Module 3.4 - Endocrine

LESSON 5
ENDOCRINE DRUGS
ANTIDIABETIC AGENTS
A. Description
1. Used to manage/treat diabetes mellitus

2. Classified into two types: insulin for parenteral use and oral antidiabetics
3. Insulin
a. Acts to facilitate the transport of glucose across the cell membrane
and to promote glycogenesis.
b. Available in three forms: human, beef, and pork
--human and purified pork insulins are less antigenic;
--administered parenterally
--brands and forms should not be substituted without medical supervision.
c. Available in rapid-acting, intermediate-acting, and long-acting forms

--rapid-acting and intermediate-acting forms are available in mixed preparations (e.g.,
Humulin 70/30, which contains 70% NPH and 30% regular insulin).
4. Oral antidiabetics
a. Require some functioning beta cells.
b. Lowers serum glucose in variety of ways depending on the drug.
B. Examples
1. Insulin: regular (Humulin R, Novolin R);

isophane suspension (Humulin N, Novolin N);
insulin zinc suspension (Humulin L, Novolin N).
2. Oral antidiabetics
a. Sulfonylureas: stimulate pancreatic beta cells to produce insulin: glipizide (Glucotrol);

chlorpropamide (diabenese); glyburide (Micronase).
b. Other: acarbose (Precose); delays digestion of carbohydrates; metformin (Glucophage)
and troglitazone (Rezulin); increase sensitivity to insulin and inhibit hepatic glucose
production.
C. Major side effects

1. Insulin: irritability, tremor (hypoglycemia); headache; confusion,
convulsion (hypoglycemia); tachycardia (hypoglycemia); moist skin
(hypoglycemia); hunger (hypoglycemia).
2. Oral antidiabetics: hypoglycemia; skin rash, allergic reactions, pruritus

(hypersensitivity); jaundice (hepatic alterations); thrombocytopenia (glucophage).
D. Nursing care
1. Assess client for signs of hypoglycemia.
2. Instruct client to:
a. Use proper medication administration procedure.
b. Comply with dietary program, including snacks.
c. Avoid alcohol, especially when taking Diabenese and Glucophage.
d. Perform blood glucose solution, hard candy, orange juice, glucagon)
NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
3. Administer insulin
a. Administer all forms of insulin subcutaneously.
b. Use only regular insulin for IV administration.
c. If premixed insulin is not prescribed and two forms are
to be mixed, draw up regular insulin first.
d. Abdomen is preferred site because it is not influenced by exercise.
e. Slight dosage adjustment may be necessary when switching from
one form of insulin to another because of different pharmacokinetics.
4. Offer emotional support to client; therapy is lifelong.
Common Types of Insulin Onset Peak Duration
* Rapid-acting Insulin 10-15 mins 1 hour 3 hours

(Lispro, Humalog)
* Short acting insulin 1 hour 2-3 hours 4-6 hours

(Humulin Regular)
* Intermediate-acting Insulin 3-4 hours 4-12 hours 16-20 hours

(Humulin NPH, Humulin
Lente)
* Long-acting Insulin 6-8 hours 12-16 hours 20-30 hours

(Humulin Ultralente)
Premixed Insulin (70%NPH + 1 hour 2-12 hours 18-14 hours

30% regular)
*1st generation Sulfonyllureas *2nd Generation Sulfonylureas

Glipizide (Glucotrol, Glucotrol XL)
* Short Acting Glyburide (Dia Beta, Micronase, Glynase)
Tolbutamide (Orinase) Glimeperide (Amaryl)
* Intermediate Acting Non Sulfonylureas

Acetohexamide (Dymelor) Meiformin (Glucophage)
Tolazamide (Tolinase) Acarpos (Precose)
Miglitol (Glysey)
*Long Acting Troglitazone (Kezulin)
Chlorpropamide (Diabenase) Rosiglitazone (Aranida)
Rapaglinide (Prandin)
THYROID ENHANCERS
The thyroid hormones, thyroxine (T4) and triiodothyronine (T3), are tyrosine-based
hormones produced by the thyroid gland. An important component in the synthesis of
thyroid hormones is iodine. The major form of thyroid hormone in the blood is thyroxine
(T4), which has a longer half life than T 3. The ratio of T4 to T3 released in the blood is
roughly 20 to 1. Thyroxine is converted to the active T 3 (three to four times more potent
than T4) within cells by deiodinases (5'-iodinase). These are further processed by
decarboxylation and deiodination to produce iodothyronamine (T1a) and thyronamine
(T0a).
Effects of thyroxine
 Increases cardiac output
 Increases heart rate
 Increases ventilation rate
 Increases basal metabolic rate
 Potentiates the effects of catecholamines
(i.e increases sympathetic activity)
 Potentiates brain development
 Thickens endometrium in females
A. Description
1. Regulate the metabolic rate of body cells; aid in growth and development of bones and
teeth; and affect protein, fat, and carbohydrate metabolism.
2. Replace thyroid hormone in clients experiencing a reduction in or absence of thyroid gland
functions.
B. Examples: levothyroxine sodium (Synthroid);

Iothyronine sodium (Cytomel);
Thyroid (Thyrar)
C. Major side effects: increased metabolism (increased serum T3, T4); hyperactivity (increased
metabolic rate); cardiac stimulation (increased cardiac metabolism).
D. Nursing care

a. Report the occurrence of any side effects to the physician immediately.
b. Take medication as scheduled at the same time daily; d0 not stop abruptly.
c. Take radial pulse; notify physician if greater than beats/minute.
d. Carry medical alert card.
e. Keep all schedule appointments with physicians; medical supervisio0n is necessary.
2. Assess client for potentiation of anticoagulant effect.

