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2011-10-21 13:18:33
Lecture 13 prototypes peak onset duration insulin

insulin and growth hormone stuff
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  1. What drug therapy is used to treat Cushing’s syndrome (too much glucocorticoid)?
    Aminoglutethimide (Cytadren) and metyrapone (Metopirone)
    Hydrocortisone/prednisone-- addison disease
    Octreotide (Sandostatin)--acromegaly & GI bleeding
    Propylthiouracil (PTU) and l-131--graves
    Aminogluethimide (Cytadren)
  2. What is the treatment for hypoparathyroidism? Vitamin D and calcium supplements
    Surgery (no drug therapy)
    Somatrem (Protropin) and somatropin (Genotropin) Aldactone (Spironolactone)
    Vit D & Ca supplements
  3. Somatotropin
    • Pituitary hormone/human growth hormone
    • has same amino acid sequence as endogenous human growth hormone
    • Produces same effects as naturally occurring form of growth hormone
    • Uses: growth failure, cachexia (severe wasting of the muscles)
    • Multiple contraindications: Epiphyseal closure (children), severe obesity, respiratory impairment, sleep apena due to potentially fatal respiratory
    • impairment, sleep apena intracranial tumor, sensitivity to glycerinserious
    • adverse effects: Severe respiratory impairment in obese patients with Prader-Willi syndrome, Diabetes, Pancreatitis, Scoliosis, Papilledema,
    • Intracranial tumor
    • Rotate injection sites
    • report joint pain immediately
  4. Octreotide
    • growth hormone antagonistproduces same effects as natural hormone somatostatin (not a “statin”); suppresses secretion of GH
    • Suppresses secretion of serotonin, gastrin, secretin, motilin, insulin, glucagon, vasoactive, intestinal peptides, and pancreatic peptiedesuses:
    • tx: acromegaly intestinal bleeding, portal HTN
    • serious: dysrhythmias, sinus bradycardia, CHF
  5. Desmopressin
    • “pressin”
    • ADH replacement, pituitary hormone has vasoconstricor activity that causes contraction of smooth muscles in vascular system, uterus, and GI tract
    • Produces increases in plasma factor VIII and Von Willebrand’s factor
    • multiple effects-serious: water intoxicity, coma, hyponatermia & anaphlaxis, thrombolytic disorder
    • tx: Diabetes Insipudis (deficiency and ADH-caused by brain injury or viral
    • pneumonia) shock (off-label) & upper GI bleeding (off-label)
    • Note diabetes insipudis not related to diabetes melitus
  6. Glucagon
    • pancreatic hormone: increases glucose levels by increasing glycogenolysis
    • uses: emergency tx of hypoglycemia when pt can’t swallowits the antidote/reversal for beta blockers
    • serious: tachycardia & hypokalemiamonitor bg closely before during and after giving this med
    • administer IV if the pt fails to respond, if this fail they will be put on continuous dextrsoe 50 (make sure line is patent and give slowly)
  7. Human Regular Insuline
    • short acting
    • hypoglycemic agentinsulin
    • decreases blood glucose levels by increasing cellular uptake of glucose & stim. storage of glucose as glycogeninhibits release glucagon
    • use: DM I & II and gestational diabetes
    • contr: hypoglycemiaInteracts w/ oral antidiabetic agents and many other interactions
    • serious: hypoglycemia, hypokalemia, rebound hyperglycemia. can cause weight gain.
    • monitor food intake, rotate injection sites, check bg’s (peak times),
    • doc. carefully & provide education. best practice is to check w/ 2nd nurse.
    • Lower the dose of insulin if you are unable to eat, but do not omit the dose.
    • An increased dose may be necessary during periods of high stress or illness.
    • if someone comes in w/ hyperkalemia insulin can be given to lower it.
