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Sunday, November 11, 2007

Pharmacology Endocrine Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination

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Pharmacology Endocrine Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: Pharmacology of the Selected Endocrine Drugs

Slide 2: Fig. 10.9

Slide 3: Fig. 10.10

Slide 4: Fig. 10.11a

Slide 6: Fig. 10.12a

Slide 7: Fig. 10.12b

Slide 9: Fig. 10.14

Slide 10: Fig. 10.17

Slide 11: Fig. 10.18

Slide 12: Fig. 10.19

Slide 13: Endocrine Medications Hormonal replacement

Slide 15: 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

Slide 16: Endocrine Medications Therapeutic Indications 2. Hormonal replacement 3. Used in diagnostic procedure 4. Used to control the hemorrhage in variceal bleeding 5. Treatment of enuresis

Slide 17: Endocrine Medications Used in DI • 1. Desmopressin and Lypressin intranasally • 2. Pitressin IntraMuscularly

Slide 18: Endocrine Medications Anti-diuretic hormones SIDE-effects • Flushing and headache • Water intoxication • CVS: heart block, MI • Renal: hyponatremia • Gangrene due to vasoconstriction

Slide 20: Thyroid Medications Thyroid hormones • These products are used to treat the manifestations of hypothyroidism • Replace hormonal deficit in the treatment of HYPOTHYROIDSM

Slide 21: Thyroid Medications Thyroid hormones • Levothyroxine (Synthroid) • Liothyroxine (Cytomel) • Thyroid dessicated • Liotrix (Thyrolar)

Slide 22: Thyroid Medications Thyroid hormones: Actions • Replaces both T3 and T4 • Increases metabolic rate

Slide 23: Thyroid Medications Thyroid hormones: Actions • Increase the metabolic rate • Increase O2 consumption • Increase HR, RR, BP

Slide 24: Thyroid Medications Thyroid hormones: Indications Hypothyroidism Diagnostic suppression test

Slide 25: Thyroid Medications Thyroid hormones Side-effects 3. Nausea and Vomiting 4. Signs of increased metabolism= tachycardia, hypertension, cardiac arrhythmias, anxiety, headache, tremors, palpitations

Slide 26: 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

Slide 27: 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

Slide 28: ANTI-Thyroid Medications ANTI-THYROID medications • The thyroid becomes oversaturated with iodine and stop producing thyroid hormone

Slide 29: ANTI-Thyroid Medications ANTI-THYROID medications • Drugs used to BLOCK the thyroid hormones and treat hyperthyroidism • Inhibit the synthesis of thyroid hormones

Slide 30: ANTI-Thyroid Medications ANTI-THYROID medications 1. Methimazole (Tapazole) 2. PTU (prophylthiouracil) 3. Iodine solution- SSKI and Lugol’s solution

Slide 31: ANTI-Thyroid Medications ANTI-THYROID medications: Indications 2. Grave’s dosease 3. Thyrotoxicosis

Slide 32: ANTI-Thyroid Medications ANTI-THYROID medications: • Absorption is good orally

Slide 33: 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

Slide 34: 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

Slide 35: ANTI-Thyroid Medications ANTI-THYROID medications Nursing responsibilities • 1. Monitor VS, T3 and T4, weight • 2. The medications WITH MEALS to avoid gastric upset

Slide 36: 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

Slide 37: 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

Slide 39: STEROIDS • Replaces the steroids in the body • Cortisol, cortisone, betamethasone, and hydrocortisone

Slide 40: STEROIDS • These drugs enter the cells and bind to receptors • They inhibit the enzyme phospholipase

Slide 41: STEROIDS • Corticosteroids are used topically and locally to achieve the desired anti-inflammatory effects at a particular site Examples: Prednisone Bethamethasone Prednisolone Fludrocortisone

Slide 42: STEROIDS Side-effects –HYPERglycemia –Increased susceptibility to infection (immunosuppression) –Hypokalemia –Edema –Peptic ulceration

Slide 43: STEROIDS Side-effects –If high doses- osteoporosis, growth retardation, peptic ulcer, hypertension, cataract, mood changes, hirsutism, and fragile skin

Slide 44: STEROIDS • Nursing responsibilities 1. Monitor VS, electrolytes, glucose 2. Monitor weight edema and I/O

Slide 45: STEROIDS • Nursing responsibilities 3. Protect patient from infection 4. Handle patient gently 5. Instruct to take meds WITH MEALS to prevent gastric ulcer formation

Slide 46: 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

Slide 47: STEROIDS Evaluation: The drugs are effective if there is: 3. Relief of signs and symptoms of inflammation 4. Return of adrenal function to normal

Slide 48: DM Drug therapy

Slide 49: DRUG THERAPY and MANAGEMENT • Usually, this type of management is employed if diet modification and exercise cannot control the blood glucose level.

