Brixean Mae M.

Batac

BSN 2-Y1-3

DRUGS ACTING ON THE THYROID GLAND: HYPOTHYROIDISM

CLASSIFICATION DRUGS PHARMACODYNAMICS PHARMACOKINETICS INDICATIONS SIDE EFFECTS/ NURSING
INTERACTIONS CONSIDERATIONS
I. THYROID Levothyroid Increase the These drugs are Replacement Tremors, Administer a single
GLAND Liothyronine metabolic rate of well absorbed from therapy in Headache daily dose before
Liotrix body tissues, the gastrointestinal hypothyroidism; Nervousness breakfast each day
Thyroid increasing oxygen (GI) tract and suppression of Palpitations to ensure
Desiccated consumption, bound to serum TSH release; Tachycardia consistent
respiration, heart proteins. treatment of Allergic skin therapeutic levels.
rate, growth and Deiodination of the thyrotoxicosis; reactions Administer with a
maturation, and the drugs occurs at synthetic hormone Loss of hair in the full glass of water
metabolism of fats, several sites, used in patients first few months of to help prevent
carbohydrates, and including the liver, allergic to therapy in children difficulty
proteins. kidney, and other desiccated thyroid Diarrhea swallowing and
body tissues. Special nausea, esophageal atresia.
Elimination is considerations: Vomiting Monitor response
primarily in the not for use with Anxiety carefully when
bile. Half-Life is 6- cardiac or anxiety Sleeplessness beginning therapy
7 days. problems to adjust dose
according to
patient response.
Monitor cardiac
response to detect
cardiac adverse
effects.
Assess patient
carefully to detect
any potential drug–
drug interactions if
giving thyroid
hormone in
combination with
other drugs.
 DRUGS ACTING ON THE THYROID GLAND: HYPERTHYROIDISM
CLASSIFICATION DRUGS PHARMACODYNAMICS PHARMACOKINETICS INDICATIONS SIDE EFFECTS/ NURSING
INTERACTIONS CONSIDERATIONS
I. ANTI THYROID
DRUGS
a. Thioamide Propylthiouracil Lower thyroid These drugs are Treatment of Paresthesias Assess for history
(PTU) hormone levels by well absorbed from hyperthyroidism Neuritis of allergy to any
Methimazole preventing the the GI tract and are Vertigo antithyroid drug;
formation of thyroid then concentrated Drowsiness pregnancy and
hormone in the in the thyroid Skin rash lactation status,
thyroid cells, which gland. The onset Urticaria, liver dysfunction;
lowers the serum and duration of Skin pigmentation and pulmonary
levels of thyroid PTU varies with Nausea edema or
hormone. They also each patient. Vomiting pulmonary
partially inhibit the Methimazole has Epigastric distress tuberculosis if
conversion of T4 to an onset of action Nephritis using strong iodine
T3 at the cellular of 30 to 40 minutes Bone marrow solutions, which
level. and peaks in about Suppression could be cautions
60 minutes. Some Arthralgia or
excretion can be Myalgia contraindications
detected in the Edema to use of the drug.
urine. Administer
Methimazole propylthiouracil
crosses the three times a day,
placenta and is around the clock,
found in a high to ensure
ratio in breast consistent
milk. PTU has a therapeutic levels.
low potential for Give iodine
crossing the solution through a
placenta and for straw to decrease
entering breast staining of teeth;
milk tablets can be
b. Iodine Containing crushed
Solutions Monitor response
Saturated Saturated Increase secretion of These drugs are To facilitate The most common carefully and
Solutions Solution of respiratory fluids by rapidly absorbed bronchial drainage adverse effect of arrange for
Potassium Iodide direct action on from the GI tract and cough in iodine solutions is periodic blood tests
(SSKI) bronchial tissue, and widely emphysema, hypothyroidism to assess patient
 thereby decreasing distributed asthma, chronic Other adverse response and to
mucus viscosity. throughout the bronchitis, effects include monitor for
Iodine solutions in body fluids. bronchiectasis, and iodism (metallic adverse effects.
high doses block Excretion occurs respiratory tract taste and burning in Monitor patients
thyroid function. through the urine. allergies the mouth, sore receiving iodine
They cause the cells Strong iodine characterized by teeth and gums, solution for any
to become products, difficult-to-raise diarrhea, cold sign of iodism so
oversaturated with potassium iodide, sputum. symptoms, and the drug can be
iodine and stop and sodium iodide Also used alone stomach upset), stopped
producing hormones. are taken orally for staining of teeth, immediately if
Low doses of iodine and have a rapid hyperthyroidism or skin rash, and the such signs appear.
