Pharmacology Test 4
thyroid replacements treat..
hypothyroidism
what is diabetes insipidus
inadequate amount of adh, causes loss of sodium and water, pee a lot
client instructions for thyroid replacements (levothyroxine- Synthroid)
1. watch for and report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and chest pain
5 signs of lactic acidosis
1. weakness 2. fatigue 3. hyperventilation 4. lethargy
Signs of B12 Deficiency
1. weakness 2. pallor 3. REDDENED TONGUE 4. fatigue
Onset, Peak and duration of Humalong (lispro)
Onset: 15-30 min Peak: 60-90 min Duration: 6-8 hours
therapeutic use for glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. replacement therapy for acute and chronic adrenocortical insufficiency (addisons disease)
somatropin shouldnt be given with
1. severe obesity 2. respiratory impairement 3. closed epiphyseal plates 4. critical illness
contraindications of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. severe obesity 2. severe respiratory impairement 3. closed epiphyses in children 4. critical illness
what is the fasting blood glucose to be diagnosed with diabetes
>126
5 signs of hypoglycemia
1. hunger 2. tachycardia 3. diaphoresis 4. weakness 5. tremors
precautions of antithyroid drugs/ radioactive iodine (iodine-131)
1. children prior to puberty
therapeutic use for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. diabetes insipidus
precautions of biguanides (metformin- Glucophage)
1. diarrhea 2. dehydration 3. anemia 4. pituitary insufficiency 5. gastroparesis 6. GI obstruction 7. hyperthyroidism 8. older adults
contraindications for mineralocorticoids (fludrocortisone)
1. drug hypersensitivity
increased dosages of mineralcorticoids can cause
1. edema 2. weight gain 3. increased sodium and water
interactions of hyperglycemic/glucagon (GlucaGen)
1. effects of oral anticoagulants (warfarin) increase 2. negates effects of insulin 3. phenytoin inhibits glucagon
adverse drug reactions for mineralocorticoids (fludrocortisone)
1. few at low, therapeutic levels 2. at levels above that which is therapeutic, fluid and electrolyte imbalances that can lead to hypertension, edema, heart failure, hypokalemia
antithyroid (propylthiouracil) drugs used in caution with..
1. immunocompromised 2. teratongenic 3. infection 4. liver dysfunction
precautions for antithyroid drugs (propylthiouracil/ PTU)
1. immunosuppression 2. bone marrow depression 3. infection 4. liver dysfunction 5. pregnancy
client instructions of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. injection site should be rotated
anitdiabetic medications
1. insulins 2. oral hypoglycemics 3. amylin analogs 4. incretin mimetics 5. dipeptidyl peptidase-4 (DPP-4) inhibitors
adverse drug reactions of biguanides (metformin- Glucophage)
1. lactic acidosis (rare but potentially fatal) 2. n,v,d 3. unpleasant metallic taste 4. vitamin deficiencies (vitamin b12, folic acid)
signs of hypothyroidism
1. listlessness 2. fatigue 3. weakness 4. weight gain 5. cold intolerance 6. dry skin
interventions of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. monitor blood glucose levels
mechanism of action of Thiazolidinediones (Glitazones)
stimulate insulin receptors on muscle, fat,and liver cells
mechanism of action for meglitinides
stimulate pancreatic stimulation of insulin
mechanism of action for Incretin Mimetics
stimulating the pancreas to secrete the right amount of insulin based on the food that was just eaten
adverse drug reactions for alpha-glucosidase inhibitors (acarbose- Precose)
1. Gastrointestinal effects (distention, flatus, hyperactive bowel sounds, diarrhea) 2. Hypoglycemia (combination therapy with insulin or a sulfonylurea) 3. Liver dysfunction 4. Anemia
hypoglycemic medications
1. Oral hypoglycemics - sulfonylureas - alpha glucosidase inhibitors - biguanide -thiazolidinediones - meglitinides
hormone that helps regulate water balance in the body by controlling the amount of water the kidneys reabsorb while they are filtering wastes out of the blood.
ADH
Medications for HYPOthyroid
1. Levothyroxine 2. Liothyronine 3. Liotrix 4. Thyroid USP
what drugs therapeutic use is for diabetes insipidus
Desmopressin (DDAVP)
Intermediate acting insulin
NPH
Short acting insulin
Regular (humulin or novolin R)
Addisons disease is caused by what
insufficency ACTH
symptoms of thyrotoxicosis
1. angina 2. tachycardia 3. nervousness 4. tremor 5. sweating 6. insomnia 7. hyperthermia
what is hyperthyroidism also called
Graves disease
precautions of hyperglycemic/glucagon (GlucaGen)
1. cardiovascular disorders 2. adrenal insufficiency
administration for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. Administer orally, intranasally, subcutaneously, sublingually, or IV. 2. Spray the nasal form high into the nasal cavity but not into the throat. 3. Monitor blood pressure, intake and output, urine and plasma osmolality, and creatinine clearance. 4. With IV vasopressin, monitor the IV insertion site, as extravasation can lead to gangrene. **5. Expect lifelong therapy.**
interactions for sulfonylureas (glipizide- Glucotrol)
1. Alcohol poses a risk for a disulfiram (Antabuse)-like reaction (nausea, palpitations, flushing) and increases hypoglycemic effects. 2. Sulfonamide antibiotics, NSAIDs, oral anticoagulants, salicylates, monoamine oxidase inhibitors, and cimetidine (Tagamet) increase hypoglycemic effects. 3. Thiazides counteract hypoglycemic effects 4. Beta blockers mask manifestations of hypoglycemia.
client instructions for biguanides (metformin- Glucophage)
1. Avoid drinking alcohol. 2. Report weakness, fatigue, lethargy, or hyperventilation. 3. If these symptoms develop, stop taking the drug and seek medical care immediately. 4. Expect these effects to diminish as drug therapy continues. 5. Lie down when feeling nauseated. 6. Maintain adequate carbohydrate and fluid intake. 7. Report weakness, fatigue, pallor, or reddened tongue
contraindications of Thiazolidinediones (pioglitazone- Actos)
1. CV disease, including hypertension 2. severe heart failure 3. active hepatic disease 4. type 1 DM 5. DKA
precautions of thyroid replacements (levothyroxine- Synthroid)
1. CV disorders (hypertension, angina pectoris, ischemic heart disease) 2. renal impairment 3. DM 4. older adults
contraindications for Meglitindes (repaglindine- Prandin)
1. DKA 2. liver, kidney, and endocrine disorders
client instructions for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. Report pounding headache, sleepiness, fluid retention, weight gain, and edema. 2. Limit fluid intake during therapy. 3. Record fluid intake and output daily. 4. Report chest pain or pressure.
interactions for mineralocorticoids (fludrocortisone)
1. Rifampin (Rifadin) and Phenobarbital decrease levels 2. Potassium-depleting diuretics, such as furosemide (Lasix), increase the risk of hypokalemia. 3. Salt and foods high in sodium - increases sodium retention and K loss
what can promote epiphyseal plate closure
1. thyroid hormones 2. estrogens 3. androgens
client instructions for Meglitindes (repaglindine- Prandin)
1. wear a medical alert bracelet 2. Watch for and report symptoms of hypoglycemia. 3. Test blood glucose to confirm. 4. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water (glucose, not table sugar, if taking miglitol), and notify health care professional. 5. Retest in 15 to 20 min and repeat treatment if still low. 6. Carry a carbohydrate snack at all times. 7. Lie down when feeling nauseated. 8. Consume adequate carbohydrates.
