Pangasinan State University

Bayambang Campus

DRUGS AFFECTING THE

ENDOCRINE SYSTEM

Pharmacology
BSN 2-1
Ancheta, Chelsei Jometh A.
Ballesteros, Hannah Loise F.
Bermudez, Czarina Cristine A.
Caballero, Lara Grace P.
Javillo, Angela A.
DRUGS AFFECTING THE ENDOCRINE SYSTEM
I. Introduction to the System
The endocrine system is a critical regulatory network in the human body, consisting of various glands
that produce and release hormones. These chemical messengers produced by various glands, including the
pituitary, thyroid, adrenal, and pancreas, travel through the bloodstream to target organs and tissues, where
they play an important role in regulating essential physiological processes. These include metabolism,
energy balance, growth and development, immune function, blood pressure, and the body's response to
stress. Additionally, the endocrine system controls reproductive functions and ensures the coordination of
different body systems to maintain internal equilibrium.
II. Drugs Affecting the Endocrine System
A. ANTIDIABETIC AGENTS
Antidiabetic agents are medications or treatments specifically designed to manage and control
diabetes, a chronic medical condition characterized by high blood sugar levels. These agents work to
either increase the body's sensitivity to insulin, stimulate the pancreas to produce more insulin, slow
down the absorption of glucose from the digestive system, or otherwise regulate blood sugar levels to
keep them within a healthy range.
SHORT ACTING ANTIDIABETIC AGENTS:
● Short-acting antidiabetic agents are medications used to rapidly lower blood sugar levels in
people with diabetes.
● They are typically taken just before or after meals to help control post-meal glucose spikes.
● These agents work relatively quickly and have a shorter duration of action compared to long-
acting antidiabetic drugs.
● Typically administered via subcutaneous injection using an insulin pen or syringe.
● They are especially useful for people with diabetes who need to manage their blood sugar levels
closely around meal times to prevent post-meal hyperglycemia.
COMMON BRAND NAMES:
● Regular Insulin: Humulin R, Novolin R
INTERMEDIATE ACTING ANTIDIABETIC AGENTS:
● Intermediate-acting insulin is a type of insulin that has a longer duration of action compared to
rapid-acting insulins but a shorter duration of action compared to long-acting insulins.
● It is primarily used to provide basal or background insulin coverage and help control blood sugar
levels between meals and overnight.
● Intermediate-acting insulin is often used in combination with rapid-acting insulins to create a
"basal-bolus" insulin regimen, which aims to mimic the body's natural insulin secretion pattern.
COMMON BRAND NAMES:
● Insulin NPH (Neutral Protamine Hagedorn): Humulin N, Novolin N
LONG ACTING ANTIDIABETIC AGENTS:
● Long-acting insulin is a type of insulin that is designed to provide a steady and prolonged release
of insulin, offering basal or background insulin coverage to help control blood sugar levels
throughout the day and night.
● Long-acting insulin is used in the management of diabetes and is typically administered once a
day or sometimes twice a day, depending on the specific type and brand.
COMMON BRAND NAMES:
● Humulin U, Ultralente insulin (insulin zinc), Lantus (insulin glargine), Basaglar (insulin
glargine), Levemir (insulin detemir)
Therapeutic Action:
Insulin is a hormone produced by the pancreas that plays a central role in regulating blood sugar
(glucose) levels in the body. Its therapeutic action involves:
● Promoting glucose uptake by cells: Insulin facilitates the uptake of glucose into cells, especially
muscle and fat cells, helping to lower blood sugar levels.
 ● Inhibiting the liver's production of glucose: Insulin suppresses the liver's release of glucose into
the bloodstream, preventing excessive glucose production.
● Promoting the storage of excess glucose: It encourages the storage of excess glucose as glycogen
in the liver and muscles, which can be released when needed.
