Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

path/pharm > exam 3 > Flashcards

exam 3 Flashcards

1
Q
  1. signals from pharynx and GI tract via vagal pathways involving serotonin and dopamine lead to
  2. blood-borne or cerebrospinal fluid brone emetic agents (e.g., chemotherapy and opiods)
  3. pregnancy.

all of the above cause

A
  • activation of chemoreceptor trigger zone involving serotonin, dopamine, and muscarinic receptors
    overall this leads to stimulation of vomiting center in medulla causing salivary center, pharyngeal, GI, and abdominal muscles causing vomiting to occur
  • in addition to the above, cerebral cortex, sensory organs (noxious stimuli such as odors, pain, sight, pain), and vestibular apparatus (motion sickness) causes histamin and muscarinic receptors to send signals to medulla oblongata initiating vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

common causes of vomiting and nausea

A
  • GI disorders
  • CV, infectious, neurologic, or metabolic disorders
  • AE of drug therapy or chemotherapy
  • pain and other noxious stimuli (sights, odors, motion sickness)
  • postop (pain, impaired GI motility, meds)
  • pregnancy
  • migraines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

antiemetics

A
  • phenothiazines (promethazine)
  • substance P/Neurokinin I antagonists (aprepitant (Emend))
  • antihistamines (hydroxyzine (vistaril)
  • 5HT3 or serotonin receptor antagonists (ondansteron (zodran))
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

phenotiazines

A

promethazine (promethegan)
- antagonizes D2 (dopamine) receptors in midbrain
- muscarinic (MI) and histamine (HI) blocking effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

indications for phenothiazines (promethazine)

A
  • prevent chemo induced emesis
  • nausea with surgery
  • anesthesia
  • migraines
  • treatment of schizophrenia/psychosis (larger doses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

contraindications of phenothiazines

A
  • glaucoma
  • older adults
  • kidney disease
  • liver disease
  • children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

adverse effects of phenothiazines

A
  • blurred vision
  • urinary retention
  • dry mouth
  • photosensitivity
  • drowsiness
  • confusion
  • worse with high doses
  • EPS
  • neuroleptic malignant syndrome
  • QT changes on EKG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

monitoring for phenothiazines

A

tissue injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

black box warning of phenothiazines

A

can cause increased death in those >80 years old when used for dementia related diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

extrapyramidal symptoms

A
  • pseudo-parkinsonism
  • akathisia
  • acute dystonia
  • tardive dyskinesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pseudo-parkinsonism

A
  • stooped posture
  • shuffling gait
  • rigidity
  • bradykinesia
  • tremors at rest
  • pill-rolling motion of the hand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

acute dystonia

A
  • facial grimacing
  • involuntary upward eye movement
  • muscle spams of tongue, face, neck and back causing trunk to arch forward
  • laryngeal spasms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

akathisia

A
  • restlessness
  • trouble standing still
  • paces floor
  • feet in constant motion, rocking back and forth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

tardive dyskinesia

A
  • protrusion and rolling of the tongue
  • sucking and smacking movements of lips
  • chewing motion
  • facial dyskinesia
  • involuntary movements of body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

antihistamines

A

hydroxyzine (vistaril)
- block H2 receptors blocking action of acetylcholine in brain
- variable half life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

indications of antihistamines (hydroxyzine (vistaril))

A
  • nausea
  • vomiting
  • motion sickness/vertigo (meclizine)
  • sedative for anxiety
  • anesthesia combination drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

contraindications for antihistamines (hydroxyzine (vistaril))

A
  • renal impairment
  • hepatic impairment
  • early pregnancy
  • prolonged QT interval
  • PIMs (potentially inappropriate meds)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

adverse effects antihistamines (hydroxine (vistaril))

A
  • drowsiness
  • dizziness
  • confusion
  • dry mouth
  • thick resp secretions
  • blurred vision
  • urinary retention
  • tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

monitoring for antihistamines (hydroxyzine (vistaril))

A
  • symptom relief
  • teaching for adverse effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

patient teaching for antihistamines (hydroxyzine (vistaril))

A
  • interactions
  • safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

5 Hydroxytryptamine3 (5HT3) or serotonin receptor antagonists (Ondanetron (Zofran))

A
  • drug of choice for chemo and post-op n/v (also used for radiation therapy)
  • can be used in early pregnancy
  • antagonizes serotonin receptors, preventing activation by emetogenic drugs or toxins
  • oral dissolving works within 30-60min
  • IV available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

contraindications/cautions for 5HT3 antagonists/serotonin receptor antagonists (ondansetron)

A
  • hypersensitivity
  • hepatic impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

adverse effects of ondanseteron

A
  • diarrhea or constipation
  • headache/dizziness
  • fatigue
  • LFT elevation
  • prolonged QT interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

monitoring for ondanseteron

A
  • s/s relief
  • balance
  • activity intolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

patient education for ondansetron

A
  • interaction
  • may impair thinking/reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

substance P/neurokinin I antagonists

A

Aprepitant (Emend)
- blocks activity of substance P and NKI receptors in brain, inhibiting signal to brain that causes nausea
- highly protein bound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

indications for substance P/neurokinin I antagonists/aprepitatnt (emend)

