ATI Pharmacology: Endocrine System

A nurse is providing teaching to a ct who has an rx for pramlintide (Symlin) for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply) a. Take oral medications 1 hr before injection b. use upper arms as preferred injection site c. mix pramlintide with breakfast dose of insulin d. inject pramlintide just before a meal e. discard open vials after 28 days.

A. pramlintide delays oral med absorption, so oral meds should be taken 1 hour before or 2 hr after pramlintide injection D. Pramlintide can cause hypoglycemia, especially when the client also take insulin, so it is important to eat a meal after injecting this medication E. Unused medication in the open pramlintide vial should be discarded after 28 days The thigh or abdomen, rather than upper arms, are preferred injection sites. Pramlintide should not be mixed in a syringe with any type of insulin. Don't take if A1C > 9%. Lie down if nauseous. Carry carbohydrate snack at all times. Watch for/report symptoms of hypoglycemia, especially 3 hrs after dosing.

Glipizide is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus

A. type II DM

Glucagon is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus

B. it's a hyperglycemic drug used to treat an insulin overdose

A nurse is caring for a client in an outpatient facility who has been taking acarbose (Precose) for type 2 DM. Which of the following laboratory tests should the nurse plan to monitor? a. WBC b. serum potassium c. platelet count d. liver function tests

D. acarbose can cause liver toxicity when taken long term. Liver function tests should be monitored periodically while the ct takes this medication. Infection is not an adverse effect, it does not affect K+, and it does not affect platelet count

Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose leve

Decreased urinary output Rationale: Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.

Adverse effects of pioglitazone (oral antidiabetic):

Fluid retention, hepatotoxicity, increased LDLs

What are some of the side and/or adverse effects of the antithyroid drug propylthiouricil [PTU] (Propyl-Thyracil)?

Hypothyroidism: drowsiness, depression, weight gain, dry skin, edema, bradycardia, anorexia, cold intolerance, heavy bleeding Agranulocytosis: sore throat, fever Rash Arthralgia, myalgia, headache

Your pt is taking insulin glargine. What drug precautions do they need to be aware of?

Sulfonylureas, beta-blockers, salicyclates & alcohol increase hypoglycemic effects Thiazide and loop diuretics, sympathomimetics, thyroid hormones, and glucocorticoids increase blood glucose levels Beta blockers mask manifestations of hypoglycemics

Pt teaching for levothyroxine:

Take on empty stomach, before breakfast. Lifelong. Watch for/report: s/s hyperthroidism report s/s of bleeding if taking warfarin Check with provider before switching brands

How can you advise a pt to decrease the side effects of fludrocortisone?

Take with food to decrease gastric distress, taper off dosage if discontinuing. Administer prophylactic H2 antagonists, give orally daily or 3x/week

Contraindications for levothyroxine

Thryotoxicosis-hyperthyroidism Recent MI Others: not for treating obesity. Caution pregnancy, lactation, CV problems.

When talking with a 30 year old woman who will receive radioactive iodine-131 to treat Graves' disease, you should include which of the following instructions? (Select all that apply). a. report weight gain and edema b. use effective contraception c. allow 2-3 months for full effects d. expect periodic blood sampling e. obtain regular eye examinations

report weight gain, use effective contraception, allow 2-3 months for full effects, expect periodic blood sampling. Radioactive iodine-131, an antithyroid drug, can cause hypothyroidism. Instruct pt to report drowsiness, depression, weight gain, or edema. Redioactive iodine-131 is a pregnancy risk category X drug. Confirm negative prg. test prior to therapy and tell pt to use effective contraception throughout. It takes 2-3 months for full effects and this drug causes bone barrow suppression so tell pt to expect periodic blood sampling.

Adverse effects of propylthiouracil (antithyroid meds)

..Hypothyroidism, agranulocytosis, liver injury, hepatitis.

Glipizide, an oral antidiabetic, can have adverse effects. Which of the following interventions might need to be taken? (select all that apply) 1. Discontinuation of glipizide due to excessive gastrointestinal side effects such as abdominal distention, diarrhea and gas. 2. Administer IV glucose if pt is unconscious and is severely hypoglycemic (<70mg/dL blood glucose) 3. Treat conscious, hypoglycemic pt with 2 oz of grape juice. 4. Monitor carefully for lactic acidosis. 5. Monitor hemoglobin and iron levels and discontinue medication if pt becomes anemic

1. Discontinuation of glipizide due to excessive gastrointestinal side effects such as abdominal distention, diarrhea and gas. 2. Administer IV glucose if pt is unconscious and is severely hypoglycemic (<70mg/dL blood glucose) 3. Treat conscious, hypoglycemic pt with 2 oz of grape juice. 5. Monitor hemoglobin and iron levels and discontinue medication if pt becomes anemic Lactic acidosis is an adverse effect of metformin, not glipizide.

