*Hormones & Hormone Antagonists*

Insulin:
2 main hormones are secreted from the pancreas:
1- Insulin which is secreted by β -cells of islets of Langerhans & stored in the pancreas (β -.cells)
as a large protein known as proinsulin.
2- Glucagon which is thought to oppose the action of insulin. It is secreted by the --- cells of
islets of Langerhans, it converts glycogen to glucose & elevates blood glucose level. Diabetes
mellitus is a disease in which the islets of Langerhans in the pancreas produce either no insulin
or insufficient quantities of insulin. It is classified as:
Insulin dependent (type 1 or juvenile-onset) & noninsulin dependent (type II or maturity –onset).
It can be treated successfully by the administration of insulin isolated from the pancreas of cattle
or hogs or of human insulin made either semisynthetically or derived from recombinant DNA
technology. The structure of insulin from pork - sources more closely resembles human insulin
than that from beef sources.
Insulin:
1- Rapid- acting insulin.
a) Insulin injection (regular, crystalline zinc insulin).
b) Prompt insulin zinc suspension.
2- Intermediate- acting insulin
a) Isophane insulin suspension (NPH)
b) Insulin zinc suspension (lente)
3- Long-acting insulin
a) Protamine zinc insulin suspension (PZI)
b) Extended insulin zinc suspension (ultralente)
N.B.: Insulin preparations with various times of onset & duration of action are often mixed to
obtain optimum control in diabetic patients.
Action:
1- Facilitates the transport of glucose into cardiac & skeletal muscles & adipose tissue.
2- Increases synthesis of glycogen in the liver.
3- Stimulates protein synthesis & lipogenesis.
4- Inhibits lipolysis & release of free fatty acids from fat cells.
5- Causes intracellular shifts of potassium.
N.B.: Since insulin is a protein, it is destroyed in the GIT thus it must be administered
parenterally.
- It is metabolized mainly in the liver.
Uses:
- Replacement therapy in type I diabetes.
- Indicated in type II diabetes when other measures have failed or with surgery, trauma,
infection, fever, endocrine dysfunction, pregnancy, gangrene, kidneys or liver disease.
- Regular insulin is used in I.V. hyperalimentation.
- Regular insulin is used in I.V. dextrose to treat sever hyperkalemia.
Contraindications:
Hypersensitivity to insulin.
Side effects:
1- Hypoglycemia due to overdose , decreased food intake or hard exercise, “ Hunger, weakness,
fatigue, nervousness pallor or flushing , profuse sweating , headache , numbness of mouth ,
tingling in the fingers, blurred vision, hypothermia & loss of consciousness.
“Sever prolonged hypoglycemia may cause brain damage.”
2- Allergic Urticaria, lymphadenopathy. “Use human Insulin product”.
3- At the site of injection: developing of swelling, itching, atrophy or hypertrophy of S.C. fat
tissue so rotate site of injection to minimize the problem.
4- Insulin resistance caused by obesity, infection, trauma, surgery ….etc.
5- Hyperglycemic rebound (somogyi effect) in patients who receive chronic overdose. Diabetic
coma is usually precipitated by the patient’s failure to take insulin.
*** Treatment of diabetic coma: 20 – 30 units of insulin, then 20 units every 30 minutes. To
avoid hypoglycemia give 1 g dextrose for each unit of insulin is administered with supplemental
electrolytes (K+) & fluids. Monitor vital signs. Urine samples for analysis.
*** Treatment of hypoglycemia:
- Mild hypoglycemia: relieved by oral administration of carbohydrate as orange juice.
- In comatose patients: administer 10 –30 ml of 50% dextrose solution I.V.
Dose:
Usually administered S.C.
N.B.: Regular insulin is the ONLY preparation that may be administered. I.V
This route should be used only for patients with severe ketoacidosis or diabetic coma.
- Always expressed in units.
- Dosage is individualized, it is established & monitored by blood glucose, urine glucose &
acetone test.
Insulin antagonists:
1- Growth hormone elevates glucose level & decreases glycogen synthesis.
2- Glucocorticoids enhance conversion of protein to glucose.
3- Adrenaline decreases insulin release & enhance glycogenolysis.
4- Thyroid hormone promote gluconeogenesis.
5- Glucagon.
Nursing considerations:
1- Read the product information & any important notes inserted into the package.
2- Refrigerate stock supply of insulin but avoid freezing.
3- Follow the guidelines with respect to mixing the various types of insulin.
4- Invert the vial several times to mix before the material is withdrawn “avoid vigorous shaking”.
5- Assist patient for self-administration of insulin.
6- Rotate the sites of S.C. injections to prevent the problem of hypertrophy or atrophy at
injection site.
7- Allow insulin to remain at room temperature 1 hour before administration.
8- Apply pressure for 1 minute, don’t massage since it may interfere with rate of absorption.
9- If breakfast must be delayed, delay the administration of morning dose of insulin.
10-Obtain a thorough nursing history from the client / family.
11-If the client has symptoms of hyperglycemia reaction:
- Have regular insulin available for administration.
- Monitor client closely after administration.
- Check blood glucose, urine glucose, and acetone.
12-Check for early symptoms of hypoglycemia.
13-Assess diabetic more closely for infection or emotional disturbances that may increase insulin
requirements.
14-Explain the necessity for close regular medical supervision.
15-Explain to patient how to test the urine for sugar & acetone.
16-Explain the use & care of equipment & the storage of medication.
17-Explain the importance of exercise & adhering to the prescribed diet.
18-Explain the importance of carrying candy or sugar at all times to counteract hypoglycemia
should it occur.
19-Provide the client & family with a printed chart explaining symptoms of hypoglycemia,
hyperglycemia & instructions concerning what to do for each.
20-Instruct client that blurring of vision will subside within 6-8 weeks.
21-Advise client to check vials of insulin carefully before each dose. Regular insulin should be
clear, where as other forms may be cloudy.

