Medications That Affect The Endocrine System
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Medications That Affect The Endocrine System

on

  • 10,543 views

 

Statistics

Views

Total Views
10,543
Views on SlideShare
10,532
Embed Views
11

Actions

Likes
1
Downloads
207
Comments
2

2 Embeds 11

http://www.slideshare.net 10
http://webcache.googleusercontent.com 1

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Medications That Affect The Endocrine System Presentation Transcript

  • 1. Medications that Affect the Endocrine System Thyroid and Adrenocortical drugs Anti-diabetic drugs Created by Amanda McBride
  • 2. Diabetes Created by Amanda McBride
  • 3. 2 Types of Diabetes CONFIDENTIAL
  • 4. Created by Amanda McBride
  • 5. CONFIDENTIAL
  • 6. Created by Amanda McBride
  • 7. Anti-diabetic
    • Insulin
    • Oral Anti-diabetic drugs
    Created by Amanda McBride
  • 8. Insulin
    • Hormone manufactured by the beta cells of the pancreas
    • Beta cells are located in the pancreas in clusters known as the islets of Langerhans.
    • Insulin is a small protein
    • Required for the proper use of carbohydrates
    • Controls the storage and utilization of amino acids and fatty acids.
    • Lowers blood glucose levels by inhibiting glucose production by the liver
    Created by Amanda McBride
  • 9. Action of Insulin
    • Insulin molecules circulate throughout the blood stream until they bind to their associated (insulin) receptors.
    • Insulin receptors promote the uptake of glucose into various tissues that contain type 4 glucose transporters (GLUT4). Such tissues include skeletal muscles (which burn glucose for energy) and fat tissues (which convert glucose to triglycerides for storage).
    • The initial binding of insulin to its receptor initiates a signal transduction cascade that communicates the message delivered by insulin: remove glucose from blood plasma .
    • By the facilitative transport of glucose into the cells, the glucose transporters effectively remove glucose from the blood stream.
    • These changes can last from minutes to hours.
    Created by Amanda McBride
  • 10. Human Insulin
    • Less allergic reactions than animal insulin
    • Structurally similar to human insulin
    Created by Amanda McBride
  • 11. Action
    • Activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue
    • Stimulates the synthesis of glycogen by the liver.
    • Promotes protein synthesis and helps the body store fat by preventing its breakdown for energy.
    Created by Amanda McBride
  • 12. Created by Amanda McBride
  • 13. Onset, Peak, Duration
    • Onset
      • When insulin first begins to act in the body
    • Peak
      • When the insulin is exerting max action
    • Duration
      • The length of time the insulin remains in effect
    Created by Amanda McBride
  • 14. Created by Amanda McBride
  • 15. Uses
    • Diabetes type 1
    • Diabetes type 2 when uncontrolled by diet, exercise or weight reduction
    • Treat severe DKA or diabetic coma
    • Treat hypokalemia in combination with glucose
    Created by Amanda McBride
  • 16. Adverse Reactions
    • Hypoglycemia
      • Too little food
      • Too much Insulin
      • Increased demand
    • Hyperglycemia
      • Too much food
      • Too little Insulin
      • Emotional stress, infection, surgery, pregnancy or acute illness
    • Increased Insulin resistance
      • Antibodies develop against Insulin
    Created by Amanda McBride
  • 17. Created by Amanda McBride
  • 18. Precautions
    • Hepatic impairment
    • Renal impairment
    • Pregnancy
    • Lactation
    Created by Amanda McBride
  • 19. Interactions
    • Drug that affect effectiveness
    Created by Amanda McBride
  • 20. Nursing Process
    • Assessment
      • Skin
      • v/s
      • Diet
      • Type and duration of symptoms
      • Blood work
      • S&S hypo/hyper glycemia
    Created by Amanda McBride
  • 21. Implementation
