Endocrine Pharm

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Endocrine Pharm
2013-11-25 00:05:38
Pharm NCLEX Prep

Pharmacology key points for NCLEX preparation
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  1. Purpose of Insulin
    • Increase available insulin
    • Modify carbohydrate metabolism
  2. Classes of Insulin
    • Rapid-acting
    • Short-acting
    • Intermediate-acting
    • Long-Acting
  3. Generic (Trade Name) for Rapid-acting
    • Lispro insulin (Humalog)
    • Insulin aspart (Novolog)
    • Insulin glulisine (Aprida)
  4. Generic (Trade Name) for Short-acting
    • Regular insulin (Humulin R)
    • Regular insuline (Novolin R)
  5. Generic (Trade Name) for Intermediate-acting
    • NPH insulin (Humulin N)
    • Insulin determir (Levemir)
  6. Generic (Trade Name) for Long-acting
    Insulin glargine (Lantus)
  7. What's the action of insulin?
    • cellular uptake of glucose
    • converts glucose into glycogen
    • moves K+ into the cell
  8. Clients c Type 2 DM require insulin when:
    • Oral hypoglycemics, diet, and exercise can't control blood glucose
    • Severe renal or liver disease
    • Painful neuropathy
    • Undergoing surgery or DX tests
    • Stress (ex. infection, trauma)
    • Emergency TX of DKA or HHNS
    • TX of hyperkalemia
  9. What med/food has additive hypoglycemic effects when use concurrently c insulin?
    • Sulfonylureas
    • Meglitinide
    • Beta Blockers
    • Alcohol
  10. What two meds raise blood glucose and counteract the effects of insulin?
    • thiazide diuretics
    • glucocorticoids
  11. What med masks SNS response to hypoglycemia (tachy, tremors)?
    Beta blockers
  12. When should dosage of insulin be increased?
    • increase calories
    • infection
    • stress
    • growth spurts
    • 2nd & 3rd trimester of pregnancy
  13. When should dosage of insulin be decreased?
    • in response to level of exercise
    • 1st trimester of pregnancy
  14. How to mix insulin?
    • mix short-acting c long-acting
    • drawn short-acting (clear) first then long-acting (cloudy)
  15. What two long-acting clear insulin should not be admin via IV and mixed with other insulin?
    • glargine (Lantus)
    • determir (Levemir)
  16. What insulin can be admin Sub Q, continuous Sub Q infusion, and IV?
    • lispro (Humalog)
    • aspart (Novolg)
    • glulisine (Aprida)
    • regular insulin (Humulin)
  17. How do you admin NPH  (Humulin N)?
    Sub Q
  18. Proper Insulin Storage
    • unopened vials store in fridge until expiration
    • premixed store for 3 mos
    • mix in syringe keep 1 to 2 wks in fridge
    • keep syringe vertical (needle pointing upward)
    • store vial in use at room temp; discard p 1 mo
  19. Med Class:  Oral Hypoglycemics
    • Sulfonylureas
    • Meglitinides
    • Biguanides
    • Thiazolidinaediones
    • Alpha Glucosidease inhibitors
    • Gliptins
  20. Sulfonyureas and Meglitinides
    insulin release from pancreas
  21. Sulfonylureas
    • tolbutamide (Orinase)
    • glipizide (Glucotrol)
    • chlorpropamide (Diabinese)
    • glyburide (DiaBeta, Micronase)
    • glimepiride (Amaryl)
  22. Meglitinides
    • repaglinide (Prandin)
    • nateglinide (Starlix)
  23. Biguanides
    • reduce production of glucose w/in liver
    • increase glucose uptake and use in muscles
  24. Biguanides
    metformin HCL (Glucophage)
  25. Thiazolidinediones (Glitazones)
    • increases cellular response to insulin by decreasing insulin resistance
    • increase glucose uptake
    • decrease glucose production
  26. Thiazolidinediones (Glitazones)
    • rosiglitazone (Avandia)
    • pioglitazone (Actos)
  27. Alpha glucosidase inhibitors
    slows carb absorption and digestion
  28. Alpha glucosidase inhibitors
    • acarbose (Precose)
