Oral anti-diabetic

Sulfonylureas stimulates pancreas to secrete more insulin; oldest & largest group; take 30min before meal; can cause HYPOGLYCEMIA & WEIGHT GAIN; watch for allergies to sulfur based drugs; used caution in pts. w/impaired live function glipizide(glucotrol) glyburide(Micronase, Diabeta) glyburide(Glynase Prestab) glimepride(Amaryl) Meglitinides stimulates pancreas to secrete more insulin; 30min before meal; shorter duration, peaks w/in 45min; can cause HYPOGLYCEMIA repaglinide (Prandin) nateglinide (Starlix) Biguanides - hepatic glucose production; improves insulin sensitivity, increases use of glucose by muscle & fat cells; 30 min before food to GI upset, gas, diarrhea; contraindicated in pts. w/KIDNEY & LIVER problems & hx. of ALCOHOLISM; DOES NOT CAUSE HYPOGLYCEMIA metformin(Glucophage XR, glumetza) metformin (Fortamet, Riomet) Gliptins inceretin mimetic, insulin release in response to meals; ADVANTAGE: satiey (being full), wt.loss; type 2 only sitagliptin (Januvia) exenatide (Byetta) Alpha-glucosidase inhibitors take w/ 1st bite of each main meal; slows down ingestion of carbs into system; works on after-meal blood sugars; DIARRHEA & BLOATING; can cause HYPOGLYCEMIA use

milk or glucose tabs/gel to treat hypoglycemia acarbose (Precose) monitor LFT miglitol (Glyset) TZDs- insulin sensitivity w/o regards to meals; stimulates receptors on fat, muscle & liver cells; effectiveness of circulating insulin; does NOT cause HYPOGLYCEMIA; can take 4-6 weeks to see an effect in blood sugar; use causiosly in LIVER DISEASE & CHF; monitor liver enzymes, can cause fluid retention & wt. gain piolitazone (Actos) rosiglitazone (Avandia) Preventing cardiovascular disease- low dose ASA, vasodilating effect (captopril, vasotec, lotension, lisinopril); statinminimizes plague formation (lipitor, crestor, zocar); drugs can proteinuria & slow progression of nephropathy Nursing assessment- vitals, blood sugar, drug allergies, urinalysis (ketones & glucose), neuro (orientation, reflexes), skin, CV- pulse, BP, resp; cardiovascular Nursing diagnosisimbalanced nutrition, disturbed sensory perception, risk for skin infection, knowledge deficit r/t drug therapy Interventions- monitor blood glucose, nutritional status, client teaching, monitor during stress, adverse effects, compliance, exercise

THYROID AGENTS HYPOthyroidism S&S- dry skin & hair, lack of energy, muscle weakness, apathy, memory impairment, emotional changes, slow speech, abnormal menses, slow thinking process, wt. gain, constipation, cold intolerance, goiter, puffy face & eyelids Levthyroxine sodium (Synthroid) liothyronine sodium (Cytomel) liotrix (Euthroid, Tyrolar) thyroid (Thyrar) Major Side effectssymptoms related to hyperthyroidism, irritability, wt. loss, palpitations, tachycardia, BP, drugs action of insulin & oral hypoglycemia (mat see false blood sugars) Nursing management- lifelong therapy (take as prescribed), best taken in morning on empty stomach to prevent insomnia, wt., blood tests, effect of anticoagulant, limit intake of caffeine, estrogen replacement therapy effectiveness, drugs can effectiveness of insulin & oral diabetic drugs, intolerance to temp changes, monitor pulse rate, consistent time (to maintain blood levels) ANTI-THYROID AGENTS HYPERthyroidism S&S- body metabolism, nervousness, wt. loss, tachycardia, body temp., tremors, excessive sweating, trouble sleeping, exophthalmos (bilging eyes), palpitations, irritability, anxiety Causes- hypersecretion of thyroid, tumor, pregnancy, surgery