1- Human Insulin:
Class: Human insulin from semisynthetic or recombinant DNA sources.
Action:
Derived from recombinant DNA technology utilizes genetically modified E.Coli . These
organisms synthesize each chain of insulin into the same aminoacid sequence as human insulin.
The chains are then combined & purified to produce human insulin see information for insulin.

2- Insulin Injection (Regular, crystalline Zinc insulin)

Class: Rapid- acting insulin.
Kinetics:
Onset ½ -1 hr (S.C) , 10-30m (I.V.).
Peak 2-4 hr (S.C) , 15-30m (I.V.) .
Duration 5-7 hr (S.C) , 30-60m (I.V.) .
Uses: suitable for treatment of diabetic coma, acidosis (diabetic) or other emergency situations.
Dose: individualized, initial 5-10 units 15-30 minutes before meals & at bedtime.
Diabetic acidosis 0.1 unit / kg given by continuous I.V. infusion.
3- Isophane Insulin Injection (NPH):
N = neutral solution P= stand of PZI
H= means that it is originated in Hagedron’s laboratory.
Class: Intermediate – acting insulin.
Kinetics: onset 3-4 hr, duration 18-28 hr.
Peak 6-12 hr.
Dose: S.C. Individualized, initial 7-26 units as a single dose 30-60 minutes before breakfast.

4- Protamine Zinc Insulin (PZI):

Class: long –acting insulin
Kinetics: onset 4-6 hr , peak 14-24 hr , duration 36 hr.
Dose: see NPH.

Oral Antidiabetic (Hypoglycemic) Agents

- Several oral antidiabetic agents are available for patients with noninsulin dependent diabetes.
- Oral hypoglycemic agents are classified as either first or second generation.
- Generation refers to structural changes in the basic molecule.
- Second–generation oral hypoglycemic agents are more lipophilic & have greater hypoglycemic
potency (200 times) than first generation.

Classification:
1- First – generation sulfonylureas compounds such as:
a) Tolbutamide (orinase).
b) Chlorpromide (diabenase).
c) Glibenclamide (Daonil).

2- Second-generation sulfonylureas compounds such as:

-Glyburide (Micronase).
Action of oral antidiabetic agents:
1- Increases the sensitivity of pancreatic islet cells.
2- Increases insulin secretion by … -cells.
3- The peripheral tissues become more sensitive to insulin due to an increase in the number of
insulin receptors & increase the insulin ability to combine with receptors.
Indication:
Non- insulin dependent diabetes mellitus (NIDDM) (type II). Patients should be subjected to a 7
day therapeutic trial. Decrease in blood sugar, decrease in glucosuria & disappearance of
polyuria, polydipsia, & polyphagia indicate that patient can be managed on oral antidiabetic
agents.
Contraindications:
- Type I of D.M.
- Renal & liver disease.
- Diabetes complicated by recurrent episodes of ketoacidosis.
Side effects:
- Hypoglycemia (most common) .
- Nausea, heartburn, diarrhea
- Headache, dizziness, general weakness.
- Pancytopenia.
- Chronic use increases risk of cardiovascular mortality.
- Cholestasis jaundice (rare).
Nursing considerations:
- See nursing considerations for insulin.
- Drugs may be taken with food to minimize GI upset.
- Stop the medication if signs of side-effects or ketoacidosis appear.
1- Chlorpromide:
Trade name: Diabenase.
Class: first generation sulfonylurea.
Dose: initial 250 mg daily as a single or divided doses.
Maintenance 100-250 mg daily as a single or divided doses.
Doses: More than 750 mg are not recommended.
2- Glyburide:
Trade name: Micronase.
Class: Second-generation sulfonylurea.
Dose: Initial 2.5-5 mg daily given with breakfast (or the first main meal) then increased by 2.5
mg weekly to achieve the desired response.

3- Tolbutamide:
Class: First-generation sulfomylurea.
Dose: Initial 0.5 – 2 g daily, so adjust the dose depending on response (Maintenance
0.25 –3 g daily) (not exceed 3g).

4- Glibenclamide:
Class: First generation sulfonylurea.
Dose: ½ -1 tablet (5mg) daily, increased by 2.5 – 5 mg weekly to achieve the desired response.

Insulin antagonist
Glucagon:
Class: Insulin antagonist.
Action:
It is a hormone produced by the alpha-islets cells of pancreas. It increases blood glucose by:
1- Breakdown of glycogen to glucose.
2- Stimulate gluconeogenesis from amino acids & fatty acids.
3- Inhibit conversion of glucose to glycogen.
Blood glucose within 5-20 minutes, Duration 1-2 hrs.
Uses: Hypoglycemic crisis (to terminate insulin induced shock in diabetic or psychiatric patients)
N.B.: The drug should only be used under medical supervision & according to instructions
received from the physician.
-Failure to respond may be an indication for I.V. administration of glucose.
Side effects: Nausea, vomiting, respiratory distress, hypotension.
Dose: I.V., I.M. or S.C. 0.5-1 mg. (1-2 additional doses may be given at 20 minutes intervals if
necessary).
Nursing considerations:
- Once the hypoglycemic client is respond, supplemental CHO should be given to prevent
secondary hypoglycemia.
- Administer with glucose solution (dextrose) not saline (precipitate may from).
- Discuss with the client & family the need to keep the dose of insulin.

*Adrenocorticosteroids and analogs*

Action:
- They are a group of natural hormones produced by the adrenal cortex.
- They are used for a variety of therapeutic purposes.
- Many slightly modified synthetic variants are available today.
- Some patients respond better to one substance than to another.
- These hormones influence many metabolic pathways & all organ systems & are essential for
survival.
- The release of corticosteroids is controlled by hormones such as corticotropin- releasing factor
produced by the hypothalamus & ACTH produced by the anterior pituitary.

Corticosteroids have the following effect:

1- CHO metabolism:
- Deposition of glucose as glycogen in the liver & conversion of glycogen to glucose when
needed. (Gluconeogenesis).
2- Protein metabolism: The stimulation of protein loss from many organs.
3- Fat metabolism: The deposition of fatty tissue in facial, abdominal & shoulder regions.
4- Water & electrolyte balance: Alteration of glomerular filtration rate, increase sodium &
fluid retention, also affect the excretion of potassium, calcium & phosphorus.
5. Have anti-inflammatory effect: they decrease prostaglandin synthesis.
6. The immunosuppressant effect: they decrease number of T-lymphocyte, monocytes, and
eosinophils.
7. They aid the organism to cope with stressful situations e.g. trauma & sever illness.
According to their chemical structure, they fall into 2 classes.
1- Glucocorticoids e.g. cortisone & hydrocortisone:
- regulate the metabolism of CHO, protein & fat.
2- Mineralocorticoids e.g. Aldosterone & desoxycorticosterone:
- increase reabsorption of Na+ (+water) & excretion of potassium & hydrogen.
Uses:
Therapy with glucocorticoids is not curative & many situations should be considered as
adjunctive rather than primary therapy:
1- Replacement therapy: adrenal insufficiency (Addison’s disease).
2- Rheumatic disorders: rheumatoid arthritis & osteoarthritis.
3- Collagen diseases: systemic lupus erythematosus, rheumatic cardiac.
4- Allergic diseases: drug hypersensitivity, urticarial transfusion reaction.
5- Respiratory diseases: bronchial asthma, rhinitis.
6- Ocular diseases: allergic & inflammatory conjunctivitis, keratitis ….
7- Dermatological diseases: psoriasis, contact dermatitis, Urticaria.
8- Diseases of the GIT: ulcerative colitis.
9- Nervous system: Myasthenia gravis.
10-Malignancies: leukemia, lymphoma.
11-Nephrotic syndrome.
12-Hematologic diseases: hemolytic anemia, thrombocytopenic purpura.
13-Miscellaneous: septic shock, liver cirrhosis, stimulation of surfactant production, prevention
of organ rejection.
Contraindications:
1- If infection is suspected (Mask signs & symptoms).
2- Peptic ulcer.
3- Acute glomerulonephritis.
4- Cushing’s syndrome.
5- Congestive heart failure.
6- Hypertension.
7- Hyperlipidemia.
Side effects:
Prolonged therapy may cause Cushing-like syndrome & atrophy of the adrenal cortex &
subsequent adrenocortical insufficiency.
N.B: steroid withdrawal syndrome may lead to: anorexia, nausea, vomiting, weight loss,
headache, myalgia & hypotension.
Side effects include: Edema, alkalosis, hypokalemia, hypertension, CHF muscle wasting,
weakness, osteoporosis, nausea & vomiting. Headache, hypercholesterolemia, hirsutism,
amenorrhea, depression.
Redistribution of body fats: thin extremities and fat trunk, moon-like face, buffalo hump.
Dose: Highly individualized according to the condition & response of the patient.
N.B.: It is most important that therapy not be discontinued abruptly.
Nursing Considerations:
1- Administer oral forms with food to minimize ulcerogenic effect.
2- For chronic use, give the smallest dose possible.
3- Corticosteroids should be discontinued gradually if used chronically.
4- Document baseline weight, B.P., Pulse & temperature.
5- Frequently take BP, monitor body weight (signs of Na+ & H2O retention).
6- Periodic serum electrolytes, blood sugar monitoring.
7- Report signs & symptoms of side effects (Cushing-like syndrome).
8- Discuss with female client potentials of menstrual difficulties.
9- Instruct the client to take diet high in protein & potassium.
10-Instruct the client to avoid falls & accidents (osteoporosis causes pathological fracture).
11-Remind the client to carry a card identifying the drug being used.
12-Stress the need for regular medical supervision.
13-Advise the client to delay any vaccination while taking these medications (weakened
immunity).
14-Explain the need to maintain general hygiene & cleanliness to prevent infection.
1- Betamethasone:
Trade name: celestone.
Class: Adrenocorticosteroid, synthetic, glucocorticoid type.
Additional Uses: prevention of respiratory distress syndrome in premature infants

2- Dexamethasone:
Trade name: dexacort.
Class: adrenocorticosteroids –synthetic, glucocorticoid type.
Forms: Tablets 0.5 mg.
Ampule 4 mg, 20 mg.

3- Hydrocortisone:
Class: adrenocorticosteroids, naturally occurring, glucocorticoid.
Forms: Vials 100 mg, 500 mg.

4-Prednisone
Class: adrenocorticosteroids , synthetic.
Forms: Tablets 5mg, 20mg.

5-fludrocortisone acetate:
Class: adrenocorticosteroids, synthetic, mineralocorticoid.
Uses: Mainly used for treatment of Addison’s disease.
Forms: 0.1 mg tablet.

4- Betamethasone ointment:
Trade name: Betacortin.
*Posterior Pituitary Hormones*
1-Methylergonovine Maleate:
Trade name: Methergine.
Class: Oxytocic agent.
Action: Is a synthetic agent stimulates the rate, tone & amplitude of uterine contractions. It also
stimulates smooth muscles surrounding certain blood vessels by interacting with adrenergic &
dopaminergic receptors.
Uses:
1- Management & prevention of postpartum & postpartum hemorrhage by producing firm
contraction & decrease uterine bleeding.
2- Incomplete abortion.
3- Migraine headache
Contraindications:
- Pregnancy - Hypertension
- To induce labor - Toxemia
- Prior to delivery of placenta
Side effects:
Nausea, vomiting, diarrhea, allergic reaction, Dizziness, headache, tinnitus.
N.B.: use of this substance during labor may result in uterine tetany with rupture, cervical
laceration, embolism of amniotic fluid & intracranial hemorrhage in infant.
Dose:
Forms: Tablet 0.2 mg (0.2- 0.4 mg /6-12 hr. for 48 hrs.).
I.V. in emergency situations.

