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Pharmacology > Antidiabetic and Endocrine #3 > Flashcards

Antidiabetic and Endocrine #3 Flashcards

1
Q

What does the Endocrine system consist of?

A

ductless glands that secrete hormones into the blood stream?

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2
Q

What organs are in the Endocrine system?

A

hypothalamus pituitary, parathyroid, thyroid, adrenals, adrenals. pancreas, ovaries, testes

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3
Q

What do hormones in the Endocrine system do?

A

chemicals secreted into blood, regulate growth/development, fluid/electrolyte balance, reproduction, adaption to stress, metabolism

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4
Q

What are the 4 peptide protein hormones?

A

insulin, vasopressin (ADH), growth (GH), and adrenocorticotropic (ACTH)

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5
Q

What are the two amine hormones?

A

epinephrine and norepinephrine

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6
Q

What are the three types of steroid hormones?

A

cortisol, estrogen, and testosterone

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7
Q

What does an amine hormone do?

A

manipulates hormones that are used as neurotransmitter to control thought processes and the ability to respond to things

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8
Q

T/F Steroid molecules look like cholesterol molecules

A

True

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9
Q

Where is the Pituitary gland/hypophysis located?

A

at the base of the brain and has two lobes.

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10
Q

What is the anterior pituitary gland called?

A

adenohypophysis

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11
Q

What does the pituitary “master gland” do?

A

excretes hormones that stimulate the release of hormones from target glands

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12
Q

T/F the pituitary gland can be the cause of tertiary problems with other glands such as secondary hypothyroidism.

A

False- causes secondary problems

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13
Q

T/F Majority problems come from anterior pituitary.

A

True

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14
Q

What hormone influences growth of bones and muscles (doesn’t have a specific target gland)?

A

Growth hormone (somatropin)

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15
Q

What does the growth hormone influence?

A

protein, lipid, carbohydrates, and calcium metabolisms

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16
Q

What is the name of GH deficiency?

A

dwarfism

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17
Q

What is the name of excess GH called?

A

gigantism, acromegaly

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18
Q

What is the replacement treatment for GH defiency?

A

somatrem (Protropin) and somatropin (Genotropin) are given before bone epiphyses are fused

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19
Q

What can replacement treatment for GH defiency lead to?

A

Diabetes Mellitus

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20
Q

When does gigantism occur?

A

during childhood/before puberty

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21
Q

When does acromegaly occur?

A

growth after puberty

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22
Q

What is the drug treatment for GH excess?

A

octreotide (Sandostatin)

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23
Q

What does octreotide (Sandostatin? do?

A

synthetic somatostatin to suppress GH release and is used for severe diarrhea from carcinoid tumors

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24
Q

T/F Thyroid stimulating hormone (TSH) is released from the posterior pituitary gland?

A

False- anterior pituitary

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25
Q

What does TSH target and do?

A

targets throid gland, to stimulate production and release of thyroid hormones

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26
Q

What is it called if there is no increase in thyroid hormone levels, the problem is with the thyroid gland?

A

primary hypothyroidism

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27
Q

What is it called if drug is given and thyroid hormone level is increased, indicated that thyroid gland is ok, problem is at pituitary level?

A

secondary hypothyroidism

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28
Q

Where is ACTH released and what does it do?

A

released from anterior pituitary and stimulates release of glucocorticoids (cortisol), mineralocorticoids (aldosterone), androgen from adrenal cortex

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29
Q

ACTH corticotropin (Acthar) and Cosyntropin (Cortrosyn) used for? (4)

A

diagnosis of adrenal gland disorders, treat adrenal insufficiencies, antiinflammatory for allergic response, treat multiple sclerosis/ autoimmune disease

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30
Q

T/F Neurohypophysis is released from the posterior pituitary

A

true

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31
Q

What is secreted by the posterior pituitary gland?

A

ADH (vasopressin) and oxytocin

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32
Q

What type of hormone is ADH and what does it do?

A

Antidiuretic hormone; decreases loss of Na and water through renal tubules; MAINTAINS WATER BALANCE IN BODY

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33
Q

What happens with ADH excess?

