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Pharmacology Endocrine Drugs

This document discusses various endocrine and reproductive drugs, including their mechanisms of action, indications, and nursing responsibilities. It covers thyroid hormones, anti-thyroid medications, steroids, diabetes drugs like insulin and oral hypoglycemics, and reproductive hormones. Nursing responsibilities for these drugs include monitoring for side effects, ensuring proper administration, teaching patients about self-care, and evaluating therapeutic effectiveness.

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Pharmacology of the Selected Endocrine Drugs pinoynursing.webkotoh.com
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Endocrine Medications Hormonal replacement
ADH
Endocrine Medications Anti-diuretic hormones Enhance re-absorption of water in the kidneys Increases water permeability in the renal collecting ducts Also stimulates VASOCONSTRICTION and increases the blood pressure
Endocrine Medications Therapeutic Indications Hormonal replacement Used in diagnostic procedure Used to control the hemorrhage in variceal bleeding Treatment of enuresis
Endocrine Medications Used in DI 1. Desmopressin and Lypressin intranasally 2. Pitressin IntraMuscularly
Endocrine Medications Anti-diuretic hormones SIDE-effects Flushing and headache Water intoxication CVS: heart block, MI Renal: hyponatremia Gangrene due to vasoconstriction
Thyroid Medications
Thyroid Medications Thyroid hormones These products are used to treat the manifestations of hypothyroidism Replace hormonal deficit in the treatment of HYPOTHYROIDSM
Thyroid Medications Thyroid hormones Levothyroxine (Synthroid) Liothyroxine (Cytomel) Thyroid dessicated Liotrix (Thyrolar)
Thyroid Medications Thyroid hormones: Actions Replaces both T3 and T4 Increases metabolic rate
Thyroid Medications Thyroid hormones: Actions Increase the metabolic rate Increase O2 consumption Increase HR, RR, BP
Thyroid Medications Thyroid hormones: Indications Hypothyroidism Diagnostic suppression test
Thyroid Medications Thyroid hormones Side-effects Nausea and Vomiting Signs of increased metabolism= tachycardia, hypertension, cardiac arrhythmias, anxiety, headache, tremors, palpitations
Thyroid Medications Thyroid hormones : Nursing responsibility 1. Monitor weight, VS 2. Instruct client to take daily medication the same time each morning WITHOUT FOOD Monitor blood tests to check the activity of thyroid
Thyroid Medications Thyroid hormones: Nursing responsibility 3. Advise to report palpitation, tachycardia, and chest pain 4. Instruct to avoid foods that inhibit thyroid secretions like cabbage, spinach and radishes
ANTI-Thyroid Medications ANTI-THYROID medications The thyroid becomes oversaturated with iodine and stop producing thyroid hormone
ANTI-Thyroid Medications ANTI-THYROID medications Drugs used to BLOCK the thyroid hormones and treat hyperthyroidism Inhibit the synthesis of thyroid hormones
ANTI-Thyroid Medications ANTI-THYROID medications 1. Methimazole (Tapazole) 2. PTU (prophylthiouracil) 3. Iodine solution- SSKI and Lugol’s solution
ANTI-Thyroid Medications ANTI-THYROID medications: Indications Grave’s dosease Thyrotoxicosis
ANTI-Thyroid Medications ANTI-THYROID medications: Absorption is good orally
ANTI-Thyroid Medications ANTI-THYROID medications Side-effects of thionamides N/V, drowsiness, lethargy, bradycardia, skin rash GI complaints Arthralgia, myalgia AGRANULOCYTOSIS Most important to monitor
ANTI-Thyroid Medications ANTI-THYROID medications Side-effects of Iodine solutions Lugol’s Most common adverse effects is HYPOTHYROIDISM Iodism= metallic taste, burning in the mouth, sore teeth and gums, diarrhea, stomach upset
ANTI-Thyroid Medications ANTI-THYROID medications Nursing responsibilities 1. Monitor VS, T3 and T4, weight 2. The medications WITH MEALS to avoid gastric upset
ANTI-Thyroid Medications ANTI-THYROID medications Nursing responsibilities 3. Instruct to report SORE THROAT or unexplained FEVER 4. Monitor for signs of hypothyroidism. Instruct not to stop abrupt medication
ANTI-Thyroid Medications ANTI-THYROID medications Lugol’s Solution Used to decrease the vascularity and size of the thyroid (in preparation for thyroid surgery) T3 and T4 production diminishes Given per orem, can be diluted with juice, administered WITH foods Use straw to decrease staining Monitor iodism
Steroids
STEROIDS Replaces the steroids in the body Cortisol, cortisone, betamethasone, and hydrocortisone
STEROIDS These drugs enter the cells and bind to receptors They inhibit the enzyme phospholipase
STEROIDS Corticosteroids are used topically and locally to achieve the desired anti-inflammatory effects at a particular site Examples: Prednisone Bethamethasone Prednisolone Fludrocortisone
STEROIDS Side-effects HYPERglycemia Increased susceptibility to infection (immunosuppression) Hypokalemia Edema Peptic ulceration
STEROIDS Side-effects If high doses- osteoporosis, growth retardation, peptic ulcer, hypertension, cataract, mood changes, hirsutism, and fragile skin
STEROIDS Nursing responsibilities 1. Monitor VS, electrolytes, glucose 2. Monitor weight edema and I/O
STEROIDS Nursing responsibilities 3. Protect patient from infection 4. Handle patient gently 5. Instruct to take meds WITH MEALS to prevent gastric ulcer formation
STEROIDS Nursing responsibilities 6. Caution the patient NOT to abruptly stop the drug 7. Drug is tapered to allow the adrenal gland to secrete endogenous hormones
STEROIDS Evaluation: The drugs are effective if there is: Relief of signs and symptoms of inflammation Return of adrenal function to normal
DM Drug therapy
DRUG THERAPY and MANAGEMENT Usually, this type of management is employed if diet modification and exercise cannot control the blood glucose level.
