Final Exam Flashcards
1
Q
Beneficence
A
Protect research subjects from harm
2
Q
What 3 drugs to check peak and troughs
A
Gentamicin
Vanco
Anticonvulsants
3
Q
Complete drug order (8)
A
Client name, medication name, dosage, route, frequency, reason, parameters if cardiac, provider signature
4
Q
Type 1 DM vs type 2
A
Type 1: genetic, insulin dependent
Type 2: From diet, non-insulin dependent
5
Q
Rapid acting insulin (clear or cloudy, names, label, onset, peak, duration)
A
Clear
Humalog (LISPRO)
Label: H
Onset: 5-15 min
Peak: 30 min-3 hours
Duration: 2-5 hours
6
Q
Short acting insulin (clear or cloudy, names, label, onset, peak, duration)
A
Clear
Humulin R and Novolin R (REGULAR)
Onset: 30 min
Peak: 2-4 hours
Duration: 3-8 hours
7
Q
Intermediate acting insulin (clear or cloudy, names, label, onset, peak, duration)
A
Cloudy
NPH: Isophane, humulin L and N
Label: L or N
Onset: 1-4 hours
Peak: 6-12 hours
Duration: 12-24 hours
8
Q
Long acting insulin (clear or cloudy, names, label, onset, peak, duration)
A
Cloudy
Evening administration
Humulin U, glargine (LANTUS), detemir
Label: U
Onset: 6-10 hours, 1 hour, 3-4 hours
Peak: N/A, N/A, 6-8 hours (not pronounced)
Duration: up to 24 hours
9
Q
Combination insulin (clear or cloudy, names, what to know, onset, peak, duration)
A
Cloudy
50/50, 70/30 (NPH/reg), 75-25
Longer acting first
Everything varies
10
Q
Somatostatin (nutropin)
A
Growth hormone-inhibiting hormone
has identical amino acid sequence as human GH; contraindicated in clients who are severely obese or who have respiratory impairment d/t reported families
11
Q
How is GH given, fun facts, what can prolonged administration cause
A
Not orally, destroys GI enzymes
SQ or IM
Very expensive
Prolonged administration can cause diabetes mellitus bc it antagonizes insulin secretion
12
Q
Somatrem (protropin)
A
used to treat growth failure due to pituitary GH deficiency. Has identical AA sequence as human GH plus an additional amino acid
13
Q
Octreotide (Sandostatin)
A
Suppresses GH release
Used alone, with radiation, or surgery
Expensive
GI side effects are common
14
Q
What does posterior pituitary gland secrete
A
ADH
15
Q
Diabetes insipidus
A
ADH deficiency leading to large amounts of water being excreted by kidneys
Severe fluid deficit and electrolyte imbalances
16
Q
ADH replacements (2)
A
Vasopressin and desmopressin acetate
17
Q
What does anterior pituitary release (2)
A
TSH because of TRH from hypothalamus
and ACTH
18
Q
Graves disease
A
Too much T3 and T4 (hyperthyroidism)
Rapid pulse, palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exophthalmos, and weight loss
19
Q
Thyroid storm
A
Severe hyperthyroidism
Death from vascular collapse
20
Q
What do parathyroid glands release
A
PTH which regulates calcium in blood
21
Q
Calcitonin
A
Increases Ca
22
Q
What is secreted by adrenal glands
A
Cortisol in response to HPA
23
Q
What do corticosteroids do (electrolytes)
A
Promote Na+ retention and K+ excretion
24
Q
Addison’s disease
A
Decrease in corticoid secretion (adrenal hyposecretion)
25
Cushing's syndrome
Increase in corticoid secretion (adrenal hypersecretion)
26
What can glucocorticoids cause
Na+ absorption from the kidney, resulting in water retention, K+ loss, and increased BP
27
3 effects of cortisol
Anti-inflammatory
Antiallergic
Antistress
28
What drug might organ transplant recipients have
Prednisone
29
Prednisone side effects
Increase blood sugar, moon face and buffalo hump, decreased extremity size, muscle wasting, edema, sodium and water retention, HTN, euphoria, psychosis, thinned skin with purpura, increased ocular pressure, peptic ulcers, and growth retardation
Long term use: adrenal atrophy
Should be tapered off!!
