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Pharm > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What does insulin do (FYI)

A

moves glucose from blood into the cells

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2
Q

Why is it important to know the peak, onset, and duration of insulin

A

So nurses know the most likely time for hypoglycemia to develop based on the insulin that was administered

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3
Q

Rapid-Acting insulin drug names

A

Insulin lispro (Humalog), Insulin aspart (Novolog), Insulin glulisine (Apidra)

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4
Q

Onset of rapid-acting insulin

A
  • Most rapid onset (within 5-15 minutes), usually taken immediately before a meal
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5
Q

Peak of rapid-acting insulin

A

1 to 2 hours

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6
Q

Duration of rapid-acting insulin

A

3.5 to 5 hours

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7
Q

Short-acting insulin is AKA

A

Regular insulin

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8
Q
  • Short-Acting: Regular insulin (Humulin __, Novolin __) [the name is literally regular insulin]
A

(Humulin R, Novolin R)

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9
Q

Onset of short-acting/regular insulin

A
  • Onset (SQ): 30 to 60 minutes, usually taken 30 to 60 minutes before a meal
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10
Q

Peak of short-acting/regular insulin- what does it signify?

A
  • Peak (SQ): 2 to 4 hours (means there’s a greatest risk for hypoglycemia after 2-4 hrs)
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11
Q

Duration of short-acting/regular insulin

A

6 to 8 hrs

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12
Q

Intermediate-Acting insulin drug name

A

NPH insulin (Novolin N, Humulin N)

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13
Q

Intermediate-Acting insulin onset

A

1-2 hrs

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14
Q

Intermediate-Acting insulin peak

A

4-8 hrs

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15
Q

Duration of Intermediate-Acting

also:
may be given ___ times ____ to provide glycemic control between ____ and during the ___

A

12-18 hours (about half a day), may be given two times daily to provide glycemic control between meals and during the night

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16
Q

Long-Acting (basal, background) insulin names

A

insulin glargine (Lantus), Insulin detemir (Levemir)

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17
Q

Onset of long-acting insulin

A

1-2 hrs

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18
Q

Peak of long-acting insulin

A

none (this is good; there’s way less risk for hypoglycemia)

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19
Q

Duration of long-acting insulin

A

24 hrs

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20
Q

Route of long-acting insulin

A

given subcutaneously (SQ), should not be mixed (in a single syringe) with other insulins, should never be given IV

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21
Q

Why is long-acting insulin called basal insulin?

A
  • Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then giving rapid-acting insulin as needed as a bolus
  • Long-acting means it releases a constant and steady level of insulin, usually given once a day
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22
Q

Know the premixed insulin that is 2 different types of insulin already combined together in one vial.

A
  • One vial contains two different insulins already combined (premixed)
  • 70% NPH and 30% Regular insulin (Humulin 70/30)
  • Mixture of intermediate and short-acting insulin
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23
Q

Review how to draw up two types of insulin in one syringe

A

When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting insulin first.

Remember “RN”

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24
Q
  • Insulin is always checked by ___ nurses who both sign the MAR (FYI)
A

2

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25
Q

Review injection technique for insulin. Why rotate injection sites?

A

Not rotating sites could cause lipohypertrophy

o Rotate injection sites and allow 1 inch between injection sites
o Rotating injection sites will facilitate the absorption of insulin and help prevent scarring

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26
Q

Insulin effect on an electrolyte

A
  • Hypokalemia:
  • Insulin can decrease blood potassium levels
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27
Q

Insulin interactions (1)

A

May cause hypoglycemia:
* Beta blockers can mask SNS response, making it difficult to identify hypoglycemia
* Sulfonylureas
* Meglitinides
* Excessive alcohol

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28
Q

Insulin interactions (2)

A

May cause hyperglycemia:
* Corticosteroids (prednisone); insulin dose may need to be increased
* Thiazide diuretics

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29
Q

Biguanide AKA Metformin (Glucophage) MOA

A

MOA: decreases glucose production by liver, improve insulin sensitivity

long version (FYI):

decreases glucose production in liver, decreases insulin resistance, does not stimulate insulin secretion from pancreas (so it does not cause significant hypoglycemia when used alone)

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30
Q

Metformin (glucophage) use

A

First choice drug for the treatment of type 2 DM

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31
Q

Metformin (glucophage) A/E

A
  • GI (most common): anorexia, nausea, diarrhea, cramping – Give with a meal. Usually subside over time.
  • Reduction in vitamin B12 levels after long-term use
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32
Q

Metformin (glucophage) toxicity

A

lactic acidosis (hyperventilation, myalgia) is rare but can be lethal (cannot use if creatinine > 1.4 mg/dL). Avoid alcohol.