DRUG THERAPY and MANAGEMENT These agents are employed to control the blood glucose level They can be insulin and oral agents These are given to replace the hormone in the body If hormone is still present BUT decreased, Oral agents are given
Diabetes Mellitus DRUG THERAPY and MANAGEMENT Because the patient with TYPE 1 DM cannot produce insulin, exogenous insulin must be administered for life.
Diabetes Mellitus DRUG THERAPY and MANAGEMENT TYPE 2 DM may have decreased insulin production, ORAL agents that stimulate insulin production are usually employed.
Diabetes Mellitus PHARMACOLOGIC INSULIN This may be grouped into several categories according to: 1. Source- Human, pig, or cow 2. Onset of action- Rapid-acting, short-acting, intermediate-acting, long-acting and very long acting
Diabetes Mellitus PHARMACOLOGIC INSULIN This may be grouped into several categories according to: 3. Pure or mixed concentration 4. Manufacturer of drug
Diabetes Mellitus GENERALITIES 1. Human insulin preparations have a shorter duration of action than animal source
Diabetes Mellitus GENERALITIES 2. Animal sources of insulin have animal proteins that may trigger allergic reaction and they may stimulate antibody production that may bind the insulin, slowing the action
Diabetes Mellitus 3. ONLY Regular insulin can be used INTRAVENOUSLY!
Diabetes Mellitus 4. Insulin are measured in INTERNATIONAL UNITS or “iu” 5. There is a specified insulin injection calibrated in units
Diabetes Mellitus Mixed insulin are also available The msot common of which is the 70-30 insulin Made up of :70% NPH and 30% regular insulin in the vial
Comparison of Insulin Peak action 10-20 hrs 4-8 hrs Ultra-lente Long Acting 6-8 hrs to 12 hrs 1 ½ to 2 hrs NPH and Lente Intermediate acting 2-4 hrs 1 hour Regular Insulin RAPID acting 1 hour 15 minutes Lispro ULTRA-acting PEAK Onset Example Insulin Type
Diabetes Mellitus RAPID ACTING INSULIN Lispro (Humalog) and Insulin Aspart (Novolog) Produces a more rapid effect and with a shorter duration than any other insulin preparation
Diabetes Mellitus RAPID ACTING INSULIN ONSET- 5-15 minutes PEAK- 1 hour DURATION- 3 hours Instruct patient to eat within 5 to 15 minutes after injection
Diabetes Mellitus REGULAR INSULIN Also called Short-acting insulin “ R” Usually Clear solution administered 30 minutes before a meal
Diabetes Mellitus REGULAR INSULIN ONSET- 30 minutes to 1 hour PEAK- 2 to 4 hours DURATION- 4 to 6 hours
Diabetes Mellitus INTERMEDIATE ACTING INSULIN Called “NPH” or “LENTE” Appears white and cloudy
Diabetes Mellitus INTERMEDIATE ACTING INSULIN ONSET- 2-4 hours PEAK- 4 to 6-12 hours DURATION- 16-20 hours
Diabetes Mellitus LONG- ACTING INSULIN “ UltraLENTE” Referred to as “peakless” insulin
Diabetes Mellitus LONG- ACTING INSULIN ONSET- 6-8 hours PEAK- 12-16 hours DURATION- 20-30 hours
Diabetes Mellitus HEALTH TEACHING Regarding Insulin SELF- Administration 1. Insulin is administered at home subcutaneously
Diabetes Mellitus HEALTH TEACHING Regarding Insulin SELF- Administration 2. Cloudy insulin should be thoroughly mixed by gently inverting the vial or ROLLING between the hands
Diabetes Mellitus HEALTH TEACHING Regarding Insulin SELF- Administration 3. Insulin NOT IN USE should be stored in the refrigerator, BUT avoid freezing/extreme temperature
Diabetes Mellitus 4. Insulin IN USE should be kept at room temperature to reduce local irritation at the injection site
Diabetes Mellitus 5. INSULIN may be kept at room temperature up to 1 month
Diabetes Mellitus 6. Select syringes that match the insulin concentration. U-100 means 100 units per mL
Diabetes Mellitus 7. Instruct the client to draw up the REGULAR (clear) Insulin FIRST before drawing the intermediate acting (cloudy) insulin
Diabetes Mellitus 8. Pre-filled syringes can be prepared and should be kept in the refrigerator with the needle in the UPRIGHT position to avoid clogging the needle
Diabetes Mellitus 9. The four main areas for insulin injection are- ABDOMEN, UPPER ARMS, THIGHS and HIPS
 
Diabetes Mellitus Insulin is absorbed fastest in the abdomen and slowest in the hips Instruct the client to rotate the areas of injection, but exhaust all available sites in one area first before moving into another area.
