pharmacology exam 2
what precautions should be taken while a patient is on tacrolimus (prograf)
Avoid grapefruit juice and take on an empty stomach. Avoid high fat and carbohydrate foods which may negatively impact absorption
what are some adverse effects of colchicine (Colcrys)
bleeding into GI or urinary tracts, contraindicated in renal, gi, hepatic, cardiac disorders, blood dyscrasias
what are some adverse effects for metformin
bloating, nausea, cramping, diarrhea, etc... usually subsides with use
if an adult is taking 81mg of asprin, which is the usual baby dose, what could that indicate?
cardiac history, treatment and prevention of acute MI and other thromboembolic disorders
your patient is unconscious and has an IV in the left antecubital space, but appears hypoglycemic. what would you do?
check blood sugar to confirm, and administer D50W (50% dextrose in water) by IV
your patient is awake and able to swallow, but appears hypoglycemic. what would you do?
check blood sugar to confirm, and administer an oral concentrated form of glucose- buccal tablet/semisolid gel
if potassium is given to a patient who is on non-K+ sparing diuretics, amphotericin B, and mineralocorticoids, what would happen?
hypokalemia
why would potassium phosphate be given
if phosphate level is low
mycophenolate mofetil (CellCept) is what kind of drug
immunosuppressant- antimetabolite
cyclosporine (Sandimmune) is what kind of drug
immunosuppressant- calcineurin inhibitor
tacrolimus (Prograf) is what kind of drug
immunosuppressant- calcineurin inhibitor
when is acarbose (precose) contraindicated?
in all bowel diseases, bc works in bowel--> inflammatory BD, malabsorption syndrome, intestinal obstruction *does not cause hypoglycemia, hyperinsulinema, or weight gain like most other drugs*
what are important nursing implications for antigout drugs
increase fluids 3L/day, avoid alcohol and caffeine
your patient has difficulty swallowing, is unconscious and has no IV access, but appears hypoglycemic. what would you do?
check blood sugar to confirm, roll pt onto side, and administer glucagon injection
when should pioglitazone (actos) NOT be given
class 3 or 4 heart failure, be cautious in pts. with renal/hepatic disease, bc this drug works in the liver and is excreted by kidneys
what kind of therapeutic effects do we look for when a patient is on somatropin
increased growth in children
what is the general therapeutic effect of diuretics?
increased urine output
mechanism of action for acarbose (precose)
inhibits alpha glucosidase enzyme--> stops transformation of polysaccharides to glucose--> causes delayed absorption of glucose *prevents postprandial spikes, but not good for controlling glucose all day, usually used w/ another drug*
mechanism of action for canagliflozin (invokana)
inhibits glucose reabsorption in proximal renal tubules *completely independent of insulin, so can also be used in type 1*
what is the primary treatment for type 1 diabetes?
insulin
name a gliptin that can increase digoxin toxicity
januvia (stagliptin)
black box warning for metformin
lactic acidosis, renal failure
bumetanide (Bumex) and furosemide (Lasix) are which kind of diuretics?
loop diuretics
which class of diuretics is most potent?
loop diuretics
name an oral antidiabetic from the biguanide class that does not increase insulin secretion from the pancreas
metformin
fludrocortisone acetate (Florinef) is what kind of drug
mineralocorticoid, adrenal drug
vasopressin (Pitressin) and Desmopressin(DDAVP) are what types of pituitary drugs and what do they do
posterior pituitary, mimics action of ADH
which kind of diuretic is spironolactone (Aldactone)
potassium sparing
which class of diuretics is least potent?
potassium-sparing diuretics
what is mycophenolate mofetil (CellCept) used for
prevention and treatment of organ rejection in kidney, liver and heart transplantation
how does mycophenolate mofetil (cellcept) work
prevents proliferation of T cells by inhibiting intracellular purine synthesis
what kind of NSAID is Ibuprofen (Motrin, Advil) and Naproxen (Naprosyn, Aleve)
propionic acid derivatives
what is the MOA for loop diuretics
work along the ascending limb of the loop of Henle block chloride and 2nd sodium resorption activate renal prostaglandins
a nurse is preparing to give a mixed insulin to her patient. she first draws 70% NPH into the syringe, and then 30% novolog. what did she do wrong?
wrong order. always draw regular/rapid acting insulins first, then intermediate/long acting
most/all sulfonylurea drugs end in...?
"-ide"
corticosteroids (adrenal drugs) all end in what?