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33
Q

Metformin (glucophage) contraindication

A
  • Contraindicated in patients with renal disease (creatinine clearance <30 mL/min or if creatinine > 1.4 mg/dL); metformin is primary excreted by kidneys

Also contraindicated in those with kidney/liver failure and alcoholism

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34
Q

Metformin (Glucophage) nursing considerations

A
  • Should be taken with meals to minimize GI side effects
  • Discontinue metformin 48 hours before and after diagnostic studies (CT/MRI) with IV contrast dye/iodine-containing contrast media
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35
Q

Drugs of thiazolidinediones (TZDs) end with

A

-zone

pioglitazone (Actos), rosiglitazone (Avandia)

36
Q

MOA of thiazolidinediones (TZDs)

A

enhances cellular response to insulin by decreasing insulin resistance; basically improves sensitivity of cells to insulin

37
Q

A/E of thiazolidinediones (TZDs)

A
  • Peripheral edema (fluid retention), monitor weight
  • May cause or exacerbate heart failure
  • Hepatotoxicity; monitor LFTs, report jaundice, dark urine
38
Q

Drugs of sulfonylureas

A
  • Drugs: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta)
39
Q

MOA of sulfonylureas (and glinides- which is a different class but can study them together)

A
  • Stimulate insulin release from pancreas; require a functioning pancreas.
40
Q

A/E of Sulfonylureas

A
  • **Hypoglycemia
  • Sensitivity to sunlight**
  • Nausea, vomiting, diarrhea; Give before breakfast
41
Q

Drugs of alpha-glucosidase inhibitors and MOA

A
  • Drug: acarbose (Precose), miglitol (Glyset)

MOA:
* Slow carbohydrate absorption and digestion

42
Q

Sodium-glucose-cotransporter 2 inhibitors drugs

A

canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance)

43
Q

Sodium-glucose-cotransporter 2 inhibitors MOA

A

excrete glucose through the urine by preventing its reabsorption in kidney; promotes weight loss

short answer: blows reabsorption of glucose

44
Q

Sodium-glucose-cotransporter 2 inhibitors side effects

A
  • Genital yeast infections (Candidiasis)
  • Urinary tract infections
  • Increased urination

serious adverse eff3ect: hypotension

45
Q

DPP-4 Inhibitors drugs

A

-liptin

sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Trajenta)

46
Q

MOA of DPP-4 Inhibitors

A

short answer: promote incretin function

FYI-
MOA: Inhibit enzyme DPP-4, an enzyme that destroys the hormone incretin, results in increased in incretin levels:
* Increase glucose-dependent insulin release
* Decrease glucagon release
* Slow gastric emptying
* Decrease appetite

47
Q

Overview of MOAs:

  • ________: decreases glucose production by liver, improve insulin sensitivity
  • ______ & ______: both stimulate the pancreas to produce more insulin
  • _____________: improve sensitivity of cells to insulin
  • ___________________: slow absorption of carbohydrate
  • _______________: block reabsorption of glucose
  • _________: promote incretin function
    _________________: incretin mimetics

Options:
Thiazolidinediones
DPP-4 inhibitors
Metformin
(SQ) GLP-1 receptor agonists
Sulfonylureas and Glinides
SGLT2 Inhibitors
Alpha-glycosidase inhibitors

A
  • Biguanide; AKA Metformin: decreases glucose production by liver, improve insulin sensitivity
  • Sulfonylureas and Glinides: both stimulate the pancreas to produce more insulin
  • Thiazolidinediones: improve sensitivity of cells to insulin
  • Alpha-glycosidase Inhibitors: slow absorption of carbohydrate
  • SGLT2 Inhibitors: block reabsorption of glucose
  • DPP-4 Inhibitors: promote incretin function
  • (SQ) GLP-1 receptor agonists: incretin mimetics
48
Q

What class is a non-insulin injectable

A
  • Incretin mimetics
49
Q

Non-Insulin Injectables-

Incretin mimetics drugs

A

-tide

50
Q

Incretin mimetics MOA

A

act like (mimic) the incretins in the body that lower blood sugar after eating.

FYI:
* Stimulate release of insulin from pancreas when glucose levels are high
* Decrease glucagon release
* Slow gastric emptying
* Increase satiety (decrease appetite)
* Lead to weight loss

51
Q

Know what blood glucose level would indicate hypoglycemia

A

Blood sugar less than 70 mg/dL

52
Q

Know signs and symptoms of hypoglycemia (know all)

A
  • Diaphoresis/sweating
  • Shakiness/tremor
  • Persistent headache
  • Tachycardia
  • Anxiety
  • Irritability
  • Dizziness
  • Confusion
53
Q

Be familiar with how to treat hypoglycemia

If they’re conscious?