2-Oxytocin:
Trade name: Pitocin
Class: oxytocic agent.
Action:
- It has uterine stimulant, vasopressive & antidiuretic properties.
- Mimics uterine contractions of normal labor.
- Facilitates ejection of milk from the breasts by stimulating smooth muscles.
Onset: I.V. immediately, I.M 3-5minutes.
Peak 40m,
Duration I.V. 20m. I.M. 30-60 m.
Uses:
- Antepartum induction or stimulation of labor.
- Uterine inertia (hypotonic contractions).
- For induction of labor in case of preeclampsia, eclampsia, maternal diabetes & other
conditions.
- To hasten uterine involution.
- Intranasal for postpartum hemorrhage & uterine atony.
Contraindications:
- Hypersensitivity - cephalopelvic disproportion (C.P.D.).
- Malpreresentation - undilated cervix
- History of cesarean delivery.
N.B.: Oxytocin should never be given I.V. undiluted in high concentration.
Side effects:
Tetanic uterine contraction, rupture uterus Hypertension, tachycardia.
To Fetus: - it may cause death, intracranial hemorrhage, Brady or tachycardia
Dose: I.M. or I.V. infusion for induction or stimulation of labor.
I.V. infusion 10 units (1ml) diluted in 1000 ml of normal saline or 5% dextrose
Initial 0.001 – 0.002 unit /minute, increased by small increments after 15 minutes intervals.

Nursing Considerations:
1- The physician should be available during administration of the drug.
2- Use Y-tubing for I.V. administration (one bottle contain oxytocin & another free).
3- Note any history of hypersensitivity & other contraindications.
4- Check for cervical dilation & uterine contractions patterns.
5- Remain with the client throughout the administration of medication.
6- Monitor fetal heart rate at least every 10 minutes.
7- Check vital signs every 15minutes.
8- Prevent uterine rupture & fetal damage by clamping off I.V. oxytocin, start medication – Free
fluid, provide O2 & notify the physician in case of hypertonic uterine contraction & abnormal
fetal heart rate patterns.

3-Vasopressin Tannate:
Trade name: Pitressin Tannate.
Class: Pituitary (antidiuretic hormone).
Action:
The ADH (vasopressin), released from the posterior pituitary regulates water conservation by
promoting reabsorption of water by increasing the permeability of the collecting ducts of the
kidney.
Uses: Neurogenic diabetes insipides.
Contraindications:
- Angina pectoris - chronic nephritis
- To be given I.V.
Side effects:
Nausea, vomiting, increased intestinal activity leading to belching & increased desire to defecate,
allergic reaction, tremor, bronchoconstriction.
N.B.:
- If used I.V. causes severe vasoconstriction & tissue necrosis.
- If used I.M causes pain & abscess formation at site of injection.
Dose: I.M. 1.5 – 5 units /1-3 days.
Nursing considerations:
1- Administer 1-2 glasses of water prior to use of medication to minimize side effects.
2- Warm the vial of vasopressin tannate in oil in hands & mix until the hormone is distributed
throughout the solution before withdrawing the dose.
3- Note any history of vascular disease.
4- Monitor intake & output.
5- Check for signs of dehydration (thirst, skin turgor).
6- Weigh the patient daily.
*Calcitonin & Calcium salts*
Appropriate calcium levels in the body are required to maintain homeostasis for many processes
including blood coagulation, regulation of heart rhythm & skeletal muscle contraction.
Maintenance of extracellular calcium levels is controlled by parathyroid hormone utilizing a
feedback mechanism similar to that of other hormones. Dysfunction of the parathyroid may
result in hypocalcemic tetany, seizures & death.

