Endocrine Flashcards by Rylee Polster

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

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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

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All insulins can cause hypoglycemia and hypokalemia, but Afeeza can also have what adverse side effect?

Acute bronchospasm

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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

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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

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Specific administration considerations for short acting insulin?

Humulin R and Novolin R

Administer 30 minutes before a meal

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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

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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

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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

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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

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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

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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

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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

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Sulfonylureas administration considerations ?

Time with meals

Peak plasma concentrations occur 1-3 hours after admin

Side effects: hypoglycemia

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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

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Metformin administration considerations:

Contraindicated in renal and hepatic disease.

Should be discontinued in patients undergoing radiologic studies involving contrast material.

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Metformin therapeutic effects?

Reduce fasting blood sugar and A1C to near normal

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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

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Metformin patient teaching

Take medication at same time each day to help control episodes of hyperglycemia

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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.

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Levothyroxine is a thyroid replacement drug used to treat hypothyroidism.

What thyroid hormone does this medication simulate?

Synthetic T4 hormone

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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

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Levothyroxine adverse reactions or side effects include:

Hypersensitivity reactions and cardiac dysrhythmias

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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

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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