    • miglitol (Glyset)
  29. Gliptins
    • promote release of insulin
    • decrease secretion of glucagon
    • lowers fasting glucose
    • lowers postprandial glucose
  30. Gliptins
    Sitagliptin (Januvia)
  31. Side/Adverse Effects of Glipizide and Repaglinide
  32. Nursing Interventions/Client Education for Glipizide and Repaglinide
    • monitor for s/sx of hypoglycemia (tachy, palpitations, diaphoresis, and shakiness)
    • self admin a snack of 15 g of carb (4 oz of OJ, 2 oz grape juice, 8 oz milk, glucose tab)
    • notify HCP of recurrent problem
    • give IV glucose for severe hypoglycemia
    • wear medical alert bracelet
  33. Side/Adverse Effects of Metformin HCL
    • GI effects (anorexia, n/v) which lead to wt loss of 6 to 8 lbs
    • Vit B and folic acid deficiency
    • lactic acidosis (hyperventilation, myalgia, sluggishness, somnolence)
  34. Nursing Intervention/Client Ed. Metformin HCL
    • GI:  d/c med if necessary
    • Vit B & folic acid def.:  supplements
    • Lactic acidosis:  d/c med & inform HCP
    • tx severe Lactic acidosis c hemodialysis
  35. Side/Adverse Effects Rosiglitazone
    • fluid retention
    • LDL elevations
    • hepatotoxicity
  36. Nursing Intervention/Client Ed. Rosiglitazone
    • fluid retention:  monitor for edema, wt. gain, and/or signs of CHF
    • LDL elevation:  monitor cholesterol
    • hepatotoxicity:  liver function test, report hepatotoxicity sxs (jaundice or dark urine)
  37. Side/Adverse Effects Acarbosb
    • Intestinal (abd distention & cramping, hyperactive bowel sounds, diarrhea, excessive gas
    • risk for anemia b/c decrease iron absorption
    • hepatotoxicity
  38. Nursing Interventions/Client Ed. Acarbse
    • Intestinal:  d/c med if necessary
    • anemia:  monitor Hgb & Fe levels; d/c med if necessary
    • hepatotoxicity:  d/c med & liver funct will return to normal
  39. Contraindications/Precautions c Oral Hypoglycemics
    • Pregnancy risk Cat. C:  glipizide, repaglinide, rosiglitazone
    • Preg. risk Cat. B:  metformin HCL (glucophage, acarbose (Precose), sitagliptin (Januvia)
    • oral usually avoided in pregnancy & lactation
    • contraindicated in DKA
    • Metformin HCL contraindicated for severe infection, shock, and hypoxic condition
    • Acarbose contraindicated for  GI disorders
  40. What are some things nurses should do?  Nursing Administration
    • encourage exercise
    • follow appropriate diet
    • keep log of glucose levels
    • refer pt to dietician &/or diabetic nurse
    • admin meds orally and at appropriate times
    • some formulations may combine two meds
    • monitor for signs of hypoglycemia
  41. Best taken 30 min prior to meal
    Glipizide (Glucotrol, Glucotrol XL)
  42. eat w/in 30 mins of taking a dose of med 3 times/day
  43. Take immediate release tabs 2 times/day c breakfast & dinner and take and take sustained release tabs 1 time/day c dinner
    Metformin HCL (Glucophage)
  44. Take med once or twice a day c or s food
    Rosiglitazone (Avandia)
  45. take c first bite of food 3 times/day
    Acarbose (Precose)
  46. take once a day c or s food
    Sitagliptin (Januvia)
  47. Med Class:  Amyline Mimetics
    primalintide (Symlin)
  48. Purpose of pramlintide (Symlin)
    • reduce postprandial glucose levels from decreased gastric emptying
    • decrease caloric intake
  49. Therapeutic uses of pramlintide (Symlin)
    • Type 1 or 2 DM
    • used in conjunction c insulin or oral hypoglycemic med (usually metformin or sulfonylurea
  50. Side/Adverse Effects & Nursing Interventions/Client Ed. Pramlintide (Symlin)
    • Nausea:  report; HCP may decrease dose
    • Reaction at injection sites
  51. Contraindications/Precautions pramlintide (Symlin)
    • Pregnancy Risk Cat. C