Abrupt withdrawal can cause severe adrenocortical insufficiency
30
What does a severe decrease in mineralocorticoid aldosterone lead to
Hypotension and vascular collapse, as seen in Addison’s disease
31
S&S of hyperglycemia
3 Ps
Dehydration*
Glycosuria
Lipolysis, ketosis, acidosis
Itchy skin
Irritability, confusion*
Fatigue, lethargy*, coma*
Fruity breath*
Kussmaul breathing*
32
S&S of hypoglycemia
Polyphagia, tingling of lips and tongue
Anxiety, irritability, mood changes, *confusion
Headache
*Dizziness, lightheadedness
Tachycardia, tachypnea
*Shaking, tremors
Sweating, *cool clammy skin (cool and clammy, give them candy)
*Blurred vision
Weakness, fatigue
*Slurring of speech
*Seizures
33
Blood glucose in DM
>200 mg/dL
34
Type I DM causes (3)
Viral infections
Environmental conditions
Genetic factors
35
Type II DM causes (2)
heredity
Obesity
36
Insulin dependence in type 2 DM
Clients who use 1-2 antidiabetic drugs may become insulin dependent years later
37
Hemoglobin A1C levels
<5% no DM
5.7-6.4% prediabetic
>6.5% DM
38
3 drugs that increase blood glucose
Glucocorticoids (-isone)
Thiazide diuretics
Epinephrine
39
Insulin vs oral hypoglycemic (antidiabetic)
Insulin:
-A protein secreted from beta cells in pancreas
-Necessary for carb metabolism
-Important in protein and fat metabolism
Oral hypoglycemic:
-Synthetic preparations that stimulate insulin release
40
where is insulin released from
Beta cells in islets of langerhans in pancreas when sugar goes up
41
Humulin insulin
R and N
duplicates insulin produced by the pancreas of the human body
42
Humulin insulin analogs
modifications of humulin insulin with alterations (humalog and novolog)
43
How is insulin admimistered
Not PO bc GI secretions would destroy it
SC
Best in the abdomen
44
When to give rapid acting insulin
No more than 5 minutes before meal time
45
When to give short acting insulin
30 minutes before meal time
46
What can cause insulin resistance besides taking it a lot
Obesity
47
How to store insulin
No freezing, direct sun, high temps
Unopened vials refrigerated
Opened vials in room temp for a month or fridge for 3 months
Prefilled should be refrigerated and used in 1-2 weeks
48
RISS
a preset scale which provides directions for the administration of rapid or short acting insulin
49
Insulin pen pros and cons
More accurate and easy compliance but more expensive
50
Implantable insulin pumps
Surgically implanted in the abdomen
Delivers basal insulin infusions and bolus doses with meals
Fewer hypoglycemia reactions occur
Blood glucose levels are well controlled
51
Portable insulin pump
Battery operated device
Regular insulin, infusion
FBS as close to normal as possible
Delivers both basal insulin infusion and bolus doses with meals. Infusions are programmed by the client
52
Important about pump
Do not DC for >1-2 hours
Type I benefits more
Regular insulin only
53
DKA
Inadequate insulin, fat catabolism (using fatty acids for energy)
Extreme thirst
Polyuria
Fruity breath
Kussmaul breathing
Rapid, thready pulse
Dry mucous membranes, poor skin turgor
Blood sugar level 250 mg/dL or >
54
What type of insulin can be administered IV
Regular
55
When should insulin doses not be held and why
During illness because high cortisol
56
When are oral hypoglycemics used
Type II DM
57
What does metformin do (bad)
Builds up, renal failure
58
Flagyl reaction
ETOH-disulfiram like
59
IV insulin for who?
