ATI The Endocrine System – Flashcards

*d. Pancreatitis* Exenatide, an incretin mimetic agent, can cause pancreatitis. You instructed to pt to watch for and report severe or persistant abd pain, so you should now inform the provider and tell the pt to *stop taking the drug*. Additionally, watch for *hypoglycemia*- test blood glucose & consume snack of 15-20g of carbs; carry carb snack w/ you at all times; wear med ID bracelet; lie down if nauseous; consume adequate calories.

*b. Tremors* This drug can cause hypoglycemia. *Indications of hypoglycemia:* hunger tachycardia, shakiness, tremors, diaphoresis.

1. Desmopressin --- diabetes insipidus 2. Glucagon --- hypoglycemia (insulin overdose) 3. Glipizide --- Type 2 DM 4. Radioactive iodine-131 --- thyroid cancer and hyperthyroidism from Graves' disease

*b. Take it once a day, 30 minutes before first meal of the day.* Additionally: watch for s/s of *hypoglycemia*; don't take if you're *pregnant or lactating*; *NO ETOH* b/c risk of disulfiram-like reaction & it increases hypoglycemic effects; *NSAIDS, oral anticoagulants, salicylates, MAOIs and Tagamet* increase hypoglycemic effects

*a. Hyperthyroidism* It can cause hyperthyroidism if prescribed dose exceeds what the pt needs to remain euthyroid. *Monitor thyroid function via T4 and TSH levels.*

*c. Height and weight* It's a *growth hormone* used to increase growth in pts who are lacking it. Gradual increases in weight and height reflect effective therapy. *Labs to monitor:* blood glucose, urine calcium, baseline thyroid function, growth hormone levels monitor monthly

*a. Expect lifelong therapy* *b. Carry extra doses of the drug* *c. Expect periodic blood sampling* *d. Report increased stress* Hydrocortisone therapy must continue for life because there are no other therapies to can restore adrenocortical function. The pt should carry extra b/c they might need more during times of physical or emotional stress. *Labs to monitor:* electrolyte, glucose, glucocorticoid levels

1. Hydrocortisone (Cortef) --- Addison's disease (acute and chronic adrenocortical insufficiency) 2. Somatropin (Genotropin) --- Turner's syndrome (growth hormone deficiency) 3. Propylthiouracil (PTU) --- Thyrotoxic crisis (hyperthyroidism or Graves' disease) 4. Levothyroxine (Synthroid) --- Hypothyroidism

*d. Inject subcut* Do not shake the vial vigorously but rather *rotate it gently* to disperse the particles. DO NOT use insulin that appears *cloudy our discolored*. *Refrigerate unopened vials until their expiration date* and keep *opened vials at room temp up to 1 month.*

*a. Report weight gain* *b. Use effective contraception* *c. Allow 2-3 months for full effects* *d. Expect periodic blood sampling.* Radioactive iodine-131, an antithyroid drug, can cause *hypothyroidism*. Instruct pt to *report drowsiness, depression, weight gain, or edema*. Redioactive iodine-131 is a *pregnancy risk category X drug*. Confirm negative pregnancy test prior to therapy and tell pt to use effective contraception throughout. It takes *2-3 months for full effects* and this drug causes *bone barrow suppression* so tell pt to expect periodic blood sampling.

*c) Acute renal failure* Metformin, a biguanide, can interact with iodine-containing contrast dye, causing acute renal failure and lactic acidosis. The HCP should withhold metformin for 48 hr prior to and following the procedure. The HCP should also monitor the pt for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain.

*a) Avoid drinking alcohol.* Alcohol can interact with glipizide, a sulfonylurea, causing a reaction similar to disulfiram (Antabuse), manifesting as nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. The HCP should tell the pt to avoid ETOH. The pt should take the drug 30 min before the first meal of the day.

*a) Eat more iron-rich foods.* Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The HCP should tell the pt to increase his intake of iron-rich foods, such as red meat, spinach, and grains, and monitor the patient's CBC.

*d) Renal impairment* Sitagliptin, a gliptin, requires cautious use with patients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The HCP should prescribe a lower dose for this pt or prescribe a different hypoglycemic drug.

*b) Inject pramlintide before meals.* The patient should inject pramlintide, an amylin mimetic, 20 min before a meal that contains at least 30 g of carbohydrates. Patients should take pramlintide TID. SC injection.

*b) urine output.* Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The HCP should monitor the patient's fluid intake and urine output along with urine and serum osmolality and blood pressure.

*b) ALT* Pioglitazone can cause liver injury. The HCP should monitor ALT at the start of therapy and every 3 to 6 months thereafter. The HCP should tell the pt to report jaundice, dark-colored urine, or abdominal pain. *c) LDL* Pioglitazone can cause elevations in both HDLs, which is a beneficial effect, and LDLs, which is a detrimental effect. The HCP should monitor the patient's plasma lipid levels at baseline and periodically throughout drug therapy.

*b) Hydrocortisone (Cortef)* Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease. Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates.

