Republic of the Philippines

Bulacan State University

City of Malolos

NCM 106 - Pharmacology

Drugs acting on the Endocrine System

Prepared by:

Christopher E. Olipas, Ph.D.

Carmina O. Fabonan, RN

Marly Molina, MAN

A.Y. 2020-2021- 1 Semester

st
Introduction

Hormones are chemical messenger secreted by different endocrine glands, this

maintains the homeostasis of the body. Each hormone communicates to a specific target
receptor that activates a certain response. This module focus on drugs that affect the
function of the endocrine system. An increase or decrease in the level of hormones in the
bloodstream, disrupting the balance can lead to a different disorder such as diabetes
insipidus, diabetes mellitus, gigantism, dwarfism, and so on.

This particular module is divided into 4 lessons:

Lesson 1 Hypothalamic and Pituitary agents
Lesson 2 Adrenocortical agents
Lesson 3 Thyroid and Parathyroid agents
Lesson 4 Antidiabetic agents
You need to have an understanding of how this medication works because it
affects, one of the most important systems in the body that maintain equilibrium. This
agent may alter signals that promote balance and if given without proper knowledge can
lead to serious effect including the death of your patient. The module includes a pre-test,
and post-test, that helps you assess and evaluate your understanding of each lesson.
You are encouraged to take time in answering the question. It will also help you to build
your study style along the way.

Objectives/Competencies
Upon completion of this module, you are expected to:

1. Explain the importance of the different drugs based on their classification, its

identified therapeutic actions, side effects, and adverse effects.

2. Apply the nursing process in drug therapy and patient safety.

3. Formulate a health teaching plan.

Pre Test
Identify the major endocrine glands by putting the letter at the box in the illustration below
and provide its function and hormone they secreted on the space provided.

A. Parathyroid gland
_________________________________________________
_________________________________________________
______________________________________________
B. Pancreas
_________________________________________________
_________________________________________________ ENDOCRINE SYSTEM
______________________________________________

C. Testes
_________________________________________________
_________________________________________________
______________________________________________

D. Ovary
_________________________________________________
_________________________________________________
______________________________________________

E. Posterior Pituitary Gland

_________________________________________________
_________________________________________________
______________________________________________

F. Thyroid gland
_________________________________________________
_________________________________________________
______________________________________________

G. Pineal gland
_________________________________________________
_________________________________________________
______________________________________________

H. Anterior Pituitary Gland

_________________________________________________
_________________________________________________
______________________________________________

I. Adrenal Cortex
_________________________________________________
_________________________________________________
______________________________________________

J. Adrenal Medulla
_________________________________________________
_________________________________________________
______________________________________________
Title of the Lesson: Hypothalamic and Pituitary agents

Duration: 2 hours
How’s your score with the pre-test? I hope you were able to recall them correctly
because you need to incorporate your basic anatomy and physiology lesson to fully
understand each drug action that affects the secretion of those glands and will give you
an idea of which disorder it causes and what drug you need to administer. The
hypothalamus controls the release of the hormone of pituitary glands, either stimulate or
inhibit its function. Available hypothalamic releasing hormones include goserelin, histrelin,
leuprolide, nafarelin, and tesamorelin. While the following drugs inhibit the release of
hormones from pituitary glands includes degarelix, ganirelix acetate. See the table below
for the summary of drugs affecting hypothalamic Hormones
Table 6.1 Drugs affecting hypothalamic Hormones
Agonist Antagonist
Generic Indication Generic Indication
Name Name
Goserilin ● Palliative treatment of prostatic Advanced
carcinoma prostate
Degarelix
● Pituitary desensitization before cancer.
ovulation induction with
gonadotrophins
Histrelin ● Palliative treatment of advanced
prostate cancer
● Central precocious puberty
Leuprolide ● Endometriosis
● Uterine Leiomyomata (Fibroids)
● Advanced Prostate Cancer
(Palliative Treatment)
● Central Precocious Puberty
(CPP)
Nafarelin ● Adjunct to induce ovulation with Ganirelix Ovarian
gonadotrophins in the treatment acetate stimulation
of infertility regimens for
● Endometriosis assisted
● Central precocious puberty reproduction in
infertility.
Tesamorelin ● Reduction of abdominal fat in
HIV patient
 Pharmacokinetics Absorbed slowly when given IM, subcutaneously, or in
depot form.
Metabolized by endogenous hormonal pathways
Cross the placenta and cross into breast milk.
Excreted in the urine
Contraindication/ Contraindication
Caution ●Contraindicated in the presence of known allergy
to any component of the drug.
● Pregnancy and lactating woman
Caution
● Patient with peripheral vascular disease, renal
impairment and rhinitis
Adverse Effect Agonists can lead to increased release of sex hormones,
leading to ovarian overstimulation, flushing, increased
temperature and appetite, and fluid retention

