🧬 Module 8 · Endocrine Disorders
15 drugs · 6 concepts · tested on Exam 5
💡 The big idea
Endocrine drugs either REPLACE a hormone that is missing or BLOCK one that is in excess. Four glands: pituitary, thyroid, adrenal, pancreas. Diabetes is most of the module, and the entire diabetes list sorts by one question — can this drug drop the blood sugar on its own?
🧠 How to think about this module
- Replace or block. Levothyroxine replaces, methimazole blocks. Hydrocortisone replaces; there is no adrenal blocker in this module.
- For every hormone drug, know the signs of too much and too little of that hormone. That is the assessment question, every time.
- Only insulin, sulfonylureas, and meglitinides cause hypoglycemia by themselves. Metformin, SGLT2 inhibitors, acarbose, and GLP-1 agonists do not, unless they are combined with one that does.
- Insulin questions are timing questions. Match the peak to the meal — hypoglycemia happens at the peak.
- The same steroid does two different jobs. Replacement doses look like normal physiology; anti-inflammatory doses cause the Cushingoid picture.
🏷️ The whole module in 9 classes
Learn these groups and the drug list stops being 15 separate names.
| Class | What it does | Examples | What gets tested |
|---|
| Pituitary hormone agents | Replace or suppress pituitary hormones. | desmopressin (ADH for diabetes insipidus), somatotropin (growth hormone), octreotide (blocks GH; also used for variceal bleeding and severe diarrhea) | Desmopressin causes water retention and hyponatremia. Daily weights, strict intake and output, and report headache, confusion, or seizures. Somatotropin can cause hyperglycemia and must be given before the growth plates close. |
| Thyroid replacement | Replaces T4 in hypothyroidism. Lifelong. | levothyroxine, liothyronine | Take on an empty stomach with water, 30 to 60 minutes before breakfast, at the same time every day. Separate calcium, iron, and antacids by 4 hours. Chest pain, palpitations, or a resting heart rate over 100 means the dose is too high — hold and call, especially in an older adult with heart disease. |
| Antithyroid agents | Block thyroid hormone synthesis in hyperthyroidism. | methimazole, propylthiouracil (PTU), radioactive iodine, potassium iodide (SSKI) | Agranulocytosis is the tested adverse effect — teach the client to report sore throat, fever, or mouth ulcers immediately and to stop the drug until seen. PTU is preferred in the first trimester of pregnancy; methimazole otherwise. |
| Corticosteroids (adrenal) | Replace cortisol or aldosterone, or suppress inflammation. | hydrocortisone, prednisone, dexamethasone (glucocorticoid); fludrocortisone (mineralocorticoid) | In adrenal insufficiency the dose must go UP during illness, injury, or surgery — 'stress dosing.' Never stop abruptly. Watch for hyperglycemia, hypokalemia, fluid retention, and infection with a masked fever. |
| Insulins | Replace insulin. The only option in type 1 diabetes and in DKA. | lispro, aspart (rapid); regular (short); NPH (intermediate); glargine, detemir, degludec (long) | Hypoglycemia occurs at the peak. Regular insulin is the ONLY insulin given IV. NPH is the only cloudy one — roll it, never shake it. Never mix glargine or detemir with any other insulin. Rotate sites within one region to prevent lipodystrophy. |
| Insulin secretagogues | Squeeze more insulin out of a pancreas that still works. | glyburide, glipizide, glimepiride (sulfonylureas); repaglinide, nateglinide (meglitinides) | These DO cause hypoglycemia. Sulfonylureas are sulfa-based and long-acting, so hypoglycemia in an older adult can last for hours and requires observation. Repaglinide is taken with meals — no meal, no dose. |
| Insulin sensitizers | Make existing insulin work better and lower hepatic glucose output. | metformin (first-line for type 2), pioglitazone | Metformin's rare but fatal adverse effect is lactic acidosis — malaise, muscle aches, hyperventilation, and somnolence. Hold before and for 48 hours after IV iodinated contrast, and check renal function before restarting. Take with food to reduce GI upset. |
