Pharm- Endocrine Test
incretin mimetic drug examples:
-dulaglutide -exenatide -liraglutide ending: -tide
Symptoms of hypoglycemia:
-tremors -sweating -confusion -rapid HR -hunger -headache -nervousness -inability to concentrate
The adrenal gland produces...
cortisol and aldosterone
Non-insulin anti-diabetic drugs are prescribed when ____ and ________ are not enough.
diet and exercise
DM type 2
disorder where a person makes some insulin but does not bind well to its receptors (insulin resistance)
What is the 1st indication of a thyroid storm?
fever
Adrenal gland hypofunction drug example:
fludrocortisone ending: -cortisone
Insulin is what type of chemical?
hormone
levothyroxine can cause...
hyperglycemia
The condition which results from too much insulin for the blood glucose is called...
hypoglycemia
Ms. Larkin complains of weight gain, lack of appetite and dryness of her skin and hair. She also reports recent difficulty with constipation. The doctor suspects thyroid problems. Thyroid tests would probably show the patient is:
hypothyroid
When pts are taking thyroid medications they must be instructed to recognize:
hypothyroid and hyperthyroid signs and symptoms
Insulin is necessary for the metabolism and use of glucose in the body and is produced where?
in the pancreas by beta cells
insulin needs may be _________ when taking birth control, corticosteroids, epinephrine and thiazide diuretics.
increased
How does insulin help lower blood sugar?
it allows movement of sugar into the cells
Adverse reactions of methimazole are...
kidney damage and bradycardia
How long will someone be treated for hypothyroidism?
lifetime
hypoglycemia
low blood sugar, too much insulin in blood
Miss. Eldridge is a 64 year old retired school teacher. She has recently been diagnosed with type 2 diabetes. The most important thing to tell her is that:
medication and diet are both important parts of the treatment plan
An increase in thyroid hormone often produces weight loss in pts because:
metabolic rate is increased
an increase in thyroid hormone often produces weight loss in pts because:
metabolic rate is increased
Biguanide drug example:
metformin
Two antithyroid drugs are:
methimazole and propylthiouracil
Type 2 diabetes develops because of...
obesity and decreased physical activity in people who are genetically predisposed
amylin analog drug example:
pramlintide
Antithyroid preparations are taken when:
production of thyroid hormones must be reduced
How do you mix insulin?
roll between hands clear to cloudy
Which way to give insulin is most common?
subq
What two routes can insulin be given?
subq and IV
almost all insulin used today is ________, in the past it was obtained by pork and beef pancreatic sources due to development of antibodies.
synthetic
ensure the insulin concentration matches the ________.
syringe
glucose
the form of sugar that circulates in the blood and provides the major source of energy for body tissues. When its level is low, we feel hunger.
severe hyperthyroidism causes...
thyroid storm/thyroid crisis -life threatening hypertension -heart failure -seizures -fever (1st indication) CAN LEAD TO DEATH IF UNTREATED
If a type 1 diabetic pt begins taking oral contraceptives, is there a change in the need for insulin?
yes, there is often an increased need for insulin
Which blood test is used to assess the patient's ability to control her blood sugar in recent months?
Hemoglobin A1C
alpha-glucosidase inhibitor drug examples:
-acarbose -miglitol
incretin mimetics are only approved for type _ diabetes
2
Which statement made by a female patient would raise concern that she is experiencing an adverse effect of the prescribed sodium-glucose cotransport inhibitor?
"I have burning when I urinate."
The home care nurse visits a client at home who has been prescribed prednisone 5 mg orally daily. The nurse reinforces teaching for the client about the medication. Which statement made by the client indicates a need for further teaching?
"I can take aspirin or my antihistamine if I need it."
Anti-thyroid medication examples:
-propylthiouracil -methimazole Ending: -thi-
Corticosteroids are commonly given for the following reasons...
-Addison's disease -anti inflammatory
The home care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client, prescribed repaglinide and metformin, asks the nurse to explain these medications. The nurse would reinforce which instructions to the client? Select all that apply.
-Diarrhea can occur secondary to metformin. -The repaglinide is not taken if a meal is skipped. -The repaglinide is taken 30 minutes before eating. -Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
The most common side effects with insulin stimulants are:
-GI symptoms -photosensitivity -upper respiratory infection
The nurse is monitoring a client receiving levothyroxine sodium to treat hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply.
-Insomnia -Weight loss -Mild heat intolerance
DPP inhibitors drug examples:
-alogliptin -linagliptin -saxagliptin -sitagliptin ending: -glitpin
Drug interactions may occur when patients take thyroid medications and also take which of the following medications?
-anticoagulants -nsaids
sodium glucose cotransport inhibitor drug examples:
-canagliflozin -dapagliflozin -empagliflozin ending: -agliflozin
The adrenal gland produces which of the following substances?
-cortisol -aldosterone
What 3 things should be on an insulin vial?
-drug name -units -exp date
insulin stimulator drug examples:
-glimepiride -glipizide -glyburide -meglitinide -nateglinide -repaglinide ending: -ide
side effects of insulin stimulators (secretagogues):
-heartburn -N/V -diarrhea -abdominal pain -photosensitivity
thyroid hormone antagonist drug examples:
-levothyroxine -liothyronine ending: -thyro-
adrenal gland hyperfunction drug examples:
-mifepristone -mitotane ending: -ne
Mrs. Halifax is a brittle diabetic (one whose blood sugar responds with wide variations in response to insulin), the nurse must watch her carefully for symptoms of hypoglycemia after giving her an insulin injection. What are the signs and symptoms of hypoglycemia?
