Endocrine System

(General Key Points)

N203
ATI (Unit 11)
Endocrine System -
 Carbohydrate, fat, and protein metabolism are all affected by diabetes
 All people with type 1 diabetes require insulin for management of blood glucose
 People with type 2 diabetes require insulin when undergoing surgery,
experiencing high levels of physiologic stress (e.g. infection), and during
pregnancy.
 Insulin is classified two ways:
 Type – How it’s made
 Natural or regular
 Addition of protein to prolong duration (NPH)
 Insulin analogs
 Lispro and Aspart insulins have shorter durations than Regular insulin
 Glargine insulin has a longer duration than Regular insulin.
 Group – Time-course-of-action
 Oral hypoglycemics used for type 2 diabetes when diet/exercise are not enough
Oral Hypoglycemics

N203
ATI (Unit 11)
Endocrine System -1A
 Agent Adverse Effect
Sulfonylureas Meglitinides (fast, short-lived)
1st generation Repaglinide (Prandin)
Tolbutamide (Orinase) (30m ac 1st meal) ( risk hypo)
Chlorpropamide (Diabinese)
2nd generation ( duration) Biguanides (take ĉ food)
Glipizide (Glucotrol) – 30 min ac 1st meal Metformin (Glucophage)
Glyburide (DiaBeta) – QD with 1st meal (Don’t promote insulin release 
Glimepiride (Amaryl) – QD with 1st meal don’t  hypoglycemia)
Thiazolidinediones α-Glucosidase Inhibitor
Rosiglitazone (Avandia) Acarbose (Precose)
(Given ŝ regard to food, usually 1x/day) (With 1st bit at 3 meals/day)
Insulin
(1 of 2)

N203
ATI (Unit 11)
Endocrine System -
 Type Duration Route Time Onset Peak
Lispro Short, Quick
SC / Pump 15 m ac 15 – 30 m ½ – 2½ hr
(Humalog) (3 - 6 h)
Aspart Short, Quick
SC / Pump 5-10 m ac 10 – 20 m 1 – 3 hr
(Novolog) (3 – 5 h)
Regular Short, Slower SC / Pump /
30 m ac 30 – 60 m 1 – 5 hr
(Humulin R) (6 – 10 h) IH / IM / IV
NPH Intermediate 2x/day
SC 1 – 2 hr 6 – 14 hr
(Humulin N) (16 – 24 h) (same time)
Glargine Long 1x/day
SC 70 min None
(Lantus) (24 h) (same time)
 Insulin: promotes cellular GLC uptake // GLCGLYC // moves K+ into
cells
 Type 2 may need insulin: severe renal/liver disease // neuropathy // Severe
stress
 Insulin also used: Tx of hyperkalemia // Tx of DKA and HHNS.
Insulin
(2)

N203
ATI (Unit 11)
Endocrine System -
Adverse Effects:  Hypoglycemia  Lipohypertrophy
Contraindications/Precautions: ♀ (?) Only regular insulin by IV
Interactions: 
 Additive GLC  effect with sulfonylurea, meglitinides, β-blocker, EtOH
 Thiazide diuretics, glucocorticoids   glucose-reducing effects
Education: 
 When mixing short-acting and long-acting  draw short-acting first and
then longer-acting in order to keep longer-acting from contaminating shorter-
acting.
 Disperse particles in suspension before drawing insulin.
 Glargine is never IV and should not be mixed
 Use one general area to produce consistent results (rate
thigharmabdomen)
 GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
 Sulfonylureas
(Oral Hypoglycemics)

N203
ATI (Unit 11)
Endocrine System -
 Proto: 1st – tolbutamide / 2nd – glipizide
Expected Action: Others: 1st – chlorpropamide, 2nd – glyburide
 Promote insulin release from the pancreas
 With diet/exercise, control blood GLC in type 2
Therapeutic Uses:
diabetes
Adverse Effects:  Hypoglycemia (abruptSNS / slowCNS symptoms)
Contraindications/Precautions: ♀ (C) Pregnancy/lactation
Diabetic ketoacidosis Renal/liver dysfunction
Interactions:  EtOH: disulfiram-like reaction
 EtOH, NSAIDs, sulfonamides, ranitidine, cimetidine  additive
hypoglycemic
 Concurrent use of β-blockers may mask awareness of hypoglycemic,
specifically SNS symptoms of tachycardia, palpitations, and diaphoresis.
Education: 
 GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
 Meglitinides
(Oral Hypoglycemics)

