DRUGS ACTING ON THE

ENDOCRINE SYSTEM

OVERVIEW OF ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM

composed of an interrelated complex of glands

that secrete a variety of hormones directly into
the bloodstream.
major function, together with the nervous system,
is to regulate body functions
HORMONE REGULATION
A. Hormones: chemical substances that act as
messengers to specific cells and organs (target
organs), stimulating and inhibiting various
processes; two major categories:
1. Local: hormones with specific effect in the area
of secretion
2. General: hormones transported in the blood to
distant sites where they exert their effect

OVERVIEW OF ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM

B. Negative feedback mechanisms:

1. Decreased concentration of a circulating
hormone triggers production of a stimulating
hormone from the pituitary gland; this hormone
in turn stimulates its target organ to produce
hormones
2. Increased concentration of a hormone inhibits
production of the stimulating hormone, resulting
in decreased secretion of the target organ
hormone.
C. Some hormones are controlled by changing
blood levels of specific substances (Ca, glucose)

OVERVIEW OF ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM

D. Certain hormones follow rhythmic

patterns of secretion (female
reproductive).
E. ANS and CNS control: hypothalamus
controls release of the hormones of the
APG through releasing and inhibiting
factors that stimulate or inhibit hormone
secretion

OVERVIEW OF ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM

Structures and Functions

Pituitary Gland (Hypophysis)
A. Located in sella turcica at the base of the brain
B. Master gland; 3 lobes:
1. Anterior lobe (adenohypophysis)
a. secretes tropic hormones (hormones that stimulate target glands to
produce their hormone):
adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone
(TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH)
b. also secretes hormones that have direct effect on tissues:
somatotropic or growth hormone, prolactin
c. regulated by hypothalamic releasing and inhibitin factors and by
negative feedback system
2. Posterior lobe (neurohypohysis): does not produce hormones; stores
and releases antidiuretic hormones (ADH) and oxytocin, produces by
the hypothalamus

3. Intermediate lobe: secretes melanocyte-stimulating hormone (MSH)

OVERVIEW OF ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM

Adrenal Glands
A. two small glands, one above each kidney
B. Consist of two sections:
1. Adrenal cortex (outer portion): produces
mineralocorticoids, glucocorticoids, sex hormones
2. Adrenal medulla (inner portion): produces
epinephrine, norepinephrine

Thyroid Gland
A. Located in anterior portion of the neck
B. Consists of two lobes connected by a narrow
isthmus
C. Produces thyroxine (T4), triiodothyronine (T3),
thyrocalcitonin

OVERVIEW OF ANATOMY AND PHYSIOLOGY OF THE ENDOCRINE SYSTEM

Parathyroid Glands
A. Four small glands located in pairs behind the thyroid gland
B. Produce parathormone (PTH)

Pancreas
A. Located behind the stomach
B. Has both endocrine and exocrine functions
C. Islets of Langerhans involved in endocrine functions
1. Beta cells: produce insulin
2. Alpha cells: produce glucagon

Gonads
A. Ovaries: located in the pelvic cavity, produce estrogen and
progesterone
B. Testes: located in the scrotum, produce testosterone

Laboratory/Diagnostic tests
Thyroid Function
A. Serum studies: nonfasting blood
studies (no prep)
1. Serum T4 level: measures total serum
level of throxine
2. Serum T3 level: measures serum
triiodothyronine level
3. TSH: measurement differentiates
primary from secondary hypothyroidism

Laboratory/Diagnostic tests
Pancreatic Function
A. Fasting blood sugar: measures serum
glucose levels; client fasts from midnight
before the test
B. Two-hour postprandial blood sugar:
measurement of blood glucose 2 hours
after a meal is ingested
1. Fast from midnight before test
2. Client eats a meal consisting of at least
75g CHO or ingests 100g glucose
3. Blood drawn 2 hours after a meal

Laboratory/Diagnostic tests
Pancreatic Function
C. Oral glucose tolerance test: most specific and
sensitive test for diabetes mellitus
1. Fast from midnight before test
2. FBG and urine glucose obtained
3. Client ingests 100g glucose; blood sugars are
drawn at 30 and 60 minutes and then hourly 35 hours; urine specimens may also be
collected
4. Diet for 3 days prior to test should include
200g CHO and atleast 1500 kcal/day
5. During test, assess the client for reactions
such as dizziness, sweating and weakness

