1. Endocrine Pharmacology
Jennifer Kean MSN, RN, CCRN

2. Insulins Rapid-acting: Lispro insulin (Humalog)
ONSET: minutes
PEAK: hours
DURATION: 3-6 hours
Short-acting: Regular insulin
ONSET: hour
PEAK: 1-5 hours
DURATION: 6-10 hours

3. Insulins Intermediate-acting: NPH insulin
ONSET: 1-2 hours
PEAK: 6-14 hours
DURATION: hours
Long-acting: Insulin glargine (Lantus)
ONSET: 70 minutes
PEAK: none
DURATION: hours

4. Other insulins Rapid-acting: insulin aspart, insulin glulisine
Long-acting: insulin detemir (Levemir)
Premixed insulins:
70% NPH and 30% regular
50% NPH and 50% regular
75% insulin lispro protamine and 25% insulin lispro
50% insulin lispro protamine and 50% insulin lispro
Purpose of insulin: to promote cellular uptake of glucose, keeping blood glucose levels at a normal (70-110) level in diabetic patients

5. Complications Hypoglycemia (blood glucose < 70 mg/dL)
Lipohypertrophy: fibrosis of subcutaneous tissue that results from overuse of injection sites
Interactions: other antidiabetic meds, beta blockers and alcohol have additive hypoglycemic effects when used with insulin
Thiazide diuretics and glucocorticoids can raise blood glucose
Beta blockers can mask the S/S of hypoglycemia; use with caution

6. Nursing administration
Adjust insulin dose to meet patient’s needs
Ensure adequate glucose is available in case of hypoglycemia
Insulin glargine and detemir should not be mixed with any other types of insulins in a syringe
When mixing insulins in a syringe, draw the short-acting insulin up first, i.e. when mixing regular and NPH, remember “RN”- the regular goes in the syringe first
Store unopened vials in a refrigerator until their expiration date

7. Oral antidiabetics Sulfonylureas: glipizide, glyburide, glimepiride
Meglitinides: repaglinide
Biguanides: metformin
TZDs: pioglitazone
Others: acarbose, sitagliptin, canagliflozin
Purpose: to release insulin from the pancreas
Used to control blood glucose in type 2 diabetes along with diet and exercise

8. Complications Hypoglycemia Weight gain GI effects: N/V, flatulence
Vitamin B12 and folic acid deficiency
Lactic acidodid
Fluid retention
Hepatotoxicity
Pancreatitis

9. Interactions
Alcohol: can result in Antabuse-like reaction (disulfuram), or lactic acidosis
Beta blockers: can mask the s/s of hypoglycemia and decrease effectiveness by inhibiting insulin release
Metformin: concurrent use with iodine-containing contrast medium can result in acute kidney failure
Patient education:
Pt. must make lifestyle changes
Maintain a log of glucose levels
Consider working with a dietician

10. Incretin mimetics Exenatide Liraglutide Albiglutide
Actions: promotes release of insulin and slows gastric emptying
Used as a supplemental med for glucose control in type 2 diabetes

11. Complications GI discomfort Pancreatitis (severe reaction)
Contraindications: severe renal or liver disease, pregnancy, older adults
Caution when using oral antidiabetics as glucose will usually drop drastically
Administered via prefilled injector pen

12. Glucagon
Action: increases blood glucose levels in cases of hypoglycemia
Used in emergency management of hypoglycemia (when pt. is unresponsive or unconscious)
Causes nausea and vomiting
Use with caution in cardiovascular disease
Administer sub-q or IM
Provide food as soon as the patient is able to swallow

13. Thyroid hormone-levothyroxine (Synthroid)
A synthetic blend of T3 and T4
A replacement, used for hypothyroidism
Given PO; can be given IV to treat myxedema coma
Overmedication can mimic hyperthyroidism; chronic overtreatment can cause dysrhythmias
Contraindicated following an MI
Use cautiously in pts. with CV problems, older adults, and diabetics
NOT for treatment of obesity!!!

14. Levothyroxine
Interacts with antiseizure and antidepressant meds- can increase levothyroxine’s metabolism
Also can increase the effects of anticoagulants
Nursing implications:
Obtain baseline weight and vital signs
Monitor for and report any cardiac effects such as tachycardia and palpitations
Instruct pt. to take on an empty stomach
Also inform pt. that this will be lifelong therapy

15. Methimazole and propylthiouracil (Tapazole and PTU)
Used in hyperthyroidism to block production of thyroid hormones
Produces a euthyroid state prior to thyroid surgery
Also used in the emergency treatment of thyrotoxicosis
Complications:
Hypothyroidism (with overdose)
Agranulocytosis
Contraindicated in pregnancy
Use cautiously in bone marrow depression

16. Interactions
Concurrent use with anticoagulants can increase their effects
Concurrent use of digoxin can increase its levels
Nursing implications:
Therapeutic effects can take y up to 2 weeks
Monitor thyroid function
Do not discontinue med suddenly
Monitor for hypothyroidism
Avoid consumption of seafood ( the iodine)

17. Radioactive iodine
Used in hyperthyroidism to destroy part or all of the overactive thyroid; given orally
Just remember about the radiation- can cause radiation sickness, and that the stool and urine of the pt. will have to have to be disposed of per facility protocol
Instruct the pt. to increase their fluid intake and that the therapeutic effect can take up to 3 months

18. Somatropin- growth hormone
Used in deficiencies to promote overall growth and the production of protein
Given sub-q or IM
Can cause hyperglycemia, hypercalcuria and renal calculi
Contraindicated in pregnancy
Use cautiously in diabetes (hyperglycemia) and hypothyroidism
Should be given after epiphyseal closure and growth has stopped

19. Antidiuretic hormone (vasopressin, desmopressin)
Used in cases of diabetes insipidus
Can be given orally, intranasal, sub-q, IM, IV
Complication: retention of too much water in the body
Contraindicated in CAD (risk for angina and MI) and pregnancy
Use with caution in renal impairment
Antiseizure meds and antidepressants can increase diuresis
Alcohol and phenytoin can decrease diuresis
Monitor vital signs, I&O, and EKG

20. Adrenal hormone replacement
Hydrocortisone
Glucocorticoids:
Prednisone
Dexamethasone
Given to mimic the effects of natural hormones
Can cause the same side effects as chronic steroid therapy: bone demineralization, hyperglycemia, GI discomfort, infection, Cushing’s syndrome, retention of sodium mand water

21. Contraindications/precautions
Pregnancy
Any active infection
Use with caution in recent MI, gastric ulcer, renal disorder, osteoporosis, diabetes, hypothyroidism, glaucoma, or seizure disorder
Interactions:
NSAIDS: can increase gastric irritation
Anticoagulants: can increase effect
Antiseizure meds can decrease effectiveness
Effectiveness of antidiabetics is decreased with use

22. Nursing administration
Monitor weight and BP
Give with food to decrease GI effects
Do not stop suddenly
Dosages need to be increased in times of stress
Therapy continues for life