Antagonists can lead to a decrease in testosterone

levels, leading to loss of energy, decreased sperm count
and activity, and potential alterations in secondary sex
characteristics, or to a decrease in female sex
hormones, leading to lack of menstruation, fluid and
electrolyte changes, insomnia, and irritability

Pituitary drugs are natural or synthetic hormones that mimic the hormones
produced by the pituitary gland. Classified into two: Anterior pituitary drugs used to
control the thyroid gland, adrenals, ovaries, and testes. Posterior pituitary drugs used
to regulate fluid volume and stimulate smooth muscle contraction.

Table 6.2 Drugs affecting Pituitary Hormones

Anterior pituitary drugs Posterior pituitary drugs
Generic Name Indication Generic Name Indication

Growth Agonist Somatropin Growth hormone Conivaptan Block

Hormones deficiency (Vaprisol) vasopressin or
ADH receptors
HIV-associated
wasting or cachexia
 Somatropin Short bowel used to treat
rDNA origin syndrome hypervolemic
or euvolemic
Antagonist Bromocriptine Treatment for Tolvaptan hyponatremia,
acromegaly (Samsca) including
Lanreotide
patients with
Octreotide SIADH

Pegvisomant

Other Chorionic gonadotropin Male infertility due to Desmopressin Treatment for

Anterior hypogonadotrophic (DDAVP, diabetes
Pituitary hypogonadism Stimate) insipidus, Von
Willebrand's
Hormones Delayed puberty disease
associated with
hypogonadism in
males

Chorionic gonadotropin alpha Anovulatory infertility

in female

Cosyntropin Diagnosis for

Adrenal function

Thyrotropin alpha Adjunct to

radioiodine for
thyroid remnant
ablation, Adjunctive
diagnostic tool with
serum thyroglobulin
testing in post-
thyroidectomy
patients for remnant
thyroid tissue

Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to
any component of the drug.
● Pregnancy and lactating woman
Adverse effect Signs of inflammation and autoimmune-type reactions,
such as swelling and joint pain, and the endocrine
reactions of hypothyroidism and insulin resistance.
Table 6.3 Nursing Process for Hypothalamic and Pituitary agents

Nursing Assessment
Process Assess the patient’s underlying condition before therapy and regularly
during therapy.

Nursing Diagnosis (Possible)

● Ineffective protection related to the underlying condition
● Risk for injury related to drug-induced adverse reactions
● Deficient knowledge related to a drug test or therapy

Planning
● The patient’s underlying condition will improve.
● The risk of injury to the patient will be minimized.
● The patient and his family will demonstrate an understanding of
the diagnostic test or drug therapy ordered.

Implementation
● Administer the drug as prescribed and monitor for effects.
● Monitor the patient carefully for hypertension and water
intoxication when giving ADH drugs. Seizures, coma, and death
can occur from water intoxication. Watch for excessively elevated
blood pressure or lack of response to the drug, which may be
indicated by hypotension. Weigh the patient daily.

Evaluation
● The patient’s underlying condition improves with drug therapy.
● The patient doesn’t experience injury as a result of drug-induced
adverse reactions.
● The patient and his family demonstrate an understanding of the
diagnostic test or drug therapy.