Laboratory/Diagnostic tests
Pancreatic Function
D. Glycosylated hemoglobin (hemoglobin
A1c) reflects the average blood sugar
level for the previous 100-120 days.
Glucose attaches to a minor hemoglobin
(A1c). this attachment is irreversible.
1. Fasting is not necessary
2. Excellent method to evaluate long term
control of blood sugar

Specific Disorders of the Pituitary Gland

Hypopituitarism
Hypofunction of the APG resulting in
deficiencies of both the hormones
secreted by the APG and those secreted
by the target glands
May be caused by tumor, trauma,
surgical removal; may be congenital
Assessment:
1. Tumor, headache
2. Retardation of growth
3. Hormonal disturbances

Specific Disorders of the Pituitary Gland

Hypopituitarism
Medical management: depends on cause
1. Tumor: removal or irradiation
2. Regardless of cause: treatment will include
replacement of deficient hormones (corticosteroids, thyroid hormones, sex hormones,
gonadotropins -> to restore fertility)

Nursing management:
1. Provide care undergoing hypophysectomy or
radiation therapy
2. Provide client teaching and discharge planning:
a. Hormone replacement therapy
b. Importance of follow-up care

Specific Disorders of the Pituitary Gland

Hyperpituitarism
Hyperfunction of the APG resulting in oversecretion
of one or more of the anterior pituitary hormones> Overproduction of GH -> acromegaly (adults) or
gigantism (children)
Assessment:
1. Tumor, headache
2. Hormonal disturbances
3. Acromegaly: enlargement of the bones, features
becomes coarse and heavy, lips heavier, tongue
enlarged

Medical management: surgical removal or irradiation

of the gland

Specific Disorders of the Pituitary Gland

Hyperpituitarism
Nursing interventions:
1. Monitor for hyperglycemia and
cardiovascular problems and modify care
2. Provide psychological support and
acceptance for alterations in body image
3. Provide care undergoing
hypophysectomy or radiation therapy

Specific Disorders of the Pituitary Gland

Diabetes Insipidus
Hypofunction of the PPG resulting in deficiency
of ADH
Excessive thirst and urination
Tumor, trauma, inflammation, surgery

Assessment
1. Polydipsia and severe polyuria with low SG
(less than 1.004)
2. Fatigue, muscle weakness, irritability, weight
loss, signs of DHN
3. Tachycardia, eventual shock -> if fluids not
replaced

Specific Disorders of the Pituitary Gland

Diabetes Insipidus
Nursing interventions
1. Maintain fluid and electrolyte balance (Keep
accurate I&O; weigh daily, fluid replacementIV/oral)
2. Monitor vs and observe for DHN and
hypovolemia
3. Administer hormone replacement as ordered
a. vasopressin (Pitressin)
b. lypressin (Diapid): nasal spray
4. Client teaching: Lifelong hormone
replacement therapy; lypressin PRN to control
polydipsia/uria

Specific Disorders of the Pituitary Gland

Syndrome of Inappropriate Antidiuretic
Hormone Secretion (SIADH)
Hypersecretion of ADH from PPG even when
the client has abnormal serum osmolality
Assessment
1. concentrated urine
2. Fluid retention and sodium deficiency

Medical management
1. Treat cause
2. Diuretics and fluid restriction

Specific Disorders of the Pituitary Gland

Syndrome of Inappropriate Antidiuretic

Hormone Secretion (SIADH)
Nursing interventions
1. Administer diuretics (furosemide [Lasix])
as ordered
2. Restrict fluids - to promote fluid loss and
gradual increase in serum Na
3. Monitor serum electrolytes
4. Careful intake and output, daily weight
5. Monitor neurologic status
6. Increase Na in diet

Specific Disorders of the Pituitary Gland

DISORDERS OF THE ADRENAL GLAND

Addisons disease
Primary adrenocortical insufficiency;
hypofunction of the adrenal cortex causes
decrease of the mineralocorticoids,
glucocorticoids, and sex hormones

Specific Disorders of the Pituitary Gland

Addisons disease
Assessment:
1. fatigue, muscle weakness
2. anorexia, nausea, vomiting, abdominal
pain, weight loss
3. history of hypoglycemic reactions
4. Hypotension, weak pulse
5. Bronze-like pigmentation of the skin
6. decreased capacity to deal with stress
7. low cortisol levels, hyponatremia,
hyperkaliemia, hypoglycemia

