exam 3 Flashcards
The nurse has just administered the morning dose of a patient’s lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next?
Inform the patient of the delay.
Check the patient’s blood glucose levels.
Call the dietary department to send a tray immediately.
Give the patient food, such as cereal and skim milk, and juice.
Give the patient food, such as cereal and skim milk, and juice.
A nurse is completing a nursing history for a client who currently takes simvastatin (Zocor). The provider recommends adding ezetimibe to the client’s medications. Which of the following disorders is a contraindication to adding ezetimibe (Zetia) to the client’s medications?
A. History of severe constipation
B. History of hypertension
C. Active hepatitis C
D. Type 2 diabetes mellitus
Active hepatitis C
Mechanism of Action/Drug effects
Competitively bind to aldosterone receptors
Block resorption of sodium and water usually induced by aldosterone,
Interfere with sodium-potassium exchange
Potassium-Sparing Diuretics
Also known as aldosterone-inhibiting diuretics
Examples;
spironolactone (Aldactone)
Onset 1-2 hr, Duration: 24 hr
Clear, colorless solution
Usually dosed once daily, referred to as basal insulin
Examples:
glargine (Lantus), detemir (Levemir)
Long-acting insulins
Indications
Hypertension (first line for HTN)
Others: edematous states, idiopathic hypercalciuria
Thiazide and Thiazide-like Diuretics
Glucocorticoids are used for ____
antiinflammatories or immune suppressant
Adrenal steroid
Mechanism of Action/Drug Effects
Work in the proximal tubule, no absorbable, producing an osmotic effect
Pull water into the renal tubules from the surrounding tissues
mannitol (Osmitrol)
Osmotic Diuretics:
Intravenous infusion only, use filter is required
May crystallize when exposed to low temperatures
restores the diabetic patient’s ability to:
Metabolize carbohydrates, fats, and proteins
Store glucose in the liver, convert glycogen to fat stores
Insulins
The nurse should teach a patient taking an oral corticosteroid to take the medication at what time?
8:00 AM
12 noon
5:00 PM
8:00 PM
8:00 AM
Powder forms must be taken with a liquid, mixed thoroughly but not stirred, and never taken dry
Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption
Bile acid sequestrant
A patient who is taking a thyroid replacement medication tells the nurse that she is starting to experience cold intolerance, depression, constipation, and dry skin. The nurse anticipates that these manifestations are caused by
inadequate doses of the medication.
possible overdose of the medication.
worsening of the underlying disease.
drug interactions with another medication.
inadequate doses of the medication.
Mechanism of action:
Delay breakdown of incretin hormones by inhibiting the enzyme DPP-IV
Incretin hormones increase insulin synthesis and lower glucagon secretion
Reduce fasting and postprandial glucose concentrations
Examples:
sitagliptin (Januvia)
saxagliptin (Onglyza)
linagliptin (Tradjenta)
Dipeptidyl peptidase-IV (DPP-IV) inhibitors “gliptin”
Used in the treatment of Cushing’s syndrome, metastatic breast cancer, and adrenal cancer
Adrenal steroid inhibitor
aminoglutethimide (Cytadren)
The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include?
Avoid prolonged exposure to the sun.
Avoid foods high in potassium content
.
Stop taking the medication if you feel dizzy.
Weigh yourself once a week and report a gain or loss of more than 1 pound.
Avoid prolonged exposure to the sun.
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is:
The medication is better absorbed at this time.
This timeframe correlates better with the natural diurnal rhythm of cholesterol production.
There will be fewer adverse effects if taken at night instead of with the morning meal.
This timing reduces the incidence of myopathy.
This timeframe correlates better with the natural diurnal rhythm of cholesterol production.