are needed in the onset of action, in conjunction with development of Provide thorough
body for the with effects seen antithyroid drugs goiter. patient teaching,
formation of thyroid within 24 hours and propranolol in Sodium iodide including measures
hormone. High doses, and peak effects treatment of (radioactive I131) to avoid adverse
however, block seen in 10 to 15 thyrotoxic crisis is usually reserved effects, warning
Strong Iodine Lugol’s Solution thyroid function. days. Treatment of for use in patients signs of problems,
Solutions The strong iodine hyperthyroidism, who are older than and the need for
products cross the thyroid blocking in 30 years of age regular evaluation
placenta and are radiation because of the if used for longer
known to enter emergencies; adverse effects than
breast milk, but the presurgical associated with the recommended, to
effects on the suppression of the radioactivity. enhance patient
neonate are not thyroid gland, knowledge of drug
known. Sodium treatment of acute therapy and
iodide I131 enters thyrotoxicosis until promote
breast milk and is thioamide levels compliance.
rated pregnancy can take effect
Sodium Iodide I131 Radioactive category X Treatment of
Iodine hyperthyroidism;
thyroid blocking in
radiation
emergencies;
destruction of
thyroid tissue in
patients who are
not candidates for
surgical removal of
the gland
 DRUGS USED FOR DIABETES MELLITUS
CLASSIFICATION DRUGS PHARMACODYNAMICS PHARMACOKINETICS INDICATIONS SIDE EFFECTS/ NURSING
INTERACTIONS CONSIDERATIONS
I. INSULIN
A. Rapid Acting Lispro Insulin replaces Onset: Treatment of type Hypersensitivity Ensure that the
Aspart endogenous insulin. Aspart- 10-20 mins 1 diabetes (insulin reaction patient is following
It is the only Lispro- 15-30 mins dependent) and Local reactions at a dietary and
parenteral Peak: type 2 diabetes injection site exercise regimen
antidiabetic agent Aspart- 1-3 hrs (non– insulin Hypoglycemia and using good
available for Lispro- 0.5-2.5 hrs dependent) to Ketoacidosis hygiene practices
exogenous Duration: improve glycemic Localized redness, to improve the
replacement of low Aspart- 3-5 hrs control. Swelling effectiveness of the
levels of insulin. It Lispro- 3-6.5 hrs OFF-LABEL: Itching (due to insulin and
reacts with the Metabolism: cellular level Insulin aspart, improper insulin decrease adverse
receptors of the cells Excretion: unknown insulin lispro, injection effects of the
to facilitate transport Half-Life: varies with each insulin regular: technique) disease.
of various preparation Gestational Allergy to insulin Gently rotate the
B. Short-Acting Regular metabolites and ions Onset: 30-60 mins diabetes, mild to cleansing solution. vial containing the
across cell Peak: 1-5 hrs moderate diabetic agent and avoid
membranes and Duration: 6-10 hrs ketoacidosis, mild vigorous shaking
stimulates the Metabolism: cellular level to moderate to ensure uniform
synthesis of Excretion: unknown hyperosmolar suspension of
glycogen from Half-Life: varies with each hyperglycemic insulin.
glucose, of fats from preparation state. Insulin Select a site that is
lipids, and of NPH: Gestational free of bruising and
C. Intermediate-Acting NPH/Isophane proteins from amino Onset: 1-2 hrs diabetes. scarring to ensure
Lente acids. Peak: 6-14 hrs good absorption of
Semilente Duration: 16-24+ hrs the insulin.
Metabolism: cellular level Give maintenance
Excretion: unknown doses by the
Half-Life: varies with each subcutaneous route
preparation only and rotate
injection sites
D. Long-Acting Glargine Onset: regularly to avoid
Analogues Detemir Detemir- 3-4 hrs. damage to muscles
Glargine- 3-4 hrs. and to prevent
Peak: subcutaneous
atrophy. Give
 Detemir- 3-9 hrs.
Glargine- no peak
Duration:
Detemir- 6-23 hrs.
Glargine- 24 hrs.
Metabolism: cellular level
Excretion: unknown
Half-Life: varies with each
preparation
II. ORAL
HYPOGLYCEMIC
regular insulin
intramuscularly or
intravenously in
emergency
situations.
Monitor response
carefully to avoid
adverse effects;
blood glucose
monitoring is the
most effective way
to evaluate insulin
dose.
