Unit 4

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RNbound
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93055
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Unit 4
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2011-07-08 10:18:45
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Pharm Unit
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Unit 4 Pharm
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  1. U-100
    100u / 1ml
  2. Which insulin do you draw up first?

    regular (clear) or NPH (cloudy)

    hint: R . N.
    regular (clear)
  3. Hypoglycemia episode after insulin administration may mean...
    • blood sugar too low & no glucose available in body... it's used up...
    • SO ALWAYS CK THE BLOOD GLUCOSE B4 ADMINISTRATION
  4. PEAK
    • maximum effect
    • *(low blood sugar)* HYPOGLYCEMIC
  5. Which insulin does not PEAK?
    • Long acting...
    • ie.: glargine (Lantus) & detemir (Levemir) never...ever MIX them
  6. Which insulin should never be MIXED?
    • LONG acting..
    • ie.: glargine (Lantus) & detemir (Levemir) no PEAK
  7. ONLY one (1) insulin can be given via IV, which one?
    REGULAR (ie.: Humulin R)
  8. Rx used to treat emergency HYPOGLYCEMIC reactions...
    • Glucagon
    • via sub-q, im, iv
  9. Which oral anti-diabetic Rx must be stopped 24-48 hrs b4 & after CT scans or procedures w dyes?
    Glucophage (metformin)
  10. Type 1 diabetes is ? ? ?
    always insulin dependent, cannot produce enuf
  11. Type 2 diabetes
    adult onset or developed
  12. Gestational diabetes
    w pregnancy
  13. Genetic or Drug induced diabetes
    w certain genetic diseases or drug induced; chemicals
  14. DO: Every 5ml/dl over 150 finger stick give 1 unit of REG. insulin... Pt finger stick (203). How much do you administer?
    • 10.6 = 10u administered
    • **NEVER ROUND INSULIN..EVER**
  15. Can you round insulin?
    NO NO NO never ! ! !
  16. How are STEROID's (cortisone) related to DIABETES?
    Cause blood sugars to INCREASE monitor closely!
  17. Rapid acting insulin types
    clear - regular... ie.: lispro (Humalog), aspart (Novolog), glulisine (Apidra).
  18. Rapid acting
    ONSET

    PEAK

    DURATION
    ONSET... 10 - 20 mins.

    • PEAK... 1 - 3 hrs.
    • DURATION... 3 - 5 hrs.
  19. Short acting insulin types
    regular...clear (Humulin R) & (Novolin R) ONLY insulins given via IV or sub-Q
  20. Short acting

    ONSET
    PEAK
    DURATION
    ONSET... 30 - 60 mins.

    PEAK... 1 - 5 hrs.

    DURATION... 5 - 10 hrs.
  21. ONSET
    initial effect
  22. DURATION
    remains active
  23. Intermediate acting insulin types
    isophane (NPH) Humulin N & Novolin N, it's reg. insulin & protamine (binding agent) combo.
  24. Intermediate acting

    ONSET
    PEAK
    DURATION
    ONSET... 1 - 2 hrs.

    PEAK... 4 - 12 hrs.

    DURATION... 16 - 28 hrs.
  25. Long acting insulin types
    • glargine (Lantus)
    • detemir (Levemir)
    • no PEAK
  26. Long acting

    ONSET
    PEAK
    DURATION
    ONSET... 1 hr.

    PEAK....no peak

    • DURATION... 24 hrs.
  27. Can you freeze insulin?
    NO
  28. How do you store insulin prefilled syringes?
    Needle up in a jar of the refrigerator...re: medication will settle to the needle and clog up if store any oth way...
  29. How do you mix & warm insulins?
    Roll in hand...DO NOT SHAKE!!!
  30. Name 3 ORAL diabetic Rx?
    metformin (Glucophage) - biguanide