s/sx adrenal insufficieny
1. weight loss 2. hypotension 3. weakness 4. anorexia 5. n/v 6. confusion
interactions with glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. when given in small doses- none 2. large doses: oral contraceptives, phenytoin, phenobarbital, and rifampin
contraindications for glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. when given in small doses- none 2. large doses: severe infection and live vaccines
precautions for glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. when given in small doses-none
client instructions for Incretin mimetics (exenatide- Byetta)
1.Watch for and report symptoms of hypoglycemia. Test blood glucose to confirm, then consume a snack of carbohydrates, and retest in 15 to 20 min and repeat treatment if still low. 2. Carry a carbohydrate snack at all times. 3. Wear a medical alert bracelet. 4. Lie down when feeling nauseated. 5. Consume adequate number of calories. 6. Report severe, persistent abdominal pain and stop taking exenatide.
onset, peak and duration of Levemir or determir
Onset: 1-2 hours peak: none duration: 6-23 hours
what drugs therapeutic use is for type 2 diabetes mellitus
Glipizide (Glucotrol)
Diabetes mellitus is a chronic, systemic disease characterized by metabolic abnormalities. T/F
False
nursing roles for delievering Levemir or Determir
Give daily, same time each day with evening meal or if bid 12 hrs between doses. *No IM or IV * Does not mix *Not for use with insulin pumps
Which insulin is the drug of choice in DKA, severe infection/ illness and surgery that can be used in a pump
Regular (humulin or novolin R)
this insulin is: taken 5-10 units 15-30 mins ac or hs Based on BS level Can be mixed and draw it up first
Regular (humulin or novolin R)
therapeutic use for alpha-glucosidase inhibitors (acarbose- Precose)
Type 2 diabetes mellitus, with or without drug therapy with insulin, a sulfonylurea, or metformin (Glucophage)
- Common chronic disorder of childhood - Autoimmune disorder that destroys pancreatic beta cells difficult to control - Sudden onset between ages 4 and 20 years - High incidence of complications - Requires exogenous insulin administration
Type 1 Diabetes
What is the therapeutic use for Amylin mimetics (pramlintide- Symlin)
Type 1 and 2 DM (as an insulin or hypoglycemic drug supplement)
contraindications for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
Vasopressin 1. Coronary artery disease 2. Poor peripheral circulation 3. Chronic nephritis Desmopressin 1. Electrolyte imbalances (oral form) 2. Renal failure 3. Nephrogenic diabetes insipidus
Can rapid acting insulin be mixed
Yes, they can be mixed with NPH/ a longer acting insulin.
Synthesized in laboratories by altering the type or sequence of amino acids
insulin analogs
A nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (select all that apply) a. obtain weight measurement daily b.report weakness or palpitations c. have blood pressure checked regularly d. eat more iron-rich foods e. avoid drinking grapefruit juice
a, b, c
A nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (select all that apply) a. inject the drug subcutaneously b. expect the peak effect in 2 hr c. use the drug as a supplement to an oral hypoglycemic d. inject the drug 1 hr after a meal e. discard used pens 10 days after the first use
a, b, c
A nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (select all that apply) a. sore throat b. joint pain c. insomnia d. bradycardia e. rash
a,b,d,e
indications for use Thiazolifinediones (Glitazones)
insulin resisitance
A nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching? a. "we will use a different spot for injection each time we give the medication" b. "we'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain" c. "we'll watch our child for signs of low blood sugar while using somatropin" d. "we should stop the medication if our child loses weight"
a. "we will use a different spot for injection each time we give the medication"
A nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? a. 0820 b. 0900 c. 1030 d. 1100
a. 0820
You give the client 5 units of lispro insujlin (Humalog) and 10 units of insulin glargine subQ at 1400. Based on your instructions, the client should expect her blood glucose level to be at the lowest at which of the following times a. 1500 b. 1730 c. 1900 d. 2130
a. 1500 rationale: lispro is a rapid acting insuling that has an onset of 15-30 minutes and peaks at 30 minutes to 2.5 hours. The clients glucose should be the lowest between 1430 and 1630. Lispro insulin has a duration of 3-6 hours, so the client should continue to check her blood glucose and watch for indications of hypoglycemia, such as tremors, headache, and weakness. Insulin glargine has an onset of 70 minutes, does not have a peak and lasts up to 24 hours
A nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? a. avoid drinking alcohol b. sit or stand for 30 min after taking the drug c. urinate every 4 hr d. take the drug 2 hr after a meal
a. avoid drinking alcohol
A nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? a. eat more iron-rich foods b. avoid drinking grapefruit juice c. increase fiber intake d. avoid drinking green tea
a. eat more iron-rich foods
A nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? a. hypotension b. hyperglycemia c. weight gains d. fat redistribution
a. hypotension
A nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? a. lactic acidosis b. anticholinergic effects c. extrapyramidal effects d. hypophosphatemia
a. lactic acidosis
You instruct the client to watch for and report which of the following indications of an adverse reaction to insulin a. palpitations b. weight gain c. low urine output d. constipation
a. palpitations rationale: insulin can cause hypokalemia. You should monitor potassium levels and instruct the client to watch for and report muscle weakness, nausea, palpiations, or parasthesias. Insilin can cause hypoglycemia, which causes tachycardia, palpitations and diaphoresis. Insulin is unlikely to cause weight gain. Desmopression, whose brand name is DDAVP, is an example of an endocrine system drug that can cause fluid retention and weight gain. Insulin is unlikely to cause reduced urine output, although hyperglycemia can cause polyuria. Insulin is unlikely to cause constipation. Reparglinide, is a meglitinide that can cause diarrhea
pills that treat type 2 diabetes. There are two medications in this group, or class, of drugs: acarbose (Precose) and miglitol (Glyset). They help keep the amount of glucose in your blood from going up too fast after you eat.
alpha-glucosidase inhibitors
injectable drugs used in the treatment of both type 1 diabetes and type 2 diabetes These compounds are administered before meals, and work similarly to the hormone _________. It has a number of benefits in terms of weight loss and reducing blood glucose levels.
amylin mimetics
are most often used to treat an overactive thyroid (hyperthyroidism) caused by Graves' disease. These drugs block the formation of thyroid hormone by the thyroid gland
antithyroid drugs (propylthiouracil/ PTU)
When are rapid insulin's typically taken
before meals
A client is about to start taking somatropin (Genotropin).You plan to evaluate the effectiveness of this drug therapy 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 rationale: somatropin, a growth hormone, increases growth in clients who have insufficient growth hormone. Gradual increases in weight and height reflect effective therapy, so youll monitor the clients weight and height on an ongoing basis. Somatropin is unlikely to affect heart rate or rhythm, LOC, or respiratory status. It can, however cause hyperglycemia and hypercalciuria. Be sure to monitor serum glucose and urine calcium instruct the client to watch for and report polyphagia, polyuria or flank pain
A nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make? a. double the dose before the next meal b. take half the dose c. skip the dose d. take the usual dose
c. skip the dose
indications for use of Dipeptidyl Peptidase-4 Inhibitors
elevated serum glucose
indications for use of meglitinides
elevated serum glucose
indications for use of sulfonylureas
elevated serum glucose
addisons need to carry..
emergency supply of ACTH
cushings disease is caused by what
excess ACTH
true or false it is recommended to discontinue antithyroid (propolthyiouracil) drugs abruptly
false
true or false long acting insulins can be used on a pump
false
true or false long acting insulins can be mixed in the same syringe just like regular and NPH
false
true or false Insulin is a lipid hormone secreted by beta cells in the pancreas.
