Test#2 Flashcards
1
Q
What are the vitamin k dependent clotting factors
A
8 9 10 prothrombin(2)
2
Q
What clotting factors does heparin act on
A
Xa
IIa
3
Q
What allergy would indicate the pt will have a possible allergic reaction to heparin
A
An allergy to enoxapain or pork
4
Q
What clotting factor does enoxaparin work on
A
Xa
5
Q
what form is does heparin come in
A
IV and Sub Q
-you don’t want to give it IM b/c you will cause a hematoma
6
Q
what is heparin derived from
A
mucosal tissue of animals.
beef lung and pig intestines.
7
Q
what does heparin do
A
inhibits the activity of coagulation factors Xa and IIa to prevent clot from forming.
-it prevents the enlarging of existing clots and prevents new ones.
8
Q
what is enoxaparin
A
a low molecular weight heparin
-it is cut up into smaller fragments of heparin which makes it less effective
9
Q
what clotting factors does enoxaparin inhibit
A
Xa
10
Q
what is anti-thrombin III
A
a protein in the blood stream
-a natural anticoagulant that prevents us from forming unnecessary clots.. it inhibits clotting factors along the cascade including thrombin
11
Q
what is the relationship between anti-thrombin III and heparin
A
anti-thrombin binds to heparin and it forms a complex that makes the heparin 1000x more effective and inhibiting Xa and IIa
12
Q
what is the relationship between anti-thrombin III and Enoxaparin
A
it binds to enoxaparin and forms a complex but creates a shorter chain therefore allowing it to only block factor Xa
13
Q
what is the indication for heparin
A
-prophylaxis and tx of thromboembolic events.
14
Q
what pts are at high risk for thromboembolic events
A
a-fib surgery pts HTN bedridden CAD pts who have multiple risk factors.
also in small doses in pediatric unit to keep peripheral IV lines open.
15
Q
with what med is heparin used with and why
A
warfarin
because warfarin has such a long onset of action and heparin is fast, heparin is given as a “bridge therapy” until warfarin’s reaches its therapeutic level
16
Q
How is heparin given if its given prophylactically
A
via a subQ injection Q8-12hours
17
Q
what needs to be monitored with heparin when given propylactically
A
nothing. No monitoring of labs etc is needed when heparin is given prophylactically.
18
Q
how long is warfarin onset of action
A
36-72hours
19
Q
how is heparin given if it is being used for treatment of clots
A
It is given IV
-it depends on the clot and what they are being treated for to decide whether it is intermittent or continuous
20
Q
what is standard practice when administering heparin initially for treatment
A
Administering a loading dose.(AKA loading bolus)
given first via IV or injection
then followed by intermittent or continuous IV therapy
21
Q
why is a heparin loading dose given
A
to get to the therapeutic level faster
22
Q
how do we monitor if the patient is in the therapeutic level of heparin
A
by assessing the PTT levels
23
Q
what is PTT and what is it for
A
Partial Thromboplastin time.
it measures the time in seconds how long it takes for a clot to form.
it is ONLY used for heparin monitoring.
24
Q
what is the therapeutic range for heparin
A
1.5-2.5 times the control
control depends on facility
25
what do you need to do prior to administering an intermittent infusion of heparin
collect a PTT 30 minutes prior to initial dose to obtain baseline
26
what is heparins half life
1-2hours
27
how often is PTT monitored when giving a continuous infusion of heparin
Q4-6Hours
28
what should you do if the PTT is critically high
stop the infusion for 1 hour and then redraw a PTT.
| consult with the pharmacy to let them know and see what their recommendation is.
29
what is HIT
Heparin induced thrombocytopenia
| it is a side effect of heparin therapy
30
what causes HIT and how does it happen
it is an immune induced response in which the body creates antibodies to platelets.
the platelets release PF4 and it binds to heparin- which then binds to antibodies creating a complex that attaches to the platelet at the receptor (this causes macrophages to clean them out{loss of platelet} and induction of tissue factor-leading to clot.)
31
what is the normal platelet range
150,000-450,000
32
when would you begin to notice HIT and what will you notice.
it will develop around the 8th day of therapy.
- the platelet amount will drop approx 50% drop
- s/s of thrombi formation
33
what do you do if HIT occurs
stop therapy immediately, notify the dr and alternative anti-coagulants can be administered.
