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Medications That Affect The Endocrine System


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Medications That Affect The Endocrine System

  1. 1. Medications that Affect the Endocrine System Thyroid and Adrenocortical drugs Anti-diabetic drugs Created by Amanda McBride
  2. 2. Diabetes Created by Amanda McBride
  3. 3. 2 Types of Diabetes CONFIDENTIAL
  4. 4. Created by Amanda McBride
  6. 6. Created by Amanda McBride
  7. 7. Anti-diabetic <ul><li>Insulin </li></ul><ul><li>Oral Anti-diabetic drugs </li></ul>Created by Amanda McBride
  8. 8. Insulin <ul><li>Hormone manufactured by the beta cells of the pancreas </li></ul><ul><li>Beta cells are located in the pancreas in clusters known as the islets of Langerhans. </li></ul><ul><li>Insulin is a small protein </li></ul><ul><li>Required for the proper use of carbohydrates </li></ul><ul><li>Controls the storage and utilization of amino acids and fatty acids. </li></ul><ul><li>Lowers blood glucose levels by inhibiting glucose production by the liver </li></ul>Created by Amanda McBride
  9. 9. Action of Insulin <ul><li>Insulin molecules circulate throughout the blood stream until they bind to their associated (insulin) receptors. </li></ul><ul><li>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). </li></ul><ul><li>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 . </li></ul><ul><li>By the facilitative transport of glucose into the cells, the glucose transporters effectively remove glucose from the blood stream. </li></ul><ul><li>These changes can last from minutes to hours. </li></ul>Created by Amanda McBride
  10. 10. Human Insulin <ul><li>Less allergic reactions than animal insulin </li></ul><ul><li>Structurally similar to human insulin </li></ul>Created by Amanda McBride
  11. 11. Action <ul><li>Activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue </li></ul><ul><li>Stimulates the synthesis of glycogen by the liver. </li></ul><ul><li>Promotes protein synthesis and helps the body store fat by preventing its breakdown for energy. </li></ul>Created by Amanda McBride
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  13. 13. Onset, Peak, Duration <ul><li>Onset </li></ul><ul><ul><li>When insulin first begins to act in the body </li></ul></ul><ul><li>Peak </li></ul><ul><ul><li>When the insulin is exerting max action </li></ul></ul><ul><li>Duration </li></ul><ul><ul><li>The length of time the insulin remains in effect </li></ul></ul>Created by Amanda McBride
  14. 14. Created by Amanda McBride
  15. 15. Uses <ul><li>Diabetes type 1 </li></ul><ul><li>Diabetes type 2 when uncontrolled by diet, exercise or weight reduction </li></ul><ul><li>Treat severe DKA or diabetic coma </li></ul><ul><li>Treat hypokalemia in combination with glucose </li></ul>Created by Amanda McBride
  16. 16. Adverse Reactions <ul><li>Hypoglycemia </li></ul><ul><ul><li>Too little food </li></ul></ul><ul><ul><li>Too much Insulin </li></ul></ul><ul><ul><li>Increased demand </li></ul></ul><ul><li>Hyperglycemia </li></ul><ul><ul><li>Too much food </li></ul></ul><ul><ul><li>Too little Insulin </li></ul></ul><ul><ul><li>Emotional stress, infection, surgery, pregnancy or acute illness </li></ul></ul><ul><li>Increased Insulin resistance </li></ul><ul><ul><li>Antibodies develop against Insulin </li></ul></ul>Created by Amanda McBride
  17. 17. Created by Amanda McBride
  18. 18. Precautions <ul><li>Hepatic impairment </li></ul><ul><li>Renal impairment </li></ul><ul><li>Pregnancy </li></ul><ul><li>Lactation </li></ul>Created by Amanda McBride
  19. 19. Interactions <ul><li>Drug that affect effectiveness </li></ul>Created by Amanda McBride
  20. 20. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Skin </li></ul></ul><ul><ul><li>v/s </li></ul></ul><ul><ul><li>Diet </li></ul></ul><ul><ul><li>Type and duration of symptoms </li></ul></ul><ul><ul><li>Blood work </li></ul></ul><ul><ul><li>S&S hypo/hyper glycemia </li></ul></ul>Created by Amanda McBride
