pharm 3 Endocrine

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pharm 3 Endocrine
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Endocrine : Forsythe
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  1. What 2 hormone drugs are contraindicated with Br F?
    methimazole & propylthiouracil
  2. What hormone med should pt be taught not to change brands in?
    levothyroxine
  3. What time of day should pt take somatropin?

    Why?
    in the evening:  causes drowsiness
  4. What is somatropin?
    synthetic growth hormone
  5. 3 uses for somatropin?
    • 1. pituitary dwarfism
    • 2. growth failure in CH
    • 3. Tx wasting ass. with AIDS
  6. Goal of Tx with somatropin for pituitary dwarfism?
    produce height of at least 5 ft
  7. Route of admin for somatropin?
    any type of injection:  SQ, IM, IV
  8. Most common AE of somatropin?
    joint pain
  9. 3 serious AE of somatropin?
    • 1. insulin resistance
    • 2. hyperglycemia
    • 3. hypothyroidism
  10. Why does somatropin cause hyperglycemia?
    causes energy production to go from carb to fat
  11. Why does insulin resistance occur in somatropin pt?
    BG is raised by the hormone and receptors become desensitized
  12. Cautious use with somatropin and what chronic illness?
    diabetes - increases insulin resistance and hyperglycemia
  13. Complication that can occur with somatropin use?
    slipped capital epiphysis
  14. S/S of slipped capital epiphysis?
    • 1. limp
    • 2. hip or knee pain (referred)
  15. How often should somatotropin pt be seen?

    What will be monitored?
    q 3 to 6 mo

    • 1. height and weight
    • 2. closure of the epiphyseal plate
    • 3. thyroid function
    • 4. s/s of slipped capital epiphysis
    • 5. BG
  16. How is the effectiveness of somatotropin assessed?
    if epiphyseal plate has closed
  17. At what time of the day is somatotropin to be given?

    Why?
    give in the evening - mimics natural hormone surge that occurs during sleep and can cause drowsiness
  18. Lipodystrophy?

    How is it prevented?
    disturbance of fat met. - will be flat depression in skin or spongy area

    rotate injection sites
  19. Consideration about somatotropin injection?
    it is very painful
  20. When will somatotropin therapy be stopped?
    when the epiphyseal plates have closed

    not effective after that
  21. What should parents of a somatotropin pt report to MD?
    limp, hip or knee pain
  22. Education for pt/parents about Creutzfeld-Jakob disease (encephalopathy) caused by human pituitary hormone in the past?
    somatotropin is a synthetic hormone & cannot transmit this disease

    old drugs were taken from human cadavers
  23. What assessment should be made prior to giving levothyroxine?
    heart rate

    >100 don't give
  24. DesmoPressin = ?
    Don't Pee
  25. Desmopressin drug type?
    posterior pituitary hormone regulator
  26. What is desmopressin?
    synthetic vasopressin/ADH
  27. What is the function of ADH?
    controls conc of body fluids in body by reabsorption of Na and water in the kidneys

    retain water and decreased UO
  28. 3 uses for desmopressin?
    • 1. DI
    • 2. prevent nocturnal enuresis
    • 3. comtrol of bleeding in hemophilia A & von Willebrand's disease
  29. What is DI?
    absence or low ADH that causes excessive voiding that leads to dehydration
  30. How does desmopressin Tx bleeding?
    vasoconstriction

    also increases circulation of clot factor VII
  31. Routes for desmopressin?

    Which is most often used?
    intranasal, oral, and parenteral - SQ &/or IV

    intranasal
  32. Way to remember what von Willebrand's is?
    sounds German - Germans make ppl bleed
  33. Frequency and relief of AE with desmopressin?
    usually mild & infrequent & resolved with dosage reduction
  34. 4 AE of desmopressin?
    • 1. arrhythmias
    • 2. decreased CO
    • 3. angina
    • 4. nasal irritation/congestion with intranasal
  35. Why does desmopressin cause arrhythmias?
    retention of Na & water = excretion of K
  36. Why does desmopressin cause decreased CO?
    fluid volume excess caused by Na and water retention
  37. Why does desmopressin cause angina?
    vasoconstriction of cardiac BV
  38. What minor illness may decrease the effectiveness of intranasal desmopressin?

    What does pt need to do?
    rhinitis or upper resp infection

    blow their nose before admin
  39. Storage of desmopressin?
    store nasal and parenteral in the fridge
  40. Why does pt need to count how many sprays are used from intranasal desmopressin?
    if used beyond labeled # of sprays will not be effective
  41. Desmopressin pt should be monitored for S/S of _______.

    Why?
    dehydration

    complication of DI
  42. Important assessments/monitoring for desmopressin?
    • 1. HR and rhythm
    • 2. weight &  edema/breath sounds
    • 3. S/S of bleeding
  43. Why should desmopressin pt be monitored for bleeding?
    if used for hemophilia
  44. 2 eval criteria for desmopressin?
    • 1. hydration status
    • 2. edema
  45. If edema occurs with desmopressin what does it mean?