Specific Disorders of the Pituitary Gland

Addisons disease
Nursing interventions
1. Administer hormone replacement therapy as
ordered
a. Glucocorticoids (cortisone, hydrocortisone):
to stimulate diurnal rhythm of cortisol release,
give 2/3 dose in early morning and 1/3 dose in
the afternoon
b. Mineralocorticoids: fludrocortisone acetate
(Florinef)
2. Monitor VS
3. decrease stress in the environment
4. prevent exposure to infection

Specific Disorders of the Adrenal Gland

Addisons disease
Nursing interventions
5. Provide rest periods; prevent fatigue
6. Monitor I&O
7. Weigh daily
8. provide small, frequent feedings of diet high in
CHO, Na and CHON to prevent hypoglycemia and
hyponatremia and proper nutrition
9. client teachings:
a. disease process/signs and symptoms
b. medications for lifelong replacement therapy; never
omit meds
c. avoid stress, trauma, infections
d. diet modification

Specific Disorders of the Adrenal Gland

Cushings Syndrome
Condition resulting from excessive
secretion of corticosteroids, particularly
the glucocorticoid cortisol;
Caused by adrenocortical tumors or
hyperplasia; neoplasms secreting ACTH,
causing increased glucocorticoids

Specific Disorders of the Adrenal Gland

Cushings Syndrome
Assessment:
1. Muscle weakness, fatigue, obese trunk with thin
arms and legs, muscle wasting
2. Irritability, depression, frequent mood swings
3. Moon face, buffalo hump, pendulous abdomen
4. Purple striae on trunk, acne, thin skin
5. Signs of masculinization in women, menstrual
dysfunction, decrease libido
6. Osteoporosis, decreased resistance to infection
7. Hypertension, edema
8. cortisol levels increased, slight hypernatremia,
hyponatremia, hypokalemia, hyperglycemia

Specific Disorders of the Adrenal Gland

Cushings Syndrome
Nursing interventions
1. Maintain muscle tone
2. Prevent accidents or falls and provide adequate
rest
3. Protect client from exposure to infection
4. Maintain skin integrity
5. Minimize stress
6. Monitor vs: hypertension, edema
7. Monitor I&O and daily weights
8. Provide diet low in calories and sodium and high in
protein, potassium, calcium, vitamin D
9. Monitor urine for glucose and acetone: administer
insulin

DISORDERS OF THE THYROID GLAND

Hypothyroidism (Myxedema)
Slowing of metabolic processes caused by
hypofunction of the thyroid glnd with
decreased thyroid hormone secretion ->
myxedema(adults); cretinism(children);
Primary: atrophy; secondary: decreased
stimulation from pituitary TSH; Iatrogenic:
surgical removal of the gland or
overtreatment of hyperthyroidism

DISORDERS OF THE THYROID GLAND

Assessment:
1. Fatigue, lethargy, slowed mental processes, dull, slow
clumsy movements
2. Anorexia, weight gain, constipation
3. Intolerance to cold, dry scaly skin, sparse hair, brittle
nails
4. Menstrual irregularities; generalized non-pitting edema
5. Bradycardia, cardiac complications (CAD, angina
pectoris, MI, CHF)
6. Increased sensitivity to sedatives, narcotics, anesthetics
7. Low T3 and T4 levels
8. Exaggeration of these findings in myxedema coma:
weakness, lethargy, syncope, bradycardia, hypotension,
hypoventilation, subnormal temperature

DISORDERS OF THE THYROID GLAND

Medical management
1. Drug therapy: levothyroxine (Synthroid),
thyroglobulin (Proloid), liothyronine
(Cytomel)
2. Myxedema coma is a medical
emergency
a. IV thyroid hormones
b. correction of hypothermia
c. maintenance of vital functions
d. treatment of precipitating causes

DISORDERS OF THE THYROID GLAND

Interventions:
1. Monitor vs, I&O, daily weights, observe
edema, signs of cardiovascular complications
2. Administer thyroid hormone replacement
as ordered and monitor effects
a. Observe for thyrotoxicosis (tachycardia,
palpitations, nausea, vomiting, diarrhea,
sweating, tremors, agitation, dyspnea)
b. Increase dosage gradually
3. Provide a comfortable warm environment
4. Provide low-calorie diet

