1. Introduction

The endocrine system consists of glands that produce hormones to regulate metabolism, growth, development, and homeostasis. Disorders occur due to hormonal excess, deficiency, or dysfunction, requiring pharmacological intervention to restore balance.

Drugs used for endocrine disorders either:

Replace deficient hormones (e.g., insulin for diabetes, levothyroxine for hypothyroidism).
Suppress excessive hormone production (e.g., methimazole for hyperthyroidism, corticosteroids for adrenal hyperactivity).
Modify hormone effects (e.g., oral antidiabetics, growth hormone inhibitors).

2. Major Endocrine Glands & Their Disorders

Gland	Hormone	Disorders
Pituitary Gland	Growth Hormone (GH), ADH, ACTH	Gigantism, Acromegaly, Diabetes Insipidus
Thyroid Gland	Thyroxine (T₄), Triiodothyronine (T₃), Calcitonin	Hypothyroidism, Hyperthyroidism, Goiter
Parathyroid Gland	Parathyroid Hormone (PTH)	Hypoparathyroidism, Hyperparathyroidism
Adrenal Glands	Cortisol, Aldosterone, Epinephrine	Addison’s Disease, Cushing’s Syndrome, Pheochromocytoma
Pancreas	Insulin, Glucagon	Diabetes Mellitus (Type 1 & Type 2)
Ovaries/Testes	Estrogen, Progesterone, Testosterone	PCOS, Hypogonadism, Menopause

3. General Classification of Drugs for Endocrine Disorders

Category	Examples	Indications
1. Hormone Replacement Therapy	Insulin, Levothyroxine, Hydrocortisone	Diabetes, Hypothyroidism, Addison’s Disease
2. Antithyroid Drugs	Methimazole, Propylthiouracil (PTU)	Hyperthyroidism
3. Oral Hypoglycemics	Metformin, Sulfonylureas	Type 2 Diabetes
4. Glucocorticoids	Prednisone, Dexamethasone	Inflammation, Addison’s Disease
5. Mineralocorticoids	Fludrocortisone	Addison’s Disease
6. Parathyroid Modulators	Calcitriol, Cinacalcet	Hypoparathyroidism, Hyperparathyroidism
7. Growth Hormone Therapy	Somatropin, Octreotide	Growth Disorders (Dwarfism, Acromegaly)
8. Sex Hormones & Antagonists	Estrogen, Testosterone, Tamoxifen	Menopause, Hypogonadism, PCOS, Breast Cancer

4. Importance of These Drugs

Restore normal hormone levels to prevent complications.
Improve metabolism, growth, and reproduction.
Prevent long-term complications like heart disease, osteoporosis, and nerve damage in diabetes.

Insulin & Oral Hypoglycemics:

1. Introduction

Insulin and oral hypoglycemic agents are used to control blood glucose levels in patients with diabetes mellitus. They help prevent complications such as diabetic ketoacidosis (DKA), neuropathy, retinopathy, nephropathy, and cardiovascular diseases.

2. Insulin

A. Composition of Insulin

Insulin is a polypeptide hormone produced by the beta cells of the pancreas. The main types of insulin used in therapy include:

Human Insulin (Recombinant DNA technology)
Analog Insulin (Modified human insulin for better absorption and effect)

B. Types of Insulin & Their Action

Type	Examples	Onset	Peak	Duration
Rapid-Acting	Lispro, Aspart, Glulisine	10-30 min	1-2 hrs	3-5 hrs
Short-Acting	Regular Insulin (Humulin R, Actrapid)	30-60 min	2-4 hrs	5-8 hrs
Intermediate-Acting	NPH (Humulin N, Insulatard)	1-2 hrs	6-12 hrs	12-18 hrs
Long-Acting	Glargine, Detemir, Degludec	1-2 hrs	No peak	24-42 hrs
Premixed	70/30 (NPH/Regular), 50/50, 75/25	Varies	Dual peak	10-24 hrs

C. Dosage & Route

Dosage: Individualized based on blood glucose levels, insulin sensitivity, and lifestyle.
Route: Subcutaneous (SC) (most common), Intravenous (IV) (only regular insulin in emergencies like DKA).
Administration Sites: Abdomen, thighs, buttocks, upper arms.

