Chapter 23 Endocrine System Drugs
A client is taking metformin (Glucophage), a biguanide oral antidiabetic agent, to treat Type 2 diabetes. Which symptom below is a known side effect of drugs in this class?
Anorexia, weight loss and hypoglycemia can be possible side effects of taking biguanides.
Which of the following is a type of rapid acting insulin?
Aspart
A client has been prescribed levothyroxine (Synthroid) for hormone replacement therapy. Which advice does the health care practitioner know would be MOST useful in preventing errors in administering this medication?
Caution is advised with decimal point placement (e.g., 0.025 mg vs. 0.25 mg) and dose conversions between mg and mcg because medication errors frequently occur.
Diabetes mellitus (DM) is a group of hormonal diseases
Characterized by impaired metabolism of carbohydrates, fats, and proteins that results in elevated levels of blood glucose
A client diagnosed with an acute exacerbation of ulcerative colitis has been prescribed corticotropin hormone (ACTH) for its anti-inflammatory action. Which route of administration does the health care practitioner know is used to administer this medication?
Corticotropin hormone (ACTH) is administered IM.
A client with diabetes has arrived at the clinic for his regularly scheduled medication management appointment. He tells the health care practitioner that he has been extremely thirsty, has been urinating frequently, and has flu-like symptoms. The health care practitioner notes a fruity odor to his breath. What physical condition is this client most likely experiencing?
Dehydration and excessive thirst, polyuria, flu-like symptoms, and fruity breath are symptoms of hyperglycemia.
A client with a history of diabetes has been placed on a thyroid agent. Which of the following statements is accurate regarding the interaction of thyroid and insulin?
Dosage adjustment of insulin may be necessary.
Which of the following is a side effect of sulfonylureas and alpha-glucosidase inhibitors?
GI distress
Which of the following is a type of long-acting insulin?
Glargine
When is insulin required for clients who have diabetes?
Insulin is required for clients who have diabetes as replacement therapy in Type 1 diabetes and in clients with Type 2 diabetes whose blood glucose is not controlled with diet or when illnesses develop.
A client has come to the health medical center experiencing an acute allergic response to poison ivy exposure. Which of the following medications would MOST likely be administered?
Methylprednisolone dose pack. Corticosteroid therapy is indicated in allergic reactions to poison plants. For acute episodes, some oral corticosteroids are available in dose packs to facilitate tapering.
What is the only type of insulin that can be administered intramuscularly, intravenously, and subcutaneously?
Only regular insulin can be administered intramuscularly, intravenously, and subcutaneously.
A health care practitioner is caring for a client with a known diagnosis of diabetes mellitus. When the health care practitioner enters the client's room, she notes that the client is perspiring, irritable, confused, and acting in a bizarre manner. The health care practitioner suspects these may be symptoms of hypoglycemia and offers the client four ounces of orange juice, followed by a protein bar. Which of the following situations would NOT result in hypoglycemia?
Overeating. Delayed or insufficient food intake (e.g., dieting) may result in hypoglycemia.
A client diagnosed with myxedema has been placed on thyroid replacement therapy. Which of the following statements is TRUE?
Prescribed dosage should be taken on an empty stomach 30-60 minutes before meals.
A client has been prescribed an antithyroid agent to relieve the symptoms of hyperthyroidism in preparation for surgery. What rare but serious side effect of antithyroid agents should the health care practitioner educate the client to report?
Rash, urticaria, and pruritis are rare side effects of antithyroid agents and should be reported to the physician immediately
A client who is obese tells the health care practitioner that her friend was recently placed on thyroid medication and lost weight. She asks the health care practitioner if she can take thyroid agents to help her lose weight. Which statement is the health care practitioner's BEST response?
The use of thyroid agents for weight reduction is contraindicated, ineffective, and dangerous, leading to a decrease in normal thyroid function and possibly life-threatening cardiac arrhythmias.
A client receiving thyroid replacement therapy came to the health clinic with complaints of heart palpitations, menstrual irregularity, and insomnia. The health care practitioner notes that she has exophthalmos. What could these signs of hyperthyroidism possibly indicate?
Toxic effects result from overdosage of thyroid and are manifested in the signs of hyperthyroidism.
A client with Type 2 diabetes has been taking chlorpropamide, a first-generation sulfonylurea oral hypoglycemic agent, for many years with good effect. Recently, the client was started on a six-month course of isoniazid for a positive PPD test. Which of the following statements is TRUE about taking isoniazid while receiving sulfonylureas?
When isoniazid is administered or discontinued in clients receiving sulfonylureas, the client should be observed closely for loss of diabetic control.
When educating a client that has been prescribed long-term corticosteroids, which of the following should the health care practitioner caution the client about?