methimazole (Tapazole)longer life; side effects severe- fever, rash, pruritis, agranulocytosis, pancytopenia, hepatitis, jaundice propylthiouracil (PTU) short life, given every 8 hrs to maintain blood levels Strong iodine solution (lugols solution [treat thyroid storm], potassium iodine solution) Sodium iodine (Iodotope) Propranolol (inderal) rate, betablocker, helps manage tachycardia, palpitations, sweating, tremors IODINE SOLUTIONSused to size of thyroid gland before thyroidectomy, short term treatment, metallic taste, gastric irritation Radioactive Iodine (I-131)used to destroy enough of the gland so that levels return to normal, diagnostic tests, pts. should not be in close contact w/ children or pregnant women for 1week following, emits small amt of radiation, lactation PARATHYROID Hypoparathyroidism- rare, hypocalcemia, PTH, Drugs used- dietary supplements of calcium & vit D, also used in pts. w/chronic renal dialysis Calcifediol (Calderol) Calcitriol (Rocaltrol) Dihydrotachysterol (hytakerol) Adverse effects- metallic taste, N&V, dry mouth, constipation, anorexia, weakness, headache, somnolenc (sleepiness), irritability, urination PT. Teaching/ management- avoid antacids (contributes to hypermagnesmia), caution

in pts. w/ kidney stones & hypercalcium, monitor calcium magn. & phosphate levels HyperparathyroidismPTH, PAGETS DISEASE, postmenoposal osteoperosis, hypercalcium malignancy, Osteolytic bone lesions, Osteomalacia (rickets) RISK FACTORS for osteoporosispostmenapause, alcohol or caffeine, anorexia, tobacco, inactivity, testosterone deficiency, lack of vit D or calcium (use of corticosteroids & immunosuppressents) Bisphosphonates- drugs act to slow down or block bone reabsorption, lower calcium levels, monitor renal pts., full glass of water & remain upright for 30min after taking fosamax & actonel, beverages other than water absorption & effectiveness, avoid antacids, take on empty stomach Etridronate (didronel) Pamidronate (aredia) Risedronate (actonel) Zoledronic acid (zometa) Alendronate (fosamax) Side effects- N&V, abdominal pain, esophageal irritation Calcitonins- salmon & human given by injection & nasal spray, bone density, should not be used during pregnancy, use caution in renal dysfunction & pernicious anemia PITUITARY AGENTS Growth Hormonestimulates skeletal, muscle, & tissue growth, PROLONGED USE ENDOGENOUS INSULIN & CAN LEAD TO DM, used in treatment of dwarfism, expensive,

enzymes in GI inactivates drug, SC or IM, Somatrem (protrpoin) Somatropin (humatrope) Anti-gowth hormone- used to treat gigantism, acromegaly (arms really long) octreotide (Sanostatin) bromocriptine (Parlodel) pegvisomant (Somavert) Anti-Diuretic Hormone ADH- regulates the reabsorption of water by the kidneys, used to treat Diabetic Insipidus DI, kidneys secreting massive amounts of dilute urine, intense thirst Uses- DI, hemophilia A, Von Willebrands Disease, noctural enuresis (bed wetting), post-op abdominal distention Vasopressin (pitressin synthetic) Desmopressin (DDAVP) Side effects- drowsiness, vertigo, sweating, headache, tremors, abdominal cramps, N&V Management- I&O, F&E, urine specific gravity, BP, pulse, wt. Oxytocin- stimulates uterine contractions, used to expel placenta, post-partum bleeding, milk let-down Management- asses vitals & fetal rate, monitor frequency, strength, rate and duration of contractions, monitor I&O Androgens & anabolic steroids- male sex hormones Use- hypogonadism, impotence, cryptorchidism (undiscended testes), endometriosis, fibrocystic breast disease, delayed puberty, carcinoma of breast, delayed growth, short stature, postmenopausal osteoporosis

Testosterone (androgen) (depo-testosterone, depandro100)- slow progression of estrogendependent breast cancers Delatesryl Andrgel 1% Testerone pellets Teslac Halotestin Side effects- abdominal pain, nausea, insomnia, diarrhea, sexual drive, constipation, hives, redness @ injection site, mouth soreness Pt teaching- wt. weekly, monitior sodium intake, liver function, glucose, lipids - pregnancy, live disease, prostate-gland disorders, child Anabolic Steroids- interrupt growth, stop bone growth, water retention, liver & kidney damage Longterm effectsCV- BP, HDL (good cholesterol), MI, stoke Liver- hepatitis, cance CNS- aggression, hostility, combativeness, withdrawal symptoms Reproductive sysimpotence, amenorrhea, priapism (continued erection of penis) Metabolic- f&e imbalance, atherosclerosis Derm- acne Impaired bone growth