    • Doses highly individualized
    • Daily dose
    • Sliding scale based on glucometer reading
    • Mixing Insulins
      • Mix in the same syringe
      • Clear to cloudy
    • Insulin syringe
    • Check date opened
    • Second checker/co-signer
    • Rotate suspension to mix insulin
    • Rotate sites to prevent lipodystrophy
    • Hypoglycemic reaction
      • Orange juice
      • Honey hard candy
      • Commercial gluoose products
      • Glucagon
      • Glucose IV
    Created by Amanda McBride
  • 22. Evalution
    • Coping
    • Education
    • Effectiveness
    Created by Amanda McBride
  • 23. Diabetic Ketoacidosis Created by Amanda McBride
  • 24. Oral Anti-diabetic drugs Sulfonylureas Biguanides Alpha inhibitors Meglitinides Thiazolidinediones Created by Amanda McBride
  • 25. Created by Amanda McBride
  • 26. Use
    • Only in the treatment of type 2 diabetes
    • May be used with Insulin
    • Some can be used together when one antidiabetic drug and diet do not control blood glucose
    Created by Amanda McBride
  • 27. Actions, Adverse reaction, Contraindications, Precautions and Interactions Created by Amanda McBride
  • 28. Sulfonylureas
    • Action
      • Stimulate beta cells
      • Not effective unless beta cells work
      • DiaBeta/ glyburide
    • Side effects
      • Hypoglcemia, anorexia, nausea, vomiting, wt gain, weakness numbness
    • Contraindicated
      • CAD, liver renal dysfunction
      • Sulpha drug allergy
      • Drug- drug interactions
    Created by Amanda McBride
  • 29. Biguanides
    • Action
      • Decreasing hepatic glucose production
      • Increasing insulin sensitivity in muscle and fat cells
      • Sensitizes the liver to circulating Insulin levels
      • Glucophage / metformin
    • Side effects
      • GI upset, lactic acidosis
      • weight loss
    • Contraindicated
      • Heart failure, renal disease, metabolic acidosis, pregnancy
    Created by Amanda McBride
  • 30. a-Glucosidase Inhibitors
    • Action
      • Delay the digestion and absorption of carbs
      • Prandase
    • Side effects
      • GI disturbances
    • Contraindications
      • Type 1 diabetes
      • Pregnancy
      • Renal impairment
      • Preexisting GI problems
    Created by Amanda McBride
  • 31. Meglitinides
    • Action
      • Stimulate the release of Insulin from pancreas
      • More rapid acting, shorter duration
      • Prandin
    • Side effects
      • Hypoglycemia, URI, headache, bronchitis, back pain
    • Contraindications
      • Type 1 diabetes
      • Pregnancy
      • Renal hepatic impairment
      • Drug- drug interactions
    Created by Amanda McBride
  • 32. Thiazolidinediones
    • Action
      • Decrease Insulin resistance
      • Increase Insulin sensitivity
      • Avandia
    • Side effects
      • Aggravated diabetes
      • URI
      • Sinusitis
      • Headache
      • Diarrhea
    • Contraindications
      • Severe heart failure
      • Edema
      • CV disease
      • Liver kidney disease
      • Decrease the effect of oral contraceptives
    Created by Amanda McBride
  • 33.
    • Use Avandia with caution if you have a problem with fluid retention or swelling. The drug has been known to cause this problem ,which in turn can lead to heart failure. Avandia should be avoided by anyone who has been diagnosed with heart failure, and it should be discontinued by anyone who develops it. Make sure doctor is aware of any heart problems you may have. Alert him immediately if you develop symptoms of heart failure such as fatigue and shortness of breath. * You should be aware that people taking Avandia tend to gain a weight, typically around 5 to 10 pounds. The cause is thought to be a combination of fluid retention and fat accumulation
    Created by Amanda McBride
  • 34. Nursing Process
    • Baseline assessment including wt
    • Integumentary
    • Blood work
      • Glycosylated hemoglobin
    • Monitor initially for hypoglycemia