● Affecting fat metabolism: Insulin can also influence the metabolism of fats and proteins.
Indications:
Insulin therapy is primarily indicated for individuals with diabetes, specifically:
● Type 1 Diabetes: People with type 1 diabetes, where the pancreas doesn't produce insulin,
require insulin replacement therapy for survival.
● Type 2 Diabetes: Some individuals with type 2 diabetes, particularly those who cannot achieve
adequate blood sugar control with oral antidiabetic medications or other non-insulin injectable,
may require insulin therapy.
● Gestational Diabetes: Pregnant women with gestational diabetes may need insulin to control
blood sugar levels.
● Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS): Insulin is used in
emergency situations to treat these life-threatening conditions.
Pharmacokinetics:
Fast-acting insulin:
Onset: <15 minutes (rapid-acting insulin analogs), ½-1 hour (Regular human insulin)
Peak: 1-2 hours (rapid-acting insulin analogs), 2-4 hours (Regular human insulin)
Duration: 4-6 hours (rapid-acting insulin analogs), 6-8 hours (Regular human insulin)
Used for controlling blood sugar during meals and correcting high blood sugars.
Intermediate-acting insulin:
Onset: 1-2 hours (NPH Human Insulin)
Peak: 4-6 hours (NPH Human Insulin)
Duration: 12+ hours (NPH Human Insulin)
Used to control blood sugar overnight, while fasting, and between meals.
Long-acting insulin:
Onset: 1 1/2-2 hours (Long-acting insulin analogs)
Peak: Flat, with max effect in 5 hours (Long-acting insulin analogs)
Duration: 12-24 hours (Insulin Detemir), 24 hours (Insulin Glargine)
Used to control blood sugar overnight, while fasting, and between meals with a stable plateau
effect.
Side Effects:
● Hypoglycemia: One of the most common and significant side effects is hypoglycemia (low blood
sugar), which can cause symptoms like shakiness, dizziness, confusion, and, in severe cases, loss
of consciousness.
● Hypokalemia: Excessive insulin use may lead to low potassium levels.
● Lipodystrophy: Repeated injections in the same area can cause lumps (lipohypertrophy) or
depressions (lipoatrophy) at the injection site.
● Allergic Reactions: Allergic reactions to insulin are rare but can occur.
Adverse Effects:
● Central Nervous System (CNS): Hypoglycemia
● Gastrointestinal (GI): Nausea, Diarrhea
● Dermatology: Skin reactions or allergies in some individuals. This can manifest as rashes or
itching.
● Endocrine: Hypothyroidism
● Hematology: Anemia
● Fluid and Electrolyte balance: Dehydration, SGLT2 inhibitors may lead to imbalances in sodium,
potassium, and magnesium levels
Nursing Considerations:
● Nurses should educate patients on proper insulin administration techniques, including rotation
of injection sites, needle length, and angle.
● Regular monitoring of blood glucose levels is essential to adjust insulin doses accurately.
● Nurses must educate patients on recognizing and managing hypoglycemia.
● Providing diabetes self-management education is a critical nursing responsibility, including
dietary management, exercise, and insulin adjustments.
 ● Proper storage of insulin (refrigeration or room temperature, depending on the type) is crucial.
B. ORAL HYPOGLYCEMIC AGENTS
Oral hypoglycemic agents are a class of drugs used to manage diabetes mellitus, specifically type 2
diabetes. These agents help lower blood sugar levels in individuals with diabetes by different
mechanisms of action.
Sulfonylureas:
● The first oral agents were introduced to treat type 2 diabetes.
● They Lower blood sugar by stimulating the release of insulin from the pancreas (secretagogue)
by binding to potassium channels on pancreatic beta cells. Thereby, improving insulin binding to
insulin receptors and increasing the number of insulin receptors.
● Effective only in patients who have functioning beta cells. They are not effective for all diabetics
and may lose their effectiveness over time with others.
● Also known to increase the effect of antidiuretic hormones on renal cells.

