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Endo Drug Study
Endo Drug Study
SYSTEM
LORREA ALEXANDRA S. CABUYA
BSN - 2B
ENDOCRINE MOA:
S Y S T E M
LOWER BLOOD GLUCOSE BY STIMULATING GLUCOSE
UPTAKE IN SKELETAL MUSCLE AND FAT, INHIBITING
DRUG CLASS: HEPATIC GLUCOSE PRODUCTION. OTHER ACTIONS
AR:
DERM: URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND
BRAND NAME/S: HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL:
LIPODYSTROPHY (LIPOATROPHY, LIPOHYPERTROPHY),
HUMALOG ITCHING, REDNESS, SWELLING. MISC: ALLERGIC REACTIONS,
INCLUDING ANAPHYLAXIS.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
ASSESS FOR HYPOGLYCEMIA FROM 1
TO 3 H AFTER INJECTION. ASSESS HIGHLY
INSULIN-DEPENDENT PATIENTS FOR
NEED FOR INCREASES IN
INTERMEDIATE/LONG-ACTING INSULINS.
AR:
DDERM: URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND
BRAND NAME/S: HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL: LIPODYSTROPHY
(LIPOATROPHY, LIPOHYPERTROPHY), ITCHING, REDNESS,
SWELLING. MISC: ALLERGIC REACTIONS, INCLUDING
APIDRA ANAPHYLAXIS. RENAL IMPAIRMENT, HEPATIC DYSFUNCTION;
LACTATION.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M MONITOR FOR S&S OF HYPOGLYCEMIA. INITIAL
HYPOGLYCEMIC RESPONSE BEGINS WITHIN 15 MIN AND
PEAKS, ON AVERAGE, 40–60 MIN AFTER INJECTION. DO NOT
INJECT INTO AREAS WITH REDNESS, SWELLING, ITCHING,
OR DIMPLING. IF MIXING WITH NPH HUMAN INSULIN,
DRAW UP INSULIN GLULISINE FIRST. INJECT IMMEDIATELY
AFTER MIXING. INGEST SOME FORM OF SUGAR (E.G.,
ORANGE JUICE, DISSOLVED TABLE SUGAR, HONEY) IF
SYMPTOMS OF HYPOGLYCEMIA DEVELOP, AND SEEK
MEDICAL ASSISTANCE. CHECK BLOOD SUGAR AS
PRESCRIBED, ESPECIALLY POSTPRANDIAL VALUES; NOTIFY
PHYSICIAN OF FASTING BLOOD GLUCOSE <80 AND >140
MG/DL. NOTIFY THE PHYSICIAN OF ANY OF THE
FOLLOWING: FEVER, INFECTION, TRAUMA, DIARRHEA,
NAUSEA, OR VOMITING. DOSAGE ADJUSTMENT MAY BE
NEEDED.
ENDOCRINE MOA:
S Y S T E M
LOWERS BLOOD GLUCOSE BY STIMULATING GLUCOSE
UPTAKE IN SKELETAL MUSCLE AND FAT, INHIBITING
DRUG CLASS: HEPATIC GLUCOSE PRODUCTION. ALSO INHIBITS LIPOLYSIS
AND PROTEOLYSIS, ENHANCING PROTEIN SYNTHESIS
ANTIDIABETIC AGENT
I:
GENERIC NAME: TREATMENT OF DIABETES MELLITUS;
CAN BE USED TO TREAT DIABETIC
INSULIN (REGULAR) KETOACIDOSIS (DKA).