| Other oral and injectable antidiabetics | Lower glucose by dumping it in urine, blocking carb absorption, or mimicking gut hormones. | canagliflozin, empagliflozin (SGLT2 inhibitors); acarbose (alpha-glucosidase inhibitor); semaglutide, liraglutide (GLP-1 agonists) | SGLT2 inhibitors cause genital yeast infections, dehydration, and euglycemic DKA — teach perineal hygiene and fluid intake. On acarbose, treat hypoglycemia with glucose or dextrose, NOT table sugar or juice, because acarbose blocks sucrose breakdown. |
| Hypoglycemia rescue | Raise blood glucose fast. | oral glucose tablets/gel, IV dextrose 50%, glucagon IM/SubQ/intranasal | Glucagon requires liver glycogen, so it works poorly in starvation, chronic alcohol use, or prolonged fasting. Vomiting is common after glucagon — turn the client on their side. |
⚖️ Insulin timing — the single highest-yield table in the course
| Insulin | Onset | Peak | Duration | Nursing rule |
|---|
| Lispro, aspart, glulisine (rapid) | 10-15 min | about 1 hr | 3-5 hr | Food must already be in front of the client. Give within 15 minutes of eating. |
| Regular (short) | about 30 min | 2-3 hr | 5-8 hr | Give 30 minutes before a meal. The only insulin that can be given IV. |
| NPH (intermediate) | 1-2 hr | 4-12 hr | 12-18 hr | The only cloudy insulin — roll, do not shake. Hypoglycemia risk mid-afternoon if given at breakfast. |
| Glargine, detemir (long) | 1-2 hr | No true peak | about 24 hr (detemir 12-24) | Once daily at the same time. Never mix in a syringe with another insulin. |
🚨 Red flags DANGER
- Blood glucose under 70 mg/dL in a conscious client who can swallow: 15 g of fast-acting carbohydrate, recheck in 15 minutes, repeat up to 3 times, then follow with a protein-plus-carb snack. If unconscious: IV dextrose 50% or IM glucagon, and NOTHING by mouth.
- Never give NPH, glargine, or detemir intravenously. Only regular insulin goes IV.
- Metformin with IV contrast or with acute kidney injury: hold it. Hyperventilation, muscle aches, and malaise on metformin means lactic acidosis — call.
- New chest pain or palpitations after starting or increasing levothyroxine in an older client with cardiac disease: hold and call. The dose is too high.
- Sudden weakness, hypotension, vomiting, and hypoglycemia in a steroid-dependent client is adrenal crisis. IV hydrocortisone and fluids — this is a rapid response, not a call-in-the-morning.
🧵 Exam traps ⭐ HIGH YIELD
- Metformin does NOT cause hypoglycemia on its own. A question that has you teach the metformin-only client to carry glucose tablets is testing exactly that.
- Sulfonylureas (glyburide, glipizide) are sulfa drugs. Ask about sulfa allergy before administering.
- Hypoglycemia and hyperglycemia both cause confusion. Cold and clammy means the client needs some candy; hot and dry means the sugar is high.
- Levothyroxine takes weeks to work. The client will not feel better tomorrow, and doubling a missed dose is dangerous.
- Regular is drawn up BEFORE NPH ('clear before cloudy') so the NPH additive does not contaminate the regular vial.
- Beta blockers mask nearly every adrenergic sign of hypoglycemia except sweating. In a client on a beta blocker, diaphoresis may be the only clue.
🧠 Ways to remember it
- Clear before cloudy — draw regular first, then NPH.
- Cold and clammy, need some candy. Hot and dry, sugar high.
- Rule of 15: 15 grams of carbs, wait 15 minutes, recheck.
- Sulfonylureas Squeeze the pancreas — so they CAN drop the sugar too low. Metformin does not squeeze.
- Levothyroxine = empty stomach, early morning, every day, forever.
🧠 The concepts 6
What are the signs and symptoms of hypoglycemia?🚨 DANGER
Hypoglycemia is a blood glucose BELOW 70 mg/dL (severe is below 40). Early symptoms are adrenergic: SHAKY, SWEATY, HUNGRY, tachycardic, pale, anxious. As it worsens the brain runs out of fuel: headache, blurred vision, confusion, irritability, combativeness, slurred speech, seizures, unconsciousness.
- The textbook's mild-to-moderate list: shaky or jittery, sweaty, hungry, headache, blurred vision, sleepy or tired, dizzy or light-headed, confused or disoriented, pale, uncoordinated, irritable or nervous, argumentative or combative, changed behavior or personality, trouble concentrating, weak, and fast or irregular heartbeat. SEVERE: unable to eat or drink, seizures or convulsions, unconsciousness.
- ANY sudden change in mood, behavior, or mental status in a diabetic patient means CHECK THE BLOOD GLUCOSE FIRST. That is the textbook's instruction and the exam answer.