Result in the removal of sodium and water
Used in the treatment of hypertension, heart failure, and renal failure
Diuretic Drugs
Adverse effects:
FDA: postmarketing cases of acute pancreatitis
Hypoglycemia can occur and is more common if used in conjunction with a sulfonylurea
Dipeptidyl peptidase-IV (DPP-IV) inhibitors “gliptin”
When administering aminoglutethimide (Cytadren) to a patient, it is most important for the nurse to monitor:
serum electrolytes. cardiac enzymes. liver enzymes. arterial blood gases.
liver enzymes.
Adverse Effects
Serious: Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis
Common: Elevations in liver enzymes or liver disease, Mild, transient GI disturbances,
Antilipemics
HMGs, or “statin”s
Interactions:
Oral anticoagulants and Statins (Risk for myopathy is increased)
Laboratory test reactions: (lactate dehydrogenase level, Decreased H/H, wbc , Increased aPTT, and bilirubin level)
gemfibrozil (Lopid), fenofibrate (Tricor)
Fibric Acid Derivatives “fibrate”
Indications
Edema associated with HF or hepatic or renal disease, HTN
hypercalcemia– increase renal excretion of calcium
Loop Diuretics
bumetanide (Bumex), furosemide (Lasix),torsemide (Demadex)
Adverse effects:
Serious: hyperkalemia,
Common: GI cramp, nausea, vomiting, etc
Potassium-Sparing Diuretics
Also known as aldosterone-inhibiting diuretics
Examples;
spironolactone (Aldactone)
A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease [GERD]). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone?
Furosemide
Levothyroxine
Proton pump inhibitor
Antacid
Furosemide
Fish oil products, used to reduce cholesterol
May cause rash, belching, allergic reactions
Potential interactions with anticoagulant drugs
Omega-3 Fatty Acids
Adverse effects:
Cardiac dysrhythmia is the most significant adverse effect
May also cause:
Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, sweating, heat intolerance, fever, others
Levothyroxine
Regular insulin (Humulin R)
Onset 30 to 60 minutes;Duration: 6-10 hr
The only insulin can be given by IV or even IM
Short-acting insulins
During pregnancy,
treatment for hypothyroidism should _______
otherwise Fetal growth may be retarded
continue
is the combination of triglyceride or cholesterol with apolipoprotein
Lipoprotein
Prevent resorption of bile acids from small intestine
Bile acids are necessary for absorption of cholesterol
Bile Acid Sequestrants
(cholestyramine (Questran),
A male patient who has a history of type 2 diabetes mellitus is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about hemoglobin A1C. The nurse will inform the patient that hemoglobin A1C provides information regarding:
which type of diabetes the patient has.
if he has an infection.
patient compliance with treatment regimen for several months previously.
current fasting blood glucose level.
patient compliance with treatment regimen for several months previously.
Adverse effects:
Serious: Hepatitis and myopathy
ezetimibe (Zetia
Cholesterol Absorption Inhibitor
A woman who has type II diabetes is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive?
She should continue the antidiabetic medication at the same dosage.
The antidiabetic medication dosage will be increased gradually throughout her pregnancy.
She will be switched to insulin therapy while she is pregnant.
She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely.
She will be switched to insulin therapy while she is pregnant.
The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient?
Store the insulins in the refrigerator
Shake the insulins for 1 full minute before use.
Administer the injection at a 30-degree angle to your skin.
Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe.
Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe.
Adverse Effects
Common: Constipation, heartburn, nausea, belching, bloating- tend to disappear over time
(cholestyramine (Questran)
The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin?
Insulin glulisine (Apidra) Insulin isophane suspension (NPH) Insulin detemir (Levemir) Regular insulin (Humulin R)
Insulin detemir (Levemir)
Preferred method of treatment for hospitalized diabetic patients
Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus
Basal insulin is a long-acting insulin (insulin glargine) Bolus insulin (insulin lispro or insulin aspart)
Basal-Bolus Insulin Dosing
A patient has been taking levothyroxine for 6 months. After this month’s laboratory work, the nurse practitioner tells the nurse that the patient is “euthyroid.” What does that term mean?
The patient is experiencing hyperthyroidism.
