Pharmacology Drug Cards.

RN Pharmacology Chapter49: Pituitary, Thyroid, Parathyroid, and Adrenal Disorders

Chapter 50 :Antidiabetic Drugs Chapter 47: Ophthalmic Drugs

Adeline Samba DNP, MSN ed, RN

Pituitary,

Drug Class Drug Action/uses Adverse Effect Nursing implications

Anterior pituitary drugs

Cosyntropin (Cortrosyn)

Stimulates release of cortisol from adrenal cortex

Hyperactivity of the adrenal glands: Table 49.2 Hypertension, hypernatremia, edema

primarily used to diagnose adrenal gland disorders, treat multiple sclerosis (MS)

Anterior pituitary drugs

Somatropin Stimulate skeletal growth Treatment of hypopituitary, dwarfism

paresthesia, arthralgia, myalgia, peripheral edema, weakness, and cephalgia glucose fluctuations, hypothyroidism, and hematuria. Flulike symptoms

Monitor height and weight, Monitor blood glucose levels.

GH antgonist Pegvisomant blocks GH receptor sites, preventing abnormal growth

hyperhidrosis, cephalgia, and fatigue  

GH antagonist Octreotide (Sandostatin )

-Suppress growth hormone production & reduce diarrhea associated with VIP

GI upset such as nausea, bloating, and flatus. Adverse effects include cardiac toxicity, such as bradycardia and arrhythmia.

 

GH antagonist Bromocripti ne

inhibits the secretion of GH caused by pituitary adenomas.

nausea, anorexia, dyspepsia, and xerostomia  

Posterior pituitary drugs

Vasopressin Potent vasoconstricto r

-Increase water resorption, reducing water excretion -treatment of diabetes insipidus & Hypotensive emergencies -used to stop bleeding of esophageal varices.

HTN, fever, vergtigo, HA,N,V heartburn,tremors, sweating

 

Posterior pituitary drugs

desmopressin -Increase water resorption, reducing water excretion. -treatment of diabetes insipidus -Management of nocturnal enuresis

Same as vasopressin  

Thyroid and Antithyroid Drugs

Drug Class Drug Action/uses Adverse Effect Nursing implications

Thyroid hormone replacement. Treatment of hypothyroidism    

Levothyroxine T4 Replaces thyroid hormone, and works same way as thyroid hormone to increase metabolism

Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, sweating, heat intolerance, fever,

Monitor for signs and symptoms of hyperthyroidism. Administer in the morning before breakfast: Rationale?

Thyroid hormone replacement.

Liothyronine T3 Same as above Same as above      

Thyroid hormone replacement.

Liotrix T3, and T4 Same as above Same as above      

Antithyroid drugs Treatment of Hyperthyroidis m

Propylthiouracil Suppress thyroid hormone production skin rash, hives, nausea, alopecia, loss of hair pigment, petechiae or ecchymoses, and weakness. liver and bone marrow toxicity leukopenia (manifested as fever, sore throat, lesions) signs of hypothyroidism

 

Antithyroid drugs

Methimazole (Tapazole    

Suppress thyroid hormone production Same as above  

Antithyroid drugs

Potassium iodine    

Suppress thyroid hormone production Same as above  

Antithyroid drugs

Radioactive iodine (iodine 131)

Radioactive iodine (I131) works by destroying the thyroid gland

Signs of hypothyroidism  

Adrenal Drugs:

Drug Class Drug Action/uses Adverse Effect Nursing implications Glucocorticoids Treatment of; -Addison’s disease -Diseases associated with inflammatory response

Prednisone   Methylprednisolon e

Glucocorticoids inhibit or help control inflammatory and immune responses

hypokalemia, hypernatremia convulsions, headache, vertigo, mood swings, nervousness, insomnia hypertension Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, peptic ulcers, fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism muscle weakness, loss of muscle mass, osteoporosis, glaucoma, weight gain

Monitor electrolytes and glucose levels. Infection control Monitor weight

Aldosterone replacement

Fludrocortisone  

  Hypokalemia Hypernatremia Hypertension      

Monitor blood pressure and electrolyte levels

Antidiabetic Drugs: Chapter 50

Drug Class Drug Action/uses Adverse Effect Nursing implications

Biguanides metformin (Glucophage ) First-line

Decrease production of glucose by the liver Decrease intestinal absorption of glucose Increase uptake of glucose by tissues

Dizziness, headache, weakness Abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea Metallic taste, Less risk for hypoglycemia

Metformin therapy should be withheld for 48 hours before and after administration of IV contrast because lactic acidosis or acute renal failure may develop.

Sulfonylureas Glipizide glimepiride

Stimulate insulin secretion. Improve sensitivity to insulin in tissues.

Drowsiness, dizziness hypoglycemia, weight gain, skin rash, nausea, epigastric fullness, and heartburn

Monitor blood glucose levels. Monitor signs and symptoms of hypoglycemia

Glinides Repaglinide (Prandin),

Action similar to sulfonylureas Increase insulin secretion from the pancreas

Headache, hypoglycemic effects, dizziness, weight gain, joint pain, upper respiratory infection

Monitor blood glucose levels. Monitor signs and symptoms of hypoglycemia

Thiazolidinediones (glitazones)

Pioglitazone (Actos) Rosiglitazon e (Avandia)

Decrease insulin resistance Increase glucose uptake and use in skeletal muscle

weight gain, edema, mild anemia Hepatic toxicity

Monitor blood glucose levels. Monitor signs and symptoms of hypoglycemia

Alpha-glucosidase inhibitors

Acarbose (Precose)

inhibit the enzyme alpha-glucosidase in the small intestine Result in delayed absorption of glucose