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: repaglinide (Prandin) — Others: nateglinide (Starlix)
 Promote insulin release from pancreas
Therapeutic Uses:  Type 2 diabetes, with diet and exercise
 Often use with metformin
Adverse Effects:  Hypoglycemia

Contraindications/Precautions: ♀ (C) Diabetic ketoacidosis
Hepatic dysfunction
Interactions: 
 Gemfibrozil (Lopid)  inhibition of repaglinide metabolism
Education: 
 GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
 Biguanides
(Oral Hypoglycemics)

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: Metformin (Glucophage)
  muscular uptake and use of
 Inhibit gluconeogenesis in liver
glucose
Therapeutic Uses:  Type 2 diabetes
 Polycystic ovarian syndrome (PCOS)
Adverse Effects:  GI effects (nausea, vomiting, weight loss 6-8 lb)
 Vitamin B12 and folate deficiency d/t altered absorption
 Lactic acidosis (hyperventilation, myalgia, sluggishness) – 50% mortality
Contraindications/Precautions: ♀ (B) Diabetic ketoacidosis
Renal, hepatic, cardiac failure Severe infection, shock, hypoxia
Interactions:  EtOH -  risk lactic acidosis with concurrent use
Education: 
 GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
Thiazolidinediones

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: rosiglitazone (Avandia) — Others: pioglitazone (Actos)

 Increased cellular response to insulin by  insulin resistance

Therapeutic Uses:  Type 2 diabetes with diet and exercise
 Fluid  Hepatoto
Adverse Effects:   LDL
retention xicity
Contraindications/Precautions: ♀ (C) DKA & heart failure
Mild heart failure d/t fluid retention effects
Interactions:  Insulin   risk for hypoglycemia
 Gemfibrozil (Lopid)   metabolism of rosiglitazone   hypoglycemia
Education: 
 GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
α-Glucosidase Inhibitor
(Oral Hypoglycemics)

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: acarbose (Precose) — Others: miglitol (Glyset)
 Slow carbohydrate absorption and digestion
Therapeutic Uses:  Control postprandial blood sugar in type 2 diabetes
Adverse Effects:  Risk for anemia d/t  iron absorption
 Hepatotoxicity with long-term use
 Intestinal effects (abdominal distention, cramping, hyperactive bowel
sounds, diarrhea, flatulence)
Contraindications/Precautions: ♀ (B) Diabetic ketoacidosis
GI disorders (inflammatory disease, ulceration, obstruction)
Interactions:  Insulin, sulfonylureas   risk of hypoglycemia
 Metformin  Additive GI effects and risk for hypoglycemia with
concurrent use.
Education:  Take medication with first bite.
 Postprandial blood glucose < 180 mg/dL  HgA1c < 7%
For Insulin Overdose

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: Glucagon

   
  gluconeogenesis
glycogenolysis glycogenesis
Therapeutic Uses:  Hypoglycemia 2º insulin overdose
  GI motility while undergoing radiological procedures of stomach /
intestines
Adverse Effects:  GI distress (turn on left side to  risk of aspiration)

Contraindications/Precautions: ♀ (?)
Pheochromocytoma d/t catecholamine stimulating effects
 Ineffective for starvation-related hypoglycemia because depleted
glycogen stores.
Education:  Provide food as soon as patient is able to eat.
Thyroid Hormones

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: levothyroxine (Synthroid) — Others: liothyronine, liotrix
 Synthetic thyroxine   metabolic rate, protein synthesis, cardiac output,
renal perfusion, oxygen use, body temperature, blood volume, and growth
processes.
Therapeutic Uses:  Hypothyroidism (all forms)
 Emergency treatment of myxedema coma by IV
Adverse Effects: 
 Hyperthyroidism (anxiety, tachycardia, palpitations,  appetite, heat
intolerance, fever, diaphoresis, and weight loss)
Contraindications/Precautions: ♀ (A) Thyrotoxicosis and MI
Cardiovascular problems and pregnancy
Interactions:  Levothyroxine breaks down vitamin K   Warfarin effects
 Many antiseizure and antidepressant meds like carbamazepine,
phenytoin, phenobarbital, sertraline  levothyroxine metabolism
 Binding agents (iron, calcium, antacids, cholestyramine)and sucralfate 
levothyroxine absorption
Antithyroid Medication