A
  • Administer oral form of glucose (glucose tablets or gel, corn syrup, honey, fruit juice, or non-diet soft drink)
54
Q

Be familiar with how to treat hypoglycemia

If they’re unconscious?

A
  • Administer Glucagon or 50% Dextrose (D50W)
  • Turn the patient on the side until patient becomes alert to prevent aspiration
  • Administer a second dose of Glucagon in 15 minutes if patient remains unconscious
55
Q

Use glucagon when

A

the sugar is gone (fyi)

56
Q

When is glucagon used

A

Uses: emergency treatment of severe hypoglycemia

57
Q

How is glucagon administered

A

IM or SQ

58
Q

Know the diabetes treatment goals (blood glucose level ranges)
* For most patients: HbA1C less than __%
* Blood glucose before meals: __ to ___ mg/dL
* ____ hours after meals: less than ___ mg/dL

A
  • For most patients: HbA1C < 7%
  • Blood glucose before meals: 80 to 130 mg/dL
  • Two hours after meals: < 180 mg/dL
59
Q

What drug is used to treat hypothyroidism

A

levothyroxine (Synthroid)

60
Q

A/E of levothyroxine (for hypothyroidism)

A
  • Nervousness, insomnia, tremor, tachycardia, palpitations
    restlessness, heat intolerance, angina, dysrhythmias, & myocardial infarction
61
Q

Pt. teaching for of levothyroxine

A
  • Take in morning, on an empty stomach, by itself
  • Don’t take w/ food, other drugs, or vitamins  can affect absorption
  • Best to take other medications 4-5 hours after levothyroxine
  • Can increase anticoagulant effects of warfarin (report bleeding)
  • Instruct patient to never stop drug abruptly; therapy is usually for life
  • Dose adjusted according to the patient’s symptoms & laboratory data
62
Q

Hyperthyroidism- what are the anti-thyroid medications?

A

propylthiouracil (PTU) and methimazole (Tapazole)

63
Q

A/E of propylthiouracil (PTU) and methimazole (Tapazole)

for HYPERthyroidism

A
  • CNS: drowsiness, headache, dizziness
  • GI: hepatotoxicity, nausea, vomiting, diarrhea, loss of taste
  • Derm: rash, skin discoloration, urticaria
  • Hemat: agranulocytosis -> severe leukopenia -> low WBC -> infections, thrombocytopenia -> low platelets -> bleeding
  • MS: arthralgia
64
Q

What to monitor for anti-thyroid drugs (hyperthyroidism)

A
  • Thyroid storm (hyperthyroidism): tachycardia, palpitations, nervousness, insomnia, diaphoresis, heat intolerance, tremors, weight loss, diarrhea.
  • Agranulocytosis: report sore throat, fever, and stop treatment. Monitor complete blood count (CBC) for low WBC and platelets. Filgrastim can be used to increase WBC and can cause bone pain.
  • Monitor thyroid function studies (TSH, T3, T4) at baseline and periodically.
  • May cause ↑ liver function tests: monitor jaundice, dark urine, light-colored stools.
65
Q

*Radioactive Iodine is contraindicated in

A

pregnancy, lactation, and children

66
Q
  • Nonradioactive strong iodine solutions include..
A
  • SSKI (saturated solution potassium iodide)
  • Lugol’s solution
67
Q

Uses of SSKI (saturated solution potassium iodide) and Lugol’s solution

A
  • Preoperative prep for thyroidectomy – decreases gland vascularity and surgical blood loss
  • Adjunctive therapy – inhibit release of thyroid hormones
68
Q

adverse effects/reporting of SSKI (saturated solution potassium iodide) and Lugol’s solution

A
  • Iodine poisoning (“Iodism”): metallic taste, burning sensations in mouth, sore teeth and gums; discontinue treatment and notify provider
  • GI: abdominal pain, diarrhea, nausea, vomiting; discontinue if severe GI distress
  • Severe toxicity– iodine can cause corrosive injury to the GI tract
  • Skin rash
69
Q

Pt. education on SSKI (saturated solution potassium iodide) and Lugol’s solution

A
  • Avoid foods high in iodine (seafood, fish liver oils, iodized salt).
  • Take with juice to improve taste. Avoid giving with milk; absorption decreased by dairy.
  • Drink with a straw to decrease staining of teeth.
  • Take at the same time each day to maintain levels.
  • Do NOT use during pregnancy or lactation (category D).
  • Can be used in conjunction with other therapy because effects are not usually permanent.
  • Report any s/s of iodism.
70
Q

Review how beta blockers can be useful in patients with hyperthyroidism

A

Beta blockers (Propranolol) are used to decrease tremors and decrease heart rate

71
Q

Drugs impacting pituitary gland:

Growth Hormone- what drug?