    • contraindicated for pts c renal failure or receiving dialysis
    • caution c pts c thyroid disease, osteoporosis, or alcoholism
  52. Med. Interaction of Pramlintide (Symlin)
    • insulin increase risk of hypoglycemia
    • use c meds that slow gastric emptying (opioids) or delay food absorption (acarbose (Precose)) may further slow gastric emptying
    • oral med absorption delayed
  53. Nursing Intervention/Client Ed Pramlintide (Symlin)
    • increase risk of hypoglycemia:  decrease insulin dose (50%)
    • slow gastric emptying:  avoid concurrent use
    • Med absorption delayed:  Admin oral med 1 to 2 hr p injection of pramlintide
  54. Nursing Administration of Pramlintide (Symlin)
    • admin sub q prior to meals
    • unopened vials in fridge
    • open vials discard p 28 days
    • do not mix c insulin in same syringe
  55. Medication Class:  Incretin Mimetic
    Exenatide (Byetta)
  56. Purpose of Exenatide (Byetta)
    • release insulin
    • decrease secretion of glucagon
    • slow gastric emptying
    • fasting and postprandial glucose levels lowered
  57. Therapeutic uses of Exenatide (Byetta)
    • supplemental glucose control for Type 2 DM
    • used along c oral hypoglycemic (metformin or sulfonylurea)
  58. Side/Adverse Efffects of Exenatide (Byetta)
    • GI effects (n/v and diarrhea)
    • pancreatitis
  59. Nursing Intervention/Client Ed. Exenatide (Byetta)
    • GI:  notify HCP if sx intolerable
    • Pacreatitis:  stop meds and notify HCP
  60. Contraindications/Precaution of Exenatide (Byetta)
    • Pregnancy risk Cat. C
    • Contraindicated in pts c renal failure, ulcerative colitis, Crohn's diseas
    • Caution in elderly & pts c renal impairment or thyroid disease
  61. Med Interaction Exenatide (Byetta)
    • Oral med absorption delayed (oral contraceptives & antibiotics)
    • use c sulfonylurea increases risk of hypoglycemia
  62. Nursing Intervention/Client Ed. Exenatide (Byetta)
    • oral med absorp delayed:  admin oral med 1 to 2 hr p
    • concurrent use of sulfonylurea:  lower dose of sulfonylurea
  63. Nursing Admin of Exenatide (Byetta)
    • in prefilled injector pens
    • admin sub q
    • give w/in 60 mins b/f morning& evening meal
    • never admin p meal
    • keep injection pen in fridge
  64. Nursing Eval of Med Effectiveness of Exenatide (Byetta)
    • Preprandial glucose levels of 90 to 130 mg/dL
    • Postprandial < 180 mg/dL
    • HgbA1c < 7%
  65. Med Clas:  Hyperglycemic Agent
  66. Purpose of Glucagon
    increase blood glucose
  67. Therapeutic uses of Glucagon
    • Emergency management of hypoglycemic rxns (ex. insulin overdose)
    • decrease in GI motility
  68. Side/Adverse Effects and Nursing Interventions of Glucagon
    GI distress (N/V):  turn pts on left side following admin to reduce risk of aspiration
  69. Contraindications/Precautions of Glucagon
    • ineffective for hypoglycemia
    • Pregnancy Risk Cat. B
    • caution in pts c cardiovascular disease
  70. Nursing Administration for Glucagon
    • admin SC, IM or IV immediately
    • provide food as soon as pt is conscious and able to swallow
    • have on hand at all times
  71. Nursing Eval or Med Effectiveness
    elevation in blood glucose level to greater than 50 mg/dL
  72. Med. Class:  Thyroid Hormone
    • levothyroxine (Synthroid, Levothroid)
    • liothyronine (Cytomel)
    • liotrix (Thyrolar)
    • Thyroid (Thyroid USP)
  73. Purpose of Thyroid Hormone (levothyroxine (Synthroid, Levothroid)
    • synthetic form of T4
    • increase metabolic rate, protein synthesis, CO, renal perfusion, O2 use, body temp, blood vol, and growth process
  74. therapuetic use of levothyroxine (Synthroid, Levothroid)
    • tx hypothyroidism
    • emergency tx of myxedema coma (IV route)
