DRUGS AFFECTING THE ENDOCRINE SYSTEM Charles Dominick C. Bustamante

ANTIDIURETIC HORMONE  Promotes antidiuretic effect and regulates fluid balance  Enhances reabsorption of water in the kidneys  Promotes smooth muscle contraction (vasocontriction)  Indication  Treatment of diabetes insipidus Desmopressin (DDAVP, Stimate)Vasopressin (Piressin)

Desmopressin  Greater antidiuretic response than vasopressin  Other Indications  to treat Nocturnal enuresis  to control bleeding Hemophilia A Mild to moderate von Willebrand disease (type1) with factor VIII greater than 5%  Contraindications and Precautions  Type IIB or pseudo von Willebrand’s disease

Desmopressin  Adverse Reactions  Water intoxication, hyponatremia, abdominal cramps, nausea, nasal congestion or changes (nasal admin), facial flushing, hypertension, chest pain, headache, epistaxis, sore throat, cough, and injection site redness or burning  Drug Interactions  Reduced effects: Alcohol, demeclocycline, epinephrine, heparin, and lithium  Increased effects: chlorpromazine, clofibrate, fludrocortisone, TCA’s, and urea

Desmopressin  Other Nursing Responsibilities  Teach Px to ingest only enough fluid to satisfy thirst To decrease risk for water intoxication and hyponatremia (drowsiness, listlessness, headache, coma and convulsion)

*Vasopressin  Other Indications  Prevention or treatment of postoperative abdominal distention  Dispel interfering gas shadows in abdominal roentgenography  Contraindications and Precautions  Hypersensitivity, chronic nephritis with N retention  Caution: epilepsy, migraines, asthma, heart failure, pregnancy, breastfeeding

Vasopressin  Adverse Reactions  Water intoxication, hyponatremia, abdominal cramps, nausea, nasal congestion or changes (nasal admin), facial flushing, hypertension, chest pain, headache, epistaxis, sore throat, cough, and injection site redness or burning  Drug Interactions  Reduced effects: Alcohol, demeclocycline, epinephrine, heparin, and lithium  Increased effects: chlorpromazine, clofibrate, fludrocortisone, TCA’s, and urea  Nursing responsibilities  Same as desmopressin

ANTITHYROIDS Iodide oxidation heps yeild thyroid hormones Large does of iodide can inhibit T 3 and T 4 synthesis Iodine Inhibit the synthesis of thyroid hormones Don’t activate existing T 4 or T 3, or interfere with exogenous thyroid hormones PTU particularly inhibits the conversion of T 4 to T 3 Propylthiouracil (PTU) and methimazole Limits thyroid hormone secretion by destroying thyroid tissues Sodium iodide I131

ANTITHYROIDS Iodine (Strong Iodine Solution, USP [Lugol’s Solution], thyroblock) Methimazole (Tapazole)PropylthriouracilSodium Iodide I131 (Iodope)

ANTITHYROIDS  Indications  Hyperthyroidism  Thyroid blocking  Thyroid carcinoma  Contraindications and Precautions  Pregnancy and breastfeeding  Hypersensitivity to iodides

ANTITHYROIDS Hypothyroidism, diarrhea, hypersensitivity, iodism (vomiting, abdominal pain, metallic taste, rash, and sore salivary glands Iodine Nausea, vomiting, agranulocytosis, and rash Propylthiouracil (PTU) and methimazole Bone marrow depression, acute leukemia, anemia, radiation sickness, chest pains, tachycardia, itching, neck tenderness/swelling, sore throat, cough, and temporary thinning of hair Sodium iodide I131

ANTITHYROIDS  Interactions  Iodine use with lithium may cause hypothyroidism  PTU and methimazole may enhance the effect of anticoagulants  Recent intake of stable forms of iodine, thyroid hormone, or antithyroid drug affecrs the uptake of sodium iodide I131

ANTITHYROIDS  Other Nursing Responsibilities  Administer drug at a consistent time of 1hr before or 2hrs after meals  Assess for S/Sx of overdose or underdose

THYROID HORMONES  Controls metabolic rate of tissues  Accelerate heat production and oxygen consumption  Synthetic TH: results in T 3 activity  Replacement of hormonal deficits or suppress excessive hormone production

THYROID HORMONES Levothyroxine sodium (T4 [Synthroid])Liothyronine sodium (T3 [Cytomel], Triostat)Liotrix (Thyrolar)Thyroid USP (desiccated [Armour Thyroid], S-P-T)

THYROID HORMONES  Contraindications and Precautions  Acute MI or Thyrotoxicosis  Caution in Px with heart diseases, hypertension, DM, DI, myxedema, or adrenal insufficiency  NOT as a weight loss program  Adverse Reaction  Hypertthyroidism, tachycardia, arrhythmias, palpitations, nervousness, sweating, heat intolerance, insomnia, weightloss, headache, decreased bone density, partial hair loss