  21. 21. Implementation <ul><li>Doses highly individualized </li></ul><ul><li>Daily dose </li></ul><ul><li>Sliding scale based on glucometer reading </li></ul><ul><li>Mixing Insulins </li></ul><ul><ul><li>Mix in the same syringe </li></ul></ul><ul><ul><li>Clear to cloudy </li></ul></ul><ul><li>Insulin syringe </li></ul><ul><li>Check date opened </li></ul><ul><li>Second checker/co-signer </li></ul><ul><li>Rotate suspension to mix insulin </li></ul><ul><li>Rotate sites to prevent lipodystrophy </li></ul><ul><li>Hypoglycemic reaction </li></ul><ul><ul><li>Orange juice </li></ul></ul><ul><ul><li>Honey hard candy </li></ul></ul><ul><ul><li>Commercial gluoose products </li></ul></ul><ul><ul><li>Glucagon </li></ul></ul><ul><ul><li>Glucose IV </li></ul></ul>Created by Amanda McBride
  22. 22. Evalution <ul><li>Coping </li></ul><ul><li>Education </li></ul><ul><li>Effectiveness </li></ul>Created by Amanda McBride
  23. 23. Diabetic Ketoacidosis Created by Amanda McBride
  24. 24. Oral Anti-diabetic drugs Sulfonylureas Biguanides Alpha inhibitors Meglitinides Thiazolidinediones Created by Amanda McBride
  25. 25. Created by Amanda McBride
  26. 26. Use <ul><li>Only in the treatment of type 2 diabetes </li></ul><ul><li>May be used with Insulin </li></ul><ul><li>Some can be used together when one antidiabetic drug and diet do not control blood glucose </li></ul>Created by Amanda McBride
  27. 27. Actions, Adverse reaction, Contraindications, Precautions and Interactions Created by Amanda McBride
  28. 28. Sulfonylureas <ul><li>Action </li></ul><ul><ul><li>Stimulate beta cells </li></ul></ul><ul><ul><li>Not effective unless beta cells work </li></ul></ul><ul><ul><li>DiaBeta/ glyburide </li></ul></ul><ul><li>Side effects </li></ul><ul><ul><li>Hypoglcemia, anorexia, nausea, vomiting, wt gain, weakness numbness </li></ul></ul><ul><li>Contraindicated </li></ul><ul><ul><li>CAD, liver renal dysfunction </li></ul></ul><ul><ul><li>Sulpha drug allergy </li></ul></ul><ul><ul><li>Drug- drug interactions </li></ul></ul>Created by Amanda McBride
  29. 29. Biguanides <ul><li>Action </li></ul><ul><ul><li>Decreasing hepatic glucose production </li></ul></ul><ul><ul><li>Increasing insulin sensitivity in muscle and fat cells </li></ul></ul><ul><ul><li>Sensitizes the liver to circulating Insulin levels </li></ul></ul><ul><ul><li>Glucophage / metformin </li></ul></ul><ul><li>Side effects </li></ul><ul><ul><li>GI upset, lactic acidosis </li></ul></ul><ul><ul><li>weight loss </li></ul></ul><ul><li>Contraindicated </li></ul><ul><ul><li>Heart failure, renal disease, metabolic acidosis, pregnancy </li></ul></ul>Created by Amanda McBride
  30. 30. a-Glucosidase Inhibitors <ul><li>Action </li></ul><ul><ul><li>Delay the digestion and absorption of carbs </li></ul></ul><ul><ul><li>Prandase </li></ul></ul><ul><li>Side effects </li></ul><ul><ul><li>GI disturbances </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Type 1 diabetes </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Renal impairment </li></ul></ul><ul><ul><li>Preexisting GI problems </li></ul></ul>Created by Amanda McBride
  31. 31. Meglitinides <ul><li>Action </li></ul><ul><ul><li>Stimulate the release of Insulin from pancreas </li></ul></ul><ul><ul><li>More rapid acting, shorter duration </li></ul></ul><ul><ul><li>Prandin </li></ul></ul><ul><li>Side effects </li></ul><ul><ul><li>Hypoglycemia, URI, headache, bronchitis, back pain </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Type 1 diabetes </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Renal hepatic impairment </li></ul></ul><ul><ul><li>Drug- drug interactions </li></ul></ul>Created by Amanda McBride