- TREATMENT if conscious and able to swallow: 15 grams of rapidly digested carbohydrate (4 oz fruit juice, 4 oz regular soda, 3 to 4 glucose tablets, 1 tablespoon honey), recheck in 15 minutes, repeat if still under 70, then give a protein-plus-carbohydrate snack. The 'rule of 15.'
- If NPO, unconscious, or unable to swallow: DEXTROSE 50% IV push, or GLUCAGON IM or subcutaneous. Never put food or fluid in the mouth of an unresponsive patient. Glucagon peaks in 13 to 20 minutes; give carbohydrate as soon as they can swallow, especially in children.
- Monitor closely for 24 hours after an episode, notify the provider and the oncoming nurse, and look for the cause (missed meal, extra insulin, exercise, alcohol, renal decline).
- BETA BLOCKERS MASK the adrenergic warning signs (tachycardia, tremor, palpitations). DIAPHORESIS still occurs and becomes the key clue. Older adults and patients with long-standing diabetes may have hypoglycemia unawareness.
| Hypoglycemia (under 70) | Hyperglycemia (over 180 to 200) |
|---|
| Sudden onset (minutes) | Gradual onset (hours to days) |
| COLD and CLAMMY, pale, diaphoretic | HOT and DRY, flushed |
| Shaky, tachycardic, anxious, hungry | Thirsty, polyuria, weak, blurred vision |
| Confusion, combativeness, seizure, coma | Lethargy, Kussmaul respirations, fruity breath, coma |
| Treat: 15 g fast carbs, or D50 IV / glucagon IM | Treat: insulin, IV fluids, electrolyte replacement |
COLD and CLAMMY, need some candy. Any weird behavior = check the sugar.
What are the signs and symptoms of hyperglycemia?⭐ HIGH YIELD
Hyperglycemia is a blood glucose above the target range. The classic three P's: POLYURIA (excessive urination), POLYDIPSIA (excessive thirst), and POLYPHAGIA (excessive hunger). Plus fatigue, blurred vision, weight loss, dry flushed skin, poor wound healing, and recurrent infections.
- Onset is GRADUAL, over hours to days, unlike hypoglycemia which comes on in minutes. The skin is HOT AND DRY rather than cold and clammy.
- The mechanism explains the symptoms: glucose spills into the urine and drags water with it (osmotic diuresis), causing polyuria and then dehydration and thirst. Cells cannot use glucose, so the patient is hungry and losing weight while the blood sugar is high.
- Severe/uncontrolled hyperglycemia progresses to DKA (type 1) or HHS (type 2). DKA adds KUSSMAUL respirations (deep, rapid, compensating for metabolic acidosis), FRUITY/acetone breath, nausea, vomiting, abdominal pain, and altered mental status. HHS produces extreme dehydration and profound neurologic changes with glucose often over 600.
- Also seen: dry mouth, headache, difficulty concentrating, yeast and urinary infections, numbness or tingling in the feet, and slow-healing wounds.
- SYMPTOMATIC HYPERGLYCEMIA MUST BE REPORTED TO THE PROVIDER IMMEDIATELY, per the textbook.
- Common triggers in the hospital: infection, stress, corticosteroids, missed insulin doses, IV dextrose or TPN, and illness. Assess glucose MORE FREQUENTLY when a diabetic patient is stressed or infected.
HOT and DRY, sugar HIGH. Three P's: pee, thirst, hunger.
What is the reference range for serum glucose?⭐ HIGH YIELD
Normal blood glucose is tightly maintained between 70 and 110 mg/dL. The ADA gives normal FASTING glucose for a non-diabetic as 80 to 130 mg/dL. HYPOGLYCEMIA is below 70; SEVERE hypoglycemia is below 40. A1C target is generally less than 7%, which corresponds to an average glucose of about 154.
- Memorize the action numbers, not just the range: UNDER 70 = treat for hypoglycemia. UNDER 40 = severe, act immediately.
- Diagnostic thresholds for diabetes: fasting glucose 126 mg/dL or higher, a 2-hour OGTT of 200 or higher, an A1C of 6.5% or higher, or a random glucose of 200 or higher with classic symptoms. Prediabetes: fasting 100 to 125, or A1C 5.7 to 6.4%.
- A1C (glycosylated hemoglobin) reflects average glucose over about 3 MONTHS, so it shows adherence over time and cannot be faked by fasting the morning of the lab. It is checked roughly every 3 to 6 months.