Withdrawal of corticosteroids following long-term therapy should always be gradual with step-down dosage to allow the body's normal hormone production and regulation to return.
In which of the following locations can insulin be injected?
abdomen
Which population does Type 1 diabetes usually affect?
adolescents
Which population does Type 2 diabetes usually affect?
adults
In which of the following locations can insulin be administered?
back of arm
Type 2
characterized by insulin resistance and deficiency
Diabetes therapy with insulin focuses initially on
controlling fasting plasma glucose with the use of a long-acting insulin analog (Lantus or Levemir)
Under what condition is meglitinides contraindicated?
diabetic ketoacidosi
Which of the following helps control Type 2 diabetes?
excercise
Somatropin
growth hormone
Which of the following is a side effect of biguanides and incretin therapies ?
hypoglycemia
Type 1
insulin-dependent; characterized by destruction of pancreatic beta cells
If thyroid replacement therapy is prescribed for true hypothyroidism, then it must be administered for
life
To reduce potentially serious side effects, corticosteroids are administered
locally if possible and for the shortest time possible.
A patient with Type 2 diabetes should be cautioned to
never skip meals
If a diabetic patient has nausea/vomiting, diarrhea, or an infection, he should
notify his doctor
In the emergency treatment of diabetic ketoacidosis or coma,
regular insulin is administered intravenously.
Which of the following is a symptom of hypoglycemia?
shakiness
Under what condition is Actos contraindicated?
symptomatic heart failure
Which of the following is a drug classification used to treat diabetes?
thiazolidinediones
Because of the increase in obesity, more children and young adults are developing
type 2 diabetes
A patient with diabetes experiencing hypoglycemia
usually presents as sweating, shaking, and confused. Without treatment, they will become unresponsive.
Prior to doing a self-fingerstick blood glucose test, the patient should
wash hands
Pituitary gland
•Somatotropin (human growth hormone): regulates growth and insufficient production will result in abnormalities •Adrenocorticotropic hormone (ACTH): cosyntropin (Cortrosyn), a synthetic peptide of ACTH, is used mainly for diagnosis of adrenocortical insufficiency
Adrenal glands secrete hormones called corticosteroids
-Act on the immune system to suppress the body's response to infection or trauma-Relieve inflammation, reduce swelling, and suppress symptoms in acute conditions-Corticosteroid therapy is not curative, but is used as supportive therapy with other medications
Incretin therapies
-Agents that mimic actions of incretin hormones may be beneficial•Examples: exenatide (Byetta), sitagliptin (Januvia), and saxagliptan (Onglyza)
Some conditions treated with corticosteroids
-Allergic reactions -Acute flare-ups of rheumatic or collagen disorders-Acute flare-ups of severe skin conditions -Acute respiratory disorders -Long-term prevention of symptoms in severe persistent asthma or chronic management of COPD-Malignancies-Cerebral edema -Organ transplant-Life-threatening shock -Acute flare-ups of ulcerative colitis
Sulfonylureas
-Consist of first-generation agents (e.g., chlorpropamide, tolbutamide) and second-generation agents (e.g., glipizide, glyburide)-Work by increasing insulin production from the pancreas and by improving peripheral insulin activity
Alpha-glucosidase inhibitors
-Delay digestion of complex carbohydrates (e.g., starch) and subsequent absorption of glucose, resulting in a smaller rise in blood glucose concentrations following meals
Thiazolidinediones
-Pioglitazone (Actos) and rosiglitazone (Avandia) lower blood glucose by decreasing insulin resistance and improving sensitivity to insulin in muscle, liver, and adipose tissue
Insulin treatment and administration
-Required as replacement therapy for Type 1 diabetics with insufficient production of insulin from the islets of Langerhans in the pancreas-Required in patients with Type 2 who have failed to maintain satisfactory concentrations of blood glucose with therapy including dietary regulation and oral antidiabetic agents-Must be administered parenterally because it is destroyed in the GI tract
thyroid
-Responsible for regulating the rate of metabolism
Antithyroid agents (e.g., methimazole or Tapazole and propylthiouracil or PTU)
-Used to relieve the symptoms of hyperthyroidism in preparation for surgical or radioactive iodine therapy, or for those who are not candidates for either procedure•Methimazole is generally considered the treatment of choice
Biguanides
-Work by decreasing hepatic glucose production and enhancing insulin update in muscle
How is insulin administered?
-subcutaneously via intermittent injections or continuous infusion -Injected in upper arms, thighs, abdomen, buttocks -Sites need to be continuously rotated to avoid lipodystrophy
Most insulin used today is U-100, which means there are
100 units of insulin per milliliter