  32. 32. Thiazolidinediones <ul><li>Action </li></ul><ul><ul><li>Decrease Insulin resistance </li></ul></ul><ul><ul><li>Increase Insulin sensitivity </li></ul></ul><ul><ul><li>Avandia </li></ul></ul><ul><li>Side effects </li></ul><ul><ul><li>Aggravated diabetes </li></ul></ul><ul><ul><li>URI </li></ul></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Severe heart failure </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>CV disease </li></ul></ul><ul><ul><li>Liver kidney disease </li></ul></ul><ul><ul><li>Decrease the effect of oral contraceptives </li></ul></ul>Created by Amanda McBride
  33. 33. <ul><li>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 </li></ul>Created by Amanda McBride
  34. 34. Nursing Process <ul><li>Baseline assessment including wt </li></ul><ul><li>Integumentary </li></ul><ul><li>Blood work </li></ul><ul><ul><li>Glycosylated hemoglobin </li></ul></ul><ul><li>Monitor initially for hypoglycemia </li></ul>Created by Amanda McBride
  35. 35. Education <ul><li>Take as prescribed </li></ul><ul><li>Avoid alcohol </li></ul><ul><li>Avoid strenuous exercise </li></ul><ul><li>Maintain good foot care </li></ul><ul><li>Medic alert </li></ul><ul><li>Know the symptoms of hypo/hyper </li></ul>Created by Amanda McBride
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  37. 37. Posterior and Anterior Pituitary Hormones <ul><li>Posterior Hormones </li></ul><ul><ul><li>Vasopressin </li></ul></ul><ul><ul><li>Oxytocin </li></ul></ul><ul><li>Anterior Hormones </li></ul><ul><ul><li>Prolactin </li></ul></ul><ul><ul><li>LH </li></ul></ul><ul><ul><li>FSH </li></ul></ul><ul><ul><li>TSH </li></ul></ul><ul><ul><li>ACTH </li></ul></ul><ul><ul><li>GH </li></ul></ul>Created by Amanda McBride
  38. 38. Vasopressin <ul><li>Used in the treatment of diabetes insipidus </li></ul><ul><ul><li>Diabetes Insipidus results from a decreased production of  antidiuretic hormone ( vasopressin) , the hormone that normally prevents the kidney from producing too much urine. </li></ul></ul><ul><li>Helps the body to conserve water when dehydrated. </li></ul>Created by Amanda McBride
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  42. 42. Adrenocorticol Hormones Created by Amanda McBride
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  44. 44. y Created by Amanda McBride
  45. 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. 46. Created by Amanda McBride
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  48. 48. Uses <ul><li>Adrenocortical insufficiency </li></ul><ul><li>Allergic reactions </li></ul><ul><li>Cancer </li></ul><ul><li>Lupus </li></ul><ul><li>Ulcerative colitis </li></ul><ul><li>Dermatologic conditions </li></ul><ul><li>Rheumatic disorders </li></ul><ul><li>Shock </li></ul><ul><li>Asthma </li></ul><ul><li>COPD </li></ul><ul><li>Spinal cord injury </li></ul><ul><li>Organ transplantation </li></ul>
  49. 49. Adverse Reactions <ul><li>S&S Cushings syndrome </li></ul>Created by Amanda McBride
  50. 50. <ul><li>immunosuppression </li></ul><ul><li>hyperglycemia due to increased gluconeogenesis , insulin resistance and impaired glucose tolerance (&quot; steroid diabetes &quot;); caution in those with diabetes mellitus </li></ul><ul><li>increased skin fragility, easy bruising </li></ul><ul><li>reduced bone density ( osteoporosis , higher fracture risk, slower fracture repair) </li></ul><ul><li>weight gain due to increased visceral and truncal fat deposition ( central obesity ) and appetite stimulation </li></ul><ul><li>adrenal insufficiency (if used for long time and stopped suddenly without a taper) </li></ul><ul><li>muscle breakdown (proteolysis), weakness; reduced muscle mass and repair </li></ul><ul><li>expansion of malar fat pads and dilation of small blood vessels in skin </li></ul><ul><li>anovulation , irregularity of menstrual periods </li></ul><ul><li>growth failure, pubertal delay </li></ul><ul><li>increased plasma amino acids , increased urea formation; negative nitrogen balance </li></ul><ul><li>excitatory effect on central nervous system </li></ul>Created by Amanda McBride
