endocdrine

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

ARE INHIBITION OF LIPOLYSIS AND PROTEOLYSIS.

PANCREATIC AGENT
I:
TREATMENT OF DIABETES MELLITUS. THESE
GENERIC NAME:
ANTIDIABETIC AGENTS ARE DESCRIBED AS VERY

RAPID-ACTING (ONSET 5–15 MIN, WITH PEAK 30–60
INSULIN ASPART, MIN).
RDNA ORIGIN
AR:
DERM: URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND
BRAND NAME/S: HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL:

LIPODYSTROPHY (LIPOATROPHY, LIPOHYPERTROPHY),
NOVOLOG ITCHING, REDNESS, SWELLING. MISC: ALLERGIC REACTIONS,

INCLUDING ANAPHYLAXIS
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
MONITOR FOR S&S OF HYPOGLYCEMIA (SEE
APPENDIX F). INITIAL HYPOGLYCEMIC RESPONSE
BEGINS WITHIN 15 MIN AND PEAKS 45–90 MIN
AFTER INJECTION. WITHHOLD DRUG AND NOTIFY
PHYSICIAN IF PATIENT IS HYPOKALEMIC. DO
NOT INJECT INTO AREAS WITH REDNESS,

SWELLING, ITCHING, OR DIMPLING. INGEST
SOME FORM OF SUGAR (E.G., ORANGE JUICE,
DISSOLVED TABLE SUGAR, HONEY) IF SYMPTOMS
OF HYPOGLYCEMIA DEVELOP, AND SEEK
MEDICAL ASSISTANCE. DO NOT BREAST FEED
WHILE TAKING THIS DRUG WITHOUT
CONSULTING PHYSICIAN.
 ENDOCRINE MOA:
S Y S T E M INSULIN LISPRO OF RECOMBINANT DNA ORIGIN IS A HUMAN INSULIN THAT IS A
RAPID-ACTING, GLUCOSE-LOWERING AGENT. IT LOWERS BLOOD GLUCOSE LEVELS BY
INCREASING PERIPHERAL GLUCOSE UPTAKE, ESPECIALLY BY SKELETAL MUSCLE AND
FAT TISSUE, AND BY INHIBITING THE LIVER FROM CHANGING GLYCOGEN TO
DRUG CLASS:
GLUCOSE. ONE UNIT OF INSULIN LISPRO HAS THE SAME GLUCOSE-LOWERING

ABILITY AS HUMAN REGULAR INSULIN, BUT THE EFFECT IS MORE RAPID AND OF
ANTIDIABETIC AGENT SHORTER DURATION.

I:
TREATMENT OF DIABETES MELLITUS. THESE
GENERIC NAME:
ANTIDIABETIC AGENTS ARE DESCRIBED AS VERY

RAPID-ACTING (ONSET 5–15 MIN, WITH PEAK 30–60
INSULIN LISPRO MIN).

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.

NOTE: RISK OF HYPOGLYCEMIA IS

GREATEST 1–3 H AFTER INJECTION. DO
NOT BREAST FEED WHILE TAKING THIS
DRUG WITHOUT CONSULTING
PHYSICIAN.
 ENDOCRINE MOA:
S Y S T E M INSULIN GLULISINE, FORMED BY RECOMBINANT DNA, IS A RAPID-
ACTING INSULIN. INSULIN LOWERS BLOOD GLUCOSE BY STIMULATING
PERIPHERAL GLUCOSE UPTAKE BY SKELETAL MUSCLE AND FAT AND BY
DRUG CLASS: INHIBITING HEPATIC GLUCOSE PRODUCTION. INSULIN CAUSES

LIPOLYSIS IN THE ADIPOCYTE, INHIBITS PROTEOLYSIS, AND
ANTIDIABETIC AGENT ENHANCES PROTEIN SYNTHESIS.

I:
TREATMENT OF DIABETES MELLITUS. THESE
GENERIC NAME:
ANTIDIABETIC AGENTS ARE DESCRIBED AS VERY

RAPID-ACTING (ONSET 5–15 MIN, WITH PEAK 30–60
INSULIN GLULISINE MIN).