Diabetes Mellitus 10. Alcohol may not be used to cleanse the skin 11. Utilize the subcutaneous injection technique- commonly, a 45-90 degree angle.
Diabetes Mellitus 12. No need to instruct for aspirating the needle 13. Properly discard the syringe after use.
Diabetes Mellitus T-I-E T est blood  I nject insulin  E at food
Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS These may be effective when used in TYPE 2 DM that cannot be treated with diet and exercise These are NEVER used in pregnancy!
Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS There are several agents: Sulfonylureas Biguanides Alpha-glucosidase inhibitors Thiazolidinediones Meglitinides
Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS These drugs are given per orem and are effective only in type 2 DM Common adverse effects include: Hypoglycemia Diarrhea, jaundice, nausea and heartburn Anemia , photosensitivity
Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS General Nursing Consideration Observe for manifestations of hypoglycemia Assess for allergic reaction Instruct to take the medication at the same time each day Caution to avoid taking other drugs without consultation with physician
Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS General Nursing Consideration 5. THESE medications SHOULD NEVER be given to pregnant women, so rule out pregnancy 6. Instruct to wear sunscreen 7. Advise to bring simple sugar to be taken when hypoglycemic episodes occur
Diabetes Mellitus SULFONYLUREAS MOA- stimulates the beta cells of the pancreas to secrete insulin Classified as to generations- first and second generations
Diabetes Mellitus SULFONYLUREAS FIRST GENERATION- Acetoheximide, Chlorpropamide, Tolazamide and Tolbutamide SECOND GENERATION- Glipizide, Glyburide, Glibenclamide, Glimepiride
Diabetes Mellitus: Sulfonylureas The most common side –effects of these medications are Gastro-intestinal upset and dermatologic reactions. HYPOGLYCEMIA is also a very important side-effect Given 30 minutes before meals- breakfast
Diabetes Mellitus: Sulfonylureas Chlorpropamide has a very long duration of action. This also produces a disulfiram-like reaction when taken with alcohol Second generation drugs have shorter duration with metabolism in the kidney and liver and are the choice for elderly patients
Diabetes Mellitus BIGUANIDES MOA- Facilitate the action of insulin on the peripheral receptors These can only be used in the presence of insulin
Diabetes Mellitus BIGUANIDES= “ formin” They have no effect on the beta cells of the pancreas Metformin (Glucophage) and Phenformin are examples
Diabetes Mellitus: Biguanides The most important side effect is LACTIC ACIDOSIS! These are not given to patient with renal impairment
Diabetes Mellitus: Biguanides These drugs are usually given with a sulfonylurea to enhance the glucose-lowering effect more than the use of each drug individually
Diabetes Mellitus ALPHA-GLUCOSIDASE INHIBITORS MOA- Delay the absorption of glucose in the GIT Result is a lower post-prandial blood glucose level They do not affect insulin secretion or action! Side-effect: DIARRHEA and FLATULENCE
Diabetes Mellitus Examples of AGI are Acarbose and Miglitol They are not absorbed systemically and are very safe They can be used alone or in combination with other OHA
Diabetes Mellitus Side-effect if used with other drug is HYPOGLYCEMIA Note that sucrose absorption is impaired and IV glucose is the therapy for the hypoglycemia
Diabetes Mellitus THIAZOLIDINEDIONES MOA- Enhance insulin action at the receptor site They do not stimulate insulin secretion
Diabetes Mellitus THIAZOLIDINEDIONES Examples- Rosiglitazone, Pioglitazone These drugs affect LIVER FUNCTION Can cause resumption of OVULATION in peri-menopausal anovulatory women
Diabetes Mellitus MEGLITINIDES MOA- Stimulate the secretion of insulin by the beta cells Examples- Repaglinide and Nateglinide
Diabetes Mellitus MEGLITINIDES They have a shorter duration and fast action Should be taken BEFORE meals to stimulate the release of insulin from the pancreas
Diabetes Mellitus MEGLITINIDES Principal side-effect of meglitinides- hypoglycemia Can be used alone or in combination
Reproductive Hormones Gonadal hormones include agents that affect the female and male reproductive cycle Female hormones include ESTROGENS, PROGESTINS and ovarian hormones Male hormones include ANDROGENS and anabolic steroids
Reproductive Hormones The GENERAL Mechanism of Action These hormones interfere with the normal cycle of hormone balance