Flatulence, diarrhea, abdominal pain Monitor blood glucose levels. Monitor signs and symptoms of hypoglycemia

Dipeptidyl peptidase-IV (DPP-IV) inhibitors (gliptins)

sitagliptin (Januvia)

Delay breakdown of incretin hormones by inhibiting the enzyme DPP-IV Incretin hormones increase insulin synthesis and lower glucagon secretion

Upper respiratory tract infection, headache, and diarrhea

Monitor blood glucose levels. Monitor signs and symptoms of hypoglycemia

Antidiabetics:

Amylin agonist Injectable Antidiabetic Drugs SQ injection   Not insulin

pramlintide (Symlin)

Slows gastric emptying Suppresses glucagon secretion, reducing hepatic glucose output

Nausea, vomiting, anorexia, headache

 

Incretin mimetics Injectable Antidiabetic Drugs SQ injection Not insulin

exenatide (Byetta)

Enhances glucose- driven insulin secretion from beta cells of the pancreas

Nausea, vomiting, and diarrhea Rare cases of hemorrhagic or necrotizing pancreatitis Weight loss

 

Insulin class Insulin drug onset peak duration Nursing implication

Rapid acting      

Lispro, Insulin aspart

15 to 30 minutes 30 to 90 minutes

3 to 5 hours Eat between 15 minutes of administration.

Short acting        

Regular, Humulin R

30 minutes 1.5 to 3.5 hours

6 to 10 hours Only insulin given IV

Intermediate acting      

NPH 1.5 hours 4-12 hours 14-18 hours  

Long acting      

glargine (Lantus) Levermir, detemir

1 to 1.5 hours none 24 hours -Cannot be mixed with others -Does not peak less risk for hypoglycemia

Ophthalmic Drugs: Chapter 47

Drug class drugs action Adverse effects Nursing implications

Antiglaucom a drugs

Cholinergics   pilocarpine (Pilocar) acetylcholine (Miochol-E)

Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor

Hypotension, bradycardia, or tachycardia Headache, nausea, vomiting, diarrhea, abdominal cramps, asthma attacks with systemic absorption

 See speaker notes on next slide

Antiglaucom a drugs

Adrenergics   Apraclonidine (Iopidine Dipivefrin (Propine)

Stimulate the dilator muscle to contract Result is increased pupil size (mydriasis). Enhance aqueous humor outflow through the canal of Schlemm

Primarily limited to ocular effects Burning, Eye pain Lacrimation Rare systemic effects  

 

Antiglaucom a drugs

Anti-adrenergics: beta blockers Timolol (Timoptic) Betaxolol (Betoptic)

Reducing aqueous humor formation Increasing aqueous humor outflow

Primarily ocular effects Transient burning and discomfort Blurred vision, Pain Photophobia

 

Antiglaucom a drugs

Carbonic anhydrase inhibitors Brinzolamide (Azopt) Dorzolamide (Trusopt)

Inhibit the enzyme carbonic anhydrase, which reduces aqueous humor formation in the eye

Drowsiness, confusion Transient myopia, tinnitus Anorexia, vomiting, diarrhea (for oral form)

 

Antiglaucom a drugs

Osmotic diuretics Mannitol

Water is forced from the aqueous and vitreous humors into the bloodstream Result in decrease IOP

Nausea, vomiting, headache May cause fluid and electrolyte imbalance

 

Antiglaucom a drugs

Prostaglandin agonists

latanoprost (Xalatan)

travoprost (Travatan-Z)

Reduce IOP by increasing the outflow of aqueous fluid eye color will change permanently to brown.

 

ophthalmic drugs

Drug class Drug Action and use Adverse effect Nursing implication

Antimicrobial Gentamicin Erythromycin, Bacitracin ciprofloxacin (Ciloxan) Ganciclovir (antiviral) Natamycin(antifungi) Trifluridine(antiviral)

Suppress and destroy pathogens Local irritation Tearing, inflammation(redness)

 

Anti-inflammatory drugs ketorolac (Acular) flurbiprofen (Ocufen Corticosteroids dexamethasone (Decadron) fluocinonide (Retisert)

Decrease inflammation Indicated post-surgery

Local irritation Tearing

 

Topical anesthetics Tetracaine Proparacaine

For eye procedures To decrease pain

Local Numbness around the eye

 

Diagnostic drugs Cycloplegic mydriatics scopolamine Cyclopentolate (Cyclogyl)

Dilate the pupil Paralyze ciliary muscle and prevent blinking

Safety concern  

Antiallergic drugs Cromolyn sodium (Crolom) Decrease inflammation from allergen

Local effect  

Lubricants and moisturizers Artificial tears Brand names include Murine, Nu-Tears, etcMoisture Drops, Tears Plus, Akwa Tears

Provides moisture to the eye    

Otic Drugs

Drug class drugs action   Adverse effects Nursing implications Antibiotics Antifungals Anti- inflammatorie s Local analgesics Local anesthetics Corticosteroid s

Acetic acid, Ciprofloxaci n    

Treat infection   Local Dizziness if administered cold.

Warm ear medication by robbing between palms prior to administering to prevent dizziness. Have patient lay on unaffected side. Apply gentle pressure on tragus for absorption

Earwax emulsifiers

Carbamide peroxide (Debrox)      

Combined with other drugs, such as glycerin, to loosen and help remove cerumen

  Dizziness  

References

• Yeager, L.M.K.D.M.B.W. J. (2023). Pharmacology (11th ed.). Elsevier Health Sciences (US).  https://pageburstls.elsevier.com/b ooks/9780323793179