*a) 0820* Pramlintide, an amylin mimetic, peaks 20 min after administration. The HCP should monitor the pt for indications of hypoglycemia, such as diaphoresis and tremors.

*a) Sore throat* Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The HCP should monitor the patient's CBC, and tell the pt to report fever or sore throat. *b) Muscle pain* Propylthiouracil can cause arthralgia and myalgia. The HCP should tell the pt to report these effects and take over-the-counter analgesics for pain relief. *d) Bradycardia* Propylthiouracil can cause hypothyroidism, manifesting as bradycardia, drowsiness, and weight gain. The HCP should tell the patient to report these effects. *e) Rash* Propylthiouracil can cause urticaria or a skin rash. The HCP should tell the pt to report these effects.

*d) a myocardial infarction.* Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the pt requires a dosage adjustment; therefore, it is contraindicated for pt who recently had an MI.

*a) Weigh yourself daily* Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. *b) Report weakness or palpitations* Fludrocortisone can cause hypokalemia. The HCP should monitor the patient's potassium levels, and tell her to report muscle weakness or palpitations. *c) Have your blood pressure checked regularly* Fludrocortisone can cause fluid retention and hypertension. The HCP should monitor the patient's fluid balance and blood pressure to expedite any essential interventions. Fludrocortisone does not cause iron-deficiency anemia, although it can cause thrombocytopenia.

*c) Beta blockers* Patients who take insulin and also take beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because they mask symptoms such as tachycardia and tremors. They also increase hypoglycemic effects.

*a) Do not drink more than 1 L of grapefruit juice per day.* More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. The HCP should tell the pt to avoid drinking large amounts of grapefruit juice. The HCP should tell the pt to avoid ginseng and garlic bc these herbal supplements can increase the hypoglycemic effects of repaglinide, a meglitinide.

*c) Weight gain* Pioglitazone, a thiazolidinedione, can cause fluid retention. The HCP should monitor weight or other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing. muscle pain, not joint diarrhea, not constipation blurred vision, not dilation

*c) Skip the dose.* To avoid a sudden and serious drop in blood glucose level, the patient should skip the dose of repaglinide, a meglitinide, whenever he skips a meal, and try to avoid skipping meals.

*a) Inject the drug subcutaneously.* *b) Expect the peak effect in 2 hr.* *c) Use the drug as a supplement to an oral hypoglycemic.* The patient should inject exenatide twice per day up to 60 min prior to the morning and evening meals, not after a meal. The patient may keep prefilled exenatide injector pens in use at room temperature up to 30 days.

*c) Urine calcium* Somatropin can cause hypercalciuria. The HCP should monitor the patient's urine calcium, and tell the patient to report flank pain, urinary frequency, or hematuria. *d) Blood glucose* Somatropin can cause hyperglycemia. The HCP should monitor the patient's blood glucose levels, and tell the patient to report polyphagia, polydipsia, and polyuria.

*d) Glucagon (GlucaGen)* Glucagon, a hyperglycemic that can be given SC, IM, or IV, treats severe hypoglycemia from an insulin overdose in patients who are unconscious and for whom IV glucose is not readily available. If the patient does not respond to glucagon, the HCP should administer a glucose solution IV.

*d) Expect full effects in 2 to 3 months.* The full therapeutic effects of radioactive iodine-131, an antithyroid drug, take 2 to 3 months, and with successful treatment, hypothyroidism can result. Patients take radioactive iodine-131, an antithyroid drug, only once, although an ineffective response can require one or more subsequent doses several months later. Preparations of radioactive iodine-131, an antithyroid drug, are odorless and tasteless. Patients should drink plenty of fluids after taking radioactive iodine-131, an antithyroid drug, especially if the dosage is high.

*a) Lactic acidosis* Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication, manifesting as muscle aches, sleepiness, malaise, and hyperventilation. The patient should stop taking the drug and seek medical care immediately.

*c) Expect life-long therapy with the drug.* Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function. Food & antacids reduce the absorption of levothyroxine. Take it on an empty stomach, at least 30 min before eating. Allow 4 hr between doses w/ antacids.

*b) Perform a fingerstick blood glucose check.* Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The HCP should tell the pt to check her blood glucose level, and if it indicates hypoglycemia, consume a snack of 15 to 20 g of carbohydrates, retest in 15 to 20 min, and repeat if her blood glucose level is still low. Glipizide treats hyperglycemia from T2 DM. Patients do not take it PRN, but on a fixed, once-daily dosing schedule. It would be inappropriate to double the dosage within the same 24-hr period, even if the patient were experiencing hyperglycemia.

*d) Lipohypertrophy* Lipohypertrophy, also called lipodystrophy, is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the patient should rotate injection sites, keeping them at least 1 inch apart, and avoid using the same spot within the same month.

*b) Hypothyroidism* Propylthiouracil, an antithyroid drug, can cause hypothyroidism, manifesting as drowsiness, depression, weight gain, edema, and bradycardia. The HCP should request that the primary care provider prescribe a lower dosage of the drug for the patient.