Exam 3 (4/26) Flashcards
Know indications for sitagliptin (Januvia)
Monotherapy for those in who metformin is contraindicated or not tolerated.
Not for type 1 diabetics
promotes the release of insulin and decreases the release of glucagon
Used in combination with metformin and other agents.
Review AE’s of glipizide (Glucotrol)
Hypoglycemia
Weight gain
GI discomfort
Review proper handling, storage, and administration of insulin
All insulins: Protect from heat and light. Do not freeze.
Vials:
Unopened:
If stored in the refrigerator, good until the expiration date on the label.
If stored at room temperature (up to 86o F), good for 1 month.
After opening: Mark the expiration date on all opened vials.
Good for about a month (regardless if stored at room temp. or in the refrigerator.)
Before administering insulin ALWAYS check your patient’s blood glucose levels
Roll vials between hands prior to withdrawing dose. Do NOT shake to mix suspensions.
Only use insulin syringes, calibrated in units to measure and give insulin
Check doses with another RN before administering
Ensure correct timing of doses with meals and know if the patient is NPO
When combining 2 compatible insulins in 1 syringe, withdraw the Regular or rapid-acting insulin first
Pens:
Most require removal of needle after every injection. Store without needle attached.
Only give regular insulin through IV
Insulin in pumps:
Insulin in reservoir should be discarded after at least every 6 days.
Infusion set (tubing) and infusion insertion site should be changed every 3 days
Identify the importance of rotating sites when administering insulin
Prevents lipodystrophy: lumps (fat) that interfere with insulin absorption
Better absorption and metabolism when sites are rotated.
Know the advantages of basal-bolus insulin therapy
It most closely mimics function of a healthy pancreas
Also allows for flexibility as to when meals are taken
Review the black box warning for pioglitazone (Actos)
Black box warning: Exacerbates CHF
S/S:
Excessive, rapid weight gain, dyspnea, and or edema.
Review interactions between insulin and beta blockers
Pt’s who are diabetic and are taking insulin and beta blockers need to be careful with monitoring blood glucose carefully.
May not be aware of hypoglycemic effects as quickly.
Identify serious AE’s of metformin (Glucophage)
Lactic acidosis: Extremely rare but serious complication vitamin B12 deficiency if used for long term GI: N/D, Anorexia Discontinue metformin (Glucophage) 24 hours before using IV contrast dye for a CT or MRI. Iv contrast dye is hard on the kidneys and so is metformin so the two should not be administered together.
Know the onset of action for each of the prototype insulins
Lispro (Humalog): Rapid-acting Onset: 15 min Regular (Humulin R): Short-acting Onset: 30-60 mins Isophane Suspension (NPH; Humulin N): Intermediate-acting Onset: 1-2 hours Insulin glargine (Lantus): Long-acting Onset: 1-2 hours
Review glycemic goal recommendations from the ADA
Fasting blood glucose 70-130
Know advantages to taking exenatide (Byetta)
Does not need to be taken as frequently
Causes weight loss and appetite suppression
Know nursing interventions for a client who is NPO and taking oral antidiabetic drugs
Primary concern is how long they will be NPO
Check blood glucose level
Consult with prescriber and figure out if you should administer or not
Review the rationale for holding metformin (Glucophage) for a client receiving IV contrast for CT/MRI
Both are very hard on the kidneys, kidney damage
Discontinue 24 hours before using IV contrast dye.
Know indications for glucagon (GlucaGen)
Insulin-induced hypoglycemia
Non-responsive with hypoglycemia
Converts liver glycogen to glucose
Review administration timing for glipizide (Glucotrol)
30 minutes prior to meals
Understand how to appropriately administer a beta 2 adrenergic agonist and a glucocorticosteroid inhaler when both are prescribed to the client
Use short-acting preparations for acute exacerbations
Use long-acting preparations for long-term control
Inhale beta 2 adrenergic agonists BEFORE inhaling glucocorticoids
Follow dosage limits and schedules
Monitor and Report:
Tachycardia
Heart palpitations
Chest pain
Understand when to give albuterol prescribed for exercise induced asthma
Use inhaler 15-30 minutes before exercise
Know the indications and contraindications for albuterol
Indications: asthma (short & long-term management)- bronchodilator Contraindications: uncontrolled hypertension cardiac dysrhythmias high risk for stroke
Know adverse effects of inhaled anticholinergics: ipratropium (Atrovent)
Dry mouth
Hoarseness
Increased intraocular pressure
Urinary retention
Understand appropriate dosing, frequency, when to give ipratropium
Administer using a nebulizer or inhaler
Maintain the prescribed time between puffs – wait 1-2 minutes before inhaling second dose (if prescribed)
Delay use of other inhalants for 5 minutes
Rise the mouth after use to avoid unpleasant taste and mucosal dryness
May cause mouth dryness – provide water and hard candy
Monitor urinary retention – especially in older adults
Do NOT use as emergency rescue drug!
Maintenance drug- scheduled twice daily
Know food interactions with theophylline
Caffeine
Charcoal broiled food
Diet high in protein and low in carbs
St. John’s wort, Smoking (nicotine), Cimetidine, floroquinolones
Know theophylline therapeutic blood level range
5-15 mcg/ml
Can give activated charcoal if too high (to decrease absorption)