A
  • chemo related n/v
  • usually in combo with 5-HT3 and corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

contraindications for substance P/neurokinin I antagonists/aprepitant (emend)

A
  • hypersensitivity
  • dont use with ranolazine, pimozide, or cisapride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

adverse effects of substance P/neurokinin I antagonists/ Aprepitant (Emend)

A
  • fatigue
  • weakness
  • dizziness
  • abnormal heart rythm
  • headahce
  • hiccups
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

monitoring for aprepitant (emend) NKI antagonists

A
  • symptom relief
  • heart rhythm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

marijuana

A
  • synthetic cannabinoids
  • dronabinol and nabilone
  • may decrease nausea in those undergoing chemo therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

risk factors for constipation

A
  • diet (enough fiber, grains, fluid)
  • lifestyle, particularly low levels of physical activity
  • age (increased age causes decrease peristalsis)
  • some drugs (opiates)
  • disease processes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

constipation

A
  • infrequent and painful expulsion of hard, dry stools
  • symptom, not a disease
  • difficult to define clearly (no “normal” number of stools)
  • traditional medical definition includes 3 or fewer bowel movements per week indicates constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

prevention of constipation

A
  • diet (fiber, grains), exercise, and fluid (6-10 glass or 8oz each/day) intake in promoting normal bowel function
  • increase activity and exercise
  • increase dietary fiber (veggies, fruits, whole grains)
  • establish and maintain routine for elimination
  • don’t ignore urge to go
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Rome 3

A

if patient has 2-3 of symptoms on criteria they may be exerpeincing constipation
changes for children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

laxative types

A
  • bulk-forming laxative (psyllium)
  • surfactant laxatives or stool softeners (docusate sodium/colace)
  • lubricant laxatives (mineral oil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

laxatives help with

A

forming stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

bulk laxatives

A
  • adds mass to feces stimulating peristalsis and defecation
  • must be taken with water to avoid obstruction
  • generally, bulk-forming drugs are for long term use and are most desirable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

lubricants

A
  • lubricate the fecal mass and slow colonic absorption of water from fecal mass
  • can interfere with absorption of some fat soluble vitamins
  • avoid in patients with difficulty swallowing as it can cause aspiration pneumonia
  • available in enema to help remove dry and hard feces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

surfactants (stool softeners)

A
  • decrease the surface tension of fecal mass to allow water to penetrate stool making it softer and easier to expel
  • little to no laxative effects
  • indicated in those who need to avoid straining like high BP, hemorrhoids, cerebrovascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

psyllium (metamucil) contraindications

A
  • undiagnosed abdominal pain (rule out before administration)
  • obstruction (most likely going to come back up)
  • fecal impaction
  • children
  • overuse in adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

adverse effects of psyllium (metamucil)

A
  • flatulence
  • bloating
  • cramping
  • bowel obstruction (drink w/ fluids (8oz)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

patient education for psyllium (metamucil)

A
  • take with 8oz of water
  • may reduce or delay absorption of some drugs (carbamazepine, digoxin, lithium, tricyclic antidepressants, warfarin)
  • 1hr before or 2hrs after other meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

evaluation of psyllium (metamucil)

A
  • did it provide relief?
  • assess for severe stomach pain, n/v, rectal bleeding, or constipation lasting >7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

cathartics

A
  • stimulant carthartics (bisacodyl)
  • saline laxatives (magnesium citrate, polyethylene glycol)
  • can be given for impaction PR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

stimulant cathartics/bisacodyl

A
  • much stronger than laxatives
  • strongest and most abused laxative
  • irritate GI mucosa and pull water into the colon stimulating peristalsis
  • produce watery stool and may lead to fluid and electrolyte imbalance and acid-base imbalance
  • short term only
  • used for bowel prep, colonoscopy, EGD, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

saline cathartics/ magnesium citrate + polyethylene glycol (Golytely)

A
  • increase osmotic pressure in intestinal lumen, resulting in retention of water which distends the bowel and stimulates peristalsis
  • produce semifluid stool and may lead to fluid and electrolyte imbalances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

bisacodyl (dulcolax) / stimulant cathartic contraindications

A
  • undiagnosed abdominal pain
  • obstruction
  • fecal impaction
  • children <6
  • limit during pregnancy
  • overuse in adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

adverse effects of bisacodyl (ducolax)/stimulant cathartics

A
  • abdominal pain*
  • cramping*
  • nausea
  • diarrhea
  • weakness
  • electrolyte imbalances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

patient education for bisacodyl (ducolax) / stimulant cathartics

A
  • dont take w/ milk nor chew as it is an enteric coated medication causing earlier release
  • take on an empty stomach or at bedtime so they poop in the morning
  • dont take with antiacids or H2RAs
  • be mindful when taking the medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