34
what is enoxaparin used for
prophylaxis and treatment of DVT/PE
35
what would you see enoxaparin be used for
post hip, knee, abdomen surgeries
| or pts who are bed ridden
36
what should you look at prior to giving enoxaparin
the platelet baseline
37
what is enoxaparins half life and duration of action
4-5 hours 1/2 life and
| 12 hours duration
38
what is prophylactic dosage for enoxaparin
30-40mg Qday or Q12H
39
what is the dosage for treatment of enoxaparin
1mg/kg q12h
or
1.5mg/kg q24h
40
what is the difference in dosages from prophylactic and treatment with enoxaparin
the treatment for coagulation is based on the patients weight.
41
what is contraindicated when giving heparin
someone who has hemorrhagic stroke and uncontrolled HTN
42
what is the antidote for heparin
protamine sulfate IV form
| it inactivates heparin
43
what are the drug drug interactions with heparin
- sulfa drugs
- 2nd generation cephalosporins (cefelexin & cefotetan)
- NSAIDS
- aspirin
- Clopidogrel (plavix)
44
what herbal products interact with heparin
the 5 G's
| ginko, ginsing, garlic, green tea, ginger
45
how does a virus survive
it needs to replicate inside the host cell. they fuse themselves to the outer membrane and enter the cytoplasm of the cell and begin replication.
once it has what it needs from one cell, it spreads and attacks other cells
46
what are the responses to viral infections
-non specific:
cell mediated immunity- macrophages
-specific:
humoral immunity
47
what is cell mediated immunity
-neutrophils, macrophages respond and perform phagocytosis
l-ymphocytes release cytokines which stimulate the immune response
-release of b & t cells
48
what is humoral immunity
specific repsonse
| the production of antibodies that can attack and destroy viruses.
49
what are the stages of a viral infection
1. virus attaches to a cell
2. virus penetrates cell membrane and injects DNA/RNA into cell
3. viral dna/rna replicates using host cell machinery
4. new viral dna/rna are packaged into viral particles and released from the host cell
50
how is herpes aquired
through physical contact with an infected person.
| the fluid that is within the sores.
51
where does herpes stay dormant
in a non replicating state in the sensory or autonomic nerve root ganglia
52
what can cause herpes to replicate
immunosuppression, medication therapy, medical condition, stressors
53
what is the cure for herpes virus
there is no cure.
| there are only medications that can treat the symptoms and reduce the number of outbreaks.
54
what are the 3 types of herpes
herpes simplex virus (HSV)- cold sores/fever blisters
HSV-2- genital herpes
HSV-3- varicella zoster & herpes zoster (chicken pox & shingles)
55
can genital herpes be transmitted when infected person does not have visible sores?
yes
56
what precautions are worn when around chickenpox
contact, airborne and droplet
57
how is chicken pox transmitted
* *it is highly contagious**
- contact with blister
- aerosolized via particles
- coughing/sneezing
- touching contaminated items
- transmitted 1-2 days prior to outbreak or rash
58
when is chicken pox no longer contagious
when the blisters are dry and crusted
59
who can acquire shingles
whoever had chicken pox and has the dormant varicella zoster virus living in their nervous system
60
is shingles contagious
no, you cannot give someone shingles HOWEVER you CAN give someone chicken pox if they've never had chicken pox
61
who is shingles common in
ppl who are older than 50
| ppl on immunosuppressants
62
what are s/s of shingles
painful blister rash that can last for 2-4 weeks
-rash usually in the trunk area in a diagonal fashion
across the torso and back.
63
when can a person give shingles to others
only contagious when the blisters appear.
64
what can occur in someone with a hx of shingles
they can suffer from post-herpetic neuralgia even after the rash has disappeared.
- aches, burns, stabbing pain, sensitive to touch and numbness
can last months to years
65
what is disseminated zoster
when shingles crosses the midline to other areas of the body. usually appears in immunocompromised system.
this kind of disseminated zoster can shed causing the area to be covered.
66
where does herpes zoster live
in the dorsal root ganglia
| when it is reactivated the virus causes shingles.
67
how do anti viral works
directly stop the virus from the replication process by entering the cell the same way the virus does.