Reproductive Hormones INDICATIONS FEMALE: Hormonal replacement therapy, oral contraception, treatment of infertility and management of some tumors MALE: replacement therapy, metabolic stimulators and treatment of some tumors
Reproductive Hormones Estrogens Conjugated estrogen Estradiol Ethinyl estradiol Diethylstilbesterol (DES) Clomiphene
Reproductive Hormones Progestins Medroxyprogesterone acetate (Provera) Megestrol Norethindrone Levonorgestrel (Norplant) Norgestrel Norethindrone acetate
Reproductive Hormones Androgens Testosterone cypionate Methyltestosterone Fluoxymesterone Aqueous testosterone
Reproductive Hormones Oral Contraceptive Pills Two types are available: Combination estrogen and progesterone AND progestins only
Reproductive Hormones Oral Contraceptive Pills: DYNAMICS Inhibits OVULATION by altering the hypothalamus and gonadotropin axis Alters the MUCUS to prevent sperm entry Alters the uterine endometrium to prevent implantation Suppresses the ovaries
Reproductive Hormones Oral Contraceptive Pills: Indicators Suppression of ovulation for prevention of pregnancy Regulation of menstrual cycle and management of dysfunctional bleeding Treatment of endometriosis
Reproductive Hormones Oral Contraceptive Pills: Kinetics Easily absorbed orally NORPLANT provides 5 years of contraception Provera provides 3 months of protection Metabolized and excreted in liver
Reproductive Hormones Oral Contraceptive Pills: Not to be used in patients with history of, hypertension, thromboemoblic or CVA disease Not given in certain cancers Contraindicates in pregnancy SMOKING should be avoided when under therapy
Reproductive Hormones Oral Contraceptive Pills: Drug Interaction Rifampicin, penicillin and tetracycline REDUCE effectiveness of contraception Benzodiazepines decrease the levels of OCP
Reproductive Hormones Oral Contraceptive Pills: Side effects CNS: headache CV: Thromboembolic disease, MI, hypertension and pulmonary edema NAUSEA and cholestatic JAUNDICE Breast tenderness, weight gain, edema, breakthrough bleeding, acne
Reproductive hormones Nursing Considerations Assess for risk factors and the ability to comply with medications Determine the type of OCP used Monophasic pills provide constant dosing of BOTH estrogen and progestin Biphasic pills provide constant estrogen but varying progestin doses Triphasic pills provide varying Estrogen and Progesterone
Reproductive hormones Nursing Considerations 3. Teach the common side-effects and re-assure that these will decrease in time 4. Instruct to use other means of contraception if antibiotics and anticonvulsants are also taken 5. WARNT the client to avoid smoking because this will increase the risk for embolic episodes
Clomiphene A synthetic, non-steroidal estrogen Increases the secretion of gonadotropins and initiates the secretion of FSH and LH OVULATION will occur Used in the treatment of infertility Readily absorbed orally
Clomiphene Side effects can be: Risk for Multiple pregnancy Nausea, breast discomfort, headache and GI disturbances Visual disturbances Enlargement of the ovaries
Viagra (Sildenafil) A medication used for penile erectile dysfunction Selectively inhibits receptors and enzyme Phosphodiesterase E This increases the nitrous oxide levels allowing blood flow into the corpus cavernosum
Viagra (Sildenafil) Contraindicated in patients with bleeding disorders and with penile implants Caution: Coronary Artery Disease and concomitant use of nitrates Side-effects: PRIAPISM, headache, flushing, dyspepsia, UTI, diarrhea and dizziness
Viagra (Sildenafil) Nursing consideration Assess for risk factors Instruct to take the drug ONE hour before sexual act Drug is taken orally

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Pharmacology Endocrine Drugs

  • 1.
    Pharmacology of theSelected Endocrine Drugs pinoynursing.webkotoh.com
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  • 15.
    Endocrine Medications Anti-diuretichormones Enhance re-absorption of water in the kidneys Increases water permeability in the renal collecting ducts Also stimulates VASOCONSTRICTION and increases the blood pressure
  • 16.
    Endocrine Medications TherapeuticIndications Hormonal replacement Used in diagnostic procedure Used to control the hemorrhage in variceal bleeding Treatment of enuresis
  • 17.
    Endocrine Medications Usedin DI 1. Desmopressin and Lypressin intranasally 2. Pitressin IntraMuscularly
  • 18.
    Endocrine Medications Anti-diuretichormones SIDE-effects Flushing and headache Water intoxication CVS: heart block, MI Renal: hyponatremia Gangrene due to vasoconstriction
  • 19.