"-one"
MOA for corticosteroids
-exert their effects by modifying enzyme activity, inhibit or help control inflammatory and immune responses -differ in their potency, duration of action, and the extent to which they cause salt and water retention
what are normal AST levels
0-35
describe the crystalloid half-normal saline
0.45% NaCl, Hypotonic- Solutions with lower concentrations are available (may cause lysis of RBCs). Fluid moves from vein into tissues/cells.
what is the normal level for creatinine
0.6 to 1.5 mg/100 mL
describe the crystalloid normal saline
0.9% NaCl, Isotonic- Physiologically normal concentration. No net fluid movement from vein into tissues/cells.
what is the peak for rapid acting insulin
1-2 hours (5-15 minutes feels like 1-2 hours during 3-5 rapid admissions)
what is the onset of NPH insulin
1-2 hours (nurses play hero once or twice every 4-8 hours to kids 10-18 years old)
what is the onset of long acting insulins?
1-2 hours (one of the 2 long nursing shifts never peaked but lasted 24 hours)
insulins premixed in syringes can be stored for how long?
1-2 weeks under refrigeration in a vertical position, needles pointing up
how would you treat a potassium OD
1. IV dextrose and insulin, sodium bicarbonate and calcium gluconate or chloride. Cause a rapid intracellular shift of K+ ions reducing the serum potassium concentrations. 2. Sodium polystyrene sulfonate (Kayexalate) 3. hemodialysis- for extremes
what is the duration of NPH insulin
10-18 hours (nurses play hero once or twice every 4-8 hours to kids 10-18 years old)
what is the normal range for sodium
135-145mEq/L
why would you use a thiazide or thiazide like diuretic
1st line HTN drug Edema Idiopathic hypercalciuria Diabetes insipidus Hepatic cirrhosis
what is the peak for humulin r (regular insulin)
2.5 hours (short staffed nurses went from 30-60 patients in 2.5 hours during their 6-10hr shift)
what is the duration of long acting insulins
24 hours (one of the 2 long nursing shifts never peaked but lasted 24 hours)
describe the crystalloid high alert saline
3% NaCl, Hypertonic-If infused too rapidly leads to osmotic demyelination syndrome and irreversible brainstem damage. Fluids move from interstitial fluid to veins
what is the duration of rapid acting insulin
3-5 hours (5-15 minutes feels like 1-2 hours during 3-5 rapid admissions)
what is the normal range for potassium
3.5-5.mEq/L
when should metformin be administered
30 minutes before breakfast and dinner
what is the onset of humulin r (regular insulin)
30-60 min (short staffed nurses went from 30-60 patients in 2.5 hours during their 6-10hr shift)
what is the normal urine output measurement
30cc/hr. 240cc/8 hrs
what is the peak for NPH insulin
4-8 hours (nurses play hero once or twice every 4-8 hours to kids 10-18 years old)
what is the onset for rapid acting insulin
5-15 minutes (5-15 minutes feels like 1-2 hours during 3-5 rapid admissions)
what is the duration of humulin r (regular insulin)
6-10 hours
what is the normal total body protein level
7.4g/dL
what is the normal BUN level
8 to 25 mg/100 mL
what are normal hemoglobin A1C levels
<7% (6% is better)
A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia? A. 1900 B. 1300 C. 1130 D. 1500
A. 1900
You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours
A. Onset: 15 minutes, Duration: 3 hours
why would Cryoprecipitate and plasma protein factors (PPF) be given
Acute bleeding (greater than 50% slow blood loss or 20% acutely)
A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them? A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.
A. They massaged the site after administering the insulin.
what labs should be checked when a patient is on Actos
AST and ALT
what are corticosteroids used for
Adrenocortical deficiency Cerebral edema Collagen diseases Dermatologic diseases GI diseases Exacerbations of chronic respiratory illnesses, such as asthma and COPD Organ transplant (decrease immune response) Palliative management of leukemia and lymphoma Spinal cord injury
what are some adverse effects of tacrolimus (prograf)
Agitation, anxiety, confusion, hallucinations, neuropathy, albuminuria, dysuria, acute renal failure, renal tubular necrosis, post transplant diabetes mellitus.
what are the 2 most commonly used colloids
Albumin 5% and 25% (from human donors) Dextran 40, 70, or 75 (a glucose solution) Hetastarch (synthetic, derived from cornstarch)
what do NSAIDs interact with?