Not type I
60
Med for weight loss
Trulicity
61
Sulfonyureas
1st and 2nd gen
First: Stimulates pancreatic beta cells to secrete more insulin (short, intermediate, and long)
Second: Increases tissue response to insulin and decreases glucose production
ASSOCIATED W WEIGHT GAIN AND HYPOGLYCEMIA
62
Second gen sulfonylureas compared to first
Greater potency than 1st
Lower effective doses
Longer duration
Fewer side effects
Less displacement potential of protein bonding sites
Don't use in liver or kidney dysfunction
Hypoglycemia common in older adults
63
Euglycemics
Bring sugar to normal (should not cause hypoglycemia)
64
Biguanides
Decreases glucose release from liver, intestinal absorption of glucose, and improves insulin sensitivity
65
Alpha-glucosidase inhibitors
Starch blockers- delay digestion and absorption of carbs
Inhibit digestive enzyme in small intestine responsible for release of glucose from complex carbs in the diet
66
Thiazolidinediones (glitazones or TZDs)
Decrease insulin resistance in the body (muscle and fat tissues)
67
GLP-1 analogs
increase insulin secretion, reduce glucose release from liver after meals, delay food emptying from stomach and promote satiety (fullness)
68
DPP-4 inhibitors
Increase insulin secretion, reduce glucose release from liver after meals
69
SGLT2 inhibitors
increase glucose excretion in the urine
70
Metformin
Decreases hepatic production of glucose from stored glycogen
Diminishes increase in serum glucose following a meal
Decreases the absorption of glucose from the small intestine
Increases insulin receptor sensitivity
Increases peripheral glucose uptake at the cellular level
71
Metformin SE
GI symptoms (diarrhea, nausea, upset stomach, metallic taste), lactic acidosis, take with meals (ER with evening meal)
Cannot use if liver or kidney problems, take a drug to treat heart failure, or drink alcohol excessively
72
SE and how to take alpha-glucosidase inhibitors
SE: Flatulence
Take with first bite of meal
Start with low dose and slowly–to minimize GI intolerance
Does not cause hypoglycemia
73
Meglitinides (action, SE/AR, contra)
Action:
-Stimulate beta cells to release insulin
-Short-acting
Side effects/adverse reactions
-Hypoglycemia
-Headache, back pain, diarrhea
-Elevated hepatic enzymes
Contraindicated
-Liver dysfunction
74
Incretin modifiers
Increase level of incretin hormones
Increase insulin secretion
Decrease glucagon secretion to reduce glucose production
adjunct treatment with exercise and diet to reduce fasting and postprandial (after meal) glucose levels
75
glucagon-like peptide agents
Enhance insulin secretion
Increase beta-cell responsiveness
Suppress glucagon secretion
Slow gastric emptying
Reduce food intake
76
SE/AR of GLPs
HA, dizziness, jitteriness
GI distress
NOT for diabetic pts
77
GLP-1 analogs and 2 important
Liraglutide and dulaglutide (-glutide)
Teach proper needle care and storage
Not covered by all insurance
78
Levothyroxine sodium routes, half life, excretion
PO and IV
6-7 days
In bile and feces
79
Calcitriol route, distribution, half life, excretion
PO
crosses the placenta
3-8 hours
In feces
80
Glipizide route, absorbed where, half life, metabolism
PO
GI tract
2-4 hours
In the urine
81
Levothyroxine sodium (use, preg cat, contra, caution)
Treats hypothyroidism, myxedema, and cretinism
A
Contra: Thyrotoxicosis, MI, severe renal disease
Caution: CVD, HTN, angina