    glimepiride (Amaryl) - sulfonylurea hypo-use, sulfur agents added

    glucagon -emergency use only for hypo-use
  31. metformin (Glucophage) - biguanide
    DO NOT INITIATE DURING ...
    abnorm. creatine (kidney) levels
  32. What life threatening complication can occur w metformin (Glucophage)?
    • Lactic acidosis
    • also causes n&v
  33. What are some complications or DO NOT USE IN situations w Sulfonylurea Oral Rx's?
    • DO NOT USE IN PT ALLERGIC TO sulfur drugs
    • Pt can become hypoglycemic
  34. glucagon assessments b4 administration
    • -used in EMERGENCY situations usually
    • -if responsive give pt something sweet to eat or drink instead
    • -routes: IV, IM, SUB-Q
  35. When taking Steroids/Prednisone (CORTISONE) aka corticosteroids what should be done to minimize stomach upset?
    prophylactically take antacids to minimize gastric symptoms.
  36. intranasal corticosteroids help by...
    reducing inflammation of nasal passages to allow easier breathing
  37. Corticosteroid Therapy and Potassium what are the issues?
    corticosteroid enhances the loss of potassium monitor hbp pt carefully w use
  38. Important anti-inflammatory effect in certain medical situation...
    usually given in allergic reaction, rashes, break outs, poison ivy situations
  39. Baseline assessments in CORTICOSTEROIDS
    wt, bp, electrolyte/glucose tests, I&O
  40. Glucocorticoids use is...
    anti-inflammatory & antiallergenic in nature