Alcohol=increased gi bleeding Anticoagulants=increased bleeding Corticosteroids, other ulcerogenic drugs Protein bound drugs=competes for binding
NSAIDs indications
Analgesia (mild to moderate) Antigout effects Antiinflammatory effects Antipyretic effects Relief of vascular headache Platelet inhibition (aspirin)
what are NSAIDs used for
Analgesic Antiinflammatory Antipyretic Antiplatelet
when would you not use a thiazide or thiazide like diuretic
Anuria, severe renal failure
A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin
B. Draw-up the Humulin R insulin first and then the NPH insulin. - remember "clear to cloudy", regular(short acting) to NPH intermediate
A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct? A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication.
B. Hold the dose and notify the doctor for further orders.
when is canagliflozin (invokana) contraindicated
DKA, renal impairment
what are some things to keep in mind while a patient is on an antithyroid drug
Better tolerated when given with food Give at the same time each day to maintain consistent blood levels Never stop these medications abruptly Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)
why are crystalloids used
Burns Shock- causes BP to drop Hemorrhage Mild hyponatremia Severe vomiting or diarrhea, dehydration Metabolic disorders i.e. Diabetic Ketoacidosis Administration of blood products -just to maintain body systems
A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A. 1300 B. 0930 C. 1100 D. 1700
C. 1100
After the patient on cyclosporine (Sandimmune) gets home, she calls the office to ask about eating grapefruit. I thought the doctor said I could have a little bit. I have a wonderful grapefruit tree in my backyard, and I love fresh grapefruit juice. What should I do?" What is the nurse's best answer?
DO NOT EAT THE GRAPEFRUIT. CUT THE TREE DOWN
Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N
C. Lantus
A patient taking the medication Precose asks when it is the best time to take this medication. Your response is: A. 1 hour prior to eating B. 1 hour after eating C. With the first bite of food D. At bedtime
C. With the first bite of food
Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog
C. humulin R
what kind of NSAID is celecoxib (Celebrex)
COX 2 inhibitor
how is celecoxib (Celebrex) different from other NSAIDs
COX 2 inhibitor, less GI effects, but same anti-inflammatory benefits
what are some adverse effects of levothyroxine (synthroid)
Cardiac dysrhythmia is the most significant May also cause: Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite changes, sweating, heat intolerance, others
what are some adverse effects of corticosteroids
Cardiovascular- Heart failure, cardiac edema, hypertension—all caused by fluid retention and electrolyte imbalances (hypokalemia, hypernatremia) CNS- Convulsions, headache, vertigo, mood swings, nervousness, insomnia, "steroid psychosis," others Endocrine- Growth suppression, Cushing's syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others GI- Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others Integumentary- Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria Musculoskeletal- Muscle weakness, loss of muscle mass, osteoporosis Ocular- Increased intraocular pressure, glaucoma, others
what are some adverse effects of antithyroid drugs
Central nervous Drowsiness, headache, vertigo, paresthesia Gastrointestinal Nausea, vomiting, diarrhea, hepatitis, loss of taste Genitourinary Smoky urine, decreased urine output Hematologic Agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, lymphadenopathy, bleeding Integumentary Rash, pruritus Musculoskeletal Myalgia, arthralgia Renal Increased blood urea nitrogen and serum creatinine levels Other Enlarged thyroid gland, nephritis
what are some signs of possible thyroid toxicity
Chest pain, weight loss, palpitations , tremors, sweating, nervousness, shortness of breath or insomnia
what is the black box warning fro mycophenolate mofetil (cell cept)
Congenital malformations and spontaneous abortions when used in pregnancy
what are some adverse effects of osmotic diuretics
Convulsions Thrombophlebitis Pulmonary congestion exfolative dermatitis
what kind of oral antidiabetic is stagliptin (januvia)
DPP-IV inhibitor (gliptins)
what therapeutic effects are we looking for with loop diuretics
Decreased fluid volume causes a reduction in: Blood pressure Pulmonary vascular resistance Systemic vascular resistance Central venous pressure Left ventricular end-diastolic pressure
what do thiazide and thiazide-like diuretics interact with
Corticosteroids, digitalis, oral hypoglycemics
A patient has a blood glucose of 45 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Call the doctor for further orders. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 3 graham crackers to eat.