68
what is the purpose of anti virals
to try to suppress or eliminate viral activity
69
what forms does acyclovir come in
PO
buccal
IV
topical
70
what is acyclovir used for
HSV 1&2
| varicella zoster and herpes zoster
71
how does acyclovir work against viral infections
interferes with viral DNA synthesis and inhibits viral replication
abd reduces the time for healing of the lesions
72
what are side effects of acyclovir
because 90% of the drug goes through the kidneys unchanged being toxic to the kidneys
-Causes
crystalluria- drug has ability to crystalize in the tubules causing renal damage.
Steven-johnson syndrome- painful red purple rash that can blister and shed skin
73
what nursing interventions should you do when pt is on acyclovir
Encourage Hydration to keep crystalluria from forming
monitor kidney function - BUN Creatinine
color of urine- check hydration
74
what is the purpose for taking acyclovir
It will not cure but it will
- decrease the amount of time the lesions need to heal
- decrease the severity
- reduce the amount of recurrence
- help pain management
75
what are 2 flu medications
Oseltamivir
and
Zanamivir
76
what are the 2 flu medications effective against
influenza A & B
77
what should you avoid if you have received the flu shot
you should avoid taking oseltamivir and zanamivir 2 days prior to getting the flu vaccine or wait 2 weeks after getting the vaccine
78
what does neuraminidase enzyme do
enables viral particles to escape from infected cells to go infect other cells
79
what does oseltamivir and zanamivir do
inhibits neuraminidase enzyme to prevent the infection of other cells
80
what is zanamivir and what is it used for
a powder form inhaler used for the tx or prophylactic flu-related symptoms
81
when should someone take oseltamivir and zanamivir
take within 2 days of exposure.
82
what can oseltamivir cause in relation to the flu vaccine
may decrease the effects of the flu vaccine
83
what is candida and where is it normally found
a type of fungus that normally lives on skin and mucous membranes
normal part of flora on our skin, mouth and urogenital tract
84
what can an overgrowth of candida cause
superficial and systemic infections
overgrowth in the mouth can cause thrush
in the genital tract- yeast infections
on the feet- athletes foot
85
what can a candida infection be caused from
from antibiotic use b/c abx kill infected cells along with normal flora so the fungus has the opportunity to overgrow.
or can be caused from immunosuppressant therapy
86
what does thrush look like
red, white colored patches in the mouth that are slightly raised.
under tongue, back of throat,
can cause difficulty swallowing
87
what are possible systemic infections of fungus caused from
histoplasmosis
aspergillosis
coccidiomycosis
88
who is more likely at risk for systemic fungal infections
immunocompromised pts
immunosuppressive pts
pts who are taking anti-rejection drugs
89
how long does it take to treat a fungal infection
they are difficult to treat
| can take weeks to months
90
what is the most anti fungal medication
nystatin
91
how does nystatin work
disrupts fungal cell wall membrane
by binding to steriles on the fungal cell membrane
which allows the contents of the fungal cell to leak out.
92
what forms does nystatin come in
```
lozenge
suspension
tablet
ointment
powder
```
93
what are the directions for taking a nystatin lozenge
it needs to dissolve orally
| do not chew or crush
94
what is specific about taking a nystatin suspension
you must swish for a few minutes and swallow
| after you've given nystatin, the patient should not eat or drink anything for 20 minutes.
95
when using a powder what do you need to ensure to make sure the medication works
the skin you are applying the powder to, you need to make sure the area is clean and DRY
96
what are adverse effects of nystatin
oral form:
cramps
topical:
skin irritation
97
how can a fungal infection be systemic
from the inhalation of spores which will affect the respiratory system and their lungs
98
where is histoplasmosis found and how transmitted
found in bird and bat droppings
| transmitted via airborne
99
when will you see symptoms of histoplasmosis
3-17 days after exposure to the spores
100
what is aspergillosis
a type of mold that can be a problem in pts with immunocompromised systems.
101
where is aspergillosis aquired
either in the hospital or environment sources.
either decaying leaves of plants, trees, shrubs
or inside such as A/C or ventilation ducts.
