Drugs Affecting the Endocrine System

Question 1

Insulin Rules/Test Tips

Answer 1

1. Give food during peaks and monitor for low sugar
2. Deadly hypoglycaemia (70 or less, give sugar)
   * Shaky, pale, cool, sweat or clammy
   *awake = ask them to eat
   *sleeping - Stab with IV D50
3. no peak No mix = long acting, draw up in two separate syringes
4. IVP/IV only = regular insulin
5. Draw up clear to cloudy
6. Rotate locations, best on abdomen near umbilicus
7. DKA type 1 “give on sick days”

Question 2

Long acting insulin

Answer 2

No peak
No mix
Detemir
Glargine
Duration: 24 hours

Question 3

NPH

Answer 3

Intermediate
Never IV
Always mix
Mix clear to cloudy
Given 2x a day
Duration 14 hours
Peak: 4-12 hours
(most at risk 5.5hours)

Question 4

Regular Insulin

Answer 4

Ready to go IV
Only IV insulin
Duration 5-8 hours
Peak 2-4 hours

Question 5

Rapid

Answer 5

Aspart/Lispro/Gluisine
Give during meals
Must be eating in 10-15min
Duration 3-5 hors
Most deadly
15min onset
Peak 30-90 minutes

Question 6

What is the fastest way to kill your diabetic client

Answer 6

Not giving a plate of food during peak times

Question 7

Insulin Infusion Pump

Answer 7

Steady doses of insulin
fewer blood sugar swings
Check BG 4x per day
Insulin bolus at meal times

Question 8

Insulin pump malfunctioning

Answer 8

Always assess patient first, pump second

Question 9

Oral Agents Rules

Answer 9

Decrease blood glucose
Use after exercise and diet have failed

Never take with TC meds
Iron
Calcium
Anti acids

Question 10

Oral Agents Type 2 Diabetes

Answer 10

Metformin
Glipiziide and Glyburide
Thiazolidinedione
Pioglitazone
Acarbose and precose

Avoid alcohol and liver disease patients

Question 11

Metformin

Answer 11

Mini chance of low sugar
Major liver + kidney toxic
Hold 48 hours before cath lab since contrast kills the kidneys

Question 12

Glipiziide and Glyburide

Answer 12

Stimulate pancreas to release insulin
Bad for heart failure and MI history
Slow pistons
Watch IDE ending not a diuretic
Cause weight gain and sunburn
Toxic for elderly patients

Question 13

Thiazolidinedione
Pioglitazone

Answer 13

Reduces insulin resistance
Heart and liver toxic
Risk of HF

Question 14

Acarbose and precose

Answer 14

Massive flatus and diarrhea
Digest foods for you
Not given to IBS

Question 15

Levothyroxine

Answer 15

Hypothyroidism
Leaves T3 and T4 in the body
No cure, Life long drug, never stop taking
Long slow onset 3-4 weeks
Early morning
Empty stomach, 30-60 before breakfast 1x daily, no doubling doses
Never stop abruptly
Report s/s of hyperthyroidism (agitation and confusion)
Pregnancy safe

Question 16

What medication to avoid with hypothyroidism

Answer 16

Narcotics and sedatives (benzos)

Question 17

Hyperthyroidism Drugs

Answer 17

Methimazole: not baby safe

Propylthiouracil: baby safe, report fever and sore throat

SSKI: potassium iodide, shrinks the thyroid before removal, strains teeth, keep 1 hour apart from other thyroid meds

Beta blockers: propanolol

Question 18

RAIU radioactive Iodine Uptake

Answer 18

Destroys thyroid in one dose
Hypothyroid s/s
Makes patient Radioactive

Question 19

Before giving radioactive Iodine Uptake

Answer 19

Negative pregnancy test
Remove neck jewelry and dentures
5-7 days before hold antithyroid meds
Awake - no anesthesia or conscious sedation
NPO 2-4 hours before 1-2 hours after

Question 20

After giving radioactive Iodine Uptake

Answer 20

Avoid everyone for up to 7 days
No crowds
No same restroom (flush 3 times)
Not same food utensils
Not same laundry as family
No cuddling or kissing

Question 21

Steroids

Answer 21

Stress and swelling hormone
“SONE”
prednisone
Dexamathasone
Hydrocortisone
Fludrocortisone

Given to help the body respond to inflammation and stress
Inflamed lungs - COPD
inflamed joints - rheumatoid arthritis
Inflamed skin - psoriasis
inflamed body - lupus/allergic reactions

Question 22

Steroids side effects

Answer 22

Swollen (water gain and weight gain)
Sepsis - infection or illness
Low WBC, 37.8
Sugar increase (normal) = Hyperglycemia, steroids increase sugar too we need to increase the insulin
Skinny muscles and bones, risk for osteoporosis
Sight, risk for cataracts, referrer to optometrist

Question 23

Prevent addisonian crisis

Answer 23

Slowly taper off (never abruptly stop)
Stress/surgery - increase dose with increase stress

Question 24

The nurse should be concerned when the clients states “I have a sore on my leg that won’t go away”
Which medication should be reviewed with HCP

Answer 24

Dexamethasone
Hydrocortisone

Question 25

Which priority teaching is required for a patient prescribed prednisone for lupus?

Answer 25

Increase dose before surgery or during times of stress

Question 26

Which of the following is an indication that the client needs additional teaching while taking fludrocortisone?

Answer 26

New bilateral pedal edema is normal