    What needs to be done?
    means pt is getting too much effect

    decrease dose
  46. What time of day should levothyroxine be givin?

    Why?
    give in the am

    thyroid hormones stimulate
  47. 2 uses for levothyroxine?
    • 1. hypothyroidism
    • 2. myxedema coma
  48. What is levothyroxine?
    replacement for natural thyroid hormones
  49. What is myxedema coma?

    S/S?
    complication of hypothyroidism

    • 1. hypopyrexia
    • 2. hypotension
    • 3. bradycardia
    • 4. bradypnea
    • 5. excess fluid and puffy eyes
    • 6. seizures & coma
  50. 2 contraindications for levothyroxine?
    • 1. recent MI
    • 2. thyrotoxicosis
  51. When do AE of levothyroxine usually occur?
    with excessive doses
  52. 3 CV AE of levothyroxine?
    • 1. tachycardia
    • 2. arrhythmias
    • 3. HTN
  53. 3 CNS AE of levothyroxine?
    • 1. irritability
    • 2. anxiety
    • 3. insomnia
  54. 2 exocrine AE of levothyroxine?
    • 1. excessive sweating
    • 2. heat intolerance
  55. Education about how pt should take levothyroxine?
    take at same time qd in the morning before breakfast
  56. Food interaction with levothyroxine?
    Grape juice
  57. Does levothyroxine cure hypothyroidism?

    Pt teaching?
    no

    teach pt that therapy is lifelong
  58. When should dose of levothyroxine be withheld?
    if HR is >100

    teach pt withhold and call MD
  59. The AE of levothyroxine are all related to _____.
    hyperthyroidism
  60. What must be done if a med is withheld?
    call MD
  61. Can levothyroxine be given with MI?
    yes, but monitor closely
  62. What condition is caused by too much thyroid hormone?
    thyrotoxic crisis or thyroid storm
  63. Levothyroxine effect on met?
    increases met rate & functions
  64. What is the use of methimozole (MMI) & propylthiouracil (PTU)?
    Tx hyperthyroidism
  65. Route of admin for methimazole & propylthiouracil?
    PO
  66. propylthiouracil

    PTU stands for?
    pull thyroid under
  67. methimazole

    MMI stands for?
    my my only I time
  68. Difference in admin of methimazole and propylthoiuracil?
    methimazole is given 1 X qd usually

    propylthiouracil is given 3 equal doses 8 h apart
  69. Onset of methimazole and propylthiouracil?
    methimazole has quicker onset

    propylthiouracil has longer onset of action - 10 to 21 days
  70. Why must propylthiouracil be given in 3 doses?
    keep level therapeutic level to prevent thyrotoxicosis
  71. 2 AE of methimazole & propylthiouracil?
    hypothyroidism & myxedema coma
  72. What drug will be given to reverse AE of methimazole and propylthiouracil?
    levothyroxine
  73. Life threatening AE of methimazole & propylthiouracil?

    When will this usually occur?
    agranulocytosis

    w/in first 3 mo of therapy
  74. Is methimazole or propylthiouracil more likely to cause agranulocytosis?
    propylthiouracil
  75. S/S of agranulocytosis that pt taking methimazole or propylthiouracil should report immediately?
    • 1. sore throat
    • 2. fever
    • 3. rash
  76. Consideration with agranulocytosis and fever?
    may not get fever r/t decreased WBC
  77. Before beginning methimazole or propylthiouracil what baseline lab test will be done?

    Monitoring?
    will do baseline CBC & repeated to monitor for hemat. changes

    thyroid blood tests will be done periodically also to monitor effectiveness of the drug
  78. 2 advantages of methimazole over propylthiouracil?
    • 1. faster
    • 2. less AE occurrence
  79. 2 important things to monitor with methimazole & propylthiouracil?
    • 1. thyroid levels
    • 2. WBC/CBC
  80. Calcitonin salmon use?
    used to decrease serum calcium
  81. Action of calcitonin?
    inhibits bone resorption & promotes renal excretion of Ca