102
who does aspergillosis affect
people with weakened immune systems
| healthier people usually do not have a problem
103
what causes valley fever
coccidioides
104
what does cocciodiomycosis affect
infects the lungs and can become disseminated
105
where can you find cocciodiomycosis
in the soil in the US and parts of mexico
106
s/s of systemic fungal infections
```
dry cough
wheezing
SOB
fever
chest pain
fatigue
body aches
```
107
when may you see symptoms of coccidiomycosis
between 1-3 weeks after the pt inhales the spores.
108
what can fluconazole be used for
oropharyngeal or esophageal candidiasis or systemic infections
109
what medication can be taken for thrush
fluconazole
110
how does fluconazole work
inhibits fungal steriles- disrupts the cell membrane of the fungus allowing the contents of the fungal cell to leak out
111
how is fluconazole excreted
10% metabolized by liver
| 80% unchanged by the kidneys
112
side effects of fluconazole
crystalluria- drug can crystallize in tubules
GI distress
S-J syndrome with immunosupporession
113
what should you monitor while on fluconazole
LFTs
BUN Creatinine
urine
adequate hydration
114
what drug interactions does fluconazole have
warfarin
-may increase risk of bleeding with warfarin
glipizide and glyburide
-increasing hypoglycemic effects
115
what is amphotericin B used for
treatment of progressive, potentially fatal systemic fungal infections
systemic candida, histoplasmosis, aspergillosis and cocciodiomycosis
-pts who have tried fluconazole without help or the fungal infection is so severe they need something more.
116
how does amphtericin B work
binds to fungal cell wall disrupting cell membrane
in healthy ppl a lower dose may be given to kick start a fungistatic effect helping the host cell to take over
in higher doses it becomes fungicidal
117
what is the strongest antifungal med
amphotericin B
118
what is the problem with amphtericin B
it has a risk of acute infusion reactions and nephrotoxicity
119
how long can amphotericin B be detected
up to 7 weeks
120
what are adverse effects of amphotericin B
```
N&V
Diarrhea
nephrotoxicity
chest pain
hypotension, elevated liver enzymes,
hypokalemia,
chills
fever,
phlebitis
```
121
what do nurses do to reduce the chances of side effects of amphotericin B
- Vital signs q1h (watch for hypotension, fever)
- assess anaphylaxis (severe allergic reaction)
- adequate hydration 2-3L fluid/day (reduce kidney damage)
- pre medicate with anti-emetics and antipyretics, antihistamines, corticosteroids, analgesics (d/t the such high risk of adverse effects)
- monitor infusion closely(continue asking how they are doing)
- infuse slowly- over 2-6 hrs
122
what does metronidazole treat
```
Broad spectrum
it is a bactericidal
trichomonacidal
amebicidal
capable of killing parasites
```
123
how does metronidazole work
disrupts DNA and protein synthesis
124
patients who have what would receive metronidazole
patients with anaerobic type infections such as intra abdominal infections
- skin-skin structures
- lower respiratory tract infections
- septicemia
- bone/joint infections
- mild to moderate c-diff (without any other complications)
125
forms of metronidazole
oral and IV forms
126
if a pt has c-diff which form of metronidazole would you give
oral form
| because you need the med to go through the GI tract
127
what is special about the IV form of metronidazole
the IV form is also effective in treating C-diff, the ONLY one
128
what does metronidazole PO cover
dysentery (inflammation/ulceration of lower part of bowel- pts suffer from bloody diarrhea)
Trichomoniasis- STI caused by parasite
peptic ulcer disease- caused by H Pylori
129
what are the adverse effects of metronidazole
```
abdominal pain
anorexia
dizzy
dry mouth
metallic taste
```
130
what drug interactions does metronidazole have
warfarin
| it increases the effects of warfarin
131
What is diabetes the leading cause of
Blindness
Renal failure
Non traumatic leg amputations
132
What is diabetes characterized by
High glucose levels and the body's inability to use or produce insulin
133
What are major risk factors for diabetes
Obesity and sedentary lifestyle
134
Is diabetes cureable
If it is caught in the ore diabetic stages. Yes it can be reversed by lifestyle and diet modifications.
If the pt is diagnosed with diabetes then no it is not cureable. It at that point has to be treated and managed.
135
What is diabetes.