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: propylthiouracil — Others: methimazole (Tapazole)
 Block thyroid hormone synthesis // Prevent oxidation of Iodine //  T4  T3
 Grave’s
Therapeutic Uses:  Adjunct to thyroid irradiation
disease
 Produce euthyroid state prior to thyroid  Emergency
removal thyrotoxicosis treatment
 Overmedication  hypothyroidism  (drowsiness,
Adverse Effects:
weight gain, edema, bradycardia, cold intolerance, dry skin)
 Agranulocytosis  Monitor for early signs (fever, pharyngitis)  Tx:
Neupogen
Contraindications/Precautions: ♀ (D) Pregnancy
Marrow depression or immunosuppression
Interactions:   anticoagulant effects
Education:  Take at consistent time and with meals ( GI distress)
 Hyperthyroidism may get β-adrenergic blocker (propranolol) to 
tremors
Radioactive Iodine (I131 )

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: Radioactive iodine

 Destroys thyroid cells at high doses

 Hyperthyroidism (  Thyroid cancer (
Therapeutic Uses:
dose) dose)
  doses: Thyroid function studies
 Marrow suppression (anemia, leukopenia,
Adverse Effects:
thrombocytopenia)
 Radiation sickness: Hematemesis, epistaxis, intense nausea, vomiting
Contraindications/Precautions: ♀ (X) Pregnancy, childbearing age, lactation
Interactions:  Reduced uptake with antithyroid meds
Education:  Take on empty stomach
 Void frequently // Limit contact to ½ hr/day/person //  fluids
 Dispose of body wastes per  Avoid coughing and
protocol expectorating
Nonradioactive Iodine

N203
ATI (Unit 11)
Endocrine System -
 Proto: strong iodine solution (Lugol’s solution) — Others: sodium
Expected Action: iodide, potassium iodide
  iodide levels   uptake (by thyroid),  thyroid hormone production,
and block release of thyroid hormones into blood stream.
 Development of euthyroid state and  size prior to
Therapeutic Uses:
removal
 Emergency treatment of thyrotoxicosis
Adverse Effects: 
 Iodism symptoms d/t corrosive property (metallic taste, stomatitis, sore
teeth and gums, gastric distress). – drink through straw // take ĉ food // OD
prevention
Contraindications/Precautions: ♀ (D) Pregnancy
Interactions:  Foods high in iodine (fish, salt)  Risk for iodism
Education:  Dilute Lugol’s solution with juice to improve taste.
Growth Hormones
(Anterior Pituitary)

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: Somatropin — Others: Somatrem (Protropin)

 Stimulate overall growth, production of proteins, and  use of glucose

Therapeutic Uses:  Growth hormone deficiencies
 Bulking up so you can hit the long ball...
Adverse Effects:  Hyperglycemia (polyphagia, polydipsia, polyuria)
Contraindications/Precautions: ♀ (C) Obese or respiratory impairment
Diabetes  Risk for hyperglycemia D/c Tx before epiphyseal closure
Interactions:  Glucocorticoids can counteract growth-promoting effects
Education:  IM or SC (less painful)
Antidiuretic Hormone

N203
ATI (Unit 11)
Endocrine System -
Expected Action: Proto: vasopressin (Pitressin) — Others: desmopressin (DDAVP)

 Promote H2O reabsorption in kidneys (desmopressin preferred)

 Vasoconstriction due to smooth muscle contraction (vasopressin)

Therapeutic Uses:  Diabetes insipidus  Cardiac arrest

Adverse Effects:  Overhydration (sleepiness, pounding headache)

Contraindications/Precautions: ♀ (X) Pregnancy

CAD or  peripheral circulation (risk for gangrene)

Education:  Monitor site carefully; extravasation can cause gangrene.