Exam 5 Flashcards
What may occur to the insulin dose of a diabetic taking a corticosteroid (prednisone)? Why?
increase because steroids can cause increase in blood glucose
What is true concerning the discontinuation of steroid medications (dexamethasone)?
avoid discontinuing abruptly
What may be indications for medications such as triamcinolone, methylprednisolone, betamethasone (corticosteroids)?
RA, lupus, Crohn’s, Addison’s
What are indications for inhaled corticosteroids?
maintenance drugs, NOT rescue. asthma, COPD (chronic inflammation), rhinitis
When may those taking life-long corticosteroids require an increase dose?
high stress* or illnesses
What symptoms should those taking hydrocortisone report that may indicate the development of Cushing’s syndrome?
moon face, buffalo hump, muscle weakness, purple striae
what education should be provided to those taking corticosteroids (fludrocortisone, cortisol) to prevent osteoporosis, what should be increased in the diet to aid in this?
weight-bearing exercises
vitamin D and calcium
What time should hydrocortisone be taken?
in the morning while waking w/food
When is the onset of lispro/aspart/glulisine (rapid acting insulins)?
15-30mins
What is the duration of action for rapid acting insulins (lispro, aspart, glulisine)?
3-6 hrs
When is the highest risk for hypoglycemia (peak) for lispro (rapid acting)?
30 mins-2.5 hrs
When is the onset for regular insulin (short acting)?
30-60mins
What is the duration of action for short acting (regular) insulin?
6-10 hrs
How long after administration is the peak of regular insulin?
1-5 hrs
when is the onset of action for NPH (intermediate acting) insulin?
1-2hrs
How long does NPH (intermediate) work (duration)?
16-24hrs
When is the expected peak for NPH?
6-14hrs
what type of insulins should never be mixed with others?
long acting (detemir and glargine)
when is the onset for glargine/detemir?
70mins
How long does glargine last (duration)?
18-25hrs
What is the peak for detemir and glargine (long acting)?
there is no peak
What are complication of insulin?
hypoglycemia*, lipohypertrophy, hypokalemia
What are the indications for insulin?
glycemic (blood sugar) control of diabetes (1, 2, and gestational)
When are sulfonylureas (glipizide, glyburide, and glimepiride) used?
treatment of type 2 diabetes for patients that metformin is contraindicated in
If those taking glyburide (sulfonylurea) drink alcohol what may occur?
disulfiram-like reaction
What allergy is prevalent to glimepiride/glyburide?
sulfa allergy (those allergic to furosemide, Bactrim, etc)
Sulfonylureas (glipizide, glimepiride) are contraindicated in the treatment of which condition?
DKA
Why should muscle cramps, body aches, exhaustion, fast/deep breathing be reported by those taking metformin?
these could represent lactic acidosis
What teaching should the nurse give to a patient taking for metformin who is scheduled for a scan that requires IV contrast dye?
discontinue for 24-48 hrs before and 48hrs after
Which medication is used to treat BPH by making it easier to pee through relaxing the muscles in bladder?
tamsulosin
Why is it important for those taking tamsulosin for BPH to move positions slowly?
hypotension
Sildenafil and Tadalafil are PDE5 inhibitors used to treat which male reproductive condition?
erectile dysfunction
What are examples of medications that are contraindicated with sildenafil and tadalafil?
nitroglycerin and isosorbide mononitrate (nitrate meds)
What medication is used in the treatment of BPH by slowing growth of prostate tissue and used to stimulate hair growth?
finasteride
True or False: Finasteride is not effective immediately.
true, it can take up to 6 months or more
Who should avoid touching finasteride?
pregnant women (can cause birth defects in male babies)
Individuals taking finasteride shouldn’t donate blood for how long?
at least one month after discontinuation
If taking finasteride, what education should be provided concerning hypotension?
dangle legs, change positions slowly, sit if dizzy, and general safety
If a patient is severely hypoglycemic and cannot take oral glucose, what should be administered?
glucagon
What are examples of bisphosphonates?
alendronate, ibandronate, risedronate, zoledronate
What condition may alendronate be utilized in?
osteoporosis (prophylaxis, treatment of, paget disease)
How long should those taking risedronate or ibandronate remain upright? What time is it taken?
at least 30 mins after taking, this med is taken on empty stomach first thing in the morning
What medications are first generation antihistamines?
diphenhydramine, hydroxyzine, meclizine, promethazine
What are the indications for first generation antihistamines?
allergic rhinitis, motion sickness, induce sleep, decrease itching/sneezing/runny nose
What are common side effects of diphenhydramine?
anticholinergic effects (can’t see, pee, spit, poop)
What adverse effects may occur as a result of taking first generation antihistamines?
sedation, urinary retention
When would medications such as meclizine and promethazine be contraindicated?
in clients with BPH and narrow angle glaucoma
What drug class are fexofenadine, azelastine, loratadine, cetirizine, and levocetirizine?