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

INSULIN REACTION DURING THE NIGHT. LEARN THE S&S

OF HYPOGLYCEMIA AND HYPERGLYCEMIA. DO NOT
BREAST FEED WHILE TAKING THIS DRUG WITHOUT
CONSULTING PHYSICIAN. IN INSULIN RESISTANT
PATIENTS, HYPERTHYROIDISM OR HYPOTHYROIDISM;
LACTATION, OLDER ADULTS, PREGNANCY (CATEGORY B),
RENAL OR HEPATIC IMPAIRMENT. SAFETY AND EFFICACY
IN CHILDREN <3 Y ARE NOT ESTABLISHED.
 ENDOCRINE MOA:
S Y S T E M INTERMEDIATE-ACTING, CLOUDY INSULIN SUSPENSION, EQUIVALENT TO A
MIXTURE OF 30% PROMPT INSULIN ZINC (SEMILENTE) AND 70% EXTENDED ZINC
INSULIN (ULTRALENTE) SUSPENSIONS. OBTAINED FROM PORK PANCREAS.
DRUG CLASS: ALLERGIC REACTIONS ARE RARE. TIME ACTION IS INTERMEDIATE BETWEEN
THOSE OF PROMPT AND EXTENDED INSULINS AND IS SO CLOSE TO THAT OF

ISOPHANE (NPH) INSULIN THAT THE TWO FORMS MAY BE USED
ANTIDIABETIC AGENT INTERCHANGEABLY.

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:
IN INSULIN RESISTANT PATIENTS, HYPERTHYROIDISM OR HYPOTHYROIDISM;
BRAND NAME/S: LACTATION, OLDER ADULTS, PREGNANCY (CATEGORY B), RENAL OR HEPATIC IMPAIRMENT.

SAFETY AND EFFICACY IN CHILDREN <12 Y HAVE NOT BEEN ESTABLISHED. DERM:
URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL:
HUMULIN L LIPODYSTROPHY (LIPOATROPHY, LIPOHYPERTROPHY), ITCHING, REDNESS, SWELLING.
MISC: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
BE ALERT FOR S&S OF HYPOGLYCEMIA; MOST
APT TO OCCUR BETWEEN MID-AFTERNOON AND
DINNER TIME (AN EARLY SYMPTOM MAY BE A
SENSE OF EXTREME FATIGUE). IMMEDIATELY TAKE
SOLUBLE CARBOHYDRATE (E.G., ORANGE JUICE,
HONEY). IF THE TIME BETWEEN THE MIDDAY AND

EVENING MEAL IS PROLONGED, AN AFTERNOON
SNACK MAY BE NEEDED. DO NOT OVERLOOK
POSSIBILITY OF NOCTURNAL HYPOGLYCEMIA,
ESPECIALLY DURING DOSE ADJUSTMENT. SIGNS
INCLUDE RESTLESSNESS OR PROFUSE SWEATING
DURING SLEEP. DO NOT BREAST FEED WHILE
TAKING THIS DRUG WITHOUT CONSULTING
PHYSICIAN.
 ENDOCRINE MOA:
S Y S T E M INTERMEDIATE-ACTING, CLOUDY INSULIN SUSPENSION, EQUIVALENT TO A
MIXTURE OF 30% PROMPT INSULIN ZINC (SEMILENTE) AND 70% EXTENDED ZINC
INSULIN (ULTRALENTE) SUSPENSIONS. OBTAINED FROM PORK PANCREAS.
DRUG CLASS: ALLERGIC REACTIONS ARE RARE. TIME ACTION IS INTERMEDIATE BETWEEN
THOSE OF PROMPT AND EXTENDED INSULINS AND IS SO CLOSE TO THAT OF

ISOPHANE (NPH) INSULIN THAT THE TWO FORMS MAY BE USED
ANTIDIABETIC AGENT INTERCHANGEABLY.

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:
IN INSULIN RESISTANT PATIENTS, HYPERTHYROIDISM OR HYPOTHYROIDISM;
BRAND NAME/S: LACTATION, OLDER ADULTS, PREGNANCY (CATEGORY B), RENAL OR HEPATIC IMPAIRMENT.