- A1C targets are individualized: under 7% for most, but LESS strict (7.5 to 8%) for older adults, children who cannot recognize hypoglycemia, and anyone with hypoglycemia unawareness, because the risk of a low is worse than the risk of a slightly high average.
- Inpatient targets are looser than outpatient targets, generally 140 to 180 mg/dL for most hospitalized patients, to avoid hypoglycemia.
- The physiology behind the range: above it, insulin is released to move glucose into cells. Below it, glucagon is released to push glucose out of the liver.
| Value | Meaning |
|---|
| 70 to 110 mg/dL | Normal tightly regulated range |
| 80 to 130 mg/dL | ADA normal FASTING range for a non-diabetic |
| Under 70 mg/dL | HYPOGLYCEMIA - treat with 15 g carbohydrate |
| Under 40 mg/dL | SEVERE hypoglycemia - D50 IV or glucagon |
| 126 mg/dL or higher fasting | Diagnostic of diabetes |
| A1C under 7% | General target (average glucose about 154) |
70 is the floor, 110 is the ceiling. Under 70 you feed them; under 40 you inject.
Which antidiabetic medications can cause hypoglycemia?⭐ HIGH YIELD
INSULIN (all types) and the SULFONYLUREAS (glipizide, glyburide, glimepiride) are the two that cause SEVERE hypoglycemia. Meglitinides (repaglinide, nateglinide) also cause it. DPP-4 inhibitors such as SITAGLIPTIN can cause it. METFORMIN by itself does NOT.
- The textbook is explicit: 'All sulfonylurea drugs are capable of producing severe hypoglycemia,' and 'Unlike sulfonylureas, metformin does not produce hypoglycemia.'
- Sulfonylureas work by squeezing insulin out of the beta cells REGARDLESS of the blood sugar, which is exactly why they cause lows. Give them 30 MINUTES BEFORE A MEAL, and hold and call if the patient is not eating.
- Drugs that make sulfonylurea hypoglycemia WORSE: NSAIDs and other highly protein-bound drugs (they displace it), alcohol, beta blockers, and renal impairment.
- The classes that do NOT cause hypoglycemia on their own are metformin, thiazolidinediones (pioglitazone), alpha-glucosidase inhibitors (acarbose), GLP-1 agonists (semaglutide, liraglutide), and SGLT2 inhibitors (empagliflozin). But ANY of them combined with insulin or a sulfonylurea can.
- SPECIAL RULE: if a patient on ACARBOSE becomes hypoglycemic, treat with pure GLUCOSE (glucose tablets or gel), not table sugar or juice, because acarbose blocks the breakdown of sucrose.
- Metformin's danger is different: LACTIC ACIDOSIS, fatal in about half of cases. Contraindicated in renal and hepatic disease, and must be HELD before and after IV iodinated contrast studies. Report chills, low blood pressure, muscle pain, or dyspnea immediately. Hypoglycemia is harder to recognize in older adults and in anyone taking a beta blocker.
| CAUSES hypoglycemia | Does NOT cause it alone |
|---|
| Insulin (every type) | Metformin (biguanide) |
| Sulfonylureas: glipizide, glyburide, glimepiride | Thiazolidinediones: pioglitazone |
| Meglitinides: repaglinide, nateglinide | Alpha-glucosidase inhibitors: acarbose |
| DPP-4 inhibitors: sitagliptin (per the textbook) | GLP-1 agonists: semaglutide, liraglutide |
| SGLT2 inhibitors: empagliflozin, dapagliflozin |
Insulin and the sulfonylureas push insulin out no matter what. Metformin just makes you use your own.
What is the onset of action, peak effect, duration of action, and administration schedule for each type of insulin?⭐ HIGH YIELD
Learn it by class. RAPID: onset 15-30 min, peak 1-3 h, lasts 3-5 h, give within 15 minutes before a meal or right after. SHORT/regular: onset 30 min, peak 3 h, lasts 8 h, give 30 minutes before a meal. INTERMEDIATE/NPH: onset 1-2 h, peak 6 h, lasts up to 24 h, once or twice daily. LONG-ACTING: onset 3-4 h, NO PEAK, lasts over 24 h, once daily.
- THE PEAK IS WHEN HYPOGLYCEMIA HAPPENS. If you know when the insulin peaks, you know when to assess and when the food has to be there.