D. Indications

Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus (when oral drugs are ineffective)
Gestational Diabetes
Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycemic State (HHS)
Perioperative & Critically Ill Patients (Blood glucose control)

E. Contraindications

Hypoglycemia
Allergy to insulin or preservatives
Severe hypokalemia (risk of cardiac arrhythmia)

F. Drug Interactions

Interacting Drug	Effect
Beta-Blockers	Mask symptoms of hypoglycemia
Corticosteroids	Increase blood glucose, reducing insulin effect
Oral Hypoglycemics	Risk of hypoglycemia when combined
Thiazide Diuretics	Increase blood glucose, reducing insulin effectiveness

G. Side Effects

Hypoglycemia (sweating, tremors, dizziness, confusion)
Weight gain
Injection site reactions (redness, swelling, lipodystrophy)
Hypokalemia (due to cellular potassium shift)

H. Adverse Effects & Toxicity

Severe hypoglycemia → Coma, seizures (requires IV dextrose or glucagon)
Insulin resistance → Leads to higher insulin requirements
Lipodystrophy → Fat loss or accumulation at injection sites

I. Role of the Nurse in Insulin Therapy

✅ Before Administration

Check blood glucose levels.
Rotate injection sites to prevent lipodystrophy.
Ensure correct insulin type and dose.

✅ During Administration

Use the correct insulin syringe (U-100, U-500).
Monitor for signs of hypoglycemia (shakiness, confusion, sweating).

✅ After Administration

Educate on self-monitoring of blood glucose (SMBG).
Advise on diet and exercise.
Teach about hypoglycemia prevention (carry glucose tablets, avoid skipping meals).

3. Oral Hypoglycemics (Oral Antidiabetic Drugs)

A. Classification & Mechanism of Action

Class	Examples	Mechanism of Action
Biguanides	Metformin	Reduces liver glucose production, increases insulin sensitivity
Sulfonylureas	Glimepiride, Glyburide, Glipizide	Stimulates pancreatic beta cells to release insulin
Meglitinides	Repaglinide, Nateglinide	Increases insulin secretion (short-acting)
Thiazolidinediones (TZDs)	Pioglitazone, Rosiglitazone	Increases insulin sensitivity in muscle and fat
DPP-4 Inhibitors	Sitagliptin, Vildagliptin	Prolongs incretin hormone action, increasing insulin secretion
SGLT-2 Inhibitors	Canagliflozin, Dapagliflozin	Increases glucose excretion via urine
Alpha-Glucosidase Inhibitors	Acarbose, Miglitol	Delays carbohydrate absorption in intestines

B. Dosage & Route

Dosage: Individualized based on HbA1c levels and patient response.
Route: Oral (tablets or extended-release formulations).

C. Indications

Type 2 Diabetes Mellitus
Prediabetes (Metformin)
Polycystic Ovarian Syndrome (PCOS) (Metformin)

D. Contraindications

Drug Class	Contraindications
Metformin	Renal failure (GFR <30), lactic acidosis risk
Sulfonylureas	Severe liver/kidney disease
TZDs	Heart failure, bladder cancer
SGLT-2 Inhibitors	Severe kidney disease

E. Drug Interactions

Oral Hypoglycemic	Interacting Drug	Effect
Metformin	Contrast agents (iodine)	Lactic acidosis risk
Sulfonylureas	NSAIDs, Alcohol	Increased hypoglycemia risk
TZDs	Insulin	Increased heart failure risk
SGLT-2 Inhibitors	Diuretics	Dehydration, hypotension

F. Side Effects

Drug Class	Common Side Effects
Metformin	Nausea, diarrhea, lactic acidosis (rare)
Sulfonylureas	Hypoglycemia, weight gain
TZDs	Fluid retention, weight gain
DPP-4 Inhibitors	Nasopharyngitis, pancreatitis
SGLT-2 Inhibitors	UTI, dehydration, ketoacidosis
Alpha-Glucosidase Inhibitors	Flatulence, diarrhea

G. Adverse Effects & Toxicity

Metformin Toxicity: Lactic acidosis (treated with sodium bicarbonate & dialysis).
Sulfonylurea Overdose: Severe hypoglycemia (treated with IV dextrose).
TZDs: Risk of heart failure & bone fractures.

H. Role of the Nurse in Oral Hypoglycemics

✅ Before Administration

Check renal & liver function (Metformin, TZDs).
Assess for hypoglycemia risk.

