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NURS 5590 > Module 7 quiz > Flashcards

Module 7 quiz Flashcards

1
Q

Medications that reduce the incidence of diabetic nephropathy

A

Insulin + ACEI or ARBs (prevention of nephropathy and HTN)

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2
Q

BP goal

A

<140/90

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3
Q

Action of Insulin

A

Stimulates uptake of glucose, amino acids, nucleotides & K promotes synthesis of complex organic molecules

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4
Q

Rapid acting insulin

A

Lispro/Humalog
Onset: 15 mins
Duration: 3-6 hours
Admin: must give with meals
Goal: Post-prandial BG control, between meals and at night
Note: Must be used with intermediate or long acting agent in DM I

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5
Q

Short Acting Insulin

A

Regular/Humalin R
Onset: 30-60 min
Duration: 6-10 hours
Admin: Must be given immediately before or after eating or via infusion pump
Goal: Post-prandial BG control when given before meals, basal control via pump
Notes: Slower onset than rapid acting, and faster onset than longer acting. Most on pumps use rapid not regular

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6
Q

Intermediate insulin

A

NPH (Humalin N/ Novolin N)
Onset: 60-120 mins
Duration: 16-24 hours
Admin: Can NOT be given at meal times to control post prandial BG. Instead BID or TID dosing.
Goal: Control b/w meals and night
Notes: Only longer acting insulin suitable for mixing with short acting (Regular, Lispro, Aspart, Gluisine)
Mixing tips: Draw short acting first to not contaminate NPH vial (clear then cloudy)

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7
Q

Long duration- Glargine

A

Onset:70min
Duration:18-24 hours
Admin: QD or BID in some to achieve full basal coverage
Goal: Prolonged control up to 24 hours
Notes:Dosing at anytime of day, must be consistent though. achieves steady state BG control throughout day

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8
Q

Ultralong duration

A

Glargine 300
Onset: 360 min
Duration: >24 hours
Admin: only insulin analog that lasts up to 42 hours
Goal: basal glycemic control
Notes: similar to glargine 100, does not have a peak

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9
Q

Long duration-Detemir

A

Onset: 60-120min
Duration: varies
Goal: basal glycemic control
Notes: slow onset, dose dependent duration of action, low doses up to 12 hours. Higher doses up to 20-24 hours

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10
Q

Biguanides action and SE

A

Metformin
-Drug of choice for initial therapy, can be used alone or in combination
-Action: does not drive blood glucose down. Inhibits glucose production in liver, reduces absorption in the gut and sensitizes insulin receptors=increased uptake
SEs: diarrhea, nausea, lactic acidosis

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11
Q

Sulfonylureas

A

Glipizide
First oral anti-diabetic drug, can be used alone or in combo
-Action: promote insulin release by stimulation of beta cells. Only used in DM II. May also increase target cell sensitivity to Insulin.
SEs: Can cause weight gain, and dose dependent hypoglycemia (may be persistent=D5 infusion)
Notes: 1st generation=less potent, more dug-drug interactions. 2nd gen=more potent, fewer interactions, used more often

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12
Q

Alpha Glucosidase Inhibitors

A

Acarbose
Monotherapy or combination therapy
Action: Act in intestines delaying absorption of carbs=reduces rise in BG after meals
SEs: R/t bacterial fermentation of carbs: flatulence, cramps, boborygmus, diarrhea, No hypoglycemia w/ monotherapy
Notes: Can decrease iron absorption. Liver dysfunction can occur-Monitor LFTs

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13
Q

Androgens (produced, actions, uses, adverse effects)

A

Produces by testes, adrenal cortex, and ovaries
Actions: promote male secondary sex characteristics
uses: management of androgen deficiency in males
Adverse effects: virilization & hepatotoxicity

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14
Q

Testosterone and testosterone esters

A

Approved for those with documented testosterone deficiency d/t hypogonadism
Indications: delayed puberty, therapy in menopausal women, cachexia, refractory anemias, drug therapy for transgender men
Adverse effects: virilization in women, girls and boys, hepatotoxicity, negative effects on blood lipids, abuse potential, thromboembolism