false Rationale: Insulin is a protein hormone secreted by beta cells in the pancreas that allows rapid entry of glucose into cells.
true or false Insulin plays a major role primarily in the metabolism of carbohydrate.
false Rationale: Insulin plays a major role in the metabolism of carbohydrate, fat, and protein where the nutrients are broken down into simpler molecules (glucose, lipids, and amino acids, respectively).
true or false Diabetes mellitus is a chronic, systemic disease characterized by metabolic abnormalities
false uRationale: Diabetes mellitus is a chronic, systemic disease characterized by metabolic and vascular abnormalities. While a major clinical manifestation of DM is hyperglycemia, vascular problems include atherosclerosis throughout the body, which results in hypertension, MI, stroke, and peripheral vascular disease (PVD).
when should NPH insulin be given?
given 30 minutes before first meal with second smaller dose 30 minutes before supper or hs
what drugs therapeutic use if for hypoglycemia
glucagon (GlucaGen)
discontinue this drug before epiphyseal plates close
growth hormone
What is a drug that has a therapuetic use for addisons disease
hydrocortisone
administer ______________ when in times of stress because higher doses need to be taken to prevent hypoglycemia and circulatory collapse. How much more should they take?
hydrocortisone (glucocortisone) 3 times the amount for 3 days
antithyroid drugs treat
hyperthyroidism
What reaction should you watch for with rapid acting insulins
hypoglycemic reaction (after 1-3 hours for lispro and aspart; within 15 minutes of Apidra)
mechanism of action for sulfonylureas
increases secretion of insulin
mechanism of action for biguanide
increases use of glucose by muscle and fat cells, decrease hepatic glucose production and decreases intestinal absorption of glucose
what is a drug that has a therapuetic use for hypothyroidism
levothyroxine
how long should you take hydrocortisone
life long therapy
Octreotide Acetate
lowers growth hormone (like in gigantism)
oral medications used to treat type 2 diabetes. They work by triggering production of insulin. Medications in this class include Prandin (repaglinide) and Starlix (nateglinide).
meglitinides
what drug should you not take with dye, and should stop taking 48 hours before a test with dye
metformin
used to treat adrenocortical insufficiency and salt-losing adrenogenital syndrome. A hormone secreted by the adrenal cortex that regulates electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium.
mineralocorticoids
Onset, peak and duration of Novalog (aspart)
onset: 10-20 minutes peak: 1-3 hours duration: 3-5 hours
Adrenal medications for Cushings' disease
1. Ketoconazole 2. Metyrapone 3. Etomidate 4. Mitotane
what ethnicities are most likely to develop diabetes
1. african americans 2. hispanics
interactions with Incretin mimetics (exenatide- Byetta)
1. sulfonylureas increase the risk of hypoglycemia 2. absorption of oral drugs slow, especially oral contraceptives and antibiotics, so clients should take them 1 hour before taking exenatide
precautions of Incretin mimetics (exenatide- Byetta)
1. thyroid disease and carcinoma 2. moderate renal dysfunction 3. hx of pancreatitis 4. concurrently with insulin
contraindications of thyroid replacements (levothyroxine- Synthroid)
1. thyrotoxicosis 2. recent myocardial infarction
therapeutic use of Gliptins (sitagliptin- Januvia)
1. treats type 2 diabetes alone or in combination with other drugs for diabets
therapeutic use of biguanides (metformin- Glucophage)
1. type 2 DM
therapuetic use for sulfonylureas (glipizide- Glucotrol)
1. type 2 DM
therapeutic use of Thiazolidinediones (pioglitazone- Actos)
1. type 2 DM, with or without drug therapy with insulin or metformin (Glucophage)
adverse drug reactions for Gliptins (sitagliptin- Januvia)
1. upper respiratory tract infection and inflamed nasal passages 2. headache 3. pancreatitis 4. Stevens Johnson syndrome 5. anaphylaxis 6. angioedema
precautions for Amylin mimetics (pramlintide- Symlin)
1. visual or dexterity impairment
3 uses for growth hormone
1. wasting syndrome for AIDS 2. Turners Sydnrome and growth defieicienies in kids 3. lean muscle mass formation in adults
onset, peak and duration of NPH
Onset: 1-1.5 hours Peak: 4-12 hours Duration: 18-24 hours
onset, peak and duration of Glargine (Lantus)
Onset: 1.5 hours Peak: no peak Duration: 20-24 hours
Two hours after self administering regular insulin subQ, the client contracts you at the providers office to report that she is sweating, 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 urge output e. self administer a long acting insulin
a,b rationale: subQ regular insulin peaks in 1-5 hours and can cause hypoglycemia. The client knows to watch for indications of hypoglycemia, such as tachycardia, hunger, shakiness, and diaphoresis. At this point, she should check her blood glucose level and, if it is low, consume glucose tablets, orange juice, sugar cubes, honey, corn syrup, or non diet soda to treat hypoglycemia. She should retest in 15-20 minutes and repeat the carbohydrate snack if she is still hypoglycemic. She should no take an oral hypoglycemia or a long acting hypoglycemic for indications of hypoglycemia, because those options would worsen her hypoglycemic state. Regular insulin is unlikely to affect urine output
You are caring for a client who is takin levothyrocine (Synthroid) to treat hypothyroidism. The client reports palpitations, weight loss, and diarrhea. You suspect which of the following adverse effects of this drug a. hyperthyroidism b. addisons disease c. myxedema d. hyperglycemia
a. hyperthyroidism rationale: Levothyrocine, a thyroid replacement hormone drug, can cause hyperthyroidism if the prescribed dose exceeds what the client requires to remain euthyroid. Monitor thyroid function via T4 and TSH levels. Instruct the client to watch for and report indications of hyperthyroidism, such as anxiety, insomnia, tachycardia, palpitations, diarrhea, and weight loss. Levothyrocine does not cause myxedema or addisons disease. Addisons disease is due to adrenal insufficency and levothyrocine treats myxedema coma. Levothyroxine is unlikely to cause hyperglycemia. Injectable hypoglycemic, such as insulin can cause hypoglycemia
A nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (select all that apply) a. thyroid-stimulating hormone (TSH) b. alanine aminotransferase (ALT) c. LDL c. CBC d. creatinine clearance
b,c
As you continue to talk with the 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,c,d,e rationale: injectable insulin can cause liohypertrophy, an accumulation of subQ fat, injecting room temperature insulin and rotating injection sites helps minimize this adberse effect. The client should carry a carbohydrate snack with her at all times in case of hypoglycemia. She should also wear a medical alert bracelet in case of hypoglycemia that causes a loss of conciousness, so that health care professionals will know to administer glucose or glucagon parenterally. The client should anticipate insulin dosage adjustments during stress, illness, infection, or pregnancy
A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? a. joint pain b. constipation c. weight gain d. dilated pupils
c. weight gain
A nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? a. mix pramlintide with insulin in the syringe b. administer pramlintide before meals c. take pramlintide once daily at bedtime d. inject pramlintide into the upper arm
b. administer pramlintide before meals
A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? a. thyrotoxicosis b. hypothyroidism c. lactic acidosis d. radiation sickness
b. hypothyroidism
A nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? a. drink 16 oz of water b. perform a fingerstick blood glucose check c. take another glipizide tablet d. lie down and rest
b. perform a fingerstick blood glucose check
You are caring for a client who takes acarbose (Percose) 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. remors c. bradycardia d. thirst
b. tremors rationale: this drug combination can cause hypoglycemia. Indications of a hypoglycemic reaction include hunger, tachycardia, shakiness, tremors, and diaphoresis. Polyuria and thirst are indications of hyperglycemia, not hypoglycemia. Tachycardia, not bradycardia, is an indication of hypoglycemia. Acarbose, with or without sulfonylurea therapy, is unlikely to cause bradycardia
A nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (select all that apply) a. blood amylase b. creatinine clearance c. urine calcium d. blood glucose e. CBC
c,d
A nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? a. hypokalemia b. hyperglycemia c. acute renal failure d. acute pancreatitis