evaluation of bisacodyl (dulcolax)/

A
  • did it provide relief?
  • side effects: abdominal cramping and vomiting secondary to premature tablet dissolution
  • senna is another example
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

other indications for use of cathartics

A
  • obtaining stool specimens for parasitological examination
  • accelerates excretion of parasites after anthelmintic drugs have been administered
  • reduce serum cholesterol levels (psyllium products)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

lactulose

A
  • exerts osmotic effect pulling water into colon and stimulating peristalsis
  • used to treat hepatic encephalopathy by decreasing production of waste product ammonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

sorbitol

A
  • often given with sodium polystyrene sulfonate (kayexalate) in treatment of hyperkalemia
  • aids in expulsion of K+-resin complex
  • going to go to the bathroom !
  • can be given with activated charcoal to help with excretion of toxic things
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

lubiprostone

A
  • aids in treating chronic constipation by increasing intestinal fluid secretion, stimulating intestinal motility and defecation
  • idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

diarrhea

A
  • symptom, not a disease
  • increased bowel motility and increased liquidity of stools causing >3 stools/day
  • frequent liquid or semi liquid stool
  • usually self limiting 24-48hrs
  • body is trying to get rid of toxins, irritants, or infectious agents
  • can be acute or chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

causes of diarrhea

A
  • excessive use/abuse laxatives
  • intestinal infections from protoza, virus, or bacteria
  • lack of digestive enzymes
  • undigested, coarse, or highly spiced food in GI tract
  • inflammatory bowel disorders
  • irritable bowel syndrome: chronic or recurrent diarrhea, constipation, abdominal pain, bloatin
  • drugs (antacids w/ Mg+, misoprostol, antibacterials, metformin, cholchicine): worry about antibiotic associated colitis or C. diff
  • functional disorders: stress/anxiety
  • surgical incision of bowel
  • intestinal neoplasms
  • HIV/AIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

chron’s disease

A
  • overactivated macrophages and leukotrine migration causing chronic recurrent inflammation of GI tract
  • patchy lesions
  • pain in RLQ is common
  • fever, bleeding (severe cases), diarrhea, anorexia, and weight loss are common signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

ulcerative colitis

A
  • mainly affects colon and rectum and continuous sections
  • chronic recurrent inflammation
  • pain in LLQ
  • blood and mucous in stool, severe pain, diarrhea more severe, anorexia, weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

bacterial infections causing diarrhea

A
  • e. coli (comes from undercooked food)
  • salmonella (undercooked chicken, eggs, dairy)
  • shigella
  • C. diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

viral infections of intestines

A
  • rotavirus
  • calicivirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

protozoan infections of GI tract

A
  • giardia lamblia
  • cryptosporidium parvum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

nursing care for diarrhea

A
  • fluid replacement (2-3L in first 24hrs)
  • potential clear or bland diet
  • monitor fluid and electrolyte imbalances
  • drug therapy
  • avoid caffeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

bland diet

A
  • bread/toast
  • rice
  • crackers
  • banana
  • applesauce
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

opiate related antidiarrheals prototype

A

diphenoxylate with atropine sulfate (lomotil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

adjuvant antidiarrheals

A
  • alosteron (lotronex)
  • bismuth subsalicylate (pepto-bismol)
  • colestipol (colestid)
  • nitazoxanide
  • octreotide
  • pancreatin or pancrealipase
  • polycarbophil preparations
  • rifaximin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

diphenoxylate with atropine (lomotil)

A
  • prototype used to treat moderate to severe diarrhea
  • slow peristalsis by acting on smooth muscle in intestines
  • schedule 5 drug meaning potential for abuse and moderate amount of controlled substances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

caution with diphenoxylate with atropine

A
  • children (not indicated for <2 years old, 2-13 should have liquid med with correct dosing, can cause hyperexcitability, if no improvement in 48 hrs it is ineffective)
  • breastfeeding
  • kidney or liver impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

adverse effects of diphenoxylate with atropine (lomotil)

A
  • tachycardia
  • dizziness
  • headache
  • flushing
  • nausea
  • vomiting
  • dry skin
  • mucous membranes
  • urinary retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

hypotension and respiratory depression have occured with larger doses of

A

diphenoxylate with atropine (lomotil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

contraindications of diphenoxylate with atropine (lomotil)

A
  • diarrhea from toxic material
  • microorganisms that penetrate intestinal mucosa
  • antibiotic associated colitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

patient education for diphenoxylate with atropine (lomotil)

A
  • avoid alcohol (can worsen CNS depression)
  • stop taking once diarrhea resolves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

loperamide (imodium)

A
  • low CNS effects and low potential for abuse
  • OTC
  • decreases GI motility by acting on intestinal muscles
  • opiate-related antidiarrheal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

adverse effects of loperamide (imodium)

A
  • abdominal pain
  • constipation
  • dizziness
  • drowsiness
  • high first pass effect so use caution with liver impairment
    -fatigue
  • n/v
  • BLACK BOX: when used in higher than recommended doses it can cause torsades, cardiac aresst, or death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

education for loperamide (imodium)

