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