused by
metabolism of carbohydrates in gut Usually mild, resolve 104
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SE to report Hypoglycemia Hepatotoxicity Can cause increased
AST, ALT Has caused hyperbilirubinemia 105
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Hyperglycemia can occur with some drugs such as
corticosteroids, phenothiazines, OBC, thyroid Digestive enzymes and
intestinal adsorbents reduce effect of acarbose Acarbose can
decrease absorption of digoxin 106
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Miglitol (Glyset) Used alone or with sulfonylureas Check liver
function before treatment Assess for malabsorption syndrome or
obstruction in gut 107
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Dosing Take with first bite of food Start with 25 mg TID
108
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SE to expect Abdominal cramps Diarrhea Flatulence 109
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SE to report Hypoglycemia 110
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Drug interactions Hyperglycemia with various agents such as
cortisone, phenothiazines Propranolol, Ranitidine not absorbed with
concurrent miglitol Digestive enzymes, intestinal adsorbents reduce
effect of miglitol 111
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Objective 32: describe the nursing interventions associated
with teaching the diabetic about the treatment 112
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Objective 33: list the therapeutic uses of estrogen and
progesterone Stimulate maturation of female sex organs Responsible
for menstrual cycle Drugs used for replacement, birth control,
control of prostate cancer, breast cancer, osteoporosis
(controversial use) 113
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Objective 34: name the estrogen preparations Various estrogens
Conjugated estrogen (Premarin) Esterified estrogens (Estratab)
Estradiol (Estrace) Estropipate (Ogen) Ethinyl estradiol (Estinyl)
114
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Objective 35: name the progesterone preparations Progestins
inhibit ovulation Norethindrone Ethynodiol diacetate Desogestrel
Levonorgestrel 115
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Objective 36: identify the most commonly used ovulatory agents
Clomiphene citrate (Clomid) Structurally similar to natural
estrogens Stimulates ovaries to release ova Used for women with
reduced circulating estrogen 116
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Objective 37: describe the actions of the oral contraceptives
Estrogens and progestins induce contraception by inhibiting
ovulation Estrogen blocks pituitary release of FSH Progestin
inhibits LH Both alter cervical mucus May change endometrial wall
117
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Minipill is progestin-only Must take every day Combination pill
Take in 21 day cycle 118
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Complete physical needed before therapy SE expected: nausea,
weight gain, spotting, changed menstrual flow, missed periods,
depression, mood changes, chloasma, headaches 119
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SE to report: vaginal discharge, breakthrough bleeding, yeast
infections Blurred vision, severe headaches, dizziness, leg pain,
chest pain, shortness of breath, acute abdominal pain 120
Slide 121
Various drugs can decrease effect of OBC Barbiturates,
Tegretol, St. Johns Wort, antibacterial agents Drugs enhance effect
and toxic effects Some antifungals, Warfain, phenytoin, thyroid
hormones, benzodiazepines 121
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< 72 hours after unprotected intercourse Previn Action:
prevents implantation or ovulation 122
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Objective 38: identify the nursing process for clients with
conditions for which female hormones are used Knowledge deficeit
Nausea Noncompliance 123
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