A

fluid overload

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34
Q

What happens with ADH defiency?

A

diabetes insipidus, dehydration

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35
Q

How do you treat diabetes insipidus?

A

DDAVP (desmopressin acetate) and vasopressin (Pitressin)

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36
Q

What can vasopressin (Pitressin) be used for?

A

GI bleed and esophagus varices

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37
Q

What does DDAVP affect?

A

clotting

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38
Q

What doe oxytocin do?

A

uterine contraction, milk letdown

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39
Q

T/F The thyroid gland secretes T3 and T4.

A

True

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40
Q

What is the function of T3 and T4?

A

regulates protein synthesis, enzyme activity and to stimulate mitochondrial oxidation

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41
Q

Explain Hypothyroidism.

A

caused by decrease in TSH or thyroid tissue dysfunction causing decreased secretion of T4 andT3; slows a majority of body functions

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42
Q

What is the term for very severe hypothyroidism?

A

Myxedema

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43
Q

What drug increases T4 and T3 and makes euthyroid?

A

levothyroxine (Synthroid)

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44
Q

What do you assess for Thyroid gland treatment?

A

assess for improvement of symptoms, watch cardiac function, drug interactions /t protein binding

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45
Q

What does a thyroid overdose look like?

A

hyperthyroid symptoms; administer drug in morning to avoid sleep disturbances

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46
Q

Explain Hyperthyroidism.

A

caused by overactive thyroid or high TSH (could be thyroid tumor)

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47
Q

What is the most common type of hyperthyroidism?

A

grave’s disease

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48
Q

What are some side effects/symptoms of Grave’s Disease?

A

tachycardia, palpitation, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos, and weight loss

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49
Q

What is anther name for Grave’s Disease and what does it do?

A

Thyrotoxixosis; increases the rate of the majority of body functions

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50
Q

What kills thyroid cells?

A

radioactive iodine- must have thyroid hormone replaced synthetically after treatment

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51
Q

What treatment givers pre-op to reduce size and vascularity?

A

iodine SSKI (Lugols)

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52
Q

What three antithyroid drugs decrease thyroid hormone production?

A

propylthiouracil (PTU), methimazole (Tapozole), and Sodium iodide IV is used for thyrotoxic crisis

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53
Q

What does the parathyroid hormone (PTH) do?

A

regulates calcium levels by decreasing Ca+ stimulates increasing PTH by mobilizing Ca+ from bone, increasing GI absorption, Increasing renal reabsorption to increase serum calcium

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54
Q

What drug takes care of hypocalcemia?

A

calcitiol (Rocaltrol) (VIT D analogue)

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55
Q

What does calcitriol do?

A

increase GI absorption of Ca+, increase release of Ca+ from bone

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56
Q

What are the consequences of calcitriol?

A

decreased bone density, fractures

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57
Q

What are the two structures in the adrenal gland?

A

adrenal medulla and adrenal cortex

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58
Q

How is the Adrenal gland controlled?

A

through salt, sex, sugar

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59
Q

This is aldosterone that regulates Na and water?

A

mineralcorticoids-salt

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60
Q

What regulates some sexual characteristics, but has a small influence?

A

androgens-sex

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61
Q

What controls glucose metabolism and storage and depresses immune system?

A

Glucocorticoids-sugar

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62
Q

T/F Glucocorticoids- sugar are also referred as a stress hormone that is increased release in fight/flight

A

True

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63
Q

What is the classifications of glucocorticoids (Cortisol)?

A

antiinflammatory, antiemetic effects, an for pain`

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64
Q

What are some side effects for glucocorticoids?

A

abnormal fat deposits (moon face and buffalo hump), muscle wasting, edema, euphoria, psychosis, nightmares, skin thinning, immunosuppression; long term can lead to loss of adrenal gland function

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65
Q

What are some drug interactions with steroids?

A

NSAIDS, diuretics, coumadin due to protein binding

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66
Q

What is ketoconazole?

A

glucocorticoid inhibitors, used to treat client with Cushings syndrome

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67
Q

Mineralocorticoids (Aldosterone) does what?