    • only regular insulin can be given be IV
  8. Insulin Aspart (NovoLog)
    • similar to regular insulin
    • Rapid actingshort duration of action that regular
  9. Insulin Detemir (Levemir)
    • Long-acting
    • slow onset and dose-dependent duration of action
    • used to provide basal glycemic control
    • not injected before meals to control postprandial (after meals) hyperglycemia
    • cannot be mixed w/ any other type of insulin
  10. Insulin Glargine (Lantus)
    • recombinant insulin analogconstat (no peak)
    • long duration insulin activity
    • provides for the maintenance of steady blood levels
    • may also help improve the lipid profiles and A1C levles of type II when added to therapy
  11. Insulin Glulisine
    • Rapid onset and short duration (3-5 horus)
    • Given by SC injectin only
  12. Insulin Lispro
    • rapid acting analog of regular insulin
    • helps control rise in bg brought on by meals
    • not given IV
    • oftern used w/ insulin infusion pumps
  13. Isophane insulin/ NPH
    • only intermediate-acting
    • has slower onset of action than regular insular
    • has slower action
    • Used to provide a basal level of insulin coverage
  14. Glyburide
    • hypoglycemic agent (lowers bg to cause hyperglycemia)
    • sulfonylureastimulates release of insulin from panceeatic beta cells
    • increases sensitivity of peripheral tissues to insulin
    • uses: lower BG in pts w/ type II
    • contra: sensitivity to sulfa (antibiotics) drugs or thiazide diuretics
    • many drug interactions
    • serious adverse effects: hypoglycemia, heptatoxicity, cholestatic jaundince,
    • aplastic anemia, leucopenia, thrombocytopenia (leuko+thrombo= agranulocytosis)
    • monior BG’s, monitor liver function labs
  15. Nursing responsibility all oral antidiabetic agents
    • identify patients at increased risk for adverse effects of drug therapy:
    • sulfonylureas: contraindicated in women who are prego or breast; feeding; persons w/ renal or liver disease
    • Metformin: contraindicated in persons who consume excessive alcohol, or who have
    • renal or liver disease or any condition predisposing them to lactic acidosis (with-hold if we know they will have dye injected before and after)
    • Meglitinedes: used w/ caution in persons w/ liver disease
    • Giltazones: contraindicated for pts w/ HF
  16. Metformin
    • Hypoglycemic agent
    • biguanide
    • reduces bg levels by reducing gluconeogenesis, thereby suppressing hepatic production of glucosedecrease
    • intestinal re-absorption of glucose & increase the cellular uptake glucose
    • multiple contradications: HF, Liver failure, Renal failure, current infection hx of lactic acidosis, any condition that predisposes pt to hypoxemia
    • Serious adverse effect: lactic acidosis
    • not as at risk for hypoglycemic event
  17. Repaglindie (Prandin)
    • hypoglycemic agent
    • Meglitinide
    • lowers glucose levels by stimulating insulin release from pancreatic beta cells
    • CYP sustrate= many interactions
    • serious adverse effects: hypoglycemia (at risk for hypoglycemic event)
  18. Rosiglitzone
    • “glitazone”
    • Thiazolidinedione (TZD)
    • lowers bg levels by increasing cellular sensitivity to insulin, thereby reducing insulin resistance
    • decrease gluconeogenesis by the liver
    • also a CYP substrate: many interatctions
    • Serious: Hypoglycemia, Hepatotoxicity, Bone fracture, Heart failure, Myocardial infarction
  19. Sitagliptin
    • Hypoglycemia agent
    • DPP-IV inhibitor
    • inhibts dipepidyl peptidase-IV (DDP-IV)
    • inhibition of DPP-IV reduces the destruction of incretins, which increases levels of incretin hormones bg level decrease