- REGULAR insulin is the only one given IV, and it is the insulin used in DKA drips. NPH is the only CLOUDY insulin; roll or invert it gently to resuspend, never shake.
- MIXING NPH AND REGULAR: air into NPH (cloudy) first, air into regular (clear), then draw REGULAR FIRST. Clear before cloudy. 'RN' - Regular before NPH. Long-acting insulins are NEVER mixed with anything.
- Sites: outer upper arm, abdomen (below the costal margin to the iliac crest and more than 2 inches from the umbilicus), anterior thighs, or buttocks. Rotate WITHIN one region to prevent lipodystrophy. Abdomen absorbs fastest.
- Insulin is a HIGH-ALERT medication: independent double check, insulin syringes or pens only, never abbreviate 'units' as U, and after injecting with a pen COUNT TO FIVE before withdrawing the needle.
- Storage: unopened vials in the refrigerator until the expiration date; opened vials labeled with the open date and refrigerated 28 to 42 days depending on the product. Used pens at room temperature away from heat and light for 10 to 28 days. Never freeze; never use discolored or clumped insulin. Inhaled insulin (Afrezza) is rapid-acting but is CONTRAINDICATED in asthma and COPD; boxed warning for acute bronchospasm.
| Type | Onset | Peak | Duration | Administration schedule |
|---|
| Rapid-acting: lispro (Humalog), aspart (Novolog), inhaled (Afrezza) | 15-30 min | 1-3 h | 3-5 h | Within 15 minutes BEFORE a meal or immediately after |
| Short-acting: regular (Humulin R, Novolin R) | 30 min | 3 h | 8 h | 30 minutes before a meal; the ONLY insulin given IV |
| Intermediate: NPH (Humulin N, Novolin N) | 1-2 h | 6 h (range 2.8-13 h) | Up to 24 h | Once or twice daily; subQ only; roll to resuspend (cloudy) |
| Combination intermediate/rapid: Humalog Mix 75/25, Novolog Mix 70/30 | 15-30 min | 1-5 h | 11-22 h | Twice daily, 15 min before a meal or right after; subQ only |
| Combination intermediate/short: Humulin 70/30, Novolin 70/30 | 30-90 min | 1.5-6.5 h | 18-24 h | Twice daily, 30-45 min before a meal; do not mix with other insulin |
| Long-acting: glargine (Lantus), detemir (Levemir) | 3-4 h | NO PEAK | Over 24 h | Once daily (sometimes split); subQ only; NEVER mix |
Clear before cloudy, RN: Regular then NPH. No peak, no mixing, for the long-acting.
Somatotropin
Somatotropin is recombinant human GROWTH HORMONE, given SUBCUTANEOUSLY to replace deficient GH. Used for growth hormone deficiency in children and adults, Turner syndrome, Prader-Willi syndrome, chronic kidney disease, small-for-gestational-age children who fail to catch up, and idiopathic short stature.
- Give it at BEDTIME, subcutaneously, to mimic the body's natural nighttime GH surge. Rotate injection sites to prevent lipoatrophy. It must be given BEFORE the epiphyseal growth plates close, or it cannot increase height.
- Monitor: height and weight at regular intervals (the whole point of therapy), BLOOD GLUCOSE (GH is a counter-regulatory hormone and causes insulin resistance and hyperglycemia), THYROID function (it can unmask hypothyroidism, which then blocks growth), and IGF-1 levels.
- Report: persistent severe headache, vision changes, nausea and vomiting (intracranial hypertension), a limp or hip and knee pain (slipped capital femoral epiphysis), and new-onset scoliosis progression.
- CONTRAINDICATED in closed epiphyses, ACTIVE MALIGNANCY, acute critical illness (post-surgery, trauma, respiratory failure - it increases mortality), proliferative diabetic retinopathy, and in Prader-Willi patients who are severely obese or have severe respiratory impairment or untreated sleep apnea, where deaths have occurred.
- Common effects: injection-site reactions, fluid retention and edema, arthralgias and myalgias, carpal tunnel syndrome, and gynecomastia.
- Store in the refrigerator, do not freeze or shake, and check the reconstitution instructions for the specific brand. Therapy is long-term and expensive; adherence and psychosocial support matter. The opposite drugs, for excess GH (acromegaly), are octreotide, lanreotide, and pegvisomant.
Growth hormone at BEDTIME, before the plates close. Watch the sugar and the thyroid.
