PHARM MOD 7
insulin lispro
15 to 30 minutes
regular insulin
30 to 60 minutes
insulin glargine
70 minutes
Patients taking the oral antidiabetics metformin and sulfonylureas must be educated to not drink
ALCOHOL
Corticotropin (adrenocorticotropic hormone [ACTH])
Acts on the adrenal cortex to promote synthesis and release of adrenocortical hormones
A clinic nurse is performing teaching with the parent of a child with a growth hormone deficiency. Which of the following will the nurse include in patient education? Select all that apply.
Administration is parenteral—IM or subQ only. Subcutaneous administration is preferred because it is less painful than IM while being just as safe and effective. Subcutaneous administration can be done using either a traditional syringe and needle or a pre-filled injection device. To avoid local tissue atrophy, the injection site should be rotated. Height and weight must be monitored monthly. Continue therapy until a satisfactory adult height has been achieved, until epiphyseal closure occurs, or until a response can no longer be elicited (usually by age 20 to 24). Close follow-up is required to monitor epiphyseal closure, GH, thyroid function, and potential adverse effects. Monitor glucose levels closely in patients diagnosed with diabetes. GH can elevate plasma glucose levels in diabetics. Increase insulin dosage as needed.
Antidiuretic Hormone (Vasopressin)
Adverse effect of excessive water retention can cause water intoxication with early signs of drowsiness, listlessness, and headache; progressing to severe intoxication with convulsions and terminal coma powerful vasoconstrictor actions which can cause severe adverse cardiovascular effects; angina to MI patients should be instructed to reduce their accustomed intake of fluid
Which of the following insulins can be administered via intravenous infusion? Select all that apply.
All insulins are administered subcutaneously, with regular, aspart, lispro, and glulisine insulin also administered IV.
ADH replacement therapy
Best treatment for hypothalamic diabetes insipidus
Toxic nodular goiter
Characterized by profound hyperthermia (105°F or greater), severe tachycardia, restlessness, agitation, and tremor.
Agranulocytosis
Dangerous toxicity for Methimazole [Tapazole] and rare with Propylthiouracil [PTU] Characterized by a dramatic reduction in circulating granulocytes, a type of white blood cell needed to fight infection
Gastroparesis
Delayed stomach emptying affects 20% to 30% of patients with long-standing diabetes.
Macrovascular complication
Diabetes carries an increased risk of heart disease, hypertension, and stroke. Cardiovascular disease (CVD) is the leading cause of death among people with diabetes.
The nurse is preparing to discharge a patient that will be taking insulin at home. Which of the following are appropriate nursing implementations?
Evaluate patients' other medications to avoid drug to drug interactions that may increase hyperglycemia or mask hypoglycemia. Ensure patient and/or family are able to perform insulin injections correctly Ensure patient and family know the onset and peak times for insulin in relations to meal schedule
Cushing's syndrome
Excess levels of circulating glucocorticoids
DMII is a life-threatening emergency of insulin deficiency. This syndrome is characterized by hyperglycemia, production of ketoacids, hemoconcentration, acidosis, and coma
FALSE
DMII treatment begins with IV fluids and electrolytes followed as soon as possible by IV insulin
FALSE
Hyperglycemia is a common complication of insulin treatment and occurs when insulin levels exceed insulin needs.
FALSE
Patients taking fludrocortisone (a mineralocorticoid) should be educated about signs of salt and water retention (e.g., unusual weight loss) and hyperkalemia (e.g., muscle weakness, irregular heartbeat), and instructed to notify the prescriber if these occur.
FALSE
The oral antidiabetics metformin and sulfonylurea should not be taken with food.
FALSE
The production of thyroid hormone increases when iodine availability is diminished.
FALSE
Methimazole [Tapazole]
First-line drug for hyperthyroidism, safer and more convenient than PTU Given to suppress thyroid hormone synthesis prior to thyroid gland surgery and adjunct in radiation therapy
Hyperglycemia and hypoglycemia
High blood glucose level and low blood glucose levels are the principle short-term complications
The clinical nursing instructor is preparing a lecture on drugs for adrenocortical insufficiency. Which of the following options will the instructor correctly include in the review? Select all that apply.