  51. 51. Cushingoid Created by Amanda McBride
  52. 52. Contraindications, Precautions, Interactions <ul><li>Containdicated with serious infections </li></ul><ul><li>Renal hepatic impairment </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Ulcerative colitis </li></ul><ul><li>Peptic ulcer disease </li></ul><ul><li>HTN </li></ul><ul><li>Convulsive disorders </li></ul><ul><li>Diabetes </li></ul><ul><li>Multiple drug-drug interactions </li></ul>Created by Amanda McBride
  53. 53. Mineralocorticoids-Aldosterone
  54. 54. Aldosterone Created by Amanda McBride
  55. 55. Action and Use <ul><li>Conserves salt and water </li></ul><ul><li>Replacement for Addison’s disease </li></ul>Created by Amanda McBride
  56. 56. Adverse Reactions <ul><li>If dosage to high of withdrawal too rapid </li></ul><ul><li>Edema, HTN, CHF, enlargement of the heart </li></ul><ul><li>Increased sweating, allergic skin reaction </li></ul><ul><li>Hypokalemia, muscle weakness, headache </li></ul>Created by Amanda McBride
  57. 57. Contraindications, Precautions, Interactions <ul><li>Fungal infection </li></ul><ul><li>Use cautiously with Addison’s </li></ul><ul><li>Infection </li></ul><ul><li>Decreased effects of hydantoins, rifampin, barbs, salicylates </li></ul>Created by Amanda McBride
  58. 58. Thyroid Drugs Created by Amanda McBride
  59. 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. 60. Created by Amanda McBride
  61. 61. Thyroid Drugs <ul><li>Synthetic replacement with exogenous source of thyroid hormone. </li></ul>Created by Amanda McBride
  62. 62. Anti-thyroid Drugs <ul><li>Act by decreasing production or release of thyroid hormones. </li></ul>Created by Amanda McBride
  63. 63. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><li>I/O </li></ul></ul><ul><ul><li>Baseline v/s </li></ul></ul><ul><ul><li>Head to toe assessment </li></ul></ul><ul><ul><li>Blood levels of thyroid hormones </li></ul></ul><ul><ul><li>Sign and symptoms </li></ul></ul><ul><ul><li>Adverse effects especially with glucocorticoids </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Administered IM, SC, IV, PO, topically, Inhalant </li></ul></ul>Created by Amanda McBride
  64. 64. Special Considerations <ul><li>Diabetics </li></ul><ul><ul><li>May require frequent adjustments of Insulin </li></ul></ul><ul><ul><li>More frequent monitoring </li></ul></ul><ul><ul><li>May precipitate latent diabetes </li></ul></ul>Created by Amanda McBride
  65. 65. <ul><li>Adrenal insufficiency </li></ul><ul><ul><li>Use of glucocorticoids can cause shutting off of the pituitary release of ACTH </li></ul></ul><ul><ul><li>Situations producing stress may precipitate the need for an increase in dosage, until the crisis is over. </li></ul></ul>Created by Amanda McBride
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  67. 67. <ul><li>Risk of infection </li></ul><ul><ul><li>Report any signs of infection, sore throat, fever </li></ul></ul><ul><ul><li>Protect pt against isolation </li></ul></ul>Created by Amanda McBride
  68. 68. <ul><li>Risk for injury </li></ul><ul><ul><li>Signs of compression fractures, pathological fractures </li></ul></ul><ul><ul><li>Skin injuries </li></ul></ul>Created by Amanda McBride
  69. 69. <ul><li>Acute pain </li></ul><ul><ul><li>Coffee grounds emesis, tarry stools, epigastric pain </li></ul></ul>Created by Amanda McBride
  70. 70. <ul><li>Excess fluid volume </li></ul><ul><ul><li>Check for edema </li></ul></ul><ul><ul><li>I/O </li></ul></ul><ul><ul><li>Daily weight </li></ul></ul><ul><ul><li>Restrict sodium intake </li></ul></ul><ul><ul><li>Electrolyte Imbalance </li></ul></ul>Created by Amanda McBride
  71. 71. Education <ul><li>GI upset, take with food </li></ul><ul><li>Do not stop abruptly </li></ul><ul><li>Follow taper instructions </li></ul><ul><li>Weight weekly </li></ul><ul><li>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. </li></ul>Created by Amanda McBride