Endocrine Agents

Drugs Acting on Endocrine a.?

System • APG • PPG
- TSH - ADH (Vnsoprcsin)
- ACTH
- FSH
- LH
- GH
- PL
- MSL

Endocrine Drugs Endocrine Agents

_.. . ,
:s. .
• Hypothalamic and Pituitary Agents • Thyroid Gland • Parathyroid Glands -'
• Adrenocortical Agents - Posterior to the - Dorsal surface of
trachea the thyroid gland
• Thyroid and Parathyroid Drugs
- Thyroxine (Tl ) - Parathyroid
• Antidiabetic Agents - Triiodothyronine Hormones
(T2)

Endocrine Agents Endocrine Agents

- Hormones • Pituitary Gland
'" ~
• Adrenal Glands • Pancreas
:tr..
• Substances (Hypophosis) - Top of each kidney - Left and behind the
synthesized by - Base of the brain - Adrenal Medulla stomach
amino acids and - Two lobes - Adrenal Cortex - Exocrine
cholesterol that • Anterior PG • Digestive
• Corticosteroids
act on the body enzymes
• Posterior PG (Glucocorticoids
tissues and
) - Endocrine
organs and affect
the cellular • Minernlocorticoi • Alpha cells
activity, ds • Beata cells

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/

• Hormones regulates
OH
- Growth Hormone
Releasing Hormone
• DRUG
GROWTH
HORMONE
~~'y·
Growth Hormgne

DEFlCIENCY
- Growtli Hormone (PWARFISM)
Inhibiting Honnone -Somatrcm
(Somatotastin) (Protropin)
- Somatropin
(Humatrope)

Thyroid Stimulating Hormone

• Excess TSH • Hypothyroimsm'~
- Hyperthyroidism • Primary
• Deficit TSH - Thyroid Gland
- Hypothyroidism Disorder
• Secondary
- DcctUSC: TSH

ffJrB§ Growth Honnones

TSH
• DRUGTHERAPY:m ~
GROWfH HORMONE
~tBt iii
~
I
"
-, ::::i:AAt
~ i
• Thytotropin
EXESS - Various laboratory (Thyropor)
(GIGANTISM/ACROMEGA exams before • Purified e:-.1ract
LY) initiation of therapy.
ofTSH
• Octreotide - Cannot be given • Diagnostic agent
(Sandostatin) orally (SubQ/IM) to determine
• Bromocriptine mesylate - Administer before (Primary or
(Parlodel) epiphyscs has fused Secondary
• Lameotide acetate - Moy cause OM Hypothyroidism)
(Somatulinc Depot)

2
AdrenocorticotropicHormone
(ACTH) DIABETES INSIPIDUS
• ACTH • CORTICOTROPIN
- Glucocorticoids (Acthar)
(Cortisol) - Used to diagnose
- Mineralocorticoids adrenal gland
(Aldosterone) disorder.
- Anti inflammatory
drug (Allergic
reaction)

CORTICOTROPIN NURSING CONSIDERATION

• Action:
- Stimulate the adrenal • Drug Interaction • ADH • GH
~
gland to sccn:teo
- Diuretics - Monitor VIS - Monitor blood sugar
corticosteroids.
- Pseudomonas - Monitor Urine output
- Suppresses the
Penicillins • ACTH
inflammatory and
immune =i,ooscs - Phenytoin
- Monitor GD
- Trat adrenal - Rifampicio - Observe client' s
insufficiently - Barbituateo weight
sccoodary lo - Check Lab finding
inadequate - WOF adverse reaction
oorticotropin 9CCrctioo
- Decrease salt intake

Posterior Pituitary Gland

I . ' ,-
• Anti Diuretic • ADHDrugs • Thyriod Honnone
Honnone (ADH) - Dcsmoprcssin acetate deficiency
- Water ,absorption (DDAVT) - HYPOTHYROIDISM
from the renal rubules. - Dcsmopressin • Excess Thyroid
• ADH Deficiency (Stimate) Hormone
- Diabetes losipidus
- Lypressin (Diapid) - HYPERTHYROIDIS
- Vasopressin (Pitressin) M
• lntranasal/SubQnM

I ~ 'I
Hypothyroidism
Cold intolerance - Fecal impaction _ __- •. .,,...,
DRUGS/or HYPOTHYROIDISM
111
- Lethargy -SlowHR _ ., y
• Liotrix (Eulhroid, • Drug interaction
- Dry sk-m / hair - Slightly elevated BP Thyrolan) - Disitalis
- Forgetfulness - Enlarged tongue - Cmbinatioo of - Estrogen
- Depression - Drooling Lcvothyroxine and - Insulin and OHD
liothyroninc
- Weight gain - increased BMR
- Obesity
- Diminished ability to sweat
- Constipation

Hyperthyroidis_'!L
BMR
appetite
~ ...
temp, RR, PR, BM
Sweating/ profuse

D I
diaphoresis
Warm skin
Heat intolerance
Hair thin and soft
Hyperactivity
Weight loss, muscle
weakness, fatigue
Hand Tremors @rest

