Endocrine Flashcards
Humalog, Novolog, and Afeeza are what type of insulin?
 Rapid acting
Onset: 15 to 30 minutes
Peak: 1 to 3 hours
Duration: 3 to 5 hours
What are administration considerations for rapid acting insulin?
❌Humalog, Novolog, and Afeeza❌
Administer within 15 minutes before a meal or immediately after a meal
🙅🏻♀️ Afeeza (inhaled insulin) contraindicated with patients who have asthma or COPD
All insulins can cause hypoglycemia and hypokalemia, but Afeeza can also have what adverse side effect?
Acute bronchospasm
The therapeutic affect for all types of insulin is what?
Maintain serum blood glucose levels within normal range
Achieve individualized target level of A1C, often 7%
Call HCP if BGL is over 250 or per facility protocol
Humulin R and Novolin R are what type of insulins?
What is their peak, onset and duration?
Short acting insulin
Onset: 30 minutes
Peak: 3 hours
Duration: 8 hours
Specific administration considerations for short acting insulin?
Humulin R and Novolin R
Administer 30 minutes before a meal
Humulin N and Novolin N are what type of insulin?
Intermediate acting insulin
Onset: 1 to 2 hours
Peak: 6 hours
Duration: up to 24 hours
Specific administration considerations for intermediate acting insulin:
Humulin N and Novolin N
Administer one to two times daily
Only subcutaneously
Roll/invert gently vial or pen before administration
Combination: intermediate acting/rapid acting insulin are:
❌first % is intermediate and second % is rapid acting❌
Humalog mix 50/50
Humalog mix 75/25
Novolog mix 70/30
Combination: intermediate acting/short acting insulin include:
What are the onset, peak and duration of the meds?
Humulin 70/30 & Novolin 70/30
Onset: 30-90 mins
Peak: 1.5 - 6.5 hours
Duration: 18-24 hours
Long acting insulin includes what medications
What are there onset, peak, duration?
Lantus and Levemir
Onset: 3-4 hours
Peak: none
Duration: greater than 24 hours
Hyperglycemic medication used to treat extremely low blood sugar when the patient is NPO?
Glucagon.
Admin sub cue, IM or IV
Supplement carbohydrates when patient is able to consume food safely. Especially PEDIATRIC patients
Sulfonylureas (Glipizide) stimulates insulin secretion from beta cells of pancreatic islets. This medication is given to help reduce what?
Reduce fasting blood sugar, and A1c to near normal
Sulfonylureas administration considerations ?
Time with meals
Peak plasma concentrations occur 1-3 hours after admin
Side effects: hypoglycemia
Biguanide (metformin) is an
Antihyperglycemics. It decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity.
How does metformin differ from Sulfonylureas? 
Metformin does not produce hypoglycemia
Metformin administration considerations:
Contraindicated in renal and hepatic disease.
Should be discontinued in patients undergoing radiologic studies involving contrast material.
Metformin therapeutic effects?
Reduce fasting blood sugar and A1C to near normal
Metformin adverse reactions include:
Stop immediately if signs of lactic acidosis, any condition associated with hypoxemia or dehydration
Diarrhea, nausea, vomiting, flatulence, abdominal discomfort, headache
 Metformin patient teaching
Take medication at same time each day to help control episodes of hyperglycemia
DPP-IV inhibitor (sitagliptin) increases insulin release and decreases glucagon levels in bloodstream.
What are the admin considerations?
Can give with or without food
Adverse reactions include: hypersensitivity (skin blisters/erosion) headache, pancreatitis, heart failure, upper respiratory infection.
 Levothyroxine is a thyroid replacement drug used to treat hypothyroidism.
What thyroid hormone does this medication simulate?
Synthetic T4 hormone
Levothyroxine administration considerations
Take with full glass of water on an empty stomach. 30 minutes to an hour before breakfast and at least 4 hours before or after any other drugs
Levothyroxine adverse reactions or side effects include:
Hypersensitivity reactions and cardiac dysrhythmias
Anti-thyroid (PTU) is used to treat hyperthyroidism or ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
This medication does what?
Inhibits the synthesis of thyroid hormones
PTU anti-thyroid medication administration
Given at 8 hour intervals
May cause hypothyroidism…..monitor TSH and T4 levels 
Notify HCP if patient becomes pregnant
PTU anti-thyroid medication side effects/adverse reactions include:
Hypothyroidism, liver failure, agranulocytosis, fetal harm
Calcitonin is used to treat osteoporosis
What are administration consideration?
It is administered VIA nasal spray with one spray in one side of the nose daily.