AR:
DERM: URTICARIA. ENDO: HYPOGLYCEMIA,
BRAND NAME/S: REBOUND HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL:
LIPODYS-TROPHY (LIPATROPHY, LIPOHYPERTROPHY),
HUMULIN R ITCHING, REDNESS, SWELLING. MISC: ALLERGIC
REACTIONS, INCLUDING ANAPHYLAXIS.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
NOTE: FREQUENCY OF BLOOD GLUCOSE MONITORING IS
DETERMINED BY THE TYPE OF INSULIN REGIMEN AND HEALTH
STATUS OF THE PATIENT. NOTIFY PHYSICIAN PROMPTLY FOR
PRESENCE OF ACETONE WITH SUGAR IN THE URINE; MAY INDICATE
ONSET OF KETOACIDOSIS. ACETONE WITHOUT SUGAR IN THE URINE
USUALLY SIGNIFIES INSUFFICIENT CARBOHYDRATE INTAKE.
MONITOR FOR HYPOGLYCEMIA AT TIME OF PEAK ACTION OF
INSULIN. ONSET OF HYPOGLYCEMIA (BLOOD SUGAR: 50–40 MG/DL)
MAY BE RAPID AND SUDDEN. CHECK BP, I&O RATIO, AND BLOOD
GLUCOSE AND KETONES EVERY HOUR DURING TREATMENT FOR
KETOACIDOSIS WITH IV INSULIN. GIVE PATIENTS WITH SEVERE
HYPOGLYCEMIA GLUCAGON, EPINEPHRINE, OR IV GLUCOSE 10–50%.
AS SOON AS PATIENT IS FULLY CONSCIOUS, GIVE ORAL
CARBOHYDRATE (E.G., DILUTE CORN SYRUP OR ORANGE JUICE WITH
SUGAR, GATORADE, OR PEDIALYTE) TO PREVENT SECONDARY
HYPOGLYCEMIA.
ENDOCRINE MOA:
S Y S T E M INTERMEDIATE-ACTING, CLOUDY SUSPENSION OF ZINC INSULIN
CRYSTALS MODIFIED BY PROTAMINE IN A NEUTRAL BUFFER. NPH
ILETIN II (PORK), AND INSULATARD NPH ARE "PURIFIED" OR "SINGLE
DRUG CLASS: COMPONENT" INSULINS THAT HAVE BEEN PURIFIED AND ARE LESS
LIKELY TO CAUSE ALLERGIC REACTIONS THAN NON-PURIFIED
ANTIDIABETIC AGENT PREPARATIONS.
I: TREATMENT OF DIABETES MELLITUS. BECAUSE OF THE DELAYED
GENERIC NAME: AND PROLONGED DURATION, CANNOT BE USED IN THE ACUTE
TREATMENT OF DIABETIC KETOACIDOSIS. INTERMEDIATE
SUSPENSIONS HAVE ONSET OF 1–2 HR AND PEAK OF 4–12 HR. EXTENDED
INSULIN, SUSPENSIONS (ULTRA LENTE) HAVE ONSET OF 4–6 HR, WITH PEAK AT 18–
ISOPHANE (NPH) 24 HR.
AR:
DERM: URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND HYPERGLYCEMIA
BRAND NAME/S: (SOMOGYI EFFECT). LOCAL: LIPODYSTROPHY (LIPOATROPHY,
LIPOHYPERTROPHY), ITCHING, REDNESS, SWELLING. MISC: ALLERGIC
REACTIONS, INCLUDING ANAPHYLAXIS. DURING EPISODES OF
HUMULIN N HYPOGLYCEMIA OR IN PATIENTS SENSITIVE TO ANY INGREDIENT IN THE
FORMULATION.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M SUSPECT HYPOGLYCEMIA IF FATIGUE, WEAKNESS,
SWEATING, TREMOR, OR NERVOUSNESS OCCUR. IF
INSULIN WAS GIVEN BEFORE BREAKFAST, A
HYPOGLYCEMIC EPISODE IS MOST LIKELY TO OCCUR
BETWEEN MID-AFTERNOON AND DINNERTIME, WHEN
INSULIN EFFECT IS PEAKING. ADVISE TO EAT A SNACK IN
MID-AFTERNOON AND TO CARRY SUGAR OR CANDY TO
TREAT A REACTION. A SNACK AT BEDTIME WILL PREVENT
AR:
PRAMLINTIDE
CNS: ANXIETY, BLURRED VISION, SEIZURES, COMA, HEADACHE,
NIGHTMARES, DIZZINESS, DEPRESSION, CONFUSION. DERM: COOL, PALE
SKIN. RESP: COUGH, PHARYNGITIS, SHORTNESS OF BREATH, WHEEZING.