Self-Check 1

1. Lolo Ambo was diagnosed of advanced prostate cancer 1 year ago. The doctor
surgically insert 1 histrelin acetate implant in the inner aspect of the upper arm, and
the nurse provide health teaching to Lolo Ambo. Which of the following statement by
Lolo Ambo indicates the need for further understanding?

a. “The medicine inside Histrelin implant is contained inside a tiny cylinder

which looks like a small, thin and flexible tube”
b. “I need to follow my regular monitoring of blood glucose level and bone
mineral density”
c. “This is a fast release medication and the implant need to replace every
month.”
 d. “Heavy lifting or any activity which may require strenuous exertion of
the arm should be avoided for 7 days after the implant insertion.”

2. Fill in the table below based on the case scenario given in the above question.

Patient Name: Diagnosis:

Drug Name: (generic) (brand name)

Drug Classification Action:

Nursing Process

Pre-Administration Post Administration Nursing Consideration/Health

Assessment Evaluation Teaching

Good job! Hope you answered the question correctly. For further reading you
can check Chapter 35 of the book entitled “Focus on nursing pharmacology” (7th
ed.). by Karch, A. M., (2013) or other references. You can also watch the video about
USMLE Pharmacology - Hypothalamic and Pituitary
agentshttps://www.youtube.com/watch?v=M7gDPMTYhF4 for a quick review.
Title of the Lesson: Adrenocortical agents

Duration: 2 hours
Adrenocortical agents are used to suppress the immune system and help people
to lessen the sign and symptoms experiencing by the patient, promoting comfort.
These agent is classified into: glucocorticoids corticosteroid hormone that is very
effective at reducing inflammation and suppressing the immune system,
mineralocorticoids is a steroid hormones directly affect the levels of electrolytes in the
system, and androgens. See table below for their properties.
Table 4 Adrenocortical agents

Glucocorticoids Beclomethasone Betamethasone Budesonide

Cortisone
Dexamethasone Flunisolide Hydrocortisone
Prednisolone
Methylprednisolone Prednisone Triamcinolone

Actions Responsible for anti-inflammatory and immunosuppressive

(Pharmacodynamics) effects
Short-term treatment of many inflammatory disorders, to
relieve discomfort, and to give the body a chance to heal
from the effects of inflammation

(Hydrocortisone, cortisone, and prednisone also have some

mineralocorticoid activity and affect potassium, sodium, and
water levels in the body)

Pharmacokinetics Cross the placenta and enter breast milk

Excreted in the urine

Contraindication/ Contraindication
Caution ● Known allergy to steroid preparation
● Pregnancy and Lactation
Caution
● Patient with diabetes

Adverse Effect Children are at risk for growth retardation associated with
suppression of the hypothalamic–pituitary system

Drug-Drug Therapeutic and toxic effects increase if corticosteroids are

Interaction given with erythromycin, ketoconazole, or troleandomycin.
Serum levels and effectiveness may decrease if
corticosteroids are combined with salicylates, barbiturates,
phenytoin, or rifampin
Mineralocorticoids Generic Name
Cortisone Fludrocortisone
Hydrocortisone

Actions Increase sodium reabsorption in renal tubules, leading to

(Pharmacodynamics) sodium and water retention, and increase potassium
excretion

For replacement therapy in primary and secondary adrenal

insufficiency. They are also indicated for the treatment of salt
wasting adrenogenital syndrome

Pharmacokinetics Cross the placenta and enter breast milk

Excreted in the urine

Contraindication/ Contraindication
Caution ● Known allergy to the drug
● Patient with ith severe hypertension, heart failure, or
cardiac disease
● Pregnancy and Lactation

Adverse Effect Sodium and water retention

Possible hypokalemia
Allergic reactions, ranging from a skin rash to anaphylaxis

Drug-Drug Decreased effectiveness of salicylates, barbiturates,

Interaction hydantoins, rifampin, and anticholinesterases

Nursing Process Assessment

Assess the history of allergy to any steroid preparations,
acute infections, peptic ulcer disease, pregnancy, lactation,
endocrine disturbances, and renal dysfunction

Assess weight; temperature; orientation and affect; grip

strength; eye examination; blood pressure, pulse, peripheral
perfusion, and vessel evaluation; respiration and
adventitious breath sounds; glucose tolerance, renal
function, serum electrolytes, and endocrine function tests as
appropriate

