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LaGuardia Community College
City University of New York
Practical Nursing Program
DRUGS AFFECTING THE ENDOCRINE SYSTEM
SCL 103_Worksheet #4
By
Anaïse Ikama
Rosemarie Mayne
Catherine Majorie
Joseph Charles
Lavern Simms
Juna Lucas
Zoya Poltilov
Kadian Green
Majorie Johnson
DRUGS AFFECTING THE ENDOCRINE SYSTEM
INSULINS AND ORAL HYPOGLYCEMIC AGENTS
1.
Diabetes mellitus is a disease that causes abnormal metabolism of:
-Kidneys
-Nerves Heart and blood vessels
2.
“Insulin-dependent diabetes” (IDDM) is also known as:
IDDM is also referred to as a type 1 diabetes or juvenile diabetes.
3.
“Type II diabetes” is also known as:
A type 2 diabetes is also known as a non-insulin-dependent diabetes mellitus or
adult-onset diabetes.
4.
“Gestational diabetes” (GDM) is:
“Gestational
diabetes” is a type of diabetes that occurs during pregnancy and disappears on
delivery.
5.
“Hypoglycemia” is: low blood glucose, under 70mg/dl.
6.
“Hyperglycemia” is high blood glucose.
7.
“Polydipsia” is excessive thirst.
8.
“Polyuria” is excessive urination.
9.
The dietary prescription for a person with diabetes mellitus, according to the
American Diabetic Association (ADA), should be composed of:
According to the American Diabetic Association (ADA), the dietary prescription
for a person with diabetes mellitus should be composed of: 60-70%
carbohydrates, 30% fats 15-20% proteins.
10.
11.
What is the source of endogenous insulin? What are the primary animal
sources of exogenous insulin?
The endogenous insulin derived from the beta cells in the pancreas.
And the primary animal sources of exogenous insulin are pork and
beef.
What methods are used to produce human exogenous insulin?
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The human exogenous insulin are commercially prepared by changing the
different amino acid of pork insulin or by using deoxyribonucleic acid (DNA)
technology.
12.
Why can’t insulin be administered orally?
Insulin cannot be administered orally because digestive enzymes destroy their
effectiveness.
13.
Do exogenous insulin differ in terms of onset, peak, and duration of action?
Describe the differences.
-The rapid-acting exogenous insulin includes lispro and regular insulins. Lispro
insulin is a rapid-acting insulin…[is characterized as clear and colorless. Lispro
has an immediate onset in 5 to 15 minutes after administration, a peak of effect
occurs in 30 to 1 hour and the duration of action 2 to 4 hours. Whereas, the
regular insulin has an onset in 0.5 to 1 minute, a peak of 2-4 hours and duration of
action is 5-7 hour.
-Short-acting insulin has an onset of action in 30 minutes to 1 hour. The peak of
action occurs in 2-4 hours, and the duration of action is 6-8 hours.
-Intermediate-acting insulins such as neutral-protamine-Hagedorn (NPH) and
Humulin N, which contain a protein that prolongs the action of the insulin, have
onset of action in 1-2 hours, peaks in 14-20 hours and the duration of 18-24 hours.
-A long-acting insulin is Humilin U, and is absorbed slower than other insulins
because of its large crystals, which dissolve slowly. Therefore, prolonging the
durationtime. Long acting insulin acts in 4-8 hours, peaks in 14-20 hours and lasts
24-36 hours.
-“A newer long-acting, Lantus… is the first long-acting recombinant DNA
(rDNA) human insulin approved by the Food and Drug Administration (FDA) for
clients with types 1 and 2 diabetes. It has a 24 - hour duration of action…”
(Pharmacology book. Page 778).
14.
What does “U 100” mean?
“U-100” mean 100 units per milliliter, is also strength insulin commonly used in
the United States.
15.
What kind of a syringe is used to measure U-100 insulin?
A 1-milliliter syringe is used to measure U-100 insulin.
16.
Why is it important to teach the patient to rotate insulin sites?
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Rotating insulin injection sites is important because it keeps skin and tissues
healthy also prevent lipodystrophy (a medical condition characterized by
abnormal or degenerative conditions of the body's adipose tissue).
17.
What effects does the long-term use of one site for inject have on insulin
absorption?
The site needs to be rotated, if not it will become irritated, and may become
infected, the area may also become so harden that it will be impossible to use.
18.
With an increase in activity and exercise, what adjustment may be required
.in the insulin dose?
