Endocrine: Drug of Choice

• Addison's Disease - Lifetime Hormone Replacement Therapy (Steroids)
• Addison's Disease

  1. Dexamethasone
  2. Fludrocortisone
  3. Betamethasone
  4. Hydrocortisone
  5. Methylprednisone
• Hydrocortisone is the emergency drug for severe low back pain, severe leg pain, and severe headache.
• Addisonian Crisis is the complication of Addison's disease.
• During Severe Hypoglycemia, you may administer 1 vial of D5050, fast drip.
• When Severe Hypotension, administer Plain Normal Saline Solution.
• Cushing Syndrome

  Adrenal Enzyme Inhibitors

  1. Mitotane (Lysodren)
  2. Metyrapone
  3. Ketoconazole
  4. Aminoglutethimide
• Cushing Syndrome Supplements

  1. Potassium Meds given Orally such as Kalium Durule.
  2. Potassium Chloride (KCl)
• Kalium Durule is an enteric coated drug absorbed by the small intestine
• Potassium Chloride or KCl is incorporated into PNSS 1L or D5W 1L. Administer 10 mEqs/hr but with a maximum of 40 mEqs/day.
• CONN'S SYNDROME

  1. Spironolactone (Aldactone) is a potassium-sparring diuretic
  2. Aldosterone Antagonist
• Diabetes Mellitus - Oral Hypoglycemic Agent
• Sulfonylureas stimulates pancreas to increase insulin secretion.
• Sulfonylureas

  1. Glimepiride
  2. Tolbutamide
  3. Chlorpopramide
• Alpha Glucosidase Inhibitor delays glucose absorption in the small intestine.
• Alpha Glucosidase Inhibitor

  1. Miglitol
  2. Acarbose (Precose)
• Biguanides delay glucagon or hepatic glucose output.
• Biguanides

  1. Metformin
• Thiazides increase peripheral receptor sensitivity to insulin and decrease insulin resistance.
• Thiazides

  1. Avandia
  2. Actos
• Grave's Disease

  1. Thiomides inhibits the synthesis of hormones
  2. Iodides inhibits the release of hormones
• Thiomides inhibits the synthesis of hormones.

  example: Propylthiouracil (safe for pregnant women)
• Iodides inhibits the release of hormones

  (mixed with 8 oz or 1 cup water or orange juice due to bitter/metallic taste; use straw because it stains the teeth)

  Examples:

  1. Lugol's Solution (3-5 drops)
  2. Saturated Solution of Potassium Iodide (1 drop)
• Pheochromocytoma

  Acute Attack

  1. Nitroprusside to decrease BP rapidly
  2. Clonidine is given to suppress catecholamine. A normal value is up to 40% decline in baseline BP for 2-3 hours.
• Pheochromocytoma

  2. Alpha-adrenergic blockers

  1. Short-acting Phentolamine (Regitine)
  2. Long-acting Phenoxybenzamine
• Phentolamine is a medication for hypertensive crisis.
• Pheochromocytoma

  3. Aplha-methyl-P-tyrosine is a catecholamine synthesis inhibitor

  1. Metyrosine
• Pheochromocytoma

  4. Dysrythmias-beta-blockers

  1. Propanolol
• Hashimoto Thyroiditis

  Lifetime Thyroid Hormone Replacement such as Thyroxine (Levothyroxine).
• Thyroxine (Levothyroxine) will be hold and the nurse will notify the physician. Physician will administer Propanolol.
• Diabetes Insipidus

  1. Vasopressin
  2. Desmopressin (via intranasal)
  3. Clorchropramin
  4. Clofibrale
• Syndrome fo Appropriate ADH Secretion

  Administer Loop Diuretics such as Furosemide (Laxix).