Nursing

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Author:
Johng9999
ID:
73058
Filename:
Nursing
Updated:
2011-03-16 09:07:32
Tags:
Endocrine
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Description:
Diabetes and Thyroid
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  1. PTU - Propylthiouracil
    • Blocks synthesis of thyroid hormones - T3 -T4
    • Watch for hypothyroidism
    • Given by mouth
    • Watch for rash, agranulosis, rash, nausea, vomiting.
  2. Methimazole
    Blocks Synthesis of thyroid hormone. More toxic than PTU, watch for rash and other symptoms as for PTU.
  3. Sodium Iodide
    • Supresses release of thyroid hormone.
    • Given 1 hour after PTU or methimazole.
    • Watch for emema, hemmorhage, GI upset. Used in prep for thyroidectomy and thyroid crisis. Reduces vascularity of gland to make surgery safer.
  4. Potassium Iodide
    • Supresses release of thyroid hormone. Discontinue for rash. Watch for signs of toxic iodinism.
    • Used in prep for thyroidectomy and thyroid crisis. Reduces vascularity of gland to make surgery safer.
  5. Saturated Solution of Potassium
    • Surpresses release of thyroid hormone. Mix with milk or juice and provide straw to avoid staining teeth.
    • Used in prep for thyroidectomy and thyroid crisis. Reduces vascularity of gland to make surgery safer.
  6. Dexamethasone
    Surpresses release of thyroid hormone. Monitor input and output. Monitor glucose. May cause hypertension, nausea, vomiting, anorexia, infection.
  7. Beta - Blockers. (propranolol)
    Monitor caridac status. Hold for bradycardia, use with caution with patients in heart failure.
  8. Is follow up nessasary with these meds?
    • Yes. It takes several weeks for symptoms to subside. Maintanance dose must be established.
    • Medication sensitization, fever, rash, urticaria, agranulosis and thrombocytopenia can develop.If pharengitis fever or mouth ulscers occur, STOP MEDS AND CONTACT MD! No nasal decongestants.
  9. Can salcylate be used during thyroid storm?
    No.
  10. First Generation Sulfonylureas
    • Acetehexamide (Dymelor) - No longer in US
    • Chlorpropamide (Diabinase)
    • Tolazamide (Tolinase)
    • Tolbutamide (Orinase)
    • Will not see these meds very much
  11. Second Generation Sulfonyureas?
    Where they work?
    Side effect?
    Implications?
    • Glipzide(Glucotrol, Glucotrol XL), Glyburide(Micronase, Glynase, Dia-Beta), Glimepiride(Amaryl)
    • They work in pancreas stimilating beta cells
    • Risk for hypoglycemia
    • When taking with Beta-Andrenic Blockers, could hide hypoglycemia
  12. Biguanides?
    Where they work?
    Side effects?
    Implications?
    • Glipzide(Glucotrol, Glucotrol XL), Glyburide(Micronase, Glynase, Dia-Beta), Glimeperide(Amaryl)
    • These work in liver inhibiting production of glucose and increases sensitivity to insulin.
    • Lactic Acidosis and renal failure can occur with use of iodinated contrast agents. Suspend med 48 hrs before and after testing.
  13. Alpha-Glucosidase Inhibitors
    What do they do?
    What are side effects?
    Implications?
    • Acarbose(Precose), Miglitol(Glyset)
    • Delays absorption of complex carbs in intestine and slows entry of glucose into systemic circulation.
    • GI side effects- abdominal discomfort, distention, diarrhea, flatulence.
    • MUST TAKE WITH FIRST BITE OF FOOD!
  14. Non-Sulfonylurea Insulin Secttretagogues
    Action?
    Side Effects?
    Implications?
    • Regalindine(Prandin), Nateglinide(Starlix)
    • Stimulates pancreas to secrete insulin
    • S/E are hypoglycemia and weight gain
    • Should be taken only if eating immediately
  15. Thiazolidinediones(Glitzones)
    Action?
    S/E?
    Implications?
    • Pioglitazone(Actose), Rosiglitazone(Avantia)
    • Sensitizes body to insulin
    • S/E Hypoglucemia, Anemia
    • Must be monitored by MD, causes strokes
  16. Dipeptidyl Peptidase Inhibitor (DPP-4)
    Action?
    S/E?
    Implications?
    • Sitagliptin(Januvia), Vildagliptin(Glavus)
    • Increases and prolongs the action of Incretin (increases insulin release and decreases glucogon)
    • Upper respiratory infection
    • Admin once a day
  17. Rapid Acting?
    Onset?
    Peak?
    Duration?
    Indications?
    • Lispro(humalog) 10-15min,Aspart(Novalog),Gluisine(Apidra)5-15min
    • Peak 1h/40-50min/30-60min
    • Duration 2-4h/2-4h/2h
    • Used for quick reduction of glucose levels to treat post prandial hyperglyciemia
  18. Short Acting?
    Onset?
    Peak?
    Duration?
    Indications?
    • Regular(Humalin R, Novalin R, Illetin 2 Regular) Onset 1/2-1H, Peak 2-3 hours, Duration 4-6 H.
    • Administered 20-30 mins before meals. Can be taken alone or with a longer acting insulin.
  19. Intermediate Acting?
    Onset?
    Peak?
    Duration?
    Indications?
    • NPH(Neutral Protamine Hagedorn)
    • Onset-2-4h Peak-4-12h duration 16-20h
    • (Humalin N, Iletin 2 NPH, Novalin L [lente], novalin N [NPH])
    • Onset 3-4h Peak 4-12h duration 16-20h
    • Usually taken after food
  20. Very Long Acting?
    Onset?
    Duration?
    Peak?
    Indications?
    • Glargine(Lantus), Detemir(Levemir)
    • Onset 1h, no peak-continuous, Duration 24 hours
    • Used as basal dose

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