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15
Q

5 Alpha Reductase inhibitors

A

Finasteride
Action: Reduced DHT in blood by 70%. Does NOT reduce testosterone=promotes regression of prostate epithelial tissue and relieves mechanical obstruction
Considerations: most effective in men w/ very enlarged prostates, decrease in ejaculate and libido in 5-10%, risk for gynocomastia

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16
Q

Alpha receptor blockers

A

Flomax
Action: Blockade of alpha 1 receptors-relaxation of bladder neck (trigone/sphincter), prostate capsule, and prostatic urethra decreasing dynamic obstruction
Considerations: Therapy must be continued life long, bloackade of alpha 1 results in systemic vasodilation and may cause hypotension, overall tolerated well, may interact w/ beta blockers

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17
Q

Estrogen type: steroidal hormone

A

Actions: supports maturation of female secondary sex characteristics, increases bone mass, reduces CVD, promotes and supresses coagulation, neuroprotective
Uses: contraceptive & non contraceptive, HRT (w/ progestin), hypogonadism, acne, cancer palliation (prostate and metastatic breast ca), GAT (off label)
Adverse effects: endometrial hyperplasia, breast ca, thromboembolic events
Side effects: nausea, headache including migraine
Contraindications: liver disease, hx of breast ca
Drug-Drug interactions: estrogens are major substrates of CYP system

18
Q

Progestins

A

Naturally produced
help prevent endometrial CA, used in IVF
SEs: breast tenderness
DONT GIVE TO PATIENTS W/ UNDIAGNOSED VAGINAL BLEEDING

19
Q

Levothyroxine

A

synthroid: identical to natural hormone T4
-Indications: All forms of hypothyroidism
SEs: Rare but many drug-drug interactions=reduced absorption (PPIs, sucralfate, antacids, Ca+, and iron supplements)
-Reduced absorption w/ food/take on empty stomach 30-60 mins before breakfast
-Highly protein bound w/ prolonged half life (7 days)
-Levels remain steady even w/ QD dosing
-Takes 1 month for levels to reach steady state
-Narrow therapeutic range- DON’T CHANGE BRANDS

20
Q

Recommendations for prescribing oral hypoglycemic agents

A

Hypoglycemia-BS <70
Fast acting oral sugar to be given PO for patients not NPO
-glucose tabs, orange juice, sugar carbs, honey corn syrup/soda
-15 grams of fast acting carbohydrate

21
Q

Comorbid illnesses that may impact the dose of insulin required (7)

A

-surgery
-acute illness
-enteral/parental nutrition
-steroids
-epi infusion
-inflammatory response
-critical illness

22
Q

Discuss dual agent therapy in the treatment of DM

A

4 step approach ( 2019 ADA standards)
1. Lifestyle changes + metformin (diagnosis)
2. Add second agent (efficacy, tolerability, hypoglycemia risk, weight considerations, cost). If A1C>9%/fasting BS>300, or BIG symptoms-start at step 2 (include injectable-basal insulin)
3. Progress to three drug combo (includes metformin)
4. After 3-6 months of #3 (including basal insulin)-combo injectable regimen (insulin +GLP-1receptor agonist)

23
Q

Describe risks for hypoglycemic episodes (9)

A

-use of insulin or oral anti-diabetics
-impaired kidney or hepatic function
-longer duration of DM
-Frailty or old age
-Cognitive impirement
-impaired counterregulatory repsonse/hypoglycemia unawareness
-physical or intellectual disability that can impair behavioral response to hypoglycemia
-alcohol use
-polypharmacy (w/ ACE/ARBS, nonselective BB)

24
Q

Treatment of hypoglycemia

A

Considerations: NPO status, LOC, Absorptive capacity of gut (edema/ileus), IV access, potential for prolonged hypoglycemia
Options: 15 grams of fast acting carb
-glucagon
-glucose tabs
-Dextrose IV or Continuous infusion

25
Q

Pt education for self administering insulin

A

Mixing of insulin should only be done with those proven compatible
-only intermediate acting insulin (NPH) is approved to mix with short acting insulin
-when mixing short acting should be drawn first to avoid contamination
-Pt should monitor glucose levels 4x daily
-Insulin dosage must be closely matched w/ insulin needs
E.g. when a meal is missed or low in carbs, decrease insulin dose
-stress, obesity, infection requires increased dose