DISORDERS OF THE THYROID GLAND

Interventions:
5. Avoid the use of sedatives; reduce by
half
6. Institute measures to prevent skin
breakdown
7. Provide increased fluids and fiber to
prevent constipation; stool softeners
8. Observe for signs of myxedema coma
9. Client teachings: take daily dose in the
morning; protection for cold weather;
prevent constipation

DISORDERS OF THE THYROID GLAND

Hyperthyroidism (Graves disease)
Secretion of excessive amounts of thyroid
hormone in the blood causes an increase
in metabolic process; thyroid gland
changes and overactivity may be present;
unknown cause
Most often seen in women (30-50)

DISORDERS OF THE THYROID GLAND

Assessment
1. Irritability, agitation, restlessness,
hyperactivity, tremor, sweating, insomnia
2. Increased appetite, hyperphagia,
weight loss, diarrhea, intolerance to heat
3. Exophthalmos, goiter
4. Warm, smooth skin; fine, soft hair,
pliable nails
5. Tachycardia, increased systolic BP,
palpitations
6. Increased T3 and T4 levels

DISORDERS OF THE THYROID GLAND

Medical management
a. Antithyroid drugs (propylthiouracil and
methimazole [Tapozole]): block synthesis
of thyroid hormone
b. Adrenergic blocking agents
(propranolol [Inderal]): used to decrease
sympathetic activity and alleviate
symptoms

DISORDERS OF THE THYROID GLAND

Nursing interventions
1. Monitor vs, daily weights
2. Administer antithyroid medications as ordered
3. Provide uninterrupted rest: (private room,
meds)
4. Provide cool environment
5. Minimize stress
6. Encourage quiet, relaxing diversional activities
7. Diet: high in carbohydrates, protein, calories,
vitamins, minerals
8. Exophthalmos:( protect eyes; artificial tears);
thyroid storm

DRUGS AFFECTING THE ENDOCRINE SYSTEM

ANTERIOR PITUITARY HORMONES
Used to antagonize the effects of specific pituitary
hormones
May be used as replacement therapy or diagnostic
purpose

GROWTH HORMONE
Responsible for growth and CHON synthesis
Indicated for growth failure (dwarfism)
Somatotropin (Nutropin, Saizen, Humatrope)
A: IV; D: wide; M: liver; E: urine and feces
Contraindicated for allergy, closed epiphysis and
obesity
Serious adverse effect: DM

DRUGS AFFECTING THE ENDOCRINE SYSTEM

POSTERIOR PITUITARY HORMONES
ADH (synthetic) antidiuretic, hemostatic,
vasopressor properties
promote water reabsorption from the renal tubules
reduction in urine output
vasopressin (Pitressin) parenteral/nasal;
desmopressin (DDAVP)
DI, hemophilia A, nocturnal enuresis, abdominal
distention
D: wide; M: liver; E: urine
CI: allergy, severe renal dysfunction; Caution:
epilepsy, pregnancy
AE: water intoxication, tremor, sweating, headache

DRUGS AFFECTING THE ENDOCRINE SYSTEM

DRUGS USED TO TREAT THYROID DISEASES
Goal: To return the patient to a euthyroid state.
Hypothyroidism: replacement of thyroid hormones
Hyperthyroidism: thyroidectomy, radioactive
iodine, antithyroid medications

Two general classes of drugs used to treat thyroid

hormones:
1. Replacement thyroid hormones levothyroxine
(T4), liothyronine (T3), liothyronine, USP
2. Antithyroid agents suppress synthesis of
thyroid hormones (radioactive iodides,
propylthiouracil, methimazole)

DRUGS AFFECTING THE ENDOCRINE SYSTEM

THYROID REPLACEMENT HORMONES

Primary goal: normal thyroid state
(euthyroid)
Natural and synthetic sources

DRUGS AFFECTING THE ENDOCRINE SYSTEM

levothyroxi Synthroid,
ne
Levoxyl

Synthetic

T4

Drug of
choice

liothyronine

Cytomel

Synthetic

T3

Rapid than
levothyroxine;
not indicated
with CVD

liotrix

Thyrolar

Synthetic

levothyroxi
ne+liothyr
onine
4:1

thyroid, USP

From pig, beef,

sheep; oldest;
least
expensive;
lack purity,
uniformity and
stability

DRUGS AFFECTING THE ENDOCRINE SYSTEM

ADVERSE EFFECTS:
Signs of hyperthyroidism
Tachycardia, anxiety, wt loss, abdominal
cramping, diarrhea, palpitations, angina,
heat intolerance