A

stop in 48h if no improvment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

alosteron (lotrenex)

A
  • used to treat chronic-severe diarrhea in females that has not responded to other conventional therapies
  • 5HT3 receptor antagonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

BLACK BOX for alosteron (lotronex)

A
  • severe constipation
  • obstruction
  • perforation
  • hemorrhage
  • ischemic colitis

avoid if hx of perforation or chrons disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

bismuth salts

A
  • have antibacterial and antiviral activity
  • common OTC
  • has antisecretory and possible anti-inflammatory effect due to salicylate component
  • so do not give if aspirin allergy or children (reye’s syndrome
  • monitor for darkening of tongue and stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

octreotide

A
  • give subq or IV
  • synthetic form of somatostatin, a hormone produced in anterior pituitary gland and pancreas
  • drug may be effective in diarrhea because it decreases GI secretion and motility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

polycarbophil (fibercon) and psyllium

A
  • most often used as bulk-forming laxatives
  • can be used for diarrhea to absorb toxins and water decreasing fluidity of stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

cholesyramine and colestipol

A
  • bile salt accumulation in conditions like Chron’s or surgical excision of ileum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

glucose metabolism

A
  • glucose is an efficient source of fuel used by many body parts and organs for energy
  • the brain requires a continuous supply of glucose so if continuously low, it can cause brain dysfunction or death
  • after a meal, glucose levels raise and insulin is secreted by pancreatic beta cells in response
  • insulin is “key” that allows glucose to enter cells and be used for energy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

pancreas

A
  • exocrine gland that releases digestive enzymes into intestine including amylase, lipase, trypsin, and more
  • endocrine gland as alpha cells release glucagon and beta cells release insulin and amylin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

glucagon and insulin regulate the

A

mobilization and storage of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

alpha cells of pancreas release

A

glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

beta cells of pancreas release

A

insulin and amylin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what cells release exocrine and endocrine components of pancreas

A

islet’s of langerhans

88
Q

how does insulin work?

A
  • stimulates carbohydrate metabolism in skeletal muscle, cardiac muscle, and adipose tissue for ENERGY
  • facilitates glucose storage in liver (glucose turned into glycogen)
  • moves glucose into fat cells to be broken down
  • low insulin = fat released as free fatty acids increasing triglycerides/cholesterol
  • stimulates protein synthesis
89
Q

liver

A
  • excess glucose is stored in liver as glycogen
  • when insulin is absent or blood glucose is low, the liver breaks down glycogen (glycogenolysis) to make glucose
  • can break down fatty and amino acids to make glucose (glucogenesis)
  • alcohol can inhibit these processes
90
Q

if patient comes in with alcohol poisoning check…

A

blood sugar levels

91
Q

homeostasis for a body w/o diabetes

A
  • low blood sugar causes alpha cells to produce glucagon
  • glucagon stimulates the liver to breakdown stored glycogen and release glucose into circulation preventing hypoglycemia
  • a high blood sugar causes beta cells to produce insulin
  • insulin stimulates liver to convert glucose to glycogen enabling glucose to enter cells of body and be used for energy and metabolism
92
Q

increase in carbs increases the need for

A

insulin

93
Q

increase in physical activity decreases the need for

A

insulin

94
Q

endogenous insulin

A
  • beta cells secrete 40-60 units of insulin/day (1-2 untis/hr)
  • boluses should be given after meals or when blood glucose >100mg/dL (about 4-6 untis/hr)
  • beta cells secrete amylin a hormone that complements insulin, delays gastric emptying, and increases satiety and suppresses glucagon
  • food in GI tract also stimualte incetin hormones to delay gastric emptying and reduce glucagon production (GLP-1)
  • several hormones raise blood glucose like cortisol, epinephrine, glucagon, growth hormone, estrogen, progesterone
95
Q

type I diabetes

A
  • 10% of cases
  • autoimmune disorder that destroys pancreatic beta cells
  • usually being after age 4 and peaks between 10-12 (males) or 12-14 (females)
  • symptoms start when 10-20% beta cells reamin or stressed body needs more insulin
  • eventually no beta cells remain and need to administer insulin (no endogenous insulin so need for exogenous)
  • higher risk for DKA
96
Q

type II diabetes

A
  • 90% of cases
  • insulin resistance (need more than usual) usually impaired at cellular level
  • formerly developed >40 years old but age is decreased in children due to obesity
  • more gradual onset
  • usually starts with oral antidiabetics (metformin)
  • exogenous insulin not always required
97
Q

risks for type II diabetes

A
  • genetic
  • obesity
  • sedentary lifestyle
  • metabolic syndrome
98
Q

signs of diabetes

A
  • glucosoria
  • polydipsia (increased thirst)
  • polyuria (increased urination)
  • dehydration
  • polyphagia (increased hunger)
  • less obvious s/s
99
Q

prediabetes

A
  • blood glucose levels higher than normal (100-125) but not high enough to be diagnosed
  • usually no symptoms
  • may be referred as impaired glucose tolerance or impaired fasting glucose
  • increased risk for diabetes AND cardiovascular disease
  • should be retested for diabetes q1-2 years
  • enroll in diabetes prevention program
100
Q

normal A1c

A

5.7%

101
Q

prediabetic A1C

A

100-125 mg/dL

102
Q

diabetic A1C

A

> 6.5%

103
Q

normal fasting plasma glucose

A
  • <100 mg/dL
104
Q

prediabetic fasting glucose

A

100-125 mg/dL

105
Q

diabetic fasting glucose

A

> 126 mg/dL

106
Q

normal 75g oral glucose tolerance test (after 2hrs)

