drug matrix exam 2 Flashcards
insulin lispro
-rapid
-15min ; 1-2 hr ; 2-4 hr
human regular
-short
-30 to 60 min ; 2-6 hr ; 3-8 hr
-can use for meals or longer
-tube feedings
NPH
-intermediate
-2 to 4 hr ; 4-10 hr ; 10-20 hr
-cloudy, use immediately
-usually given twice a day
-when combining, pull up 2nd
glargine
-long acting
-70 min ; x ; all day
-1x per day , usually night
-never mix
glipizide & glyburide MOA
binding and closing the K-ATP channels in the pancreatic beta cells thereby stimulating secretion of insulin [increases sensitivity & reduces release of glucose]
more insulin
(a marriage is binding)
glipizide & glyburide side effects
hypoglycemia (brides no longer eat the cake, low sugar)
glipizide & glyburide nursing considerations
-do not take during pregnancy
-ETOH, NSAIDS, tagament, sulfa based ATB potentiates side effects
(brides shouldn’t be pregnant or drunk at their wedding & downing NSAIDs)
metformin MOA
lowers BG by decreasing production of glucose in the liver & enhances glucose uptake & utilization by muscle
(met for my muscles, min glucose in liver)
metformin side effects
-abdominal bloating
-N/V/D
-risk for acidosis in pts w/ elevated creatinine
(contract looks like acid metabolic acidosis and that would cause stomach upset & kidney dys)
metformin nursing considerations
-monitor serum glucose
-give 30 mins before meals
-must be held 48 hrs before IV contrast
-do not use in pts w/ elevated ALT levels
-do not use in those w/ HR, kidney disease, liver disease, or excessive alc
-onset is several weeks w/ peak at 2-4 wk
-low risk of hypogly
therapeutic usages of metformin
glycemic control, prevent type 2, polycystic ovarian syndrome
linagliptin, sazagliptin & sitagliptin MOA
inhibits DPP4 (a hormone that inactivates the incretin hormone)
-increases insulin release by enhancing incretin activity
-reduces glucagon release
-decreases glucose production
-slows down digestion
4 things to reduce BG
linagliptin, sazagliptin & sitagliptin side effects
-N/D & stomach pain
-flu like symptoms
-skins reactions
-increased risk for pancreatitis
(zach got panc which caused the flu w/ stomach probs & a rash)
linagliptin, sazagliptin & sitagliptin nursing considerations
-indicated in combo w/ diet & life styles changes
-can be used alone or w/ metformin
-low chance of hypoglycemia
(Z&C life, 1 or 2 twins, never low bc hotel buffet)
DPP4 inhibitors
linagliptin, sazagliptin & sitagliptin
GLP-1 receptor agonists
dulaglutide, exenatide & semaglutide
dulaglutide, exenatide & semaglutide MOA
enhances glucose dependent insulin secretion & inhibits postprandial release of glucagon & suppressive appetite (don’t eat a tide pod, the pod release so if we dont eat them they wont, need proper food for insulin)
dulaglutide, exenatide & semaglutide side effects
-N/D/V
-injection site reactions
-headache
-upper respiratory infections
-wt loss
(salt water from the tide is irritating when u drink or inject it, can cause infection & wt loss)
dulaglutide, exenatide & semaglutide nursing considerations
-BBW: risk of thyroid c cellls tumors (contraindicated for people who have hx of thyroid & endocrine probs)
-not recommended for pt w/ ESRD
-given subQ
-peak in 2 hr
-usually used with metformin
(avoid the glup w/ subQ)
dapafliflozin MOA
prevents the kidneys from reabsorbing glucose back into the blood (pee out extra glucose & less is reabsorbed d/t blocking of sodium-glucose transport proteins)
sodium - glucose cotransport ER 2 (SLG2) inhibitors
dapafliflozin
dapafliflozin side effects
-increased risk for UTI &genital mycotic infections
-hypotension, fainting, dizziness, fatigue
(urine is flozin so dyhydrated)
dapafliflozin nursing considerations
-do not give to someone with ESRD
-not FDA approved for T1 DM
-can give w/ other DM meds
-starting to be used for heart failure
(zins are not FDA approved)
what drugs should not be given to renal pts
-GLP1
-SLG2
-metformin
-ketorolac
-napronxen [hardest on kidneys]
what is the hypoglycemia antidote
glucagon
glucagon MOA
activates hepatic glucagon receptors, stimulates glycogenolysis and release of glucose
-short half life so many need multiple doses
orlistat MOA
binds to gastric and pancreatic enzymes and blocks these enzymes reduces fat absorption by 30%
orlistat side effects
BBW: liver injury
-GI symptoms, oily spotting, flatulence & fecal incontinence [can reduce by reducing fat intake]
-decreases vitamin concentrations
(oils is fat, think signs of fat malab.)