The patient is experiencing hypothyroidism.
The patient’s thyroid hormone levels are within normal limits.
The patient’s thyroid hormone levels are still fluctuating.
The patient’s thyroid hormone levels are within normal limits.
Which information will the nurse include when teaching a patient about thyroid replacement therapy?
“Take the medication before bed.”
“You will experience beneficial effects of the drug after one week of treatment.”
“Stop taking the drug if you experience insomnia.”
“Take the medication on an empty stomach.”
“Take the medication on an empty stomach.”
Adverse effects:
Most Common: flatulence, diarrhea, abdominal pain
*Do not cause hypoglycemia, hyperinsulinemia, or weight gain
Alpha-glucosidase inhibitors
Adverse effects:
Common: hypoglycemic effects, weight gain,
Others: headache, dizziness, joint pain, upper respiratory infection or flulike symptoms
Glinides “glinide”
Indications:
To reduce intracranial pressure, treatment of cerebral edema
NOT indicated for peripheral edema
Acute renal failure – early, oliguric phase
mannitol (Osmitrol)
Osmotic Diuretics:
Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption
Increase renal prostaglandins-dilation of blood vessels
Potent diuresis-loss of fluid, potassium and sodium loss
Loop Diuretics
bumetanide (Bumex), furosemide (Lasix),torsemide (Demadex)
A patient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be to:
take the medication at bedtime.
take the medication with a small dose of a steroid.
take the medication with a full glass of water on an empty stomach.
start with a low initial dose, and then increase it gradually.
start with a low initial dose, and then increase it gradually.
Inhibits absorption of cholesterol and related sterols from the small intestine
Often combined with a statin drug
ezetimibe (Zetia
Cholesterol Absorption Inhibitor
To treat all three forms of hypothyroidism. ________ is the preferred drug because its hormonal content is standardized.
Levothyroxine
Mechanism of action:
Stimulate pancreas to secretion insulin (Beta cell function?)
result in lower blood glucose levels
Examples:
Second generation: glipizide (Glucotrol), glyburide (DiaBeta, Micronase) glimepiride (Amaryl),
Sulfonylureas
Insulin isophane suspension (also called NPH)
Cloudy appearance
Onset: 1-2 hr, duration: 10-18 hr
Intermediate-acting insulins
Adverse effects:
The most common: affects GI tract, abdominal bloating, nausea, cramping, diarrhea, feeling of fullness
Lactic acidosis is rare but lethal if it occurs
Others: metallic taste, reduced vitamin B12 levels
Biguanides
Believed to work by activating lipase, which breaks down cholesterol
Also suppress the release of free fatty acid from adipose tissue, inhibit synthesis of triglycerides in the liver, and increase secretion of cholesterol in the bile
Fibric Acid Derivatives “fibrate”
gemfibrozil (Lopid), fenofibrate (Tricor)
Drugs used to lower lipid levels
Used as an adjunct to diet therapy
Antilipemic drugs
increase activity of lipase, which breaks down lipids
Effective in lowering triglyceride, total serum cholesterol, and LDL levels, increases HDL levels
Niacin
Adverse effects:
FDA warning: Fluid and electrolyte depletion,
Serious: severe hypokalemia, bone marrow suppression
Common: dizziness, hypotension, hyperglycemia, urinary frequency
Loop Diuretics
bumetanide (Bumex), furosemide (Lasix),torsemide (Demadex)
Mechanism of action:
Reversibly inhibit the enzyme alpha-glucosidase in the small intestine
Result in delayed absorption of glucose
Must be taken with meals to prevent excessive postprandial blood glucose elevations (with the “first bite” of a meal)
Examples:
acarbose (Precose), miglitol (Glyset)
Alpha-glucosidase inhibitors
( first line drug for type 2)
Mechanism of Action:
Decrease glucose production by the liver
Improve insulin receptor sensitivity
Do not increase insulin secretion, do no cause hypoglycemia
metformin (Glucophage)
Biguanides
Adverse Effects
Serious: myopathy, rhabdomyolysis, Increased risk of gallstones,
Common: Liver enzyme levels increase, abdominal discomfort, diarrhea, nausea, prolonged prothrombin time,
gemfibrozil (Lopid), fenofibrate (Tricor)
Fibric Acid Derivatives “fibrate”
Onset: 15 minutes, Duration: 3-5 hr
Patient must eat a meal after injection
Insulin lispro (Humalog) Similar action to endogenous insulin Insulin aspart (NovoLog) Insulin glulisine (Apidra)
May be given subcutaneously or via continuous subcutaneous infusion pump (but not IV)
Rapid-acting insulin
When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug?