    resorption- bone B/C & release Ca
  82. 3 uses for calcitonin?
    • 1. Paget disease/osteitis deformans
    • 2. postmenapausal osteoporosis
    • 3. hypercalcemia
  83. What is Paget disease?
    skel disorder with excessive bone resorption followed by replacement of normal marrow by vascular, fibrous conn tissue and new  bone that is larger, disorganized, and weaker
  84. Contraindication for calcitonin?
    salmon/fish allergies
  85. 4 S/S of hypercalcemia?
    • 1. confusion
    • 2. bradycardia
    • 3. kidney stones
    • 4. flank pain/deep bone pain
  86. S/S of hypocalcemia?
    • 1. tetany
    • 2. paresthesia
    • 3. muscle twitching
    • 4. seizures
    • 5. cardiac arrhythmias
    • 6. mental confusion
    • 7. laryngospasm
  87. What med is used to treat hypocalcemia caused by calcitonin?
    calcium gluconate
  88. What s/s of hypocalcemia means Ca is very low?
    seizures
  89. What assessment should be done prior to the admin of calcitonin?
    apical HR 1 full minute
  90. Life threatening side effect of calcitonin?
    anaphylaxis r/t salmon/fish allergy
  91. What testing may be done prior to the admin of calcitonin?
    intradermal allergy testing for salmon/fish allergy
  92. What s/s should pt report if taking calcitonin?
    s/s of hypercalcemia returning
  93. Assessment for of a pt on calcitonin?
    • 1. tetany - chevoskic sign (tap cheek and eye winks), spasms
    • 2. parasthesia- ask if tingle/warmth
    • 3. HR
    • 4. mental state
  94. Calcitriol?
    increases serum Ca in hypocalcemia
  95. 2 actions of calcitriol?
    1. increases serum Ca & Ph by increasing absorption in int. & promoting bone->blood

    2. reduces renal excretion of Ca & Ph
  96. 2 uses for calcitriol?
    • 1. Tx & prevent deficiency
    • 2. Ca & Ph homeostasis in renal failure
  97. Contraindication for calcitriol?

    Why?
    liver or biliary disease

    it is fat-soluble vitamin D -  bile is necessary for it's absorption
  98. AE of calcitriol?
    1. arrhythmias
  99. Why does calcitriol cause arrhythmias?
    if get too much Ca from calcitriol effects can cause arrhythmias
  100. Assessment of pt taking calcitriol?
    monitor for s/s of hypo or hyper calcemia
  101. Precautions that need to be taken with a pt taking calcitriol?
    • 1. seizure precautions
    • 2. fall precautions due to mental confusion
    • 3. increase fluid intake to prevent kidney stones
  102. Pt taking what endocrine med needs to be on a monitor?
    pt taking calcitriol or calcitonin r/t arrhythmia risk with Ca levels high or low
  103. What group of endocrine meds can cause osteoporosis?
    corticosteroids
  104. 4 glucocorticoid meds?

    Effects?
    • 1. prednisone
    • 2. dexamethasone
    • 3. hydrocortisone
    • 4. methylprednisolone

    mostly glucocorticoid but some mineralocorticoid effects
  105. 3 types of corticosteroids?
    glucocorticoid, mineralocorticoid, and androgens
  106. 6 uses for glucocorticoids/prednisone?
    • 1. anti-inflammatory
    • 2. anti-allergenic
    • 3. immunosuppresive
    • 4. adjunct to cancer meds
    • 5. maintain BP during times of stress
    • 6. replacement therapy for adrenal insufficiency - Addison's Disease
  107. Why is corticosteroid/prednisone used to maintain BP in stress?
    promotes retention of Na & water through actions of aldosterone & causes release of EPI
  108. Life threatening emergency that can occur with glucocorticoid/prednisone therapy?
    adrenal insufficiency if abruptly stopped!
  109. Early s/s of adrenal insufficiency?
    • 1. general s/s of oncoming illness
    • 2. despondency
    • 3. hypotension
  110. Late s/s of adrenal insufficiency?
    • 1. hypotension
    • 2 tachycardia
    • 3. dehydration
    • 4. hyponatremia
    • 5. hyperkalemia
    • 6. hypoglycemia
    • 7. confusion
  111. 3 contraindications/precautions with use of glucocorticoids/prednisone?
    • 1. systemic fungal infection
    • 2. admin of live virus vaccines:  MMR & varicella
    • 3. hypertension
  112. Why are glucocorticoids/prednisone contraindicated with systemic fungal infection?
    glucocorticoids increase BG & suppress immune system

    fungus likes the sugar
  113. Why is glucocorticoid/prenisone contraindicated in HTN?
    has mineralocorticoid activity -> aldosterone -> Na & water retention -> increased BP
  114. Admin of glucocorticoids/prednisone?