● All the sulfonylureas can cause hypoglycemia.

COMMON BRAND NAMES:
● Orinase (tolbutamide), Dymelor (acethexamide), Diabenese (chlorpropramide),
Tolinase (tolazamide), Amaryl (glimiperide), Glucotrol (glipizide), Diabeta (glyburide)
Oral Biguanides:
The term "biguanidine" often refers specifically to a class of drugs that function as oral
antihyperglycemic drugs used for used primarily for the treatment of type 2 diabetes mellitus
or prediabetes treatment. The most common and widely prescribed biguanide is metformin. These
medications help lower blood glucose levels by reducing the production of glucose in the liver and
increasing the body's sensitivity to insulin, allowing cells to take in and use glucose more effectively.
COMMON BRAND NAMES:
● Glucophage (metformin)
Therapeutic Actions:
Oral hypoglycemic agents are medications used to lower high blood sugar levels in individuals with
type 2 diabetes. They work by various mechanisms, including enhancing insulin secretion, improving
insulin sensitivity, reducing glucose production by the liver, or slowing down carbohydrate digestion and
absorption.
Indications:
These agents are indicated for the management of type 2 diabetes, either as a monotherapy or in
combination with other antidiabetic medications.
Pharmacokinetics:
Absorption: Oral hypoglycemic agents are absorbed from the gastrointestinal tract into the
bloodstream. The rate and extent of absorption can vary among different medications.
Distribution: These drugs are distributed throughout the body via the bloodstream.
Metabolism: Some oral hypoglycemic agents undergo metabolism in the liver, while others may not.
Excretion: Excretion of these agents can occur through the kidneys or other routes.
Side Effects:
● Feeling dizzy
● Drowsy
● Having heartburn
● Being sick
● Feeling sick
● Having stomach pain
● Feeling full
● Feeling stomach discomfort
● Feeling constipated
● Frequently urinating
Adverse Effects:
● Hypoglycemia
● Gastrointestinal disturbances
● Weight gain
 ● Liver function abnormalities
● Lactic acidosis (rare but serious)
● Edema (swelling)
● Cardiovascular effects
● Hematological effects
● Hypersensitivity reactions
● Bone health effects
● Vitamin B12 deficiency
Nursing Considerations/Implications:
● Nurses should educate patients on proper medication administration, dosing, and the
importance of adherence to their prescribed regimen.
● Regular monitoring of blood glucose levels is crucial to assess the drug's effectiveness and adjust
the treatment plan as needed.
● Patients should be aware of signs and symptoms of hypoglycemia and hyperglycemia and know
how to respond.
● Nurses should counsel patients on lifestyle modifications, including diet and exercise, to
complement the medication's effects.
● Close monitoring for adverse effects is essential, and any unusual or severe side effects should
be reported to healthcare providers promptly.
C. THYROID HORMONES
● Thyroid hormones are made available to replace the low or absent levels of natural thyroid hormone
and suppress the overproduction of TSH by the pituitary.
● These can contain both natural and synthetic thyroid hormone.

COMMON BRAND NAMES:

● Synthroid (levothyroxine), Cytomel (liothyronine sodium), Thyrlar (liotrex), Proloid
(thyroglobulin)
Therapeutic Action
The desired and beneficial action of thyroid hormones:
● This is replacement hormone for hypothyroid states like myxedema coma, goiters, and
thyroid cancer increases the metabolic rate of body tissues, increasing oxygen consumption,
respiration, heart rate, growth and maturation, and the metabolism of fats, carbohydrates, and
proteins.
● Levothyroxine, a synthetic salt of T4, is the most frequently used replacement hormone because
of its predictable bioavailability and reliability.
Indications
Thyroid hormones are indicated for the following medical conditions:
● Replacement hormone for hypothyroid states like myxedema coma, goiters, and thyroid cancer
● Treatment for thyroid toxicity in conjunction with antithyroid drugs
● Treatment for thyroid overstimulation during pregnancy
Pharmacokinetics
Here are the characteristic interactions of thyroid hormones and the body in terms of absorption,
distribution, metabolism, and excretion:

Route Onset Peak Duration

PO Slow 1-3 wk 1-3 wk

IV 6-8 h 24-48 h Unknown

T1/2: 6-7 d
Metabolism: liver
Excretion: bile
 Side Effects
● Heart-related symptoms: Fast or irregular heartbeats, fluttering in the chest.
● Shaking or tremors, especially in the hands.
● Sweating and heat sensitivity.
● Nervousness and anxiety.
● Insomnia or sleep disturbances.
● Digestive issues: Changes in bowel movements (diarrhea, constipation, increased frequency).
● Appetite changes: Increased or decreased appetite.
Adverse Effects
Use of thyroid and hormones may result to these adverse effects:
● Skin reactions and loss of hair
● Symptoms of hyperthyroidism
Nursing considerations for thyroid hormone medications:
● Assess the patient's medical history and vital signs.
● Educate patients on medication purpose, timing, and side effects.
● Monitor vital signs and thyroid-related symptoms.
● Adjust dosage based on lab results.
● Be aware of drug interactions.
● Special considerations for pregnancy and breastfeeding.
● Promote medication adherence.
● Ensure proper storage and prevent sharing.
● Schedule regular follow-up appointments.
● Provide emotional support and resources.
D. ANTITHYROIDS
Antithyroid medications are used to treat hyperthyroidism by reducing the production and release
of thyroid hormones. Two main classes of antithyroid drugs are thioamides and iodides.
THIOAMIDES:
Thioamides are a class of medications used in the treatment of hyperthyroidism; a condition
characterized by an overactive thyroid gland that produces an excessive number of thyroid hormones.
COMMON BRAND NAMES:
● PTU (propylthiouracil), Tapazole (methimazole)
IODIDES:
Iodides are a class of medications used in the treatment of hyperthyroidism; a condition
characterized by an overactive thyroid gland that produces an excessive number of thyroid hormones.
Iodides are typically used to prepare the thyroid gland for surgery or to protect it from radiation exposure
in cases of hyperthyroidism.
COMMON BRAND NAMES:
● lugol’s solution, saturated solution potassium iodide (SSKI)
Therapeutic actions:
● Antithyroid medications, such as thioamides (Propylthiouracil and Methimazole) and iodides
(Lugol's Solution and Saturated Solution Potassium Iodide), work to reduce the production and
release of thyroid hormones, specifically triiodothyronine (T3) and thyroxine (T4).
● Thioamides inhibit the synthesis of thyroid hormones within the thyroid gland.
● Iodides decrease thyroid hormone production, preparing the thyroid for surgery or protecting it
from radiation exposure.
Indications:
● Hyperthyroidism: Antithyroid medications are primarily used to manage hyperthyroidism, a
condition characterized by an overactive thyroid gland that produces excessive thyroid
hormones.
Pharmacokinetics:
a) Thioamides (e.g., Propylthiouracil and Methimazole):
 ● Absorption: Antithyroid are typically well-absorbed after oral administration. They are rapidly
absorbed from the gastrointestinal tract, and absorption is not significantly affected by food
intake.
● Distribution: After absorption, they will be distributed throughout the body, including the thyroid
gland, which is their primary site of action. Their mechanism of action involves the suppression
of thyroid hormone production by the thyroid gland.
● Metabolism: Antithyroid undergo some metabolic transformations in the body. It is partially
metabolized in the liver and excreted unchanged in the urine.
● Excretion: The antithyroid are filtered by the kidneys and excreted in the urine. The excretion
occurs through various routes, including renal excretion.
Side effects:
● Thioamides may lead to skin rashes, gastrointestinal disturbances, and in rare cases, liver toxicity.
● Iodides can cause gastrointestinal upset and a metallic taste.
Adverse effects:
● Thioamides may cause agranulocytosis (a severe drop in white blood cells) and are associated
with potential liver toxicity.
● Iodides may rarely lead to iodism, which includes symptoms like headache, coryza, salivation,
and acne-like skin lesions.
Nursing consideration/implication:
● Monitor for signs and symptoms of adverse effects, especially agranulocytosis and liver toxicity,
when administering thioamides.
● In the case of PTU, be aware of its potential use during pregnancy, as it can block the conversion
of T4 to T3 in the placenta.
● When administering iodides, be prepared to address potential iodism, which can be
characterized by headache, coryza, salivation, and acne-like skin lesions.