DRUGS for HYPOTHYROJDI~AJ DRUGS for HYPERTHYROIDISM

Lcvothyro_xioc 50dium
(Levothro1d, Symthro1d)
• Lcotbyronioc (C.)1ysl) '.it,
- Synthetic T3, short half~-"
• llUOREA
oERJVATIVEs •
iii.I!
sTR0No10Blb7P
- Iner-cases level of T3 and life and duration. - IX)C to decrease TH PREPARATlON
T4 - Not recommended as production
• Lugo\' s solution
- Cl maintcnanacc therapy - Blocks the thyroid - SUP!ftSI thyroid function
• Thyrotoxicosis bonnooe action
• MI
_ iodide lV
Propylthiorucil (PTU)
- Suw= the lh)'roid function
• CRF - inhibit periphCTIII
- S/E conversion of T4 to D
• NN, Diarrhea, cramps, • Methimazole (Topazole)
tremors, ner,ousness,
insomia, inrcasc - Docs not inhibit
Metabolic Rate, peripheral convenion of
Weight Loss T4 to T3
- Mon, potent than PTIJ

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Nursing Consideration NURSING CONSIDERATION

• HYPERTHYROIDISM
I. Take drugs "'ith meals
• HYPOTiiYROIDl"ij -
I. Monitor VS
--
2. Breastfeeding and 2. Monitor weight • Monitor scrum
·th 3. Instruct pl to take the calcium level
pregnancy c/1 WI medication at the same time
antithyroid drugs each day, preferably before • Report sign and SX of
3. Instruct the client to report breakfast Hyper/Hypop11rathyroi
side effects of 4. Advise client to repot s&.SlC of
hypethyroidism. dsm
hypothyroidism
5. Suggest client: medicAlert • Pregnancy status
card. tag, bracelet before initiation of
treatment

PARATHYROID GLAND Adrenal Glands

Qr
Parathyroid Honnone
(PTII) ~~ Adrenal Cort11
- Mlneralocortlcolds
- Regulates the calcium I.;.: ,,:._4 /_\ - Glucocortlcolds