    Why?
    take in 2 divided doses

    take 2/3 of dose in am before 9:00 & 1/3 in pm

    mimics normal hormone releases
  115. When may a person taking glucocorticoid/prednisone require a higher dose?
    during periods of physical or emotional stress
  116. Glucocorticoid/prednisone teaching to minimize GI AE?
    take with food
  117. Pt teaching if pt takes inhaled glucocorticoids/prednisone?
    need to rinse mouth/brush teeth following inhalation to prevent fungal infections of mouth, larynx, pharynx
  118. Most important teaching for pt taking glucocorticoids/prednisone?
    do not stop abruptly
  119. Pt taking glucocorticoid/prednisone should eat a diet high in _____.
    K
  120. Foods high in K?
    • 1. salt substitute - 1 tsp = 2000mg K
    • 2. baked potato with skin has most
    • 3. bananas
    • 4. oranges
    • 5. cantaloupes
    • 6. honeydew
    • 7. grapefruit
    • 8. peaches
  121. What lab values need to be monitored with glucocorticoid/prednisone admin?
    serum Na & K
  122. Assessments/monitoring of pt taking glucocorticoids/prednisone?
    • 1. edema - weight, rales
    • 2. HR & rhythm/arrhythmias
    • 3. BG
    • 4. Na & K
    • 5. lipids
    • 6. BP
  123. What can 3rd heart sound with glucocorticod/prednisone indicate?
    pulmonary edema
  124. 3 meds that may be used with corticosteroids?
    • 1. antihypertensive
    • 2. acid-reducing drug
    • 3. diabetic med
  125. What do AE of corticosteroids depend on?
    duration of Tx and dose - usually AE occur with long-term Tx
  126. GI AE of corticosteroids short-term?
    • 1. NV
    • 2. increased appetite
    • 3. dyspepsia
    • 4. weight gain
  127. CNS AE of short term corticosteroid use?
    • 1. anxiety
    • 2. mood swings
    • 3. insomnia
    • 4. HA
  128. Endocrine AE of short term corticosteroid use?
    • 1. mentrual irregularities
    • 2. hyperglycemia
    • 3. suppression of pituitary ACTH (Cushings)
  129. Dermatologic & integumentary short term AE of corticosteroid use?
    • 1. acne
    • 2. suppression of skin est reactions r/t immunosuppression
    • 3. delayed wound healing
  130. 11 AE of long term corticosteroid use?
    • 1. iatrogenic diabetes mellitus
    • 2. peptic ulcer
    • 3. cushingoid characteristics
    • 4. osteoporosis & vertebral compression fractures
    • 5. hyperlipidemia & thrombus formation
    • 6. muscle B/D
    • 7. cataracts
    • 8. glaucoma
    • 9. risk for infection
    • 10. HTN & cardiac arrhythmias
    • 11. growth retardation in CH
  131. Why do corticosteroids cause peptic ulcers?
    prednisone/glucocorticoids can augment secretion of gastric acid & pepsid, inhibit production of cytopretective mucus, and reduce gastric mucosal blood flow

    these things are usually regulated by prostaglandin which is inhibited by the steroid
  132. 3 cushingoid characteristics?
    • 1.  moon face
    • 2.  buffalo hump
    • 3.  truncal obesity
  133. Why does corticosteroid cause osteoporosis/vertebral compression fractures?
    decreases activity of osteoblasts (bone forming cells) & decreases GI absorption of Ca -> hypocalcemia-> Ca leaves bone to increase serum Ca
  134. Why does corticosteroid use cause muscle B/D?
    suppresses protein synthesis which causes protein catabolism -> negetive nitrogen balance & muscle wasting
  135. Do cataracts and glaucoma go away after stop corticosteroid use?
    cataracts require surgery

    glaucoma will go away after stopping med
  136. What is the risk for a pt who has had TB & taking corticosteroids?
    can reactivate the TB
  137. Why do corticosteroids cause HTN & arrhythmias?
    cause Na & water retention and K excretion
  138. Why do corticosteroids cause growth retardation in CH?
    reduce DNA synth & decrease cell division
  139. What is Cushing's Syndrome?
    decreased adrenal hormones caused by increased corticoids
  140. Skin of a person taking corticosteroids?
    will tear easily - thin
  141. Fludrocortisone?
    mineralocorticoid used in place of aldosterone b/c aldosterone is expensive and must be given IV
  142. 2 therapeutic uses for fludrocortisone?
    • 1. adrenocortical insufficiency - Addison's
    • 2. Tx of adrenogenital syndrome
  143. 4 contraindications/precautions with fludrocortisone use?
    • 1. hypersensitivity
    • 2. systemic fungal infection
    • 3. CV disease
    • 4. renal disease
  144. AE of fludrocortisone are r/t ?
    too much action of the med/too much aldosterone effect
  145. 4 AE of fludrocortisone?
    • 1. HTN
    • 2. heart failure
    • 3. cardiomegaly
    • 4. hypokalemic alkalosis - hold Na & excrete K
  146. Cytadren?
    hormone antagonist
  147. Action of cytadren?
    inhibits or suppresses the adrenal cortex blocking synth of glucocorticoids, mineralcorticoids, and androns
  148. 2 uses for cytadren?
    • 1. temp use to decrease excessive corticosteroid production while waiting for long-term Tx
    • 2. off label for advanced breast carcinoma in postmenopausal women who have positive estrogen receptor test
  149. How long will cytadren usually be used temporarily for excessive corticosteroid production?