  75. Side/Adverse Effects of thyroid hormone, levothyroxine (Synthroid, Levothroid)
    over-medication results in signs of hyperthyroidism
  76. What are the signs of hyperthyroidism?
    • anxiety
    • tachy
    • palpitations
    • altered appetite,
    • abd cramping
    • heat intolerance
    • fever
    • diaphoresis
    • wt loss
    • menstrual irregularities
  77. Contraindications/Precautions of Thyroid Hormone, Levothyroxine (Synthroid, Levothroid)
    • Preg Risk A Cat
    • caution in pregnancy and lactation
    • contraindicated in pts c thyrotoxicosis
    • contraindicated following MI
    • caution in pts c cardio problems (HTN, angina pectoris, ischemic heart disease)
    • do not use to tx obesity
  78. What med increases the anticoag effects of warfarin (Coumadin) by breaking down Vit K?
  79. Since levothyroxine increases the effects of warfarin, how should you educate pts?
    • monitor PT and INR
    • report signs of bleeding (bruising, petechia)
    • decrease dose of warfarin
  80. How should you take Thyroid Hormone, levothyroxine?
    • take daily on empty stomach
    • before breakfast daily
  81. Should pts switch Thyroid Hormone meds whenever?
    • No
    • check c HCP first
  82. Nursing Eval of Med Effectiveness of Thyroid Hormone, levothyroxine (Synthroid, Levothroid)
    • decrease TSH levels
    • Normal T4 levels
    • absence of hypothyroidism sxs
  83. What are hypothyroidism sxs?
    • depression
    • wt gain
    • bradycardia
    • anorexia,
    • cold intolerance
    • dry skin
    • menorrhagia
  84. Med Class:  Antithyroid Medication
    • propylthiouracil (PTU)
    • methimazole (Tapazole)
  85. What's the purpose of antithyroid meds, propylthiouracil (PTU)?
    • blocks synthesis of thyroid hormones
    • prevents oxidation of iodine
    • blocks conversion of T4 into T3
  86. How are antithyroid hormones, propylthiouracil (PTU) used?
    • tx Graves disease
    • make euthryoid prior too thyroid removal surgery
    • use c irradiation of thyroid gland
    • emergency tx of thyrotoxicosis
    • admin oral
  87. What happens if pt over-medicates on antithyroid med, propylthiouracil (PTU?
  88. What are the s/sx of hypothyroidism?
    • drowsiness
    • depression
    • wt gain
    • edema
    • brady
    • anorexia
    • cold intolerance
    • dry skin
    • menorrhagia
  89. What should the pt do if hypothyroidism effects occur in a pt using antithyroid meds, propylthiouracil (PTU)?
    • report signs of over-medication
    • reduce dose
    • may temporarily admin thyroid supplements
  90. Agranulocytosis
    Side Effect of antithyroid hormone
  91. Signs of agranulocytosis
    sore throat fever
  92. Nursing intervention/client education for agranulocytosis side effect of antithyroid hormone, propylthiouracil, (PTU)
    • monitor for early signs
    • monitor blood count
    • stop tx and monitor reversal
    • give neupogen to tx
  93. Contraindication/Precaution of antithyroid med, propylthiouracil (PTU)
    use cautiously in bone marrow depression and/or immunosupression
  94. What happens if you use antithyroid med, propylthiouracil (PTU) c anticoag?
    increase anticoagulation
  95. use antithyroid med, propylthiouracil (PTU) and digoxin (Lanoxin0 together
    increase glycoside
  96. if antithyroid med propylthiouracil (PTU) and anticoags are used together
    • monitor PT, INR, aPTT
    • adjust dosages of anticoag
  97. if antithyroid med, propylthiouracil (PTU) and dig are used together
    • monitor dig level
    • reduce dig dose as need
  98. how should pt take antithyroid hormone med, propylthiouracil (PTU)
    • take same time each day
    • take c meals (maintain consistent therapeutic level and decrease gastric distress)
  99. should pts d/c antithryroid med, propylthiouracil (PTU) abruptly?
  100. What labs should be monitored for antithyroid med, propylthiouracil (PTU)
    • CBC for leukopenia
    • thrombocytopenia
  101. What's the purpose of antithyroid med, radioactive iodine?
    • absorbed by thyroid
    • destroys thyroid producing cells
  102. What are some therapeutic uses for high dose thyroid-radioactive iodine?
    • hyperthyroidism
    • thyroid cancer
  103. What are some therapeutic uses for low dose thyroid-radioactive iodine?
    diagnosis of thyroid disorders
  104. Side/Adverse Effects of radioactive iodine
    • radiation sickness
    • bone marrow suppression
    • hypothyroidism
  105. which antithyroid med use should you monitor pts for anemia, leukopenia, and thrombocytopenia?
    radioactive iodine