A CHO metabolism disorder
| A multi factoral multi organ condition
136
What can diabetes predispose patients to
Cardiovascular disease
Renal damage
PVD
Eyes and nervous system disorders
137
What are immediate complications of hyperglycemia
- WBC cells do not work effectively. (The T cells and phagocytic effect is deminished causes the immune system to be less effective causing immunosuppression)
- Which leads to poor wound healing
- Increases colonization of staph aureus (these pts already have an increase in susceptibility-which affects wound healing)
- Frequent occurrence of UTI, yeast infections, and soft tissue infections
-Increase in coaguability of RBC
138
What does chronic hyperglycemia do to the arteries of the body
It causes angiopathy because the endiothelial lining is injured which causes the arterioles to narrow(arteriosclerosis) the narrowing can lead to HTN
139
What are the hyperglycemic complications related to microvascular angiopathy
Retinopathy- the smallest arteries in our retina are damaged
Neuropathy-damage to sensory and motor neurons
Nephropathy- damage to arterioles around the nephron
140
What causes diabetic retinopathy
The hyperglycemia caused endothelial injury in the retinal arterio vessels which cause inflammation and cause platelets to respond clogging the arteries and capillaries leading to retinal ischemia
141
What can retinopathy lead to
If not treated it can lead to seeing spots
Unclear vision
Eventually blindness
142
What causes diabetic neuropathy
Hyperglycemia damages the arterioles that supply nutrients to the neurons and the neurons begin to demyelinate and degenerate in the nerve fibers of the lower extremities first
143
What are symptoms of neuropathy
Numbers
Tingling
Pain
Sensitive to touch
Causing weakness and unsteady gait
144
What can nephropathy lead to
Renal insufficiency and renal failure due to the damage to the arterioles around the nephron
145
What does hyperglycemia do to the glomerular capillaries
Damages them causing them to become hyperpermeable causing proteins and other substances leak out
Leading to proteinuria and microalbuminuria
146
What are the complications of hyperglycemia related to macrovascular angiopathy
Coronary artery disease
Cerebrovascular disease
PVD
2-4x at risk of a cardiovascular event
147
How does hyperglycemia affect the macrovascular arteries
It damages them causing arteriosclerosis leading to -HTN leading to myocardial ischemia
- TIA-decreased blood flow to the brain
- PVD
148
Which islets of langerhans cells produce insulin
Beta cells
149
What stimulates beta cells to release insulin
The rise in blood glucose
150
What is insulin
An anabolic hormone that has body building function
| It can build muscle, store fat and form glycogen
151
Where is excess glucose stores
In the liver and muscles in the form of glycogen
Or
In adipose tissue as fatty acids
152
What areas of the body do not need insulin
The brain and the contractile muscle
153
What do alpha cells produce
Glucagon which is an opposing hormone to insulin
| It is secreted when blood sugar is LOW
154
What does glucagon do
1-glycogenolysis: breakdown of glycogen to glucose
2-activate gluconeogenesis: making new glucose from amino acids and lipids. (Gluconeogenesis has the ability to activate lipase which breaks down fat)
155
What happens when fat breaks down
It is broken down into fatty acids and glycerol
The glycerol is what is used to make glucose
The fatty acids break down to keytones which can lead to diabetic ketoacidosis
156
Type 1 diabetes vs type 2
-type 1
Occurs more in adolescent.