    Why is it only temporary Tx?
    no more than 3 months usually

    only Tx s/s - need to Tx underlying prob
  150. Why is cytadren used for breast carcinoma with positive estrogen receptor test?
    estrogens supplied by adrenals in postmenapausal and oophrectomized women

    cytadren lowers estrogen by suppressing adrenal
  151. AE of cytadren?
    • 1. myalgia
    • 2. measles like rash
    • 3. hypotension
    • 4. tachycardia
    • 5. NV
  152. Life threatening AE of cytadren?
    agranulocytosis
  153. Teaching for a pt taking cytadren?
    • 1. change position slowly r/t ortho hypotension
    • 2. report sore throat or malaise immediately r/t agranulocytosis
    • 3. return to office for CBC
  154. Important monitoring/assessment with cytadren?
    • 1. skin for measles-like rash
    • 2. BP & HR - causes hypotension, ortho hypotension & tachycardia
    • 3. CBC for agranulocytosis
  155. 4 types of insulin?
    • 1. rapid acting
    • 2. short acting
    • 3. intermediate acting
    • 4. long-acting
  156. 2 actions of insulin?
    • 1. lowers BG
    • 2. stimulates cellular uptake of K, reducing serum K
  157. 4 uses for insulin?
    • 1. DM I
    • 2. DM II when diet and oral meds fail
    • 3. gestational diabetes
    • 4. hyperkalemia
  158. Sliding scale:
    What pt uses it?
    What is it for?
    What meds may be used with it?
    What is the normal parameter for an additional dose of insulin?
    ill or hospitalized pt

    correct elevations r/t illness or food

    may use short or rapid acting insulin

    100mg/dl
  159. Basal insulin?
    continuous secretion that maintains glucose homeostasis - baseline insulin
  160. Prandial insulin?
    insulin secretion stimulated in response to meals
  161. Which type of insulin has a rigid meal schedule in which pt must eat w/in 45 minutes of admin?
    R insulin
  162. Sliding scale covers the pt basal/prandial insulin dose?

    When should it be given?
    prandial

    with a meal or hs
  163. Rotation method for injection of insulin?
    intrasite rotation - rotate within the locale with about 2 inch b/t sites of injection
  164. How often should each site be used for insulin injectin?
    ideally each site should be used only once per month
  165. Order of absorption of injection sites for insulin?
    • 1. abd 2 inches from umbilicus
    • 2. arm
    • 3. thigh
    • 4. butt
  166. How long is insulin good in RA?
    1 month
  167. How long is insulin good when refrigerated?
    3 months
  168. How should prefilled insulin syringes be stored?
    in refrigerator with capped needle pointing up

    will keep for 1 month
  169. What should pt do before admin prefilled insulin?
    roll to resuspend and warm
  170. AE of insulin?
    hypoglycemia - BG <50
  171. S/S of hypoglycemia?
    • 1. hunger
    • 2. N
    • 3. nervousness
    • 4. trembling
    • 5. HA
    • 6. tachycardia
    • 7. sweating
    • 8. confusion
    • 9. convulsions
    • 10. coma
    • 11. death
  172. How to prevent hypoglycemia when giving regular insulin?
    assess current BG before giving
  173. Which oral hypoglycemic med is suitable for use in elderly?

    Why?
    repaglinide

    has minimal renal excretion
  174. When should insulin dose be withheld?
    if BG is less than 70
  175. What should always be done before admin dose of insulin?
    have it double checked by another nurse
  176. How can you prevent local irritation at site of insulin injection?
    • 1. avoid injecting cold insulin
    • 2. rotation of sites
  177. Why is it important to know the peak action time of insulins?
    need to monitor pt for hypoglycemia esp around this time
  178. Teaching for pt that can help avoid dosing errors?
    use same type/brand of syringe
  179. What type of medication is recommended for Tx of diabetes during pregnancy?
    human like insulin
  180. Follow-up assessment after admin of insulin?
    • 1. assess for hypoglycemia esp around peak action time
    • 2. assess for hypotension
    • 3. make sure pt eats after admin
  181. Use for rapid-acting insulin?
    used for prandial/supplemental insulin coverage
  182. 3 rapid-acting insulins?
    LAG

    • Lispro/humalog
    • Aspart/novolog
    • Glulisine /apidra
  183. What 3 insulins may be given IV?
    • 1. Aspart/novolog
    • 2. Apidra/glulisine
    • 3. regular insulins

    AA - alcoholics anonymous - need IV fluids
  184. Peak of action for rapid-acting insulins?
    30 min - 11/2 h
  185. Which insulin cannot be used during pregnancy?
    Apidra

    pregnant ppl p alot so they can't take apidra
  186. When are rapid-acting insulins admin?

    Advantage?
    15 before or after a meal

    allows for greater flexibility in eating schedule
  187. What type of insulins are best for use in implantable insulin pumps?

