Mod 11 Flashcards
What are the similarities and differences between long and short acting insulins?
Similarities:
Used for treatment of DM that can’t be controlled by diet or oral hypoglycemics
Increase insulin
Differences:
Long acting: Insulin glargine (Lantus)
Given once daily in the evening
DO NOT MIX GLARGINE
Onset is 70 minutes
No peak bc the levels are steady
Duration = 18-24 hours
Modified human insulin
Normally a once daily subcutaneous dose but it can sometimes be used twice-daily to achieve a full 24 hours of basal coverage
Short acting:
Regular insulin (Humulin R)
Given before meals multiple times a day, RIGHT BEFORE they eat
Onset = 30 minutes - 60 min
Peak = 1-5 hours (quicker peak than long acting so can give many times)
Duration = 6-10 hours
Unmodified human insulin
Routes: subcutaneous injection, subcutaneous infusion, IM injection, IV infusion
WATCH FOR HYPOGLYCEMIA
Shakiness, tachycardia, fatigue, excessive hunger, palpitation
Treat with Glucagone
Draw up regular FIRST then nph
Glypizide and metformin also for diabetes
Metformin - GI upset, decrease appetite, nausea/diarrhea, weight LOSS expected
What patient teaching is required for the long and short acting insulins?
Patient Teaching:
Watch for symptoms of hypoglycemia to prevent loss of consciousness
Check blood glucose
Carry a snack at all times
Ensure adequate glucose is available at time of onset of insulin
Gently rotate vial between palms of insulin suspensions before drawing
Encourage pts to eat a proper diet and have consistent activity
Proper storage of insulin:
Unopened vials can be stored in fridge
Premixed insulins can be stored up to 3 months in fridge
Premixed in syringes can be stored up to 1-2 weeks in fridge with needle pointing up and resuspended prior to admin
Store vial that is in use at room temperature, avoid sunlight and intense heat, and discard after 1 month
Glargine (LONG)
Duration of 24 hrs to maintain steady levels
Take once a day
Do not mix with other solutions
Rotate sites of administering
Store unopened in a fridge
Monitor blood sugar levels for hypoglycemia
Explain the patient teaching required for those taking corticosteroids
Patient Teaching:
Dosages need to be increased during times of stress
Client may need to take it for the rest of their lives
Report physical and emotional stress
Eat a diet high in protein, potassium, and calcium
Report signs of infections
Contact provider before receiving vaccinations
Observe for manifestations of peptic ulcer- coffee-ground emesis, blood or tarry stools, abdominal pain
Notify provider of manifestations of acute adrenal insufficiency- fever, muscle and joint pain, weakness, fatigue
Replacement therapy for Addison’s disease must continue for life
Carry an extra supply of glucocorticoids for emergencies and wear medical identification at all times
List the side effects of biguanide [metformin]
For type 2
Side Effects:
Common: decreased appetite, nausea, diarrhea
Decreased absorption of Vitamin B12 and folic acid
Lactic acidosis
Metallic taste
Excessive thirst
Fruity breath
Metformin can delay development of type 2 diabetes in high risk indivisuals
Describe the mechanism of action and side effects of sulfonylureas
MOA: stimulate release of insulin from the islet cells of the pancreas
Side Effects:
Hypoglycemia
Hunger → weight gain
Explain the onset of action for Levothyroxine.
Treats HYPOthyroidism
Increase metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume, and growth processes. Mix of T3 to T4 so replaces T3 hormone
PT:
Sucralfate and ferrous sulfate can reduce levothyroxine
Sertraline can increase levothyroxine
Take it in the morning, 30 min before breakfast
Monitor Labs:
TSH
Serum free T4 test lab
What are the adverse effects of receiving ADH?
Adverse Effects:
Hypertensive crisis
Water intoxication (too much water is retained)
Myocardial ischemia
Explain the rationale for concomitant use of Estrogen and Progesterone in Menopausal women.
Estrogen is to control menopausal symptoms by replacing the estrogen that was lost from menopause.
Progestin is used to counterbalance/suppress estrogen-influenced stimulation which can lead to endometrial hyperplasia and cancer.
Estrogen can stimulate growth of uterus lining = increases the risk of endometrial cancer
Benefits for estrogen therapy:
Reduced risk of osteoporosis
Outweigh risks
Risks of eestrogen therapy:
Blood clots, DVT, PE, stroke, breast, ovarian, lung cancer
Describe all the drug interactions with phosphodiesterase (PDE5) inhibitors.
Drug Interactions:
Nitroglycerin (nitrates) → fatal hypotension
CYP3A4 - Ketoconazole, erythromycin, & cimetidine → increased levels of sildenafil
Alpha adrenergic antagonists - Doxazosin & rifampin → causes orthostatic hypotension