Nursing Diagnosis (Possible)

● Imbalanced nutrition: More than body requirements
related to metabolic changes
● Excess fluid volume related to sodium retention
● Impaired urinary elimination related to sodium
retention
 ● Deficient knowledge regarding drug therapy
● Risk for infection related to immunosuppression

Planning
● The patient will receive the best therapeutic effect
from the drug therapy.
● The patient will have limited adverse effects on drug
therapy.
● The patient will have an understanding of the drug
therapy, adverse effects to anticipate, and measures
to relieve discomfort and improve safety.

Implementation Rationale
1. Provide thorough patient 1. Enhance patient
teaching, including measures to knowledge of drug
avoid adverse effects, warning therapy and promote
signs of problems, and the need compliance
for regular evaluation, including
blood tests 2. Minimize adverse
2. Use the minimal dose for the effects.
minimal amount of time
3. Discontinue if signs of overdose 3. Prevent the
development of more
severe toxicity

Evaluation
● Monitor patient response to the drug
● Monitor for adverse effects
● Evaluate the effectiveness of the teaching plan
(patient can name drug, dosage, possible adverse
effects to watch for, and specific measures to help
avoid adverse effects).
● Monitor the effectiveness of comfort and safety
measures and compliance with the therapeutic
regimen.

Self-Check 2
1. Patient Ana is taking dexamethasone 0.1% solution instill 3 drops into the cleaned aural
canal twice a day for allergic otitis externa. Glucocorticosteroid hormone that is very
effective at reducing inflammation and suppressing the immune system. Which of the
following statement made by Patient Ana needs further understanding?

a. “I will wash my hand with soap and water before using the ear drops, and
ensure my ear canal is clean and dry.”
 b. “I will stop using the medication and inform my doctor if I developed rashes,
breathlessness, and swollen eyes.”
c. “I will take dexamethasone ear drops exactly as directed by my doctor”
d. “I can still use the remaining ear drops after 4 weeks it was open.”

2. Complete the diagram below summarizing the mechanism of action of the

adrenocortical agent including nursing responsibilities in administering the medication.

Adrenocortical agent

Glucocorticoids
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Mineralocorticoids
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

Take a break for a while. If you need further reading you can check Chapter 36 of
the book entitled “Focus on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or
other references. You can also watch the video about Pharmacology - USMLE
Pharmacology - Adrenocortical agents https://www.youtube.com/watch?v=C0zMG-
zPns0
Title of the Lesson: Thyroid and Parathyroid agents

Duration: 2 hours
Thyroid and antithyroid drugs function to correct thyroid hormone deficiency
(hypothyroidism) and thyroid hormone excess (hyperthyroidism). Thyroid function is low,
thyroid hormone needs to be replaced. But when the thyroid function is too high the
thyroid might need to be removed or destroyed pharmacologically, and when it happens
the hormone needs to be replaced with thyroid hormone drugs.
Thyroid agents include thyroid hormones and antithyroid drugs, which are further
classified as thioamides and iodine solutions.
Thyroid Drugs: Treatment Action Drug Adverse effect
for HYPOTHYROIDISM interaction
Natural Desiccated stimulate protein Oral toxicity
source thyroid synthesis and anticoagulants manifested by
promote increasing the headache,
Synthetic Levothyroxine gluconeogenesi tendency totremor, insomnia,
Salt (synthetic salt s and increase bleed. nervousness,
of T4) the use of fever, heat
Cholestyramine
liothyronine glycogen stores, intolerance, and
and colestipol
(synthetic salt thus increased reduce the
menstrual
of T3) metabolic rate in irregularities.
absorption of
body tissues
liotrix thyroid
(synthetic salt hormones.
of T3 and T4) Phenytoin may
accelerate the
metabolism of
levothyroxine.
Taking thyroid
drugs with
digoxin may
reduce serum
digoxin levels,
increasing the
risk of
arrhythmias or
heart failure.
Carbamazepine
, phenytoin,
phenobarbital,
 and rifampin
increase thyroid
hormone
metabolism,
reducing
effectiveness.
Serum
theophylline
levels may
increase when
theophylline is
administered
with thyroid
drugs.
Antithyroid drug: Treatment Action Drug Adverse effect
for HYPERTHYROIDISM interaction