~ ..~
in the blood,
. - Andro&ens

~~~1
Adrenl Medulla
- Epinephrine
- Noreplnephrlne

Drugs for ParathyroidDisorder ADDISON'S DISEASE

• Hypoparnthyoidism
I ,.11 A D DHiON''6 01S E"A 6 £

~
• Hyperparathyroidis - CALClFEDIOL (Caldero!)
- CALCITONIN - CALCITRIOL (Rocaltro)
l_o-U\H C.U IN
• Promotes renal - ERGOCIFEROL (Drisdor) D1:U"U KU • I O N
CM"' & .t t•Y 111\1 ...
excretion of
• Promotes calcium
calcium.
absorption from the GI ,.;1 l>1 ~ ru"! \\A"4C: .,_ ' , - J 4 . - -- ll
• PO/SQ tract and secretion of W .. A AN4:! C G - -

calcium from bone to the

blood stn:am

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SIE and AIR

♦ Increasedbid sugar ♦NA and Ht
♦ Abnormal fat deposits retention, HPN
in the face and trunk ♦Euphoria
(moon face and buffalo ♦ Thinned skin with
~ Thin Extremltl• hump) pwpura
~Decreased extremity ♦ Growth retardation
s12e
♦Muscle wasting
♦Edema

GLUCOCORTICOIDS Glucocorticoid Inhibitors

• Treat many diseases and health • KETOCONAZOLE

(NIZORAL)
~
problems: inflammatory (arthritis, • MITOTANE
glumerulonephritis, shock, cerebral (Lysodren)
edema), allergic (dennatitis, • AMINOGLUTETHIM
IDE(Cytadren)
asthma), and debilitating
conditions

•
Glucocorticoi<¥.._ MINERALOCORTICOIDS
. '"j i:
• DEXAMETHASONE PREDNISOLONE • Aldosterone
(DECADRON) (PREDNISONE)
- Sc\-ere inflammatory - Suppress an acute • Maintain fluid balance by promoting the
response resulting from inflammatory process reabsorption of sodium from renal tubules.
head trauma or allergic and for
rcoction. immunosupprcsin.
• Fludrocortisone (Florine()

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DIABETES MELLITUS INSULIN

• A chronic systemic disease characterized by • A hormone produced by the beta cells of a

either a deficiency of insulin or a decreased pancreatic islet (islet of Langerhans) that
ability of the body to use insulin decreases the blood glucose level
• 5 P' s: Polyuria, Polydipsia, • Promotes the transport of glucose into the
Polyphagia, Progressive weight loss, cells
Paresthesia • Inhibits the conversion of glycogen and
amino acids to glucose

TypesofDM Sources ofInsulin

• TYPE I DM / JUVENILE-ONSET • Beef insulin ~

DM/IDDM • Pork insulin
• TYPE II DM / ADULT-ONSET • Human insulin
DM/NIDDM
• SECONDARY DM
• GESTATIONAL DM

ANT/DIABETIC DRUGS Classification: INSULIN

, JI, ·-?~-'
• INSULIN • SHORT ACTING / RAPID ACTING

• ORAL HYPOGLYCEMIC ex: Humulin R

DRUGS
• Onset of action: 30-60 minutes
• Peak: 2-4 hours
• Duration: 6-8 hours

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Classification: INSULIN INSULIN STORAGE

• 2. INTERMEDIATE ACTING ~ • 1. Vials of insulin should be refrigerated.

ex: Humulin N
Lente (Insulin Zinc Suspension)
• NPH (Neutral Protamine Hagedorn) • 2. Avoid temperature extremes of <36F or
• Onset of action: 1-2 hours >86F.
• Peak: 6-12 hours / 8-12 hours
• Duration: 18-24 hours

INSULIN PREPARATION AND

Classification: INSULIN ADMINISTRAT{.O1
- .. _jjf;
• 3. LONG ACTING • Wash hands.
• ex: Protamine Zinc Insulin (PZI) • Roll insulin vial in palm ofhands to
• Extended Insulin Zinc Suspension resuspend the insulin.
• (Ultralente) • Inject amt of air that is equal to each dose
into the bottle.
• Onset of action: 4-8 hours
• Aspirate prescribed amt of short acting
• Peak: 14-20 hours
insulin into syringe first
• Duration: 24-36 hours

INSULIN PREPARATION AND

INSULIN SYRINGES ADMINISTRATION
• .25 ml insulin syringe • 5. Inspect syringe for air bubbles.
A'
• 6. Clean site with soap and water or 70%
• .30 ml insulin syringe isopropyl alcohol.
• 7. Pinch up and hold skinfold and inject at
• .50 ml insulin syringe 90degrees angle.
• 8. If you are thin or have loose skin, inject
insulin at 45 degrees to avoid IM injection,
• I ml insulin syringe w/c is absorbed faster.

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INSULIN PREPARATION AND
ADMJNISTRA TION Insulin 's Drug Interactions
• 9. Routine aspiration is not necessary. rP • Increase the bid sugar Decrease the bid
• l 0. Inject insulin. • Thiazide diuretics sugar
• l l. If injection is painful or serum oozes • Glucocorticoids • Antidepressant
from site, apply pressure for 5-10 seconds. • Epinephrine
• Aspirin
• Th}Toid agents
• Anticoagulants
• Estrogen

SITE SELECTION AND

ROTATI~ • HYPOGLYCEMIC ..d!J..Y!NfNreaction,_.. _,
• Insulin Shock ..
• Give insulin injection in one area, about al' • s/sx: nervousness
inch apart, until the whole area has been
trembling
used, before changing to another site.
uncoordinated
• ABDOMEN - fastest I rapid absorption
rate. tremors
confusions
• apprehension
cold clammy skin

• diaphoresis
DISPOSAL
·:::, • Headache
!i~ • Lightheadedness
• Needles and syringes be disposed of as n · • Slurred speech
single unit in a puncture resistant container. • Memory lapse
It is unsafe to recap, bend or break the • Seizures
needle. • Tachycardia
• Blood sugar <60mg/dl
• Tx: D50 50
Glucagon
Diazoxide

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ORAL HYPOGLYCEMIC DRUGS SIE AND ADVERSE REACTION
..:-3✓
A. SULFONYLUREAS • S/E: Hypoglycemia
- r/t sulfonamides • AIR: Hematologic disorders
- stimulate beta cells to secrete more aplastic anemia
insulin leukopenia
- increases the insulin cell receptors
thrombocytopenia
- 111 generation: short, intermediate, long acting
- 2nd generation • C/1: type I DM, pregnancy, breastfeeding,
stress, surgery or severe infection

First generatiop: b. NONSULFONYLUREAS

A Short-acting ·~ . "'¥
- Tolbutamide (Orinase) ·· i ~
I. Metfonnin (Glucophage)
- 4-7 hr / 6-12 hr duration of action
B. lntennediate-acting - decrease hepatic production of glucose
- Acetohexamide (Dymelor) from stored glycogen
-Tolazamide (Tolinase) 2. Acarbose (Precose)
- 10-20 hr/ 12-24 hr duration of action - inhibit the digestive enzyme in the
C. Long-acting small intestine responsible for the release
- 36 hr / up to 60 hr duration of action of glucose from CHO in the diet
- Chlorpropamide (Diabenese)

Second Generation HYPERGLYCEWC DRUGS

- Increase tissue response to insulin aru1_
decrease glucose production by th~ li'ver."' !JJ~
,....-,,
- Longer duration\fewer side effects A. Glucagon
- stimulates glycogenolysis in
Duration of Action: 10-24 hr
the liver
Examples: Glipizide (Glucotrol)
Glyburide (Diabeta) - protects the body cells, esp.
Glimepiride (Amaryl) brain and retina
-newest
- SC, IM, IV

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HYPERGLYCEMIC DRUGS
B. Diazoxide ~.;~J
- Diazoxide (Proglycem)
- inhibit insulin release and
stimulate release of epi from adrenal
medulla.
- used to treat chronic
hypoglycemia
SM,'05

.. end

..

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