Pharmacology Week 5

TSH

thyroid stimulating hormone

TRH

thyrotropin releasing hormone

The nurse is initiating discharge teaching with the newly diagnosed patient with diabetes. Which of the following statements indicates the patient needs additional teaching?

"I must draw the NPH insulin first if I am mixing it with regular insulin"

PIH

prolactin inhibiting hormone

Human Regular Insulin mechanism of action

promote the reuptake of glucose

Thiazolidinediones (TZDs)

redcuce blood glucose by decreasing insulin resistance and inhibiting hepatic glugoneogenesis ["zone"]

DM 2

reduce weight gradually by excising safely, lifestyle changes, and proper eating habits

How to determine Adrenocotical insufficiency

1 admin small dose of cosyntropin 2. 30 to 60 mins later measure corticol levels in plasma 3. Adrenal secretes corticosteroids or Adrenal gland

Mineralocorticoids

1. Adrenal Cortex 2. 95 % aldosterone

Glucocorticoids

1. Adrenal Cortex 2. affect the metabolism of all cells and prepare the body for long term stress 3. Cortisol, Corticosterone, cortisone

Gonadocorticoids

1. Adrenal Cortex 2. sex hormones; mostly androgens (male), some estrogen (female) 3. onset of puberty

hydroctisone (Cortef)

1. Asses for hypernatremnia (na) and hyperglycemia 2. high sodium and sugar

A nurse is preparing the teaching plan for a patient who will be discharged on methylprednisolone (Medrol Dosepak) after a significant response to poison ivy. The nurse will include instruction on reporting adverse effects to the healthcare provider. Which of the following should the patient report? (Select all that apply.)

1. Edema 2. Eye pain or visual changes 3. Abdominal pain

1 DM Signs abd Symptoms

1. Hyperglycemia-fasting blood glucose greater than 126mg/dl (2x) 2. Polyuria- excessive urination 3. Polyphagia- Increased hunger 4. Polydipsia- increased thirst 5. Glucosuria- high glucose in urine 6. Weight loss 7. Fatique

What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? (Select all that apply.)

1. Monitor blood glucose levels before and after exercise 2. Eat a complex carbohydrate prior to strenuous exercise

levothyroxine (synthroid)

1. Takes several weeks to see full benefits 2. Keep follow up appts 3. Do not take Fiber Laxative without consulting PCP 4. Take Ca and Na supplement 4 hrs after dose 5. assess sleep patters

R Insulin

1. alcohol and garlic make glucose decrease 2. do not store in sunlight 3. monitor K

Regulation of Corticosteroids

1. cortisol level rises 2. negative feedback given ti hypothalamus and pituitary 3 corticosteroid release shut off (negative feedback)

DM Pharmacotherapy

1. goal is to keep blood glucose within normal range 2. insulin admin must be carefully planned w/ meal and lyfestyle 3. insulin secretion varies based on ADLs

Exenatide (Byetta)

1. prescribed twice a day to increase secretion of insulin 2. AE: nausea, vomiting, & diarrhea

Cosyntropin (cortrosyn)

1. resembles ACTH 2. used to diagnose cause of Adrenocortical insufficiency

propylthiouracil (PTU)

1. treats hyperthyroididms 2. lowered hr, less anxiety, and better sleep 3. report fever, rashes, sore throat, chills, malaise, & weakness

Aldosterone

regulate plasma volume by promoting na absorption and K secretion in renal tubes

Which of the following assessment findings would cause the nurse to withhold the patient's regularly scheduled dose of levothyroxine (Synthroid)?

A heart rate of 110 beats/minute

negative feedback

A hormone causes an action at its target cell or tissue; output signal has reversed the condition of the original stimulus

Desmopression (DDAVP) intranasal

spray high in the nostril

Sulfinylureas

stimulate the release of insulin from pancreatic cells (avoid Alcohol) [1st gen: "Mide" 2nd gen: "ride" except glipizide]

Meglitinides

stimulate the release of insulin from pancreatic islet like sulfonylureas ["inide"]

A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient understands that there are two different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress?

