Transcript Ch. 27-Drugs Used to Treat Diabetes and Thyroid Diseasex

 Endocrine system is made up of glands (fig. 27-1 p. 338)
 endocrine glands secrete hormones that affect other
organs and glands
 pancreas and thyroid gland are part of the endocrine
system
 diabetes is MOST common endocrine disorder, it involves
the pancreas
 hyperthyroidism and hypothyroidism are thyroid
disorders
 Box 27-1 p. 338
 diabetes is a disorder in which the body cannot produce
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or use insulin properly
insulin is needed for glucose to move from the blood and
into the cells, cells need glucose for energy
pancreas secretes insulin
without enough insulin, sugar builds up in the blood,
blood glucose (sugar) is high, cells do not have enough
sugar for energy and cannot function
3 types of diabetes:
 Type I
 Type II
 gestational
diabetes cont…
 Type I:
 occurs often in: children, teens, young adults
 pancreas produces little or no insulin, rapid onset
 risk factors: family history, whites have higher risk than non-
whites
 Type II:
 occurs at any age, persons over 45 at higher risk
 pancreas secretes insulin, however the body cannot use it well,
slow onset
 frequent infections, wounds heal slowly, gum disease is common
 risk factors: overweight, lack of exercise, hypertension, African
Americans, Native Americans, Hispanics
diabetes cont…
 Gestational:
 develops during pregnancy
 usually goes away after baby is born
 mother is at risk for Type II diabetes later in life
 Signs and Symptoms of Diabetes:
 being very thirsty
 urinating often
 feeling hungry or tired
 losing weight without trying
 having sores that slowly heal
 having dry, itchy skin
 losing feeling or tingling in feet
 having blurred vision
 diabetes must be controlled to prevent complications
 blood sugars must be monitored daily or 3-4 x/day
 Type I: treated with insulin therapy, healthy eating and
exercise
 Type II: treated with healthy eating and exercise, oral
drugs, some need insulin
 hyperglycemia: high sugar in the blood
 hypoglycemia: low sugar in the blood
 see table 27-1 p. 339, for causes, signs/symptoms of hypo
and hyper- glycemia
Thyroid diseases
 the anterior pituitary gland secretes thyroid-stimulating
hormone (TSH).
 TSH stimulates the thyroid gland to release hormones
 Tri-iodothyronine (T3)
 Thyroxine (T4)
 Thyroid hormones regulate metabolism
 imbalances in thyroid hormone production may interfere
with:
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growth/development
carbohydrate, protein, fat metabolism
temperature regulation
cardiovascular function
lactation
reproduction
 goal for therapy: return person to normal thyroid state
**BOX 27-2 discusses hyperthyroidism and hypothyroidism**
Drug Therapy for Diabetes:
 insulin required to control type I diabetes
 if diet and exercise don’t control, oral agents are used to
treat type 2 diabetes
 many people with type 2 diabetes need insulin:
 if it is not controlled with other measures
 during increased physical and psychological stress, surgery,
infection, and pregnancy are examples
 goals for treatment:
 normal blood glucose levels
 fewer long-term complications from poorly controlled
diabetes
 Insulin
 hormone produced by the pancreas
 insulin is needed for glucose to enter skeletal muscles,
heart muscle and fat, also needed for protein and
lipid metabolism
 pancreas secretes insulin at a steady rate
 it is released in greater amounts when the blood glucose
rises, such as after meals
 insulin deficiency reduces rate of glucose transport into
cells, this results in hyperglycemia
Delegation Guidelines
Drug Class: Insulin
Insulin is given parenterally- by subcutaneous or intravenous
injection. Because you do NOT give parenteral dose forms, you do
NOT give insulin. Should a nurse delegate the administration of
such to you, you must:
-Refuse the delegation. Make sure to explain why. Do NOT just
ignore the request. Make sure the nurse knows that you cannot give
drug and why.
Some states allow MA-C’s to give insulin by the subcutaneous route or
by inhalation. Exubera is an insulin inhalation powder. If you are
allowed to give subcutaneous or inhaled insulin, make sure that:
 you receive necessary education about the drug and dose form
 you receive necessary education and training to perform skill
correctly
 a nurse is available to supervise you
 a nurse is available to monitor how the drug affects the person
Promoting Safety and Comfort
Drug Class: Insulin
Safety:
Insulin should not be allowed to freeze or be heated above 98°F,
therefore its stored in refrigerator. Once opened, bottle is
discarded in 30 days. After 30 days contents may not be
sterile, microbes may grow in bottle. Pre-filled insulin
syringes are stored vertically with the needle up. They are
stored for up to 30 days.
Having cold insulin injected is uncomfortable, therefore the
agency may keep insulin at room temperature (68°-75°F).
Insulin loses potency if kept above room temperature.