D. Give the patient 3 graham crackers to eat.
when would you not give a patient potassium
Known allergy Hyperkalemia Severe renal disease Acute dehydration Untreated Addison's disease Severe hemolytic disease Extensive tissue breakdown (multiple trauma, severe burns)
what are some adverse effects of potassium sparing diuretics
Dizziness Headache GI - cramps, NVD Hyperkalemia Gynecomastia Amenorrhea Irregular menses Postmenopausal bleeding
when should corticosteroids not be given
Drug allergies Serious infections, including septicemia, systemic fungal infections, and varicella Cautious use in patients with Gastritis, reflux disease, ulcer disease, Diabetes- can cause hyperglycemia, Cardiac/renal/liver dysfunction- can cause fluid retention=overload
why would you use an osmotic diuretic
Early, oliguric (low urine o/p) phase of acute renal failure (ARF). Increase in renal blood flow resulting from dilation of vessels supplying blood to the kidneys= allows more filtration to take place=more urine Promote excretion of toxic substances Reduce intracranial pressure and cerebral edema from trauma
when would you not give a patient sodium
Elevated serum sodium levels, edema, HTN
T or F misoprostol (Cytotec) is the only NSAID that is safe for pregnant women
FALSE- never safe for pregnant women, causes abortions
what are some adverse effects of octreotide (sandostatin)
GI disturbances, hypo/hyperglycemia
when should pramlintide (symlin) not be used
Gastroparesis With other meds that alter GI motility
what is octreotide (Sandostatin) used for
Gigantism in children, acromegaly in adults, carcinoid tumors and esophageal varicies
how to you avoid most GI effects when giving an NSAID, such as asprin?
Give asprin with food, milk or meals to avoid GI irritation
what forms are loop diuretics given in
Given IV or orally, initially IV, sent home on oral
what are some adverse effects with sulfonylureas
HYPOglycemia (from an OD, not eating), weight gain, epigastric fullness, heartburn, allergies
what are some adverse effects of somatropin (humatrope)
Headache, hyperglycemia, hypothyroidism, hypercalciuria, rash, urticaria (hives), flu like symptoms
why would you use a potassium sparing diuretic
Hyperaldosteronism- bc. blocks it Hypertension Reversing potassium loss caused by potassium-losing drugs HF due to diastolic dysfunction Children with heart failure (often accompanied by excess secretion of aldosterone) Ascites from cirrhosis of the liver
when would you not use potassium sparing diuretics
Hyperkalemia, level exceeding 5.5 Severe renal failure Anuria- no urine o/p
what are some adverse effects of thiazide and thiazide like drugs and how are they controlled
Hypokalemia Elevate levels of calcium, lipids, glucose, uric acid Headache, impotence, decreased libido- more subjective complaints Metolazone: dizziness and vertigo -usually from excessive fluid and electrolyte loss which are usually dose related and controlled by titration
what are some adverse effects of loop diuretics
Hypokalemia-may need K+ supplement ototoxicity nephrotoxicity/neurotoxicity increased effects with thiazides
what do blood products do
Increase colloid osmotic pressure and plasma volume Increase body's supply of various products (e.g., clotting factors, hemoglobin) Pull fluid from extravascular space into intravascular space (plasma expanders) Red blood cell (RBC) products also have the ability to carry oxygen. Can maintain COP for hours to days- long lasting
how would you treat hypernatremia
Increase fluid intake Dietary restriction of sodium D5W or D10W Too rapid correction may cause brain edema.
why would diabinese and other antidiabetics from the sulfonylurea class produce weight gain?
bc stimulates beta cells of pancreas to produce more insulin, insulin=fat hormone
NSAIDs mechanism of action
Inhibition of the leukotriene pathway, the prostaglandin pathway, or both
how does tacrolimus (prograf) work
Inhibits T-cell activation, possibly by binding to an intracellular protein known as FKBP-12
how does cyclosporine (sandimmune) work
Inhibits activation of T cells by blocking the production and release of IL2(interleukin 2)
what should you teach your patient to report when giving NSAIDs?
Instruct patient to report black or tarry stools, bleeding around gums, petechiae, ecchymosis (bruising), purpura(big purple spots)
metformin (glucophage) is what type of oral antidiabetic?
biguanides
what does potassium interact with
K+ sparing diuretics ACE inhibitors Non K+ sparing diuretics Amphotericin B Mineralocorticoids
why would potassium chloride be given
Low chloride is often associated with low potassium
how would you treat hyponatremia
Mild - oral administration of NaCl tablets /fluid restriction Severe - IV normal saline/lactated Ringer's solution Hypertonic saline is sometimes used. Conivaptan (Vaprisol) - inhibits the effectiveness of ADH
what is the mechanism of action for pramlintide (symlin)
Mimics the natural hormone amylin-->Slows gastric emptying-->Suppresses glucagon secretion, reducing hepatic glucose output helps with appetite and satiety, used when other drugs have not achieved adequate glucose control
why is potassium so important in the body
Muscle contraction Transmission of nerve impulses Pacemaker function of the heart Maintenance of acid-base balance Isotonicity Maintain electrodynamic characteristics of the cell
which insulin is intermediate acting
NPH (isophane insulin suspension- cloudy)
what are the adverse effects of pramlintide (symlin)
Nausea, vomiting, Anorexia, Headache
what are some adverse effects of giving sodium
Nausea, vomiting, cramps if given orally IV administration can cause Venous phlebitis
how do you avoid most GI effects when giving an NSAID that is not asprin?