2nd generation antihistamines
What medications are the first line therapy for mild/moderate allergic rhinitis and used for symptoms like itchy eyes/runny nose?
2nd generation antihistamines (fexofenadine, cetirizine, etc)
What should those taking cetirizine avoid?
Juice (apple, grapefruit, and orange)
What should 2nd generation antihistamines be taken with?
with food, while avoiding juice
Due to the risk of anticholinergic effects, what teaching should the nurse provide to those taking fexofenadine (2nd generation antihistamines)?
use hard candy, gum, ice chips, increase fluids/fiber, use caution in heat (due to limited diaphoresis)
What type of medications are phenylephrine and pseudoephedrine?
decongestants
How are decongestants like pseudophedrine effective?
vasoconstriction within nasal passages, shrinking of tissue, and reduction of secretions
What are potential adverse effects that may occur with decongestants?
cardio (palpitations, arrythmias, and HTN) and CNS (hallucinations, convulsions, delusions)
What are contraindications and precautions with decongestants?
contra: preexisting HTN, cardiac disease, hyperthyroidism, glaucoma
precaution: diabetes (hyperglycemia)
What are examples of topical (intranasal) decongestants?
tetrahydrozoline, xylometazoline, naphazoline, oxymetazoline
What would be more effective for *quicker relief of nasal congestion than pseudoephedrine?
topical decongestants such as oxymetazoline because they act directly on the nasal passages
How often should topical decongestants be taken?
for no more than 3 days at a time, every 12 hrs
What effects may occur with tetrahydrozoline (topical decongestants)?
dry mucus membranes, rebound congestion with overuse, dependance, systemic effects if medication is swallowed
When should guaifenesin be used (expectorant)?
to help clear mucus/phlegm and make cough more productive
What education should be provided for a patient receiving an expectorant medication?
coughing/deep breathing, increase fluids (8 glasses a day), and use in caution w/asthma due to bronchospasm
What type of medications are benzonatate, codeine, and dextromethorphan?
antitussives
What type of cough should antitussive medications be used in?
dry non productive cough
What effects may occur with codeine?
respiratory depression, dependance, drowsiness, dizziness, irritability/restlessness
What should be prescribed in case of respiratory depression with codeine (antitussive)?
naloxone
What are effects that may occur with dextromethorphan?
dizziness, nausea, sedation
What should be reported to the provider for a patient taking codeine?
rash/fever or cough that lasts longer than a week
What type of medications are used in the *maintenance of asthma and COPD, but not for acute attacks?
inhaled corticosteroids such as, ciclesonide, mometasone, flunisolide, triamcinolone, beclomethasone, budesonide
What are the contraindications of inhaled corticosteroids (budesonide, triamcinolone)?
active fungal infection, altered immune system, live virus vaccine, acute asthma
How can oral yeast be prevented for those using inhaled beclomethasone?
rinsing mouth with water
What may montelukast be used for?
prophylactic/chronic treatment of asthma
This adverse effect of leukotriene modifiers should be reported immediately and pt should go to ED?
SI - suicidal ideation
Ipratropium and tiotropium may be used in the treatment of what conditions?
pulmonary emphysema, bronchitis, and asthma
What are contraindications of ipratropium and tiotropium?
peanut allergies
For which present conditions should we assess before administering ipratropium or tiotropium (precautions)?
narrow angle glaucoma and BPH
What type of medications are theophylline and aminophylline?
methylxanthines (these relax airways, and reduce airway responsiveness to allergens)
What adverse effects may occur with a serum level of 20-25 mcg/ml of aminophylline?
insomnia, irritability, N/V/D, headaches
What adverse effects may occur with greater than 30 mcg/ml of theophylline?
seizures, arrythmias, brain damage, hypotension, hyperglycemia, and death
Patients taking a methylxanthines should avoid?
smoking and caffeine (tea, soda, chocolate, and coffee)
What s/s may represent a thromboembolic event, which could occur while taking estrogen medications?
A- abdominal pain
C- chest pain
H- headaches
E- eye changes
S- severe leg pain
What should the nurse do if the pts HR is over 100 and they are due for a dose of levothyroxine?
hold the med