26
Q

Primary and adjunct treatment for Grave’s disease

A

-Surgical thyroidectomy
-destruction w/ radioactive iodine
-Supression of hormone synthesis w/ an antithyroid drug
Radiation is preferred treatment for adults, antithyroid drugs are preferred for younger patients
-BB and nonradioactive iodine may be used as adjunct therapy
-BB suppress tachycardia + non radioactive iodine inhibits synthesis and release of thyroid hormones

27
Q

Grave’s Disease

A

hyperthyroidism ( most common in women 20-40)

28
Q

Thionamides

A

Methimazole & Propylthiouracil (PTU)
Actions: suppress synthesis of thyroid hormones
Indication: long term treatment for hyperthyroidism, or short term prep for thyroidectomy or treatment w/ radioactive iodine

29
Q

Methimazole

A

First line drug.
Does not destroy exisiting thyroid hormone so effects may be delayed
-Uses: monotherapy for Graves Dz, adjunct to radiation therapy/surpresson prior to thyroidectomy/thyrotoxic crisis
Containdications: pregnancy/breast feeding
SEs: agranulocytosis-rare symptom of toxicity

30
Q

Radioactive Iodine

A

Action: destruction of thyroid tissue, results in clinical remission w/out destroying the entire thyroid (ideally but not always)
-Adverse effects: delayed hypothyroidism (frequent complication)
Benefits: low cost, lacks the risks associated with thyroidectomy, death is extremly rare, no tissue other than thyroid is injured
Contraindications: pregnancy and breast feeding

31
Q

Pt w/ thyrotoxic crisis

A

thyroid storm=excessive thyroid hormone
Triggers: major surgery or severe illness
S/S: profound tachycardia, severe hyperthermia, restlessness, tremor, agitation, coma, hypotension, HF
Life threatening response to excessive thyroid hormone
Treatment: high dose potassium iodide, methimazole, BB
More supportive measures: sedation, cooling, glucocortioids, IV fluids
-Fever, tachycardia can look like sepsis, be aware

32
Q

Implications of pregnancy as it r/t thyroid treatment

A

Avoid methimazole in first trimester
Methimazole can cause neonatal hypothyroidism, goiter, and congenital hypothyroidism
PTU is preferred drug during first trimester

33
Q

Emergency contraceptive options currently available in the US

A

Emergency contraceptive-taken immediately following intercourse
-Progestin only pills-Plan B one-step-levonorgestrel alone
-next choice one dose
-Ulpristal acetate emergency contraceptive (ella)-supresses ovulation
Estrogen/progestin (Yupze regimen)
Copper IUD-expensive

34
Q

what is ED most commonly treated with

A

PDE-5 inhibitors (Sidenafil)

35
Q

Sidenafil adverse effects

A

hypotension, priapism aka painful erection lasting more than 4 hours, nonarteritic optic neuropathy, hearing loss, headache, flushing, diarrhea, rash, dizziness

36
Q

Sidenafil drug interaction

A

-avoid nitrates for at least 12 hours after sidenafil as they cause hypotension, life threatening hypotension can be caused if drugs are combined
-Alpha-adrenergic antagonists (Cadura) used for prostate hyperplasia-can dilate arterioles and lower BP leading to postural hypotension
-Inhibitors of CYP34A can suppress the metabolism, increasing its level
-grapefruit juice can elevate its level

37
Q

Premature Ejaculation treatment

A

no drugs are FDA approved, off label uses include:
SSRIs
Topical anesthetics
trycyclic antidepressants (Clomiprmine) used as 2nd line when SSRI can not be taken
Radiofrequency ablation

38
Q

Selective estrogen receptor modifiers (SERMS)

A

Activate estrogen in selected tissue
-prototype: tamoxifen-inhibits cell growth in breast (cancer treatment)
-SEs: hot flashes, thromboembolism

39
Q

What oral antidiabetic is similar to sulfonyuras?

A

Meglitinides/Glinides

40
Q

Meglitinidies/Glinides

A

actions similar to sulfonyureas. Shorter acting, must be taken with meals (w/in 30 min)

non responders to sulfonyureas will not respond to glinides

NURS 5590 (11 decks)

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