Pharm Week 2 Exam

Regular insulin onset

.5-1hr

Lispro Peak

0.5-2.5 hrs

NPH onset

1 to 2 hr

Regular insulin Peak

1-5 hrs

Lispro Onset

15-30 mins

NPH duration of action

16 to 24 hr

Glargine Duration

18-24 hrs

DM type 2 signs and symptoms

3 Ps, delayed wound healing, fatigue.

Lispro Duration

3-6 hrs

NPH peaking

6 to 14 hr

Regular Insulin duration

6-10 hrs

Glargine Onset

70 mins

H2 receptor antagonists

Cimetidine, ranitidine used with antibiotics to treat H. Pylori

juvenile DM

DM type 1, can be diagnosed in children, teens, or young adults.

A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Decrease in TSH level

A nurse is teaching a client who has DM and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following should the nurse include?

Expect the NPH insulin to peak in 6 to 14 hr.

emergency management of hypoglycemia

GI distress, n/v

Metformin complications

GI upset, V B12 and folic acid deficiency, pregnant category B

Long acting

Glargine

A nurse is providing teaching for a client who is newly diagnosed with type 2 DM and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?

Glipizide stimulates your pancreas to release insulin

Antagonist factors of peptic ulcer diseases

Hpylori, infection, gastric acid, pepsin, smoking.

Insulin complication hypoglycemia

Hypoglycemia (BG, 70mg/dl) toxic dose, too little food, N/V, diarrhea, ETOH, strenuous exercise

High TSH

Hypothyroidism

Addisonian crisis treatment

IV fluid to treat hypotension, hydrocortisone steroid replacement

A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of thyrotoxicosis?

Insomnia, tachycardia, and hypperthermia

DM's 3 P's

Polyuria, Polydipsia, Polyphagia

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 DM. The nurse should recognize which of the following medications can cause glucose intolerance?

Prednisone

A nurse is assessing a client who is on long term omeprazole therapy. Which of the following findings should indicate to the nurse the medication is effective?

Reduced Indigestion (dyspepsia)

A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching?

Your doctor might need to reduce your theophylline dose while taking this medication.

Diabetes Mellitus (DM)

a chronic condition that results from deficient glucose metabolism. Results in insufficient insulin secretions from the beta cells of the pancreas.

Cushing Syndrome

adrenal hyper secretion; results from over production of cortisol from pituitary gland. most common cause prolonged use of steroids

Addisons disease

adrenal hypo secretion; d/o of the adrenal glands which do to produce enough hormone.

Medication for PUD

antibiotics such as metronidazole, clarithriomycin

DM type 2

beta cells of pancreas are not producing enough insulin

DM type 1

beta cells of pancreas do not produce enough/stopped insulin

Proton pump inhibitors

block basal and stipulated acid production. used in prevention of stress ulcers.

Propylthiouracil (PTU)

blocks conversion of T4 to T3

Ondansetron mechanism of action

blocks serotonin receptors

Thionamides

blocks synthesis of thyroid hormone. Propylthiouracil and Methimazole

Prednisone

can cause glucose intolerance and hyperglycemia.

Addisonian crisis

can result from stress states and is life threatening emergency

Sulfonylureas

chlorpropamide, glipizide

H2 receptor interactions

cimetidine can inhibit medication metabolizing enzymes. Increase levels of warfarin, phenytoin, and theophylline.

Rantidrine

constipation, diarrhea, nausea

Insulin Complication Hypokalemia

decrease blood K+ levels

Addisons disease is a result of

decrease in steroid secretion. inadequate production of cortisol and aldosterone to a lesser degree.

Cimetidine

decreased libido, gynecomastia

constipation

diphenhydramine

Hypothyrodism signs and symptoms

fatigue, increased sensitivity, weight gain, puffy face, thin hair, dry skin, severe can lead to myxedema coma

Cushing syndrome symptoms

fatty deposits in upper back midsection and face.Purple striae

magnesium hydroxide

for stomach.

Hyperglycemic agents

glucagon increases blood glucose by increasing breakdown of glycogen into glucose

thionamides treat

graves disease, used prior to thyroid removal surgery and emergency treatment of thyrotoxicosis.

Glipizide

helps lower blood glucose levels in clients who have type 2 DM. It reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the suctioning beta cells of the pancreas.

Low TSH

hyperthyroidism

Addison disease s/s

hypoglycemia, postural hypotension, weight loss, GI disturbances, weakness, weight loss, changes in distribution of body hair, bronze pigmentation of skin.

Glipizide complications

hypoglycemia, weight gain, pregnancy category C

thionamides complications

hypothyroidism, agranulocytosis, leikopenia, liver injury, hepatitis.

levotyroxine increase thyroid function by

increasing metabolic rate, protein synthesis, cardiac output, renal profusion, body temperature, growth prcesss

Hyperthyroidism signs and symptoms

irritability, tachycardia, heat intolerance, frequent bowel movement, tremors, graves disease, thyrotoxicosis

Omeprazole

is a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis.

Types of proton pump inhibitors

lansoprazole and pantroprazole

Common drugs for constipation and diarrhea

laxative, psyllium, docusate sodium, Senna, lactulose.

Rapid acting

lispro

Cushing syndrome treatments

lower cortisol levels, titrate steroids slowly, BP w/fluids.

Examples of Antacids

magnesium hydroxide, calcium carbonate (tums)

Biguanides

metformin

extrapyramidal symptoms

metoclopramide reglan

Nursing considerations for Addisonian crisis

monitor renal function BMP, CrCL, BUN

Antacids

neutralize or reduce acidity of gastric acid

Glargine Peak

none

Prolonged qt interval/anxiety

ondanestron

GERD complications

pneumonia, osteoporosis, rebound acid hyper secretion, hypomagnesameia

Adrenal crisis (addisonian crisis)

profound fatigue, dehydration, vascular collapse, renal shut down, serum NA drop, Serum K increase.

Regular insulin

short acting

GERD risk factors

smoking, obesity, pregnancy, delayed stomach emptying

Emergency treatment of thyrotoxicosis

thionamides

If you give a patient with hypothyroidism levothyroxine, what would you expect for TSH levels?

to go down

Levothyroxine thyrotoxicosis

tremors, chest pain, palliations, heat intolerance

Hypomagnesaemia complications

tremors, seizures, muscle cramps