lithium (Eskalith)
acetaminophen (Tylenol)
penicillin
theophylline
lithium (Eskalith)
The patient is ordered furosemide (Lasix). Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class?
Aminoglycosides
Sulfonamides
Macrolides
Penicillins
Sulfonamides
Used as an antispasmodic, antihypertensive, antiplatelet, lipid reducer
Adverse effects: dermatitis, vomiting, diarrhea, flatulence, antiplatelet activity
Possible interactions with warfarin, diazepam
May enhance bleeding when taken with NSAIDs
Garlic
Subcutaneous short-acting or regular insulin doses adjusted according to blood glucose test results
Sliding-Scale Insulin Dosing
A nurse is collecting data from a client who is taking gemfibrozil (Lopid). Which of the following assessment findings is an adverse reaction to the medication? A. Mental status changes B. Tremor C. Jaundice D. Pneumonia
C. Jaundice
Mechanism of action :
Decrease insulin resistance, “Insulin sensitizing drugs”
Increase glucose uptake and use in skeletal muscle
Inhibit glucose and triglyceride production in the liver
Examples: Also known as “glitazones”
Thiazolidinediones“glitazones”
Produced by the liver
Transports endogenous lipids to the cells
Very-low-density lipoprotein (VLDL)
start on low initial dose and gradually increase it, and take with meals
Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing
Niacin- to minimize adverse effects of niacin,
Glucocorticoids differ in their potency, duration of action, and the extent to which they cause ______ retention
salt and fluid
Which would be the best menu choice for a patient who is taking an antithyroid medication?
A seafood platter
Sushi
Tofu burger
Pasta with marinara sauce
Pasta with marinara sauce
Better tolerated when given with food
Give at the same time each day to maintain consistent blood levels
Never stop these medications abruptly
Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)
Antithyroid Drugs
A patient with type 1 diabetes is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). He is placed on IVPB antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastrointestinal esophageal reflux disease (GERD). He takes a dose of glargine insulin every evening. That evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels?
The albuterol
The antibiotics
The proton pump inhibitor
The corticosteroid
The corticosteroid
Humulin 70/30
Humulin 50/50
Novolin 70/30
NovoLog 70/30
Fixed combinations (less use) insuins
Indications:
To reduce intracranial pressure, treatment of cerebral edema
NOT indicated for peripheral edema
Acute renal failure – early, oliguric phase
mannitol (Osmitrol)
Osmotic Diuretics:
and not to switch brands without primary care provider approval
report any unusual symptoms, chest pain, or heart palpitations
not to take over-the-counter medications without primary care provider approval
Alerting health care providers if start taking other medication (anticoagulants, hypoglycemic meds, digoxin)
Antithyroid Drugs
loop diuretic is the strongest type of ______
Diuretic Drugs
Both the seed and oil of the plant are used
Uses: atherosclerosis, hypercholesterolemia, GI distress, menopausal symptoms
May cause diarrhea and allergic reactions
Possible interactions: antidiabetic drugs,anticoagulant
Flax
Cautious use in patients with
Gastritis, reflux disease, ulcer disease
Diabetes
Cardiac/renal/liver dysfunction
Adrenal steroid
Adverse Effects:
Serious: convulsions, thrombophlebitis, pulmonary congestion
Others: headache, nausea, vomitting
mannitol (Osmitrol)
Osmotic Diuretics:
A patient is taking an inhaled corticosteroid for asthma. After the patient takes a dose of the inhaler, the nurse’s priority should be to:
listen to the patient’s breath sounds.
have the patient rinse his mouth with warm water.
instruct the patient to cough and deep breathe.
take the patient’s apical pulse for 1 minute.
have the patient rinse his mouth with warm water.