A patient is about to start taking hydrocortisone (Cortef) to treat adrenocortical insufficiency. You should instruct the pt to do which of the following to help reduce her risk for adverse effects of the drug? (Select all that apply) 1. expect lifelong therapy 2. carry extra doses of the drug 3. expect periodic blood sampling 4. urinate q 4 hr 5. report increased stress

1. expect lifelong therapy, 2. carry extra doses of the drug, 3. expect periodic blood sampling, 5. report increased stress Hydrocortisone therapy must continue for life because there are no other therapies to can restore adrenocortical function. The pt should carry extra b/c they might need more during times of physical or emotional stress. Labs to be monitored: electrolyte, glucose, glucocorticoid levels

Which of the following should be included in a teaching plan for a client newly diagnosed with type 2 diabetes? (Select all that apply.) 1. "Check your blood glucose levels less frequently when not feeling well." 2. "Take an extra dose of the oral hypoglycemic agent the next day if you miss a dose." 3. "Carry a fast-acting glucose source." 4. "Eat a snack prior to planned exercise." 5. "Inspect feet surfaces daily

3."Carry a fast-acting glucose source." 4."Eat a snack prior to planned exercise." 5."Inspect feet surfaces daily." A client with diabetes should always carry a fast-acting glucose source to treat unexpected hypoglycemia. Active muscle cells can take in glucose without insulin, and therefore prior to exercising the client should eat a snack to ensure enough glucose is available to prevent hypoglycemia. A client with diabetes should inspect his feet daily to monitor for skin breakdown and signs of infection. A client with newly diagnosed diabetes should check blood glucose levels at least before meals and at bedtime and more frequently when ill because acute illness can lead to hyperglycemia. The client should not take an extra dose of medication if a dose is missed.

You give a pt five units of lispro insulin (Humalog) and 10 units of insulin glargine subcut at 1400. Based on your instructions, the pt should expect her blood glucose level to be lowest at which of the following times? a. 1430 b. 1530 c. 1630 d. 1730

A. 1430 Lispro insulin is rapid acting and has an onset of less than 15 minutes and peaks at 30 minutes to an hour. Pt's glucose should be lowest between 1430 and 1500. Insulin glargine does not have a peak and lasts up to 24 hours.

A client taking hydrocortisone for adrenocortical insufficiency (Addison's disease) is admitted to the hospital for a total hip arthroplasty. Which of the following actions is the highest priority? A. Administration of supplemental doses of hydrocortisone B. Instruction on coughing and deep breathing C. Insertion of an indwelling urinary catheter D. Requesting a referral for physical therapy

A. Administration of supplemental doses of hydrocortisone The greatest risk to a client with Addison's disease who is taking a glucocorticoid and undergoing surgery is adrenal crisis. To prevent adrenal crisis, the client should receive supplemental doses during times of increased stress, such as infection or surgery. Instruction on coughing and deep breathing, insertion of an indwelling urinary catheter, and a referral for physical therapy are important but not the highest priority

Clients taking metformin (Glucophage) should be monitored for which of the following? A. Lactic acidosis B. Hypertension. C. Hyperlipidemia. D. Respiratory alkalosis.

A. Lactic acidosis Lactic acidosis is a rare side effect, but if it occurs, it has a 50% mortality rate. Hypertension, hyperlipidemia, and respiratory alkalosis are not side effects of metformin.Other side effects: vitamin b12 deficiency and GI effects

A nurse is caring for client with a rx for metformin (Glucophage). The nurse should monitor the client for which of the following effects? a. lactic acidosis b. hypoglycemia c. hyperlipidemia d. respiratory alkalosis

A. Lactic acidosis, manifested by extreme drowsiness, hyperventilation, and muscle pain, is a rare but very serious adverse effect caused by metformin. 50% MORTALITY RATE Additional adverse effects: anorexia; N & V resulting in weight loss of 3-4 kg; vitamin b12 & folic acid deficiency from altered absorption Although many oral antidiabetic meds cause hypoglycemia, this is not an effect caused by metformin, which works by slowing glucose production in the liver. Hyperlipidemia is not an effect. Respiratory acidosis is not an effect.