A

controlled by renin angiotensin system and maintains fluid balance by reabsorption of sodium and water

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68
Q

What happens if there is too little aldosterone?

A

decrease in BP and vascular collapse

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69
Q

What is used to treat too little aldosterone and what does it do?

A

Fludrocoticone (Florinef); oral mineralocorticoid, high protein diet and monitor serum potassium levels, rarely used for elderly

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70
Q

What is Cushing’s Syndrome?

A

too much corticosteroid secretion by the Adrenal glands

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71
Q

What is Addison’s Syndrome?

A

too little corticosteroid secretion by the Adrenal Glands

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72
Q

What are some side effects of drug withdrawal or too little drug resemble Addison’s crisis?

A

low BP, low glucose, lethargy, fatigue, weakness, death

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73
Q

What are the routes of administration for corticosteroids?

A

oral, Im, IV, inhaled, topical, rectal

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74
Q

What are corticosteroids used for?

A

immunosuppression of autoimmune diseases, allergy reaction (Asthma), and transplant therapy

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75
Q

Corticosteroids used with chemotherapy in cancer can have what effects?

A

pain control, control nausea, reduce inflammation related to cell death, and reduce brain swelling

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76
Q

Name some nursing interventions for steroids.

A

check for interactions, don’t stop suddenly, dosage adjustment if stressors increase (illness), monitor weight/I&O/K/Na/glucose, may worsen DM, increased appetite, gastric mucosal protection, increase vigilance for infection which symptoms may be decreased

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77
Q

What are the three symptoms of DM?

A

polyuria, polydispsia, polyphagia

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78
Q

Why does some with DM experience the three Ps/

A

increase serum glucose causes osmotic pull of fluid from cells into vascular compartment, then osmotic diuresis in kidney from excess glucose, then thirst due to increased serum osmolarity

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79
Q

what does polyphagia mean?

A

increased hunger

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80
Q

what does polydipsia mean?

A

Increased thirst

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81
Q

What is type 1 diabetes?

A

needs insulin replaced

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82
Q

What is type 2 diabetes?

A

problem with insulin receptors on cells/insulin resistant

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83
Q

What is insulin?

A

promotes uptake of glucose, fatty acids, amino acids by cells

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84
Q

Where is insulin secreted?

A

by beta cells in pancreas

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85
Q

Why is insulin secreted?

A

secreted in response to increased serum levels

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86
Q

How does insulin work?

A

glucose is converted to gylcogen for future glucose needs in liver and muscle, this lowers the blood glucose

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87
Q

How is insulin available?

A

vials, pens, and inhalant

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88
Q

What is the name of rapid acting insulin?

A

lispro (Humalog), aspart (Novolog) glulisine

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89
Q

What is the name of short acting insulin?

A

regular (Humulin)

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90
Q

What is the name of Intermediate acting insulin?

A

NPH, Lente

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91
Q

What is the name of long acting insulin?

A

Detemir (Levemir) and Lantus (Glargine)

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92
Q

What is lantus (Glargine)

A

analog of human insulin, give once/day at bedtime, 24 hr duration, less nighttime hypoglycemia, no peak, no mixing with other insulins

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93
Q

What insulins can be combined?

A

NPH (70) with Regular (30)

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94
Q

How does a patient store insulin?

A

refrigerate unopened vials, if open room temp for one month or in refrigerator for 3 months

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95
Q

Who is more common to have insulin resistance?

A

obese clients

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96
Q

What is the main side effect of insulin?

A

hypoglycemia

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97
Q

What causes Ketoacidosis?

A

caused by lack of insulin, type 1 DM, and is frequently triggered by illness (UTI, URI)

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98
Q

What causes hyperosmolar hyperglycemic nonketotic (HHNK)?

A

lack of insulin, type 2 DM or too much CHO

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99
Q

Which insulin should be drawn into the syringe first?

A

short acting should always be drawn into syringe first if mixing with longer acting insulin

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100
Q

T/F Draw the cloudy medication first

A

false- draw clear then cloudy into syringe

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101
Q

When should you give lispro, aspart Insulin?

A

rapid onset, give within 5-10 minutes before eating, do not mix

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102
Q

What insulin can be only given IV?