c. acute renal failure
A nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? a. oral contraceptives b. calcium supplements c. beta blockers d. iron supplements
c. beta blockers
A nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? a. take levothyroxine with food to increase absorption b. take levothyroxine with an antacid to reduce gastrointestinal effects c. expect life-long therapy with the drug d. carry a carbohydrate snack at all times
c. expect life-long therapy with the drug
Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? a. naloxone b. diphenhydramine c. acetylcysteine d. glucagon
d. glucagon
When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? a. somatropin b. hydrocortisone c. glucagon d. desmopressin
d. hydrocortisone
When talking with a client 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 the insulin subcutaneously rationale; make sure the client understands how to inject insulin subQ. Tell him or her to shake the vial vigorously but to rotate it gently to disperse the particles. Do not use insulin that appears cloudy or discolored. Remind them to refrigerate unopened vials until their expiration date and opened vials can be left out at room temperature up to 1 month
A nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? a. rapid absorption b. intradermal injection c. injection pain d. lipohypertrophy
d. lipohypertrophy
You are caring for a client who is taking exenatide (Byetta) to treat type 2 diabetes mellitus. The client reports severe abdominal pain. You suspect which of the following adverse reactions to this drug? a. peptic ulcer disease b. hyperkalemia c. hyperglycemia d. pancreatitis
d. pancreatitis rationale: Exenatide, an incretin mimetic agent, can cause acute pancreatitis. You instructed the client to watch for and report severe or persistent abdominal pain, sometimes radiating to the back, may or may not be accompanied by vomiting a beginning of therapy and with dose increases, so you should now inform the primary care provider and tell the client to stop taking the drug. Exenatide is unlikely to cause and instruct them to report muscle weakness or palpitations. Exenatide is more likely to cause hypoglycemia than hyperglycemia, so monitor blood glucose levels carefully and administer a carbohydrate for hypoglycemia. Indications of hypoglycemia include tachycardia, diaphoresis, shakiness, and weakness
A nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? a. bacterial skin infections b. diabetes insipidus c. immunosuppression d. recent myocardial infarction
d. recent myocardial infarction
A nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? a. thyroid disease b. bronchitis c. heart failure d. renal impairment
d. renal impairment
indications of use for alpha glucosidase inhibitors
decrease in postprandial glucose
mechanism of action in alpha glucosidase inhibitors
delay digestion of complex carbohydrates
major adverse effect of somatotropin
hyperglycemia
agents that act like incretin hormones such as glucagon-like peptide-1 (GLP-1). They bind to GLP-1 receptors and stimulate glucose dependent insulin release, therefore act as antihyperglycemics. Incretin mimetics also suppress appetite and inhibit glucagon secretion. They slow gastric emptying and as a result prevent steep rise in post-prandial blood glucose levels
incretin mimetics
indications for use of biguanide
insulin resistance
onset, peak and duration of Regular (humulin or novolin R)
onset: 30 min-1 hours peak: 2-4 hours duration: 5-7 hours
onset, peak and duration of Apidra (glulisin)
onset: 5-10 min peak: 60 min duration: 4 hours
indications for use of Incretin Mimetics
postprandial glucose elevations
what is a drug that has a therapuetic use for thyrotoxic crisis
proplthiouracil
what drugs therapeutic use is for thyroid cancer
radioactive iodine-131 (Iodotope)
indications for use of Amylin analogs
regulate the postprandial rise in blood glucose
what is a drug that has a therapeutic use for Turners syndrome
somatropin
when using exenatide,what drug is highly likely to cause hypoglycemia when paired with
sulfonlyureas
primarily for the treatment of diabetes mellitus type 2. These drugs are ineffective where there is absolute deficiency of insulin production such as in type 1 diabetes or post-pancreatectomy. This drug can be used to treat some types of neonatal diabetes.
sulfonylureas
mechanism of action for Amylin analogs
suppresses postprandial glucagon secretion
oral insulin-sensitizing medications used in type 2 diabetes mellitus that reduce glucose with minimal risk of hypoglycemia and potential benefits on atherosclerosis.
thiazolidinediones
prevent thyroid hormone release from cancerous thyroid nodules and are used therefore to treat thyroid cancers
thyroid replacements (levothyroxine- Synthroid)
-Characterized by hyperglycemia and insulin resistance - Historically, onset after age 40 years - Increasing prevalence among children and teens - Gradual onset with less severe symptoms - 90% of people with diabetes have type 2 disease.
type 2 diabetes
desmopressin does what to the vessels?
vasoconstricts so watch BP, s/sx of MI
adverse drug reactions of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. hyperglycemia 2. fatality in PWS clients 3. neutralizing antibodies
contraindications for Gliptins (sitagliptin- Januvia)
1. hypersensitivity 2. type 1 diabetes 3. DKA
contraindications of insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. hypersensitivity to insulin
contraindications for antithyroid drugs (propylthiouracil/ PTU)
1. hypersensitvity
therapeutic use for insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. DM (type 1,2 and gestational)
interactions with Meglitindes (repaglindine- Prandin)
1. Gemfibrozil (Lopid), erythromycin, and chloramphenicol increase hypo- glycemic effects. 2. Alcohol, corticosteroids, and rifampin decrease hypoglycemic effects.
administration of hyperglycemic/glucagon (GlucaGen)
1. Give IV, IM, or subcutaneously. 2. Expect unconscious clients to regain consciousness about 20 min after IV administration. 3. Provide food after clients regain consciousness and can swallow. 4. Be aware that, for severe hypoglycemia, IV glucose is the treatment of choice because it acts faster than glucagon does
administration for glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. Give orally (with meals) for chronic adrenal insufficiency, as a total daily dose in the morning right after waking up or in divided doses (two thirds in the morning and one third in the early afternoon). 2. Give IV for acute and emergency situations. 3. Obtain CBC, electrolytes, glucose, and glucocorticoid levels at baseline and periodically thereafter. 4. Make sure clients wear a medical alert band and carry an emergency supply of glucocorticoids. 5. Taper the dose slowly to establish the lowest possible oral dose. • Give supplemental doses as needed in times of stress
administration of antithyroid drugs (propylthiouracil/ PTU)
1. Give orally at regular intervals, such as every 8 hr. 2. Measure baseline vital signs and weight and monitor periodically thereafter. 3. Monitor T3 and T4 levels.
administration of thyroid replacements (levothyroxine- Synthroid)
1. Give orally to treat hypothyroidism and IV to treat myxedema coma. 2. Give daily on an empty stomach (at least 30-60 min before breakfast with full glass of water). 3. Measure baseline vital signs, weight, and height, and monitor periodically thereafter. 4. Monitor for cardiac excitability (angina, chest pain, palpitations, dysrhythmias). 5. Monitor T4 and TSH levels. 6. Be aware that the various formulations of thyroxine are not interchangeable; instruct clients to notify the provider if a pharmacy dispenses a different levothyroxine product. 6. Expect lifelong replacement therapy.
administration of antithyroid drugs/ radioactive iodine (iodine-131)
1. Give orally. 2. Obtain a negative pregnancy test before administration. 3. Measure baseline vital signs and weight and monitor periodically thereafter. 4. Dosage is miniscule for thyroid disorders, larger for thyroid cancers 5. Initiate radiation precautions for large doses (limited contact, increased fluids, body waste disposal per facility protocol).
administration for alpha-glucosidase inhibitors (acarbose- Precose)
1. Give with the first bite of food, three times a day. 2. Tell clients who skip a meal to also skip the dose usually taken with that meal and to take only one dose at the next meal.
long acting insulins
1. Glargine (Lantus) 2. Levemir or detemir
interactions of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. Glucocorticoids and adrenocorticotropic hormone counteract growth-stimulating effects. 2. Thyroid hormones, estrogens, and androgens promote epiphyseal clo- sure.