The risk for hypoglycemia is greatest around the peak of insulin activity

GH

Growth Hormone

Hyper- aldosterone

HTN and hypOkalemia

The nurse is assisting a patient with chronic adrenal insufficiency to plan for medication consistency while on a family vacation trip. He is taking hydrocortisone (Cortef) and fludrocortisones (Florinef) as replacement therapy. What essential detail does this patient need to remember to do?

Carry an oral and injectable form of both drugs with him on his trip

The patient with type 2 diabetes has been nothing by mouth (NPO) since midnight for surgery in the morning. He has been on a combination of oral type 2 antidiabetic drugs. What would be the best action for the nurse to take concerning the administration of his medications?

Contact the health care provider for further orders

Primary Adrenalcortical insufficiency

Corticosteroids fail to rise after injection

How to treat Adrenalcortical insufficiency

IV therapy of hydrocortisone (the symptoms of Adren. insufficiency can cause shock)

MSH-IH

Melanocyte-stimulating hormone inhibiting hormone

Biguanide

Metformin; reduces glucose by decreasing hepatic production of glucose and reducing insulin resistance

Miscellaneous DM2 drugs

bromocriptin & colesevelam: acts on CNS to increase dopamine "liflozin" : inhibiting SGLT in kidney allowing more glucose to be secreted through urine

A 63-year-old patient with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels?

It is a temporary condition related to the stress response with increased glucose release

The patient is scheduled to receive 5 units of Humalog and 25 units of NHP (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this patient?

Make sure the patient's breakfast is available to eat before administering the insulin

Symptoms of adrenalcortical insufficiency

Nausea, vomiting, lethargy, confusion, coma.

A patient will be started on desmopressin (DDAVP) for treatment of diabetes insipidus. Which instruction should the nurse include in the teaching plan?

Obtain and record your weight daily

PRL

Prolactin

Incretin Enhancers (DPP-4 Inhibitors & GLP-1 agonists)

Signal the pancreas to increase insulin secretion and the liver to stop producing glucagon [D:"ptin" G:"tide"]

A patient is being treated with propylthiouracil (PTU) for hyperthyroidism, pending thyroidectomy. While the patient is taking this drug, what symptoms will the nurse teach the patient to report to the health care provider?

Sore throat, chills, low-grade fever

The nurse is talking with the parents of a child who will receive somatotropin (Nutropin) about the drug therapy. Which important detail will the nurse include in the teaching for these parents?

The drug must be given by injection

Signs and symptoms of Cushing's

adrenal atrophy, osteoporosis, HTN, increased risks of infection, delayed wound healing, acne, ulcers, general obesity, moon face, and buffalo back. Mood and personality changes and pt can become psychologically dependent.

ACTH

adrenocorticotropic hormone

ADH

antidiuretic hormone

Mitotane (Lysodren)

antineoplastic drug for adrenal cortex cells; treat inoperable tumors in adrenal gland

Alpha-glucosidase inhibitors (

break complex carbs into smaller sugars (monosaccharides) [acarbose & Miglitol]

Cushing's syndome

caused by long term therapy with high doses of corticosteroids

CRH

corticotropin releasing hormone

FSH

follicle-stimulating hormone

GnRH

gonadotropin releasing hormone

GHIH

growth hormone inhibiting hormone

GHRH

growth hormone releasing hormone

Cortisol

hydrocortisone; secreted in the highest amount and most important pharmacologically.

Cushing's Disease

hyper secretion is caused by a pituitary gland tumor producing excess amounts of ACTH;

Secondary Adrenalcortical insuffenceny

if Adrenal secretes corticosteroids the problem is at pituitary or hypothalumus

Hyperthyroidism

increased body metabolism, tachycardia, weight loss, elevated body temp, and anxiety

Desmopression (DDAVP) Mechanism of Action

increases the reabsorption of water in the kidney

Untreated DM

long term damage to arteries causing heart disease, stroke, kidney disease, or blindness

LH

luteinizing hormone

MSH

melanocyte-stimulating hormone