A

regular insulin

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103
Q

T/F Decreased insulin needed if more exercise happens.

A

True

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104
Q

T/F Less insulin needed if ill.

A

False- more is needed due to the stress response

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105
Q

What is a benefit of Insulin pen Injectors?

A

convenience= increase compliance

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106
Q

What method of administering insulin is available but difficult to regulate?

A

Intranasal Insulin

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107
Q

What is Insulin jet Injectors?

A

needleless systems that inject insulin

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108
Q

What are some benefits of Insulin Pumps?

A

contains regular insulin, implantable/portable, expeensive, and keep blood glucose levels close to normal because deliver basal dose and then additional dose depending on need

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109
Q

What is three criteria for use of oral antidiabetic drugs?

A

onset of DM at more than 40 years, diagnosis less than 5 years, fasting glucose less than 200 mg, normal renal and hepatic function

110
Q

This drug acts by stimulating secretion of insulin so must have functioning islets is called what?

A

sulfonylureas

111
Q

What is the first generation sulfonylurea called?

A

Orinase

112
Q

What is the first generation intermediate acting sulfonylurea called?

A

Tolinase

113
Q

What is the long acting first generation sulfonylurea called?

A

Diabinese

114
Q

What are a few characteristics of second generation sulfanylureas?

A

less drug interactions (more potent), increase tissue response, decrease liver production of glucose, and longer duration

115
Q

What is the second generation sulfonylurea called?

A

Glipizide (Glucotrol), glyburide (Diabeta), and glimepiride (Amaryl)

116
Q

T/F second generation is used for clients with liver or kidney dysfunction.

A

false- do not give

117
Q

T/F Sulfonylureas are highly protein binding drugs.

A

true

118
Q

What does the oral anitdiabetic drug Metformin (Glucophage) do?

A

decrease hepatic glucose production from stored glycogen, decrease the absorption of glucose from the small intestine, increase insulin receptor sensitivity

119
Q

T/F Metformin doesn’t cause hyper or hypoglycemia.

A

True

120
Q

What classification is Metformin?

A

Biguanide

121
Q

Why do you need to hold Metformin for 48 hours prior to and after IV use?

A

Iv contrast dye due to increased risk of lactic acidosis or renal failure

122
Q

What are the two alpha glucosidase inhibitors of oral antidiabetic?

A

Acarbose (Presode) and Miglitol (Glyset)

123
Q

What do alpha glucosidase inhibitors do?

A

decrease CHO absorption from intestine doesn’t cause hypoglycemia if used alone and frequently used with other oral antidiabetic drugs

124
Q

What are the two Thiazolidinediones called?

A

Piglitazone (Actos) and Rosiglitazone (Avandia)

125
Q

How does Thiazolidinediones work?

A

acts by decreasing resistance and can be used in combination with sulfonyureas

126
Q

What are the two Meglitinide drugs called?

A

Repaglinide (Prandin) and Nateglinide (starlix)

127
Q

How does Meglitinides work?

A

acts by stimulating the beta cells to release insulin, can be used with metformin, and don’t use with liver disease

128
Q

What are the two hyperglycemic drugs?

A

Glucagon and Diazoxide (Proglycem)

129
Q

What drug is used in emergency for treatment for hyperglycemia?

A

Glucagon

130
Q

What is Glucagon?

A

counteracts insulin effects, stimulates glycogen breakdown, use if other method to give glucose not available, given IV/IM/SC

131
Q

What is Diazoxide (Proglycem)?

A

do not use for emergency use, inhibits insulin release fromthe beta cells, for clients with hyperinsulinism.

132
Q

When is Diazoxide used?

A

not for emergency use; for clients with hyperinsulinism

133
Q

What does Diazoxide (Proglycem) do?

A

Inhibits insulin release from beta cells

134
Q

What is the treatment for Hypoglycemia?

A

eat juice/candy, oral glucose tablets, IV dextrose, Glucagon (SQ, IM, IV)

135
Q

What is the treatment of Hyperglycemia with Insulin?