    Why?
    rapid-acting

    mimics endogenous insulin response
  188. What is required to give Aspart and Apidra IV?
    close monitoring
  189. What oral hypoglycemic causes digoxin toxicity?
    Januvia
  190. Mixing rapid-acting insulins?
    can mix with NPH/intermediate insulins

    • cannot mix with R/short-acting insulins
    • short and rapid don't mix because short ppl can't go fast
  191. Teaching for pt taking glyburide?
    wear sunscreen & protective clothing r/t photosensitivity
  192. Rapid-acting insulin in children and pregnancy?
    can be used in CH

    pregnancy category C
  193. 2 types of short-acting insulins?
    Humulin R & Novolin R
  194. What is R insulin used for?
    prandial and supplemental insulin coverage
  195. Imp consideration when giving insulin IV?
    must run some out first r/t binding to tubing
  196. What type of insulin is safest during pregnancy?
    R insulin
  197. Peak of R insulins?
    2-3 h
  198. What oral hypoglycemic drug decreases oral contraceptive effectiveness?
    rosiglitazone
  199. AE of R insulin?

    Why does this occur?
    causes weight gain

    insulin converts excess glucose to glycogen & promotes storage of fat
  200. 3 things that can affect the peak time of an insulin?
    • 1. site
    • 2. type of insulin
    • 3. individual pt response
  201. somogyi?
    nocturnal hypoglycemia
  202. What type of insulins are cloudy?
    intermediate acting/NPH/N insulins
  203. Use of intermediate-acting/NPH insulins?
    provides basal insulin coverage
  204. What is intermediate-acting insulin?
    isophane insulin suspenction NPH
  205. 3 types of intermediate-acting insulin?
    • humulin N
    • novolin N
    • lente
  206. Peak of intermediate-acting insulins?

    If give am dose when will it usually peak?
    4 - 12 h

    during mid to late afternoon
  207. Long-acting insulin use?
    basal insulin coverage
  208. 2 types of long-acting insulins?
    • 1. Lantus/detemir
    • 2. Levemir/glargine

    L = Long acting
  209. 2 advantages of long-acting insulin?
    • 1. less weight gain
    • 2. less somogyi
  210. Peak of action for long-acting insulins?
    Levemir = 3 to 14 hours

    Lantus has no peak
  211. How long does Lantus remain constant after admin?
    24 h
  212. When is Levemir given?
    with evening meal or hs
  213. Mixing long-acting insulins?
    do not mix with any other insulins
  214. How are longer acting insulins formulated?
    have additives that increase their lenght of action: 

    • 1. protamine
    • 2. zinc
    • 3. isophan
  215. How do additives in long-acting insulins work?
    delay absorption = later onset, peak, & duration of action
  216. How is the strength of long acting insulin set up?
    long acting part will be listed first (mix of insulin and additive)

    short acting part will be just the insulin and will be listed last
  217. Glucose reading <___ = hold insulin.
    70
  218. Insulin = ____ u/mL
    100
  219. How is a regular insulin syringe calibrated?

    What should you do if you need an even # amnt?
    in increments of 2u up to 100u/1mL

    use a low-dose syringe calibrating in 1 u increments up to 50u/.5mL
  220. How many times may a pt reuse a needle?

    What should they monitor for?
    3 to 4 times

    monitor for s/s of site infection:  red, warmth, edema, etc
  221. What are sulfonylureas?

    2 sulfonylureas?
    oral hypoglycemic agents

    • 1. glyburide
    • 2. repaglinide
  222. What must pt have in order for glyburide to act?
    must have functioning pancreas b/c glyburide increases effects of insulin and receptors
  223. What is glyburide used for?
    lower BG in DM II

    non-insulin dependent
  224. Contraindications for sulfonylureas/glyburide/repaglinide?
    known hypersensitivity to sulfa drugs
  225. AE of glyburide?
    • 1. hypoglycemia
    • 2. photosensitivity (glyburide - tan your hide)
  226. Class of repaglinide?
    meglitinide
  227. Action of repaglinide?
    stim pancreas to prod more insulin
  228. Repaglinide is good for use in _____ & causes AE of ______ _______.
    • elderly
    • weight gain

    fat-hag-linide - fat old person - use in old ppl and makes them fat
  229. What med may be used if a person is allergic to sulfa in glyburide?
    repaglinide
  230. Can repaglinide be taken with sulfa allergies?
    yes
  231. Admin schedule of repaglinide?

    Advantage?
    take dose 15 to 30 min before each meal - # of meals matches doses for the day

    gives flexibility for ppl who don't eat on same schedule qd
  232. Action of repaglinide that allows it to be taken directly before meals?
    has short half life - effects wear off before next meal and insulin levels return to normal
  233. 3 types of nonsulfonylureas?
    • 1. Biguanide
    • 2. Thiazolidinediones
    • 3. Alpha-glucosidase inhibitors
  234. Class of metformin?
    Biguanide

    George Formin is big

    metformin is biguanide
  235. 2 complications of metformin?