Adverse Effects
Serious: hepatotoxicity
Common: Flushing (caused by histamine release), pruritus, GI distress, hyperuricemia
Niacin
Interaction:
with iodinated radiologist contrast increase risk of acute renal failure and lactic acidosis
Biguanides
Indications:
Hypertension, HF, Reversing potassium loss caused by potassium-losing drugs, hyperaldosteronism
Potassium-Sparing Diuretics
Also known as aldosterone-inhibiting diuretics
Examples;
spironolactone (Aldactone)
Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)?
Hypocalcemia
Hypophosphatemia
Hypokalemia
Hypomagnesemia
Hypokalemia
Adverse effects
Cause peripheral edema and weight gain, risk of CHF?
Hepatic toxicity—monitor alanine aminotransferase (ALT) levels
Others: reduce bone density
Thiazolidinediones“glitazones”
While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. The most appropriate action by the nurse is to
administer the infusion slowly.
discard the solution and obtain another bag of medication.
obtain a filter, and then infuse the solution.
return the fluid to the IV bag to dissolve the crystals.
discard the solution and obtain another bag of medication.
methimazole (Tapazole)
Propylthiouracil (PTU)
Antithyroid drugs-thioamide derivatives
Adverse effects:
Serious: hypokalemia and electrolyte imbalance, bone marrow
Common: hypokalemia, hypochloremia, hypokalemia, hyperglycemia,
Thiazide and Thiazide-like Diuretics
replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid)
levothyroxine (Synthroid, Levoxyl)
Synthetic thyroid hormone T4
Adverse effect: potent effects on all body systems
electrolyte imbalances (hypokalemia, hypernatremia)
Adrenal Steroid
Metolazone remains effective to a creatinine clearance of 10 mL/min
metolazone (Mykrox, Zaroxolyn)
Mechanism of action:
Increase insulin secretion from the pancreas
Examples:
repaglinide (Prandin), nateglinide (Starlix)
Glinides “glinide”
The nurse enters the patient’s room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose reading of 48 mg/dL. What is the most appropriate response by the nurse?
Place a packet of table sugar in the patient’s mouth.
Start CPR.
Roll the patient to the side and administer the ordered glucagon.
Have the patient drink orange juice.
Roll the patient to the side and administer the ordered glucagon.
Adverse effect:
The most common: Hypoglycemia, weight gain
Others: hematologic effects, nausea, epigastric fullness, heartburn, many others
Contraindication:
Hypoglycemia, limited caloric intake, allergic to sulfa
**What is the best time to take it? When to hold?
Sulfonylureas
first-line drug therapy for HLD
Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol-Lower the rate of cholesterol production
HMGs, or “statin”s
Antilipemic drugs
not be used if creatinine clearance is less than 30 to 50 mL/min (normal is 125 mL/min)
hydrochlorothiazide (Esidrix, HydroDIURIL)
Responsible for “recycling” of cholesterol
Also known as “good cholesterol”
High-density lipoprotein (HDL)
Interactions:Interactions
Oral anticoagulants
Drugs metabolized by CYP3A4
Erythromycin, Azole antifungals, Verapamil, Diltiazem, HIV protease inhibitors, Amiodarone, Grapefruit juice
Antilipemics
HMGs, or “statin”s
Mechanism of Action/Drug Effect
Inhibit tubular resorption of sodium, chloride, and potassium
Dilate the arterioles by direct relaxation
Thiazide and Thiazide-like Diuretics