  • 20.
    Thyroid Medications Thyroidhormones These products are used to treat the manifestations of hypothyroidism Replace hormonal deficit in the treatment of HYPOTHYROIDSM
  • 21.
    Thyroid Medications Thyroidhormones Levothyroxine (Synthroid) Liothyroxine (Cytomel) Thyroid dessicated Liotrix (Thyrolar)
  • 22.
    Thyroid Medications Thyroidhormones: Actions Replaces both T3 and T4 Increases metabolic rate
  • 23.
    Thyroid Medications Thyroidhormones: Actions Increase the metabolic rate Increase O2 consumption Increase HR, RR, BP
  • 24.
    Thyroid Medications Thyroidhormones: Indications Hypothyroidism Diagnostic suppression test
  • 25.
    Thyroid Medications Thyroidhormones Side-effects Nausea and Vomiting Signs of increased metabolism= tachycardia, hypertension, cardiac arrhythmias, anxiety, headache, tremors, palpitations
  • 26.
    Thyroid Medications Thyroidhormones : Nursing responsibility 1. Monitor weight, VS 2. Instruct client to take daily medication the same time each morning WITHOUT FOOD Monitor blood tests to check the activity of thyroid
  • 27.
    Thyroid Medications Thyroidhormones: Nursing responsibility 3. Advise to report palpitation, tachycardia, and chest pain 4. Instruct to avoid foods that inhibit thyroid secretions like cabbage, spinach and radishes
  • 28.
    ANTI-Thyroid Medications ANTI-THYROIDmedications The thyroid becomes oversaturated with iodine and stop producing thyroid hormone
  • 29.
    ANTI-Thyroid Medications ANTI-THYROIDmedications Drugs used to BLOCK the thyroid hormones and treat hyperthyroidism Inhibit the synthesis of thyroid hormones
  • 30.
    ANTI-Thyroid Medications ANTI-THYROIDmedications 1. Methimazole (Tapazole) 2. PTU (prophylthiouracil) 3. Iodine solution- SSKI and Lugol’s solution
  • 31.
    ANTI-Thyroid Medications ANTI-THYROIDmedications: Indications Grave’s dosease Thyrotoxicosis
  • 32.
    ANTI-Thyroid Medications ANTI-THYROIDmedications: Absorption is good orally
  • 33.
    ANTI-Thyroid Medications ANTI-THYROIDmedications Side-effects of thionamides N/V, drowsiness, lethargy, bradycardia, skin rash GI complaints Arthralgia, myalgia AGRANULOCYTOSIS Most important to monitor
  • 34.
    ANTI-Thyroid Medications ANTI-THYROIDmedications Side-effects of Iodine solutions Lugol’s Most common adverse effects is HYPOTHYROIDISM Iodism= metallic taste, burning in the mouth, sore teeth and gums, diarrhea, stomach upset
  • 35.
    ANTI-Thyroid Medications ANTI-THYROIDmedications Nursing responsibilities 1. Monitor VS, T3 and T4, weight 2. The medications WITH MEALS to avoid gastric upset
  • 36.
    ANTI-Thyroid Medications ANTI-THYROIDmedications Nursing responsibilities 3. Instruct to report SORE THROAT or unexplained FEVER 4. Monitor for signs of hypothyroidism. Instruct not to stop abrupt medication
  • 37.
    ANTI-Thyroid Medications ANTI-THYROIDmedications Lugol’s Solution Used to decrease the vascularity and size of the thyroid (in preparation for thyroid surgery) T3 and T4 production diminishes Given per orem, can be diluted with juice, administered WITH foods Use straw to decrease staining Monitor iodism
  • 38.
  • 39.
    STEROIDS Replaces thesteroids in the body Cortisol, cortisone, betamethasone, and hydrocortisone
  • 40.
    STEROIDS These drugsenter the cells and bind to receptors They inhibit the enzyme phospholipase
  • 41.
    STEROIDS Corticosteroids areused topically and locally to achieve the desired anti-inflammatory effects at a particular site Examples: Prednisone Bethamethasone Prednisolone Fludrocortisone
  • 42.
    STEROIDS Side-effects HYPERglycemiaIncreased susceptibility to infection (immunosuppression) Hypokalemia Edema Peptic ulceration
  • 43.
    STEROIDS Side-effects Ifhigh doses- osteoporosis, growth retardation, peptic ulcer, hypertension, cataract, mood changes, hirsutism, and fragile skin
  • 44.
    STEROIDS Nursing responsibilities1. Monitor VS, electrolytes, glucose 2. Monitor weight edema and I/O
  • 45.
    STEROIDS Nursing responsibilities3. Protect patient from infection 4. Handle patient gently 5. Instruct to take meds WITH MEALS to prevent gastric ulcer formation
  • 46.
    STEROIDS Nursing responsibilities6. Caution the patient NOT to abruptly stop the drug 7. Drug is tapered to allow the adrenal gland to secrete endogenous hormones
  • 47.