With an increase in activity and exercise, the clients must make appropriate
insulin adjustments based on blood glucose level.
19.
When are patients who are receiving fast-acting, intermediate-acting, or
extended-action insulin most likely to develop hypoglycemia?
Fast –Acting
Intermediate –Acting
Extended -Acting
Onset: 1-2 hrs.
Peak effect: 4-12 hrs.
Duration: 24 hrs.
Onset: 1-3 hrs.
Peak effect: 6-14 hrs.
Duration of effect: 24 +
Onset: 6 hrs.
Peak effect: 17-18 hrs.
Duration: 36 hrs.
20.
When are blood or urine test for glucose performed in relation to the time of
insulin administration?
In relation to the time of insulin administration, blood and urine need to be
checked every 4 to 8 hrs.
21.
Differentiate between the symptoms of hypoglycemia and hyperglycemia:
HYPOGLYCEMIA
Is caused by the presence of too much insulin, sometimes it is caused by too little
food or too much exercise.
HYPERGLYCEMIA
Is the result of too little insulin (a lack of insulin).
22.
What is the treatment for hypoglycemia and hyperglycemia?
Hypoglycemia: The acute treatment for hypoglycemia is glucose by mouth or by
rectum; dextrose intravenously, or glucagon intramuscularly or subcutaneously.
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Hyperglycemia: High blood sugar levels can be reduced with caloric restriction,
regular exercise, oral hypoglycemic agents, insulin, and withholding offending
drugs.
23.
If uncertain whether a patient is hypoglycemic, what action should be taken?
Lower blood sugar glucose, by stimulating the release of insulin from the
pancreas and increasing the sensitivity to insulin at receptor sites.
24.
Describe the procedure for mixing two insulins in the same syringe?
Clean the rubber tops of the insulin bottles, draw in air and inject it into the
insulin bottle then withdraw the needle. Draw up the amount of units of air and
inject it in to the regular insulin bottle, first withdraw the regular insulin. Insert
needle into the other insulin and withdraw the correct amount of insulin.
Administer the two insulins immediately.
Two different lente insulin, they will mix well together.
25.
What temperature should insulin be before being administered?
Insulin should be refrigerated until needed.
26.
What types of insulin can be mixed in the same syringe and stored for use at
a later time (e.g. a to 2 weeks later versus used immediately)?
Regular insulin can be mixed with protamine or zinc insulin in the same syringe.
When mixing NPH and short-acting regular insulin, you can use it right away or
refrigerate it to be used at a later time.
27.
How do oral hypoglycemic agents differ from insulin?
Oral hypoglycemic agents are used to lower blood glucose level in the blood,
while insulin is released from the beta cells of the islets of langerhans in response
to an increase in blood glucose
28.
Which types of diabetes mellitus requires treatment with insulin and which
type may be treated with an oral hypoglycemia?
Insulin I is an insulin- dependant diabetes mellitus that requires treatment with
insulin. Type ii diabetes is a non-insulin dependent that can be treated with an oral
hypoglycemic agent.
29.
What type of allergic should you check the chart and the patient for, before
initiating therapy with an oral hypoglycemic agent?
Antibodies develop over time in persons taking animal insulin. This can slow the
onset of insulin action and extend its duration of action. Antibody development
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can cause insulin resistance and insulin allergy. Skin tests with different insulin
preparations may be performed to determine whether there is an allergic effect.
Human and regular insulin produce fewer allergens.
30.
Differentiate between the terms onset, peak, and duration in relation to
insulin therapy:
Onset: is the length of time before insulin reaches the bloodstream and begins
lowering blood glucose.
Peak time: the time during which insulin is at its maximum strength in terms of
lowering blood glucose levels.
Duration: is the length it takes the insulin to continue lowering blood glucose.
THYROID HORMONES.
1.
Thyroid replacement hormones are used to replace what hormones secreted
by the thyroid.
The thyroid replacement hormones are used to replace the thyroxine (T4) and
triiodothyronine (T3) hormones.
2.
Name the thyroid replacement hormones and their ingredients:
-Levothyroxine (Levothroid, Synthroid)
-Leothyronine (Cytomel) synthetic T3 drug
-Liotrix (Euthroid, Thyrolar) is a mixture of levothyroxine sodium and ---liothyronine sodium in a 4:1 ratio.
3.
Of the thyroid products available which one has the most rapid onset of
action?
The most rapid onset of action of the thyroid product is Leothyronine (Cytomel).
4.