For most refrigerated insulins, the bottle or syringe is gently
rolled between the hands (not shaken) to warm and re-mix
the insulin. Label directions must be followed
Assisting With the Nursing Process
Insulin:
**To assist nurse you need to understand the onset, peak and
duration for type of insulin used (27-2 p. 341-342). You assist with
the planning and implementation steps.
Onset: time required for the insulin to have an initial effect or action
Peak: when the insulin will have the greatest effect
Duration: the length of time that the insulin is active in the body
ASSESSMENT: measure blood glucose, note person’s activity level,
note when and what the person eats
EVALUATION: report and record:
-signs and symptoms of hypoglycemia (see table 27-1), more likely to
occur when insulin reaches its peak
-signs/symptoms of hyperglycemia (see table 27-1)
-itching, swelling, redness at injection site: these signal allergic
reaction, tell nurse at once
Biguanide Oral Anti-Diabetic Agents:
 anti-diabetic agents prevent or relieve the symptoms of
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diabetes
ie: metformin (Glucophage)
metformin decreases the amount of glucose produced by the
liver, also decreases the amount of glucose absorbed by
the small intestine
by improving sensitivity more glucose enters skeletal muscle
cells and fat cells
drug is used alone or with other oral anti-diabetic agents
Assisting With the Nursing Process
metformin (Glucophage):
ASSESSMENT: measure blood glucose, note person’s activity level, note when
and what the person eats
PLANNING: oral dose forms are:
500, 850, 1000mg tablets
500 and 750mg extended-release tablets
500mg/5mL oral solution
IMPLEMENTATION: adult dosages:
 initial dose is 500mg 2x/day with morning and evening meal
 dosage is increased by adding 500mg to the daily dose each week, up to 2000
or 2500mg daily
 most persons need at least 1500mg daily for desired effects
 at dosages of 2000mg and more, one of the following is ordered:
-drug is given 3x/day: 1000mg with breakfast, 500mg with lunch, 1000mg with dinner
-850mg is given 3x/day with breakfast, lunch and dinner
EVALUATION: report and record:
-nausea, vomiting, anorexia, abdominal cramps, flatulence: usually mild and
tends to resolve, take drug with meals to reduce side effects
-malaise, muscle pains, respiratory distress, hypotension: signal a build-up of
lactic acid in blood
Sulfonylurea Oral Hypo-Glycemic Agents:
 hypo-glycemic agents are drugs that lower the blood glucose
level
 sulfonylureas lower blood glucose by stimulating the release
of insulin from pancreas
 they reduce amount of sugar produced and metabolized by
the liver
 drugs used when pancreas can still secrete insulin,
hypoglycemia may result if too much insulin is produced
Assisting With the Nursing Process
sulfonylureas:
ASSESSMENT: measure blood glucose, note person’s activity level,
note when and what the person eats
PLANNING: see table 27-3 pg. 343 for “oral dose forms”
IMPLEMENTATION: : see table 27-3 pg. 343 for “Initial Adult Dose”,
“Adult Dose Range”, “Duration”
EVALUATION: report and record:
-nausea, vomiting, anorexia, abdominal cramps: usually mild and
tends to resolve
-signs and symptoms of hypoglycemia (see table 27-1)
-anorexia, nausea, vomiting, jaundice: may signal liver toxicity
-sore throat, fever, jaundice, weakness: may signal changes in red
blood cells and white blood cells
-rash, itching: may signal allergic reaction: tell nurse at once, do not
give next dose until approved by nurse
Meglitinide Oral Hypo-Glycemic Agents:
 stimulate pancreas to secrete insulin
 drugs used when pancreas can still secrete insulin
 may cause hypoglycemia if too much insulin is
produced
 drugs used alone or with metformin
 have short duration of action, this reduces risk of
hypoglycemia
Assisting With the Nursing Process
meglitinides:
ASSESSMENT: measure blood glucose, note person’s activity level,
note when and what the person eats
PLANNING: see table 27-4 pg. 344 for “oral dose forms”
IMPLEMENTATION: : see table 27-4 pg. 344 for “Daily Adult Dose”
and “Maximum Daily Dose”, dose is given 1 minute to 30 mins
before meals, doses taken 2-4x/day in response to changing meal
times, skip a dose if meal is skipped
EVALUATION: report and record:
-nausea, vomiting, anorexia, abdominal cramps: usually mild and
tends to resolve
-signs and symptoms of hypoglycemia (see table 27-1)
-anorexia, nausea, vomiting, jaundice: may signal liver toxicity
-sore throat, fever, jaundice, weakness: may signal changes in red
blood cells and white blood cells
-rash, itching: may signal allergic reaction: tell nurse at once, do not
give next dose until approved by nurse
Thiazolidinedione Oral Anti-Diabetic Agents:
 TZD oral agents make muscle and fat cells more sensitive to insulin, this
lowers blood glucose levels
 TZDs also may decrease the amount of glucose produced and released by liver
 used when pancreas can still produce insulin
Assisting With the Nursing Process
TZDs:
ASSESSMENT: measure blood glucose, note person’s activity level, note when
and what the person eats
PLANNING: see table 27-5 pg. 345 for “oral dose forms”
IMPLEMENTATION: : see table 27-5 pg. 345 for “Daily Adult Dose” and
“Maximum Daily Dose
EVALUATION: report and record:
-nausea, vomiting, anorexia, abdominal cramps: usually mild and tends to resolve
-signs and symptoms of hypoglycemia (see table 27-1)
-anorexia, nausea, vomiting, jaundice: may signal liver toxicity
-weight gain: common to gain a few pounds, may be edema though
Alpha-Gluocosidase:
 acarbose (Precose)
 miglitol (Glyset)
Acarbose (Precose)
 inhibits a pancreatic and GI enzymes used to digest sugars
 this results in delayed glucose absorption and lowers
hyperglycemia after eating
 drug does NOT cause hypoglycemia
 may be used with other oral anti-diabetic drugs
Assisting With the Nursing Process
acarbose (Precose):
ASSESSMENT: measure blood glucose, note person’s
activity level, note when and what the person eats
PLANNING: oral dose forms: 25, 50, 100mg tablets
IMPLEMENTATION: : initial oral dose is 25mg 3x/day,
given at start of each main meal, dosage is adjusted at 4-8
week intervals based on blood glucose levels.
