Pharmacology ATI Study Guide

THYROID REPLACEMENT

Examples Levothyroxine sodium (Synthroid, Levothroid, Levoxyl, Unithroid)

Liothyronine sodium (Cytomel)
Thyroid (Armour Thyroid)
Liotrix (Thyrolar)
Indications Hypothyroidism:
 Depression
 Weight Gain
 Bradycardia
 Anorexia
 Cold intolerance
 Dry Skin
 Menorrhagia
Myxedema Coma (IV emergency tx)
Side Effects Signs of Hyperthyroidism:
 Anxiety
 Tachycardia
 Palpitations
 Altered appetite
 Abd cramping
 Heat intolerance
 Fever
 Diaphoresis
 Weight loss
 Menstrual irregularities
Administration  4 hrs apart from vitamins, antacids, iron, & Carafate
 Monitor & report signs of cardiac excitability (angina, chest
pain, palpitations, dysrhythmias)
 Monitor T4 and TSH
 Take on empty stomach
 Lifelong replacement, don’t d/c abruptly
 Check w/ provider before switching brands
Contraindications  Preg Category A
 Caution in preg & lactation
 CI in Thyrotoxicosis
 Caution: CV problems (HTN, angina, ischemic heart disease)
 CI following an MI due to cardiac stimulant effects
 Not used in tx for obesity
INSULIN

 Only regular insulin may be given IV

 Side effects:
o Lipohypertrophy (rotate sites & leave 1 inch between injection sites)
o Hypoglycemia
 If abrupt onset – SNS sx (tachycardia, palpitations, diaphoresis, shakiness)
 Gradual – PNS sx (HA, tremors, weakness)
 Administer 15 g carb (4 oz OJ, 2 oz grape juice, 8 oz milk, glucose tabs)
 If unconscious, administer IV glucose or glucagon
 Interactions
o Sulfonylureas, meglitinides, beta blockers, & ETOH ↑ hypoglycemic effects
o Thiazide & glucocorticoids ↑ glucose levels

Classification Generic (Trade) Onset Peak Duration

Rapid-acting  Lispro insulin <15 mins. 0.5 – 1 hr 3 – 4 hr
(Humalog)
 Insulin glulisine
(Apridra)
Short-acting  Regular insulin 0.5 – 1 hr 2 – 3 hr 5 – 7 hr
(Humulin R or
Novolin R)
Intermediate-  NPH insulin 1 – 2 hr 4 – 12 hr 18 – 24 hr
acting (Humulin N)
 Insulin detemir
(Levemir)
Long-acting  Insulin glargine 1 hr None 10.4 – 24 hr
(Lantus)

ORAL HYPOGLYCEMICS

Medications Expected Pharmacological Action

Sulfonylureas:
 1st Generation:
 Results in insulin release from the
o Tolbutamide (Orinase)
pancreas
o Chlorpropamide (Diabinese)
 2 Generation:
nd

o Glipizide (Glucotrol)
o Glyburide (DiaBeta, Micronase)
 o Glimepiride (Amaryl)

 SE: hypoglycemia
Meglitinides:
 Food/Med intxns:
 Repaglinide (Prandin)
o Gemfibrozil (Lopid) ↑ risk of
 Nateglinide (Starlix)
hypoglycemia
 SE:
o GI effects (anorexia, N&V,)
o Vit B12 & folic acid deficiency
Biguanides: o Lactic acidosis
 Metformin HCl (Glucophage) (hyperventilation, myalgia,
sluggishness, somnolence)
 Med/Food Intxns:
o ETOH ↑ risk of lactic acidosis
 SE:
o Fluid retention
o ↑ LDL
Thiazolidinediones (Glitazones):
o Hepatotoxicity
 Rosiglitazone (Avandia)
 Med/Food Intxns:
 Pioglitazone (Actos)
o Gemfibrozil: ↑ risk of
hypoglycemia
o Insulin: ↑ risk of hypoglycemia
 SE:
Alpha glucosidase inhibitors o Abd distention & cramping;
hyperactive bowel sounds;
diarrhea; excessive gas
o Anemia
o Hepatoxicity
 Med/Food Intxns:
o Sulfonylureas & insulin: ↑ risk
of hypoglycemia
o Metformin: added GI effects &
↑ risk of hypoglycemia