A

<140 mg/dL

107
Q

prediabetic 75g oral glucose tolerance test (after 2hrs)

A

140-199 mg/dL

108
Q

diabetic 75g oral glucose tolerance test (after 2 hrs)

A

> 200 mg/dL

109
Q

all diagnostics besides A1C should be

A

repeated on secondary day to repeat diagnosis

110
Q

diabetic ketoacidosis

A
  • ketones accumulate in blood causig acidemia (low pH and icnreased H+)
  • bdoy tries to compensate
  • result of no insulin and illness
  • early s/s: blurred vision, anorexia, n/v, thirst, polyuria
  • late s/s: drowsiness, stupor, coma, kussmaul respirations, fruity breath, dehydration, fluid and electrolyte imbalances, low BP, elevated HR, shock
  • labs: check BG OFTEN!, UA, bloodwork
  • treatment: continuous IV insulin, IVF, K+, sodium bicarb, ID and treat infection
111
Q

hyperosmolar hyperglycemic states (HHS)

A
  • no ketosis
  • excessive amount of glucose and electrolytes in body in relation to water
  • caused by unknown Dm or mild type II DM or after an illness
  • associated with other hyperglycemic conditions (burns, corticosteroid use)
  • s/s: glucosuria, dehydration, altered mental status progressing to seizures, coma
  • can lead to HHNC (non-ketotic coma)
  • labs: high BG, pH and bicarb will be higher in DKA, may have elevated BUN and creatinine
  • treatment: continuous IV insulin, IVF, K+, sodium bicarb, ID and treat underlying illness
112
Q

macrovascular abnormalities of diabetes mellitus

A
  • HTN
  • atherosclerosis, ischemic heart disease
  • myocardial infarction
  • stroke
  • peripheral vascular disease (PVD) which can lead to amputation
113
Q

diabetes mellitus microvascular abnormalities

A
  • retinopathy (can cause blindness)
  • nephropathy (can lead to CKD or renal failure)
114
Q

diabetic neuropathy

A
  • somatic: diminished perception; vibration, pain, temperature
  • autonomic neuropathy: defects in vasomotor, and cardiac responses, inability to empty bladder/urinary incontinence, impaired motility of GI tract (constipation), and sexual dysunfction
115
Q

What is the effect of stress hormones (e.g., epinephrine or cortisol) on blood glucose?

A

increased blood glucose

116
Q

What is the effect of exercise on blood glucose?

A

decreases blood glucose

117
Q

What is the effect of carbohydrate intake on blood glucose?

A

increases blood glucose

118
Q

exogenous insulins

A
  • lowers blood glucose by increasing uptake by body cells and decreasing production by liver
  • use is effective in those with type I diabetes, type II not controlled with diet, weight or orals, gestational diabetes and hyperkalemia
119
Q

pharmacokinetics of exogenous insulins

A
  • can be given subq or IV (regular ONLY)
  • subq: amount absorbed depends on injection site, pt bloody supply and degree of tissue hypertrophy at site
120
Q

what is the only form of insulin that can be given subq

A

regular insulin

121
Q

contraindication for insulin

A
  • hypoglycemia
  • hypersensitivity
122
Q

adverse effects of insulin

A
  • hypoglycemia
  • weight gain
  • lipodystrophy at site of injections
123
Q

drug interactions with insulin that increase effect causing risk for hypoglycemia

A
  • oral hypoglycemics
  • alcohol
  • beta blockers
  • antimicrobials
  • ACE inhibitors
124
Q

drug interactions that decrease effect on insulin causing risk for hyperglycemia

A
  • thiazide diuretics
  • glucagon
  • oral contraceptives
  • thyroid drugs
  • phenytoin
  • corticosteroids
125
Q

hypoglycemia

A
  • blood glucose <60-70
  • cold, clammy skin
  • tachycardia
  • palpitations
  • diaphoresis
  • shakiness
  • change in mental status
  • headache
  • weakness
126
Q

education for hypoglycemia

A
  • med-alert bracelet recommended
  • treat hypoglycemia per protocol
  • if pt is awake and alert give them 15g of carbohydrates like glucose tablets, juice, crackers, sugar, etc.
  • if pt is unresponsive IV push 25-50% dextrose or IM glucagon
  • retest levels and repeat if necessary
127
Q

rapid acting insulin

A
  • insulin lispro
  • insulin aspart
  • insulin glulisine
128
Q

short acting insulin

A

regular insulin

129
Q

intermediate acting insulin

A

NPH

130
Q

long actin insulin

A
  • insulin glargine
  • insulin detemir
131
Q

give rapid acting insulin when

A

right before meal because it will start working immediately (within 15 minutes)