A

usually give short acting to cover pre meal, or when expect changes, add intermediate acting when estimated daily needs found and supplement as needed with short acting drug and if emergency may give Regular IV or infusion

136
Q

What is the treatment of hyperglycemia with fluids?

A

to replenish loss from osmotic diuresis, may need to replace K, start with normal saline then switch to more specific to match loss

137
Q

What organs are in the Endocrine system?

A

hypothalamus pituitary, parathyroid, thyroid, adrenals, adrenals. pancreas, ovaries, testes

138
Q

What do hormones in the Endocrine system do?

A

chemicals secreted into blood, regulate growth/development, fluid/electrolyte balance, reproduction, adaption to stress, metabolism

139
Q

What are the 4 peptide protein hormones?

A

insulin, vasopressin (ADH), growth (GH), and adrenocorticotropic (ACTH)

140
Q

What are the two amine hormones?

A

epinephrine and norepinephrine

141
Q

What are the three types of steroid hormones?

A

cortisol, estrogen, and testosterone

142
Q

What does an amine hormone do?

A

manipulates hormones that are used as neurotransmitter to control thought processes and the ability to respond to things

143
Q

T/F Steroid molecules look like cholesterol molecules

A

True

144
Q

Where is the Pituitary gland/hypophysis located?

A

at the base of the brain and has two lobes.

145
Q

What is the anterior pituitary gland called?

A

adenohypophysis

146
Q

What does the pituitary “master gland” do?

A

excretes hormones that stimulate the release of hormones from target glands

147
Q

T/F the pituitary gland can be the cause of tertiary problems with other glands such as secondary hypothyroidism.

A

False- causes secondary problems

148
Q

T/F Majority problems come from anterior pituitary.

A

True

149
Q

What hormone influences growth of bones and muscles (doesn’t have a specific target gland)?

A

Growth hormone (somatropin)

150
Q

What does the growth hormone influence?

A

protein, lipid, carbohydrates, and calcium metabolisms

151
Q

What is the name of GH deficiency?

A

dwarfism

152
Q

What is the name of excess GH called?

A

gigantism, acromegaly

153
Q

What is the replacement treatment for GH defiency?

A

somatrem (Protropin) and somatropin (Genotropin) are given before bone epiphyses are fused

154
Q

What can replacement treatment for GH defiency lead to?

A

Diabetes Mellitus

155
Q

When does gigantism occur?

A

during childhood/before puberty

156
Q

When does acromegaly occur?

A

growth after puberty

157
Q

What is the drug treatment for GH excess?

A

octreotide (Sandostatin)

158
Q

What does octreotide (Sandostatin? do?

A

synthetic somatostatin to suppress GH release and is used for severe diarrhea from carcinoid tumors

159
Q

T/F Thyroid stimulating hormone (TSH) is released from the posterior pituitary gland?

A

False- anterior pituitary

160
Q

What does TSH target and do?

A

targets throid gland, to stimulate production and release of thyroid hormones

161
Q

What is it called if there is no increase in thyroid hormone levels, the problem is with the thyroid gland?

A

primary hypothyroidism

162
Q

What is it called if drug is given and thyroid hormone level is increased, indicated that thyroid gland is ok, problem is at pituitary level?

A

secondary hypothyroidism

163
Q

Where is ACTH released and what does it do?

A

released from anterior pituitary and stimulates release of glucocorticoids (cortisol), mineralocorticoids (aldosterone), androgen from adrenal cortex

164
Q

ACTH corticotropin (Acthar) and Cosyntropin (Cortrosyn) used for? (4)

A

diagnosis of adrenal gland disorders, treat adrenal insufficiencies, antiinflammatory for allergic response, treat multiple sclerosis/ autoimmune disease

165
Q

T/F Neurohypophysis is released from the posterior pituitary

A

true

166
Q

What is secreted by the posterior pituitary gland?

A

ADH (vasopressin) and oxytocin

167
Q

What type of hormone is ADH and what does it do?

A

Antidiuretic hormone; decreases loss of Na and water through renal tubules; MAINTAINS WATER BALANCE IN BODY

168
Q

What happens with ADH excess?

A

fluid overload

169
Q

What happens with ADH defiency?