    • Serious adverse: hypoglycemia if used w/ sulfonylurea or insulin
  20. Insulin Aspart: name the action, onset, peak, duration, adminstration and timing, and compatibility.
    • Action: rapid
    • Onset: 10-20 mins
    • Peak: 1-3 hr
    • Duration: 3-5 hr
    • Admin & tim: SC: 5-10 min before meal
    • Compatibility: can give w/ NPH: draw aspart first, give immediately
  21. Insulin Lispro: name the action, onset, peak, duration administration and timing and compatibility
    • Action: Rapid
    • Onset: 5-15 min
    • Peak: 1-1.5 hr
    • duration: 3-4 hr
    • admin & tim: SC: 5-10 min before meal
    • Compatibility: can give w/ NPH, draw lispro first, give immediately
  22. Insulin Gluisine: name action, onset, peak, duration, time and admin, compatibility
    • Action: rapid
    • Onset: 15-30
    • Peak: 1 hr
    • Duration 3-4 hr
    • Admin & tim: SC 15 min before meals
    • Compatibility: can give w/ NPH, draw glulisine first, give immediately
  23. Insulin Regular: name action, onset, peak, duration, admin and timing, compatibility
    • Action: short
    • onset: 30-60 min
    • peak: 1-5 hr
    • duration: 6-10 hr
    • Admin and tim: SC: 30-60 min before meal; IV
    • compatibiity: can mix w/ NPH, sterile water, NS; don't mix w/ glargine
  24. NPH: action, onset, peak, duration, admin & timing, compatibility
    • Action: intermediate
    • Onset: 1-2 hr
    • Peak: 6-14 hr
    • Duration: 16-24 hr
    • Admin & tim: SC: mix (cloudy)
    • Compatibility: can mix w/ aspart, lispro, reg; don't mix w/ glargine
  25. Insulin Determir (Levemir): action, onset, peak, duration, admin & timing, compatibility
    • action: long
    • onset: gradual
    • peak: 6-8 hr
    • duration: 24 hr
    • admin and timing: SC: 1/day or 2/day
    • compatibility: don't mix w/ any insulin
  26. Insulin Glargine: action, onset, peak, duration, admin and timing, compatibility
    • action: long
    • onset: 1.1 hr
    • peak: no peak
    • duration: to 24 hr
    • admin and time: SC 1/day, same time each day
    • Compatibility: don't mix w/ any insulin
  27. Sulfonylureas: name the drug in this class, its action, and nursing considerations
    • drug: Glyburide
    • action: stimulates insulin release; increase cellular sensitivity to insulin; decrease insulin resistance
    • Nursing consideration: can cause hypoglycemia, GI disturvances, rash, cross sensitivity w/ sulfa drugs and thiazide diuretics, possible disulfiram response w/ alcohol
  28. Biguanides: name the drug in this class, its actin, and nursing considerations.
    • Drug: Metformin
    • Actions: decreases hepatic glucose production & release; increase cellular uptake of glucose: lowers lipid levels; promotes weight loss
    • Nursing considerations: common GI adverse effects; risk for lactic acidosis; avoid alchol; hold 2 days before and after IV contrast; less risk for hypoglycemia
  29. Meglitindes: name drug in this class, action, and nursing considerations
    • Drug: Repaglinide
    • action: stimulates insulin release; decreases postprandial glucose & hemoglobin A1C; little effect on fasting glucose
    • Nursing considerations: can cause hypoglycemia, GI effects, well tolerated; administer shortly before meals
  30. Thiazolidinediones: name drugs in class, action and nursing considerations
    • Drug: Rosiglitazone
    • actions: decreases hepatic glucose production and secretion; increases cellular sensitivity to insulin
    • nursing considerations: can cause edema, worsening of HF; monitor liver fx test; theraputic effects take several weeks to develope
  31. Alpha-glucosidase inhibitors; name drug in class, action and nursing considerations
    • Drug: acarbose
    • Action: interferes w/ carb breakdown & absorption; acts locally in Gi w/ little systemic absorption
    • Nursing consideration: common GI efects; hypoglycemia can occur if combined w/ another oral agent; if this occurs, tx w/ glucose, not sucrose; take w/ meals
  32. Incretin Enhancer (DPP-IV inhibitor): name drug in class, action and nurisng considerations
    • Drug: Sitagliptin
    • Action: increases synthesis and release of insulin; decreases glucagon production & glucose secretion; increases satiety; support wieght loss
    • Nursing considerations: Well tolerated; can cause H/A, diahrea, nasopharyngitis; can cause hypoglycemia if used in combo w/ another oral agent