GI: DIFFICULTY SWALLOWING, VOMITING, WEIGHT LOSS, INCREASED
BRAND NAME/S:
HUNGER. MS: MUSCLE PAIN OR STIFFNESS, PAIN IN JOINTS. CV: FAST
HEARTBEAT, TIGHTNESS IN CHEST. MISC: HIVES; ITCHING; PUFFINESS OR
SYMLIN SWELLING OF THE EYELIDS OR AROUND THE EYES, FACE, LIPS, OR TONGUE;
SKIN RASH; AND OTHER ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
MONITOR FOR SEVERE HYPOGLYCEMIA, WHICH USUALLY
OCCURS WITHIN 3 H OF INJECTION. HYPOGLYCEMIA IS WORSE IN
TYPE 1 DIABETICS. MONITOR DIABETICS FOR LOSS OF GLYCEMIC
CONTROL. LAB TESTS: BASELINE AND PERIODIC HBA1C; FREQUENT
PRE/POST MEAL PLASMA GLUCOSE LEVELS. WITHHOLD DRUG AND
NOTIFY PHYSICIAN FOR CLINICALLY SIGNIFICANT NAUSEA OR
INCREASED FREQUENCY OR SEVERITY OF HYPOGLYCEMIA. NOTE:
PATIENTS SHOULD REDUCE A.C. RAPID-ACTING OR SHORT-ACTING
INSULIN DOSAGES BY 50% WHEN PRAMLINTIDE IS INITIATED.
CHECK WITH PHYSICIAN. DO NOT DRIVE OR ENGAGE IN
POTENTIALLY HAZARDOUS ACTIVITIES UNTIL RESPONSE TO DRUG
IS KNOWN. REPORT ANY OF THE FOLLOWING TO PHYSICIAN:
PERSISTENT, SIGNIFICANT NAUSEA; EPISODES OF HYPOGLYCEMIA
(E.G., HUNGER, HEADACHE, SWEATING, TREMOR, IRRITABILITY, OR
DIFFICULTY CONCENTRATING). DO NOT BREAST FEED WHILE
TAKING THIS DRUG WITHOUT CONSULTING PHYSICIAN.
ENDOCRINE MOA:
S Y S T E M MIMICS THE ACTION OF INCRETIN, WHICH PROMOTES INSULIN
SECRETION FROM PANCREAS, DECREASES ABSORPTION OF GLUCOSE FROM
THE GUT, DECREASES THE ACTION OF GLUCAGON, AND DECREASES
DRUG CLASS: APPETITE. IMPROVES GLYCEMIC CONTROL BY REDUCING FASTING AND
POSTPRANDIAL GLUCOSE CONCENTRATIONS IN PATIENTS WITH TYPE 2
DIABETES.
ANTIDIABETIC AGENT
I: TREATMENT OF TYPE 2 DIABETES UNCONTROLLED
GENERIC NAME: BY METFORMIN AND/OR A SULFONYLUREA. CONTROL
OF POST-PRANDIAL GLUCOSE LEVELS.
AR:
EXENATIDE
CV: DIZZINESS, HEADACHE, JITTERINESS, WEAKNESS. GI:
DIARRHEA, NAUSEA, VOMITING, DYSPEPSIA,
GASTROINTESTINAL REFLUX. DERM: HYPERHIDROSIS. METAB: ↓
BRAND NAME/S: APPETITE, WEIGHT LOSS. DUE TO ITS ABILITY TO SLOW GASTRIC
EMPTYING, EXENATIDE CAN DECREASE THE RATE AND/OR
BYETTA SERUM LEVELS OF ORAL MEDICATIONS THAT REQUIRE GI
ABSORPTION.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
MONITOR FOR AND REPORT S&S OF
SIGNIFICANT GI DISTRESS, INCLUDING NV&D.