Dose-related; may occur after 1-3wks

Reduction of dosage or discontinuation

DRUGS AFFECTING THE ENDOCRINE SYSTEM

DRUG INTERACTIONS:
Warfarin: requires increased dosage of
anticoagulants; assess also for signs of
bleeding; reduce after four weeks
Digoxin: requires decrease dosage if with
hypothyroidism, but with therapy, gradual
increase may be necessary
Estrogen: may require increase dosage
of thyroid hormone
Hyperglycemia: monitor for development
of hyperglycemia, specially early weeks->
assess; adjust dosage

DRUGS AFFECTING THE ENDOCRINE SYSTEM

ANTITHYROID MEDICATIONS
Propylthiouracul (PTU, Propasil);
methimazole (Tapazole)
Antithyroid agents by blocking synthesis of T3 and
T4 in the thyroid gland
Do not destroy any T3 and T4 already produced

USES: long-term treatment of hyperthyroidism or

short-term treatment before subtotal
thyroidectomy
ADVERSE EFFECTS:
Purpuric rash/puritus (most common), bone
marrow suppression, hepatotoxicity, nephrotoxicity

DRUGS AFFECTING THE ENDOCRINE SYSTEM

ADRENOCORTICAL AGENTS
GLUCOCORTICOIDS
- enter target cells and bind to cytoplasmic receptors,
initiating many complex reactions -> antiinflammatory and immunosuppressive effects

ACTIONS: suppresses hypersensitivity and immune

response

USES: short-term treatment of inflammatory disorders,

to relieve discomfort, and give the body a chance to
heal from inflammatory effects
: replacement therapy for patients with
adrenocortical insufficiency; immunosuppression;
reduction of inflammation and its effects

DRUGS AFFECTING THE ENDOCRINE SYSTEM

Bethametasone Celestone

Long-acting steroid; parenteral

or oral; inflammation

Cortisone

Cortone
Acetate

Dexamethasone

Decadron,
etc.

Hydrocortisone

Cortef

Methylprednisolo
ne

Medrol

prednisolone

DeltaCortef

Prednisone

Deltasone,

One of the first corticosteroids; orally

and parenteral for adrenal
insufficiency and acute inflammation
Dermatologic, ophthalmologic,
parenteral, inhalation; can last 2-3
days
Powerful; both M & G; replacement
therapy in patients with adrenal
insufficiency
Little mineralocorticoid; drug of
choice for inflammatory and immune
disorders; oral, parenteral, enema
Intermediate corticosteroid; oral,
topical, intralesional and intraarticular injections, oral, topical
Oral; adrenal insufficiency;

DRUGS AFFECTING THE ENDOCRINE SYSTEM

PHARMACOKINETICS:
ABSORPTI Many sites
ON
DISTRIBUTI Well-distributed; crosses placenta and BM
ON
METABOLIS Liver
MCONTRAINDICATIONS AND CAUTIONS:
EXCRETION Urine

Allergy; lactation; diabetes; pregnancy; ulcers

ADVERSE EFFECTS:
fluid retention, potential CHF, increased
appetite and weight gain; fragile skin and loss
of hair; muscle weakness and atrophy,
Cushings syndrome

DRUGS AFFECTING THE ENDOCRINE SYSTEM

NURSING RESPONSIBILITIES:
Take drugs at meal time or with food.
Eat foods high in potassium, low in sodium.
Instruct client to avoid individuals with RTI.
Instruct client not to stop medication abruptly,
it should be tapered to prevent adrenal
insufficiency
Avoid taking NSAID while taking steroids.
Take inhaled bronchodilators first before
taking inhaled steroids, and rinse mouth after
using.
Teach the client the signs and symptoms of
excess use of glucocorticoids

ANTIDIABETIC AGENTS:
1. Sulfonylureas
- stimulate insulin secretions and increase tissue
sensitivity to insulin.
First Generation :
chlorpropamide (Diabenese)
- most frequently used
- disulfiram precautions
tolbutamide (Orinase)
- more easily cleared from the body
- congenital defect
tolazamide
Second Generation :
glypizide, glimepiride (Glucotrol)-less expensive

ANTIDIABETIC AGENTS:
2. Biguanides
- facilitates insulin action on the
peripheral receptor site.