THYROID HORMONES  Other Nursing Responsibilities  Administer thyroid hormones in morning to prevent insomnia  Take on empty stomach  Caution patients not to change medication brands  Notify physician if headache, nervousness, diarrhea, or other unusual events occur

ANTIDIABETICS Insulin Reduces serum glucose level by increasing glucose transport into cells and promoting glucose conversion to glycogen Oral Hypoglycemic Agents Stimulates pancreas to produce more insulin and increase the sensitivity of peripheral receptors to insulin Ultimately decreasing glucose serum level

Oral Hypoglycemic Agents

Insulin  Given parenteral  Destroyed in the GI tract  Indications  Type 1 DM  Type 2 DM that is unresponsive to dietary measures and oral hypoglycemics  Administered with glucose for Hyperkalemia  Contraindications and Precautions  Hypersensitivity  Adverse Reactions  Hypoglycemia, rebound hyperglycemia, lipodystrophy, lipoatrophy, skin reactions at injection site

Rapid Acting Insulins Generic Name Trade NameOnset (hrs) Peak (hrs)Duration (hrs) Insulin Injection (regular) Humulin R Novolin R Regular Iletin II Velosulin ½ to 1Unknown8 to 12 Lispro Insulin Solution Humalog¼½ to 1 ½6 to 8 Insulin Aspart Solution Novolog¼1 to 33 to 5

Intermediate Acting Insulins Generic Name Trade NameOnset (hrs) Peak (hrs)Duration (hrs) Isophane Insulin Suspension (NPH) Novolin N Humulin N NPH Iletin II 1 to 1 ½4 to 1224 Insulin Zinc Suspension (Lente) Humulin L Lente Iletin II 1 to 2 ½7 to 1524

Long Acting Insulins Generic Name Trade NameOnset (hrs) Peak (hrs)Duration (hrs) Insulin Glargine Solution Lantus Extended Insulin Zinc Suspension (Ultralente) Humulin U4 to 810 to 3036

Insulin  Other Nursing Responsibilities  Only regular insulin can be administered IV, if needed in an emergency  When administering mixed insulin, draw regular insulin into syringe first to avoid contaminating it with the longer acting insulin  Don’t shake insulin vial, roll between hands  Schedule snacks, to coincide with insulin’s peak action  Stress, fever, trauma, infection and surgery may increase insulin requirements  Rotate sites of injection

Oral Hypooglycemic Agents Acarbose (Precose) Miglitol (Glyset) Alpha-Glucoside Inhibitors Metformin hydrochloride (Glucophage) Biguanides Glyburide/Metformin (Glucovance) Rosiglitazone maleate/Metformin (Avandamet) Glipizide/Metformin (Metaglip) Combinations Repaglinide (Prandin) Nateglinide (Starlix) Meglitides

Oral Hypooglycemic Agents Acetohexamide (dymelor) Chlorpropamide (Diabinese) Glimepiride (Amaryl) Glipizide (Glucontrol) Glyburide (DiaBeta) Tolazamide (Tolinase) Tolbutamide (Orinase) Sulfonylureas Rosiglitazone maleate (Avandia) Pioglitazone hydrochloride (Actos) Thiazolidinediones

Contraindications and Precautions Cirrhosis Other conditions that may deteriorate because of increased intestinal gas formation Alpha- Glucoside Inhibitors Liver Cirrhosis Intestinal Diseases Caution in w/ Liver Impairment Meglitinides Renal insufficiency Hepatic insufficiency Alcoholism Biguanides (metformin)

Contraindications and Precautions Hypersensitivity to sulfa drugs Sulfonyureas Liver Cirrhosis Heart Failure Caution n Liver impairment, edema Thiazolidinediones Type 1 DM Caution in pregnant and breastfeeding women General Contraindications and Precautions

Adverse Reactions  Hypoglycemia, nausea, vomiting, heartburn, dizziness, drowsiness, headache  Edema, Heart Failure  Sulfonylureas  Photosensitivity Reactions  Metformin  Metabolic Acidosis  Alpha-Glucoside Inhibitors  Flatulence and diarrhea  Meglitinides  URTI

Other Nursing Responsibilities  Take alpha-glucoside inhibitors with the first bite of food and to take meglitinides within 30 mins of each meals  Sulfonyurea: Use sunscreen and protective clothing to prevent photosensitivity reactions  Stress, fever, trauma, infection, and surgery may increase insulin requirements or necessitate switching from an oral hypoglycemic agent to insulin  Inform client that OHA’s cannot cure DM

END Charles Dominick C. Bustamante