SAFETY AND EFFICACY IN CHILDREN <12 Y HAVE NOT BEEN ESTABLISHED. DERM:
URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL:
HUMULIN L LIPODYSTROPHY (LIPOATROPHY, LIPOHYPERTROPHY), ITCHING, REDNESS, SWELLING.
MISC: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
BE ALERT FOR S&S OF HYPOGLYCEMIA; MOST
APT TO OCCUR BETWEEN MID-AFTERNOON AND
DINNER TIME (AN EARLY SYMPTOM MAY BE A
SENSE OF EXTREME FATIGUE). IMMEDIATELY TAKE
SOLUBLE CARBOHYDRATE (E.G., ORANGE JUICE,
HONEY). IF THE TIME BETWEEN THE MIDDAY AND

EVENING MEAL IS PROLONGED, AN AFTERNOON
SNACK MAY BE NEEDED. DO NOT OVERLOOK
POSSIBILITY OF NOCTURNAL HYPOGLYCEMIA,
ESPECIALLY DURING DOSE ADJUSTMENT. SIGNS
INCLUDE RESTLESSNESS OR PROFUSE SWEATING
DURING SLEEP. DO NOT BREAST FEED WHILE
TAKING THIS DRUG WITHOUT CONSULTING
PHYSICIAN.
 ENDOCRINE MOA:
S Y S T E M
A RECOMBINANT HUMAN INSULIN ANALOG WITH A LONG DURATION OF
ACTION. ENHANCES TRANSMEMBRANE PASSAGE OF GLUCOSE ACROSS CELL
MEMBRANES. LOWERS BLOOD GLUCOSE LEVELS OVER AN EXTENDED PERIOD OF
DRUG CLASS: TIME BY STIMULATING PERIPHERAL GLUCOSE UPTAKE ESPECIALLY IN MUSCLE

AND FAT TISSUE. IN ADDITION, INSULIN INHIBITS HEPATIC GLUCOSE
ANTIDIABETIC AGENT PRODUCTION.
(BASAL AGENTS) I:

TREATMENT OF DIABETES MELLITUS. BECAUSE OF ITS
GENERIC NAME: DELAYED ONSET (1-2 HRS) AND PROLONGED DURATION,

MEDICATION CANNOT BE USED IN THE ACUTE TREATMENT OF
DIABETIC KETOACIDOSIS (DKA).
INSULIN
GLARGINE AR:

DERM: URTICARIA. ENDO: HYPOGLYCEMIA, REBOUND

BRAND NAME/S: HYPERGLYCEMIA (SOMOGYI EFFECT). LOCAL: LIPODYSTROPHY

(LIPATROPHY, LIPOHYPERTROPHY), ITCHING, REDNESS,
LANTUS SWELLING. MISC: ALLERGIC REACTIONS, INCLUDING
ANAPHYLAXIS.
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
MONITOR FOR S&S OF HYPOGLYCEMIA. INITIAL
HYPOGLYCEMIC RESPONSE BEGINS WITHIN 15 MIN AND
PEAKS 45–90 MIN AFTER INJECTION. WITHHOLD DRUG
AND NOTIFY PHYSICIAN IF PATIENT IS HYPOKALEMIC. DO
NOT INJECT INTO AREAS WITH REDNESS, SWELLING,
ITCHING, OR DIMPLING. INGEST SOME FORM OF SUGAR
(E.G., ORANGE JUICE, DISSOLVED TABLE SUGAR, HONEY)

IF SYMPTOMS OF HYPOGLYCEMIA DEVELOP, AND SEEK
MEDICAL ASSISTANCE. DO NOT BREAST FEED WHILE
TAKING THIS DRUG WITHOUT CONSULTING PHYSICIAN.
CHECK BLOOD SUGAR AS PRESCRIBED, ESPECIALLY
POSTPRANDIAL VALUES; NOTIFY PHYSICIAN OF FASTING
BLOOD GLUCOSE <80 AND >120 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 PRAMLINTIDE IS A SYNTHETIC ANALOG OF HUMAN AMYLIN, A HORMONE
SECRETED BY PANCREATIC BETA CELLS. IN TYPE 2 DIABETIC PATIENTS USING
INSULIN AND IN TYPE 1 DIABETICS, BETA CELLS IN THE PANCREAS ARE EITHER
DRUG CLASS: DAMAGED OR DESTROYED, RESULTING IN REDUCED SECRETION OF BOTH

INSULIN AND AMYLIN AFTER MEALS. AMYLIN REDUCES POST MEAL GLUCAGON
ANTIDIABETIC AGENT LEVELS, THUS LOWERING SERUM GLUCOSE LEVEL.
SYNTHETIC ANALOGUE
OF HUMAN AMYLIN. I:
TREATMENT OF TYPE 1 AND TYPE 2 DIABETES IN
GENERIC NAME: CONJUNCTION WITH OTHER ANTIDIABETIC AGENTS.