A

Somatropin

72
Q

Growth Hormone/ Somatropin A/E

A
  • Adverse effects:
  • Hyperglycemia (polyuria, polydipsia, polyphagia)
  • Interacts w/ glucocorticoid steroids
73
Q

Growth Hormone/ Somatropin nursing implications

A

Nursing implications:
* administer injections at bedtime
* Monitor height & weight, usually monthly;
* If no stimulation of growth occurs, discontinue drug

74
Q

Posterior Pituitary drugs- ADH; the drugs are __________ or ______; used for _______ ________

A

Vasopressin or desmopressin; used for diabetes insipidus

75
Q

Vasopressin and desmopressin MOA

A

water reabsorption & decreased urine production

76
Q

Vasopressin and desmopressin A/E

A
  • Hyponatremia
  • Water intoxication (excessive water retention) – drowsiness, headache
  • Increased blood pressure
77
Q

Vasopressin and desmopressin nursing implications

A
  • Monitor intake and output (I&O), thirst, weight, and BP
  • Expect urine osmolality and urine specific gravity to increase
  • If being used for DI, dose will be adjusted based on urine output
  • Drink only enough water to satisfy thirst
  • If intranasal, clear nasal passage before using
  • If SQ, rotate injection sites
78
Q
  • _______ of ___________ Antidiuretic Hormone (SIADH): ________ (Tegretol) can cause
  • Body makes ___ ___ ____
  • Body retains too much ____, can result in ________(muscle cramps, weakness)
A

Too much ADH-
* Syndrome of Inappropriate Antidiuretic Hormone (SIADH): Carbamazepine (Tegretol) can cause
* Body makes too much ADH
* Body retains too much water, can result in hyponatremia (muscle cramps, weakness)

79
Q

Treatment of Syndrome of Inappropriate Antidiuretic Hormone (SIADH):

it’s MOA
and something to keep in mind

A
  • Treatment: demeclocycline, a tetracycline that blocks the action of ADH and increases urine output. Do not take with iron, antacids, or dairy products.
80
Q

Drugs affecting adrenal gland- class

A

Corticosteroids

81
Q

Drugs affecting adrenal gland- class is corticosteroids- what drugs?

A

Glucocorticoids: hydrocortisone, prednisone, dexamethasone, methylprednisolone
* Drugs “-sone”

Mineralocorticoid: fludrocortisone

82
Q

A/E of long-term use of corticosteroids

A
  • Delayed wound healing – Increased Risk for infections
  • Hyperglycemia (worsening of diabetes)
  • Irritability/depression/mood swings
  • Thinning of skin, bruising
  • Peptic ulcers (coffee ground emesis, tarry stools)
  • Weight gain (increased appetite), report > 5 lb/week
  • Increased BP (salt/water retention)
  • Muscle weakness
  • Osteoporosis (bone loss)
  • Abnormal fat distribution – Cushing’s syndrome (long term steroid use)
83
Q

How does glucocorticoid, such as prednisone, affect glucose levels?

A

Can get Cushing’s syndrome-
* Occurs with prolonged or frequent use of glucocorticoids
* Report if:
* Moon face, buffalo hump, muscle weakness, facial erythema.

hyperglycemia

84
Q

Drugs affecting the adrenal gland- corticosteroids

Know patient teaching for preventing steroid withdrawal syndrome

A

Do not stop drug suddenly if used long-term to prevent steroid withdrawal syndrome

85
Q

Review ACTH and why the need to taper glucocorticoid drugs

A
  • Drug doses must be tapered down (dose decreased) very gradually
  • If corticosteroids are suddenly withdrawn, abrupt withdrawal s/s (hypo-adrenal crisis, shock) can occur
  • Hypotension
  • Weakness
  • Shock
  • Can be fatal!
86
Q

Know the adverse effects of Interferon

A

◦ Flu-like reactions
◦ CNS: Depression/suicidal ideation (need to report), bone marrow depression
◦ Hepatotoxicity

87
Q

Review the actions of mineralocorticoid – fludrocortisone (Florinef)

A
  • Works by decreasing the amount of sodium that is lost in the urine and increasing urinary potassium excretion (causes potassium loss).
  • Retention of sodium and water -> can lead to high BP, edema

Pharm (9 decks)

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