    Created by Amanda McBride
  • 35. Education
    • Take as prescribed
    • Avoid alcohol
    • Avoid strenuous exercise
    • Maintain good foot care
    • Medic alert
    • Know the symptoms of hypo/hyper
    Created by Amanda McBride
  • 36. Created by Amanda McBride
  • 37. Posterior and Anterior Pituitary Hormones
    • Posterior Hormones
      • Vasopressin
      • Oxytocin
    • Anterior Hormones
      • Prolactin
      • LH
      • FSH
      • TSH
      • ACTH
      • GH
    Created by Amanda McBride
  • 38. Vasopressin
    • Used in the treatment of diabetes insipidus
      • Diabetes Insipidus results from a decreased production of  antidiuretic hormone ( vasopressin) , the hormone that normally prevents the kidney from producing too much urine.
    • Helps the body to conserve water when dehydrated.
    Created by Amanda McBride
  • 39. Created by Amanda McBride
  • 40. Created by Amanda McBride
  • 41. Created by Amanda McBride
  • 42. Adrenocorticol Hormones Created by Amanda McBride
  • 43. Created by Amanda McBride
  • 44. y Created by Amanda McBride
  • 45. Effects of Glucocorticoids on Body Systems System Effect of Glucocorticoids, Cortisol CNS Euphoria and behavioural changes Lower Seizure Threshold Resp Opens airways. Stabilize mast cells, to inhibit release of bronchoconstrictive and inflammatory substances, eg histamine GI Facilitation of fat absorption Increased acid, pepsin, and trypsin Skeletal Muscle Weakness (excess and deficiency) Muscle atrophy (chronic excess) Skin Atrophy and thinning (chronic excess) Hematopeoietic system Decrease in peripheral lymphocytes, monocytes, eosinophils, clotting time Increase in peripheral neutrophils, platelets, RBCs Decreased phagocyte competence CVS Increased blood pressure (increased blood volume) Kidneys Increased reabsorption of water, sodium, chloride Increased excretion of potassium, calcium Bone Inhibition of collagen synthesis by fibroblasts Antagonism of Vitamin D Inflammatory and Immune response Decrease inflammatory response, decrease capillary permeability, decrease immune response, decrease antibodies, anti-allergic actions
  • 46. Created by Amanda McBride
  • 47.
  • 48. Uses
    • Adrenocortical insufficiency
    • Allergic reactions
    • Cancer
    • Lupus
    • Ulcerative colitis
    • Dermatologic conditions
    • Rheumatic disorders
    • Shock
    • Asthma
    • COPD
    • Spinal cord injury
    • Organ transplantation
  • 49. Adverse Reactions
    • S&S Cushings syndrome
    Created by Amanda McBride
  • 50.
    • immunosuppression
    • hyperglycemia due to increased gluconeogenesis , insulin resistance and impaired glucose tolerance (" steroid diabetes "); caution in those with diabetes mellitus
    • increased skin fragility, easy bruising
    • reduced bone density ( osteoporosis , higher fracture risk, slower fracture repair)
    • weight gain due to increased visceral and truncal fat deposition ( central obesity ) and appetite stimulation
    • adrenal insufficiency (if used for long time and stopped suddenly without a taper)
    • muscle breakdown (proteolysis), weakness; reduced muscle mass and repair
    • expansion of malar fat pads and dilation of small blood vessels in skin
    • anovulation , irregularity of menstrual periods
    • growth failure, pubertal delay
    • increased plasma amino acids , increased urea formation; negative nitrogen balance
    • excitatory effect on central nervous system
    Created by Amanda McBride
  • 51. Cushingoid Created by Amanda McBride
  • 52. Contraindications, Precautions, Interactions
    • Containdicated with serious infections
    • Renal hepatic impairment
    • Hypothyroidism
    • Ulcerative colitis
    • Peptic ulcer disease
    • HTN
    • Convulsive disorders
    • Diabetes
    • Multiple drug-drug interactions
    Created by Amanda McBride
  • 53. Mineralocorticoids-Aldosterone
  • 54. Aldosterone Created by Amanda McBride
  • 55. Action and Use
