HARD TIME Flashcards
Which antiparkinsonian drug is contraindicated in hot weather/ exercise?
Benztropine/ antichollinergic
Which antiparkinsonian drug is contraindicated in angle-closure glaucoma?
Levodopa (DOPAMINE REPLACEMENT DRUGS)
Which antiparkinsonian drug is contraindicated in ischemic/ PVD and erythromycin?
bromocriptine (non dopamine dopamine receptor agonists)
Which antiparkinsonian drug is contraindicated to antichollinergic drugs?
amantadine and antichollinergic (benztropine)
What is contraindicated to selegiline and rasagiline?
Meperidine
Which antihyperglycemic medication can cause hypoglycemia when given with DPP4 enzymes?
Sulfonylureas
Which antihyperglycemic medication increases HDL and LDL?
Sodium-glucose cotransporter 2 inhibitor (dapagliflozin)
Drugs that cause hyperglycemia when given with insulin? (antagonizes insulin)
corticosteroids
diuretics
sympathomimetic
niacin
thyroid drugs
Drugs that cause hypoglycemia when given with insulin?
alcohol
sulfa antibiotics
anabolic steroids
MAOIs
salicylates
Drugs that mask hypoglycemia symptoms when given with INSULIN?
non-selective beta blockers
Functions of the drug INSULIN
metabolize carbohydrates, fats, and proteins
stores glucose in the liver
convert glycogen into fat stores
substitute for endogenous insulin
Does not reverse defects in insulin receptors
OA and malnourished patients may adversely affect which antihyperglycemic medication?
Biguanides
What is important to note when giving sulfonylureas and glinides?
Baseline glucose
Conditions that may predispose patients to hypoglycemia [drop in caloric intake, alcohol use, exercise]
Allergy to sulfonamides
Not allowed in patients with type 1 diabetes
What is a major contraindication in thiazolidinediones/ glitazones?
Class III or IV heart failure
Contraindication for a glucosidase inhibitor
IBS
Malabsorption
Incretin mimetics are used to treat?
Typer 2 diabetes
Poor control with metformin, sulfonylutreas, or glitazones
Glucagon injection may induce?
vomiting so assess for LOC and prevent aspiration
If insulin is is to be used within 1 month
it may be stored at room temperature
administer at room temperature
angle to administer insulin?
90 degrees unless they are emaciated (thin) do 45 degrees
Injecting air into vial process of mixing insulin?
Inject air into intermediate-acting acting then into rapid-acting
BUT always draw up rapid/ regular acting insulin first then intermediate acting (clear before cloudy)
If lispro is mixed with NPH, when would you give it?
give combination 15 minutes before meals because lispro has an onset of 10 to 15 minutes.
When to give (meals) in intermediate-acting insulin with an onset of 1 to 2 hours?
meals should be given 30 to 45 minutes prior to administration
In hospital settings, give insulin when?
when tray arrives
How often to check glucose when a patients is on SC?
every 4 hours, 6, or several times per day to obtain fasting/ preprandial glucose levels
Used in variable caloric intake, drastic changes to glucose levels due to infections/ stress, receives TPN
Insulin in BBT
Long acting
Rapid acting
Oral antihyperglycemic are usually given __ minutes before meals?
30 minutes
Glitazones adverse effect
It causes weight gain/ edema so weigh patients
Incretin mimetics (exenatide) are not given with?
Insulin
Sitagliptin (DPP 4 I) is not given with?
May be given with or without?
Insulin
Food
Key diagnostic criterion of hyperglycemia
Fasting glucose: greater than 7mmol/L
Non-fasting glucose: greater than 11.1 mmol/L
A1C of equal to/ greater than 6.5%
[A1C of 6.5% is the threshold for micro and macrovascular complications]
Diabetes Canada Reccomends
A1C of less than 7%
F PG of 4 to 7 mmol/L
2 hour postprandial of 5 to 10 mmol/L
Bowel assessment
Inspection
Auscultation (1st to prevent stimulation of peristalsis and BS)
Percussion
Palpation
Hypoactive BS
Normoactive
less than 6 sounds per minute
6 to 32 sounds per minute
Overuse of diphenoxylate hcl with atropine sulphate may cause?
dry mouth
abd pain
tachycardia
blurred vision
Prior to use of hyperosmotic laxatives, assess for?
baseline fluid and electrolyte imbalances
thorough and assessment
Older adults react adversely to hyperosmotic so avoid use
Saline laxatives are used in caution in OA because?