✅ During Administration

Give with food (Sulfonylureas) to prevent hypoglycemia.
Monitor for GI symptoms (Metformin).

✅ After Administration

Teach lifestyle modifications (exercise, diet).
Advise on self-monitoring of glucose levels.
Educate on hypoglycemia symptoms & management.

Thyroid and Anti-Thyroid Drugs:

1. Introduction

Thyroid hormones regulate metabolism, growth, energy production, and organ function. Thyroid disorders occur due to excessive (hyperthyroidism) or insufficient (hypothyroidism) hormone levels. Medications are used to replace deficient hormones or suppress overactive thyroid function.

2. Thyroid Hormones (For Hypothyroidism)

A. Composition of Thyroid Hormones

Drug	Composition
Levothyroxine (T4)	Synthetic Thyroxine (T4)
Liothyronine (T3)	Synthetic Triiodothyronine (T3)
Desiccated Thyroid (Armour Thyroid)	Animal-derived T3 & T4 mix

B. Mechanism of Action

Levothyroxine (T4): Converts to T3 (active form) in the body, replacing deficient thyroid hormone.
Liothyronine (T3): Directly provides active thyroid hormone for rapid action.

C. Dosage & Route

Drug	Dosage	Route
Levothyroxine	25-200 mcg/day	Oral, IV (for myxedema coma)
Liothyronine	5-25 mcg/day	Oral, IV
Desiccated Thyroid	15-120 mg/day	Oral

D. Indications

Hypothyroidism (Primary & Secondary)
Congenital Hypothyroidism (Cretinism)
Myxedema Coma (Severe hypothyroidism)
Goiter (due to iodine deficiency)
Post-Thyroidectomy Hormone Replacement

E. Contraindications

Untreated adrenal insufficiency
Thyrotoxicosis
Recent myocardial infarction
Hyperthyroidism (unless adjusting dose for treatment)

F. Drug Interactions

Interacting Drug	Effect
Iron, Calcium, Antacids	Reduce absorption
Warfarin	Increases anticoagulant effect
Beta-Blockers	Reduces effectiveness
Oral Hypoglycemics	May require dose adjustment

G. Side Effects

Insomnia, weight loss, tremors
Palpitations, tachycardia
Heat intolerance, sweating
Nervousness, anxiety

H. Adverse Effects & Toxicity

Hyperthyroidism-like symptoms (thyrotoxicosis)
Atrial fibrillation, osteoporosis (long-term use)
Acute overdose: Thyroid storm (requires beta-blockers, IV fluids)

I. Role of the Nurse in Thyroid Hormone Therapy

✅ Before Administration

Check TSH, T3, T4 levels.
Assess heart rate and BP.
Give on an empty stomach (morning, 30 min before food).

✅ During Administration

Monitor for overdose symptoms (palpitations, weight loss).
Adjust dose gradually.

✅ After Administration

Educate on lifelong therapy.
Avoid abrupt discontinuation.
Monitor for signs of effectiveness (improved energy, stable weight, normal HR).

3. Anti-Thyroid Drugs (For Hyperthyroidism)

A. Composition of Anti-Thyroid Drugs

Drug	Composition
Methimazole (MMI)	Thioamide derivative
Propylthiouracil (PTU)	Thioamide derivative
Radioactive Iodine (I-131)	Radioactive isotope
Beta-Blockers (Propranolol, Atenolol)	Non-selective β-blockers for symptom control

B. Mechanism of Action

Methimazole (MMI) & Propylthiouracil (PTU): Inhibit thyroid peroxidase, preventing thyroid hormone synthesis.
Radioactive Iodine (I-131): Destroys thyroid cells, reducing hormone production.
Beta-Blockers: Control symptoms (tachycardia, tremors) but do not reduce hormone levels.