Caused from predisposition,genetic factor, autoimmune response
End result-lack of insulin production
-type 2
Either causes from not enough insulin or insulin resistance
Caused from obesity and sedentary lifestyle
End result need oral or insulin therapy
157
what is insulin resistance characterized by
cellular resistance to insulin which causes the pancreas to work even harder, leading to hyperinsulism
this leads to an overworked and exhausted pancreas leading to a decrease in insulin production
158
what happens after the pancreas becomes weak and tired and begins to produce less insulin
the blood glucose rises and stays higher
159
what are the two contributing factors to insulin resistance
1. the lack of physical activiyt
| 2. obesity
160
why is obesity a contributing factor to insulin resistance
because fat cells are more resistant to insulin
161
how does physical activity help with diabetes
physical activity can improve our cells sensitivity to insulin and improve glucose uptake
162
what is a condition of type 1 diabetes
Diabetic Ketoacidosis
because there is not enough insulin so the alpha cells perform gluconeogenesis which results in the breakdown of fat causing increase of keynotes leading to DKA
163
walk through the steps of hypoglycemia development
- glucose absorbed via GI
- glucose stimulates pancreas to secrete insulin
- body cells resist insulin/glucose can't enter cells
- glucose accumulates in the bloodstream
- pancreas continues to put out insulin
- cells may be resistant to insulin causing hyperinsulinemia
- cells feeling starved-
- -liver will break down glycogen to glucose and break down fats and amino acids to further increase glucose
164
what are risk factors for developing diabetes that cannot be controlled
```
age (older)
family hx- especially a 1st degree relative
hx of gestational diabetes
ethnicity
genetic mutations
```
165
what ethnicities are at greater risk for diabetes
african-american
asian-american
hispanic
native american
166
what are risk factors for diabetes that can be controlled
- obesity/diet
- lack of physical inactivity
- metabolic syndrome
167
what is metabolic syndrome and what has to be present to qualify
group of risk factors that raises the risk for developing heart disease, diabetes, stroke, coronary artery disease, PVD, thromboembolic events
have to have 3 of 5:
- hyperglycemia
- abdominal obesity (apple shape)
- decreased HDL
- high BP
- high triglycerides
168
when should you perform a fasting blood glucose test
after 8 hours of NPO
169
What is OGTT
oral glucose tolerance test
pt will ingest 75g CHO drink and 2 hours later the glucose will be assessed.
this is to assess how the pancreas is working
170
what can blood glucose diagnostics tell us
it will tell us if the pt has hyperglycemia, diagnose pre or diabetes, and can also be used to tell how people are controlling their hyperglycemia
171
How does the hgb A1c work
it is used to assess the blood glucose control over 120 days..
glucose attaches irrevirsibly to hgb molecules and survives for the life of the RBC.
the A1c does not show peaks or valleys but gives us an understanding of how hyperglycemia has been. indicates how therapy has been or to diagnose diabetes.
172
what levels of fasting blood glucose is diabetic
normal: <99
pre diabetic: 100-125 on TWO separate occasions
diabetic >126 - on TWO separate occasions
173
what are the levels of hgbA1c
normal: 5.6
pre diabetic: 5.7-6.5
Diabetes: >6.5
174
what are the levels of 2 hr post OGTT
normal: <139
pre diabetic: 140-199
diabetes: >200
175
level to diagnose diabetes with a random blood glucose test
>200 with symptoms
176
what are ways to modify lifestyle for pre diabetest/diabetes
- follow a meal plan that has a balanced CHO intake w/ pancreas function
- increase intake of healthy foods.
- low sugar, low CHO
- increase activity level-promote weight loss and muscle growth (exercise can reduce insulin resistance)
- self monitor glucose levels
177
what is encouraged in a diabetic diet
Protein
it can slow down digestion and slows the rise of glucose
high protein can stimulate insulin response but does not cause insulin spikes
should have intake of 15-20%/day
178
what effect does fat have on blood glucose
- slows digestion which slows the rise of glucose
- promotes the feeling full (eats less)
- should have less than 7% saturated fats.
- intake should be 25-30% calories/day
179
what effect does alcohol have on blood glucose
-inhibits gluconeogenesis therefore can cause hypoglycemia in pts taking insulin (because new glucose cannot be formed)
recommendation:
-drink in moderation- women 1/day, men 2/day
-drink w/ meals, sugar free mixes, dry or white
180
CHO effects on glucose and recommendations
-contribute to post prandial glucose spikes.
-include sugars, starches and fibers
promote healthier CHO such as whole grain bread, fruits and veggies.
daily allowance 130g/day
50% of calories/day
181
how many grams is 1 serving of CHO
1 serving CHO = 15 grams
182
what is the recomendation for patient who are on antiglycemic agents
that they do not skip meals and have snacks throughout the day
183
how many grams of CHO should a person have each meal
45-60 grams/meal
and 15-30grams/snack
130 is the minimum
184
how is my plate separated
1/2 plate veggies, 1/4 starch, 1/4 protein and a side of dairy and fresh fruit
185
what is the first line drug choice for type 2 diabetes or preventing type two
metformin
(abiguanide)
either a mono therapy or a used with other oral or insulin meds
186
how do biguanides work
- they make body tissues less resistant to endogenous insulin (more sensitive to the insulin our body makes)
- decrease the amount of glucose produced by the liver
- decrease the intestinal absorption of glucose
187
what are the adverse effects of metformin
nausea
diarrhea
abdominal bloating (can cause ppl to not eat as much because they feel full so may cause weight loss)
metallic taste
188
what are nsg implications of metformin
-med needs to be taken with meals
189
what is metformin contraindicated in
-renal insufficiency
| because it is almost completely eliminated in the kidneys
190
how long should metformin be held if a pt is going for a test with radiographic contrast
needs to be held at 1-2 hours BEFORE the procedure and 48 hours AFTER procedure
191
what should you do before starting metformin after a pt has gone for a test with contrast
- need to check kidney function BUN/Creatinine
| - need an order to restart med.