132
Q

bolus doses of insulin are typically

A

rapid acting

133
Q

combination insulin

A
  • composed of short and intermediate-acting or rapid-and-intermediate acting
  • ex. humulin 70/30 (isophane NPH 70% regular 30%), insulin isophane NPH 50/50 (humulin NPH 50%,regular 50%), humalog 75/25 (lispro protamine 75% lispro 25%
134
Q

inhaled insulin

A

afrezza

135
Q

onset peak and duration of lispro (rapid acting)

A

onset 15 min>
peak 1-1.5hr
duration 6-8hrs

136
Q

onset peak and duration of aspart (rapid acting)

A

onset 10-20 minutes
peak 1-3hrs
duration 3-5hrs

137
Q

onset peak and duration of regular insulin (short acting insulin)

A

onset 30-60min
peak 2-3hrs
duration 5-7hrs

138
Q

onset peak and duration of NPH (humulin N) (intermediate)

A

onset 1-1.5hrs
peak 8-12hrs
duration 18-24hrs

139
Q

onset peak and duration of glargine (long acting)

A

onset 60+ minutes
peak none
duration 24hrs

140
Q

you can mix what kinds of insulin

A

intermediate and short acting

141
Q

all insulin orders should be in…

A

units

142
Q

insulin considerations

A
  • main insulin concentration is U-100 in US
  • measured with orange tipped syringes
  • subq injection absorbed most rapidly in abdomen, then upper arm, tight, and buttocks
  • two nurses should check dosage prior to administration
  • can be used with oral agents
  • unopened vials stored in fridge, open vials/pens at room temp for 28 days
  • insulin pens
  • insulin pumps
143
Q

benefits of insulin pens

A
  • multidose
  • easier than the syringe
  • easier to see than syringe
  • easy to throw in bag and keep with you
144
Q

insulin pump benefits

A
  • constant placement
  • less injections
145
Q

patient education for administration of insulin

A
  • prime insulin pens
  • hold pens in for 10 seconds
  • do not share needles and pens w/ others
  • carry candy or something sweet incase hypoglycemic episode occurs
  • medical alert band
  • don’t skip meals
  • teach back
  • clean site
  • monitor levels before
  • type of insulin and when to take it
  • rotation of sites
  • hand hygeine
  • s/s of hypo and hyperglycemia
  • what is sliding scale and how to use it
  • how to inject, angle, locations, technique
  • disposal of needle
146
Q

special considerations for administration of insulin

A
  • KIDS
  • coordinate insulin w/ meals and snack
  • create schedule
  • higher risk for hypoglycemia
  • often present different with signs of lethargy and irritability
147
Q

mixing insulins

A
  • for mixed dose, putting sufficient air into both bottles before drawing up dose is important
  • when mixing rapid or short acting insulin with intermediate, the clear rapid or shortacting should be drawn FIRST
  • never mix long acting
148
Q

what insulin should be drawn first in mixed insulins

A

clear short acting or rapid acting
then cloudy intermediate

149
Q

goals for drug therapy of diabetes mellitus

A
  • blood glucose levels normal or near normal
  • promote normal metabolism of carbs, fats, and protein
  • prevent acute and long-term complications
  • prevent hypoglycemic episodes
150
Q

insulins drug class

A

regular insulin (humulin R)

151
Q

sulfonylureas

A

glyburide (glynase)

152
Q

biguanide

A

metofrmin
inital drug of choice

153
Q

alpha glucosidase inhibitors

A

acarbose (precose)

154
Q

thiazolidinediones

A

rosiglitazone (avandia)

155
Q

meglitinides

A

repaglinide (prandin)

156
Q

glucagon like peptide 1 receptor antagonists

A

exenatide (byetta)

157
Q

dipeptidyl peptidase 4 inhibitor

A

sitagliptin (januvia)

158
Q

amylin analgos

A

pramlintide (symlinpen)

159
Q

adjuvent meds for diabetes

A
  • ACE inhibitors
  • ARBs
  • thiazide diuretics
  • antiplatets
  • HMG-CoA reductase inhibitors
160
Q

alpha-glucosidase inhibitors like acarbose work on

A

GI tract to decrease absorption of glucose

161
Q

thiazolidinediones like rosiglitazone work on

A

liver and muscle tissue to decrease insulin resistance

162
Q

meglitinides and sulfonylureas like repaglinide and glyburide work on

A

increase secretion of insulin

163
Q

dipeptidyl peptidase 4 inhibitors like sitagliptin work on

A

prolonging action of incretin hormones to increase secretion of insulin by the pancreas