C. Dosage & Route

Drug	Dosage	Route
Methimazole	5-30 mg/day	Oral
Propylthiouracil (PTU)	50-150 mg 3x/day	Oral
Radioactive Iodine (I-131)	4-10 mCi single dose	Oral (capsule/liquid)
Propranolol	10-40 mg every 6-8 hrs	Oral, IV (severe cases)

D. Indications

Hyperthyroidism (Graves’ Disease)
Toxic Multinodular Goiter
Thyroid Storm (PTU preferred)
Pre-surgery for Thyroidectomy
Thyroid Cancer (Radioactive Iodine)

E. Contraindications

Pregnancy (Methimazole is teratogenic; PTU preferred in 1st trimester)
Severe liver disease (PTU)
Hypothyroidism

F. Drug Interactions

Interacting Drug	Effect
Warfarin	Increased bleeding risk
Digoxin	Increased levels due to slower metabolism
Beta-Blockers	Enhanced effect in hyperthyroid patients

G. Side Effects

Methimazole/PTU:
- Skin rash, nausea
- Joint pain, headache
Radioactive Iodine:
- Mild sore throat, dry mouth
- Hypothyroidism (may require levothyroxine)
Beta-Blockers:
- Fatigue, dizziness, bradycardia

H. Adverse Effects & Toxicity

Agranulocytosis (low WBCs, life-threatening infections)
Hepatotoxicity (PTU)
Thyroid Storm (if untreated)
- Symptoms: Fever, tachycardia, confusion, seizures
- Treatment: PTU, Beta-blockers, IV fluids, steroids

I. Role of the Nurse in Anti-Thyroid Therapy

✅ Before Administration

Assess WBC count (risk of agranulocytosis).
Monitor liver function (PTU risk).
Check for pregnancy (avoid Methimazole in 1st trimester).

✅ During Administration

Give Methimazole once daily; PTU multiple times daily.
Monitor for infection signs (fever, sore throat).
Ensure radiation precautions if using I-131.

✅ After Administration

Monitor thyroid function (TSH, T3, T4).
Educate on agranulocytosis signs (fever, sore throat).
Advise on lifelong monitoring (radioactive iodine patients may develop hypothyroidism).

Steroids: Corticosteroids & Anabolic Steroids

1. Introduction

Steroids are a class of drugs used for various medical conditions. They are divided into:

Corticosteroids – Used to reduce inflammation and suppress the immune system.
Anabolic Steroids – Used to enhance muscle growth and treat conditions like testosterone deficiency.

CORTICOSTEROIDS

2. Corticosteroids

A. Composition of Corticosteroids

Corticosteroids are synthetic drugs that mimic hormones produced by the adrenal glands. They are classified into:

Glucocorticoids: Affect metabolism and immune response.
Mineralocorticoids: Regulate salt and water balance.

Type	Examples	Main Effects
Glucocorticoids	Prednisone, Dexamethasone, Hydrocortisone	Anti-inflammatory, immunosuppressive
Mineralocorticoids	Fludrocortisone	Regulates sodium and water balance

B. Mechanism of Action

Glucocorticoids: Bind to intracellular receptors, regulating gene transcription to reduce inflammation, suppress immunity, and alter metabolism.
Mineralocorticoids: Increase sodium and water retention, helping regulate blood pressure and fluid balance.

C. Dosage & Route

Drug	Dosage	Route
Prednisone	5-60 mg/day	Oral
Dexamethasone	0.5-10 mg/day	Oral, IV, IM
Hydrocortisone	20-100 mg/day	IV, Topical, Oral
Fludrocortisone	0.05-0.2 mg/day	Oral

D. Indications

Autoimmune Diseases (Rheumatoid arthritis, Lupus)
Allergic Reactions (Anaphylaxis, Asthma)
Inflammatory Disorders (IBD, COPD, Psoriasis)
Endocrine Disorders (Adrenal insufficiency – Addison’s Disease)
Cancer Treatment (Leukemia, Lymphoma)
Shock Management (Septic Shock, Adrenal Crisis)

E. Contraindications

Active infections (e.g., tuberculosis, fungal infections)
Uncontrolled diabetes mellitus
Severe osteoporosis
Glaucoma
Peptic ulcer disease

F. Drug Interactions

Interacting Drug	Effect
NSAIDs (Aspirin, Ibuprofen)	Increased risk of GI bleeding
Diuretics	Increased potassium loss (hypokalemia)
Insulin & Oral Hypoglycemics	Reduced effectiveness, causing hyperglycemia
Warfarin	Alters anticoagulant effect

G. Side Effects

Short-Term	Long-Term (Chronic Use)
Hyperglycemia	Osteoporosis
Hypertension	Cushing’s Syndrome (moon face, buffalo hump)
Mood changes	Growth suppression (children)
Insomnia	Cataracts, Glaucoma

H. Adverse Effects & Toxicity

Cushingoid Appearance (Fat redistribution, weight gain, acne)
Adrenal Suppression (Long-term use suppresses natural cortisol production)
Osteoporosis (Bone loss, fractures)
Hyperglycemia & Diabetes
Steroid Withdrawal Syndrome (Fatigue, nausea, low BP after sudden stopping)

🔹 Management of Toxicity:

Gradual tapering (prevent adrenal insufficiency)
Monitor blood glucose & electrolytes
Calcium & Vitamin D supplements (prevent osteoporosis)

I. Role of the Nurse in Corticosteroid Therapy

✅ Before Administration

Check baseline blood sugar, BP, weight, and bone density.
Assess for infection risk.