Non-aspirin NSAIDS may be taken with antacids to decrease GI upset
how does gout form?
Overproduction of uric acid or decreased excretion or combo of both= Hyperuricemia= uric acid crystals collect in tissues and joints=inflammation and pain
what are some important things to assess before administering crystalloids
Patients medical hx, Esp GI, Renal Cardiac Hepatic system Medication hx, dietary hx- for all drugs Fluid vol and electrolyte status (older adults and peds have increased sensitivity to fluids and electrolytes) Assess skin turgor
why would whole blood be given
Same as for PRBCs, except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma and increases the circulating blood volume. Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues Useful in acute blood loss (Trauma or surgery) Volume expansion in extensive burns, dehydration or shock.
what are some things that should be considered when administering octreotide (sandostatin)
Use with caution in patients with renal impairment. Monitor glucose levels in patients with diabetes and even in those who do not have diabetes. Can be given intravenously, intramuscularly, or subcutaneously. Give injections without food or at bedtime to minimize symptoms
what therapeutic effects are we looking for with osmotic diuretics
Vasodilation, increasing glomerular filtration and renal plasma flow, prevents kidney damage during acute renal failure Reduces intracranial pressure or cerebral edema associated with head trauma- go to diuretic for increased ICP Reduces intraocular pressure
what is tacrolimus (prograf) used for
Prevention of organ rejection and other unlabeled uses in autoimmune diseases and severe psoriasis
what is cyclosporine (sandimmune) used for
Prevention of organ rejection, treatment of rheumatoid arthritis and psoriasis
what are some adverse effects of cosyntropin (cortrosyn)
Renal retention of sodium, edema, hypertension
canagliflozin (invokana) belongs to which class of oral antidiabetics
SGLT2 inhibitors
what kind of NSAID is asprin
Salicylates
why would you give a patient potassium
Treatment or prevention of potassium depletion when dietary means are inadequate Stop irregular heartbeats Management of tachy-dysrhythmias that can occur after cardiac surgery
what are some signs of hypokalemia
Serum K+ level < 3.5mEq/L Hypotension Lethargy Mental confusion Muscle weakness Nausea Increase digoxin toxicity and cause serious arrhythmias Later: cardiac arrhythmias, neuropathies and paralytic ileus
what are some signs of hyperkalemia
Serum level K+ > 5.5 mEq/L Generalized fatigue, often related to the heart Weakness Paresthesia, Palpatations Paralysis
what are some signs of hyponatremia
Serum sodium levels < 135 mEq/L Lethargy/fatigue Hypotension Stomach cramps Vomiting Diarrhea Seizures anorexia confusion headache
what are some signs of hypernatremia
Serum sodium levels > 145 mEq/L Anorexia, restlessness Lethargy Muscle weakness Nausea Thirst Elevated Blood Pressure Edema
why would you administer colloids
Shock Burns When plasma volume expansion is needed Rapid onset, long duration
what does a basic metabolic panel consist of
Sodium Na PotassiumChloride KCL Carbon dioxide CO2 Glucose BUN Creatinine
why would you give a patient sodium
Sodium is primarily administered for Treatment or prevention of sodium depletion when dietary measures are inadequate
what are crystalloids
Solutions containing fluids and electrolytes that are normally found in the body- DO NOT CONTAIN PROTEINS
what is somatropin (humatrope) used for
Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism Long term replacement therapy for children who have growth failure because of inadequate endogenous growth hormome wasting associated with HIV
what is cosyntropin (cortrosyn) used for
Stimulates release of cortisol from adrenal cortex Antiinflammatory effect Used to diagnose adrenocortical insufficiency Wasting associated with HIV Promotes renal retention of sodium
what do we need to teach patients when they are prescribed levothyroxine (synthroid)
Teach patient to take thyroid drugs once daily in the morning, ½ - 1 HOUR before breakfast on an EMPTY stomach- for best absorption, take meds at the same time every day and do not switch brands, report any unusual symptoms, chest pain, or heart palpitations, do not take over-the-counter medications without physician approval, effects may take several months to occur, alert health care providers of thyroid medication use bc can enhance activity of anticoagulants, need increased dosages of hypoglycemic meds, decrease serum digoxin levels
what is the primary side effect of immunosuppressant medications
The primary side effect of immunosuppressant medications is the development of opportunistic infections
why would packed red blood cells be given
To increase oxygen-carrying capacity in patients with: anemia, substantial hemoglobin deficits, and who have lost up to 25% of their total blood volume- don't add much to BV
how do potassium sparing diuretics work?