164
Q

biguanide like metformin works on

A
  • liver to decrease production of glucose
  • muscle and fat to increase glucose uptake
  • GI tract to decrease absorption of glucose
165
Q

biguanide and liver

A

redueces hepatic glucose production

166
Q

pancreas and sulfonylereas and meglitinides

A

stimulate insulin secretion

167
Q

thiazolidinediones and giduanide

A

increase insulin sensitivity on cells and tissues

168
Q

alpha-glucosidase inhibitors work on

A

gut to block absorption of glucose

169
Q

GLP-1 receptor agonists and DPP-4 inhibitors act by

A

mimicing incretins to increase pancreatic release of insulin

170
Q

SGLT-2 transporters effect

A

kidneys by reducing renal glucose reabsorption

171
Q

glyburide (glynase)/ sulfonylureas action and contraindications

A
  • increase insulin secretion by pancreatic beta cells
  • not commonly prescribed as high risk for hypoglycemia
  • hypersensitivity to sulfa-based meds or med itself
  • severe renal impairment
  • severe hepatic impairment
172
Q

cautions for glyburide (glynase)/ sulfonylureas

A
  • pregnancy
  • lactation
  • pituitary or thyroid issues
173
Q

education for glyburide (glynase)/ sulfonylureas

A

take with breakfast

174
Q

biguanides/metformin action and contraindications

A
  • used in 1st line treatmet for type II diabetes
  • decreases hepatic glucose production
  • decreases intestinal absorption of glucose to increase insulin sensitivity and uptake
  • don’t give with sevre hepatic or renal disease, age 80+, cardiac/resp insufficiency, or hx of lactic acidosis
175
Q

adverse effects of metformin (biguanides)

A
  • lactic acidosis
  • dizziness
  • n/v
  • diarrhea
  • abdominal discomfort/cramping
  • malabsorption of aminoacids
  • weight loss
176
Q

patient education for metformin (biguanides)

A
  • take whole with meals in evening
  • meds may be held for procedures using IV contrast dye
  • when taking w/ certain drug there is increase risk of hypoglycemia
  • don’t take w/ alcohol
177
Q

alpha-glycosidase inhibitors/acarbose (precose)

A
  • inhibits enzymes responsible for digesting carbs (sucrase, maltase, and amylase)
  • does not enhance insulin so often prescribed with another drug that does
  • don’t give if in DKA, w/ cirrhoisis, inflammatory/malabsorptive intestinal disease (chron’s/UC), or sevre abnormal kidney function
178
Q

adverse effects of acarbose (precose)/ alpha-glycosidase inhibitors

A
  • bloating
  • diarrhea
  • will NOT cause hypoglycemia
  • may effect blood count
  • CAN DECREASE DIGOXIN LEVELS
179
Q

patient education on acarbose (precose)/alpa-glycosidase inhibitors

A
  • take when starting meals
  • if taken in conjunction with another med and hypoglycemia occurs, glucose or glucagon must be given
  • prevents digestion of carbs so don’t give if hypoglycemic
  • start low and build dose
180
Q

thiazolidinediones/ rosiglitazone maleate (avandia)

A

decreases insulin resistance

not commonly prescribed as high risk for HF and atherosclerotic CV events

needs effective beta cells to be effective

181
Q

meglitinides/repaglinide (prandin)

A
  • stimulates pancreatic secretion of insulin
  • when given combo with insulin or metformin, better reduction of A1C than when either used alone
182
Q

adverse effects of meglitinides/repaglinide (prandin)

A
  • hypoglycemia is most common
183
Q

education for meglitinides/repaglinide (prandin)

A
  • take 15-30 minutes before each meal
184
Q

incretin based therapies GLP and GIP agonists

A
  • following ingestion of meal, gut hormones including glucagon-like-peptide 1 releases in circulation
  • exerts 4 main actions
    1. stimulates release of insulin and improves sensitivity
    2. decreases/slow gastric emptying
    3. may increase formation of new beta cells
    4. decreased glucagon production
185
Q

dipeptidyl peptidase 4 (DPP4) inhibitors/Sitagliptin (Januvia)

A

prevents inactivation of incretins by inhibitng the DPP4 enzyme; therby increasing incretin levels

186
Q

contraindications of DPP4/Sitagliptin (januvia)

A
  • insulin use
  • urine ketones
  • KF
  • HF risk
  • don’t use w/ other meds that can cause hypoglycemia
187
Q

patient education for DPP4/Sitaliptin (Januvia)

A
  • oral meds taken daily w/ or w/o food
188
Q

adverse effects of DPP 4/ Sitagliptin (januvia)

A
  • URI s/s
  • stuffy nose
  • sore throat
  • headache
  • joint pain
189
Q

sodium glucose cotransporter 2 (SGLT2) Inhibitor/ Canagliflozin (Invokana)

A

decreases renal absorption of glucose and promotes excretion in urine

190
Q

contraindications for sodium glucose cotransporter 2 (SGLT2) inhibitor/Canagliflozin (Invokana)

