Respiratory and Endocrine Flashcards
Mixed
(respiratory)
combination drugs for maintenance
NOT rescue
metformin (Glucophage)
(biguanide)
1st line treatment for type 2 diabetes
NO hypoglycemia
salmetrol (Serevent)
(bronchodilator - stimulate beta 2)
for asthma
albuterol (Proventil)
(bronchodilator - stimulate beta 2)
for asthma
first choice, inhaled
expectorants
- thin respiratory secretions
- relief of productive cough
- can be combined in cold remedy formula
- take only as needed
Humulin 70/30
(mixed insulin)
- NPH 70%, Regular 30%
Humalog 75/25
(mixed insulin)
NPH 75%, Rapid 25%
insulin lispro (Humalog)
rapid release insulin
Humulin
regular short
subQ/IV
insulin isophane (NPH)
intermediate insulin
insulin glargine (Lantus) insulin detemir (Levimer)
long insulin
Insulin
- synthesized pancreatic hormone
- IV, SubQ, nasal
- caution: hypoglycemia
- given on U-100 increments
Don’t forget to memorize the chart!
phosphate salt (Neutra-Phos)
(calcium)
inhibits intestinal absorption of calcium and increases deposition of calcium in bones
calcium gluconate
(calcium)
- IV
- for hypocalcemia
- calcium supplement + Vit D
calcium carbonate (Os-Cal)
(calcium)
- for hypocalcemia
- calcium supplement + Vit D
I believe this one is po
calcitonin
(calcium)
- synthetic thyroid hormone
- injectable or nasal
raloxifene (Evista)
(calcium-selective estrogen receptor modulator)
- increase estrogen receptors on bone and increase bone density
- Black box warning: risk for PE or stroke
pramlintide (Symlin)
- slows gastric emptying
- can be used with insulin, sulfonylures or metformin
- hypoglycemia
- given subQ
exenatide (Byetta)
(incretin mimetics)
- use: type 2
- adverse: GI upset
subQ
sitagliptin (Januvia)
(incretin mimetics)
po
type 2 diabetes
incretin mimetics
hormones released by GI tract in response to food, slows gastric emptying and increases satiety
cosyntropin (Cortrosyn)
(hypothalamic/anterior pituitary)
stimulates secretion of cortisol
- use: test of adrenal sufficiency
somatropin (Humatrope)
(hypothalamic/anterior pituitary)
promotes growth in kids
3x/week, IM
oxytocin (Pitocin)
(posterior pituitary)
induce labor, control postpartum bleeding
alpha glucosidase inhibitors (AGI)
inhibit enzymes in GI tract delaying digestion of complex carbs
- adverse: GI upset, bloating, will not cause hypoglycemia
- must take with meal
miglitol (Glycet)
(AGI)
inhibit enzymes in GI tract delaying digestion of complex carbs
- DOES NOT cause hypoglycemia
- take with meal
acarbose (Precose)
(AGI)
inhibit enzymes in GI tract delaying digestion of complex carbs
- DOES NOT cause hypoglycemia
- take with meal
repaglinide (Prandin)
(meglitinide)
- type 2 diabetes specifically
- similar to sulfonylures - NEVER pair
- facilitates pancreas to produce more insulin after a meal
meglitinides
- facilitates pancreas to produce more insulin after a meal
- type 2
- never pair with sulfonylures
Adverse:
- hypoglycemia, weight gain, GI issues
propylthiouracil (PTU)
(antithyroid drug)
- Thiomide (she doesn’t explain this .. guess its a class?)
- for hyperthyroidism, and thyroid crisis
- suppress thyroid hormone and prevent conversion of T4 to T3
Radioactive iodine (Sodium iodide 131)
(antithyroid drug)
- beta and gamma rays destroy thyroid tissue
Lugol’s solution
(antithyroid drug)
- iodine solution
- hyperthyroidism, thyroid crisis
Potassium iodine (SSKI)
(antithyroid drug)
- iodine solution
- hyperthyroidism, thyroid crisis
diphenhydramine (Benadryl)
(antihistamine)
- First generation: drowsiness issue
- seasonal allergic rhinitis
fexofenadrine (Allegra)
(antihistamine)
- second generation
- seasonal allergic rhinitis
take with food, safety, for seasonal - take regularly
loratadine (Claritin)
(antihistamine)
- second generation
- seasonal allergic rhinitis
take with food, safety, for seasonal - take regularly
antihistamines
antagonize the action of histamine by occupying receptor sites
nasal decongestants
shrink engorged nasal mucosa by constricting arterioles and decreasing blood flow to nasal mucosa
- relives nasal congestion
- can cause nervousness, insomnia, and palpitations
- contraindicated with severe hypertension (look for heart on the box - means it can be taken by people with hypertension)
- tolerance dependance
oxymetazolin (Afrin)
nasal decongestant
phenylephrine (NeoSynephrine)
nasal decongestant
pseudoephedrine (Sudafed)
nasal decongestant
- cannot be taken by people with hypertension
- tolerance
dextromethorpan (Benylin)
(anti-tussive)
non-opiod - non-narcotic
relieves dry, hacking cough
codeine/hydrocodone added to syrup
(anti-tussive)
opiod-narcotic
- used to relieve dry, hacking cough
anti-tussives
suppress cough center in the medulla
relief of dry, hacking cough
guaifenesin (Mucinex, Robitussin)
(expectorant)
- relief of productive cough
- thins respiratory secretions
bronchodilators
- stimulate beta 2
- use: asthma
- adverse: increase heart rate and force of contraction
- contraindications: cardiac tachyarrythmias, severe CAD, HTN, DM (? diabetes?)
xanthines
- cause bronchodilation
- adverse: CNS stimulation, increase cardiac output, restlessness, convulsions, tachycardia
- not first line agent
- therapeutic level 5-15mcg/mL
- Toxicity: seizures, arrythmias
theophylline (Theo-dur, Aminophylline)
causes bronchodilation
not 1st line agent
epinephrine (Adrenaline)
(bronchodilator - stimulate beta 2)
for asthma
given sq
biguanides
decreased hepatic glucose production and decreased intestinal absorption of glucose
- Use: 1st line treatment for type 2
- does not cause hypoglycemia
- contraindicated - renal disease
- adverse: GI, bloating, N/D
octreotide (Sandostatin)
- inhibits growth hormone release
- use: acromegaly, carcinoid tumors, antidiarrheals
vasopressin (Pitressin)
(posterior pituitary)
synthetic anti-diuretic hormone
use: severe hypotension, shock, diabetes insipidus
- monitors: water intoxication - chest pain, MI, high BP, abdominal cramps
rosiglitazone (Avandia)
increases effectiveness of circulatory insulin
Black Box warning: fluid retention, edema, heart failure, and MI
Leukotriene modifiers
- bronchoconstriction and inflammation
- used with bronchodilators and steroids
- PREVENTION ONLY
- adverse: N/V, HA, infection
- contraindications: liver disease
montelukast (Singular)
(leukotriene modifier)
bronchoconstriction and inflammation
used with bronchodilators and steroids
zafirlukast (Accolate)
(leukotriene modifier)
bronchoconstriction and inflammation
used with bronchodilators and steroids
Sulfonylures
increase insulin excretion from pancreas
- use: type 2
- adverse: hypoglycemia, weight gain, GI issues
- contraindicated: renal disease
glipizide (Glucotrol)
(sulfonylures)
- second generation
- type 2 diabetes
- hypoglycemia risk
alendronate (Fosamax)
(calcium-biphosphate)
inhibit breakdown of bone
sit up for 30 mins after taking
fluticasone/salmetrol (Advair)
(mixed)
- inhaled steroid and long lasting beta 2
- maintenance NOT rescue
ipratropium/albuterol (Combivent)
(mixed)
anticholinergic and short term beta 2
- maintenance NOT rescue
liothyronine (Cytomel)
(thyroid agent)
- stimulate metabolism and cardiac function
- replacement hormone
- given to replace what the thyroid cannot produce
- adverse: none unless given inappropriate dose
- caution in elderly
levothyroxine (Synthroid)
(thyroid agent)
- stimulate metabolism and cardiac function
- replacement hormone
- given to replace what the thyroid cannot produce
- adverse: none unless given inappropriate dose
- caution in elderly
corticosteroids
- suppress inflammation
- decrease mucus production
- decrease edema
- inhaled, IV, po
- Adverse: inhaled avoids systemic problems, impaired growth in children, dry mouth, cough
- short term treatment
- does not cure - control symptoms
methylprednisone
(Solu-Medrol) - endocrine
(corticosteroid)
- IV
- decrease inflammation, mucus production and edema
- anti-inflammatory, immunosuppressive, anti-allergic, and anti-stress
triamcinolone (Azmacort)
(corticosteroid)
- inhaled
- decrease inflammation, mucus production and edema
prednisone
prednisone (Deltasone) - endocrine
(corticosteroid)
- po
- decrease inflammation, mucus production and edema
- anti-inflammatory, immunosuppressive, anti-allergic, and anti-stress
fluticasone (Flonase)
(corticosteroid)
- inhaled
- decrease inflammation, mucus production and edema
beclomethasone (Beclovent)
(corticosteroid)
- inhaled
- decrease inflammation, mucus production and edema
budesonide (Pulmicort)
(corticosteroid)
- inhaled
- decrease inflammation, mucus production and edema
dexamethasone (Decadron)
(corticosteroid - endocrine)
- IV
- anti-inflammatory, immunosuppressive, anti-allergic, and anti-stress
anticholinergics
- block action of acetylcholine in bronchial smooth muscle
- use: for maintenance therapy for bronchitis/emphysema
- Adverse: nervousness, HA, hypotension and GI distress
tiotropium (Spiriva)
(anticholingeric)
for: maintanence therapy for bronchitis/emphysema
NOT for rescue
ipratropium (Atrovent)
(anticholingeric)
for: maintanence therapy for bronchitis/emphysema
NOT for rescue
Nursing Implications of Bronchodilators
- teach prevention
- use of inhaler: wait 3-5 mins between puffs, rinse mouth
- may use spacer
- bronchodilator first then other inhaler
- mark rescue inhaler for easy ID
Nursing implications of corticosteroids
- usually not given in acute attack
- may be given alone or with bronchodilator
- use corticosteroid inhaler last
- gargle after use - fungal infections
Nursing implications of hypothalamic/anterior pituitary hormones
- inappropriate use of growth hormone (athletic)
- used for anti-aging
- link between growth hormone and tumor growth
- monitor height growth
Adverse effects of corticosteroids
- moon face
- obese trunk with thin extremities
- hyperglycemia
- psychosis
- osteoporosis
- paper think skin
- slow healing
Nursing implications of thyroid agents
- given IV or po
- monitor pulse and BP
- withhold med with HR > 100bpm
- take in am prior to breakfast
- monitor weight
- life long replacement
- do not take with iron or calcium
- do not switch brands
- monitor thyroid function
Nursing implications and Adverse reactions of antithyroid agents
Adverse:
- hypothyroidism, iodine toxicity, agranulocytosis
Nursing:
- monitor pulse, BP, weight
- mix iodine in full glass of liquid, drink with straw, metallic taste
- iodine toxicity - abd pain, vomiting, diarrhea, and glottis edema
- radioactive iodine causes hyporthyroidism and will require lifelong thyroid replacement
Insulin Onset/Peak/Duration
insulin lispro (Humalog):
15 min (O)
30min-90min (P)
6-8 hrs (D)
regular insulin (Humulin):
30min-60min (O)
2-3 hrs (P)
5-7 hrs (D)
insulin isophane (NPH):
60min-90min (O)
8-12 hrs (P)
18-24 hrs (D)
insulin glargine or detemir:
1 hr (O)
NONE (P)
6-23hrs (D)
Nursing implications of Insulin
- monitor blood sugars
- hemoglobin A1C
- Teach: techniques for administration, need to time food with peaks, emergency simple sugars on hand, signs/symps of hypo/hyperglycemia
Nursing implications of Biguanides
- take with meals to decrease stomach upset
- discontinue 48 hours before diagnostic tests
- monitor blood glucose
- need to diet/exercise
Nursing implications of sulfonylures
- monitor blood glucose
- take before meals
- teach signs/symps of hypoglycemia
- diet/exercise
Nursing implications of meglitinides
- give a dose with each meal, if you skip a meal = no dose
- give 15-30 min before meal
- monitor blood glucose