Store insulin in a
cool place away
from direct
sunlight to ensure
effectiveness. Pre-
drawn syringes are
stable for 1 week if
refrigerated; they
offer a good way to
ensure the proper
dose for patients
who have limited
vision.
Help the patient to
deal with necessary
lifestyle changes,
including diet and
exercise needs,
sensory loss, and
the impact of a
drug regimen that
includes giving
injections, to help
encourage
compliance with
the treatment
regimen.
AGENTS (OHA)
A. SULFUNY-
LUREAS
First Generation Chlorpropamide Stimulates the These drugs are Adjunct to diet GI discomfort Administer the
Tolbutamide release of insulin rapidly absorbed for the Anorexia drug as prescribed
from functioning from the GI tract management of Heartburn in the appropriate
cells in the pancreas; and undergo type 2 diabetes Vomiting relationship to
may improve the hepatic Adjunct to insulin Nausea meals to ensure
binding of insulin- metabolism. They for management therapeutic
Hypoglycemia
to-insulin receptor are excreted in the in certain type 2 effectiveness.
sites or increase the urine. The peak diabetics, Ensure that the
number of insulin effects and reducing the patient is following
receptor sites. duration of effects insulin dose and diet and exercise
They are also known differ because of decreasing the modify cations to
to increase the effect the activity of risks of improve
of antidiuretic various metabolites hypoglycemia effectiveness of the
hormone on renal of the different drug and decrease
cells. drugs. adverse effects.
Monitor nutritional
Half-life of 36 status to provide
hours nutritional
Second Generation Glimepiride Stimulates insulin Route PO, Peak 2- Adjunct to diet GI discomfort consultation as
Glyburide release from 3 hrs, Duration 24 and exercise in Anorexia needed.
functioning beta hrs. Completely the management Nausea Monitor response
Glipizide
cells in the pancreas; absorbed from GI of type 2 diabetes; Vomiting carefully; blood
may improve insulin tract. Protein with metformin or Heartburn glucose monitoring
binding to insulin binding: greater insulin for Diarrhea is the most
receptor sites or than 99%. stabilization of Allergic skin effective way to
increase the number Metabolized in diabetic patients. reactions evaluate dose.
of insulin receptor liver. Excreted in Hypoglycemia Obtain blood
sites. urine (60%), feces glucose levels as
(40%). Half-life: ordered to monitor
5–9.2 hrs. drug effectiveness.

B. NON-SULFUNY-
LUREAS
Meglitinides Nateglinide Stimulates insulin Rapidly, Adjunct to diet to Frequent Administer the
Repaglinide release from beta completely lower blood Upper respiratory drug as prescribed
cells of pancreas by absorbed from GI glucose in type 2 tract infection in the appropriate
depolarizing beta tract. Protein diabetics; in Back pain relationship to
cells, leading to binding: 98%. combination with Headache meals to ensure
opening of calcium Metabolized in metformin to Rhinitis therapeutic
Bronchitis
channels. Resulting liver. Excreted in control blood effectiveness.
 calcium influx feces (90%), urine sugar in patients Occasional Monitor nutritional
induces insulin (8%). Unknown if whose diabetes Flu-like symptoms status to provide
secretion. removed by cannot be Dizziness nutritional
hemodialysis. controlled with Arthropathy consultation as
Half-life: 1-1.5 hrs. either drug alone Diarrhea needed.
Monitor serum
Dyspepsia glucose, food
Sinusitis intake
Nausea Ensure follow-up
Arthralgia instruction if
UTI patient, family do
Rare not thoroughly
Constipation understand
Vomiting diabetes
Paresthesia management,
Allergy glucose-testing
technique.

Thiazolidinediones Pioglitazone Improves target-cell Rapidly absorbed. Adjunct to Frequent Assess for
Rosiglitazone response to insulin Protein binding: diet/exercise to Headache hypoglycemia
without increasing 99%. Metabolized lower serum Upper respiratory (cool/wet skin,
pancreatic insulin in liver. Excreted glucose in pts tract infection tremors, dizziness,
Occasional
secretion. Action in urine (64%), with type 2 anxiety, headache,
dependent on feces (23%). Not diabetes. Used as Sinusitis tachycardia,
presence of insulin. removed by monotherapy or Myalgia numbness in
Therapeutic Effect: hemodialysis. in combination Pharyngitis mouth, hunger,
Lowers serum Half-life of with metformin, Aggravated diabetes diplopia),
glucose Rosiglitazone 3–4 sulfonylurea to Edema hyperglycemia
concentration. hrs. While improve glycemic Diarrhea (polyuria,
Decreases hepatic Pioglitazone 16-24 control. Use with Fatigue polyphagia,
glucose output, hrs. insulin not polydipsia, nausea,
increases insulin- recommended. vomiting, dim
dependent glucose vision, fatigue,
utilization in skeletal deep rapid
muscle.
breathing).
