Janunvia - in January alot of upper resp infections & pipes freeze so have to digoxin them up (also causes digoxin toxicity)
Drug interaction with januvia?
raises digoxin levels
Rosiglitazone memory story?
will be pushing up roses b/c causes fluid retention, HTN, CV probs, increased lipids, & liver probs & your kid will bring roses to your grave b/c you got pregnant b/c the med interfered with your oral contraceptive
glucose elevating agent
2 actions of glucagon?
1. stimulates hepatic prod. of glucose from glycogen stores
2. relaxes musculature of GI tract within 15 min of admin and temp inhibits mvmt. for about 30 min
2 uses for glucagon?
1. hypoglycemic event in unconcious person
2. relaxes GI for examination
Onset & duration of action for glucagon?
increases glucose in 30 min and lasts for 1 to 2 h
What should be done prior to the admin of glucagon for hypoglycemic event?
put pt on side b/c they will throw up
What should pt do after they wake up from hypoglycemic event that was Tx with glucagon?
eat a meal that contains protein to prevent BG from dropping again
Contraindiction of glucagon?
glucagon causes release of catecholamines & exacerbates extreme HTN ass. with this illness
2 nursing intervention to prevent hypoglycemic unconcious pt from aspirating after glucagon admin?
1. position on side before admin
2. have suction equipment available
In what pt will glucagon be ineffective?
How will they be Tx?
pt with no glycogen stores: malnutrition, chronic hypoglycemia, adrenal insufficiency
will be given glucose instead
Actions of exanatide?
regulates prod of glucose and insulin
slows down rate at which glucose enters BF by decreasing gastric emptying
Who may use exanatide?
only adults with type II DM
not for CH
Admin of exanatide?
taken bid by SQ injection 60 min before morning and evening meal
DO NOT take after meal
AE of exenatide?
3. weight loss
N will subside over time
Contraindications for exenatide?
1. preg - cat C
3. DM I
4. severe GI disease (gastroparesis)
What should pt do if they miss a dose of exenatide?
skip the dose
Storage of exenatide?
do not store with needle attached - can cause leaking and air bubbles
Why does pt need to keep up with the day they start exenatide pen?
use for 30 days then throw away
New pen set up?
How many doses in the pen?
do only 1 time or will run out of med
Teaching pt about drug interactions with exenatide?
pt should take meds that require GI absorption 1 h before exenatide inj - contraceptives, tylenol, ABX
What type of pt would not be suitable for exenatide injections?
pt who is not able to comply with rigid schedule or not able to follow directions
tumor that has extreme HTN
2 actions of testosterone?
1. normal growth and dev of male sex organs
2. maintenance of male secondary sex characteristics
3 uses for testosterone?
1. male hypogonadism
2. to initiate male puberty
3. suppression of tumor growth in breast cancers that are estrogen dependent (testosterone lowers estrogen levels)
AE of testosterone in women?
2. deepening of voice
3. change in libido
4. clitoral enlargement that is permenant
5. decreased breast size
AE of testosterone in men?
2. facial hair
AE of testosterone that occur in men & women?
1. hypercalcemia esp in immobile pt and those with metastitic breast cancer
2 edema from Na & water retention
3 s/s of hypercalcemia?
1. decreased LOC
3 complications of testosterone therapy?
2. hepatocellular carcinoma with prolonged use of high doses
3. premature closing of long bones
Test that should be done with prepubescent boys on testosterone therapy?
radiographs q 6 mo to det rate of bone maturation and effects on epiphyseal closure
Admin of testosterone?
inject deep IM to prevent inflammation and pain at injection site
Assessment/monitoring for pt on testosterone?
1. weight daily
2. assess for fluid volume excess
3. monitor hepatic function tests & serum Ca levels
3 actions of premarin/estrogen?
1. promote growth and dev of F sex organs
2. reduces chol.
3. conserves Ca and Ph & has a positive effect on bone mass
Therapeutic uses for premarin?
1. restore hormone balance in deficiency states
2. Tx of hormone-sensitive tumors
3. part of HRT to Tx vasomotor s/s of menopause (hot flashes)
4. reduce bone loss & improv bone density in postmenopausal women
5. Tx abn uterine bleeding from hormonal imbalance with no organic pathology
6. palliative therapy in advanced prostatic cancer, men with metastatic breast cancer who don't have estrogen-dependent tumor
AE of estrogen therapy/premarin?
4. weight changes
6. breakthrough bleeding
8. breast tenderness
10. testicular atrophy
13. chloasma - dark patchy pigmentation to the skin
Complications of premarin?
3. Br cancer
4. endometrial cancer
5. acute pancreatitis
4 contraindications for estrogen therapy?
1. breast cancer
2. thromboembolic disease
3. estrogen-dependent neoplastic diseases
4. pregnancy - category X
What should be assessed before and periodically throughout estrogen therapy?
Teaching for estrogen therapy?
1. instruct to use sunscreen and protective clothing to prevent chloasma & due to photosensitivity
2. undergo pelvic exam and pa test to rule out cervical cancer
3. undergo physical to rule out Br cancer, genital bleeding, and thrombophlebitis
Long-bone growth and estrogen?
during estrogen therapy need to assess long-bone growth to prevent premature closing of epiphyses in prepubescent pt
2 actions of prometrium?
1. prod secretory changes in the endometrium
2. prod histologic changes in vaginal epithelium
4 uses for prometrium?
1. restoration of hormonal balance with control of uterine bleeding
2. Tx amenorrhea & prod normal cycles
3. add to postmenopausal HRT to decrease risk of endometrial cancer from estrogen therapy
4. used in combo with estrogen in oral contraceptives to prevent preg
Contraindications of prometrium?
2. cerebral hemorrhage
3. carcinoma of the breast or genital organs
5. severe liver disease
AE of prometrium?
1. breakthrough bleeding
2. change in menstrual flow
3. breast tenderness
4. fluid retention
5. pulmonary embolism
7. increased risk of breast cancer
8. increased risk of endometrial cancer
Action of fosamax?
inhibits resorption of bone by inhibiting osteoclast activity
2 uses for fosamax?
1. reversal of progression of osteoporosis in postmenopausal women
2. decreased progression of Paget's
Contraindications for fosamax?
AE of fosamax?
1. esophageal irritation & acid reflux
2. other GI upset
How can a pt prevent esophageal irritation with fosamax?
take with plain water only at least 6 to 8 oz. & remain upright for 30 min after admin
Fosamax and other meds/food?
should take at least 30 min before eating, drinking, or other meds b/c has many drug interactions