Work in collecting ducts and distal convoluted tubules; block the aldosterone receptors used as adjuncts to thiazides
how do thiazide and thiazide-like diuretics work
Work in the distal convoluted tubule to inhibit resorption of sodium, potassium and chloride Osmotic water loss Relax small blood vessels Reduced peripheral vascular resistance (afterload) Decreased preload or filling pressures Decreased afterload (force ventricles must overcome to eject the volume of blood they contain)
how do osmotic diuretics work
Works in the proximal tubule and descending loop of henle Increases osmotic pressure in the glomerular filtrate which pulls water into the renal tubules from the surrounding tissues =Inhibits tubular resorption of water and solutes, thus producing rapid diuresis
what are some signs of lactic acidosis
abdominal discomfort, decreased appetite, diarrhea, fast/shallow breathing, muscle pain/cramping, sleepy/tired
what kind of NSAID is ketorolac (Toradol)
acetic acid derivatives
what are some adverse effects of allopurinol (Zyloprim)
agranulocytosis, aplastic anemia, steven-johnsons skin condition
why would you not administer colloids
allergy, hypervolemia, heart failure
acarbose (precose) belongs to which class of oral antidiabetics
alpha-glucosidase inhibitors
what kind of injectable antidiabetic is pramlintide (Symlin)
amylin agonist (mimetic)
Somatotropin (Serostim, Humatrope) is what kind of pituitary drug and what does it do
anterior pituitary, mimics growth hormone
Cosyntropin (Cortrosyn) is what kind of pituitary drug and what does it do
anterior pituitary, stimulates production of hydrocortisone
what is allopurinol (Zyloprim) used for?
antigout- Inhibits enzyme xanthine which prevents uric acid production, indicated for patients whose gout is from excess production of uric acid
what is colchicine (Colcrys) used for?
antigout-Reduces inflammatory response to deposits of urate crystals in joint tissue. Used in short-term treatment of acute gout
what do methimazole (Tapazole) and propylthiouracil (PTU) do
antithyroid drugs, not to cure hyperthyroidism but to palliate it. inhibits iodine=stops formation of thyroid hormone
what are some early signs of an allergic reaction to a blood transfusion
anxiety, swelling, difficulty breathing, joint/back pain
what is the preferred method of insulin treatment for hospitalized patients?
basal-bolus insulin dosing. delivers basal insulin constantly (mimics pancreas), and then as needed as a bolus. basal insulin is a long acting (lantus), and bolus is a rapid acting (humalog)
why would potassium acetate be given
corrects acidosis
when should stagliptin (januvia) be given
daily
when should sulfonylureas be given?
daily with breakfast
what are some signs of renal failure?
decreased urinary output, edema, unusual creatinine/BUN levels
what is the mechanism of action of metformin
decreases production of glucose in the liver--> decreased glucose absorption in intestines--> improves insulin receptor sensitivity
what is the mechanism of action for stagliptin (januvia)
delays breakdown of incretin (stimulates insulin prod. after eating) hormone--> increases insulin synthesis--> lowers glucagon secretions--> slows gastric emptying time *results in better, longer lasting incretin*
what is Radioactive iodine (I131) used for
destroys thyroid gland in cases of hyperthyroidism
what are vasopressin (Pitressin) and desmopressin (DDAVP) used for
diabetes insipidus, vasopressin is also used for Hypotensive emergencies such as vasodilatory shock (septic shock), Advanced Cardiac Life Support (ACLS), stop bleeding of esophageal varices, because it is a potent vasoconstrictor. desmopressin can also be used for blood disorders; and nocturnal enuresis
what does stagliptin (januvia) interact with
digoxin levels, some other drugs may not be metabolized correctly
how long should you wait between metformin and a test with contrast dye
discontinue day of test and 48 hours after
what kind of precautions should be taken for a patient that is on cyclosporine (sandimmune)
do not interchange brand names with generic, avoid grapefruit juice, do not use Styrofoam containers, very narrow therapeutic index so monitor patient's BUN, LDH, AST, and ALT closely
after administering insulin, when is the patient most at risk for hypoglycemia?
