Endocrine Pharmacology

Question 1

What are the 4 instances you should check glucose levels?

Answer 1

1. N/V 30 minutes after insulin dose
2. weak, confused, nervous after insulin and a light breakfast
3. restless and peripheral tingling
4. concerns about sugar levels

Question 2

How does exercise affect insulin levels in the body?

Answer 2

reduces the body’s need for insulin
* increased muscle activity accelerates transport of glucose into muscle cells
* can cause hypoglycemia

Question 3

What can cause hyperglycemia?

4 factors

Answer 3

1. stress
2. infection
3. surgery
4. diet

Question 4

Other than glucose, what other electrolyte does insulin influence in the blood?

Answer 4

insulin causes K+ to drop in blood
* insulin opens the glucose channel on cells, allowing glucose and K+ to enter the cell

Question 5

What syringe is most commonly used for injection of insulin?

Answer 5

U-100

Question 6

When mixing insulin, what is the order in which you should draw?

Answer 6

• inject air into cloudy
• inject air into clear
• draw clear
• draw cloudy

Question 7

What are the 2 most important things to monitor in DKA pts on insulin?

Answer 7

glucose levels (hypoglycemia) and potassium (hypokalemia)

Question 8

How does acute kidney failure relate to insulin?

Answer 8

• acute kidney failure causes elevated K+
• treat with D50 with insulin infusion to prevent hyperkalemia – since insulin promotes movement of K+ into cells

Question 9

How will insulin needs change in a pt with gestational diabetes?

Answer 9

insulin needs increase in second trimester

Question 10

Why can’t pts take insulin in tablet form?

2 reasons

Answer 10

• insulin is poorly absorbed orally – not available in a tablet
• insulin is destroyed by gastric juices

Question 11

What are the 3 types of rapid acting insulin? What are their onsets? What are their peaks?

Answer 11

• 3 types:
  1. lispro
  2. glulisine
  3. aspart
• onset = 10 - 15 minutes
• peak = 1 - 2 hours

Question 12

What is the peak of regular insulin?

Answer 12

2 - 4 hours

Question 13

What is 1 type of intermediate acting insulin? What is its peak?

Answer 13

• NPH insulin
• peak = 4 - 12 hours

Question 14

What are the 2 types of long acting insulin? What are their peaks?

Answer 14

• 2 types:
  1. detemir
  2. glargine
• peak = none

Question 15

rapid acting insulin
* types
* nursing pro tips

4 nursing pro tips

Answer 15

• types: GAL
  1. glulisine
  2. aspart
  3. lispro
• nursing pro tips:
  1. used for emergency treatment of DKA
  2. can be given IV infusion – stops acting once pump is stopped
  3. onset = 10 - 15 minutes
  4. peak = 40 - 60 minutes

Question 16

regular (short acting) insulin
* nursing pro tips

1 nursing pro tip

Answer 16

• nursing pro tips:
  1. peak = 2 - 4 hours

Question 17

intermediate acting insulin
* type
* nursing pro tips

2 nursing pro tips

Answer 17

• type: NPH insulin
• nursing pro tips:
  1. peak = 4 - 12 hours
  2. give bedtime snacks:
• counteracts late insulin activity
• prevents hypoglycemia at night

Question 18

long acting insulin
* types
* purpose
* nursing pro tips

3 nursing pro tips

Answer 18

• types:
  1. glargine
  2. detemir
• purpose: provide steady, long, continuous insulin coverage without peaks
• nursing pro tips:
  1. do not mix this insulin with other insulins or IVs
  2. do not administer via IV infusion
  3. give with a snack to prevent hypoglycemia

Question 19

metformin
* purpose
* mechanism of action
* classification
* nursing pro tips

1 nursing pro tip

Answer 19

• purpose: oral treatment of type 2 diabetes
• mechanism of action: decreases release of glucose from the liver, increases uptake of glucose into the cell
• classification: biguanides
• nursing pro tips:
  1. black box warning: lactic acidosis
• withhold metformin for 48 hours before use of iodinated contrast materials to prevent lactic acidosis

Question 20

gli- & gly-
* purpose
* mechanism of action
* nursing pro tips

2 nursing pro tips

Answer 20

• purpose: oral treatment of diabetes
• mechanism of action: stimulates pancreas to release insulin
• nursing pro tips:
  1. not effective against DKA – since it is oral, it won’t be fast acting enough for DKA treatment (no oral meds are appropriate for DKA)
  2. must take at specific times – if not spaced correctly, insulin levels may increase or decrease causing hypo or hyperglycemia

Question 21

-tide
* purpose
* mechanism of action
* nursing pro tips

4 nursing pro tips

Answer 21

• purpose: oral treatment of diabetes
• mechanism of action: slows gastric emptying, increases insulin release, decreases postprandial glucagon release, and reducing appetite
• nursing pro tips:
  1. may experience weight loss
  2. take other oral medications 1 hour before these medications – slowed gastric emptying
  3. can be subq injection
  4. monitor postprandial glucose – should be below 180 mg/dL

Question 22

levothyroxine
* purpose
* classification
* nursing pro tips

4 nursing pro tips

Answer 22

• purpose: hypothyroidism
• classification: hormone replacement
• nursing pro tips:
  1. contraindicated in pts with recent MIs – can induce cardiac stimulant effects
  2. daily formed bowel movements – sign that med is working (constipation s/s of hypothyroidism)
  3. take first thing in the AM on an empty stomach – minimizes effect of insomnia and facilitates absorption
  4. black box warning: do not take for weight loss

Question 23

potassium iodide (PI)
* purpose
* classification
* nursing pro tips

2 nursing pro tips

Answer 23

• purpose: hyperthyroidism
• classification: anti-hormone
• nursing pro tips:
  1. mix medication with juice or milk to decrease gastric irritation
  2. will decrease size and vascularity of thyroid gland, reduces risk of hemorrhage during surgery

Question 24

radioactive iodide (RI)
* purpose
* classification
* nursing pro tips

1 nursing pro tip

Answer 24

• purpose: thyroid cancer
• classification: radiation therapy
• nursing pro tips:
  1. do not share eating utensils