Pharmacology of the Selected Endocrine Drugs

Fig. 10.9

Fig. 10.10

Fig. 10.11a

Fig. 10.12a

Fig. 10.12b

Fig. 10.14

Fig. 10.17

Fig. 10.18

Fig. 10.19

Endocrine Medications Hormonal replacement

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

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

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

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

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 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 hormones

Levothyroxine (Synthroid)

Liothyroxine (Cytomel)

Thyroid dessicated

Liotrix (Thyrolar)

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

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 hormones: Actions

Increase the metabolic rate

Increase O2 consumption

Increase HR, RR, BP

Thyroid Medications Thyroid hormones: Indications Hypothyroidism Diagnostic suppression test

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 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 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

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

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

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

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: Indications

Grave’s dosease

Thyrotoxicosis

ANTI-Thyroid Medications ANTI-THYROID medications: Absorption is good orally

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

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

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

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 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

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

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

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

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

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

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

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

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

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

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.

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

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.

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.

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

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

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

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

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!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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.

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

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!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Estrogens

Conjugated estrogen

Estradiol

Ethinyl estradiol

Diethylstilbesterol (DES)

Clomiphene

Reproductive Hormones Progestins Medroxyprogesterone acetate (Provera) Megestrol Norethindrone Levonorgestrel (Norplant) Norgestrel Norethindrone acetate

Progestins

Medroxyprogesterone acetate (Provera)

Megestrol

Norethindrone

Levonorgestrel (Norplant)

Norgestrel

Norethindrone acetate

Reproductive Hormones Androgens Testosterone cypionate Methyltestosterone Fluoxymesterone Aqueous testosterone

Androgens

Testosterone cypionate

Methyltestosterone

Fluoxymesterone

Aqueous testosterone

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nursing consideration

Assess for risk factors

Instruct to take the drug ONE hour before sexual act

Drug is taken orally