Two hours after self-administering regular insulin subcutaneously, the pt contacts you at the provider's office to report that she is sweaty, shaky, and has a rapid pulse. Which of the following actions should you advise her to take?(select all that apply) A. drink 4 oz of orange juice B. Check her blood glucose C. take an oral hypoglycemic D. measure her urine output E. self-administer a long-acting insulin

A. drink 4 oz of orange juice B. Check her blood glucose

A nurse is providing teaching to a client who is prescribed pramlintide (Symlin) for type 1 diabetes. Which of the following should the nurse include in the teaching? A. "Take oral medications 1 hr before injection." B. "Use upper arms as preferred injection sites." C."Mix medication with breakfast dose of insulin." D. "Freeze unopened vials of medication." E. "Discard open vials after 28 days."

A."Take oral medications 1 hr before injection." E."Discard open vials after 28 days." Pramlintide delays oral medication absorption, so these medications should be taken 1 hr or 2 hr after an injection. Any opened vials of pramlintide should be discarded after 28 days. Pramlintide should only be injected into the thighs or abdomen and should not be mixed in a syringe with any type of insulin. Unopened vials should be refrigerated but not frozen.

A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the client indicates understanding of the administration of this medication? A. "I'll take this medicine with my meals." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medicine as soon as I wake up in the morning."

B. "I'll take this medicine 30 minutes before I eat." Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is being digested Also: Patient should skip dose if they skip a meal. Only take one dose with next meal. Don't exceed 4 doses a day.

A nurse is caring for a client who is prescribed somatropin (Genotropin) to stimulate growth. The nurse should plan to monitor the client's laboratory values for which of the following? A. Anemia B. Hyperglycemia C. Decreased urine specific gravity D. Increased urine amylase

B. Hyperglycemia Somatropin may increase blood glucose levels and the nurse should monitor the client for hyperglycemia. There is no indication to monitor laboratory values for anemia, decreased urine specific gravity, or increased urine amylase

A patient is about to start taking sustained release glipizide (Glucotrol) to treat type 2 diabetes mellitus. Which of the following instructions should you include when talking with the patient about this drug? a. chew the tablet completely before swallowing it b. take it once a day, 30 min before selected meals c. take in the evening before bedtime d. drink 16 oz of water right after taking it

B. Take it once a day, 30 minutes before first meal of the day. Additionally: watch for s/s of hypoglycemia; don't take if you're pregnant or lactating; don't consume alcohol b/c risk of disulfiram-like reaction & it increases hypoglycemic effects; NSAIDS, oral anticoagulants, salicylates, MAOIs and Tagamet increase hypoglycemic effects

A nurse is providing teaching to a ct who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the ct indicates understanding of the administration of this medication? a. "I'll take this medication with my meals." b. "I'll take this medication 30 minutes before I eat." c. "I'll take this medication just before I go to bed." d. "I'll take this medication as soon as I wake up in the morning."

B. repaglinide causes a rapid, short-lived release of insulin. The ct should take this med within 30 mins before each meal so that insulin is available when food is digested. Additionally: wear a med. alert ID, watch for/report s/s of hypoglycemia, carry snack at all times, like down when nauseated. SKIP DOSE IF YOU DON'T EAT It should not be taken with a meal, just before bed, or upon wakening.

You are caring for a pt who takes acarbose (Precose) and a sulfonylurea to treat type 2 diabetes mellitus. Which of the following is an indication of an adverse reaction to this drug combination? a. polyuria b. tremors c. bradycardia d. thirst

B. tremors This drug can cause hypoglycemia. Indications of hypoglycemia: hunger tachycardia, shakiness, tremors, diaphoresis.

A nurse is caring for a client who is taking levothyroxine (Synthroid). For which of the following should the nurse monitor to identify levothyroxine toxicity? A. Hair loss B. Lethargy C. Weight loss D. Cold intolerance

C. Weight loss Overmedication with levothyroxine may result in toxicity. Findings of toxicity include weight loss despite increased appetite, insomnia, nervousness, and palpitations. Hair loss, lethargy, and cold intolerance are findings seen in the client who have hypothyroidism.