192
what are the 3 sulfonylureas
glipizide
glyburide
glimepiride
193
what are the actions of sulfonylureas
- lower blood sugar by stimulate release of insulin
- increase sensitivity to insulin at receptor sites
- decrease hepatic glucose production
194
what are adverse effects of sulfonylureas
```
hypoglycemia
increased appetite (d/t the increased insulin)- may cause weight gain
```
195
s/s of hypoglycemia
```
sweating
hunger
weakness
dizziness
tremors
tachycardia
anxiety
```
196
what are nursing implications when administering sulfonylureas
- administer meds 30 min BEFORE meals
- assess for sulfonamide allergies
- assess liver function because these meds are metabolized by the liver.
- hold during post op until pt is intaking regular meals to prevent hypoglycemia
197
which med can sulfonylureas be given concurrently with to help therapy
metformin
198
what are incretins
natural stimulating hormones that are found in the GI tract.
in response to food they stimulate pancreatic insulin secretion
199
what would incretin dysfunction result in
post parandial hyperglycemia
because the incretin is not working correctly and not detecting food therefore cannot stimulate the pancreas to secrete insulin
200
what is DPP 4
di peptidyl peptidase 4
an enzyme that destroys incretin hormones.
found in obese pts and pts with insulin resistant type diabetes
201
what do DPP 4 inhibitors do
a medication that inhibits the DDP 4 enzyme from destroying the incretins thus allowing the incretins to stimulate the pancreas to secrete insulin and reduce fasting BG and post parandial BG
202
what are DPP 4 inhibitors used for
the management of type 2 diabetes
203
what are the DPP 4 inhibitor drugs
Sitagliptin (januvia)
| Saxaglipitin
204
what is the combo DPP4 inhibitor drug
sitagliptin and metformin (JANUMET)
205
what drug interactions are with DPP 4 inhibitors
increased risk for hypoglycemia with sulfonylureas or insulin
206
what are the nursing implications for DPP 4 inhibitors
-administered w/o regards to food
-sx pts may need to be stopped pre op/post op-check w/ md
-check glucose levels
assess for s/s of hypoglycemia
-sweating
-hunger
-weakness
-dizziness
-tremors
-tachycardia
-anxiety
207
what is the goal of insulin therapy
to mimic the pancreatic pattern of pancreatic secretions of insulin without causing hypoglycemia
208
what are they types of insulin
rapid
short
intermediate
long acting
209
what are the rapid acting insulins and when are they given
| rapid acting do not LAG
lispro
aspart
glulisine
(lispro and aspart are the same and interchangeable)
they are given 15 minutes before a meal. given 3-4 times/day
210
what are the short acting insulins
| and when are they given
Humilin R
Novolin R
they are given 30-60 minutes before a meal
211
what are the intermediate acting insulins and what is special about them
```
humulin N
Novolin N
a suspension
it is the only insulin that looks cloudy
it is given twice a day
it can be mixed with short or rapid acting insulin
```
212
what are the long acting insulins and what is it used for
Glargine
Detemir
(no peak and last 24+hrs)
-its used to control the fasting plasma glucose level.
-released steadily and continuously and mimics pancreas delivery of insulin
-given once daily
213
what is a basal bolus insulin regimen
a one daily injection of long acting insulin with several short acting insulin blouses
approximates normal patterns
requires frequent glucose monitoring AC and HS
214
what are other factors that can affect glucose levels
- corticosteroids
| - stress
215
how does corticosteroids and stress cause hyperglycemia
increase glucose levels
- corticosteroids promote glucose production from the liver and reduce cell sensitivity to insulin
- stress can increase glucose levels