Administer the
drug as prescribed
in the appropriate
relationship to
meals to ensure
therapeutic
effectiveness.
Ensure that the
 patient is following
diet and exercise
modify cations to
improve
effectiveness of the
drug and decrease
adverse effects.
Biguanides Metformin Decreases hepatic Slowly, Management of Occasional Assess activity
production of incompletely type 2 diabetes ▪ GI disturbances level, including
glucose. absorbed after PO mellitus as (diarrhea, nausea, amount and degree
Decreases intestinal administration. monotherapy or vomiting, abdominal of exercise, which
absorption of Food delays, concomitantly bloating, flatulence, can alter serum
glucose, improves decreases extent of with oral anorexia) that are glucose levels and
insulin sensitivity transient and resolve
absorption. Protein sulfonylurea or dosage needs for
▪ Therapeutic Effect: binding: insulin. spontaneously these drugs.
Improves glycemic Negligible. Metformin is during therapy Monitor folic acid,
control, approved for use Rare renal function tests
Primarily ▪ Unpleasant/metallic
stabilizes/decreases distributed to in children 10 for evidence of
body weight, taste that resolves
intestinal mucosa, years of age and early lactic
improves lipid spontaneously
salivary glands. older. It is also acidosis.
profile. during therapy Investigate
Primarily excreted being used in the
▪ It is effective in treatment of nutritional intake,
lowering blood unchanged in noting any
urine. Removed by women with
glucose levels and polycystic ovary problems with
does not cause hemodialysis. intake and
Half-life: 9–17 hrs. syndrome,
hypoglycemia as the gestational adherence to
sulfonylureas do. diabetes mellitus. prescribed diet, to
Prevention of help prevent
type 2 diabetes. adverse reactions
to drug therapy.
Alpha-Glucosidase Acarbose Acarbose and Route: Oral These drugs are Common adverse effects Administer the
Inhibitors Miglitol inhibit Onset: Slow used in include drug as prescribed
Miglitol alpha-glucosidase, in the appropriate
Peak: 2-2.5 h combination with Hypoglycemia
an enzyme that Duration: 10-16 h sulfonylureas, Lactic acidosis relationship to
breaks down glucose Metabolism: Liver metformin, and GI upset meals to ensure
for absorption. Excretion: Urine insulin for Nausea therapeutic
Therefore, they Half-Life: 6.2 h then 17 h patients whose Anorexia effectiveness.
delay the absorption glucose levels Ensure that the
Diarrhea patient is following
of glucose. cannot be Heartburn
They have only a controlled with a diet and exercise
mild effect on Allergic skin modify cations to
single agent or reaction.
glucose levels and diet and exercise improve
 do not enhance alone. effectiveness of the
insulin secretion. drug and decrease
They are associated adverse effects.
with severe hepatic Monitor nutritional
toxicity and GI status to provide
distress. nutritional
consultation as
needed.
Monitor response
carefully; blood
glucose monitoring
is the most
effective way to
evaluate dose.
Obtain blood
glucose levels as
ordered to monitor
drug effectiveness.

Sodium-Glucose- Canagliflozin Increases excretion Readily absorbed Adjunctive Genital mycotic Monitor serum
Like Transporter Dapagliflozin of urinary glucose following PO treatment to diet infections potassium,
Inhibitors (SGLT Empagliflozin by inhibiting administration. and exercise to Recurrent urinary cholesterol;
Inhibitors) reabsorption of Metabolized in improve glycemic tract infections capillary blood
Increased urinary
filtered glucose in liver. Peak plasma controls in pts frequency glucose,
kidney. Inhibits concentration: 1–2 with type 2 Hypotension hepatic/renal
SGLT2 in proximal hrs. Protein diabetes mellitus. Increased serum function tests.
renal tubule. binding: 99%. Reduce risk of creatinine Assess for
Therapeutic Effect: Excreted in feces cardiovascular LDL, Hgb, Hct hypoglycemia,
Lowers serum (42%), urine death in pts with Hyperkalemia hypersensitivity
glucose levels. (33%). Half-life: type 2 diabetes Hypermagnesemia reaction
and Hyperphosphatemia Monitor for signs
11–13 hrs. of hyperkalemia
cardiovascular
Fractures Screen for glucose-
disease. altering conditions:
fever, increased
activity or stress,
surgical
procedures.