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

DIABETES MELLITUS; MAY BE USED AS

SITAGLIPTIN MONOTHERAPY OR COMBINATION THERAPY WITH

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

ADMINISTERED WITHOUT REGARD TO

FOOD. FOLLOW PRESCRIBED DIET,
MEDICATION, AND EXERCISE REGIMEN
TO REMAIN EUGLYCEMIC. DO NOT USE
DURING PREGNANCY OR IF LACTATING.
WEAR A MEDIC-ALERT BRACELET.
 ENDOCRINE MOA:
S Y S T E M
STIMULATE THE RELEASE OF INSULIN FROM
PANCREATIC BETA CELLS BY CLOSING POTASSIUM
DRUG CLASS: CHANNELS, WHICH RESULTS IN THE OPENING OF

CALCIUM CHANNELS IN BETA CELLS. THIS IS FOLLOWED
ANTIDIABETIC AGENT BY RELEASE OF INSULIN. THIS IS A SECRETAGOGUE.
MEGLITINIDE I:
GENERIC NAME:
TREATMENT OF TYPE 2 DIABETES MELLITUS,

WITH DIET AND EXERCISE; MAY BE USED WITH
REPAGLINIDE METFORMIN, ROSIGLITAZONE, OR
PIOGLITAZONE.
AR:
BRAND NAME/S:

CV: ANGINA, CHEST PAIN. ENDO:
PRANDIN, HYPOGLYCEMIA, HYPERGLYCEMIA
GLUCONORM
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M MONITOR CAREFULLY FOR S&S OF
HYPOGLYCEMIA ESPECIALLY DURING THE 1-WK
PERIOD FOLLOWING TRANSFER FROM A LONGER-
ACTING SULFONYLUREA SUCH AS
CHLORPROPAMIDE. TAKE ONLY WITH MEALS TO
LESSEN THE CHANCE OF HYPOGLYCEMIA. IF A

MEAL IS SKIPPED, SKIP A DOSE; IF A MEAL IS
ADDED, ADD A DOSE. START REPAGLINIDE THE
MORNING AFTER THE OTHER AGENT IS STOPPED
WHEN CHANGING FROM ANOTHER ORAL
HYPOGLYCEMIA DRUG. BE ALERT FOR S&S OF
HYPERGLYCEMIA OR HYPOGLYCEMIA; REPORT
POOR BLOOD GLUCOSE CONTROL TO PHYSICIAN.
DO NOT BREAST FEED WHILE TAKING THIS DRUG.
 ENDOCRINE MOA:
S Y S T E M
ACARBOSE IS AN ORAL ALPHA-GLUCOSIDASE INHIBITOR. IT INHIBITS OR
DELAYS THE ABSORPTION OF SUGARS FROM THE INTESTINAL TRACT. THE
INHIBITORY EFFECT OF ACARBOSE VARIES ACCORDING TO WHICH ENZYMES
DRUG CLASS: ARE INVOLVED; FROM MOST TO LEAST INHIBITED ARE GLUCOAMYLASE,

SUCRASE, MALTASE, AND ISOMALTASE. LACTASE IS NOT AFFECTED BY
ANTIDIABETIC AGENT ACARBOSE. ACARBOSE REDUCES BLOOD SUGAR BY INTERFERING WITH
ALPHA-GLUCOSIDASE CARBOHYDRATE ABSORPTION FROM THE GI TRACT.
INHIBITORS

I: MANAGEMENT OF DIABETES IN
GENERIC NAME:
CONJUNCTION WITH DIETARY THERAPY; MAY

BE USED WITH INSULIN OR OTHER

ACARBOSE
HYPOGLYCEMIC AGENTS.
AR:
GI: ABDOMINAL PAIN, DIARRHEA, FLATULENCE, ↑ IN
BRAND NAME/S: TRANSAMINASES. INFLAMMATORY BOWEL DISEASE, COLON

ULCERS, PARTIAL BOWEL OBSTRUCTION, PREDISPOSITION FOR
PRECOSE OBSTRUCTION; PATIENTS <18 Y; LACTATION. GI DISTRESS OR

LIVER DISORDERS, PREGNANCY (CATEGORY B).
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
TREAT HYPOGLYCEMIA WITH DEXTROSE;
NOT WITH SUCROSE (TABLE SUGAR).
NOTE: ACARBOSE PREVENTS THE
BREAKDOWN OF TABLE SUGAR. HAVE A
SOURCE OF DEXTROSE, SUCH AS DEXTROSE
PASTE, AVAILABLE TO TREAT LOW BLOOD

