Exam Flashcards
Paresthesia
Any abnormal sensations: burning, tingling, aching, cold sensation,
Dysesthesia
Painful paresthesia
Allodynia
Pain caused by a non-painful stimulus
Hyperalgesia
Hypersensitivity to the pain stimulus, causing more pain then it should
4 phases of nociception
Transduction- transmitting action potential
Transmission- stimuli passing to brain
Perception- processing or experiencing the pain
Modulation- how each person uniquely copes with pain
Strong opioid agonists
Morphine
Fentanyl
Meperidine
Methadone
Hydromorphone
Moderate to strong opioid agonists
Codeine
Oxycodone
Hydrocodone
Tapentadol
Morphine
Mechanism of action: endogenous opioid at the mu receptors
Can cause drowsiness, reduction in anxiety
Nursing considerations of morphine
Resp depression
Orthostatic hypotension
Cough suppression
Emesis- nausea
Birth defects
Meperidine function
Strong opioid
It is not preferred anymore because of the short half-life, lots of drug interactions
Methadone
Strong opioid
Pain and treat opioid addiction
-increased QT prolongation
-very long acting- up to 72 hours
Codeine function
Less harmful effects to strong opioids but doesn’t cause as much effects
Can combine with acetaminophen
-cough suppressant
Pentazocine
Agonist antagonist med- mu antagonist, kappa agonist
Not as much risk for abuse because less affect and less consequences
Increases cardiac output- avoid in MI patients
Tapentadol
Moderate to strong opioid
Blocks reuptake of norepinephrine a little bit so there is less constipation than other opioids
How do opioids affect mu and kappa receptors
Activate mu and kappa receptors
Buprenorphine
Partial mu agonist and kappa antagonist
Used for opioid use disorder
Prolongs QT interval
Tramadol- more important
Analog of codeine
Weak agonist activity at mu receptors
Side effect of seizures
-hard to wean- 5mg tapering opposed to morphine tapering at 0.5 intervals
Acetaminophen
Non opioid
Works at liver level so can’t have alcohol with
NSAIDS
Non steroid anti inflammatory
Can’t use with kidney issues
Polyphagia
Excessive hunger- high glucose but body not able to take that glucose for energy
Polydipsia
Excessive thirst- such high glucose in blood so water is pulled from cells stimulating thirst
DKA
Diabetic ketoacidosis
Primarily in T1D but can be T2 in extreme stress
Develops over hours to days
Presence of ketones in urine and blood
Polyuria, polydipsia, dehydration
Later manifestations severe hypotension
Kaussmaul’s respirations and fruity odour on breath
Electrolyte imbalances- hyponatremia and hypokalemia
HHS
Hyperosmolar hyperglycemia syndrome
Usually older patients with T2D
Precipitated by stressful events- illness, injury, surgery
Severe hyperglycemia, profound dehydration
Rapid acting insulin
Lispro, aspart, glulisine
Slightly modified human insulin
SC, IV
15mins before meal
Short acting
Regular insulin
Unmodified human insulin
SC, IV, IM
30-45 mins before meal
Intermediate acting insulin
NPH (neutral protamine hagedorn)
Regular insulin conjugated with protamine (large protein) which decreases solubility and slows absorption
SC only
2 times dose a day- some exceptions for one
Peaks 5-8 hours- lasts 18 hours
Long acting insulin analogues
Insulin degludec, insulin glargine, insulin glargine
Modified human insulin
SC
Slowly over 24 hrs+
Lacks a peak
-insulin glargine usually taken at bedtime
-insulin detemir- slightly shorter duration of action
Somogyi effect
Nocturnal hypoglycemia triggers a rebound hyperglycemia via glucagon and cortisol
Metformin
Buguanide
Reduces hepatic glucose production and increases insulin sensitivity
Lowers FPG and PPG, decreases A1C 2%
No hypoglycemia, no weight gain
Side effect- GI intolerance, avoid in renal or liver dysfunction
Weight gain in response diabetes meds
Insulin therapy in general caused weight gain
Sulfonylureas, meglitinide- weight gain
Some t2d meds cause weight loss-
Sulfonylureas
T2d med
End in ide: gliclazide, glimepiride, glyburide
Stimulates the release of insulin from beta cells
Avoid with renal dysfunction, alcohol
Taken once or twice daily- just before or after meals
Adverse effects: hypoglycemia, weight gain
DPP-4 inhibitors
End in gliptin
Increase levels of in incretin hormones which are released normally in response to high glucose levels to promote insulin secretion
-decreases hepatic glucose production
Lowers PPG, minimal effect on FPG
No hypoglycemia or weight gain
Once daily dose
Adverse effects- headache, infections (uti, respiratory), pancreatitis and anaphylaxis
Thiazilidinediones
End in glitazones
Increased glucose uptake in muscle and fat cells and inhibits hepatic glucose production
Lowers FPG and PPG
Slow onset and no regard for meals
Significant fluid retention (especially for HF)
-rosiglitazone avoid if patient has increased risk of MI such as HF and angina
SGLT2i
End in flozin
Blocke glucose reabsorption in kidney causing more glucose to be secreted
Weight loss may occur, no hypoglycemia
Lowers FPG and PPG
Not effective with renal dysfunction
Increased urination, genital yeast infection, UTI, postural hypotension, dizziness
Dosed once daily before meals (canagliflozin best before first meal)
GLP-1 receptor agonists
End in tide
Enhances incretin activity, increasing insulin secretion
Delays gastric emptying, suppresses appetite
Lowers PPG, minimal effect FPG
No hypoglycemia, weight loss may occur
Bad for renal dysfunction and at risk for pancreatitis, GI side effects
SC injection
-Rybelsus is oral
What are the weight loss meds
GLP-1 receptor agonists- semaglutide (wegovy)- weekly injection
and liraglutide (saxenda)- daily injection
Meglitinide
Repaglinide- ends in ide so memorize this one- only med in class
Rapid, short lived release of insulin
Caution in liver dysfunction, increased risk hypoglycemia
Possible weight gain but less that sulfonylureas
Alpha-glycosidase inhibitor
Only drug is Acarbose
Inhibits gut enzyme (alpha-glycosidase) which breaks down carbs so delays absorption and gastric emptying
Lowers PPG, no effect FPG
No weight gain or hypoglycemia
Flatulence, abdominal pain, diarrhea
Taken before meals- 3 times daily
What t2d meds have a risk of hypoglycemia
Sulfonylureas, meglitides