Hydrocortisone is a preferred drug for all forms of adrenocortical insufficiency. Hydrocortisone and other glucocorticoids are used to treat a broad spectrum of nonendocrine disorders, ranging from allergic reactions to inflammation to cancer. The doses required are considerably higher than those employed for replacement therapy. Fludrocortisone causes elevation of blood pressure due to mineralocorticoid actions. Hydrocortisone is a synthetic steroid with a structure identical to that of cortisol, the principal glucocorticoid produced by the adrenal cortex.
Negative feedback loop
Hypothalamic and anterior pituitary hormones release regulation
Glucocorticoids
Increase the availability of glucose, produced by adrenal cortex promote lipolysis giving the patient a "potbelly," "moon face," and "buffalo hump" protein catabolism and cause muscle wasting, thinning of the skin, and negative nitrogen balance
Levothyroxine
Inform patients about symptoms of thyrotoxicosis (tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating), and instruct them to notify the prescriber if these develop. Instruct the patient to take levothyroxine on an empty stomach in the morning, at least 30 to 60 minutes before breakfast. Provide education of treatment is designed to resolve signs and symptoms of hypothyroidism and restoration of normal laboratory values for serum TSH and free T4.
The nurse is preparing to administer the antidiuretic hormone vasopressin. Which of the following does the nurse know are correct regarding this drug? Select all that apply.
It is important to determine creatinine clearance and fluid and electrolyte status. Excessive retention of water can produce water intoxication—most often at the beginning of therapy. Instruct patients to decrease their accustomed fluid intake at the start of treatment. Inform patients about early signs of water intoxication Teach the patient to monitor and record daily intake and output of fluid. To promote adherence, make certain the patient understands that treatment is lifelong. The drug will not cure diabetes insipidus. Diabetes insipidus is the same as diabetes mellitus: Deficiency of ADH produces hypothalamic diabetes insipidus, a condition in which large volumes of dilute urine are produced. Diabetes mellitus is sustained hyperglycemia.
The nurse is preparing to administer levothyroxine (T4). Which of the following are true regarding this drug? Select all that apply.
Levothyroxine should be taken on an empty stomach in the morning, at least 30 to 60 minutes before breakfast. Adverse effects are dose appropriate Levothyroxine is indicated for treatment of all forms of hypothyroidism
Hypothyroidism
Low serum levels of T3 and T4
The first line drug used to treat Type 2 diabetes mellitus is which of the following?
Metformin
Drug action suppresses synthesis of thyroid hormones
Methimazole [Tapazole] Propylthiouracil [PTU]
Propylthiouracil [PTU]
Monitor for severe hepatoxicity
Type 1 diabetes
More common in children, onset in childhood or adolescence
Type 2 diabetes
Most prevalent - insulin resistance and impaired insulin secretion
Which of the following are true regarding metformin? Select all that apply.
Now being used with gestational diabetes. Common side effects of GI disturbances. Contraindicated for people with heart failure. Decreases absorption of vitamin B12 and folic acid. The sulfonylureas, introduced in the 1950s, were the first oral antihyperglycemic agents available. Belong to classification biguanides.
Insulin lispro
PEAK TIME 0.5 - 2.5 hrs
Insulin aspart
PEAK TIME: 1 - 3 hrs
Regular insulin
PEAK TIME: 1 - 5 hrs
Insulin glargine
PEAK TIME: NONE
Microvascular damage
Pathology in small blood vessels contributes to kidney damage (nephropathy), blindness (retinopathy), and various neuropathies.
Ketoacidosis
Potentially fatal acute complication, develops when hyperglycemia becomes severe and is allowed to persist
Addison's disease
Primary adrenocortical insufficiency (PAI) in which the adrenal glands are damaged and unable to make glucocorticoids
Pituitary adenoma
Primary cause of GH excess
Hypothalamus
Primary responsibility for regulating the release of hormones from the anterior pituitary
Growth hormone (GH)
Produced by the anterior pituitary and stimulates growth in practically all tissues and organs
Antidiuretic hormone
Promotes renal conservation of water
Which of the following correctly identify treatment interventions for Type 1 diabetes mellitus? Select all that apply.