✅ During Administration

Administer in the morning (mimic natural cortisol rhythm).
Take with food to reduce gastric irritation.

✅ After Administration

Monitor for Cushing’s syndrome signs (moon face, hypertension).
Educate patients on gradual dose tapering.
Advise lifestyle changes (calcium-rich diet, exercise).

ANABOLIC STEROIDS

3. Anabolic Steroids

A. Composition of Anabolic Steroids

Anabolic steroids are synthetic derivatives of testosterone, used to enhance muscle growth, strength, and performance.

Drug	Composition
Testosterone	Synthetic androgen
Nandrolone	Injectable anabolic steroid
Oxandrolone	Oral anabolic steroid
Stanozolol	Performance-enhancing steroid

B. Mechanism of Action

Bind to androgen receptors, stimulating protein synthesis.
Increase red blood cell production (enhanced oxygen delivery).
Promote muscle and bone growth.

C. Dosage & Route

Drug	Dosage	Route
Testosterone	50-200 mg every 2-4 weeks	IM, Topical
Nandrolone	25-100 mg/week	IM
Oxandrolone	2.5-20 mg/day	Oral
Stanozolol	2-10 mg/day	Oral, IM

D. Indications

Hypogonadism (Testosterone deficiency)
Delayed Puberty
Muscle Wasting Disorders (HIV/AIDS, Cancer)
Anemia (Stimulates RBC production)
Severe Burns (Muscle regeneration)

E. Contraindications

Prostate & Breast Cancer
Pregnancy
Severe Liver or Kidney Disease
Heart Disease & Hypertension

F. Drug Interactions

Interacting Drug	Effect
Warfarin	Increased bleeding risk
Insulin	Enhanced hypoglycemia
Corticosteroids	Increased fluid retention
NSAIDs	Increased cardiovascular risk

G. Side Effects

Men	Women	Both
Testicular shrinkage	Deep voice	Liver toxicity
Baldness	Excess body hair	Acne
Infertility	Irregular periods	High cholesterol
Gynecomastia (breast enlargement)	Clitoral enlargement	Aggressive behavior

H. Adverse Effects & Toxicity

Liver Damage (Hepatotoxicity)
Heart Disease (High LDL, Low HDL)
Psychological Effects (“Roid Rage”)
Severe Acne & Hair Loss
Blood Clots & Stroke

🔹 Management of Toxicity:

Liver function monitoring
Psychiatric evaluation for aggression
Hormonal therapy for withdrawal symptoms

I. Role of the Nurse in Anabolic Steroid Therapy

✅ Before Administration

Assess testosterone levels before prescribing.
Screen for cardiovascular risks.

✅ During Administration

Rotate injection sites for IM administration.
Monitor for mood changes & aggression.

✅ After Administration

Educate on long-term risks (heart disease, infertility).
Encourage natural muscle-building methods (exercise, diet).
Monitor lipid profile & liver function regularly.

Calcitonin, Parathormone, Vitamin D3, and Calcium Metabolism.

1. Introduction

The calcium metabolism system regulates blood calcium levels through the interaction of hormones (calcitonin & parathormone), vitamin D3, and calcium salts. These components are essential for bone health, nerve conduction, muscle contraction, and blood clotting.

Calcitonin lowers calcium levels by inhibiting bone resorption.
Parathyroid Hormone (PTH) increases calcium levels by stimulating bone resorption, enhancing intestinal absorption, and reducing renal excretion.
Vitamin D3 (Cholecalciferol) promotes calcium absorption in the intestines.
Calcium salts are used for calcium supplementation.

2. Calcitonin

A. Composition of Calcitonin

Drug	Composition
Calcitonin-Salmon	Synthetic salmon calcitonin
Human Calcitonin	Recombinant human calcitonin

B. Mechanism of Action

Inhibits osteoclast activity, reducing bone resorption.
Increases calcium excretion by kidneys, lowering serum calcium levels.