Rapid acting insulin's
1. Humalog (Lispro) 2. Novolog (aspart) 3. Apidra (glulisin)
Adrenal medications for Addisons Disease
1. Hydrocortisone cypionate 2. hydrocortisone sodium succinate 3. Fludrocortisone acetate
therapeutic use of antithyroid drugs/ radioactive iodine (iodine-131)
1. Hyperthyroidism (Graves disease) 2. thyroid cancer
When talking with a 30 year old woman who will receive radioactive iodine-131 (Iodotope) 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
a,b,c,d rationale: Radioactive iodine-131, an antithyroid drug can cause hypthyroidism. Instruct the client to report any indications of hypothyroidism, such as drowsiness, depression, weight gain, or edema. Radioactive iodine-131 is a teratogenic drug. Confirm a negative pregnancy test prior to therapy and tell the client to use effective contraception throughout treatment. It may take 2-3 months to see the full effects. This drug can cause bone marrow suppression, so make sure the client expects periodic blood sampling to detect bone marrow suppression, such as CBCs as well as thyroid hormone levels. Radioactive iodine-131 is unlikely to affect the clients eyes. Fludrocortisone is an example of an endocrine-system drug that can cause cataracts and glaucoma with long term use
A client is about to start taking hydrocortisone (Cortef) to treat adrenocortical insufficiency. You should instruct the client to do which of the following to help reduce the risk for adverse effects of this drug? (Select all that apply) a. increase her calcium and vitamin D intake b. take the drug with food c. record weight regularly d. urinate ever 4 hours e. report increased stress
a,b,c,e rationale: hydrocortisone can cause bone loss. Instruct the client to increase intake of calcium and vitamin D and increase weight bearing activity. Hydrocortisone can cause peptic ulcer disease and gastric distress. Suggest taking the drug with food and avoid NSAIDs, expecially asprin. Hydrocortisone can cause fluid and electrolyte imbalances, such as hypernatremia. Advise the client to weigh regularly and report weight gain or edema. Hydrocortisone is unlikely to cause urinary retention, although it can cause urinary urgency and frequency. Tell the client to report increased stress, as dosage might require an adjustment during stressful times
The client will self inject eight unitys of NPH insulin and four units of regular insulin each day before breakfast. As you show the client 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 insulin e. use one syringe to reduce the number or injections
a,c rationale: you should instruct the client to draw the regular insulin into the syringe first to prevent mixing NPH insulin into the vial of regular insulin, which could cause a change in the onset of action of the regular insulin. The client should inject insulin subcutaneously, not into a large muscle. The client may store premixed syringes for 1-2 weeks refridgerated and vertical with the needles pointing upward. The client should resuspend the insulin gently prior to injection and must always use an insulin syringe to prevent errors in dosing. The cleitn may mix NPH insulin and regular insulin in the same syringe to reduce the number of injections. The client should not mix insulin glargine or insulin detemir with any other insulin
therapeutic use for antithyroid drugs (propylthiouracil/ PTU)
1. hyperthyroidism (Graves disease) 2. thyrotoxic crisis 3. suppression of thyroid hormone production in preparation for thyroidectomy
indications antithyroid drugs
1. hyperthyroidism secondary to - graves disease; nodular goiter - thyroidititis; functioning thyroid carcinoma - pituitary adenoma; thyroid storm
adverse drug reactions for insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. hypoglycemia 2. injection site reactions (lipodystrophy or Lipohypertrophy) 3. hypersensitivity to insulin 4. allergic response
adverse drug reactions for sulfonylureas (glipizide- Glucotrol)
1. hypoglycemia 2. n/d
adverse drug reactions for Meglitindes (repaglindine- Prandin)
1. hypoglycemia 2. n/v
adverse drugs reactions for Incretin mimetics (exenatide- Byetta)
1. hypoglycemia 2. n/v/d 3. pancreatitis 4. renal failure 5. severe hypersensitivity reactions
adverse drug reactions for Amylin mimetics (pramlintide- Symlin)
1. hypoglycemia (severe) when combined with insulin 2. nausea 3. injection site reactions
therapeutic use of hyperglycemic/glucagon (GlucaGen)
1. hypoglycemia from an insulin overdose
contraindications for hyperglycemic/glucagon (GlucaGen)
1. hypoglycemia from starvation (due to lack of stores glycogen) 2. Phenochromocytoma 3. hypersensitivity
therapeutic use of thyroid replacements (levothyroxine- Synthroid)
1. hypothyroidism
adverse drug reactions for antithyroid drugs (propylthiouracil/ PTU)
1. hypothyroidism 2. agranulocytosis 3. hepatotoxicity 4. aplastic anemia 5. rash 6. arthralgia, HA 7. vertigo, drowsiness, HA
Adverse drug reactions of antithyroid drugs/ radioactive iodine (iodine-131)
1. hypothyroidism (expected for most clients, but still required drug therapy) 2. bone marrow depression (rare) 3. radiation sickness (rare)
precautions of Thiazolidinediones (pioglitazone- Actos)
1. mild heart failure, risk for heart failure 2. hepatic impairment 3. pioglitazone- may increase risk of bladder cancer after 1 year or use 4. caution should be used in clients with a history of bladder cancer
interventions for glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. monitor for side effects related to adrenal insufficiency 2. weight loss, hypotension, weakness, anorexia, nausea, vomiting, confusion, lethargy or restlessness
client instructions for antithyroid drugs/ radioactive iodine (iodine-131)
1. Watch for and report anxiety, drowsiness, depression, weight gain, swelling, slow heart rate, appetite loss, cold intolerance, dry skin. 2. Report fever, sore throat, weakness, or fatigue. 3. Report bloody vomit, nosebleeds, or severe nausea and vomiting.
adverse drug reactions of hyperglycemic/glucagon (GlucaGen)
1. GI effects (n/v) 2. hypotension 3. anaphylaxis
interactions for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. Carbamazepine (Tegretol) and chlorpropamide (Diabinese) increase antidiuretic action. 2. Other vasopressors and lithium (Lithobid) decrease antidiuretic action. 3. Loop diuretics 4. Glucocorticoids 5. SSRIs, NSAIDs, thiazide diuretics
interactions of thyroid replacements (levothyroxine- Synthroid)
1. Cholestyramine (Questran), antacids, iron and calcium supplements, and sucralfate (Carafate) reduce absorption, so clients should not take levothyroxine within 4 hr of these drugs. 2. Food reduces absorption. 3. Many antiseizure and antidepressant drugs, including carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital, and sertraline (Zoloft), decrease levels. 4. Anticoagulant effects of warfarin (Coumadin) increase. 5. Cardiac response to catecholamines (such as epinephrine) increases.
interactions for antithyroid drugs (propylthiouracil/ PTU)
1. Concurrent use with antineoplastics or radiation therapy can lead to additional bone marrow depression. 2. Increased antithyroid effects noted when taken with lithium or potassium iodide. 3. Risk of agranulocytosis increases with concurrent use of phenothiazines.