A nurse is teaching clients in an outpatient facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the cts to expect a peak effect 1-5 hr after administration? a. insulin glargine (Lantus) b. NPH c. regular insulin d. insulin lispro (Humalog)

C. regular insulin has a peak effect of 1-5 hr following administration Insulin glargine is a long lasting insulin that does not have a peak time. NPH insulin has a peak effect around 6-14 hours following administratoin Insulin Lispro has a peak effect arond 30 min to 2.5 hr following administration

Radioactive iodine-131 is used to treat: a. type 2 diabetes mellitus b. hypoglycemia c. thyroid cancer d. diabetes insipidus

C. thyroid cancer and hyperthyroidism from Graves' disease

What is the treatment for insulin overdose?

Check blood glucose to confirm. Give 15-20g of carbohydrates (4 oz OJ, 2 oz grape juice, 8 oz milk, 1 TBSP honey, glucose tablets). For unconscious pts, administer glucose or glucagon parenterally (such as IV glucose or subcut/IM glucagon)

Labs to monitor when a pt is taking pioglitazone, an oral antidiabetic.

Cholesterol: causes elevation in LDL Liver function tests: hepatotoxic

A client taking glipizide (Glucotrol) for control of type 2 diabetes mellitus should be cautioned against the use of which of the following? A. Magnesium hydroxide (Milk of Magnesia) B. Hydrocortisone acetate cream C. Calcium supplements D. Alcohol

D. Alcohol Alcohol taken currently with a sulfonylurea hypoglycemia agent can result in a disulfiram-like reaction. The client will experience intense nausea and vomiting, flushing, and palpitations. Clients taking glipizide can use magnesium hydroxide (Milk of Magnesia), but should not take it within 1 hr of taking glipizide. Topical hydrocortisone creamwill not have any systemic effects and should not interfere with glipizide. There are no contraindications of calcium supplements with the use of glipizide

Four clients need to receive morning insulin. Breakfast trays are due in 15 min. A nurse should first administer insulin to which of the following clients? A. Client with a glucose level of 70 mg/dL, scheduled to receive NPH insulin (Humulin N) 3 units B. Client with acglucose level of 90 mg/dL, scheduled to receive Regular insulin (Humulin R) 5 units C. Client with a glucose level of 120 mg/dL, scheduled to receive NPH (Humulin N) 15 units insulin and Regular insulin 6 units D. Client with a glucose level of 170 mg/dL, scheduled to receive lispro insulin (Humalog) 5 unit

D. Client with acglucose level of 170 mg/dL, scheduled to receive lispro insulin (Humalog) 5 units This client's glucose level is already above pre-meal parameters. An onset of 15 min will coincide with food intake and may be helpful in avoiding post-meal hyperglycemia. The other clients' glucose levels are within normal range or low and a delay of a few minutes will not negatively impact their clinical outcomes

When talking with a patient about self-administering regular insulin (Humulin R), you should include which of the following instructions? a. shake the vial vigorously b. expect the solution to appear cloudy c. store unopened vials at room temperature d. inject the insulin subcutaneously

D. inject subcut Do not shake the vial vigorously but rather rotate it gently to disperse the particles. DO NOT use insulin that appears cloudy our discolored. Refrigerate unopened vials until their expiration date and keep opened vials at room temp up to 1 month.

You are caring for a patient who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The patient reports severe abdominal pain. You suspect which of the following adverse reactions to this medication? A. Peptic ulcer disease b. hyperkalemia c. hyperglycemia d. pancreatitis

D. pancreatitis Exenatide, an incretin mimetic agent, can cause pancreatitis. You instructed to pt to watch for and report severe or persistant abd pain, so you should now inform the provider and tell the pt to stop taking the drug. Additionally, watch for hypoglycemia-test blood glucose & consume snack of 15-20g of carbs; carry carb snack w/ you at all times; wear med ID bracelet; lie down if nauseous; consume adequate calories.

A nurse is collecting data from a client receiving pioglitazone (Actos) 30 mg orally daily. Which finding indicates that the client is experiencing the expected result of the action of this medication?

Decreased fasting blood glucose and reduced hemoglobin A1C (HbA1c)

How should pramlintide (Symlin) be given and in particular, when should the pt expect it to have the most effect (peak)?

Expect peak about 20 minutes after dosing; don't mix w/ insulin in same syringe; give subcut in thigh or abdomen prior to meals that contain > 30 g of carbs; rotate injection sites; keep vials in use at room temp for up to 28 days

What drug is used for chronic adrenocortical insufficiency?