C. Dosage & Route

Drug	Dosage	Route
Calcitonin-Salmon	50-100 IU/day	SC, IM, Nasal Spray
Human Calcitonin	0.5-1 mg/day	SC, IV

D. Indications

Hypercalcemia
Osteoporosis
Paget’s Disease
Bone pain from metastatic cancer

E. Contraindications

Hypocalcemia
Allergy to calcitonin
Pregnancy & breastfeeding

F. Drug Interactions

Interacting Drug	Effect
Bisphosphonates	Enhanced effect in osteoporosis
Loop Diuretics	Increased calcium loss
Lithium	Decreased lithium effectiveness

G. Side Effects

Nausea, vomiting
Flushing of the face
Hypocalcemia (muscle cramps, tingling)
Nasal irritation (with nasal spray)

H. Adverse Effects & Toxicity

Severe hypocalcemia (tetany, muscle spasms)
Allergic reactions (anaphylaxis)
Long-term nasal spray use → Nasal ulceration

🔹 Management of Toxicity:

Calcium & Vitamin D supplementation.
Discontinue drug if severe allergic reaction occurs.

I. Role of the Nurse in Calcitonin Therapy

✅ Before Administration

Check serum calcium levels.
Assess for nasal irritation (if using nasal spray).

✅ During Administration

Rotate injection sites (SC, IM).
Monitor for hypocalcemia symptoms.

✅ After Administration

Educate patients on nasal spray use (alternate nostrils).
Encourage calcium-rich diet.

3. Parathyroid Hormone (Parathormone – PTH)

A. Composition of Parathyroid Hormone

Drug	Composition
Teriparatide	Recombinant human PTH (1-34)
Natpara	Full-length recombinant PTH

B. Mechanism of Action

Stimulates osteoblasts, increasing bone formation.
Enhances calcium reabsorption in kidneys.
Increases intestinal calcium absorption via Vitamin D activation.

C. Dosage & Route

Drug	Dosage	Route
Teriparatide	20 mcg/day	SC
Natpara	50-100 mcg/day	SC

D. Indications

Osteoporosis (high fracture risk)
Hypoparathyroidism
Severe vitamin D-resistant rickets

E. Contraindications

Hypercalcemia
Paget’s disease
Bone cancer history

F. Drug Interactions

Interacting Drug	Effect
Digoxin	Increased risk of toxicity
Loop Diuretics	Increased calcium loss

G. Side Effects

Dizziness, nausea
Hypercalcemia (kidney stones, constipation)
Leg cramps

H. Adverse Effects & Toxicity

Osteosarcoma risk (long-term use)
Severe hypercalcemia (confusion, arrhythmias)

🔹 Management of Toxicity:

Reduce calcium intake.
Monitor renal function.

I. Role of the Nurse in Parathormone Therapy

✅ Before Administration

Assess calcium levels.
Check renal function.

✅ During Administration

Administer SC in the thigh.
Monitor for dizziness (fall risk).

✅ After Administration

Educate on daily SC injections.
Ensure adequate calcium intake.

4. Vitamin D3 (Cholecalciferol)

A. Composition of Vitamin D3

Drug	Composition
Cholecalciferol	Vitamin D3
Ergocalciferol	Vitamin D2
Calcitriol	Active Vitamin D3

B. Mechanism of Action

Enhances calcium & phosphorus absorption in intestines.
Stimulates osteoblasts, improving bone formation.
Reduces PTH secretion in hyperparathyroidism.

C. Dosage & Route

Drug	Dosage	Route
Cholecalciferol	400-1000 IU/day	Oral
Calcitriol	0.25-1 mcg/day	Oral, IV

D. Indications

Osteoporosis
Rickets (Children)
Hypoparathyroidism
Chronic kidney disease (CKD)

E. Contraindications

Hypercalcemia
Vitamin D toxicity
Kidney stones

F. Drug Interactions

Interacting Drug	Effect
Thiazide Diuretics	Increased hypercalcemia risk
Corticosteroids	Reduced Vitamin D effect

G. Side Effects

Nausea, vomiting
Constipation
Muscle weakness

H. Adverse Effects & Toxicity

Hypercalcemia (kidney stones, confusion, arrhythmias)
Vitamin D toxicity (excessive thirst, polyuria)

🔹 Management of Toxicity:

Stop Vitamin D intake.
Increase fluid intake.