Thioamide Propylthiouraci block iodine’s Can be used granulocytopenia

s l ability to during . Hypersensitivity
combine with pregnancy: reactions may
Methimazole
tyrosine, thereby propylthiouracil also occur
preventing is preferred in
thyroid hormone the first
synthesis. trimester of
pregnancy.
Methimazole is
used
in the second
and third
trimesters.
Iodide Radioactive reduces React unpleasant
solutions iodide hormone synergistically brassy taste and
secretion by with lithium, burning sensation
destroying causing in the mouth,
thyroid tissue hypothyroidism. increased
through salivation, and
induction of painful swelling of
acute radiation the parotid glands
thyroiditis
Stong iodide inhibits hormone
synthesis
 through the
Wolff-Chaikoff
effect, in which
excess iodine
decreases the
formation and
release of
thyroid hormone

Parathyroid glands are four very small groups of glandular tissue located on the
back of the thyroid gland, they are important in regulating the serum calcium levels.
Parathyroid Drugs: Action/ Contraindication Drug Advers
Treatment for interaction e effect
Indication
HYPOPARATHYROIDISM
Antihypoca Calcitriol Managem hypercalcemia or risk of Metallic
lcemic (Rocaltrol) ent of vitamin D toxicity hypermagn taste,
Agents hypercalce esemia nausea,
mia increases if vomitin
Caution in use in these drugs g, dry
Parathyroid Maintenan
a patient with a are taken mouth,
hormone ce of
history of renal with constip
(Natapara) serum
stones and magnesium ation,
calcium
lactation -containing and
antacids. anorexi
Teriparatide Managem a
(Forteo) ent of
Osteoporo Digoxin
sis toxicity can
occur with
hypercalce
mia
Parathyroid Drugs Treatment for Action/ Contraindi Drug Advers
HYPERPARATHYROIDISM cation interaction e effect
Indication
Antihyperc Bisphosph Alendro Treatment should not Oral headac
alcemic onates nate for Paget's be used in absorption he,
Agents disease the of nausea,
Etidrona
presence bisphospha and
te
of tes is
 Ibandro hypocalce decreased diarrhe
nate mia with a
antacids,
Pamidro
calcium
nate
Pregnancy products, flushing
Risedro and iron, or of the
nate lactation multiple face
vitamins and
Zoledro hands,
nic Acid
skin
Calcitonin Calcitoni Treatment GI distress
rash,
s n of Paget's may
nausea
Salmon disease increase if
and
bisphospha
(Miacalc vomitin
tes are
in) g,
combined
urinary
Calcitoni Treatment with aspirin
frequen
n for cy, and
Salmon postmenop local
ausal inflamm
(Fortical
osteoporos ation at
)
is the site
of
injectio
n with
calciton
ins
Self-Check 3
Case Scenario:
Patient Anita 32-year-old woman, visit your clinic for complaint of shaking in the
hands, weight gain, even she’s on a diet. She noticed that her skin is pale and dry and
she feels cold when other people do not. She was diagnosed with hypothyroidism after
the doctor's evaluation. The doctor prescribed Levothyroxine 100 mcg/day by mouth as
her maintenance drug. Formulate a Drug study and health teaching plan for Patient Anita.
Drug Study

Date Route of
Mechanis
ordered/ Administration/Dosa Contraindica Clients Nursing
Medication m of Indication
Given/ ge/ tion Response Responsibilities
Action
Taken Frequency

Generic Date Dosage: Before:

Name: ordered:

Brand Name: Date

Route; During:
given:

Classification
s: Date
Taken: Frequency: After:

If you need further reading you can check Chapter 37 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Pharmacology - Parathyroid agents
https://www.youtube.com/watch?v=QguPTJ6wuPg
Title of the Lesson: Antidiabetic agents

Duration: 2 hours

Diabetes is one of the most modifiable disease identified. More and more
individuals develop diabetes mellitus due to poor lifestyle behavior. In this lesson, you will
learn drugs that use to treat diabetes.