-pale skin -hunger -diaphoresis -feeling shaky
insulin sensitizer drug examples:
-pioglitazone -rosiglitazone ending: -glitazone
Mr. Primrose often does not take his insulin at the correct time, and skips doses when he gets busy. He is at risk for hyperglycemia. What are signs and symptoms of hyperglycemia?
-polyuria -blurred vision -abdominal pain
insulin stimulators are given at least __ minutes before meals.
15
A patient with DM type 2 has been prescribed sitagliptin 100 mg daily. You have 50-mg tablets available. How many tablets should you give this patient?
2 tablets
Mr. Walker, age 47, was recently diagnosed with diabetes. His physician has begun treatment with insulin. Mr. Walker will receive regular insulin. The nurse monitors for the onset of action approximately:
30-60 minutes
A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions to the client and would tell the client that which is the most likely time for a hypoglycemic reaction to occur?
6 to 14 hours after administration
How many categories of non-insulin anti-diabetic drugs are there?
8
Give insulin at __ degrees, do not massage, do not aspirate and rotate inj sites.
90
Glimepiride is prescribed for a client with diabetes mellitus. The nurse reinforces instructions for the client and tells the client to avoid which while taking this medication?
Alcohol
You are preparing to give a subcutaneous injection of insulin to a patient. Which of the following procedures is correct?
Assess and rotate the injection sites.
Before administering levothyroxine to a pt check __ and __.
BP and HR
Desmopressin acetate is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
Decreased urinary output
Incretin mimetics action:
Injectable drugs that act like gut hormones such as glucagon secreted in response to food in the stomach they work with insulin to prevent glucose levels from becoming too high after meals
You are preparing an injection of Lantus insulin for a diabetic patient, and you notice that the fluid appears cloudy. What action should you prepare to take?
Notify the pharmacy of the cloudy appearance
RAPID ACTING human lispro/Humalog
Onset: 0.25/ 15 minutes Peak: 0.5-1.5/ 30-90 minutes Duration: 5 hours
INTERMEDIATE ACTING 75% insulin lispro protamine suspension/25% insulin lispro/ Humalog mix 75/25
Onset: 0.25/ 15 minutes Peak: 1-2 hours Duration: 24 hours
RAPID ACTING aspart/Novolog
Onset: 0.25/ 15 minutes Peak: 1-3 hours Duration: 3-5 hours
INTERMEDIATE ACTING 70% insulin aspart protamine suspension/ 30% insulin aspart/ Novolog Mix 70/30
Onset: 0.25/ 15 minutes Peak: 1-4 hours Duration: 24 hours
INTERMEDIATE ACTING isophane suspension 30% human insulin injection/ Humulin 70/30
Onset: 0.5/ 30 minutes Peak: 2-12 hours Duration: 24 hours
SHORT ACTING regular human/Humulin R
Onset: 0.5/ 30 minutes Peak: 2-5 hours Duration: 5-7 hours
LONG ACTING INSULIN insulin detemir/Levemir
Onset: 1 hour Peak: 6-8 hours Duration: 5.7-24 hours
INTERMEDIATE ACTING isophane insulin NPH 70% human insulin/ Humulin N
Onset: 1.5/ 1 hour and 30 minutes Peak: 4-12 hours Duration: 16-24 hours +
LONG ACTING INSULIN insulin glargine/Lantus
Onset: 2-4 hours Peak: none Duration: 24 hours
A client with diabetes mellitus visits a healthcare clinic. The client's diabetes mellitus has been previously well controlled with glyburide daily, but recently the fasting blood glucose level has been 180 mg/dL to 200 mg/dL. Which medication, added to the client's regimen, may have contributed to the hyperglycemia?
Prednisone
The homecare nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse would provide which information?
Refrigerate the insulin.
What two hormones are critical for life?
T3 and T4
The primary health care provider (PHCP) prescribes exenatide for a client with type 1 diabetes mellitus who takes insulin. The nurse prepares for which most appropriate intervention?
The medication is withheld and the PHCP is called to question the prescription for the client.
The pt asks the nurse why she has to take both insulin and an oral hypoglycemic agent to control her blood sugars. The best response for the nurse is:
The oral agent and the insulin work differently to help control your blood sugar; it is to help you gain better control
The nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which action performed by the client indicates the need for further teaching?
Withdraws the NPH insulin first
In counseling Mrs. Wilson, a newly diagnosed diabetic, the nurse discovers that she has been administering regular insulin deep IM just before meals. She seems to have confidence in giving the injection and can draw up her dosage properly. What suggestions would you give her?
You need to be giving your injection subcutaneously, not in your muscle. Let's review that technique.
diabetic ketoacidosis
acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy
DM type 1
autoimmune beta cells of the pancreas that store and release insulin are destroyed when a person's own immune system produces antibodies against insulin secreting cells
How does insulin work to lower blood glucose?
binds to insulin receptors
A nurse is caring for a client who is taking methimazole. For which of the following adverse effects of this med should the nurse monitor?
bradycardia
biguanide drug interaction:
contrast dye for diagnostic testing, can lead to kidney failure the drug needs to be stopped 24 hrs before testing and restarted 48 hrs after