    STEROIDS Evaluation: Thedrugs are effective if there is: Relief of signs and symptoms of inflammation Return of adrenal function to normal
  • 48.
  • 49.
    DRUG THERAPY andMANAGEMENT Usually, this type of management is employed if diet modification and exercise cannot control the blood glucose level.
  • 50.
    DRUG THERAPY andMANAGEMENT These agents are employed to control the blood glucose level They can be insulin and oral agents These are given to replace the hormone in the body If hormone is still present BUT decreased, Oral agents are given
  • 51.
    Diabetes Mellitus DRUGTHERAPY and MANAGEMENT Because the patient with TYPE 1 DM cannot produce insulin, exogenous insulin must be administered for life.
  • 52.
    Diabetes Mellitus DRUGTHERAPY and MANAGEMENT TYPE 2 DM may have decreased insulin production, ORAL agents that stimulate insulin production are usually employed.
  • 53.
    Diabetes Mellitus PHARMACOLOGICINSULIN This may be grouped into several categories according to: 1. Source- Human, pig, or cow 2. Onset of action- Rapid-acting, short-acting, intermediate-acting, long-acting and very long acting
  • 54.
    Diabetes Mellitus PHARMACOLOGICINSULIN This may be grouped into several categories according to: 3. Pure or mixed concentration 4. Manufacturer of drug
  • 55.
    Diabetes Mellitus GENERALITIES1. Human insulin preparations have a shorter duration of action than animal source
  • 56.
    Diabetes Mellitus GENERALITIES2. Animal sources of insulin have animal proteins that may trigger allergic reaction and they may stimulate antibody production that may bind the insulin, slowing the action
  • 57.
    Diabetes Mellitus 3.ONLY Regular insulin can be used INTRAVENOUSLY!
  • 58.
    Diabetes Mellitus 4.Insulin are measured in INTERNATIONAL UNITS or “iu” 5. There is a specified insulin injection calibrated in units
  • 59.
    Diabetes Mellitus Mixedinsulin are also available The msot common of which is the 70-30 insulin Made up of :70% NPH and 30% regular insulin in the vial
  • 60.
    Comparison of InsulinPeak action 10-20 hrs 4-8 hrs Ultra-lente Long Acting 6-8 hrs to 12 hrs 1 ½ to 2 hrs NPH and Lente Intermediate acting 2-4 hrs 1 hour Regular Insulin RAPID acting 1 hour 15 minutes Lispro ULTRA-acting PEAK Onset Example Insulin Type
  • 61.
    Diabetes Mellitus RAPIDACTING INSULIN Lispro (Humalog) and Insulin Aspart (Novolog) Produces a more rapid effect and with a shorter duration than any other insulin preparation
  • 62.
    Diabetes Mellitus RAPIDACTING INSULIN ONSET- 5-15 minutes PEAK- 1 hour DURATION- 3 hours Instruct patient to eat within 5 to 15 minutes after injection
  • 63.
    Diabetes Mellitus REGULARINSULIN Also called Short-acting insulin “ R” Usually Clear solution administered 30 minutes before a meal
  • 64.
    Diabetes Mellitus REGULARINSULIN ONSET- 30 minutes to 1 hour PEAK- 2 to 4 hours DURATION- 4 to 6 hours
  • 65.
    Diabetes Mellitus INTERMEDIATEACTING INSULIN Called “NPH” or “LENTE” Appears white and cloudy
  • 66.
    Diabetes Mellitus INTERMEDIATEACTING INSULIN ONSET- 2-4 hours PEAK- 4 to 6-12 hours DURATION- 16-20 hours
  • 67.
    Diabetes Mellitus LONG-ACTING INSULIN “ UltraLENTE” Referred to as “peakless” insulin
  • 68.
    Diabetes Mellitus LONG-ACTING INSULIN ONSET- 6-8 hours PEAK- 12-16 hours DURATION- 20-30 hours
  • 69.
    Diabetes Mellitus HEALTHTEACHING Regarding Insulin SELF- Administration 1. Insulin is administered at home subcutaneously
  • 70.
    Diabetes Mellitus HEALTHTEACHING Regarding Insulin SELF- Administration 2. Cloudy insulin should be thoroughly mixed by gently inverting the vial or ROLLING between the hands
  • 71.
    Diabetes Mellitus HEALTHTEACHING Regarding Insulin SELF- Administration 3. Insulin NOT IN USE should be stored in the refrigerator, BUT avoid freezing/extreme temperature
  • 72.
    Diabetes Mellitus 4.Insulin IN USE should be kept at room temperature to reduce local irritation at the injection site
  • 73.
    Diabetes Mellitus 5.INSULIN may be kept at room temperature up to 1 month
  • 74.
    Diabetes Mellitus 6.Select syringes that match the insulin concentration. U-100 means 100 units per mL
  • 75.