● Monitor patient compliance with medication regimens and educate them about the importance
of taking the medication as prescribed.
● Advise patients to report any signs of skin rashes, gastrointestinal disturbances, or other adverse
effects.
● Conduct regular assessments of thyroid function to evaluate the medication's efficacy in
managing hyperthyroidism.
● Recognize the importance of providing patient education regarding potential side effects and
adverse reactions.
● Ensure that pregnant patients are appropriately managed with antithyroid medications in
consultation with an endocrinologist and obstetrician to optimize maternal and fetal health.
E. CORTICOSTEROIDS
It is the most powerful anti-inflammatory medication available. Corticosteroids lower inflammation
and alleviate the symptoms of inflammatory diseases such as arthritis, asthma, and skin rashes. They
suppress the immune system, allowing them to regulate tissue attacks. These medications help rashes,
inflammatory bowel disease, and asthma, but there is a danger of adverse effects.
Corticosteroids are similar to cortisol, a hormone produced naturally by our bodies' adrenal glands.
Cortisol plays an important role in a variety of biological functions, including metabolism, immunological
response, and stress.
Corticosteroids can come in the form of:
● Tablets
● Capsules
● Eye drops
● Lotions, creams, ointments, or gels
● Nasal or mouth sprays
● Injections
IMPORTANT NOTE: The use of steroids can cause significantly high blood sugar levels. These hormones
decrease the effectiveness of insulin and make your liver dump more glucose into your bloodstream.
COMMON BRAND NAMES:
● Deltasone (prednisone), Medrol (methylprednisolone), Decadron (dexamethasone), Cortef
(hydrocortisone), Pulmicort (inhaler) (budesonide)
Therapeutic Actions:
Corticosteroids are synthetic drugs that mimic the actions of natural corticosteroid hormones
produced by the adrenal glands. They have powerful anti-inflammatory and immunosuppressive effects.
Corticosteroids can reduce inflammation, suppress the immune system, and influence various metabolic
processes in the body.
Indications:
Corticosteroids are used to manage a wide range of medical conditions, including autoimmune
disorders, allergic reactions, inflammatory diseases, and as part of cancer treatment regimens. Common
indications include asthma, rheumatoid arthritis, eczema, lupus, and inflammatory bowel diseases.
Pharmacokinetics
Absorption: Oral and intravenous corticosteroids are rapidly and completely absorbed into the
bloodstream. Topical corticosteroids are absorbed through the skin, while inhaled corticosteroids
are absorbed through the respiratory tract.
Distribution: Widely throughout the body, including inflamed areas.
Metabolism: Mainly in the liver.
Excretion: Primarily through the urine.
Side Effects
All corticosteroid types can put you at risk of developing fungal infections. Some may also cause
high blood sugar, or hyperglycemia.
Side effects of oral steroids may include:
● skin and muscle atrophy
● increased risk of infections
● high blood pressure
● mood or behavioral changes
● osteoporosis
● glaucoma
● diabetes
Side effects from inhaled corticosteroids may include:
● cough
● difficulty speaking (dysphonia)
● oral thrush
Side effects from topical corticosteroids may include:
● acne
● rosacea
● atrophy
● stretch marks
● perioral dermatitis
● delayed wound healing (rare)
Adverse Effects
● CNS: Nervousness, insomnia, “steroid psychosis”
● Cardiovascular: Growth suppression, Cushing’s syndrome, menstrual irregularities,
hyperglycemia
● GI: Peptic ulcer with possible perforation
● Integumentary: Fragile skin, ecchymosis, facial erythema, poor wound healing, hirsutism
● Musculoskeletal: Muscle weakness, loss of muscle mass, osteoporosis
● Ocular: Increased intraocular pressure, glaucoma
● Other: Weight gain
Nursing Implications
● Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease
● Be aware that these drugs may alter serum glucose levels
● Oral forms should be given with food or milk to minimize GI upset
● Clear nasal passages before giving a nasal corticosteroid
● After using an orally inhaled corticosteroid, instruct patients to rinse their mouths to prevent
possible oral fungal infections
● Teach patients on corticosteroids to avoid contact with people with infections and to report any
fever, increased weakness, lethargy, or sore throat
● Patients should be taught to take all adrenal medications at the same time every day, usually in
the morning, with meals or food.