    Which is rare?
    • 1. lactic acidosis
    • 2. blood dyscrasias - rare
  236. S/S of lactic acidosis?
    • 1. malaise
    • 2. myalgia
    • 3. resp distress
    • 4. increasing somnolence
    • 5. nonspecific abd distress
    • 6. hypothermia
    • 7. hypotension
    • 8. bradyarrhythmias
  237. What pH imbalance is caused by the drug fludrocortisone?
    hypokalemic alkalosis
  238. Contraindications for metformin?
    renal and hepatic impairment
  239. Advantage of metformin use?
    causes weight loss
  240. Teaching to decrease GI effects of metformin?
    take with food
  241. When should pt take metformin?
    at same time each day
  242. When should metformin ALWAYS be withheld?
    24 h before & 48 h after use of iodinated contrast dye b/c both metformin and dye can be toxic to kidneys
  243. What will be done if creatinine/BUN shows decreased kidney functioning with use of metformin & pt needs contrast dye?
    will give fluids to increase BF to kidney before giving contrast dye
  244. When may metformin cause hypoglycemia?
    when used with other hypoglycemic meds

    when used as monotherapy metformin cannot cause hypoglycemia
  245. Class of acarbose?
    alpha-glucosidase inhibitor AKA starch blocker

  246. Actions of acarbase?
    delays absorption of dietary carbs -> reduces rise in BG after meals

    acarbase - decreased carb absorption
  247. What is the action of alpha-glucosidase enzyme that is inhibited by acarbase?
    B/D carbs in the int -> carb absorption
  248. AE of acarbase?
    GI:  flatulence, cramps, abd distention, borbormus, and diarrhea

    all r/t carbs remaining in GI longer than usual and fermenting -> forms gas

    acarbose - bose is a speaker and acarbose causes stomach sounds
  249. Complication of acarbose?
    liver dysfunction with long-term high dose therapy
  250. Contraindications of acarbose?
    diseases of the bowel:  IBD, absorptive disorders, colonic ulceration, and Hx of bowel obstruction
  251. If a pt taking acarbose exp a hypoglycemic event what should they do?
    take oral glucose tabs not table sugar r/t decreased absorption of carbs
  252. Rosiglitazone class?
    thiazolidinedione
  253. 3 AE of rosiglitazone?
    • 1. fluid retention and weight gain
    • 2. increased blood lipids
    • 3. HA
  254. Fluid retention from rosiglitazone can cause what other AE>
    HTN
  255. Contraindications for rosiglitazone?
    liver disease or increased ALT or AST to more than 2.5 times upper limits of normal
  256. Cautious use of rosiglitazone?
    CV disease esp CHF & HTN b/c can be exacerbated by fluid retention with rosiglitazone
  257. Drug interaction with rosiglitazone?
    oral contraceptives
  258. What testing will be done with rosiglitazone?
    will have liver function test q 2 mo X 1 yr and periodically thereafter to monitor for hepatotoxicity
  259. Hypoglycemia in rosiglitazone?
    cannot cause hypoglycemia with monotherapy
  260. Januvia class?
    DDP-4 inhibitor
  261. Action of januvia/DDP-4 inhibitors?
    inhibit the enzyme DDP-4 that metabolizes incretin hormones

    incretin hormones increase insulin release therefor inhibiting DDP-4 that breaks them down will allow the hormones to have their antihyperglycemic effects
  262. Patho of DDP-4 inhibition by Januvia?
    inhibits DDP-4 -> slowing of incretin metabolism (increase incretin hypoglycemic effect) -> increase insulin release or synth & decrease glucagon secretion -> decreased BG
  263. 2 AE of Januvia?
    • 1. upper resp infection
    • 2. nasopharyngitis

    Janunvia - in January alot of upper resp infections & pipes freeze so have to digoxin them up (also causes digoxin toxicity)
  264. Drug interaction with januvia?
    raises digoxin levels
  265. 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
  266. Glucagon class?
    glucose elevating agent
  267. 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
  268. 2 uses for glucagon?
    • 1. hypoglycemic event in unconcious person
    • 2. relaxes GI for examination
  269. Onset & duration of action for glucagon?
    increases glucose in 30 min and lasts for 1 to 2 h
  270. What should be done prior to the admin of glucagon for hypoglycemic event?
    put pt on side b/c they will throw up
  271. 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
  272. Contraindiction of glucagon?