during the peak time of the insulin drug
mechanism of action for pioglitazone (actos)
enhances sensitivity of insulin receptors= increase in glucose uptake, and storage and use in skeletal muscles. inhibits glucose and triglyceride production in liver *because this drug affects gene regulation, it takes several weeks/months to see affects*
what kind of NSAID is meloxicam (Mobic)
enolic acid derivative
T or F during pregnancy, treatment for hypothyroidism should stop and then start again after the child is born
false- should be continued throughout entire pregnancy to avoid severe growth retardation
T or F oral antidiabetics are mainly used for type 1 diabetes
false- used for type 2
what are some adverse effects of acarbose (precose)
flatulence, abdominal pain, diarrhea, anemia, hepatotoxicity with long term use
what are some adverse effects of fludrocortisone acetate (florinef)
generally related to water retention heart failure hypertension elevated intracerebral pressure (e.g., leading to seizures) Systemic fungal infections
what are some adverse effects of canagliflozin (invokana)
genital yeast infections, UTI, urinary incontinence, hypotension, hypovolemia, hyperkalemia, increased LDL cholesterol
which insulins are long acting?
glargine (lantus) and detemir (levemir)
what type of oral antidiabetic is repaglinide (prandin)
glinide
why choose a glinide antidiabetic over a sulfonylurea antidiabetic
glinides are good for erratic/bad eaters because when a meal is skipped, a dose is skipped
what are some adverse effects for glinides
headache, dizziness, nausea, joint pain, weight gain, upper respiratory infection/flu-like symptoms, hypoglycemic effects most common
when would you not use a loop diuretic
hepatic coma severe electrolyte loss allergy to sulfonamide antibiotics (may still be given in practice) **caution in elderly**
which 2 insulins are rapid acting?
humalog and novolog
which insulin is short acting?
humulin R (regular insulin)
if potassium is given to a patient who is on K+ sparing diuretics and ACE inhibitors, what would happen?
hyperkalemia
octreotide (Sandostatin) is what kind of pituitary drug and what does it do
hyperpituitarism drug, antagonist to growth hormone by inhibiting its release
what are some adverse effects of cyclosporine (sandimmune)
hypertension, neurotoxicity, hepatotoxicity, nephrotoxicity, post transplant diabetes mellitus, gingival hyperplasia and hirsutism
what are some adverse effects of mycophenolate mofetil (cellcept)
hypertension, peripheral edema, tachycardia, pain, headache, hyperglycemia, hyperlipidemia, electrolyte disturbances, abdominal pain, leukopenia, thrombocytopenia, cough and dyspnea
what is the most common problem/adverse effect in diuretics?
hypo/hyperkalemia
why would you give a patient mixed insulin instead of other unmixed insulins?
mixed insulin is cheaper, fewer Accu-Cheks, easier
what are some adverse effects of pioglitazone (actos)
moderate weight gain, peripheral edema, mild anemia, hepatic toxicity (monitor ALT and AST levels), elevations in LDL cholesterol
a nurse is preparing to give insulin to her patient. she is going to give NPH, a cloudy solution. before giving the intermediate insulin, she shakes the vial to mix the suspension. what did she do wrong?
never shake vials, gently roll to mix
with parental potassium, how fast should you infuse it
no faster than 10mEq/hr
what is the peak for long acting insulins?
no peak (one of the 2 long nursing shifts never peaked but lasted 24 hours)
what are some adverse effects of blood products
none very common, but: Incompatibility with recipient's immune system resulting in acute hemolytic reaction Febrile nonhemolytic reactions Mild allergic reactions Circulatory overload Anaphylaxis Transmission of pathogens to recipient (hepatitis, HIV) or sepsis Iron overload with whole blood or PRBC
what are normal ALT levels
normal range, 4 to 36 units/L
what are normal LDH levels
normal range, 45 to 90 units/L
when should canagliflozin (invokana) be given
once a day before breakfast
when should pioglitazone (actos) be given
once daily or in two divided doses
chloropropamide (diabenese) belongs to which diabetic drug class?
oral antidiabetic sulfonylurea
glipizide (glucotrol) belongs to which diabetic drug class?
oral antidiabetic sulfonylurea
mannitol (osmitrol) is what kind of diuretic
osmotic
fludrocortisone acetate (Florinef) is used for...?
partial replacement therapy for adrenocortical insufficiency in Addison's disease treats salt-losing adrenogenital syndrome
When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin?
peak
why would fresh frozen plasma (ffp) be given
plasma expander and increases clotting factors- also good for bleeding
what are colloids
protein substances-Increase COP, Move fluid from interstitial compartment to plasma compartment by pulling fluid into the blood vessels (when plasma protein levels are low) Increase the blood volume, sometimes called plasma expanders bc they keep fluid inside the blood vessel.