Slide 50: 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

Slide 51: Diabetes Mellitus DRUG THERAPY and MANAGEMENT • Because the patient with TYPE 1 DM cannot produce insulin, exogenous insulin must be administered for life.

Slide 52: Diabetes Mellitus DRUG THERAPY and MANAGEMENT • TYPE 2 DM may have decreased insulin production, ORAL agents that stimulate insulin production are usually employed.

Slide 53: 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

Slide 54: Diabetes Mellitus PHARMACOLOGIC INSULIN • This may be grouped into several categories according to: 3. Pure or mixed concentration 4. Manufacturer of drug

Slide 55: Diabetes Mellitus GENERALITIES • 1. Human insulin preparations have a shorter duration of action than animal source

Slide 56: 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

Slide 57: Diabetes Mellitus • 3. ONLY Regular insulin can be used INTRAVENOUSLY!

Slide 58: Diabetes Mellitus • 4. Insulin are measured in INTERNATIONAL UNITS or “iu” • 5. There is a specified insulin injection calibrated in units

Slide 59: 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

Slide 60: Comparison of Insulin Peak action Insulin Type Example Onset PEAK 15 1 hour ULTRA-acting Lispro minutes 1 hour 2-4 hrs RAPID acting Regular Insulin 1 ½ to 2 6-8 hrs Intermediate NPH and hrs acting Lente to 12 hrs 4-8 hrs 10-20 hrs Long Acting Ultra-lente

Slide 61: 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

Slide 62: 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

Slide 63: Diabetes Mellitus REGULAR INSULIN • Also called Short-acting insulin • “R” • Usually Clear solution administered 30 minutes before a meal

Slide 64: Diabetes Mellitus REGULAR INSULIN • ONSET- 30 minutes to 1 hour • PEAK- 2 to 4 hours • DURATION- 4 to 6 hours

Slide 65: Diabetes Mellitus INTERMEDIATE ACTING INSULIN • Called “NPH” or “LENTE” • Appears white and cloudy

Slide 66: Diabetes Mellitus INTERMEDIATE ACTING INSULIN • ONSET- 2-4 hours • PEAK- 4 to 6-12 hours • DURATION- 16-20 hours

Slide 67: Diabetes Mellitus LONG- ACTING INSULIN • “UltraLENTE” • Referred to as “peakless” insulin

Slide 68: Diabetes Mellitus LONG- ACTING INSULIN • ONSET- 6-8 hours • PEAK- 12-16 hours • DURATION- 20-30 hours

Slide 69: Diabetes Mellitus HEALTH TEACHING Regarding Insulin SELF- Administration • 1. Insulin is administered at home subcutaneously

Slide 70: 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

Slide 71: Diabetes Mellitus HEALTH TEACHING Regarding Insulin SELF- Administration • 3. Insulin NOT IN USE should be stored in the refrigerator, BUT avoid freezing/extreme temperature

Slide 72: Diabetes Mellitus • 4. Insulin IN USE should be kept at room temperature to reduce local irritation at the injection site

Slide 73: Diabetes Mellitus • 5. INSULIN may be kept at room temperature up to 1 month

Slide 74: Diabetes Mellitus • 6. Select syringes that match the insulin concentration. –U-100 means 100 units per mL

Slide 75: Diabetes Mellitus • 7. Instruct the client to draw up the REGULAR (clear) Insulin FIRST before drawing the intermediate acting (cloudy) insulin

Slide 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

Slide 77: Diabetes Mellitus • 9. The four main areas for insulin injection are- ABDOMEN, UPPER ARMS, THIGHS and HIPS

Slide 79: 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.

Slide 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.

Slide 81: Diabetes Mellitus • 12. No need to instruct for aspirating the needle • 13. Properly discard the syringe after use.