SUGAR. MONITOR CLOSELY BLOOD GLUCOSE
ESPECIALLY FOLLOWING DOSAGE CHANGES.
REPORT ABDOMINAL DISTRESS; DIETARY
ADJUSTMENT OR DOSAGE REDUCTION MAY
BE WARRANTED. MONITOR WEIGHT AND
REPORT SIGNIFICANT CHANGES. DO NOT
BREAST FEED WHILE TAKING THIS DRUG.
 ENDOCRINE MOA:
S Y S T E M
ACARBOSE IS AN ORAL ALPHA-GLUCOSIDASE INHIBITOR. IT INHIBITS OR
DELAYS THE ABSORPTION OF SUGARS FROM THE INTESTINAL TRACT. THE
INHIBITORY EFFECT OF ACARBOSE VARIES ACCORDING TO WHICH ENZYMES
DRUG CLASS: ARE INVOLVED; FROM MOST TO LEAST INHIBITED ARE GLUCOAMYLASE,

SUCRASE, MALTASE, AND ISOMALTASE. LACTASE IS NOT AFFECTED BY
ANTIDIABETIC AGENT ACARBOSE. ACARBOSE REDUCES BLOOD SUGAR BY INTERFERING WITH
ALPHA-GLUCOSIDASE CARBOHYDRATE ABSORPTION FROM THE GI TRACT.
INHIBITORS

I: MANAGEMENT OF DIABETES IN
GENERIC NAME:
CONJUNCTION WITH DIETARY THERAPY; MAY

BE USED WITH INSULIN OR OTHER

ACARBOSE
HYPOGLYCEMIC AGENTS.
AR:
GI: ABDOMINAL PAIN, DIARRHEA, FLATULENCE, ↑ IN
BRAND NAME/S: TRANSAMINASES. INFLAMMATORY BOWEL DISEASE, COLON

ULCERS, PARTIAL BOWEL OBSTRUCTION, PREDISPOSITION FOR
PRECOSE OBSTRUCTION; PATIENTS <18 Y; LACTATION. GI DISTRESS OR

LIVER DISORDERS, PREGNANCY (CATEGORY B).
 ENDOCRINE NURSING MANAGEMENT:
S Y S T E M
TREAT HYPOGLYCEMIA WITH DEXTROSE;
NOT WITH SUCROSE (TABLE SUGAR).
NOTE: ACARBOSE PREVENTS THE
BREAKDOWN OF TABLE SUGAR. HAVE A
SOURCE OF DEXTROSE, SUCH AS DEXTROSE
PASTE, AVAILABLE TO TREAT LOW BLOOD

SUGAR. MONITOR CLOSELY BLOOD GLUCOSE
ESPECIALLY FOLLOWING DOSAGE CHANGES.
REPORT ABDOMINAL DISTRESS; DIETARY
ADJUSTMENT OR DOSAGE REDUCTION MAY
BE WARRANTED. MONITOR WEIGHT AND
REPORT SIGNIFICANT CHANGES. DO NOT
BREAST FEED WHILE TAKING THIS DRUG.
 ENDOCRINE MOA:
S Y S T E M
ENZYME INHIBITION OF INTESTINAL GLUCOSIDASES THAT DELAYS
THE FORMATION OF GLUCOSE FROM SACCHARIDES IN THE SMALL
INTESTINE. MIGLITOL DOES NOT ENHANCE INSULIN SECRETION. IT
DRUG CLASS:

DELAYS THE DIGESTION OF CARBOHYDRATES, LOWERS THE
ANTIDIABETIC AGENT POSTPRANDIAL HYPERGLYCEMIA, AND REDUCES THE LEVELS OF
ALPHA-GLUCOSIDASE GLYSYLATED HEMOGLOBIN (HBA1C) IN TYPE 2 DIABETICS.
INHIBITORS I:

GENERIC NAME: MANAGEMENT OF DIABETES IN CONJUNCTION

WITH DIETARY THERAPY; MAY BE USED WITH
MIGLITOL INSULIN OR OTHER HYPOGLYCEMIC AGENTS.

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.

