Endocrine Medications of the Adult Client

methimazole (Tapzole)

Antithyroid/hyperthyroidism Side effect: pregnancy risk Teaching: take at same time each day

metformin (Glucophage)

Biguanide; oral medication; decreases glucose production by the liver; increases tissue response to insulin Major adverse effects: GI symptoms; lactic acidosis; IV contrast dye adversity - hold before and 48 hours after study

sitagliptin (Januvia)

Gliptins; oral medication; increases insulin release by enhancing the activity of incretins; increases insulin release, reduces glucagon release, decreases hepatic glucose production Major adverse effects: pancreatitis, hypersensitivity reactions

propylthiouracil (PTU)

antithyroid; hyperthyroidism Side effects: GI: jaundice, hepatitis/liver Teaching: wt loss, fever, nervousness, insomnia

phentermine (Adipex-P)

appetite suppressant; These drugs act on the central nervous system, including suppressing the appetite center in the hypothalamus

Insulin storage

avoid extremes in temp never freeze or keep in direct sunlight or hot car Before injection - needs to be room temperature Vial must be refrigerated if keeping longer than 1 month Roll vial; do not shake Draw up the shortest acting insulin first when mixing

NPH insulin

duration - Immediate duration onset: 30-120 Peak: 6-14 duration: 16-24

insulin glargine (Lantus)

duration - Long duration **cannot be mixed with any other types of insulin! onset: 70 Peak: none duration: 18-24

insulin aspart (Novolog)

duration - Short duration; rapid acting onset: 10-30 Peak: 0.5-3 duration: 3-5

regular insulin

duration - short; slower acting onset: 30-60 Peak: 1-5 duration: 6-10

repaglinide (Prandin)

meglitinides; oral medication; promote insulin secretion by the pancreas Major adverse effects: hypoglycemia; wt gain

orlistat (Xenical)

obesity drug; inhibits lipids side effects include loose stools, abdominal cramps, and nausea unless they reduce their fat intake to less than 30%; used with caution and limited to adults between 18 and 75 years of age. Treatment is usually not extended beyond 12 months

glipizide (Glucotrol)

second-generation sulfonylureas; oral medication; promote insulin secretion by the pancreas; may also increase tissue response to insulin. Major adverse effects: hypoglycemia; wt gain; avoid alcohol while taking sulfonylureas

pioglitazone (Actos)

thiazolidinediones; oral medication; decrease insulin resistance; increases glucose uptake by muscle and adipose tissue; decrease glucose production by the liver Major adverse effects: hypoglycemia, heart failure, bladder cancer, fractures, ovulation

levothyroxine sodium (Synthroid)

thyroid hormone/hypothyroidism Side effects: interacts with aluminum and magnesium (antacids) teaching: take on an empty stomach; take with a full glass of water

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply: 1. Administer methimazole with food. 2. Place the client on a low-calorie, low-protein diet. 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5. Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1. Administer methimazole with food. (common side effects are GI upset) 3. Assess the client for unexplained bruising or bleeding. 4. Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. (Hyperthyroidism - clients should consume high-calorie diet; methimazole is not radioactive and should not be stopped abruptly due to risk of thyroid storm)

The home health nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide and metformin. The nurse should provide which instructions to the client? Select all that apply: 1. Diarrhea may occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes. 5. Muscle pain is an expected effect of metformin and may be treated with acetaminophen 6. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.

1. Diarrhea may occur secondary to the metformin. 2. The repaglinide is not taken if a meal is skipped. 3. The repaglinide is taken 30 minutes before eating. 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes.

A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instructions to the client? Select all that apply: 1. Hypoglycemia may be experienced before dinnertime. 2. The insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature. 4. the insulin vial needs to be shaken vigorously to break up the precipitates. 5. The NPH insulin should be drawn into the syringe first, then the regular insulin.

1. Hypoglycemia may be experienced before dinnertime. 3. The insulin should be administered at room temperature. (NPH is an intermediate-acting insulin; onset of action is 60-120 min; peaks in 6-14 hours; regular insulin is short acting, peaks in 1-5 hours and duration is 6-10. Count to dinnertime)

The nurse is teaching the client about his prescribed prednisone. Which statement, if made by the client, indicates that further teachinig is necessary? 1. I can take ASA or my antihistamine if I need it. 2. I need to take the medication every day at the same time. 3. I need to avoid coffee, tea, cola, and chocolate in my diet. 4. If I gain more than 5 pounds a week, I will call my health care provider.