    immunosuppression, ie.: cancer pt, organ transplantation, etc.
  41. Therapeutic use of GLUCOCORTICOIDS...
    • reduce pain and inflammation
    • reduce chemotherapy n&v
  42. GLUCOCORTICOID common & adverse side effects...
    eletrolyte imbalance, behavior changes, hyperglycemia, delayed wound healing, osteoporosis
  43. Corticosteroids and Immunocompromised pts
    certain cancers, organ trnsplantation, autoimmune diseases (ie.: lupus, rheumatoid arthritis)
  44. Does a pt have to be weaned off of Corticosteroid therapy?
    Yes, abrupt discontinuation may result in adrenal insufficiency.
  45. Should or is it alright for HYPERTENSIVE pts to take Corticosteroids?
    be monitored closely, due to the possible electrolyte imbalance in potassium.
  46. Best way to prevent RHINITIS MEDICAMENTOSA...
    prevention... careful administration
  47. What is RHINITIS MEDICAMENTOSA?
    REBOUND effect by OVER use of topical (nasal) decongestants
  48. What does a person that works outside a lot w itchy-watery eyes need to take?
    ANTI-HISTAMINE...oral administration because there is no REBOUND affect
  49. REBOUND effect
    overuse of nasal/topical decongestants aka rhinitis medicamentosa
  50. An example of a nasal decongestant...
    AFRIN...shrinks the tissue
  51. What adverse reaction does sinus Rx/decongestants have on HBP pt's?
    increases BP... all decongestants w "D" in their name
  52. What indication tell you that a Rx has a decongestant in it?
    "D" included in their name, (ie.: Allegra "D" fexofenadine)
  53. Bronchodialator purpose
    relaxes bronchial tree allowing increased opening of the bronchioles to increase air flow
  54. Expectorant action
    liqufy mucus by stimulating secretions of natural lubricant fluids
  55. Mucolytic agent actions
    • decreases stickiness & viscosity of pulmonary secretions
    • ie. Mucomyst (acetylcysteine)
  56. Flovent (fluticasone)
    Inhalant Corticosteroid (steroid inhalant)
  57. How does Flovent (fluticasone) steroid inhalant work?
    • dialation of the broncho tree
    • enhances smooth muscle relaxation
    • inhibits inflammatory responses that result from bronchoconstrictions..
  58. Sympathomimetic Decongestants
    • vasoconstriction occurs
    • reduces engorged nasal area blood flow
    • promotes sinus drainage
    • relieves stuffiness/congestion & obstruction
  59. Sympathomimetic Decongestants adverse reactions:
    serious effect is hypertension
  60. Most effective cough suppressant
    (ANTITUSSIVE)
    dextromethorphan (as effective as codeine)
  61. Antihistamine aka (Benadryl)-diphenhydramine ...
    • counter acts effects of histamine
    • does not prevent histamine
    • reduces symptoms
  62. Anti-histamines commonly treat...
    allergic rhinitis & conjunctivitis
  63. Anti-histamine adverse effects...
    • sedative effects
    • drying effects
    • anticholinergic effects (ie.: dry mouth & skin, blurred vision, constipation, urinary retention)
  64. Corticosteriod Inhalant is
    • steroid inhalant
    • inhibits inflammatory responses while...
    • dilating brono-tree area, allowing steroid to get in effectively
  65. Two medications ordered which one gets administered first... bronchodialator or steroid?
    BRONCHODIALATOR
  66. Pt w flu...taking Humibid aka Muccinex (guaifenesin) expectorant 4 therapy of influenza...what instructions are given by the NURSE:
    • force fluids to increase/liquefy & loosen mucus secretions
    • it has no sedative effect
  67. Antitussive medications act by...
    • suppressing cough center in the brain
    • loosens bronchial secretions
    • ie.: codeine, dextromethorphan
  68. Can a pt w AGINA (chest pain) take Sudafed (pseudoephedrine)?
    NO... do not take...NOT SAFE 4 any heart disease/issues
  69. Asthma pt taking Bronchial dialator... GOAL for pt w an appropriate NURSING DX...of activity intolerance.
    This pt VITAL SIGNS stay stable w activity
  70. Proventil (albuterol) is a ...
    • bronchodilator
    • stimulate smooth muscles in tracheobronchial tree to relax
    • opening airway 4 greater vol of air
  71. OTC cold & allergy Rx
    • 1st generation antihistamine (alcohol)
    • dries runny nose
    • helps you sleep
  72. 1st GENERATION anti-histamines work by...
    • more Rx ingredients to make you sleep
    • dries runny nose
  73. ??? Calms coughs ???
    dextromethorphan
  74. ??? Relieves nasal stuffiness ???
    decongestant
  75. ??? Relieves body aches in cold & allergy Rx ???
    acetaminophen, occasionally ibuprofen
  76. ??? Loosens mucous ???
    guaifenesin
  77. Some 1st generation oral anti-histamines are:
    • diphenhydramine (Benadryl)
    • chlorpheniramine (Chlor-Trimeton)
    • clemastine (Tavist)
  78. Some 2nd generation oral anti-histamines are:
    • loratadine (Claritin)
    • cetirizine (Zyrtec)
  79. Intranasal Corticosteroids
    • reduces inflammation in nasal passages
    • decreases nasal stuffiness
    • reduces rhinitis, itching, sneezing...
    • adverse effect...Nasal burning
  80. NURSING instructions for taking anti-histamines?
    • begin taking b4 allergy season begans
    • avoid driving/oth. activities w mental alertness needed
    • report excessive coughing/lethargy/confusion
  81. Education for pt taking inhalants:
    • exhale completely
    • hold breath 10 seconds after medication inhaled
    • rinse mouth to avoid thrush on tongue
  82. COMMON Lower Respiratory Disease
    • COPD - chronic obstructive pulmonary disease
    • CALD -chronic airton disease
    • Asthma
    • Chronic bronchitis
    • Emphysema
  83. Mucolytic Agents are
    • acetylcysteine (Mucomyst)
    • loosens, thick viscous bronchial secretion
    • mucus becomes thinner
    • common adverse reaction: n & v
    • serious adverse reaction: bronchospasm
  84. EXPECTORANTS adverse reaction...
    • GI upset
    • N & V
  85. ANTI-TUSSIVE adverse reactions:
    • dry mouth
    • drowsiness
    • constipation
  86. Beta-Adrenergic Bronchodilating Agents action:
    • stimulate smooth muscle of tracheobronchial tree
    • reverse airway constriction
  87. Beta-Adrenergic Bronchodilating Agents serious adverse effects:
    • tachycardia
    • palpitations
    • nervousness, anxiety, restlessness
    • headache, dizziness, N & V
  88. Anticholinergic Bronchodilating Agents aka (ipratropium bromide) ATROVENT or (tiotropium) SPIRIVA actions are:
    • produce bronchodilation
    • used w long-term tx of COPD
    • common adverse effects: dry mouth, throat irritation
    • serious adverse effects: tachycardia, urinary retention, exacerbation of sx
  89. Respiratory Anti-inflammatory Agents act to:
    • inhibit inflammatory responses
    • use w pt unresponsive to sympathomimetic agents
    • prevents sx of asthma
    • common adverse effects: hoarseness, dry mouth
    • serious adverse effects: thrush (advise pt to rinse mouth out after use)

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