💉 The drugs 15
💉 DesmopressinBLACK BOX
Pituitary hormone, Synthetic antidiuretic hormone
What it is for
Hemophilia A, von Willebrand’s disease type 1, nonnephrogenic diabetes insipidus, symptoms of polyuria/polydipsia caused by pituitary dysfunction, nocturnal enuresis, nocturia Unlabeled: Uremic bleeding
How it works
Promotes reabsorption of water by action on renal tubular epithelium; causes smooth muscle constriction, increase in plasma factor VIII levels, which increases platelet aggregation, thereby resulting in vasopressor effect …
Watch for
- CNS Drowsiness, headache, lethargy, flushing, seizures
- CV Increased B/P, palpitations, tachycardia
- EENT Nasal irritation, congestion, rhinitis
- GI Nausea, heartburn, cramps
- GU Vulval pain
- META Hyponatremia, hyponatremiainduced seizures
- SYST Anaphylaxis (IV)
Teaching
- About the proper technique for nasal instillation: to insert tube into nostril to instill product, clear nasal passage before use
- To avoid OTC products (cough, hay fever) because these preparations may contain EPINEPHrine, decrease product response; not to use with alcohol because adverse reactions …
- To wear emergency ID specifying therapy
- That if dose is missed, to take when remembered up to 1 hr prior to next dose; not to double dose; to avoid fluids from 1 hr to up to 8 hr after PO dose
🔗 Full card in the drug guide
💉 Fludrocortisone
Corticosteroid, synthetic, Mineralocorticoid
What it is for
Adrenal insufficiency, salt-losing adrenogenital syndrome, Addison’s disease
🔗 Full card in the drug guide
💉 Hydrocortisone
Corticosteroid, Short-acting glucocorticoid
What it is for
Severe inflammation, adrenal insufficiency, ulcerative colitis, collagen disorders, asthma, COPD, SLE, Stevens-Johnson syndrome, ulcerative colitis, TB Unlabeled: Carpal tunnel syndrome, Churg-Strauss syndrome, COVID-19, endophthalmitis …
How it works
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability, and lysosomal stabilization
Watch for
- CNS Depression, flushing, sweating, psychosis, headache, mood changes, pseudotumor cerebri, euphoria, insomnia, seizures
- CV Hypertension, edema
- EENT Increased intraocular pressure, blurred vision, cataracts, glaucoma
- GI Diarrhea, nausea, abdominal distention, GI hemorrhage, pancreatitis …
Teaching
- That emergency ID as corticosteroid user should be carried
- To immediately report abdominal pain, black tarry stools because GI bleeding/perforation can occur; if received by epidural route, to report immediately a change in visio …
- To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed; about signs of infection
- Not to discontinue abruptly because adrenal crisis can result; that product should be tapered
🔗 Full card in the drug guide
💉 LevothyroxineBLACK BOX
Thyroid hormone, Levoisomer of thyroxine
What it is for
Hypothyroidism, myxedema coma, thyroid hormone replacement, thyrotoxicosis, congenital hypothyroidism, some types of thyroid cancer, pituitary TSH suppression
How it works
Increases metabolic rate; controls protein synthesis; increases cardiac output, renal blood flow, O2 consumption, body temperature, blood volume, growth, development at cellular level via action on thyroid hormone receptors
Watch for
- CNS Anxiety, insomnia, tremors, headache, thyroid storm, excitability
- CV Tachycardia, palpitations, angina, dysrhythmias, hypertension, cardiac arrest
- GI Nausea, diarrhea, increased or decreased appetite, cramps
- MISC Menstrual irregularities, weight loss, sweating, heat intolerance, fever …
Teaching
- That hair loss will occur in child, is temporary; that hypothyroid child will show almost immediate behavior/personality change
- To report excitability, irritability, anxiety, which indicate overdose
- Not to switch brands unless approved by prescriber; to protect from light, moisture
🔗 Full card in the drug guide
💉 Methimazole
Thyroid hormone antagonist (antithyroid), Thioamide
What it is for
Hyperthyroidism
How it works
Inhibits synthesis of thyroid hormones by decreasing iodine use in manufacture of thyroglobulin and iodothyronine; does not affect circulatory T4, T3
Watch for
- CNS Drowsiness, headache, vertigo, fever, paresthesias, neuritis
- ENDO Enlarged thyroid
- GI Nausea, diarrhea, vomiting, jaundice, hepatitis, loss of taste
- GU Nephritis
