Levothyroxine
What is the mechanism of action of levothyroxine
-It is a synthetic, yet chemically pure thyroxine (t4) substitution, being 100% t4. It's job is to stimulate thyroid function
What are some indications for methimazole and PTU
-Hyperthyroidism, Grave's disease, and preparation for a thyroidectomy
Insulin Lispro (Humalog):
-What kind of insulin is it?
-Onset/Peak/Duration?
-Biggest risk factor?
-When to be given?
-Rapid acting insulin
-Onset 15 minutes, peak is 1 hour, and duration is 3-4 hours
-Biggest risk factor is hypoglycemia
-Should be given with meals either 15 minutes before or 15 minutes after.
What is the MOA of Somatropin
Mimics human growth hormone and stimulates growth.
What is the MOA of desmopressin.
Mimics the action of antidiuretic hormone and promotes water reabsorption in the distal tubules and collecting ducts of the nephrons. Concentrates urine and reduces water excretion
When should levothyroxine be administered?
What are the mechanisms of action for methimazole and PTU
-Blocks synthesis of thyroid hormones t3 and t4 (triiodothyronine and thyroxine)
Regular Insulin (Humulin R, Novolin R)
-What kind of insulin is it?
-Peak time?
-Biggest side effect?
-When to be given?
-Indications
-Can this medication be given IV?
-It is a short-acting insulin
-Peak time is 2-4 hours after administration
-Biggest side effect is hypoglycemia
-Should be given 30 minutes before meals
-Indications include mealtime and for DKA
-This type of insulin is the ONLY kind that can be given IV and should be given IV for treatment of DKA.
What is an important drug class that cannot be given with this medication and why?
Somatropin cannot be given with glucocorticoids because it suppresses the stimulation of growth that somatropin is supposed give.
What are some important things to monitor when treating a patient who is on desmopressin?
Monitor the patient's serum sodium levels and blood pressure.
What will happen if the dosage of this medication is too high?
-Symptoms will mimic hyperthyroidism (weight loss, anxiety, heat intolerance, GI upset, and sweating.
What are some side effects for methimazole and PTU and which one is the most important?
-Side effects include agranulocytosis (destruction of infection fighting cells) and hepatotoxicity.
-Most important is agranulocytosis but it is also important to monitor liver function for signs of hepatotoxicity.
NPH Insulin (Humulin N, Novolin N)
-What kind of insulin is it?
-Onset and Peak Time?
-Side effect?
-Indications
-Nursing considerations
-Intermediate acting insulin
-Onset is 2-4 hours and peak time is 4-12 hours
-Side effect is hypoglycemia
-Indicated for basal insulin coverage
-Considerations: if the vial is cloudy, gently roll before use; this insulin can be mixed with short acting insulin
What patients should not be given somatropin?
Patient's who's epiphyseal plates are closed.
What should you not administer desmopressin with and why?
Carbamazepines because they increase the effects of desmopressin
What should you avoid giving with levothyroxine to ensure full drug absorption?
-Grapefruit Juice
-Iron
-Antacids
What will happen if the dosage of methimazole or PTU are too high?
The symptoms will mimic hypothyroidism (lethargy, weight gain, cold intolerance, depression, and bradycardia).
Insulin Glargine (Lantus, Basaglar)
-What kind of insulin is it?
-Nursing Considerations
-Onset/Peak/Duration
-Long acting insulin
-DO NOT mix with other insulins and give it at the same time every day
-Onset 1-4 hours, there is no peak time, and duration is 24 hours
What are some indications for somatropin
Patients with growth hormone deficiency, Turner's syndrome, or AIDS wasting.
What are some adverse effects of desmopressin?
-ELEVATED BP
-Fever, headache, and vertigo
-Uterine cramping
-Nausea, heartburn, and cramps
-Tremors
-Sweating
What labs should you monitor in patients taking this medication and how often should you teach patients to get these labs re-checked?
-Monitor t4 and TSH levels
-Teach patients to get their TSH and t4 levels rechecked at least once a year.
-Patients that are immunosuppressed
-Patients that are pregnant.
What should you give your patients immediately after administering glucagon and how often do you need to check their blood sugar levels?
-Follow up glucagon with a quick carbohydrate and follow the carbohydrate up with a protein to avoid rebound hyperglycemia.
-Check the patient's blood glucose levels every 15 minutes.
What are some side effects of somatropin and what is the most important one to monitor for?
Side Effects:
-Hyperglycemia
-Pancreatitis
-Joint Pain
-Edema
-Increased intracranial pressure
Most Important:
-Hyperglycemia
What is the most common indication for desmopressin?
-Diabetes insipidus