Contraindicated during pregnancy
Discard unrefrigerated bottle after 30 days of opening
The store unopened bottles in refrigerator until expiration date
Calcitonin side effects/adverse reactions include:
Serious hypersensitivity reactions (Angioedema)
Hypocalcemia
Nasal mucosa adverse effects 
Bisphosphonates (Alendronate) is used for prevention and treatment of osteoporosis in postmenopausal women and men with loss of bone mass
 What are some administration consideration?
Administered every eight hours at least 30 mins before first food, beverage or medication of the day.
Take only with water !!!!!
Patient should sit upright or stand for 30 minutes after administration
 contraindicated in pregnancy, hypocalcemia, and kidney disease 
Bisphosphonates (Alendronate) enhances bone mineral density in osteoporosis, but has what adverse side effects?
Upper G.I. Tract adverse events, severe musculoskeletal pain (jaw)
Symptoms of hypoglycemia:
Shaky, sweaty, hungry, sleepy, weak, confused, argumentative, dizzy
Symptoms of hyperglycemia:
Fatigue, lethargic, glycosuria, polyuria, polyphagia, polydipsia, itchy skin
What should you do for blood glucose levels below 50?
Check LOC and follow facility protocol
Type 1 diabetes occurs because?
An autoimmune condition that affects beta cells in the pancreas.
Doesn’t produce insulin at all !!!!
How does type 2 diabetes occur?
Usually due to lifestyle
Body cells become resistant to affects of insulin
Labs that should be monitored in patients with diabetes?
Hemoglobin A1C (Aka: glycated hemoglobin)
Accuchecks (blood glucose meters)
Urinalysis (looking for ketones)
Lipid panels (cholesterol & triglycerides)
Eye exams (changes to retina)
Bun and creatinine (kidney)
Signs of hyperthyroidism?
Skinny, can’t gain weight, tremors, fatigue, abnormal heart rhythm, insomnia, puffy eyes
Signs of hypothyroidism?
Fatigue, sensitivity to cold, weight gain, constipation, dry skin, hair loss, delayed growth in puberty
Basal insulin
 Can be long or intermediate acting
Prandial insulin
Used with meals
Maybe rapid or short acting
Insulin may come from humans and animals. What are the two animals?
Porcine and bovine
insulin pump admin considerations?
Usually is regular insulin
Wearable device that should be moved and replaced every 3 days
Administered subcutaneously and continuously
Preferred placement for better absorption are in the abdomen and low back. 
Iodine deficiency causes a condition called?????
Goiter = increased levels of TSH causes enlarged thyroid in neck
Diabetic teaching points?
Signs/symptoms of hyperglycemia and hypoglycemia
BGL over 250 contact HCP
Dietary recommendations
No alcohol-decreases insulin effectiveness
When you exercise, you may need to decrease insulin dose
A1c labs done every 3 to 12 months
Check blood glucose levels regularly
Treatment for hypoglycemia?
Glucagon, glucose tablets, dextrose, orange juice, candy, honey
Hyperglycemia causes and treatment
Not enough insulin, stress, steroids
Treatment = insulin
Adrenal cortex hormones include:
Aldosterone and cortisol
Adrenal medulla hormones include
Epinephrine and norepinephrine
Pancreas hormones include
Insulin and glucagon
Thyroid hormones include
Calcitonin, T4, T3
How does insulin affect potassium levels?
All insulin products cause a shift in potassium from extracellular to intracellular space which can lead to hypokalemia.
foods that are high in iodine
Shellfish, cod, sardines, tuna, eggs, seaweed, kidney beans, chickpeas, milk, baked, potato, yogurt, prunes
What drug class can cause osteoporosis?
Glucocorticoids
What is the best practice for giving combination insulin injections?
Give TWO separate shots. Do not mix in same syringe.
After giving insulin subcutaneously, how long should you leave the needle in the skins before retracting?
Five seconds
important patient teaching education for giving injections?
Syringes, sharps container, vantage point needles.
What should patients know about taking beta blockers and their glucose levels?
Monitor blood glucose levels more closely.
Fasting blood glucose levels
70 to 100
A1c test measures average blood sugar level over past 2 to 3 months what A1c is considered normal ?
Below 5.7%
The stress response triggered by illness, will result in an increase the creation of what hormones?
Cortisol, glucagon and growth
When insulin therapy is indicated the healthcare provider may choose from several preparation’s based on what reasoning?
Insulin is prescribed based on the clients likelihood of long-term recovery
New patient is diagnosed with hypothyroidism 
Diagnostic testing as indicated that the clients health problem is caused by anterior pituitary dysfunction
 The clients hypothyroidism is rooted in a deficiency of
Thyroid stimulating hormone