A

diabetes insipidus, dehydration

170
Q

How do you treat diabetes insipidus?

A

DDAVP (desmopressin acetate) and vasopressin (Pitressin)

171
Q

What can vasopressin (Pitressin) be used for?

A

GI bleed and esophagus varices

172
Q

What does DDAVP affect?

A

clotting

173
Q

What doe oxytocin do?

A

uterine contraction, milk letdown

174
Q

T/F The thyroid gland secretes T3 and T4.

A

True

175
Q

What is the function of T3 and T4?

A

regulates protein synthesis, enzyme activity and to stimulate mitochondrial oxidation

176
Q

Explain Hypothyroidism.

A

caused by decrease in TSH or thyroid tissue dysfunction causing decreased secretion of T4 andT3; slows a majority of body functions

177
Q

What is the term for very severe hypothyroidism?

A

Myxedema

178
Q

What drug increases T4 and T3 and makes euthyroid?

A

levothyroxine (Synthroid)

179
Q

What do you assess for Thyroid gland treatment?

A

assess for improvement of symptoms, watch cardiac function, drug interactions /t protein binding

180
Q

What does a thyroid overdose look like?

A

hyperthyroid symptoms; administer drug in morning to avoid sleep disturbances

181
Q

Explain Hyperthyroidism.

A

caused by overactive thyroid or high TSH (could be thyroid tumor)

182
Q

What is the most common type of hyperthyroidism?

A

grave’s disease

183
Q

What are some side effects/symptoms of Grave’s Disease?

A

tachycardia, palpitation, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos, and weight loss

184
Q

What is anther name for Grave’s Disease and what does it do?

A

Thyrotoxixosis; increases the rate of the majority of body functions

185
Q

What kills thyroid cells?

A

radioactive iodine- must have thyroid hormone replaced synthetically after treatment

186
Q

What treatment givers pre-op to reduce size and vascularity?

A

iodine SSKI (Lugols)

187
Q

What three antithyroid drugs decrease thyroid hormone production?

A

propylthiouracil (PTU), methimazole (Tapozole), and Sodium iodide IV is used for thyrotoxic crisis

188
Q

What does the parathyroid hormone (PTH) do?

A

regulates calcium levels by decreasing Ca+ stimulates increasing PTH by mobilizing Ca+ from bone, increasing GI absorption, Increasing renal reabsorption to increase serum calcium

189
Q

What drug takes care of hypocalcemia?

A

calcitiol (Rocaltrol) (VIT D analogue)

190
Q

What does calcitriol do?

A

increase GI absorption of Ca+, increase release of Ca+ from bone

191
Q

What are the consequences of calcitriol?

A

decreased bone density, fractures

192
Q

What are the two structures in the adrenal gland?

A

adrenal medulla and adrenal cortex

193
Q

How is the Adrenal gland controlled?

A

through salt, sex, sugar

194
Q

This is aldosterone that regulates Na and water?

A

mineralcorticoids-salt

195
Q

What regulates some sexual characteristics, but has a small influence?

A

androgens-sex

196
Q

What controls glucose metabolism and storage and depresses immune system?

A

Glucocorticoids-sugar

197
Q

T/F Glucocorticoids- sugar are also referred as a stress hormone that is increased release in fight/flight

A

True

198
Q

What is the classifications of glucocorticoids (Cortisol)?

A

antiinflammatory, antiemetic effects, an for pain`

199
Q

What are some side effects for glucocorticoids?

A

abnormal fat deposits (moon face and buffalo hump), muscle wasting, edema, euphoria, psychosis, nightmares, skin thinning, immunosuppression; long term can lead to loss of adrenal gland function

200
Q

What are some drug interactions with steroids?

A

NSAIDS, diuretics, coumadin due to protein binding

201
Q

What is ketoconazole?

A

glucocorticoid inhibitors, used to treat client with Cushings syndrome

202
Q

Mineralocorticoids (Aldosterone) does what?

A

controlled by renin angiotensin system and maintains fluid balance by reabsorption of sodium and water

203
Q

What happens if there is too little aldosterone?

A

decrease in BP and vascular collapse

204
Q

What is used to treat too little aldosterone and what does it do?