Hydrocortisone (Solu-Cortef), Prednisone, dexamethason, fludrocortisone. For acute & chronic replacement therapy for adrenocortical insufficiency (Addison's disease)

What are some contraindications that would make taking the gliptin drug sitagliptim (Januvia) risky for the patient?

Type I diabetes mellitus. Lactic acidosis (ATI Active Stack) Caution: hemodyalisis, moderate to severe renal dysfunction, a hx of pancreatitis

What should you monitor for with a patient taking desmopressin?

Water intoxication: Headache, confusion, sleepiness I&O and urine/plasma osmolality Monitor for MI: angina pectories, cardiac insufficiency, chest pain/pressure

A pt is self-injecting eight units of NPH insulin and four units of regular insulin each day before breakfast. As you show the pt how to self administer insulin, you should include which of the following instructions? (select all that apply) a. draw the regular insulin into the syringe first, then the NPH insulin b. inject the insulin mixture into a large muscle c. discard any unused premixed syringes within 5 days d. use a 5-mL syringe when mixing two types of insulins e. use one syringe to reduce the number of injections

a. draw the regular insulin into the syringe first, then the NPH insulin E. use one syringe to reduce the number of injections You don't want to mix NPH into the regular insulin, which could cause a change in the onset action of the regular insulin, so draw regular in first, then the NPH. The pt should inject subcut, not into a large muscle. The pt may store premixed syringes 1-2 weeks, refrigerated w/ needles pointing up; the patient should resuspend the insulin gently prior to injection and always use an insulin syringe to prevent errors in dosing. The pt may mix regular insulin and NPH insulin in the same syringe.

You are caring for a pt who is taking levoxythroxine (Synthroid) to treat hypothyroidism. The pt reports palpitations, weight loss, and diarrhea. You suspect which of the following effects of this drug? a. hyperthyroidism b. addison's disease c. myxedema d. hyperglycemia

a. hyperthyroidism It can can hyperthyroidism of prescribed dose exceeds what the pt needs to remain euthyroid. Monitor thryoid function via T4 and TSH levels.

Instruct the patient receiving insulin to watch for and report the following indications of an adverse reaction to insulin? a. palpitations b. weight gain c. low urine output d. constipation

a. palpitations insulin can cause hypokalemia. you should monitor K+ and ECG and instruct pt to report muscle weakness, nausea, palpitations, or parasthesias. Insulin can cause hypoglycemia, which can cause tachycardia, palpitations and diaphoresis.

In teaching a pt newly prescribed acarbose (Precose) to control type II diabetes mellitus, which of the follow instructions should not be included: a. "Watch for and report fatigue, pallor and shortness of breath as these are signs of anemia, which is an adverse effect." b. "Take 30 mins before meals, three times a day." c. "Consume glucotabs or dextrose instead of juice if you become hypoglycemic." d. "Dark urine, abdominal pain, vomiting or fatigue could indicate liver dysfunction, an adverse effect of this medication."

b. "Take 30 mins before meals, three times a day." should NOT be included in pt teaching. Acarbose should be taken with the first bite of food, 3x/day. If you skip a meal, you should skip the dose as well and only take one dose at the next meal. Pts should watch for/report s/s of anemia and liver dysfunction as these are adverse effects of acarbose. If after testing blood glucose, pt finds it to be < 70 mg/dL-they should take 4 g of dextrose of Glucotabs, not a food source or juice.

As you speak with your diabetic client about managing her diabetes with regular insulin (Humulin R), you should include which of the following instructions? (Select all that apply) A. self-inject chilled insulin b. carry a carbohydrate snack c. rotate injection sites d. wear a medical alert bracelet e. expect to adjust the dosage during illness

b. carry a carbohydrate snack c. rotate injection sites d. wear a medical alert bracelet e. expect to adjust the dosage during illness Injecting room temp insulin can reduce liphypertrophy (an accumulation of subcut fat at the injection site).

What labs should be monitored when a pt is taking somatropin?

blood glucose urine calcium baseline thyroid function growth hormone levels monitor monthly

A pt is about to start taking somatotropin (Genotropin). You plan to evaluate the effectiveness of this drug with which of the following assessments? a. level of consciousness b. ECG c. height and weight d. breath sounds and respiratory rate

c. height and weight It's a growth hormone used to increase growth in pts who are lacking it. Gradual increases in weight and height reflect effective therapy.

Desmopressin is used to treat: a. type 2 DM b. hypoglycemia c. thyroid cancer d. diabetes insipidus

d. desmopressin is an antidiuretic hormone used to treat diabetes insipidus