3. Offer emotional support to client; therapy may be lifelong.
4. Assess client for signs of hyperthyroidism.
THYROID INHIBITORS
A. Description
1. Interfere with the synthesis and release of thyroid hormone; inhibit oxidation of iodides
to prevent their combination with tyrosine in formation of thyroxine.
2. Treat hyperthyroidism.
3. Available in oral and parenteral (IV) preparations.
B. Examples: iodine (Lugol’s solution)

methimazole (Tapazole);
Propylthiouracil (PTU)
C. Major side effects: agranuclocytosis (decreased WBCs); skin disturbances

(hypersensitivity); nausea, vomiting (irritation of gastric mucosa); decreased metabolism
(decreased production of serum T3, T4); iodine: (bitter taste, stains teeth because of local
oral effect on mucosa and teeth).
D. Nursing care
a. Report the occurrence of any side effects to physician, especially sore throat and fever.
b. Avoid crowded places and potentially infectious situations.
2. Administer liquid iodine preparations diluted in beverages of choice; use a straw.

3. Assess client for signs of hypothyroidism.
ADRENOCORTICOIDS
A. Description
1. Interfere with the release of factors important in producing the normal inflammatory
auditory immune responses.
2. Increase glucose and fat formation and promote protein breakdown.
3. Used for hormonal replacement therapy.
4. Available in oral, parenteral (IM, IV), inhalation, intraarticular, and topical, including
ophthalmic, preparations.
B. Examples: dexamethasone (Decadron);
hydrocortisone succinate (Solu-Cortef);
prednisone (Deltasone).
1. Cushing-like symptoms (increased glucocorticoid activity)

2. Hypertension (promotion of sodium and water retention)
3. Hyperglycemia (increased carbohydrate catabolism; gluconeogenesis)
4. Mood changes (CNS effect)
5. GI irritation and ulcer formation (local GI effect)
6. Cataracts (hyperglycemia)
7. Hypokalemia (promotion of potassium excretion)
D. Nursing care
1. Administer oral preparations with food milk or antacid.

2. Monitor client’s weight, blood pressure, and serum electrolytes during therapy.
3. Avoid placing client in potentially infectious situations.
4. Assess for GI bleeding; monitor blood glucose in people with diabetes.
5. In addition to carrying a medical alert card, instruct client to:
a. Avoid exposure to infections; notify physician if fever or sore throat occurs; avoid
immunizations during therapy.
b. Avoid using salt; encourage foods high in potassium.
c. Avoid missing changing, or withdrawing drug suddenly.
6. Withdraw drug therapy gradually to permit adrenal recovery.
ANTIDIURETIC HORMONE
A. Description
1. Promotes water reabsorption by the distal renal tubules and causes vasoconstriction and
increased muscle tone of the bladder, GI tract, uterus, and blood vessels.
2. treatment for diabetes insipidus
3. Available in parenteral (IM, SC) or nasal preparation
B. Examples:
1. Lypressin (Diapid) for intranasal administration
2. vasopressin (Pitressin)
1. Increased intestinal activity (direct peristaltic stimulant)

2. Hyponatremia (promotion of water reabsorption)
3. Pallor (hemodilution)
4. Water intoxication (promotion of water reabsorption)
5. Cardiac disturbances (Fluid/electrolyte imbalance)
6. Nasal irritation (lypressin has local effect on nasal mucosa)
D. Nursing care
1. Assess client for signs of dehydration during therapy, monitor intake and output.
2. Assess vital signs, especially blood pressure
3. If drug is administered to improve bladder or bowel for continence or passage.

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LESSON 5

1. Used to manage/treat diabetes mellitus

c. Available in rapid-acting, intermediate-acting, and long-acting forms

1. Insulin: regular (Humulin R, Novolin R);

a. Sulfonylureas: stimulate pancreatic beta cells to produce insulin: glipizide (Glucotrol);

C. Major side effects

2. Oral antidiabetics: hypoglycemia; skin rash, allergic reactions, pruritus

4. Offer emotional support to client; therapy is lifelong.

Common Types of Insulin Onset Peak Duration

* Rapid-acting Insulin 10-15 mins 1 hour 3 hours

* Short acting insulin 1 hour 2-3 hours 4-6 hours

* Intermediate-acting Insulin 3-4 hours 4-12 hours 16-20 hours

* Long-acting Insulin 6-8 hours 12-16 hours 20-30 hours

Premixed Insulin (70%NPH + 1 hour 2-12 hours 18-14 hours

*1st generation Sulfonyllureas *2nd Generation Sulfonylureas

* Intermediate Acting Non Sulfonylureas

B. Examples: levothyroxine sodium (Synthroid);

1. Instruct client to:

2. Assess client for potentiation of anticoagulant effect.

B. Examples: iodine (Lugol’s solution)

C. Major side effects: agranuclocytosis (decreased WBCs); skin disturbances

1. Instruct client to:

2. Administer liquid iodine preparations diluted in beverages of choice; use a straw.

C. Major side effects

1. Cushing-like symptoms (increased glucocorticoid activity)

1. Administer oral preparations with food milk or antacid.

6. Withdraw drug therapy gradually to permit adrenal recovery.

C. Major side effects

1. Increased intestinal activity (direct peristaltic stimulant)

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