1) Calcitonin “Human or salmon”

Trade name: calcimar
Classification: calcium regulator.
Action:
Calcitonins are polypeptide hormones produced by the parafollicular cells of the thyroid gland in
response to elevated serum ca++ level. It antagonizes the action of PTH through independent
mechanism:
1- Reduce the rate of turnover of bone, to decrease absorption of calcium & may stimulate of
bone formation.
2- Increase renal excretion of Na+, ca++ & phosphate.
N.B.: Calcitonin isolated from salmon (calcimar) has the same therapeutic effect as the human
hormone except for a greater potency per milligram & somewhat longer duration of action.
- Calcitonin-human is a synthetic substance that has the same sequence of amino- acids as the
natural hormone.
Uses 1- For early treatment of hypercalcemia.
2- With calcium & vitamin D to treat postmenopausal osteoporosis.
3- Hyperparathyroidism.
4- Moderate to severe Paget’s disease.
5- Vitamin D intoxication.
Contraindication: Hypersensitivity.
Side effects:
Skin rash, nausea, vomiting, abdominal pain, diarrhea, inflammation at site of injection.
Headache, dizziness, eye pain and nasal congestion.
Calcium Salts:
Classification: Electrolyte, mineral
Action:
It is essential for maintenance of normal function of nerves, muscles, skeletal system &
permeability of cell membranes & capillaries.
- Necessary for activation of many enzymes, contraction of cardiac, skeletal & smooth muscles,
never impulses, respiration, and blood coagulation.
- Normal calcium serum concentration is 9-10.2 mg/dl.
N.B.: Hypocalcemia is characterized by muscular fibrillation, twitching, skeletal muscle spasm,
leg cramps, tetanic spasms, cardiac arrhythmias, mental depression & anxiety.
- Excessive chronic hypocalcemia is characterized by brittle defective nails, poor dentation &
brittle hair.
- Daily requirements for adult of calcium is 0.8 g /day.
N.B.: calcium is well absorbed from the upper GIT, sever tetanic hypocalcemia is well treated by
I.V calcium gluconate.
Uses:
** I.V.: 1- Acute hypocalcemic tetany secondary to:
* Renal failure
* Hypoparathyroidism.
* Premature infants.
2- To treat depletion of electrolytes.
3- During cardiac resuscitation.

** I.M. or I.V:
1- To reduce spasm (renal & intestinal).
2- To relief sensitivity reactions of insect bites.
** P.O:
1- Chronic Hypoparathyroidism.
2- Osteoporosis
3- Osteomalacia.
4- Rickets
5- Myasthenia gravis
6- Supplement for pregnant women.
Contraindications:
1- Digitized patients.
2- Some renal & cardiac patients.
3- Cancer with bone metastasis.
Side effects:
Hypercalcemia characterized by lassitude – fatigue, skeletal muscle weakness, confusion &
constipation.
Renal calculi, bradycardia, arrhythmias & renal impairment.
** Following P.O: constipation & gastrointestinal irritation may occur.
** Following I.V: venous irritation, tingling sensation, and feeling of heat chalky taste.
N.B.: Rapid I.V. administration. May result in vasodilation, decreased B.P. & H.R. , cardiac
arrhythmias, syncope and cardiac arrest.
** Following I.M: .Burning feeling, necrosis & cellulitis.
Nursing considerations:
A-Oral:
-administer 1-1.5 hr after meals, alkalis & large amounts of fat decrease the absorption of
calcium.
- If the client has difficulty swallowing large tablets, obtain a calcium in water suspension by
diluting the calcium in hot water then cooled by administration.
B-I.V:
- Administer slowly.
- Observe vital signs closely for evidence of bradycardia & hypotension.
- Prevent any leakage of medication into the tissue since it is extremely irritating.
- Rotate the injection sites.
- Obtain baseline renal function.
- In case of hypocalcemic tetany, provide safety precautions to prevent injury.
Examples:
1- Calcium Carbonate
Trade name: Apocal
Class: calcium salt.
Dose: capsules , tablets, suspensions 1.25 – 1.5 g 1-3 times daily.

2-Calcium Gluconate
Class: calcium salt.

*Thyroid & Antithyroid Drugs*

The thyroid manufactures 2 active hormones, thyroxine and Triiodothyronine, both which
contain iodine.
Diseases involving the thyroid fall into 2 groups:

1- Hypothyroidism: decreased thyroid hormones.

- Cretinism in infancy & early life.
- Myxedema in adult.
* Cretinism leads to decreasing in physical & mental development.
* Myxedema causes: dry swelling, edema (nonpitting) -- Primary results from atrophy of the
thyroid & -- secondary as a result of hypofunction of pituitary gland or prolonged administration
of Antithyroid drugs.