I. Role of the Nurse in Vitamin D Therapy

✅ Before Administration

Assess calcium levels.
Ensure no kidney stone history.

✅ During Administration

Give with food for better absorption.

✅ After Administration

Educate on sunlight exposure for natural Vitamin D.
Monitor calcium intake.

5. Calcium Salts

A. Types of Calcium Salts

Calcium Supplement	Elemental Calcium Content
Calcium Carbonate	40%
Calcium Citrate	21%
Calcium Gluconate	9%

B. Indications

Osteoporosis prevention
Hypocalcemia
Hyperkalemia (Calcium Gluconate IV)

C. Adverse Effects

Constipation
Hypercalcemia (kidney stones, confusion)

🔹 Management:

Hydration & dietary balance.

Role and Responsibilities of Nurses in the Administration of Drugs for Endocrine System Disorders

1. Introduction

The endocrine system regulates metabolism, growth, development, and homeostasis through hormones. Disorders such as diabetes, hypothyroidism, hyperthyroidism, adrenal dysfunction, osteoporosis, and calcium imbalances require pharmacological intervention. Nurses play a crucial role in safe drug administration, patient education, monitoring therapy, and preventing complications.

2. Drugs Used for Endocrine Disorders & Nursing Responsibilities

Endocrine Disorder	Drug Class	Examples
Diabetes Mellitus	Insulin, Oral Hypoglycemics	Insulin, Metformin, Glipizide, Dapagliflozin
Hypothyroidism	Thyroid Hormones	Levothyroxine, Liothyronine
Hyperthyroidism	Anti-Thyroid Drugs	Methimazole, Propylthiouracil
Adrenal Insufficiency (Addison’s Disease)	Glucocorticoids & Mineralocorticoids	Prednisone, Hydrocortisone, Fludrocortisone
Cushing’s Syndrome	Cortisol Inhibitors	Ketoconazole, Metyrapone
Osteoporosis	Bisphosphonates, Calcitonin	Alendronate, Risedronate, Calcitonin
Calcium Disorders	Calcium & Vitamin D, PTH Analogues	Calcium Gluconate, Calcitriol, Teriparatide

3. Nursing Responsibilities in Endocrine Drug Administration

Nurses have multiple roles in ensuring safe and effective medication therapy for endocrine disorders.

A. Before Administration

✅ Assess Baseline Data

Vital signs (BP, HR for thyroid & adrenal drugs)
Blood glucose levels (for insulin & oral hypoglycemics)
Electrolyte levels (for calcium, potassium, sodium imbalances)
Thyroid function tests (TSH, T3, T4)
Adrenal function tests (ACTH, cortisol levels)

✅ Check for Contraindications

Avoid insulin overdose in hypoglycemic patients.
Monitor for liver dysfunction before prescribing Metformin.
Check renal function before giving bisphosphonates or SGLT2 inhibitors.

✅ Confirm Correct Drug, Dose & Route

Insulin: Ensure correct type (rapid, short, intermediate, long-acting).
Thyroid hormones: Administer Levothyroxine on an empty stomach.
Calcium supplements: Give Calcium Citrate for patients with low stomach acid.

✅ Educate the Patient

Diabetic patients: Teach how to self-monitor blood glucose (SMBG).
Hypothyroidism patients: Advise lifelong therapy adherence.
Osteoporosis patients: Instruct on posture while taking bisphosphonates (stay upright for 30 minutes to prevent esophageal irritation).

B. During Administration

✅ Monitor for Drug Reactions

Hypoglycemia (for Insulin & Sulfonylureas): Sweating, dizziness, confusion.
Thyroid Hormone Overdose: Palpitations, insomnia, weight loss.
Glucocorticoid Side Effects: Hyperglycemia, mood changes, Cushing’s syndrome.

✅ Ensure Proper Drug Administration Techniques

Insulin Injection: Rotate injection sites to prevent lipodystrophy.
Oral Bisphosphonates: Take with water on an empty stomach; remain upright.
IV Calcium: Administer slowly to prevent arrhythmias.

✅ Monitor Blood Levels

Diabetes drugs: Check HbA1c every 3 months.
Thyroid medications: Adjust dose based on TSH & T4 levels.
Adrenal drugs: Monitor cortisol levels & electrolytes.