A

Fludrocoticone (Florinef); oral mineralocorticoid, high protein diet and monitor serum potassium levels, rarely used for elderly

205
Q

What is Cushing’s Syndrome?

A

too much corticosteroid secretion by the Adrenal glands

206
Q

What is Addison’s Syndrome?

A

too little corticosteroid secretion by the Adrenal Glands

207
Q

What are some side effects of drug withdrawal or too little drug resemble Addison’s crisis?

A

low BP, low glucose, lethargy, fatigue, weakness, death

208
Q

What are the routes of administration for corticosteroids?

A

oral, Im, IV, inhaled, topical, rectal

209
Q

What are corticosteroids used for?

A

immunosuppression of autoimmune diseases, allergy reaction (Asthma), and transplant therapy

210
Q

Corticosteroids used with chemotherapy in cancer can have what effects?

A

pain control, control nausea, reduce inflammation related to cell death, and reduce brain swelling

211
Q

Name some nursing interventions for steroids.

A

check for interactions, don’t stop suddenly, dosage adjustment if stressors increase (illness), monitor weight/I&O/K/Na/glucose, may worsen DM, increased appetite, gastric mucosal protection, increase vigilance for infection which symptoms may be decreased

212
Q

What are the three symptoms of DM?

A

polyuria, polydispsia, polyphagia

213
Q

Why does some with DM experience the three Ps/

A

increase serum glucose causes osmotic pull of fluid from cells into vascular compartment, then osmotic diuresis in kidney from excess glucose, then thirst due to increased serum osmolarity

214
Q

what does polyphagia mean?

A

increased hunger

215
Q

what does polydipsia mean?

A

Increased thirst

216
Q

What is type 1 diabetes?

A

needs insulin replaced

217
Q

What is type 2 diabetes?

A

problem with insulin receptors on cells/insulin resistant

218
Q

What is insulin?

A

promotes uptake of glucose, fatty acids, amino acids by cells

219
Q

Where is insulin secreted?

A

by beta cells in pancreas

220
Q

Why is insulin secreted?

A

secreted in response to increased serum levels

221
Q

How does insulin work?

A

glucose is converted to gylcogen for future glucose needs in liver and muscle, this lowers the blood glucose

222
Q

How is insulin available?

A

vials, pens, and inhalant

223
Q

What is the name of rapid acting insulin?

A

lispro (Humalog), aspart (Novolog) glulisine

224
Q

What is the name of short acting insulin?

A

regular (Humulin)

225
Q

What is the name of Intermediate acting insulin?

A

NPH, Lente

226
Q

What is the name of long acting insulin?

A

Detemir (Levemir) and Lantus (Glargine)

227
Q

What is lantus (Glargine)

A

analog of human insulin, give once/day at bedtime, 24 hr duration, less nighttime hypoglycemia, no peak, no mixing with other insulins

228
Q

What insulins can be combined?

A

NPH (70) with Regular (30)

229
Q

How does a patient store insulin?

A

refrigerate unopened vials, if open room temp for one month or in refrigerator for 3 months

230
Q

Who is more common to have insulin resistance?

A

obese clients

231
Q

What is the main side effect of insulin?

A

hypoglycemia

232
Q

What causes Ketoacidosis?

A

caused by lack of insulin, type 1 DM, and is frequently triggered by illness (UTI, URI)

233
Q

What causes hyperosmolar hyperglycemic nonketotic (HHNK)?

A

lack of insulin, type 2 DM or too much CHO

234
Q

Which insulin should be drawn into the syringe first?

A

short acting should always be drawn into syringe first if mixing with longer acting insulin

235
Q

T/F Draw the cloudy medication first

A

false- draw clear then cloudy into syringe

236
Q

When should you give lispro, aspart Insulin?

A

rapid onset, give within 5-10 minutes before eating, do not mix

237
Q

What insulin can be only given IV?

A

regular insulin

238
Q

T/F Decreased insulin needed if more exercise happens.

A

True

239
Q

T/F Less insulin needed if ill.

A

False- more is needed due to the stress response

240
Q

What is a benefit of Insulin pen Injectors?