2-Hyperthyrsidism:
- Increased production of thyroid hormones.
- Graves’ disease characterized by protruding eyes & extreme nervousness.
Thyroid hormone preparations:
- Levothyroxine sodium (T4) (synthroid)
- Liothyronine sodium (T3) (cytomel)
- Liotrix (Mixture of T4+ T3) (Euthroid, thyrolar).

Action of thyroid hormones:

1- Essential for normal physical & mental development of the fetus & infants.
2- Increase the BMR & blood sugar level, increase synthesis of fatty acids, and decrease plasma
cholesterol & triglycerides.
3- Increase H.R. & peripheral resistance.
4- Decrease thyroid releasing hormone (TRH) & TSH from the hypothalamus & anterior
pituitary.
Indications:
- Replacement therapy in primary & secondary myxedema, nontoxic goiter, and chronic
thyroiditis.
- With Antithyroid drugs for thyrotoxicosis to prevent hypothyroidism.
- Surgical removal of thyroid gland.
Contraindications:
- Uncorrected adrenal insufficiency.
- M.I.
- Hyperthyroidism.
N.B.:
- Should not be used to treat obesity or infertility in either males or females.
- In adrenal insufficiency corticosteroids should be initiated first before administration of thyroid
preparations.
Side effects:
C.N.S.: Nervousness, headache, insomnia, tremor.
C.V.S.: Arrhythmias, palpitations, angina pectoris, dyspnea & hypertension.
GIT: Abdominal Cramps. Appetite changes, nausea, vomiting, diarrhea &loss of weight.
Others: Menstrual irregularities, hyperthyroidism, sweating, allergic reaction, hyperglycemia.
Nursing considerations:
1- The treatment is initiated slowly (with small doses) & gradually increased.
2- Store medications in cool dark place.
3- Take complete nursing history.
4- Note if the client is taking antidiabetic drugs & document.
5- Take baseline ECG. then at regular intervals.
6- Monitor thyroid function closely.
7- Observe client for side effects.
8- Monitor PT & PTT closely since the drug increases hypoprothrombinemia.
9- Monitor HR & B.P. closely for cardiac patients.
10-Instruct the client to report side effects e.g. weight loss & nervousness to physician.
11-Have dietitian counsel clients regarding diet according to the energy demands.
12-Female client should record menstrual irregularities.
13-Encourage the client to keep follow-up visits.

*Antithyroid Drugs*
Anti-thyroid drugs include thiourcil derivatives & large doses of iodide.
Action:
Inhibit partially or completely the production of thyroid hormones by the thyroid gland.
N.B.:
Since these agents don’t affect release or activity of performed hormone, it may take several
weeks for the therapeutic effect to become established.
Uses:
- Hyperthyroidisim
- In preparing the patient who must undergo surgery or radioactive iodine therapy.
Contraindications: Lactation.
Side effects:
Loss of taste, enlargement of salivary glands.
Thrombocytopenia, Leukopenia, Agranulocytosis.
Skin rash & hypoprothrombinemia.
Examples:
1- Methimazole (Tapazole) is 10 times stronger than (PTU).
2- Propylthiouracil (PTU).

**Radioctive Agents:
Sodium Iodide I 131
Trade name: Idotope.
Class: Radioactive agent.
Action:
It is distributed throughout the extracellular fluids following oral ingestion, it concentrates in the
thyroid gland where it selectively damage or destroy the thyroid tissue.
Indications:
- Hyperthyroidism.
- Thyroid cancer.
Contraindications:
- Patient with vomiting & diarrhea.
- Lactation.
- Patients under 30 years of age.
Side-effects: Especially when used for thyroid carcinoma.
Bone marrow depression: anemia, leukopenia, thrombocytopenia.
Nausea, vomiting, swelling or tenderness in neck.
Pain on swallowing, sore throat, sickness, alopecia.
Nursing considerations:
- Only given to hospitalized patients.
- Solution may be darken upon storage, this not affect efficacy.
- Take complete nursing history (for sensitivity) prior to administration.
- If patient take Antithyroid drugs 2-3 days before discuss with the physician & reassure patient.
- Institute proper measures to protect visitors & health personnel.
- Increase fluid intake to promote excretion (through the kidney).