📘 Endocrine Pharmacology Study Guide

1. Oral Hypoglycemics

Repaglinide (Prandin) – meglitinide

• Take 15–30 min before meals.
• ❌ If meal skipped → skip dose (to prevent hypoglycemia).
• Rapid onset, short duration.

Glipizide (Glucotrol) – sulfonylurea

• Take 30 min before meals.
• Avoid alcohol (can cause disulfiram-like reaction + hypoglycemia).

Pioglitazone (Actos) – thiazolidinedione

• Monitor:
• ALT (liver function)
• LDL (lipids)
• Adverse effects: weight gain, edema, risk of heart failure, risk of bladder cancer.
• Teach: Call provider for nausea, vomiting, abdominal pain (liver injury).

2. Injectable Diabetes Medications

Pramlintide (Symlin) – amylin mimetic

• SQ injection before meals.
• Delays gastric emptying, suppresses glucagon, increases satiety.
• Risk for hypoglycemia, especially with insulin.
• Peak action: ~3 hours → watch for hypoglycemia around this time.

3. Insulins

Types & Timing

• Lispro (Humalog) – Rapid acting
• Onset: 15–30 min
• Peak: 30–90 min
• Duration: 3–5 hr
• Give 15 min before meals.
• Regular insulin – Short acting
• Onset: 30–60 min
• Peak: 2–4 hr
• Duration: 6–8 hr
• Only insulin given IV.
• NPH – Intermediate acting
• Onset: 1–2 hr
• Peak: 6–12 hr
• Duration: 18–24 hr
• Cloudy, roll vial gently (don’t shake).
• Glargine (Lantus) – Long acting
• No peak
• Duration: 24 hr
• Give same time every day (often at night or morning).
• Never mix with other insulins.

General Rules

• Rotate injection sites → best absorption in abdomen.
• Store unopened vials in refrigerator. Opened vials at room temp ~28 days.
• Mix clear (Regular) before cloudy (NPH).

4. Hypoglycemia Management

If conscious

• Give 15 g carb (juice, glucose tabs).
• Recheck glucose in 15 min.

If unconscious, no IV access

• Give glucagon IM/SQ.
• Place patient on side (prevent aspiration).

If unconscious, IV access

• Give IV dextrose 50% (works fastest).
• Recheck glucose in 15 min.

5. Growth Hormone Therapy

Somatropin – growth hormone

• Monitor:
• Blood glucose (can cause hyperglycemia).
• TSH (may cause hypothyroidism).
• Long-term risk: slipped epiphysis, scoliosis progression in children.

6. Antithyroid Medications

Propylthiouracil (PTU)

• Used for hyperthyroidism / Graves’ disease.
• Adverse effects:
• Hypothyroidism → weight gain, drowsiness, depression.
• Agranulocytosis → report sore throat, fever, joint pain, rash.
• Hepatotoxicity → report jaundice, dark urine.

7. Thyroid Replacement Therapy

Levothyroxine (Synthroid)

• Take on empty stomach in the morning.
• Therapy is lifelong.
• Don’t take with antacids, iron, calcium (reduce absorption).
• Monitor TSH to adjust dose.

8. Adrenal Disorders

Hydrocortisone – glucocorticoid (Addison’s disease)

• Replacement for adrenal insufficiency.
• Monitor for:
• Hypotension & fatigue → may need dose increase.
• Hyperglycemia, weight gain, fat redistribution (if excessive).
• Stress or illness = may need higher dose.

Fludrocortisone – mineralocorticoid

• Used with Addison’s.
• Nursing teaching:
• Daily weights.
• Report edema, weakness, palpitations (signs of too much).
• Monitor blood pressure regularly.

9. Key Lab Monitoring

• Pioglitazone → ALT, LDL
• Somatropin → TSH, blood glucose
• PTU → CBC (WBCs), LFTs
• Levothyroxine → TSH
• Hydrocortisone → glucose, electrolytes, BP

✅ Quick NCLEX Tips

• IV dextrose = fastest hypoglycemia fix if IV available.
• Skip repaglinide dose if skipping meal.
• PTU: watch for agranulocytosis (sore throat, fever).
• Pioglitazone = risk of weight gain, edema, liver toxicity, bladder cancer.
• Levothyroxine = lifelong, take AM on empty stomach.