MONITOR FOR S&S OF HYPOGLYCEMIA WHEN USED
IN COMBINATION WITH A SULFONYLUREA DRUG.
FOLLOW DIRECTIONS FOR TAKING THIS DRUG. IF A
DOSE IS MISSED, WAIT FOR THE NEXT SCHEDULED
DOSE. DISCARD ANY PEN THAT HAS BEEN IN USE
FOR GREATER THAN 30 D. EXENATIDE MAY CAUSE
DECREASED APPETITE AND SOME WEIGHT LOSS.
REPORT SIGNIFICANT GI DISTRESS TO PHYSICIAN.
DO NOT BREAST FEED WHILE TAKING THIS DRUG
WITHOUT CONSULTING PHYSICIAN.
ENDOCRINE MOA:
S Y S T E M INHIBITS THE ENZYME DIPEPTIDYL PEPTIDASE-4 (DPP-4), WHICH
SLOWS THE INACTIVATION OF INCRETIN HORMONES. THESE
HORMONES ARE RELEASED BY THE INTESTINE THROUGHOUT THE
DRUG CLASS: DAY AND ARE INVOLVED IN APPETITE CONTROL, INCREASE IN
INSULIN RELEASE, AND DECREASE IN GLUCAGON LEVELS.
ANTIDIABETIC AGENT
ENZYME INHIBITOR I:
GENERIC NAME:
ADJUNCT TO DIET AND EXERCISE TO IMPROVE
GLYCEMIC CONTROL IN CLIENTS WITH TYPE 2
METFORMIN OR A THIAZOLIDINEDIONE.
AR:
BRAND NAME/S:
CNS: HEADACHE
JANUVIA
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
WATCH FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIC REACTIONS,
ESPECIALLY IF COMBINED WITH OTHER
ANTIDIABETIC AGENTS. MONITOR
GLUCOSE AS DIRECTED. MAY BE
AR:
GI: ABDOMINAL PAIN, DIARRHEA, FLATULENCE, ↑ IN
BRAND NAME/S: TRANSAMINASES. INFLAMMATORY BOWEL DISEASE, COLON
ULCERS, PARTIAL BOWEL OBSTRUCTION, PREDISPOSITION FOR
GLYSET OBSTRUCTION; PATIENTS <18 Y; LACTATION. GI DISTRESS OR
LIVER DISORDERS, PREGNANCY (CATEGORY B).
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
MONITOR FOR THERAPEUTIC EFFECTIVENESS: INDICATED
BY IMPROVED BLOOD GLUCOSE LEVELS AND DECREASED
HBA1C. MONITOR FOR S&S OF HYPOGLYCEMIA WHEN
USED IN COMBINATION WITH SULFONYLUREAS, INSULIN,
OTHER HYPOGLYCEMIA AGENTS. LAB TESTS: MONITOR
HBA1C Q3MO. TREAT HYPOGLYCEMIA WITH ORAL
GLUCOSE (DEXTROSE); MIGLITOL INTERFERES WITH THE
BREAKDOWN OF SUCROSE (TABLE SUGAR). KEEP A
SOURCE OF ORAL GLUCOSE AVAILABLE TO TREAT LOW
BLOOD SUGAR; MIGLITOL PREVENTS DIGESTIVE
BREAKDOWN OF TABLE SUGAR. ABDOMINAL
DISCOMFORT, FLATULENCE, AND DIARRHEA TEND TO
DIMINISH WITH CONTINUED THERAPY. DO NOT BREAST
FEED WHILE TAKING THIS DRUG.