contraindications of biguanides (metformin- Glucophage)
1. DKA 2. cardiopulmonary, hepatic or renal insufficiency 3. alcoholism 4. heart failure 5. severe infection 6. shock 7. acute MI 8. hypoxemia 9. lactic acidosis
precautions of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. DM 2. Prader- Willi syndrome 3. hypothyroidism 4. chronic renal failure
medications for the posterior pituitary
1. Desmopressin acetate (DDAVP) 2. Vasopressin 3. Oxytocin
administration of Amylin mimetics (pramlintide- Symlin)
1. Do not mix with insulin in the same syringe. 2. Give subcutaneously (thigh or abdomen) 3. prior to meals that contain at least 30 g of carbohydrates 4. Rotate injection sites. 5. Expect the peak action 20 min after dosing. 6. Refrigerate unopened vials until their expiration date. 7. Keep vials in use at room temperature for 28 days.
contraindications of alpha-glucosidase inhibitors (acarbose- Precose)
1. GI disorders (IBD, obstruction, ulceration)
administration of Incretin mimetics (exenatide- Byetta)
1. Injection considerations 2. Give subcutaneously into the thigh, abdomen, or upper arm up to 60 min prior to the morning and evening meals, not after meals. 3. Rotate injection sites. 4. Expect the peak action 2 hr after dosing. 5. Preparation and care of the injection pen 6. Available in 5 mcg and 10 mcg doses 7. Follow manufacturer's instructions for "New Pen Setup." 8. Use needle size prescribed by provider. 9. Use new needle each time injection pen is used. 10. Keep pens in use at room temperature up to 30 days. 11. Do not store pens with needle attached. 12. Refrigerate unused injector pens until their expiration date.
administration of insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. Injection considerations 2. Give subcutaneously (using an insulin syringe) or IV (Humulin R). 3. Select an appropriate needle length for injecting insulin into subcutaneous tissue versus intradermal (too short) or intramuscular (too long). 4. For insulin suspensions (cloudy insulins), gently rotate the vial between your palms to disperse the particles. 5. When mixing short-acting insulin with longer-acting insulin, draw the short-acting insulin into the syringe first, then the longer-acting insulin. 6. Do not mix insulin glargine or insulin detemir with any other insulin. 7. Do not administer short-acting insulins if they appear cloudy or discolored. 8. Instruct clients to self-administer insulin subcutaneously in one general area for consistent absorption rates. 9. Storage of insulin 10. Keep vials in use at room temperature for 1 month. 11. Refrigerate unopened vials of a single type of insulin until their expiration date. 12. Keep insulins premixed in syringes for 1 to 2 weeks under refrigeration and vertical, with the needles pointing upward. Prior to administration, resuspend the insulin via gentle motion. 13. Expect dosage adjustments in response to caloric intake, infection, exercise, stress, growth spurts, and pregnancy. 14. Make sure adequate glucose is available at onset and peak insulin times
interactions of alpha-glucosidase inhibitors (acarbose- Precose)
1. Insulin and sulfonylureas increase the risk of hypoglycemia
interactions for Amylin mimetics (pramlintide- Symlin)
1. Insulin increases the risk for hypoglycemia. 2. Absorption of oral drugs slows, so clients should take them 1 hr before or 2 hr after pramlintide. 3. Drugs that slow gastric emptying, such as opioids, and drugs that delay food absorption, such as acarbose (Precose) and miglitol (Glyset), fur- ther slow gastric emptying.
interactions with Thiazolidinediones (pioglitazone- Actos)
1. Insulin increases the risk of heart failure and edema. 2. Gemfibrozil (Lopid) and ketoconazole increase hypoglycemic effects. 3. Reduced effectiveness of contraceptives. 4. Glucosamine can have a negative impact on blood glucose control 5. Chromium as well as coenzyme Q10 can increase hypoglycemic effects.
HYPOthalamic medications
1. Leuprolide acetate -Goserelin - Histrelin - Naferelin - Triptorelin
interventions for Thiazolidinediones (pioglitazone- Actos)
1. Monitor for edema, weight gain, or indications of heart failure. 2. Hepatotoxicity 3. Obtain serum alanine aminotransferase (ALT) levels: Baseline and every 3 to 6 months thereafter. 4. Stop drug therapy for indications of liver injury. 5. Monitor serum lipid levels. 6. Watch for increases in triglycerides 7. Watch for increases in both high-density (favorable) and low-density (unfavorable) lipoproteins
interventions for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. Monitor for headache, confusion, or other signs of water intoxication. 2. Monitor fluid intake and output. 3. Monitor serum sodium levels. 4. Restrict fluid intake when appropriate. 5. Recommend diuretic therapy for moderate and severe fluid retention.
interventions of biguanides (metformin- Glucophage)
1. Monitor for indications of lactic acidosis. 2. For signs of lactic acidosis, stop drug therapy immediately. 3. Expect that severe lactic acidosis will require hemodialysis. 4. Monitor for persistent nausea, vomiting, or diarrhea. • Monitor fluid intake and output. 5. Monitor for indications of vitamin B12 or folic acid deficiency. 6. Recommend the appropriate supplements. 7. Monitor renal function upon initial therapy and yearly afterward
interventions for Gliptins (sitagliptin- Januvia)
1. Monitor for respiratory symptoms. 2. Monitor temperature if respiratory effects occur. 3. Monitor for headaches. 4. Administer over-the-counter analgesic for persistent headache, if provider approves. 5. Monitor for gastrointestinal effects that could be signs of pancreatitis. 6. Monitor blood amylase level to help confirm pancreatitis if needed. 7. Assess skin for signs of Stevens-Johnson syndrome 8. Monitor for acute renal failure
interventions for sulfonylureas (glipizide- Glucotrol)
1. Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors). 2. If the client is conscious, give glucose orally in either pill form, 2-3 tsp of sugar, glass of orange juice, honey, or corn syrup dissolved in water. 3. If the client is not conscious, give intravenous glucose; give parenteral glucagon if IV not available 4. Check the client's blood glucose every 15-20 minutes. 5. Continue treatment until the blood glucose has returned to the expected reference range and the client is no longer symptomatic. 6. Monitor for persistent nausea, vomiting, or diarrhea. 7. Monitor CBC levels
interventions for Meglitindes (repaglindine- Prandin)
1. Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors). 2. If the client is conscious, give glucose orally in either pill form, glass of orange juice, 2-3 tsp of sugar, honey, or corn syrup dissolved in water. 3. If the client is not conscious, give intravenous glucose; give parenteral glucagon if IV not available 4. Check the client's blood glucose every 15-20 minutes. 5. Continue treatment until the blood glucose has returned to the expect- ed reference range and the client is no longer symptomatic. 6. Monitor for persistent nausea, vomiting, or diarrhea. 7. Monitor CBC levels
Client instructions for antithyroid drugs (propylthiouracil/ PTU)
1. Watch for and report signs of hyperthyroidism and hypothyroidism 2. Report fever or sore throat. 3. Report rash. 4. Report joint or muscle pain or headache. 5. Report any OTC meds, herbal remedies, and supplements to the provider
interventions for insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. Monitor for signs of hypoglycemia (with abrupt onset: tachycardia, palpitations, diaphoresis, shakiness; with gradual onset: headache, tremors, weakness). 2. Check blood glucose level to confirm, then give glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water or an appropriate number of glucose tablets as needed for hypoglycemia. 3. For unconscious clients, administer glucagon parenterally. 4. Monitor skin for subcutaneous fat accumulation. 5. Monitor potassium levels. 6. Monitor ECG. 7. Monitor for indications of hypokalemia.