Maintenance dose is usually 50-100mg, 3x/day
EVALUATION: report and record:
-abdominal cramps, diarrhea, flatulence: usually mild and
tends to resolve
-signs and symptoms of hypoglycemia (see table 27-1)
-anorexia, nausea, vomiting, jaundice: may signal liver
toxicity
Assisting With the Nursing Process
Miglitol (Glycet):
ASSESSMENT: measure blood glucose, note person’s activity
level, note when and what the person eats
PLANNING: oral dose forms: 25, 50, 100mg tablets
IMPLEMENTATION: : initial oral dose is 25mg 3x/day, given at
start of each main meal, dosage is adjusted at 4-8 week
intervals based on blood glucose levels. Maintenance dose is
usually 50-100mg, 3x/day, maximum dosage is 100mg, 3x/day
EVALUATION: report and record:
-abdominal cramps, diarrhea, flatulence: usually mild and
tends to resolve
-signs and symptoms of hypoglycemia (see table 27-1)
Drug Therapy for Thyroid Disease
 2 classes of drugs are used to treat thyroid disease:
 Thyroid replacement hormones: used for tx of
hypothyroidism
 Anti-thyroid agents: suppress the production of
thyroid hormones
Delegation Guidelines
Drug Therapy for Thyroid Disease
Some drugs used to treat thyroid diseases are given
parenterally. Because you do NOT give parenteral dose
forms, you do NOT give insulin. Should a nurse delegate
the administration of such to you, you must:
-remember that parenteral dosages are often very
different from dosages for other routes
-Refuse the delegation. Make sure to explain why. Do
NOT just ignore the request. Make sure the nurse knows
that you cannot give drug and why.
Thyroid Replacement Hormones
 Hypothyroidism is treated by replacing the thyroid hormones T3, T4
 Thyroxine (T4) is partially metabolized into T3
 Therapy with T4 replaces both T3 and T4
Assisting With the Nursing Process
Thyroid replacement hormones:
ASSESSMENT: measure vitals, use apical site for heart rate, ask about bowel
elimination, measure weight, observe for signs of hyperthyroidism (box
27-2)
PLANNING: see table 27-6 for “oral dose forms”
IMPLEMENTATION: see table 27-6 for “Adult Dosage Range”
EVALUATION: report and record:
- Signs and symptoms of hyperthyroidism (box 27-2)
Anti-Thyroid Drugs:
 block formation of T3 and T4 in thyroid gland, they do not
destroy any that already has been produced
 once therapy is started it takes a few days to 3 weeks to notice
improvement of symptoms
 examples: propylthiouracil (PTU, Propacil)
methimazole (Tapazole)
Assisting With the Nursing Process
Anti-Thyroid Drugs:
ASSESSMENT: measure vitals, measure weight, observe for signs of hypothyroidism
(box 27-2)
PLANNING: oral dose forms:
PTU: 50 and 100mg tablets
Tapazole: 5 and 10mg tablets
IMPLEMENTATION: PTU initial dose is 100-150mg every 6-8 hours, ranges up to
900mg/day, maintenance dose is usually 50mg 2-3x/day
Tapazole: initial dose is 5-20mg every 8 hours, maintenance dose is 5-15mg daily
EVALUATION: report and record:
- rash, itching: often occur in first 2 weeks of therapy, usually resolve
- headache, salivary gland and lymph node enlargement, loss of taste, usually mild
and resolve
- sore throat, fever, jaundice: may signal problems with blood cell production
- anorexia, nausea, vomiting, jaundice: may signal liver toxicity
- decreased urine output, bloody or smoky-colored urine: may signal kidney toxicity