orlistat nursing considerations
-3 months to show effect
-must be taking a multi vitamin
-teach diet and lifestyle
-best for BMI >30 or >27 w/ other risks
(low nut in obese so vits, wt loss doesnt happen over night)
cholinesterase inhibitor
donzepezil (I get Z’s in a nest)
NMDA receptor antagonist
memantine (no more dementia)
donzepezil MOA
works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterasae &relaxes smooth muscle (chol is in class name, increase smaller word)
donzepezil side effects
-GI upset
-drowsy
-dizzy
-insomnia
-muscle cramping
-bradycardia & reflex tachy
-syncope
donzepezil nursing considerations
-do not take with NSAIDs if GI upset is present
-give at bedtime w/ food
-find way to make sure pt doesn’t forget
-indicated for mild to moderate AD
memantine MOA
blocks the stimulation of NMDA receptors believed to be associated w/ AD
memantine side effects
uncommon
-confusion, hypotension, headache, dizziness, constipation (take fiber)
-indicated for moderate to severe AD
-can give with or without food
(me take fiber)
centrally acting analgesic
tramadol
tramadol MOA
-binds weakly to mu opioid receptors
-inhibits re uptake of both norepi and serotonin
tramadol indications
treat moderate or severe pain (periods are never mild)
tramadol side effects
usually none
-drowsy, dizzy, headache, nausea, constipation, respiratory depression
-rare: seizures when combined w/ other CNS depressors
anti - convulsants
gabapentin & pregablin
gabapentin & pregablin MOA
thought to spontaneously suppress neuronal firing [anti convulsant] (put the neurons in a pen)
gabapentin & pregablin indication
to complement opioid effects and used specifically neuropathic pain
gabapentin & pregablin side effects
-drowsy
-dizzy
-vision problems
(the eyes follow the pen light)
gabapentin & pregablin nursing considerations
can only be partially reversed with naloxone
(the pent up tin man is only partially human)
what NSAID has no anti inflammatory property
acetaminophen
non selective COX inhibitor NSAIDs
aspirin, ibuprofen, naproxen, ketorolac
(all words we know: the 1st two and then nap & keto)
selective COX inhibitor NSAID
celecoxib
NSAID MOA
anti prostaglandins by blocking key enzyme COX which is crucial for the production of prostaglandins
what pills cannot be crushed
enteric coated
non selective cox inhibitors side effects
GI upset & inhibits platelet aggregation
-stomach ulcers & bleeding
-rash
-edema
-kidney failure
-increases BP
-SOA in asthma pts
selective cox inhibitors side effects
serious cardiovascular thrombotic events
black box warning for all NSAIDs
cardio risk and increased risk of serious GI adverse events
specific aspirin side effects
-salicylate poisoning [N/V, seizures, edema -> ringing ears & hearing loss]
-Reye’s syndrome
(“rin” for ring)
what med can you not give to children
aspirin
ketorolac specific considerations
-most potent NSAID
-for short term
-mainly post opt
-similar to morphine w/o res depression
-GI ulcers & high risk of renal dysfunction [esp if low renal function or dehydrated]
acetaminophen MOA
-unknown
-decreases prostaglandin synthesis in the CNS possibly
acetaminophen indications
mild to moderate pain and fever
acetaminophen limitations
-ceiling effect
-not anti inflammatory
acetaminophen side effects
w/ large amounts
-hepatic necrosis, liver failure, mild nephropathy
(ac=alcohol which is processed in the liver)
adult acetaminophen dosage
4g/24 hr
acute ingestion antidote for acetaminophen
acetylcysteine [mucomyst]
acetaminophen nursing consideration
do not mix with alcohol (ac = acholol)
advantages to IV acetaminophen
manage pain w/ less opioid abuse
when is merperidine given
only for acute migraines or when a pt is shivering post opt
MOA for all anti epileptic drugs
1) increase the threshold making it harder for the nerves to come receptive
2) limit the spread of the seizure
3) decrease the speed of nerve impulse
anti epileptic drugs
phenytoin, valproic acid, topiramate, levetiracetam
phenytoin indication
first line of defense for epilepsy tonic-clonic seizures and partial focal seizures (Ph=F, F is for First)
phenytoin side effects
tons
-lethargy
-abnormal movements
-mental confusion
-cognitive changes
phenytoin causes what special side effects
-gingival hyperplasia teeth -> dentist
-hirsutism
-osteoporosis
-hypertrophy of subQ facial tissue
(pheny T = funny teeth -> teeth are on your head w/ your hair & face tissue)
phenytoin nursing consideration
monitor therapeutic effect, highly protein bound [rapid rise,CYP450] (ph is for first & fast)
valproic acid indication
treatment of generalized seizures [absence, myoclonic, tonic clonic & partial] (val can do it all)
valproic acid nursing consideration
-highly protein bound [CYP 450 + lots of interaction]
-safe for children
(pro for protein)
valproic acid adverse effects
hepatoxicity, pancreatitis (acid is toxic)
what drugs should not be given to liver pt
-valproic acid
-metformin
-orlistat
-acetaminophen
what drugs should not be given to pancreas pt
-valproic acid
-DPP4 meds
valproic acid is contraindicated for
liver disease, urea cycle disorder (U V in the alphabet are together)
can you give valproic acid to children
in the delayed release form
topiramate indication
adjunct therapy for partial and secondary generalized seizures, tonic clonic (mates are 2 people, partial w/o eachother)
topiramate adverse reactions
general CNS depression, GI upset
watch for vision changes, can cause closed angle glaucoma
(u see ur mate w/ ur eyes)
topiramate nursing consideration
can interact w/ contraceptive meds & cause cleft lip if taking during pregnancy
what seizure med can be taken while pregnant
none -> should be on a contraceptive
levetiracetam
indicated for adjunct therapy for partial seizures w/ or w/o generalization
all anti epileptic BBW
increased risk for suicidal thoughts, depression and unusual changes in mood
gold standard for rapid mgt of seizures
if needed (usually stop on their own) IV push benzodiazepines
what are the side effects of all opioids
nausea, vomiting, constipation and respiratory depression (possibly itching, dry mouth, dizziness & confusion)
codeine, hydrocodone and oxycodone help with what else besides pain
cough
morphine is used for what type of pain
moderate to severe
hydromorphone is used for what type of pain
severe pain (when I have severe pain I go into the water)
fentanyl is used for what type of pain
most severe pain
codeine is used for what type of pain
mild to moderate
hydrocodone is used for what type of pain
mild to moderate
oxycodone is used for what type of pain
moderate to severe (oxygen has ranges)
methodone is used for what
pain from detox