Remember that the pancreas secrets Insulin. Insulin preparation is also an oral
antidiabetic drug that are classified as hypoglycemic drugs because they lower blood
glucose levels. Glucagon, another pancreatic hormone, is classified as a hyperglycemic
drug because it raises blood glucose levels.

The presence of too much glucose, which is a large molecule,

takes water into the CNS and can cause swelling and nerve
instability. The presence of too little glucose results in less energy
for the nerves to use to function and loss of cell membrane
integrity.
Diabetes mellitus, known simply as diabetes, is a chronic disease
of insulin deficiency or resistance causing increase glucose level
in the blood (hyperglycemia).
Diabetes type 1 requires an external source of insulin to control
blood glucose levels. The type of Insulin to be use depends on its
Figure 6. SEQ Figure \*
rate of absorption:
ARABIC 2 The insulin
level is inversely
proportional•to glucose.
rapid-acting,
It such as lispro (Humalog)
works like a •seesaw.
short-acting,
such as regular insulin (Humulin R)
• intermediate-acting, such as NPH
• long-acting, such as glargine (Lantus) and insulin detemir (Levemir).

Insulin promotes the storage of glucose as glycogen, increase in protein and fat
synthesis, deceleration of the breakdown of glycogen, protein, and fat, and a balance of
fluids and electrolytes. Insulin is also used to treat two complications of diabetes: diabetic
ketoacidosis (DKA), which is more common with type 1 diabetes, and hyperosmolar
hyperglycemic nonketotic (HHNK) syndrome, which is more common with type 2
diabetes. Also, help to treat severe hyperkalemia
Drug interaction occurs between anabolic steroids, salicylates, alcohol, sulfa
drugs, angiotensin-converting enzyme inhibitors, propranolol, guanethidine, and
monoamine oxidase (MAO) inhibitors may increase the hypoglycemic effect of insulin.
Corticosteroids, sympathomimetic drugs, isoniazid, thyroid hormones, niacin, furosemide,
and thiazide diuretics may reduce the effects of insulin, resulting in hyperglycemia. And
beta-adrenergic blockers may prolong the hypoglycemic effect of insulin and may mask
signs and symptoms of hypoglycemia.Adverse reaction includes hypoglycemia, Somogyi
effect, hypersensitivity, lipodystrophy, and insulin resistance.
Oral antidiabetic drugs are used to stimulate pancreatic beta cells to release insulin
in a patient with a minimally functioning pancreas.

First-generation sulfonylureas drugs

Chlorpropamide, Tolazamide,tolbutamide
Sulfonylureas
Second-generation sulfonylureas drugs
Glimepiride, Glipizide, Glyburide

Alpha-glucosidase inhibitors
Acarbose, Miglitol

Biguanide
Oral
Metformin
antidiabetic
drugs
Meglitinides
Repaglinide, Nateglinide

Thiazolidinediones
Pioglitazone, Rosiglitazone
Other
antidiabetic Glucagon-like polypeptide receptor agonists
agents Abiglutide, Dulaglutide, Liraglutide

Incretin mimetic
Exenatide

Human amylin
Pramlintide

DDP-4 inhibitors
Alogliptin, Linagliptin, Saxagliptin, Sitagliptin

Sodium–glucose cotransporter 2 inhibitors

Dapagliflozin, Empagliflozin

Glucagon, a hyperglycemic drug that raises blood glucose levels, is a hormone

normally produced by the alpha cells of the islets of Langerhans in the pancreas.
Decrease glucose levels (hypoglycemia) occur when patients with diabetes take
an antidiabetic drug dosage too high, or increase in activity, and noncompliance with drug
therapy. Glucagon is used in emergency treatment of severe hypoglycemia. It’s also used
during radiologic examination of the GI tract to reduce GI motility.

Glucagon regulates the rate of glucose production through:

● glycogenolysis, the conversion of glycogen back into glucose by the liver
● gluconeogenesis, the formation of glucose from free fatty acids and proteins
● lipolysis, the release of fatty acids from adipose tissue for conversion to glucose.
Glucagon increasing the tendency to bleed with oral anticoagulants.

