NCLEX Quick Sheet – Endocrine Pharmacotherapeutics &
Hormonal Emergencies
•Insulin Therapy – Rapid (lispro/aspart), Short (regular), Intermediate (NPH), Long (glargine/detemir). NCLEX:
Clear before cloudy; rotate sites; monitor for hypoglycemia.
•Hypoglycemia – BG <70 mg/dL. S/S: tremor, diaphoresis, confusion. Tx: 15 g carb, recheck in 15 min.
Unconscious: IM glucagon or IV D50.
•DKA – Type 1 DM; BG >250, ketones, acidosis. Tx: NS → insulin → K■ replacement. NCLEX: Rehydrate
before insulin; monitor anion gap closure.
•HHS – Type 2 DM; BG >600, no ketones. Severe dehydration, AMS. Tx: IV fluids, insulin drip. NCLEX:
Gradual correction to prevent cerebral edema.
•Metformin – ↓ hepatic glucose output; no hypoglycemia. Hold 48 hr before contrast; watch for lactic acidosis.
NCLEX: Take with meals.
•Sulfonylureas (glipizide, glyburide) – Stimulate insulin release. SE: hypoglycemia, weight gain. NCLEX: Avoid
alcohol (disulfiram reaction).
•SGLT2 Inhibitors (empagliflozin, canagliflozin) – ↑ glucose excretion in urine. SE: UTIs, dehydration,
euglycemic DKA. NCLEX: Monitor hydration and infection signs.
•GLP-1 Agonists (semaglutide, liraglutide) – ↓ appetite, ↑ insulin secretion. SE: nausea, risk of pancreatitis.
NCLEX: Administer SC; avoid if hx of thyroid cancer.
•DPP-4 Inhibitors (sitagliptin) – ↑ incretin activity, ↑ insulin. SE: URI, pancreatitis. NCLEX: Report abdominal
pain.
•Thiazolidinediones (pioglitazone) – ↑ insulin sensitivity. SE: fluid retention, HF risk, fractures. NCLEX:
Contraindicated in HF.
•Insulin Pumps – Deliver basal + bolus doses. NCLEX: Rotate infusion site q2–3 days; monitor for DKA if
device failure.
•Thyroid Replacement (levothyroxine) – Take on empty stomach, AM. Monitor TSH q6–8 wks. NCLEX: Watch
for angina or palpitations.
•Antithyroid Drugs (methimazole, PTU) – Inhibit thyroid hormone synthesis. SE: agranulocytosis,
hepatotoxicity. NCLEX: Report fever/sore throat immediately.
•Thyroid Storm – Life-threatening hyperthyroidism. Tx: PTU → iodine → beta-blocker → corticosteroid.
NCLEX: Cooling blanket, airway, avoid aspirin.
•Myxedema Coma – Severe hypothyroidism. Tx: IV levothyroxine + hydrocortisone. NCLEX: Warm slowly,
avoid sedatives, airway support.
•Corticosteroids (prednisone, hydrocortisone) – Anti-inflammatory and immunosuppressive. SE:
hyperglycemia, infection, osteoporosis, Cushingoid appearance. NCLEX: Taper slowly; take with food;
monitor glucose.
•Mineralocorticoid (fludrocortisone) – For Addison’s disease. NCLEX: Monitor BP, weight, edema, electrolytes.
•Addison’s Disease – ↓ cortisol/aldosterone. Tx: lifelong steroid replacement. NCLEX: Stress dose ↑ during
illness, carry emergency hydrocortisone injection.
•Addisonian Crisis – Severe hypotension, shock. Tx: IV hydrocortisone + D5NS. NCLEX: ABCs, treat
precipitating cause.
•SIADH – ↑ ADH → ↓ Na, concentrated urine. Tx: fluid restriction, tolvaptan, hypertonic saline. NCLEX:
Prevent seizures, correct Na slowly.
•Diabetes Insipidus – ↓ ADH → polyuria, hypernatremia. Tx: Desmopressin (central) or thiazides
(nephrogenic). NCLEX: Monitor urine SG and Na.
•Growth Hormone Therapy (somatropin) – For GH deficiency. SE: hyperglycemia. NCLEX: Monitor growth
rate, glucose, thyroid function.
•Octreotide – Suppresses GH in acromegaly or carcinoid syndrome. SE: gallstones, bradycardia. NCLEX:
Monitor ECG and abdominal pain.
•NCLEX Endocrine Tip – Always assess vitals and electrolytes first; endocrine crises often require airway, BP,
or glucose stabilization before drug therapy.