May also cause?
possible dehydration and electrolyte loss
MG toxicity in those with compromise renal function
Bismuth subsalicylate effects on feces?
dark or grey feces
If tablet Bismuth subsalicylate is used they must be?
chewed thoroughly before swallowing and must be taken with at least 180 mL of fluid
How to give Diphenoxylate hcl and loperamide
without regard to food but must be given with adequate fluid
Bulk forming once stirred with 240 mL of water must be
taken immediately to avoid choking
never give in a dry form
Bisacodyl is best taken
how to give whole tablets
do not give with?
in an empty stomach
whole tablets must not be crushed
do not take milk, juices or antacids with the dose or an hour or taking this medication
Soft rectal suppositories
place in a medicine cup with ice, apply lubricant
lay on the left side for at least 15 to 30 minutes to allow drug to dissolve
Lactulose may be given with
juice, milk, or water to increase palatability (taste)
pale yellow color
Retention enema with dilution
retain 30 to 60 minutes
lubricate tip of the apparatus, nozzle pointed towards the umbilicus, lying on the left side
release fluid gradually
discontinue if pt experiences severe abd pain
AE of dry mouth… encourage?
frequent mouth care
increased fluid intake
sugarless gum/ candy
Taking senna
avoid other medications within 1 hour of taking it
it takes 6 to 12 hours to work
Antichollinergics for antidiarhheals mechanism of action
AE
decrease peristalsis through their parasympathetic blocking effects
AE: urinary retention, headache, confusion, dry skin, rash, and blurred vision
Opiates
decrease bowel motility, permits longer contact of intestinal contents, reduce pain and spasms
stool softeners and bulk forming are
preferred due to fewer problems with fluid and electrolyte loss
Oral antihyperglycemic can cause
photosensitivity, use sunblock and appropriate clothing when exposed to sun
Insulin main function
removal of glucose form the plasma and store it as glycogen in the liver
Bovin and porcine insulin are associated with?
higher incidence of allergic reaction and insulin resistance
mixing short and intermediate-acting insulin color
will appear uniformly cloudy
Antichollinergic dry mouth
artificial saliva drops/ gum
mouth care
drink fluids
sugarless gum/ hard candy
entacapone can cause ____ urine
dark
non ergot ropinirole can cause
drowsiness
fatigue
syncope
COMT I must be taken with
meal or snack to minimize GI upset or without regard to food
COMT I can cause
Liver dysfunction
monitor for jaundice, back/ abd pain
dark urine
COMT I plus levodopa results in
reduced wearing off phenomenon
Common AE of antiparkinsonian drugs
Dyskenesias
Which medication does it require the nurse to check the BP (ORTHOSTATIC HYPOTENSION)
Amantadine
Levodopa & Ropinirole
Alkaline phosphate levels are indicators of?
Liver function
AST, ALT
BUN (blood urea nitrogen), creatinine
measure kidney function
Amantadine onset
delayed for several days or longer
lose effectiveness after 6 to 12 months
What systems to assess when giving anticholinergic medications?
GI
GU
Visual
Cardiac
Neurological
2 prolactin inhibitor
Amantadine and bromocriptin
Amantadine can cause
dizziness, headache, insomnia, and anxiety
assess CNS
orthostatic hypotension and dizziness- for longterm
Selegiline or other indirect acting antiparkinson drugs
assess cardiac status due to risk of hypo or hypertension and chest pain
Entacapone (COMT inhibitor)
assess for orthostatic hypotension and syncope
Administration time of Levodopa and COMT-I
Give 1 to 2 hours after Levodopa due to bioavailability effects
Assess ALT when giving
COMT inhibitors due to increased risk of liver failure
Levodopa contraindication
control protein portion and take it an hour before eating high protein meals
Antichollinergic administration time
Do not give anticholinergics to patients with?
do not take anticholinergics at the same time as other meds
may take several weeks for the therapeutic effect to show
take with food
take at night due to sedation effects
Glaucoma
MAOs
what to avoid
Pt instructions
avoid tyramine rich foods to reduce the risk of hypertension
move slowly and purposefully due to to orthostatic hypotension
Which anti parkinson medication works peripherally and does not cross blood brain barrier
COMT I
Hot weather and exercise, alcohol is contraindicated with which anti parkinson medication?
Antichollinergic
What do anti cholinergic medications treat?
muscle rigidity and tremors
Take COMT with which kind of MAOI
non selective due to risk of HTN