A patient received cyclosporine (Sandimmune) yesterday. Today another nurse comes in with the patient's morning medications. The patient says, "You can't give me the medicine like that. Don't you know how to mix it?" What do you think the nurse did wrong?
put the med in a Styrofoam cup
how long does it take for a loop diuretic to kick in, and how long does it last?
rapid acting, even in single daily dose. effects last at least 2 hours
your patient has been taking prandin for a few days, and is concerned because he is not noticing any differences in his health or seeing any effects of the drug. what do you tell him?
remind him that prandin (glinides) take a few weeks to kick in fully
what should metformin NOT be taken
renal failure, heart failure, alcoholism, metabolic acidosis, hepatic disease, other tissue hypoxia disorders
which diabetic drug would you give to a patient who has a crazy work schedule and eating habits?
repaglinide (prandin)
what is the most important thing to keep in mind while a patient is on corticosteroids
risk for infections bc suppressed immune system. make sure patient avoids crowds, stays away from sick people, report any fever, increased weakness, lethargy, or sore throat
what are normal glucose levels
serum levels of 70 to 100 mg/dL
when would you not use an osmotic diuretic
severe renal disease- acts in EARLY stages, not severe pulmonary edema (use loop)- bc of way it affects lungs active intracranial bleeding Not indicated for patients with peripheral (feet, ankles, body) edema because it does not promote sufficient sodium excretion
what kind of therapeutic effects do we look for when a patient is on octreotide
should decrease diarrhea associated with carcinoid syndrome
what kind of therapeutic effects do we look for when a patient is on Desmopressin and vasopressin
should reduce severe thirst and decrease urinary output in diabetes insipidus
mechanism of action for glinides
similar to sulfonylureas, but shorter duration. increase insulin secretion from beta cells in pancreas
mechanism of action for sulfonylureas?
stimulate insulin secretion from beta cells, causes decreased glucagon secretion *must have functioning beta cells*
how is NPH insulin administered
subQ b.i.d. w/ meals (may be combined)
how/when do you administer rapid acting insulin
subQ injection or pump, pt must eat after admin
how is humulin r administered
subQ, intramuscular, or IV- only drug w/ IV
when should pramlintide (symlin) be given
subcutaneous injection, at least 1 hour before oral meds *may have to reduce rapid/short insulin doses by 50%*
what class of drugs should not be used with glinides
sulfonylureas- same MOA
what kind of diuretic is hydrochlorothiazide (Esidrix, Hydrodiuril)
thiazide diuretic Most common, least expensive, numerous combinations with antihypertensives, sometimes used alone for HTN *Doses over 50 mg a day rarely produce additional results, ceiling effect, many ppl only on 25mg/day *Oral route only
what kind of diuretic is metolazone (Zaroxolyn)
thiazide-like diuretic
pioglitazone (actos) belongs to which class of oral antidiabetics?
thiazolidinediones (TZDs) (glitazones)
when on loop, osmotic, thiazide or thiazide-like diuretics, what types of foods show you instruct your patient to eat
those high in potassium, bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes
what kind of a drug is levothyroxine (Synthroid) and what does it do
thyroid replacement drug, given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid), for all three forms of hypothyroidism
when should adrenal drugs be taken
to take all adrenal medications at the same time every day, usually in the morning, with meals or food Patients should not take with alcohol, aspirin, or NSAIDs
T or F Most glucocorticoids have some mineralocorticoid activity
true
T or F adrenal drugs (corticosteroids) are considered immunosuppressants
true
T or F normal saline is the only fluid compatible with blood products
true
T or F pramlintide (symlin) can be used in both type 1 and type 2 diabetes
true
vials of premixed insulin can be stored for how long?
up to 3 months in the refrigerator
what are some adverse effects of stagliptin (januvia)
upper respiratory infection, headache, diarrhea, hypoglycemia (bc. making insulin produce more), some cases of pancreatitis
why would you use a loop diuretic
useful in treatment of edema associated with heart failure, hepatic cirrhosis (ascites), and renal disease Used especially when rapid diuresis is needed. pulmonary edema, edema with HF, liver disease, ascites, hypertension increase renal excretion of calcium in patients with hypercalcemia
when should acarbose (precose) be given
with the first bite of a meal, three times a day