- HEMA Agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, lymphadenopathy, bleeding, vasculitis
- INTEG Rash …
Teaching
- To take pulse daily
- To report redness, swelling, sore throat, mouth lesions, fever, which indicate blood dyscrasias
- To keep graph of weight, pulse, mood
- To avoid OTC products, seafood that contain iodine, other iodine products
🔗 Full card in the drug guide
💉 Octreotide
Growth hormone, antidiarrheal, Synthetic analog of somatostatin
What it is for
SandoSTATIN: acromegaly, improves symptoms of carcinoid tumors, vasoactive intestinal peptide tumors (VIPomas); LAR Depot: long-term maintenance of acromegaly, carcinoid tumors, VIPomas Unlabeled: GI fistula, variceal bleeding, diarrheal conditions …
How it works
A potent growth hormone similar to somatostatin
Watch for
- CNS Headache, dizziness, fatigue, weakness, depression, anxiety, tremors, seizure, paranoia
- CV Sinus bradycardia, conduction abnormalities, dysrhythmias, chest pain, SOB, thrombophlebitis, ischemia, HF, hypertension, palpitations, QT prolongation
- ENDO Hypo/hyperglycemia, ketosis, hypothyroidism …
Teaching
- That regular assessments are required; that diabetics need to monitor blood glucose
- To use as prescribed, not to miss, double doses; if a dose is missed, take when remembered unless close to next dose
- About SUBCUT inj if patient or other persons will be giving inj, provide instructions for use
- That product may cause dizziness, drowsiness, weakness; to avoid hazardous activities if these occur; to report abdominal pain immediately
🔗 Full card in the drug guide
💉 PropylthiouracilBLACK BOX
Antithyroid agent, Thioamide
What it is for
Hyperthyroidism and Graves disease, particularly in the first trimester of pregnancy and in thyroid storm.
How it works
Blocks the enzyme that builds thyroid hormone, and — unlike methimazole — also blocks the conversion of T4 to the more active T3 out in the tissues. It does nothing to hormone already stored, so the effect takes weeks.
Watch for
- HEMA Agranulocytosis (the dangerous one), leukopenia, thrombocytopenia.
- GI Nausea, loss of taste.
- HEPA Severe liver injury and failure.
- INTEG Rash, itching.
- MS Joint pain.
- ENDO Hypothyroidism if overtreated.
Teaching
- A sore throat, fever or mouth ulcer is not a minor complaint on this drug — it is agranulocytosis until proven otherwise. Stop and call the same day.
- Report yellow skin or eyes, dark urine, pale stools or right upper abdominal pain (liver injury).
- Preferred over methimazole in the first trimester of pregnancy. It is also often chosen in thyroid storm because it blocks T4-to-T3 conversion — but note that thyroid storm is NOT part of the boxed warning, so do not say it if asked what the boxed warning states.
- Methimazole is usually preferred otherwise.
🔗 Full card in the drug guide
💉 AcarboseHIGH ALERT
Oral antidiabetic
What it is for
Type 2 diabetes mellitus, alone or in combination with a sulfonylurea, metformin, insulin
🔗 Full card in the drug guide
💉 CanagliflozinBLACK BOX
Oral antidiabetic, Sodium-glucose cotransporter 2 (SGLT2) inhibitor
What it is for
Type 2 diabetes mellitus, with diet and exercise; may use in combination; to reduce CV events in type 2 diabetes mellitus with CV disease
How it works
Blocks glucose reabsorption by the kidney, increases glucose excretion, lowers blood glucose concentrations by inhibiting proximal renal tubular sodium glucose transporter 2 (SGLT2)
Watch for
- CV Hypotension, orthostatic hypotension
- GI Pancreatitis, nausea, vomiting dehydration
- GU Cystitis, candidiasis, urinary frequency, polydipsia, polyuria, renal impairment, UTI, genital fungal infections
- INTEG Photosensitivity, rash, pruritus
- META Hypercholesterolemia, lipidemia, hypoglycemia …
Teaching
- The symptoms of hypo/hyperglycemia, what to do about each
- That medication must be taken as prescribed; explain consequences of discontinuing abruptly; that insulin may need to be used for stress, including trauma, fever, surgery …
- To avoid OTC medications and herbal supplements unless discussed with health care professional
- That diabetes is a lifelong illness; that the diet and exercise regimen must be followed; that this product is not a cure
🔗 Full card in the drug guide
💉 Glucagon
Antihypoglycemic
What it is for
Hypoglycemia, used to temporarily inhibit movement of GI tract as a diagnostic test