Metformin and Glucophage

(Glucovance)
-acts by decreasing hepatic production of
glucose from stored glycogen. As the result
of this action, metformin:decreases the
serum glucose levels following a meal
inhibits glycogenolysis, reduces absorption
of glucose, increases insulin sensitivity
improving glucose uptake; decrease in FBG

ANTIDIABETIC AGENTS:
3. Alpha-glucosidase inhibitors
- antihyperglycemic agent; enzyme inhibitor
(alpha-amylase, alpha-glucoside hydrolase)
- This agent is prescribed for clients who
cannot control blood sugar by diet because:
- delay carbohydrate absorption in the
intestinal system/ it inhibits the digestive
enzyme for carbohydrates in the small
intestine
- does not cause hypoglycemia
Acarbose (Precose) side effect is diarrhea

ANTIDIABETIC AGENTS:
4. Thiazolinidine (TZD)
- increase tissue sensitivity of insulin. ->
allowing more glucose to enter the cells
in the presence of insulin for metabolism
- do not stimulate the release of insulin,
rather, insulin must be present to be
effective
Rosiglitazone (Avandia)

ANTIDIABETIC AGENTS:
5. Meglitinides
- stimulate insulin release in pancreatic
B-cells.
- effective in type 2 DM not controlled by
diet or exercise (pancreas still has
capacity to secrete insulin); not effective
in type 1DM
Repaglinide (Prandin)

ANTIDIABETIC AGENTS:
Nursing considerations :
- Effective only for type II DM.
- Contraindicated to pregnant &
breastfeeding.
- Given before meals.
- Monitor for signs of hypoglycemia.

ANTIDIABETIC AGENTS:
INSULIN
hormone produced in the beta cells of the
pancreas
required for the entry of glucose into
skeletal and heart muscle and fat
if insulin is deficient, the transport of
glucose into the cells is reduced
hyperlipidemia, ketosis, acidosis

ANTIDIABETIC AGENTS:
Insulin
Immediateacting (lispro)
Shortacting(regularIV, semilente,
human)
Intermediateacting (NPH,
lente)
Long-acting
(ultralente,
Lantus no
peak)
Mixed Humulin
(regular 30%,
NPH 70%)

Onset
0.15h (ave: 5
mins)
0.5-1 h

Peak
0.51h

Duration
5h

2-4 h

5-7h

1-3 h

8-12 h

18-24 h

4-6h

10-30 h

24-36 h

0.5 h

4-8 h

25 h

ANTIDIABETIC AGENTS:
Nursing considerations :
- The insulin that has fewer antigenic, allergic, and
insulin resistance effects is: human insulin
(Humulin)
- Usually given before meals.
- Roll the bottle in palm of hands, dont shake.
- insulin syringe (100-unit insulin syringe)
- Inject amount of air that is equal to each dose
into the bottle short acting last (clear).
- The client is to receive regular and NPH insulins. In
preparing the syringe(s), the nurse or client would
use: one injection: draw up regular insulin first
- Aspirate short acting first, then long or
intermediate (cloudy).

ANTIDIABETIC AGENTS:
- Alcohol is recommended for cleansing bottle but not
with skin.
- Pinch skin, avoid I.M, dont aspirate (SC).
- Rotate the injection site an inch a part.
- Prefilled syringes are stored vertically, needle-up.
- May increase dose during illnesses.
- Used bottles stored in room temperature, unused
bottle stored in refrigerator.
Combination insulins that are commercially premixed,
such as Humulin 70/30, are primarily for clients:
who can use the prepared amount of regular and NPH
units
- insulin pump: regular insulin -> maintain glucose
level
-in case of infection/s: increase dosage

ANTIDIABETIC AGENTS:
- assesses signs and symptoms of
hypoglycemic reaction (insulin
shock):nervousness and tremors
- Monitor for acute hypoglycemia :

a. 3-4 commercially prepared glucose

tablet

b. 4-6 ounce of fruit juice or regular soda

c. 2-3 teaspoon or honey

d. Glucagon 1 gm SQ or IM

e. D50-50 IV.
- give glucagon as first aid on collapsed
person