Nursing Assessment
Process Assess for conditions in which anticholinergic drugs would be used,
such as bradycardia, heart block diarrhea, and peptic ulcer disease.
Assess for conditions that are contraindicated with the use of
anticholinergic drugs glaucoma, myasthenia gravis, prostatic
hyperplasia, reflux esophagitis, or GI obstructive disease.

Nursing Diagnosis (Possible)

● Urinary retention related to adverse effects on the bladder
● Constipation related to adverse effects on the GI tract
● Risk for injury related to adverse drug effects

Planning
● The patient will experience relief of symptoms.
● The patient will remain free from adverse reactions.

Implementation
● Follow dosage recommendations. Some drugs should be given
with meals.
● Monitor vital signs, cardiac rhythm, urine output, and vision for
potential drug toxicity.
● Monitor for adverse reactions, such as dry mouth, increased
heart rate, and blurred vision.
● Have emergency equipment available to treat new cardiac
arrhythmias.
● Help alleviate symptoms if adverse effects occur. For example,
provide lozenges and frequent mouth care for patients
experiencing dry mouth.

Evaluation
● The patient’s underlying condition improves, maintains a normal
heart rate, normal voiding pattern, normal bowel patterns.
● Patients and family or caregivers demonstrate an understanding
of drug therapy.
Self-Check 4
1. Patient Anita was diagnosed with diabetes mellitus type 1. The doctor prescribed
insulin 15 IU daily injected subcutaneously. The nurse is giving health teaching to Patient
Anita. Which of the following statement made by Lola Anita indicate further teaching is
needed.
a. “Insulin relieves signs and symptoms but doesn’t cure the disease; therapy
is lifelong.”
b. “I will follow the prescribed therapeutic regimen; adhere to specific diet,
weight reduction, exercise, and personal hygiene programs—including daily
foot inspection—and consult with the doctor about ways to avoid infection.”
c. “I can alter the order in which insulin types are mixed or change the model
or brand of the syringe or needle used”
d. “I will always have a candy on hand for emergencies”
2. You are preparing a take-home instruction to Patient Anita about the Insulin. Fill in the
table below to guide Patient Anita in taking the medication.

Patient Name: Diagnosis:

Drug Name: (generic) (brand name)

Drug Classification Action:

Health Teaching

If you need further reading you can check Chapter 38 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Pharmacology - Antidiabetic agents
https://www.youtube.com/watch?v=LWDQyaKVols
 Post-test
Multiple Choice: Encircle the best answer.
1. A client is receiving desmopressin (DDAVP) intranasally for management of diabetes
insipidus. The nurse assess the client, knowing that which of the following measurements
would assist in determining the effectiveness of his medication?
a. Daily weight
b. Temperature
c. Apical heart rate
d. Pupillary response
2. A client with diabetes mellitus receives Humulin Regular insulin 8 units subcutaneously
at 7:30 am. The nurse would be most alert to signs of hypoglycemia at what time during
the day?
a. 1:30 pm to 3:30 pm
b. 3:30 pm to 5:30 pm
c. 11:30 am to 1:30 pm
d. 9:30 am to 11:30 am
3. A client is admitted to the hospital for metabolic acidosis caused by diabetic
ketoacidosis (DKA). The nurse prepares to administer which of the following medications
as a primary initial treatment for this problem?
a. Potassium
b. Regular Insulin
c. Calcium gluconate
d. Sodium bicarbonate
4. A client has been taking the glucocorticoid prednisone (Deltasone) control rheumatoid
arthritis. The nurse monitors the client for which adverse effect of this pharmacological
therapy?
a. Increased serum glucose
b. Decreased serum sodium
c. Elevated serum potassium
d. Increased white blood cell
5. A client has an order for beclomethasone dipropionate (Qvar) by the intranasal route.
The client also has an order for a nasal decongestant. The nurse plans to:
a) Administer the beclomethasone 15 minutes before the decongestant.
b) Administer the decongestant 15 minutes before the beclomethasone
c) Administer the decongestant immediately before beclomethasone
d) Administer the beclomethasone immediately before the decongestant.
6. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy
precipitate inside the insulin vial. The nurse should:
a) Draw the dose from a new vial.
b) Draw up and administer the dose.
c) Shake the vial in an attempt to disperse the clumps.
d) Warm the bottle under running water to dissolve the clump.
7. A nurse is planning discharge teaching for the parents of a child who sustained a head
injury and who is now receiving tapering doses of dexamethasone sodium phosphate
(Decadron). The nurse plans to make which statement to the parents?
a. “This medication decreases the chance of infection.”
b. “This medication will be discontinued after two doses”
c. “If your child’s face becomes puffy, the medication dose needs to be
increased”
d. “This medication is tapered to decrease the chance of recurring swelling in
the brain”
8. A client is started on tolbutamide (Orinase) once daily. The nurse observes for which
of the following intended effect of this medication?
a. Weight lose
b. Resolution of infection
c. Decreased blood glucose
d. Decreased blood pressure
9. A nurse administer 30 units of NPH insulin 7:00 am to a client with a blood glucose
level of 200 mg/dL. The nurse monitors the client for a hypoglycemic reaction, knowing
that NPH insulin peaks in approximately how many hours following administration?
a. 2 hours
b. 3 to 4 hours
c. 6 to 14 hours
d. 16 to 24 hours
10. The client has diabetes mellitus that has been well controlled with glyburide (Dia-
Beta), but recently, the client’s fasting blood glucose has been reported to be 180 to 200
mg/dL. Which of the following medications, if noted in the client’s record, may be
contributing to the elevated blood glucose level?
a. Ranitidine (Zantac)
b. Cimetidine (Tagamet)
c. Prednisone (Deltasone)
d. Ciprofloxacin hydrochloride (Cipro)
Final Requirement:
Case Scenario:
Patient Anita 32-year-old woman, visit your clinic for complaint of increased thirst,
frequent urination, extreme hunger, unintended weight loss. She also notice that she was
easily to feel Irritable and mood changes. She experience fatigue and weakness with
blurred vision. She was diagnosed with diabetes mellitus 1 after the doctor's evaluation.
The doctor prescribed insulin15 IU daily injected subcutaneously. Formulate a Drug study
and health teaching plan for Patient Anita.
Drug Study

Date Route of
Mechanis
ordered/ Administration/Dosa Contraindica Clients Nursing
Medication m of Indication
Given/ ge/ tion Response Responsibilities
Action
Taken Frequency

Generic Date Dosage: Before:

Name: ordered:

Brand Name: Date

Route; During:
given:

Classification
s: Date
Taken: Frequency: After:

Health Teaching Plan

Learning Objectives Learning Content Strategies Time Allotment Resources Evaluation
Suggested Readings and Website
Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto,George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

Med Made Sirius-ly easy. (2019). Pharmacology- Parathyroid Hormones MADE EASY!
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=QguPTJ6wuPg
Speed Pharmacology. (2017). Pharmacology - DRUGS FOR DIABETES (MADE EASY)
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=LWDQyaKVols
The Pharm Guys. (2019). USMLE Pharmacology- Adrenocorticosteroids [YouTube
Video]. In YouTube. https://www.youtube.com/watch?v=C0zMG-zPns0
The Pharm Guys. (2019). USMLE Pharmacology- Hypothalamic and Pituitary Agents
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=M7gDPMTYhF4
References:

Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto,George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

Med Made Sirius-ly easy. (2019). Pharmacology- Parathyroid Hormones MADE EASY!
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=QguPTJ6wuPg
Speed Pharmacology. (2017). Pharmacology - DRUGS FOR DIABETES (MADE EASY)
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=LWDQyaKVols
The Pharm Guys. (2019). USMLE Pharmacology- Adrenocorticosteroids [YouTube
Video]. In YouTube. https://www.youtube.com/watch?v=C0zMG-zPns0
The Pharm Guys. (2019). USMLE Pharmacology- Hypothalamic and Pituitary Agents
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=M7gDPMTYhF4