82
Levothyroxine sodium (SE, AR, life threatening, drug food)
SE: HA, N/V/D, cramps, tremors, nervousness, insomnia, weight loss
AR: tachy, HTN, palpitations
LT: thyroid crisis, angina, dysrhythmias, CV collapse
Drug food: Increases effects of anticoagulants, tricyclic antidepressants, vasopressors
Decreased effects of antidiabetics (oral and insulin), digitalis products
83
Calcitrol (use, preg cat, contra, caution)
Treats hypoparathyroidism and manage hypocalcemia in chronic renal failure
C
Contra: Hypersensitivity, hypercalcemia, hyperphosphatemia, hypervitaminosis D, malabsorption syndrome
Caution: CVD, renal calculi
84
Calcitriol SE, AR, drug food
SE: A/N/V/D, cramps, drowsiness, H/A, dizziness, lethargy, photophobia
AR: Hypercalciuria, hyperphosphatemia, hematuria
Drug food: Increased cardiac dysrhythmias with digoxin, verapamil, increased serum calcium with thiazide diuretics, calcium supplements
85
Prednisone (use, preg cat, contra, caution)
Decreases inflammatory occurrences; as an immunosuppressant, to tc dermatologic disorder
C
Contra: Hypersensitivity, psychosis, fungal infection
Caution: DM
86
Prednisone SE, AR, life threatening, and drug food
SE: N/D, H/A, abdominal distension, increased appetite, sweating, depression, flush mood changes
AR: Petechiae, ecchymosis, HTN, tachy, osteoporosis, muscle wasting
Life threatening: GI hemorrhage, pancreatitis, circulatory collapse, thrombophlebitis, embolism
Drug food: Increased effect with estrogen, diltiazem, ketoconazole
Concurrent use of ASA and NSAIDS increase GI toxicity, concurrent use with cardiac glycosides increases risk of dysrhythmias and digoxin toxicity
87
Glipizide (use, preg cat, contra)
Directly stimulate beta cells to secrete insulin; thus decreasing the blood glucose level
C
Diabetic ketoacidosis, hepatic or renal dysfunction, older adults, adrenal or pituitary insufficiency
88
Metformin (use, preg cat, contra, caution)
Hypoglycemic med
B
Concurrent infection, hepatic or renal dysfunction, cardiopulmonary insufficiency, ETOH
Caution: Pregnancy, lactation
89
Glipizide (SE, AR, LT, drug food)
SE: Dizziness, fatigue, H/A, A/N/V/D, agitation, bitter or metallic taste
AR: Lactic acidosis, malabsorption of AAs, Vt B12, and folic acid
LT: lactic acidosis
drug food: Iodinated contrast dyes may lead to lactic acidosis or acute renal failure. Altered LFTs
90
SE of GLP-1 analogs
HA, N/D, hypoglycemia when used with insulin secretagogues
rare pancreatitis
Not for medullary thyroid cancer (good for heart dx)
91
Actions of GLP-1
Enhance insulin secretion
Increase beta-cell responsiveness
Suppress glucagon secretion
Slow gastric emptying
Reduce food intake
92
Amylin analogues
TYPE 1 AND 2
Lowers blood sugar
NOT insulin but can reduce amt u need
Children or older ppl bc they dk hypoglycemia
93
Action of amylin analogues
Suppress glucagon secretion
Slow gastric emptying
Modulate appetite by inducing satiety
This drug works by slowing the movement of food through your stomach. It also decreases your appetite and the amount of sugar your liver makes
94
Glucagon
Hyperglycemic drug
Stimulates glycogenolysis
Provides nutrients and energy
parenteral
Treats insulin-induced hypoglycemia
95
Diazoxide
Treats hypoglycemia caused by hyperinsulinism
Inhibits insulin release and stimulates release of epi from adrenal medulla
96
Methylprednisolone comes in what?