    • Conserves salt and water
    • Replacement for Addison’s disease
    Created by Amanda McBride
  • 56. Adverse Reactions
    • If dosage to high of withdrawal too rapid
    • Edema, HTN, CHF, enlargement of the heart
    • Increased sweating, allergic skin reaction
    • Hypokalemia, muscle weakness, headache
    Created by Amanda McBride
  • 57. Contraindications, Precautions, Interactions
    • Fungal infection
    • Use cautiously with Addison’s
    • Infection
    • Decreased effects of hydantoins, rifampin, barbs, salicylates
    Created by Amanda McBride
  • 58. Thyroid Drugs Created by Amanda McBride
  • 59. System Effects of thyroid hormone Metabolism Lipid metabolism : Increased thyroid hormone levels stimulate fat mobilization, leading to increased concentrations of fatty acids in plasma. They also enhance oxidation of fatty acids in many tissues. Finally, plasma concentrations of cholesterol and triglycerides are inversely correlated with thyroid hormone levels - one diagnostic indiction of hypothyroidism is increased blood cholesterol concentration. Carbohydrate metabolism : Thyroid hormones stimulate almost all aspects of carbohydrate metabolism, including enhancement of insulin-dependent entry of glucose into cells and increased gluconeogenesis and glycogenolysis to generate free glucose. Growth Growth hormones CVS Increases heart rate, cardiac contractility and cardiac output. They also promote vasodilation, which leads to enhanced blood flow to many organs. CNS Both decreased and increased concentrations of thyroid hormones lead to alterations in mental state. Too little thyroid hormone, and the individual tends to feel mentally sluggish, while too much induces anxiety and nervousness
  • 60. Created by Amanda McBride
  • 61. Thyroid Drugs
    • Synthetic replacement with exogenous source of thyroid hormone.
    Created by Amanda McBride
  • 62. Anti-thyroid Drugs
    • Act by decreasing production or release of thyroid hormones.
    Created by Amanda McBride
  • 63. Nursing Process
    • Assessment
      • Weight
      • I/O
      • Baseline v/s
      • Head to toe assessment
      • Blood levels of thyroid hormones
      • Sign and symptoms
      • Adverse effects especially with glucocorticoids
    • Implementation
      • Administered IM, SC, IV, PO, topically, Inhalant
    Created by Amanda McBride
  • 64. Special Considerations
    • Diabetics
      • May require frequent adjustments of Insulin
      • More frequent monitoring
      • May precipitate latent diabetes
    Created by Amanda McBride
  • 65.
    • Adrenal insufficiency
      • Use of glucocorticoids can cause shutting off of the pituitary release of ACTH
      • Situations producing stress may precipitate the need for an increase in dosage, until the crisis is over.
    Created by Amanda McBride
  • 66. Created by Amanda McBride
  • 67.
    • Risk of infection
      • Report any signs of infection, sore throat, fever
      • Protect pt against isolation
    Created by Amanda McBride
  • 68.
    • Risk for injury
      • Signs of compression fractures, pathological fractures
      • Skin injuries
    Created by Amanda McBride
  • 69.
    • Acute pain
      • Coffee grounds emesis, tarry stools, epigastric pain
    Created by Amanda McBride
  • 70.
    • Excess fluid volume
      • Check for edema
      • I/O
      • Daily weight
      • Restrict sodium intake
      • Electrolyte Imbalance
    Created by Amanda McBride
  • 71. Education
    • GI upset, take with food
    • Do not stop abruptly
    • Follow taper instructions
    • Weight weekly
    • Excessive glucocorticoid levels resulting from administration as a drug or hyperadrenocorticism have effects on many systems. Some examples include inhibition of bone formation, suppression of calcium absorption (both of which can lead to osteoporosis), delayed wound healing, muscle weakness and increased risk of infection.
    Created by Amanda McBride