Interventions for alpha-glucosidase inhibitors (acarbose- Precose)
1. Monitor hyperactive bowel sounds, distention, and diarrhea. 2. Report persistent gastric distress. 3. Monitor for signs of hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, tremors). 4. Measure liver enzymes at baseline, every 3 months for the first year, and periodically thereafter. 5. Stop drug therapy for indications of liver injury. 6. Monitor CBC 7. Watch for indications of anemia (pallor, fatigue, shortness of breath). 8. Recommend iron-rich foods and supplements accordingly.
interventions for antithyroid drugs/ radioactive iodine (iodine-131)
1. Monitor thyroid function. 2. Monitor for indications of thyroid dysfunction (drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia). 3. Monitor CBC and platelet count at baseline and periodically thereafter. 4. Monitor for indications of anemia, leukopenia, and thrombocytopenia. 5. Monitor for manifestations of radiation sickness (hematemesis, epistax- is, intense nausea, vomiting).
interventions for antithyroid drugs (propylthiouracil/ PTU)
1. Monitor thyroid function. 2. Monitor for indications of hypothyroidism (fatigue and weakness, weight gain, cold intolerance, dry skin, and listlessness). 3. Recommend a reduced dosage for clients who develop these effects. 4. Monitor CBC at baseline and periodically thereafter (leukocytes, neutrophils). 5. Monitor for indications of agranulocytosis; for these symptoms, stop therapy. 6. Monitor integumentary status. 7. Monitor for joint and muscle pain and headache.
precautions for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. Older adults 2. Cardiovascular disease 3. Hypertension 4. History of hyponatremia 5. Severe heart failure 6. History of thromboembolic events
interventions for Amylin mimetics (pramlintide- Symlin)
1. Recommend a reduced insulin dosage when initiating therapy. 2. Monitor for signs of hypoglycemia, which tends to occur within 3 hr after dosing. 3. Recommend gradual titration of doses. 4. Monitor for persistent nausea and vomiting (more common with type 1 than with type 2). 5. Use appropriate injection technique for drug
therapeutic use of mineralocorticoids (fludrocortisone)
1. Replacement therapy for acute and chronic adrenocortical insufficiency (Addison's disease-use caution as clients with Addison's may have an exaggerated response, primary hypoaldosteronism, congenital adrenal hyperplasia), usually along with hydrocortisone
client instructions glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. Report increased stress, as higher dosages are essential at such times (generally three times the usual dose for three days). 2. Avoid live vaccines 3. Monitor and report weight gain, swelling, or vision changes 4. Include a diet high in protein, potassium, calcium and low in sodium and carbohydrates
medications for the anterior pituatary
1. Somartropin 2. GH 3. Ocetreotide acetate 4. Corticotropin 5. Human chorionic gonadotropin 6. Menotropins 7. Pegvisomant 8. Thyroptropin 9. Urofollitropin (alpha and beta)
interactions for insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. Sulfonylureas, meglitinides, beta blockers, salicylates, and alcohol increase hypoglycemic effects. 2. Thiazide and loop diuretics, sympathomimetics, thyroid hormones, and glucocorticoids increase blood glucose levels, thus counteracting hypoglycemic effects. 3. Beta blockers mask manifestations of hypoglycemia (tachycardia, tremors)
adverse drug reactions of thyroid replacements (levothyroxine- Synthroid)
1. Thyrotoxicosis, Hyperthyroidism (from excessive doses) 2. Headache, irritability, insomnia 3. Abdominal cramping, diarrhea 4. Tachycardia, arrhythmia 5. Heat intolerance, diaphoresis 6. Menstrual irregularities
interventions of hyperglycemic/glucagon (GlucaGen)
1. Turn unconscious clients on their side to prevent aspiration from vomiting. 2. Monitor for persistent nausea and vomiting. 3. Monitor fluid and carbohydrate intake. 4. Assess neurologic status throughout treatment 5. Monitor for signs of hypoglycemia before and during treatment
therapeutic use for Incretin mimetics (exenatide- Byetta)
1. Type 2 DM, as a supplement to sulfonylureas or metformin (Glucophage)
client instructions for alpha-glucosidase inhibitors (acarbose- Precose)
1. Warn client about the gastric side effects of alpha- glucosidase inhibitors. 2. Follow the diet regimen recommended by the provider. 3. Wear a medical alert bracelet. 4. Watch for and report symptoms of hypoglycemia. 5. Test blood glucose to confirm 6. Consume oral (Glucotabs) if necessary 7. Retest in 15 min and repeat if still low. 8. Carry dextrose tablets at all times. 9. Report dark urine, abdominal pain, vomiting, or fatigue. 10. Report pallor, fatigue, or shortness of breath.
client instructions for hyperglycemic/glucagon (GlucaGen)
1. Warn client and family that vomiting is common after administration of glucagon 2. Explain need to keep client on side until consciousness is regained 3. Encourage oral intake when tolerated to prevent another episode of hypoglycemia 4. Educate client on signs and symptoms of hypoglycemia and how to prevent severe hypoglycemic event by carrying sugar packets or candy for emergencies.
client instructions for Amylin mimetics (pramlintide- Symlin)
1. Wear a medical alert bracelet. 2. Watch for and report symptoms of hypoglycemia, especially 3 hr after dosing. Test blood glucose to confirm, then consume a snack of carbo- hydrates, and retest in 15 to 20 min and repeat if still low. 3. Carry a carbohydrate snack at all times. 4. Lie down when feeling nauseated. 5. Instruct on proper injection technique.
client instructions for sulfonylureas (glipizide- Glucotrol)
1. Wear a medical alert bracelet. 2. Watch for and report symptoms of hypoglycemia. 3. Test blood glucose to confirm. 4. Consume a snack of carbohydrates. 5. Retest in 15 to 20 min and repeat if still low. 6. Carry a carbohydrate snack at all times.
Client instructions for insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. Wear a medical alert bracelet. 2. Watch for symptoms of hypoglycemia. Test blood glucose to confirm, then consume a snack of carbohydrates, and retest in 15 to 20 min and repeat treatment if still low. 3. Carry a carbohydrate snack at all times. 4. Report recurring episodes of hypoglycemia to provider. 5. Rotate injection sites systematically and space them 1 inch apart. 6. Do not inject cold insulin. 7. Report weakness, nausea, palpitations, or paresthesia.
administration for Gliptins (sitagliptin- Januvia)
1. administration orally alone or in comb with metformin (Janumet) 2. give with or without food 3. give a reduced dosage to clients with severe renal impairment and low creatinine clearance
adverse reactions of antithyroid (propylthiouracil) drugs
1. agranulocytosis 2. aplastic anemia 3. hepatotoxicity 4. rash 5. n/v 6. arthralgia 7. headache 8. dizziness 9. muscle pain
interactions of biguanides (metformin- Glucophage)
1. alcohol and cimetidine (Tagamet) increase the risk of lactic acidosis 2. any contrast medium containing iodine increases the risk of acute renal failure, this worsening lactic acidosis 3. Nifedipine (Procardia), furosemide (Lasix), morphine, ranitidine (Zantac), antifungals, and many other drugs increase hypoglycemic effects.