Obtain dietary
consult for
nutritional
education.
Encourage PO
 intake.
Glucagon-Like Albiglutide Agonist of human Metabolized by Adjunct to diet Occasional Monitor capillary
Peptide (GLP- 1 Dulaglutide glucagon-like protein degradation and exercise to Upper respiratory blood glucose
Agonists) peptide-1 (GLP-1). into small peptides, improve glycemic tract infection levels, Hgb A1c;
Liraglutide Diarrhea
Increases glucose amino acids by control in pts with hepatic/renal
dependent insulin proteolytic type 2 diabetes Nausea function in pts with
Injection site
secretion, decreases enzymes. Protein mellitus. reactions renal impairment
inappropriate binding: Not (hematoma, reporting severe
glucagon secretion. specified. Peak erythema, rash) gastrointestinal
Slows gastric plasma Cough reactions including
emptying. concentration: 3–5 Back pain gastroparesis,
Therapeutic Effect: days. Steady state Arthralgia vomiting, diarrhea.
Augments glucose- reached in 4–5 Sinusitis Assess for
dependent insulin wks. Half-life: 5 contraindications
Influenza or cautions: history
secretion. days. Rare
of allergy to any of
Dyspepsia these agents to
Vomiting avoid
Gastric reflux hypersensitivity
reactions; severe
renal or hepatic
dysfunction, which
could interfere
with metabolism
and excretion of
the drugs; and
status of pregnancy
or lactation, which
are
contraindications
to the use of these
agents.
Administer the
drug as prescribed
in the appropriate
relationship to
meals to ensure
therapeutic
effectiveness.
Ensure that the
patient is following
diet and exercise
 modify cations to
improve
effectiveness of the
drug and decrease
adverse effects.
Dipeptidyl Alogliptin lina-, saxa-, and Rapidly absorbed Adjunctive Nasopharyngitis Assess for
Peptidase- 4 (DDP- Linagliptin sitagliptin slow the following PO treatment to diet Cough contraindications
4) Saxagliptin breakdown of GLP- administration. and exercise to Headache or cautions: history
Sitagliptin 1 to prolong the Metabolized in improve glycemic Upper respiratory of allergy to any of
effects of increased liver. Protein control in pts with tract infections these agents to
insulin secretion, binding: 20%. type 2 diabetes as Arthralgia avoid
decreased glucagon Minimal monotherapy or Back pain hypersensitivity
Urinary tract
secretion, and metabolism (60%– in combination infection reactions; severe
slowed GI 70% excreted with other renal or hepatic
emptying. unchanged). Peak antidiabetic dysfunction, which
Slows inactivation plasma agents could interfere
of incretin hormones concentration: 1–2 with metabolism
by inhibiting DDP-4 hrs. Primarily and excretion of
enzyme. excreted in urine. the drugs; and
Therapeutic Effect: Half-life: 21 h status of pregnancy
Incretin hormones or lactation, which
increase insulin are
synthesis/release contraindications
from pancreas and to the use of these
decrease glucagon agents.
secretion. Lowers Assess for the
serum glucose presence of any
levels. skin lesions for
indication of
possible infection
and to establish
appropriate sites
for subcutaneous
administration as
appropriate;
orientation and
reflexes; baseline
pulse and blood
pressure;
adventitious breath
sounds; abdominal
sounds and
 function, to
monitor effects of
altered glucose
levels.
Administer the
drug as prescribed
in the appropriate
relationship to
meals to ensure
therapeutic
effectiveness
Monitor response
carefully; blood
glucose monitoring
is the most
effective way to
evaluate dose.
Obtain blood
glucose levels as
ordered to monitor
drug effectiveness.

REFERENCES:
Karch, A.M. (2013). Focus on Pharmacology (6th Edition). Lippincott Williams & Wilkins
Hodgson, K.J., Kizior, R.J. (2019). Saunders Nursing Drug Handbook. Elsevier
Tabangcora, I.D. (2019). Insulin. Retrieved from https://nurseslabs.com/insulin/
Tabangcora, I.D. (2019). Antidiabetic Agents. Retrieved from https://nurseslabs.com/antidiabetic-agents/
Tabangcora, I.D. (2019). Sulfonylureas. Retrieved from https://nurseslabs.com/sulfonylureas/
Tabangcora, I.D. (2019). Thyroid Agents. Retrieved from https://nurseslabs.com/thyroid-agents/
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/P064.html