    Why?
    pheochromocytoma

    glucagon causes release of catecholamines & exacerbates extreme HTN ass. with this illness
  273. 2 nursing intervention to prevent hypoglycemic unconcious pt from aspirating after glucagon admin?
    • 1. position on side before admin
    • 2. have suction equipment available
  274. 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
  275. Exanatide class?
    incretin minimetics
  276. Actions of exanatide?
    regulates prod of glucose and insulin

    slows down rate at which glucose enters BF by decreasing gastric emptying
  277. Who may use exanatide?
    only adults with type II DM

    not for CH
  278. Admin of exanatide?
    taken bid by SQ injection 60 min before morning and evening meal

    DO NOT take after meal
  279. AE of exenatide?
    • 1. NV
    • 2. anorexia
    • 3. weight loss

    N will subside over time
  280. Contraindications for exenatide?
    • 1. preg - cat C
    • 2. children
    • 3. DM I
    • 4. severe GI disease (gastroparesis)
  281. What should pt do if they miss a dose of exenatide?
    skip the dose
  282. Storage of exenatide?
    fridge

    do not store with needle attached - can cause leaking and air bubbles
  283. Why does pt need to keep up with the day they start exenatide pen?
    use for 30 days then throw away
  284. New pen set up?

    How many doses in the pen?
    do only 1 time or will run out of med

    60 doses
  285. Teaching pt about drug interactions with exenatide?
    pt should take meds that require GI absorption 1 h before exenatide inj - contraceptives, tylenol, ABX
  286. 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
  287. Pheochromocytoma?
    tumor that has extreme HTN
  288. 2 actions of testosterone?
    • 1. normal growth and dev of male sex organs
    • 2. maintenance of male secondary sex characteristics
  289. 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)
  290. AE of testosterone in women?
    • virilism:
    • 1. amenorrhea
    • 2. deepening of voice
    • 3. change in libido
    • 4. clitoral enlargement that is permenant
    • 5. decreased breast size
  291. AE of testosterone in men?
    • 1. acne
    • 2. facial hair
    • 3. gynecomastia
    • 4. impotence
    • 5. oligospermia
    • 6. priapism
  292. 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
  293. 3 s/s of hypercalcemia?
    • 1. decreased LOC
    • 2. arrhythmias
    • 3. HR
  294. 3 complications of testosterone therapy?
    • 1. hepatitis
    • 2. hepatocellular carcinoma with prolonged use of high doses
    • 3. premature closing of long bones
  295. 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
  296. Admin of testosterone?
    inject deep IM to prevent inflammation and pain at injection site
  297. Assessment/monitoring for pt on testosterone?
    • 1. weight daily
    • 2. assess for fluid volume excess
    • 3. monitor hepatic function tests & serum Ca levels
  298. Estrogen drug?
    premarin
  299. 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
  300. 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
  301. AE of estrogen therapy/premarin?
    • 1.HTN
    • 2. edema
    • 3. N
    • 4. weight changes
    • 5. amenorrhea
    • 6. breakthrough bleeding
    • 7. dysmenorrheal
    • 8. breast tenderness
    • 9. impotence
    • 10. testicular atrophy
    • 11. gynecomastia
    • 12. acne
    • 13. chloasma - dark patchy pigmentation to the skin
  302. Complications of premarin?
    • 1. MI
    • 2. thromboembolism
    • 3. Br cancer
    • 4. endometrial cancer
    • 5. acute pancreatitis
  303. 4 contraindications for estrogen therapy?
    • 1. breast cancer
    • 2. thromboembolic disease
    • 3. estrogen-dependent neoplastic diseases
    • 4. pregnancy - category X
  304. What should be assessed before and periodically throughout estrogen therapy?
    BP
  305. 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
  306. Long-bone growth and estrogen?
    during estrogen therapy need to assess long-bone growth to prevent premature closing of epiphyses in prepubescent pt
  307. Progesterone med?
    prometrium
  308. 2 actions of prometrium?
    • 1. prod secretory changes in the endometrium
    • 2. prod histologic changes in vaginal epithelium
  309. 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
  310. Contraindications of prometrium?
    • 1. thrombophlebitis
    • 2. cerebral hemorrhage
    • 3. carcinoma of the breast or genital organs
    • 4. pregnancy
    • 5. severe liver disease
  311. AE of prometrium?
    • 1. breakthrough bleeding
    • 2. change in menstrual flow
    • 3. breast tenderness
    • 4. fluid retention
    • 5. pulmonary embolism
    • 6. thromboembolism
    • 7. increased risk of breast cancer
    • 8. increased risk of endometrial cancer
  312. Fosamax class?
    biophosphonates
  313. Action of fosamax?
    inhibits resorption of bone by inhibiting osteoclast activity
  314. 2 uses for fosamax?
    • 1. reversal of progression of osteoporosis in postmenopausal women
    • 2. decreased progression of Paget's
  315. Contraindications for fosamax?
    hypocalcemia
  316. AE of fosamax?
    • 1. esophageal irritation & acid reflux
    • 2. other GI upset
  317. 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
  318. Fosamax and other meds/food?
    should take at least 30 min before eating, drinking, or other meds b/c has many drug interactions
  319. When should pt d/c use of fosamax and call MD?
    • 1. pain or difficulty swallowing
    • 2. retrosternal pain
    • 3. new/worsening heartburn

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