A

convenience= increase compliance

241
Q

What method of administering insulin is available but difficult to regulate?

A

Intranasal Insulin

242
Q

What is Insulin jet Injectors?

A

needleless systems that inject insulin

243
Q

What are some benefits of Insulin Pumps?

A

contains regular insulin, implantable/portable, expeensive, and keep blood glucose levels close to normal because deliver basal dose and then additional dose depending on need

244
Q

What is three criteria for use of oral antidiabetic drugs?

A

onset of DM at more than 40 years, diagnosis less than 5 years, fasting glucose less than 200 mg, normal renal and hepatic function

245
Q

This drug acts by stimulating secretion of insulin so must have functioning islets is called what?

A

sulfonylureas

246
Q

What is the first generation sulfonylurea called?

A

Orinase

247
Q

What is the first generation intermediate acting sulfonylurea called?

A

Tolinase

248
Q

What is the long acting first generation sulfonylurea called?

A

Diabinese

249
Q

What are a few characteristics of second generation sulfanylureas?

A

less drug interactions (more potent), increase tissue response, decrease liver production of glucose, and longer duration

250
Q

What is the second generation sulfonylurea called?

A

Glipizide (Glucotrol), glyburide (Diabeta), and glimepiride (Amaryl)

251
Q

T/F second generation is used for clients with liver or kidney dysfunction.

A

false- do not give

252
Q

T/F Sulfonylureas are highly protein binding drugs.

A

true

253
Q

What does the oral anitdiabetic drug Metformin (Glucophage) do?

A

decrease hepatic glucose production from stored glycogen, decrease the absorption of glucose from the small intestine, increase insulin receptor sensitivity

254
Q

T/F Metformin doesn’t cause hyper or hypoglycemia.

A

True

255
Q

What classification is Metformin?

A

Biguanide

256
Q

Why do you need to hold Metformin for 48 hours prior to and after IV use?

A

Iv contrast dye due to increased risk of lactic acidosis or renal failure

257
Q

What are the two alpha glucosidase inhibitors of oral antidiabetic?

A

Acarbose (Presode) and Miglitol (Glyset)

258
Q

What do alpha glucosidase inhibitors do?

A

decrease CHO absorption from intestine doesn’t cause hypoglycemia if used alone and frequently used with other oral antidiabetic drugs

259
Q

What are the two Thiazolidinediones called?

A

Piglitazone (Actos) and Rosiglitazone (Avandia)

260
Q

How does Thiazolidinediones work?

A

acts by decreasing resistance and can be used in combination with sulfonyureas

261
Q

What are the two Meglitinide drugs called?

A

Repaglinide (Prandin) and Nateglinide (starlix)

262
Q

How does Meglitinides work?

A

acts by stimulating the beta cells to release insulin, can be used with metformin, and don’t use with liver disease

263
Q

What are the two hyperglycemic drugs?

A

Glucagon and Diazoxide (Proglycem)

264
Q

What drug is used in emergency for treatment for hyperglycemia?

A

Glucagon

265
Q

What is Glucagon?

A

counteracts insulin effects, stimulates glycogen breakdown, use if other method to give glucose not available, given IV/IM/SC

266
Q

What is Diazoxide (Proglycem)?

A

do not use for emergency use, inhibits insulin release fromthe beta cells, for clients with hyperinsulinism.

267
Q

When is Diazoxide used?

A

not for emergency use; for clients with hyperinsulinism

268
Q

What does Diazoxide (Proglycem) do?

A

Inhibits insulin release from beta cells

269
Q

What is the treatment for Hypoglycemia?

A

eat juice/candy, oral glucose tablets, IV dextrose, Glucagon (SQ, IM, IV)

270
Q

What is the treatment of Hyperglycemia with Insulin?

A

usually give short acting to cover pre meal, or when expect changes, add intermediate acting when estimated daily needs found and supplement as needed with short acting drug and if emergency may give Regular IV or infusion

271
Q

What is the treatment of hyperglycemia with fluids?

A

to replenish loss from osmotic diuresis, may need to replace K, start with normal saline then switch to more specific to match loss

Pharmacology (5 decks)

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