    Diabetes Mellitus 7.Instruct the client to draw up the REGULAR (clear) Insulin FIRST before drawing the intermediate acting (cloudy) insulin
  • 76.
    Diabetes Mellitus 8.Pre-filled syringes can be prepared and should be kept in the refrigerator with the needle in the UPRIGHT position to avoid clogging the needle
  • 77.
    Diabetes Mellitus 9.The four main areas for insulin injection are- ABDOMEN, UPPER ARMS, THIGHS and HIPS
  • 78.
  • 79.
    Diabetes Mellitus Insulinis absorbed fastest in the abdomen and slowest in the hips Instruct the client to rotate the areas of injection, but exhaust all available sites in one area first before moving into another area.
  • 80.
    Diabetes Mellitus 10.Alcohol may not be used to cleanse the skin 11. Utilize the subcutaneous injection technique- commonly, a 45-90 degree angle.
  • 81.
    Diabetes Mellitus 12.No need to instruct for aspirating the needle 13. Properly discard the syringe after use.
  • 82.
    Diabetes Mellitus T-I-ET est blood  I nject insulin  E at food
  • 83.
    Diabetes Mellitus ORALHYPOGLYCEMIC AGENTS These may be effective when used in TYPE 2 DM that cannot be treated with diet and exercise These are NEVER used in pregnancy!
  • 84.
    Diabetes Mellitus ORALHYPOGLYCEMIC AGENTS There are several agents: Sulfonylureas Biguanides Alpha-glucosidase inhibitors Thiazolidinediones Meglitinides
  • 85.
    Diabetes Mellitus ORALHYPOGLYCEMIC AGENTS These drugs are given per orem and are effective only in type 2 DM Common adverse effects include: Hypoglycemia Diarrhea, jaundice, nausea and heartburn Anemia , photosensitivity
  • 86.
    Diabetes Mellitus ORALHYPOGLYCEMIC AGENTS General Nursing Consideration Observe for manifestations of hypoglycemia Assess for allergic reaction Instruct to take the medication at the same time each day Caution to avoid taking other drugs without consultation with physician
  • 87.
    Diabetes Mellitus ORALHYPOGLYCEMIC AGENTS General Nursing Consideration 5. THESE medications SHOULD NEVER be given to pregnant women, so rule out pregnancy 6. Instruct to wear sunscreen 7. Advise to bring simple sugar to be taken when hypoglycemic episodes occur
  • 88.
    Diabetes Mellitus SULFONYLUREASMOA- stimulates the beta cells of the pancreas to secrete insulin Classified as to generations- first and second generations
  • 89.
    Diabetes Mellitus SULFONYLUREASFIRST GENERATION- Acetoheximide, Chlorpropamide, Tolazamide and Tolbutamide SECOND GENERATION- Glipizide, Glyburide, Glibenclamide, Glimepiride
  • 90.
    Diabetes Mellitus: SulfonylureasThe most common side –effects of these medications are Gastro-intestinal upset and dermatologic reactions. HYPOGLYCEMIA is also a very important side-effect Given 30 minutes before meals- breakfast
  • 91.
    Diabetes Mellitus: SulfonylureasChlorpropamide has a very long duration of action. This also produces a disulfiram-like reaction when taken with alcohol Second generation drugs have shorter duration with metabolism in the kidney and liver and are the choice for elderly patients
  • 92.
    Diabetes Mellitus BIGUANIDESMOA- Facilitate the action of insulin on the peripheral receptors These can only be used in the presence of insulin
  • 93.
    Diabetes Mellitus BIGUANIDES=“ formin” They have no effect on the beta cells of the pancreas Metformin (Glucophage) and Phenformin are examples
  • 94.
    Diabetes Mellitus: BiguanidesThe most important side effect is LACTIC ACIDOSIS! These are not given to patient with renal impairment
  • 95.
    Diabetes Mellitus: BiguanidesThese drugs are usually given with a sulfonylurea to enhance the glucose-lowering effect more than the use of each drug individually
  • 96.
    Diabetes Mellitus ALPHA-GLUCOSIDASEINHIBITORS MOA- Delay the absorption of glucose in the GIT Result is a lower post-prandial blood glucose level They do not affect insulin secretion or action! Side-effect: DIARRHEA and FLATULENCE
  • 97.
    Diabetes Mellitus Examplesof AGI are Acarbose and Miglitol They are not absorbed systemically and are very safe They can be used alone or in combination with other OHA
  • 98.
    Diabetes Mellitus Side-effectif used with other drug is HYPOGLYCEMIA Note that sucrose absorption is impaired and IV glucose is the therapy for the hypoglycemia
  • 99.
    Diabetes Mellitus THIAZOLIDINEDIONESMOA- Enhance insulin action at the receptor site They do not stimulate insulin secretion
  • 100.
    Diabetes Mellitus THIAZOLIDINEDIONESExamples- Rosiglitazone, Pioglitazone These drugs affect LIVER FUNCTION Can cause resumption of OVULATION in peri-menopausal anovulatory women
  • 101.