Self-monitoring of blood glucose is recommended for all patients who use insulin. Requires daily dosing with insulin Glycemic control decreases nephropathy progression It is essential to coordinate insulin dosage with carbohydrate intake. Proper diet, balanced by insulin replacement, is the cornerstone of treatment
Hypothalamic diabetes insipidus
Syndrome caused by partial or complete deficiency of ADH characterized by polydipsia and excretion of large volumes of dilute urine
Hypoglycemia is a common complication of insulin treatment and occurs when insulin levels exceed insulin needs.
TRUE
Insulin may be used to treat Type 1 diabetes and Type 2 diabetes mellitus.
TRUE
Patients taking fludrocortisone (a mineralocorticoid) should be educated about signs of salt and water retention (e.g., unusual weight gain, swelling of the feet or lower legs) and hypokalemia (e.g., muscle weakness, irregular heartbeat), and instructed to notify the prescriber if these occur.
TRUE
The oral antidiabetics metformin and sulfonylurea should be taken with food.
TRUE
Metformin is used to lower blood sugar alone or in combination of insulin to treat Type ________ diabetes mellitis.
TWO
The nurse is caring for a patient taking glucocorticoids for treatment of Addison's disease. Which of the following are correct nursing implications? Select all that apply.
Teach patient importance of regular follow-up for lab checks Instruct patient to wear a Medic Alert bracelet or identification to notify emergency medical personnel of drug Teach patient signs and symptoms of Cushing's syndrome and to notify provider Teach patients that drug replacement is lifelong
Acromegaly
The resulting syndrome of GH excess in adults
Gigantism
The resulting syndrome of GH excess in children
Radioactive iodine (131I)
Therapeutic effect is destruction of thyroid tissue Used to destroy malignant thyroid cells
Radioactive Iodine (131I)
Therapeutic effects take 2 to 3 months to develop fully Education patients of likely need for thyroid hormone supplements post treatment Evaluate birth control measures due to contraindications during pregnancY Used for suppression of thyroid hormone production
Graves' disease
Three treatment modalities are: (1) surgical removal of thyroid tissue, (2) destruction of thyroid tissue with radioactive iodine, and (3) suppression of thyroid hormone synthesis with an antithyroid drug
Somatropin (Human Growth Hormone)
Treatment for pediatric growth deficiency, non-growth-hormone-deficient short stature, Prader-Willi Syndrome, and growth hormone deficiency in adults patients should be instructed to reduce their accustomed intake of fluid Administration is parenteral—IM or subcutaneous, IM injection is very painful GH is diabetogenic, glucose levels should be monitored
DKA treatment begins with IV fluids and electrolytes followed as soon as possible by IV insulin
True
Diabetic ketoacidosis is a life-threatening emergency of insulin deficiency. This syndrome is characterized by hyperglycemia, production of ketoacids, hemoconcentration, acidosis, and coma
True
Glucagon is a drug used to treat insulin overdose or severe hypoglycemia.
True
Insulin is drawn up in designated syringes, which are measured in unit.
True
Serum T3 test
Used for diagnosing hyperthyroidism
Methimazole
Used for suppression of thyroid hormone production Instruct patient that drug effects include weight gain and decreased heart rate as thyroid hormones are suppressed Inform patients about early signs of agranulocytosis (fever, sore throat), and instruct them to notify the prescriber if these develop.
Serum TSH
Used primarily for screening and diagnosis of hypothyroidism and for monitoring replacement therapy in hypothyroid patients.
Serum T4 test
Used to monitor thyroid hormone replacement therapy and to screen for thyroid dysfunction
Type 1 diabetes
Usually thin and undernourished at diagnosis
Acute adrenal insufficiency crisis
brought on by adrenal failure, pituitary failure, or failure to provide patients receiving replacement therapy with adequate doses of glucocorticoids
Mineralocorticoids
renal processing of sodium, potassium, and hydrogen
Aldosterone
secretion regulated by the renin-angiotensin-aldosterone system (RAAS) promotes sodium and potassium hemostasis and helps maintain intravascular volume