z pack
97
Uses for prednisone
Trauma, surgery, emotional upset, anxiety, shock
Inflammation, ulcerative colitis, glomerulonephritis
Autoimmune disorders, drug reactions, anaphylaxis
Asthma, prevent organ rejection (they are on long term steroids)
98
bad effects of prednisone
Headache, flushing, euphoria, depression, psychosis
Increases appetite, sweating, thin skin with purpura
Tachycardia, HTN, hyperglycemia
Edema, sodium, and water retention, adrenal atrophy
Give diuretics but also watch K+ and others
Abnormal fat deposits, muscle wasting
Glaucoma, peptic ulcers, growth retardation
99
Fludrocortisone (oral mineralocorticoid)
Promotes sodium retention and H+ ion and K+ secretion
For adrenocortical insufficiency
100
SE of fludocortisone
Negative nitrogen balance, fluid imbalance, fluid overload, HTN, hypokalemia, GI distress
Watch cardiac patients for HTN, adventitious lung sounds, fast, shallow respirations, bounding pulse, etc.
101
Astragalus (2)
Boost immune system
Limits cold and flu symptoms
102
Chamomile (2)
Relief of anxiety, sleeplessness, digestive complaints, skin conditions, and oral ulcers
SE: allergic reactions
103
Cinnamon (3)
Used to treat bronchitis, GI problems, anorexia, diabetes
Generally safe without allergic reactions
May decrease blood clotting
104
Echinacea (2)
Used for colds, flu, infections
Stimulates immune system
105
Garlic (2)
Used for hypercholesterolemia, HTN, heart disease, preventing stomach and colon cancer
Side effects may include heartburn, upset stomach, body odor, decreased blood clotting
106
Ginger (2)
Used for nausea, motion sickness, diarrhea, relieves pain, swelling, arthritic stiffness
Side effects may include gas, bloating, heartburn, nausea
107
Ginkgo biloba (4)
Used for asthma, bronchitis, fatigue, tinnitus
Used to improve memory, decrease intermittent claudication
Treats sexual dysfunction, MS
Side effects include headache, dizziness, nausea, GI upset, increased bleeding, allergic reactions
108
Ginseng (3)
Improves well-being, stamina, and immune system
Treats erectile dysfunction, hepatitis C, menopausal symptoms, lowers glucose and BP
Side effects include headaches, GI distress, HTN, hypoglycemia, breast tenderness, menstrual irregularities
109
Hawthorn (2)
Used for heart disease, digestive issues, kidney disease
Side effects include headache, dizziness, nausea
110
Licorice (2)
Used for bronchitis, sore throat, stomach ulcers, viral hepatitis
High doses can lead to salt and water retention, HTN, low potassium (not given to pts with existing cardiac problems)
111
Kava Kava (3)
Used for relaxation and anxiety
Adverse effects include liver damage; dry, scaly, yellowing skin; eye irritation, heart problems
Alcoholic sclerosis and liver patients are not given this
112
Milk thistle (2)
Used for hypercholesterolemia, insulin resistance, chronic hepatitis, cirrhosis, gallbladder disorders
Side effects include upset stomach, hypoglycemia, allergic reactions
113
Peppermint (2)
Used for hypercholesterolemia, insulin resistance, chronic hepatitis, cirrhosis, gallbladder disorders
Side effects include upset stomach, hypoglycemia, allergic reactions
114
Saw palmetto (2)
Used for urinary symptoms, chronic pelvic pain, decreased libido, migraines, hair loss
Side effects include digestive problems, headache
115
St. John's wort (3)
Used for mental disorders, nerve pain, sleep disorders, malaria, wounds
Side effects include anxiety, dry mouth, dizziness, headache, fatigue, sensitivity to sunlight, GI problems, sexual dysfunction
Interacts with antipsychotic medications and cardiac drugs
116
Turmeric (2)
Used for heartburn, stomach ulcers, gallstones, inflammation, cancer
High doses may cause nausea, diarrhea
117
Valerian (2)
Used for anxiety, headache, insomnia, tremors, depression, irregular heartbeat, side effects include headache, dizziness, fatigue, stomach upset
Cardiac patients shouldn’t use