adverse drug reactions for glucocorticoids (hydrocortisone- Cortef, Solu-Cortex)
1. few at low, therapeutic levels 2. multiple at high levels needed to suppress inflammation and the immune system 3. adrenal insufficiency 4. Cushings syndrome
adverse drug reactions for Thiazolidinediones (pioglitazone- Actos)
1. fluid retention 2. hepatotoxicity (potential) 3. increased serum lipid levels 4. increased risk for bladder cancer 5. upper respiratory tract infection 6. HA 7. myalgia
adverse drug reactions for desmonpression
1. fluid retention 2. water intoxication 3. hyponatremia
adverse drug reactions for ADH hormone (desmopression- DDAVP, Stimulate, Minirin; vasopressin)
1. fluid retention (leading to water intoxication; hyponatremia) 2. vasoconstriction (vasopressin, not desmopressin) 3. seizures
client instructions of Thiazolidinediones (pioglitazone- Actos)
1. follow instructions provided in access program 2. report swelling, weight gain, or SOB immediately 3. report jaundice, dark urine, abd pain, vomiting or fatigue 4. expect periodic cholesterol testing 5. report chest pain or discomfort, diaphoresis or atypical fatigue 6. report swelling, rapid weight gain, dyspnea
administration of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. give IM or subQ (preferable) 2. dosage is based on weight 3. given daily or several times a week 4. very costly 5. ped clients: obtain baseline height, weight, thyroid function, and growth hormone levels and monitor montly; yearly X rays of long bones 6. when reconsituting the drug, rotate the vial gently and dont shake it 7. inject subQ into the abdomen and thighs and rotate sites 8. discontinue treatment prior to epiphyseal closure in children
administration of sulfonylureas (glipizide- Glucotrol)
1. give orally 30 minutes before selected meal 2. make sure clients swallow the sustained release form whole and do not crush or chew it
administration of Meglitindes (repaglindine- Prandin)
1. give orally 30 minutes or less before meals, usually 3 times a day 2. tell clients to skip a dose if they skip a meal and to add a dose if they add a meal 3. do not exceed 4 doses a day
administration of mineralocorticoids (fludrocortisone)
1. give orally daily or three times a week 2. obtain CBC and electrolyte levels at baseline and periodically thereafter 3. make sure clients wear a medical alert bracelet 4. expect lifelong therapy
administration of Thiazolidinediones (pioglitazone- Actos)
1. give orally once per day with or without food
administration of biguanides (metformin- Glucophage)
1. give orally twice a day with the morning and evening meals (immediate release) or once a day with with the evening meal (extended release) 2. make sure clients swallow the extended release form whole and do not crush or chew
what two drugs counteract growth hormone
1. glucocorticoids 2. adrenocorticotrophic hormone
therapeutic use of Growth hormone (somatropin-- Genotropin,Nutropin, Humatrope, Serostim)
1. growth hormone deficiencies, such as Turners Syndrome 2. Growth hormone deficiency in adults to increase lean muscle mass 3. AIDs wasting syndrome
precautions for mineralocorticoids (fludrocortisone)
1. heart failure 2. addisons disease 3. OB
mineralcotricoids can lead to...
1. heart issues - increase in blood pressure - excretes potassium, so heart tissues - hypertension -heart failure - edema -heart palpitations
precautions for Gliptins (sitagliptin- Januvia)
1. hemodialysis 2. moderate to severe renal dysfunction 3. hx of pancreatitis
precautions of alpha-glucosidase inhibitors (acarbose- Precose)
1. hepatic impairment 2. GI distress 3. not typically used in the US
interventions for mineralocorticoids (fludrocortisone)
1. monitor for side effects related to inappropriate dosing 2. signs of excess dosing (increase in weight, fluid retention, increase in BP, hypokalemia) 3. signs of inadequate dosing (weight loss, poor appetite, fatigue, muscle weakness, hypotension)
interventions for thyroid replacements (levothyroxine- Synthroid)
1. monitor thyroid function 2. monitor for indications of hyperthyroidism (anxiety, tachycardia, palpitations, tremors, altered appetite, heat intolerance, fever, diaphoresis, weight loss)
what do IV forms of thyroid replacement drugs help treat
1. myxedma coma 2. prolonged hypothyroidism
precautions of insulin (lispo- Humalog, regular- Humaline R, NPH- Humulin N, insulin glargline- Lantus)
1. older adults 2. fever 3. stress 4. altered nutrition
interactions of antithyroid drugs/ radioactive iodine (iodine-131)
1. other antithyroid drugs reduce uptake
contraindications for Amylin mimetics (pramlintide- Symlin)
1. poor insulin regimen adherence 2. gastroparesis and drugs affecting GI motility
contraindications for sulfonylureas (glipizide- Glucotrol)
1. pregnancy, lactation (insulin is recommended during pregnancy) 2. DKA
contraindications for antithyroid drugs/ radioactive iodine (iodine-131)
1. pregnancy; teratogenic effects 2. lactation
medications for HYPERthyroid
1. propylthiouracil 2. Methimazole 3. Radioactive iodine 4. Sodium Iodine 5. Potassium Iodine
interventions for Incretin mimetics (exenatide- Byetta)
1. recommend a reduced oral hypoglycemic drug dosage when initiating therapy 2. monitor for signs of hypoglycemia 3. monitor for persistent nausea, vomiting, or diarrhea 4. monitor fluid and carbohydrate intake 5. monitor for indications of pancreatitis 6. stop drug therapy for clients who develop signs of pancreatitis
contraindications of Incretin mimetics (exenatide- Byetta)
1. renal impairment 2. type 1 DM 3. DKA 4. severe GI disease 5. pregnancy- teratogenic effects 6. children
precautions of sulfonylureas (glipizide- Glucotrol)
1. renal or hepatic dysfunction 2. adrenal or pituitary insufficiency
precautions for Meglitindes (repaglindine- Prandin)
1. renal or hepatic dysfunction 2. systemic infection 3. older adults 4. use of alcohol, NSAIDs, warfarin, loop diuretics, and anabolic steroids
client instructions for mineralocorticoids (fludrocortisone)
1. report weight gain or swelling (high sodium levels) 2. report weakness or palpitations (low potassium levels) 3. have BP checked regularly 4. follow a diet high in potassium
interactions for Gliptins (sitagliptin- Januvia)
1. sitagliptin may increase digoxin levels 2. concurrent use with other antidiabetics increases risk of hypoglycemia
A client is about to start taking sustained release glipizide to treat type 2 diabetes mellitus. Which of the following instructions should you include when talking with the client about taking this drug? a. Chew the tablet completely before swallowing b. take it once a day, 30 minutes before breakfast c. take it in the evening before bedtime d. drink 16 oz of water right after taking it
b. take it once a day, 30 minutes before breakfast rationale: instruct the client to take sustained release glipizide; a sulfonyluea, 30 minutes before the first meal of the day. Tell the client not to chew or crush a sustained release tablet. It is not necessary to drink 16 oz of water after taking the drug, but it is not harmful to do so, either. Because glipizide peaks in 1-2 hours, it is inappropritae to take it at bedtime and appropritae to have a meal after taking it. Be sure to monitor the client for signs of hypoglycemia, such as diaphoresis and tachycardia, sweating, hunger, weakness, dizziness, tremor, bradycardia, anxiety. Also, monitor heart rate and ECG. Instruct the client to watch for and report palpitations
A nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? a. peripheral pulses b. urine output c. skin integrity d. blood glucose
b. urine output
Dipeptidyl Peptidase-4 inhibitors
balance the release of insulin and limit the release of additional glucose from the liver; it has also been linked to increased beta cell neogenesis, inhibition of beta cell apoptosis, inhibition of glucagon secretion, delayed gastric emptying and induction of satiety
When using pramlintide, what medication is highly likely to cause hypoglycemia when paired with
insulin
therapeutic use for Meglitindes (repaglindine- Prandin)
type 2 diabetes mellitus