C. After Administration

✅ Evaluate Drug Effectiveness

Diabetes: Check improved blood glucose control (FBS <126 mg/dL).
Hypothyroidism: Assess energy levels, weight normalization, HR stabilization.
Osteoporosis: Monitor bone density scans (DEXA scans).

✅ Manage Side Effects

Steroids: Educate about infection risk & osteoporosis prevention.
Antithyroid drugs: Monitor for agranulocytosis (fever, sore throat).
SGLT2 inhibitors: Monitor for UTIs & dehydration.

✅ Educate Patients for Long-Term Management

Diabetic patients: Maintain diet, exercise, foot care.
Thyroid patients: Take medications consistently at the same time.
Osteoporosis patients: Increase calcium intake & weight-bearing exercises.

4. Emergency Management in Endocrine Drug Therapy

Complication	Emergency Drug	Nursing Actions
Severe Hypoglycemia (from Insulin or Sulfonylureas)	IV Dextrose, Glucagon	Check blood glucose, administer dextrose, monitor vitals
Thyroid Storm (from Hyperthyroidism)	Beta-blockers, PTU, Corticosteroids	Monitor HR & BP, provide oxygen, IV fluids
Adrenal Crisis (from Steroid Withdrawal)	IV Hydrocortisone, IV Fluids	Monitor BP, replace fluids, provide emergency corticosteroids
Hypercalcemia (from Overdose of Calcium/Vitamin D3)	IV Fluids, Diuretics, Calcitonin	Hydration therapy, monitor ECG

Published February 21, 2025By mynursingapp

Categorized as BSC - SEM 3 - PHARMACOLOGY, Uncategorised

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BSC – SEM 3 UNIT 6 PHARMACOLOGY

Drugs Used in the Treatment of Endocrine System Disorders: Introduction

1. Introduction

2. Major Endocrine Glands & Their Disorders

3. General Classification of Drugs for Endocrine Disorders

4. Importance of These Drugs

Insulin & Oral Hypoglycemics:

1. Introduction

2. Insulin

A. Composition of Insulin

B. Types of Insulin & Their Action

C. Dosage & Route

D. Indications

E. Contraindications

F. Drug Interactions

G. Side Effects

H. Adverse Effects & Toxicity

I. Role of the Nurse in Insulin Therapy

3. Oral Hypoglycemics (Oral Antidiabetic Drugs)

A. Classification & Mechanism of Action

B. Dosage & Route

C. Indications

D. Contraindications

E. Drug Interactions

F. Side Effects

G. Adverse Effects & Toxicity

H. Role of the Nurse in Oral Hypoglycemics

Thyroid and Anti-Thyroid Drugs:

1. Introduction

2. Thyroid Hormones (For Hypothyroidism)

A. Composition of Thyroid Hormones

B. Mechanism of Action

C. Dosage & Route

D. Indications

E. Contraindications

F. Drug Interactions

G. Side Effects

H. Adverse Effects & Toxicity

I. Role of the Nurse in Thyroid Hormone Therapy

3. Anti-Thyroid Drugs (For Hyperthyroidism)

A. Composition of Anti-Thyroid Drugs

B. Mechanism of Action

C. Dosage & Route

D. Indications

E. Contraindications

F. Drug Interactions

G. Side Effects

H. Adverse Effects & Toxicity

I. Role of the Nurse in Anti-Thyroid Therapy

Steroids: Corticosteroids & Anabolic Steroids

1. Introduction

CORTICOSTEROIDS

2. Corticosteroids

A. Composition of Corticosteroids

B. Mechanism of Action

C. Dosage & Route

D. Indications

E. Contraindications

F. Drug Interactions

G. Side Effects

H. Adverse Effects & Toxicity

I. Role of the Nurse in Corticosteroid Therapy

ANABOLIC STEROIDS

3. Anabolic Steroids

A. Composition of Anabolic Steroids

B. Mechanism of Action

C. Dosage & Route

D. Indications

E. Contraindications

F. Drug Interactions

G. Side Effects

H. Adverse Effects & Toxicity

I. Role of the Nurse in Anabolic Steroid Therapy

Calcitonin, Parathormone, Vitamin D3, and Calcium Metabolism.

1. Introduction

2. Calcitonin

A. Composition of Calcitonin

B. Mechanism of Action