ENDOCRINE MOA:
S Y S T E M
SECOND GENERATION SULFONYLUREA HYPOGLYCEMIC AGENT. POTENCY IS
ENHANCED BY AS MUCH AS 200-FOLD OVER FIRST GENERATION AGENTS. DIRECTLY
STIMULATES FUNCTIONING PANCREATIC BETA CELLS TO SECRETE INSULIN,
DRUG CLASS: LEADING TO AN ACUTE DROP IN BLOOD GLUCOSE. INDIRECT ACTION LEADS TO
ALTERED NUMBERS AND SENSITIVITY OF PERIPHERAL INSULIN RECEPTORS,
ANTIDIABETIC AGENT RESULTING IN INCREASED INSULIN BINDING. IT ALSO CAUSES INHIBITION OF
SULFONYLUREA HEPATIC GLUCOSE PRODUCTION AND REDUCTION IN SERUM GLUCAGON LEVELS.
I:
GENERIC NAME: TREATMENT OF TYPE 2 DIABETES MELLITUS,
AS AN ADJUNCT TO DIET THERAPY OR IN CASES
GLIPIZIDE OF INSULIN RESISTANCE.
AR:
CNS: DIZZINESS, DROWSINESS, HEADACHE, WEAKNESS. GI:
BRAND NAME/S: CONSTIPATION, CRAMPS, DIARRHEA, DRUG-INDUCED HEPATITIS,
DYSPEPSIA, INCREASED APPETITE, NAUSEA, VOMITING. DERM:
PHOTOSENSITIVITY, RASHES. ENDO: HYPOGLYCEMIA. F AND E:
GLUCOTROL, HYPONATREMIA. HEMAT: APLASTIC ANEMIA, AGRANULOCYTOSIS,
GLUCOTROL XL LEUKOPENIA, PANCYTOPENIA, THROMBOCYTOPENIA.
THYROID AGENT I:
REPLACEMENT THERAPY IN CLIENTS WITHOUT THYROID HORMONE, OR
GENERIC NAME: PHARMACOLOGIC DOSES TO ENHANCE DIMINISHED THYROID
FUNCTION. REPLACEMENT OR PHARMACOLOGIC DOSES IN NEONATES
TO CORRECT INBORN ERRORS OF METABOLISM (PREVENTS
LEVOTHYROXINE DEVELOPMENTAL DELAY).
AR:
CNS: INSOMNIA, IRRITABILITY, NERVOUSNESS, HEADACHE. CV:
CARDIOVASCULAR COLLAPSE, ARRHYTHMIAS, TACHYCARDIA, ANGINA
BRAND NAME/S: PECTORIS, BLOOD PRESSURE CHANGES, INCREASED CARDIAC OUTPUT. GI:
CRAMPS, DIARRHEA, VOMITING. DERM: HAIR LOSS IN CHILDREN,
DIAPHORESIS. ENDO: HYPERTHYROIDISM, MENSTRUAL IRREGULARITIES.
LEVOTHROID, METAB: WEIGHT LOSS, HEAT INTOLERANCE. MS: ACCELERATED BONE
LEVOXYL, MATURATION IN CHILDREN.
SYNTHROID .
.
ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
WATCH FOR POSSIBLE ADDITIVE EFFECTS DURING
THE EARLY PERIOD OF LIOTHYRONINE SUBSTITUTION
FOR ANOTHER PREPARATION, PARTICULARLY IN
OLDER ADULTS, CHILDREN, AND PATIENTS WITH
CARDIOVASCULAR DISEASE. RESIDUAL ACTIONS OF
OTHER THYROID PREPARATIONS MAY PERSIST FOR
WEEKS. METABOLIC EFFECTS OF LIOTHYRONINE
PERSIST A FEW DAYS AFTER DRUG WITHDRAWAL.
TAKE MEDICATION EXACTLY AS ORDERED. LEARN S&S
OF HYPERTHYROIDISM (SEE APPENDIX F); NOTIFY
PHYSICIAN PROMPTLY IF THEY APPEAR. DO NOT
BREAST FEED WHILE TAKING THIS DRUG WITHOUT
CONSULTING PHYSICIAN.