Why should a patient taking Liotrix be told not to switch between Euthroid
and Thyrolar?
Because (Euthroid and Thyrolar) is a mixture of levothyroxine and liothyronine
sodium in a 4:1 ratio. There is no significant advantage of switching one over the
over and also thyroid drugs are seldom used.
6.
What are the drugs used to treat hyperthyroidism?
Propylthiouracil (PTU) and methymazole(Tapazol) are effective thioamide
antithyroid drugs useful to treat hyperthyroidism
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7.
8.
9.
What are the side effects to assess when propyklthiouracil or methimazole
are administered?
The side effects to assess when propyklthiouracil or methimazole are
administered are: drowsiness headache, vertigo. GI: diarrhea, drug- induced
hepatitis, loss of taste, nausea, paratitis, vomiting, and rash skin discoloration
uriticoria.
What laboratory studies should be performed at periodic intervals for clients
taking propylthiouracil?
Client should be monitored prior to therapy, monthly during initial therapy and
every 2-3 monthss throughout therapy.
If a patient has hyperthyroidism, would he be most likely to require a smaller
or larger dose of a digitalis glycoside?
If a patient has hyperthyroidism it would be more likely to require a small dose of
digitalis because digitalis glycoside is used with patient with congestive heart
failure.
CORTICOSTEROIDS
1.
Define “corticosteroids:
Corticosteroids is any several steroid hormones secreted by the cortex of the
adrenal gland or manufactured synthetically for used of drug.
2.
When are glucocorticoids commonly prescribed?
Glucocorticoids are commonly prescribed for adrenocortical insufficiency and
inflammatory to treat inflammation or immunosuppresure effect. Inhalation for
treatment bronchial asthma and bronchial inflammation are also treated for
seasonal rhinitis.
3.
What endogenous hormone is known as a glucocorticoid?
Cortisol is a potent hormone known as a glucocorticoid that affects the
metabolism of carbohydrates, proteins and fat, but especially glucose.
4.
Do corticosteroids cures a disease? Explain.
Corticosteroids such as glucocorticoids treat many diseases and health problems
including… ocular and vascular inflammation… head trauma with cerebral edema
and hepatitis… allergic condition include asthma, drug reaction… and debilitation
condition. On the other hand, mineralcorticoids, the second type of
corticosteroid…maintains fluid balance by promoting the reabsorption of sodium
from the renal tubules (page768-770).
5.
What possible side effects may be observed with the administration of
glucocorticoids?
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6.
Because of their many mineralorticoid effects, glucocorticoids can cause sodium
absorption from the kidney, resulting in water retention, potassium loss, and
increased BP. The side effects of glucocorticoids…include increased blood sugar,
abnormal fat deposit in the face and trunk (moon face and buffalo hump)…muscle
wasting, edema…peptic ulcer and growth retardation. Long-term use of
glucocorticoid drugs can cause adrenal atrophy (loss of adrenal gland function).
(Pharmacology: A Nursing Process Page 769).
What time of the day is best to administer corticoisteroids?
The best time of the day to administer corticoisteroids is during mealtime.
7.
Why would corticosteroids and diuretics produce or enhance hypokalemia
when give simultaneously?
By losing water through urination (diuretics) and decrease edema inflammation
(Corticosteroids), the client loses potassium, and becomes hypokalemic.
8.
Why must patients, taking corticosteroids, be cautioned to avoid contact with
persons with an infection?
Clients are instructed to avoid persons with an infection because corticosteroid
drugs suppress the immune system.
9.
What instructions need to be given to a patient taking corticosteroids?
Client should be advised to take the drugs as prescribed, take cortisone…with
food…[because] glucocorticoids can irritate the gastric mucous and cause a peptic
ulcer. Clients should eat food reach in potassium, such as fresh and dried fruits,
vegetables, meats and nuts. They also should report signs and symptoms of drug
overuse…to avoid possible rebound effect (page 772).
10.
What baseline assessments should be completed for patients taking any type
of corticosteroids?
For patients taking any type of corticosteroids baseline assessment such as: vital
signs (blood pressure, temperature, pulse and respirations). Pulmonary function
tests may be assessed periodically during and for months after a transfer from
systemic to inhalation corticosteroids, as well as client’s weight and urine output
should be completed. Laboratory test results, especially serum electrolytes and
blood sugar have to be monitored.
12.
What types of eye disorders are treated using corticosteriods?
Types of eye disorders that are treated using corticosteroids include iritis and
panuveitis.
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