🔗 Full card in the drug guide
💉 Glyburide/glipizideHIGH ALERT
Antidiabetic, Sulfonylurea (2nd generation)
What it is for
Type 2 diabetes mellitus
How it works
Causes functioning β-cells in pancreas to release insulin, thereby leading to a drop in blood glucose levels
Watch for
- CNS Headache, weakness, paresthesia
- ENDO Hypoglycemia
- GI Nausea, hepatotoxicity, cholestatic jaundice, vomiting, diarrhea, weight gain
- HEMA Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia (rare)
- INTEG Rash, pruritus, photosensitivity, erythema
- MISC Angiedema …
Teaching
- To check for symptoms of cholestatic jaundice: dark urine, pruritus, jaundiced sclera; if these occur, notify prescriber
- To use a blood glucose meter for testing while taking this product
- About the symptoms of hypo/hyperglycemia, what to do about each
- That product must be continued on a daily basis; about consequences of discontinuing product abruptly; that in times of stress, infection, surgery, trauma, a higher dose …
Antidote / reversal: 1
🔗 Full card in the drug guide
💉 Insulin glargine/detemirHIGH ALERT
Antidiabetic, Long-acting insulin analog
What it is for
Basal insulin coverage in type 1 and type 2 diabetes.
How it works
Engineered to be barely soluble at body pH, so it forms a small depot under the skin and trickles out steadily. The result is a flat level with essentially no peak — background insulin, covering what the liver puts out between meals and overnight.
Watch for
- ENDO Hypoglycemia, weight gain.
- INTEG Injection site pain, lipodystrophy.
Teaching
- Clear, but never mix it in a syringe with any other insulin — mixing ruins the flat release. It gets its own syringe and its own site.
- Essentially peakless, given once daily at about the same time each day. Because there is no peak, it is not the insulin you use to cover a meal or to correct a high.
- Subcutaneous only. Not IV, not in a pump.
- It still causes hypoglycemia — usually overnight or when a meal is skipped.
Antidote / reversal: 1
🔗 Full card in the drug guide
💉 Insulin lispro
Antidiabetic, pancreatic hormone, Modified structures of endogenous human insulin
What it is for
Type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes; insulin lispro may be used in combination with sulfonylureas in children >3 yr
How it works
Decreases blood glucose; by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium …
Watch for
- EENT Blurred vision, dry mouth
- INTEG Flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness
- META Hypoglycemia, rebound hyperglycemia (Somogyi effect 12-72 hr or longer)
- MISC Peripheral edema
- SYST Anaphylaxis
Teaching
- That blurred vision occurs; not to change corrective lenses until vision is stabilized after 1-2 mo
- To keep insulin, equipment available at all times; to carry a glucagon kit, candy, or oral glucose preparation to treat hypoglycemia
- That product does not cure diabetes but controls symptoms
- To carry emergency ID as diabetic
🔗 Full card in the drug guide
💉 MetforminHIGH ALERTBLACK BOX
Antidiabetic, oral, Biguanide
What it is for
Type 2 diabetes mellitus
How it works
Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin
Watch for
- ENDO Lactic acidosis, hypoglycemia
- GI Nausea, vomiting, diarrhea, heartburn, anorexia, metallic taste
🔗 Full card in the drug guide
💉 RepaglinideHIGH ALERT
Antidiabetic, Meglitinide
What it is for
Type 2 diabetes mellitus
How it works
Causes functioning β-cells in pancreas to release insulin, thereby leading to a drop in blood glucose levels; closes ATP-dependent potassium channels in the β-cell membrane; this leads to the opening of calcium channels …
Watch for
- CNS Headache, weakness, paresthesia
- CV Angina
- EENT Tinnitus, sinusitis
- ENDO Hypoglycemia
- GI Nausea, vomiting, diarrhea, constipation, dyspepsia, pancreatitis
- INTEG Rash, allergic reactions
- MISC Chest pain, UTI, allergy
- MS Back pains, arthralgia
- RESP URI, sinusitis, rhinitis, bronchitis
Antidote / reversal: 1
🔗 Full card in the drug guide
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Where this came from. The drug cards come from your own drug guide, fact-checked against FDA labeling. The explanations were written from your course textbook,
Pharmacology (WTCS, 2e). If anything here contradicts your instructor, believe your instructor — they write the exam.