 ENDOCRINE NURSING MANAGEMENT:

S Y S T E M
OBSERVE RESPONSE TO THE INITIAL DOSE AND
ESTABLISH MAINTENANCE REGIMEN CAUTIOUSLY
IN OLDER ADULT OR DEBILITATED PATIENTS;
EARLY SIGNS OF HYPOGLYCEMIA ARE EASILY
OVERLOOKED. NOTE: SEVERE DRUG-INDUCED SKIN
RASHES AND PRURITUS MAY NECESSITATE

DISCONTINUATION OF DRUG USE. SYMPTOMS
USUALLY SUBSIDE RAPIDLY WHEN DRUG IS
WITHDRAWN. CHECK URINE FOR SUGAR AND
KETONE BODIES AT LEAST 3 TIMES DAILY DURING
INSULIN WITHDRAWAL AND TRANSFER TO
GLIPIZIDE. CONTACT PHYSICIAN IF TESTS ARE
ABNORMAL.
 ENDOCRINE MOA:
S Y S T E M
METABOLISM OF ALL NUTRIENTS IS INCREASED,
PROMOTING CELL GROWTH AND INCREASED
DRUG CLASS: PROTEIN SYNTHESIS.

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
MONITOR PULSE BEFORE EACH DOSE DURING DOSE ADJUSTMENT. IF
RATE IS >100, CONSULT PHYSICIAN. MONITOR FOR ADVERSE EFFECTS
DURING EARLY ADJUSTMENT. IF METABOLISM INCREASES TOO RAPIDLY,
ESPECIALLY IN OLDER ADULTS AND HEART DISEASE PATIENTS,
SYMPTOMS OF ANGINA OR CARDIAC FAILURE MAY APPEAR. NOTE:
LEVOTHYROXINE MAY AGGRAVATE SEVERITY OF PREVIOUSLY OBSCURED
SYMPTOMS OF DIABETES MELLITUS, ADDISON'S DISEASE, OR DIABETES
INSIPIDUS. THERAPY FOR THESE DISORDERS MAY REQUIRE
ADJUSTMENT. LAB TESTS: BASELINE AND PERIODIC TESTS OF THYROID

FUNCTION. CLOSELY MONITOR PT/INR AND ASSESS FOR EVIDENCE OF
BLEEDING IF PATIENT IS RECEIVING CONCURRENT ANTICOAGULANT
THERAPY. A DECREASE IN ANTICOAGULANT DOSAGE MAY BE NEEDED 1–4
WK AFTER CONCURRENT LEVOTHYROXINE IS STARTED. MONITOR BONE
AGE, GROWTH, AND PSYCHOMOTOR FUNCTION IN CHILDREN. SOME
CHILDREN HAVE PARTIAL HAIR LOSS AFTER A FEW MONTHS; IT RETURNS
EVEN WITH CONTINUED THERAPY. SYNTHROID 100 AND 300 MCG
TABLETS CONTAIN TARTRAZINE, WHICH MAY CAUSE AN ALLERGIC-TYPE
REACTION IN CERTAIN PATIENTS; PARTICULARLY THOSE WHO ARE
HYPERSENSITIVE TO ASPIRIN.
 ENDOCRINE MOA:
S Y S T E M
SYNTHETIC FORM OF NATURAL THYROID HORMONE. SHARES ACTIONS AND USES
OF THYROID BUT HAS MORE RAPID ACTION AND MORE RAPID DISAPPEARANCE OF
EFFECT, PERMITTING QUICK DOSAGE ADJUSTMENT IF NECESSARY. USED IN T3
DRUG CLASS: SUPPRESSION TEST TO DIFFERENTIATE SUSPECTED HYPERTHYROIDISM FROM
EUTHYROIDISM. PRINCIPAL EFFECT: INCREASE IN THE METABOLIC RATE OF ALL

BODY TISSUES.
THYROID AGENT I:
REPLACEMENT OR SUPPLEMENTAL THERAPY FOR
GENERIC NAME:
CRETINISM, MYXEDEMA, GOITER, SECONDARY (PITUITARY)

OR TERTIARY (HYPOTHALAMIC) HYPOTHYROIDISM, AND T3
LIOTHYRONINE SUPPRESSION TEST.

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.
CYTOMEL, METAB: WEIGHT LOSS, HEAT INTOLERANCE. MS: ACCELERATED BONE
TRIOSTAT MATURATION IN CHILDREN.

.
 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.