    Diabetes Mellitus MEGLITINIDESMOA- Stimulate the secretion of insulin by the beta cells Examples- Repaglinide and Nateglinide
  • 102.
    Diabetes Mellitus MEGLITINIDESThey have a shorter duration and fast action Should be taken BEFORE meals to stimulate the release of insulin from the pancreas
  • 103.
    Diabetes Mellitus MEGLITINIDESPrincipal side-effect of meglitinides- hypoglycemia Can be used alone or in combination
  • 104.
    Reproductive Hormones Gonadalhormones include agents that affect the female and male reproductive cycle Female hormones include ESTROGENS, PROGESTINS and ovarian hormones Male hormones include ANDROGENS and anabolic steroids
  • 105.
    Reproductive Hormones TheGENERAL Mechanism of Action These hormones interfere with the normal cycle of hormone balance
  • 106.
    Reproductive Hormones INDICATIONSFEMALE: Hormonal replacement therapy, oral contraception, treatment of infertility and management of some tumors MALE: replacement therapy, metabolic stimulators and treatment of some tumors
  • 107.
    Reproductive Hormones EstrogensConjugated estrogen Estradiol Ethinyl estradiol Diethylstilbesterol (DES) Clomiphene
  • 108.
    Reproductive Hormones ProgestinsMedroxyprogesterone acetate (Provera) Megestrol Norethindrone Levonorgestrel (Norplant) Norgestrel Norethindrone acetate
  • 109.
    Reproductive Hormones AndrogensTestosterone cypionate Methyltestosterone Fluoxymesterone Aqueous testosterone
  • 110.
    Reproductive Hormones OralContraceptive Pills Two types are available: Combination estrogen and progesterone AND progestins only
  • 111.
    Reproductive Hormones OralContraceptive Pills: DYNAMICS Inhibits OVULATION by altering the hypothalamus and gonadotropin axis Alters the MUCUS to prevent sperm entry Alters the uterine endometrium to prevent implantation Suppresses the ovaries
  • 112.
    Reproductive Hormones OralContraceptive Pills: Indicators Suppression of ovulation for prevention of pregnancy Regulation of menstrual cycle and management of dysfunctional bleeding Treatment of endometriosis
  • 113.
    Reproductive Hormones OralContraceptive Pills: Kinetics Easily absorbed orally NORPLANT provides 5 years of contraception Provera provides 3 months of protection Metabolized and excreted in liver
  • 114.
    Reproductive Hormones OralContraceptive Pills: Not to be used in patients with history of, hypertension, thromboemoblic or CVA disease Not given in certain cancers Contraindicates in pregnancy SMOKING should be avoided when under therapy
  • 115.
    Reproductive Hormones OralContraceptive Pills: Drug Interaction Rifampicin, penicillin and tetracycline REDUCE effectiveness of contraception Benzodiazepines decrease the levels of OCP
  • 116.
    Reproductive Hormones OralContraceptive Pills: Side effects CNS: headache CV: Thromboembolic disease, MI, hypertension and pulmonary edema NAUSEA and cholestatic JAUNDICE Breast tenderness, weight gain, edema, breakthrough bleeding, acne
  • 117.
    Reproductive hormones NursingConsiderations Assess for risk factors and the ability to comply with medications Determine the type of OCP used Monophasic pills provide constant dosing of BOTH estrogen and progestin Biphasic pills provide constant estrogen but varying progestin doses Triphasic pills provide varying Estrogen and Progesterone
  • 118.
    Reproductive hormones NursingConsiderations 3. Teach the common side-effects and re-assure that these will decrease in time 4. Instruct to use other means of contraception if antibiotics and anticonvulsants are also taken 5. WARNT the client to avoid smoking because this will increase the risk for embolic episodes
  • 119.
    Clomiphene A synthetic,non-steroidal estrogen Increases the secretion of gonadotropins and initiates the secretion of FSH and LH OVULATION will occur Used in the treatment of infertility Readily absorbed orally
  • 120.
    Clomiphene Side effectscan be: Risk for Multiple pregnancy Nausea, breast discomfort, headache and GI disturbances Visual disturbances Enlargement of the ovaries
  • 121.
    Viagra (Sildenafil) Amedication used for penile erectile dysfunction Selectively inhibits receptors and enzyme Phosphodiesterase E This increases the nitrous oxide levels allowing blood flow into the corpus cavernosum
  • 122.
    Viagra (Sildenafil) Contraindicatedin patients with bleeding disorders and with penile implants Caution: Coronary Artery Disease and concomitant use of nitrates Side-effects: PRIAPISM, headache, flushing, dyspepsia, UTI, diarrhea and dizziness
  • 123.
    Viagra (Sildenafil) Nursingconsideration Assess for risk factors Instruct to take the drug ONE hour before sexual act Drug is taken orally