Slide 82: Diabetes Mellitus T-I-E Test blood Inject insulin  Eat food

Slide 83: 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!

Slide 84: Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS • There are several agents: – Sulfonylureas – Biguanides – Alpha-glucosidase inhibitors – Thiazolidinediones – Meglitinides

Slide 85: 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

Slide 86: Diabetes Mellitus ORAL HYPOGLYCEMIC AGENTS General Nursing Consideration 3. Observe for manifestations of hypoglycemia 4. Assess for allergic reaction 5. Instruct to take the medication at the same time each day 6. Caution to avoid taking other drugs without consultation with physician

Slide 87: 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

Slide 88: Diabetes Mellitus SULFONYLUREAS • MOA- stimulates the beta cells of the pancreas to secrete insulin • Classified as to generations- first and second generations

Slide 89: Diabetes Mellitus SULFONYLUREAS • FIRST GENERATION- Acetoheximide, Chlorpropamide, Tolazamide and Tolbutamide • SECOND GENERATION- Glipizide, Glyburide, Glibenclamide, Glimepiride

Slide 90: 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

Slide 91: 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

Slide 92: Diabetes Mellitus BIGUANIDES • MOA- Facilitate the action of insulin on the peripheral receptors • These can only be used in the presence of insulin

Slide 93: Diabetes Mellitus BIGUANIDES= “formin” • They have no effect on the beta cells of the pancreas • Metformin (Glucophage) and Phenformin are examples

Slide 94: Diabetes Mellitus: Biguanides • The most important side effect is LACTIC ACIDOSIS! • These are not given to patient with renal impairment

Slide 95: 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

Slide 96: 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

Slide 97: 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

Slide 98: 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

Slide 99: Diabetes Mellitus THIAZOLIDINEDIONES • MOA- Enhance insulin action at the receptor site • They do not stimulate insulin secretion

Slide 100: Diabetes Mellitus THIAZOLIDINEDIONES • Examples- Rosiglitazone, Pioglitazone • These drugs affect LIVER FUNCTION • Can cause resumption of OVULATION in peri-menopausal anovulatory women

Slide 101: Diabetes Mellitus MEGLITINIDES • MOA- Stimulate the secretion of insulin by the beta cells • Examples- Repaglinide and Nateglinide

Slide 102: 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

Slide 103: Diabetes Mellitus MEGLITINIDES • Principal side-effect of meglitinides- hypoglycemia • Can be used alone or in combination

Slide 104: 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

Slide 105: Reproductive Hormones The GENERAL Mechanism of Action • These hormones interfere with the normal cycle of hormone balance

Slide 106: Reproductive Hormones INDICATIONS 2. FEMALE: Hormonal replacement therapy, oral contraception, treatment of infertility and management of some tumors 3. MALE: replacement therapy, metabolic stimulators and treatment of some tumors

Slide 107: Reproductive Hormones Estrogens • Conjugated estrogen • Estradiol • Ethinyl estradiol • Diethylstilbesterol (DES) • Clomiphene

Slide 108: Reproductive Hormones Progestins • Medroxyprogesterone acetate (Provera) • Megestrol • Norethindrone • Levonorgestrel (Norplant) • Norgestrel • Norethindrone acetate

Slide 109: Reproductive Hormones Androgens • Testosterone cypionate • Methyltestosterone • Fluoxymesterone • Aqueous testosterone

Slide 110: Reproductive Hormones Oral Contraceptive Pills • Two types are available: Combination estrogen and progesterone AND progestins only

Slide 111: 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

Slide 112: 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

Slide 113: 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

Slide 114: 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

Slide 115: Reproductive Hormones Oral Contraceptive Pills: Drug Interaction • Rifampicin, penicillin and tetracycline REDUCE effectiveness of contraception • Benzodiazepines decrease the levels of OCP

Slide 116: 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

Slide 117: Reproductive hormones Nursing Considerations 2. Assess for risk factors and the ability to comply with medications 3. 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

Slide 118: 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

Slide 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

Slide 120: Clomiphene • Side effects can be: • Risk for Multiple pregnancy • Nausea, breast discomfort, headache and GI disturbances • Visual disturbances • Enlargement of the ovaries

Slide 121: 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

Slide 122: 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

Slide 123: 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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