1. I can take ASA or my antihistamine if I need it. (client needs to consult with HCP)

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply: 1. Insominia 2. Wt loss 3. Bradycardia 4. Constipation 5. Mild heat intolerance

1. Insominia 2. Wt loss 5. Mild heat intolerance (key word is "side effects associated with the medication - bradycardia and constipation are side effects of hypothyroidism)

A client with DM visits a health care clinic. The client's DM previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180-200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Atenolol 3. Phenelzine 4. Allopurinol

1. Prednisone (Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Prednisone is a corticosteroid and all corticosteroids decrease the effects of oral hypoglycemics.)

The health care provider prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse should plan to take which most appropriate intervention? 1. Withhold the medication and call the HCP, questioning the RX for the client. 2. Administer the medication within 60 minutes before the morning and evening meal. 3. Monitor the client for GI side effects after administering the medication. 4. Withdraw the insulin from the pre-filled pen into an insulin syringe to prepare for administration.

1. Withhold the medication and call the HCP, questioning the RX for the client. (this is not recommended for clients who are taking insulin)

The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? 1. withdraws the NPH insulin first 2. withdraws the regular insulin first 3. Injects air into NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial

1. withdraws the NPH insulin first (remember - RN-draw up the regular insulin before NPH insulin)

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. It is okay if I skip meals now and then 2. I need to constantly watch for signs of low blood sugar. 3. I will let my health care provider know if I get unusually tired. 4. I will be sure to not drink alcohol excessively while on this medication.

2. I need to constantly watch for signs of low blood sugar (metformin lowers blood sugar after a meal as well as fasting blood glucose levels. Metformin does not stimulate insulin release therefore poses little risk for hypoglycemia; clients can skip a meal now and then.)

The nurse teaches the client, who is newly diagnosed with diabetes insipidus, about the prescribed intranasal desmopressin. which statements by the client indicate understanding? Select all that apply: 1. This medication will turn my urine orange. 2. I should decrease my oral fluids when I start this medication. 3. The amount of urine that I make should increase if this medication is working. 4. I need to follow a low-fat diet to avoid pancreatitis when taking this medication. 5. I should report a headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin.

2. I should decrease my oral fluids when I start this medication. 5. I should report a headache and drowsiness to my health care provider since these symptoms could be related to my desmopressin. (diabetes insipidus is a deficiency in antidiuretic hormone resulting in large urinary losses; headache and drowsiness are signs of water intoxication)

Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? select all that apply 1. ETOH 2. Red meats 3. Whole-grain cereals 4. Low-calorie desserts 5. Carbonated beverages

2. Red meats 3. Whole-grain cereals 5. Carbonated beverages (alcohol combined with glimepiride may produce flushing, palpations, and nausea; or hypoglycemic effects. Low-calorie desserts probably have high carbs)

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1. Freeze the insulin 2. Refrigerate the insulin 3. Store the insulin in a dark, dry place. 4. Keep the insulin at room temperature.

2. Refrigerate the insulin.

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching? 1. Inject the pramlintide at the same time you take your other medication. 2. Take your prescribed pills 1 hour before or 2 hours after the injection. 3. Be sure to take the pramlintide with food so you don't upset your stomach 4. Make sure you take your pramlintide immediately after you eat so you don't experience a low blood sugar.

2. Take your prescribed pills 1 hour before or 2 hours after the injection. (Pramlintide is used for clients with types 1 and 2 DM who use insulin; it is administered subcutaneously before meals to lower blood glucose levels after meals. Pramlintide delays gastric emptying, oral medications should be given 1 hour before or 2 hours after an injection of pramlintide)

The nurse should tell the client, who is taking levothyroxine, to notify the health care provider if which problem occurs? 1. fatigue 2. tremors 3. cold intolerance 4. excessively dry skin

2. tremors (excessive doses of levothyroixine can produce signs and symptoms of hyperthyroidism which include: tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating).

The client with hyperparathyroidism is taking alendronate. Which statements by the client indicate understanding of the proper way to take this medication? Select all that apply: 1. I should take this medication with food. 2. I should take this medication at bedtime. 3. I should sit up for at least 30 minutes after taking this medication. 4. I should take this medication first thing in the morning on an empty stomach. 5. I can pick a time to take this medication that best fits my lifestyle as long as I take it at the same time each day.

3. I should sit up for at least 30 minutes after taking this medication. 4. I should take this medication first thing in the morning on an empty stomach. (primary concern with alendronate is esophagitis - so don't lay down; should be taken on an empty stomach)

A daily dose of prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the client that which time is best to take this medication? 1. at noon. 2. at bedtime 3. early morning 4. Any time at the same time, each day

3. early morning (corticosteroids should be administered before 9:00 am to help minimize adrenal insufficiency and mimic the burst of glucocorticoids released naturally by the adrenal glands each morning.)

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1. With food 2. at lunchtime 3. on an empty stomach 4. at bedtime with a snack

3. on an empty stomach (oral doses of levothyroxin should be taken on an empty stomach to enhance absorption; dosing should be done in the morning before breakfast)