A
  • hypersensitivity
  • severe or end stage renal disease
  • severe hepatic impairment
  • pregnancy
  • lactation
191
Q

caution in sodium glucose cotransportase inhibitor (SGLT2) / Canagliflozin (Invokana)

A
  • moderate renal disease
  • pancreatic disease
  • HF
  • hypovolemia
  • PVD
  • neuropathy
  • older pts at higher risk for hypotension, dizziness, and syncope
192
Q

benefits of SGLT-2 inhibitors/canagliflozin

A
  • systolic BP
  • weight loss
  • reduced CV death in pts with CVD
  • reduced hospitalizations for HF and reduced renal disease progression
193
Q

adverse effect of sodium glucose cotransportase inhibitors (SGLT2)/ Canagliflozin

A
  • genital yeast or fungal infections
  • hyperkalemia
  • UTI
  • dehydration
  • necrotizing fascitis of perineum (rare)
  • acute kidney injury
  • bone disease
  • increased risk of lower limb amputation
194
Q

preventing interactions w/ SGLT2s/canagliflozin

A
  • ACE inhibitors, ARBs, and loop diuretics can cause hypotension, syncope, and hyperkalemia
  • K+ sparring diuretics can cause hyperkalemia
  • insulin or antidiabetics can cause increased risk for hypoglycemia
195
Q

administration of SGLT2 inhibitors

A
  • assure hydration
  • take drug with first meal of day w/o regard to food
196
Q

monitoring for SGLT2 inhibitors

A
  • monitor hydration
  • monitor BP
  • monitor K+
197
Q

patient education for SGLT2 inhibitors

A
  • avoid salt substitutes because they carry K+
  • notify HCP prior to OTC meds or herbs
  • report s/s of yeast infection
198
Q

glucagon like peptide GLP 1 receptor agonists/exenatide (byetta)

A
  • incertin like action that potentiates secretion of insulin in presence of glucose
  • suppresses gluconeogenesis
  • slows gastric emptying
  • promotes satiety
199
Q

BLACK BOX warning of GLP1 receptor agonists

A
  • thyroid cancer in animals
200
Q

contraindications of GLP1 receptor agonists/Exenatide

A
  • hypersensitivity
  • liver disease on HMG-CoA reductase inhibitors
  • pregnancy/lactation
  • kidney failure
201
Q

adverse effects of GLP1 receptor agonists/exenatide

A
  • GI distress
  • nausea
  • hypoglycemia
  • weight loss
  • pancreatitis (rare)
202
Q

patient education for GLP1 receptor agonists/exenatide

A
  • 6 hrs between each dose
203
Q

amylin analogues/pramlintide (symlin)

A

works with mealtime insulin and potentiates its action mimicing naturally occuring amylin leading to slowed gastric emptying, increased satierty, suppresion of postprandial glucagon production
- high cost
- BLACK BOX: sevre hypoglycemia

204
Q

combination therapy of DM

A
  • can combine many therapies if glucose is not well controlled w/ one med + diet and exercise
  • drugs w. different mechanisms of action are combined
  • if failing to have adequate glycemic control, may need to discontinue and start insulin
  • insulin can also be combined with some drugs
205
Q

adjuvant meds for DM

A
  • other measures to help prevent diabetes complications
  • ACE inhbitiors to delay nephropathy and protect kidneys
  • ARBs to slow progression of nephropathy
  • thiazide diuretics/antiplatelets (aspirin) to reduce risk of CV events
206
Q

administer biguanides/metformin

A

with meals (morning or evening)

207
Q

administer sulfonylureas/glyburide

A

30 min before breakfast

208
Q

administer meglitinides/repaglinide

A

just before meals

209
Q

administer alpa-glucosidase inhbitors/acarbose

A

just before meals

210
Q

administer thiazolidinediones/rosiglitazone

A

with meals

211
Q

GLP-1 receptor antagonists/exentaide administration

A

just before moring and evening meals q6hr

212
Q

take SGLT2 inhibitors/canaglifozin

A

with first meal of day

213
Q

administer DPP4 inhibitors/sitaglipton

A

1x daily w/ or w/o food

214
Q

what type 2 meds can cause hypoglycemia

A
  • sulfonylureas/glyburide
  • meglitinides/repaglindine
  • GLP1 receptor antagonists
    TCZ and DPP4 can if combined with other meds
215
Q

nursing interventions for diabetes

A
  • use nondrug measures to improve diabetes and control complications
  • assist pt in diet maintenance
  • assist pt to develop and maintain regular exercise
  • interpret and perform blood tests for accurate readings
  • test urine for ketones when sick, when levels are >200, and when episodes of nocturnal hypoglycemia are suspected
  • educate family members
  • promote early recognition and treatment of problems by watching for UTI, PVD, vision changes, ketoacidosis, hypoglycemia, etc.
  • discuss importance of follow ups for BS measurements, weight, BP monitoring, and eye exams
  • educate on foot care
  • provide approriate pt teaching and combo therapy for pts with type 2 DM
216
Q
A

path/pharm (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions