test 3 Flashcards
rapid insulin (insulin aspart, insulin lispro, insulin glulisine) onset, peak and duration
onset- 10-30 mins
peak- 1/2 hour to hour and a half
duration- 3-5 hours
give 5-10 mins before meal
short insulin (regular) onset, peak, duration
onset- 30-60 mins
peak- 2- 4 hours
duration- 5-8 hours
admin 30-60 mins before meal
intermediate insulin (Insulin Isophane) onset, peak, duration
onset- 1-2 hours
peak- 4-12 hours
duration- 18-24 hours
give 30 mins before first meal of day
long insulin (insulin degludec, insulin detemir, insulin glargine) onset, peak action
onset- 1.5-1.6 hours
no peak
duration- 24 hours
give at the same time daily
only insulin that can be given IV
Insulin regular (short acting)
what insulin can not be mixed with other insulins
long (insulin degludec, insulin detemir, insulin glargine)
type I diabetes
cells are no longer responsive to insulin. Insulin resistance
type II diabetes
beta cells don’t have insulin to release
what is glucagon and what secretes it
secreted by alpha cell, raises blood glucose level
what is insulin and what secretes it
secreted by beta cell, lowers blood glucose level
diabetes symptoms
fasting glucose above 126, polyuria, polyphagia, polydipsia, glucosuria, fatigue, weight loss (Type I)
Regular insulin (Humulin R, Novolin R)
Ther class-Parenteral drug for diabetes; pancreatic hormone
pharm class- short acting insulin
preg cat B
Promote cellular uptake of glucose, amino acids, and potassium; to promote protein synthesis, glycogen formation and storage, and fatty acid storage as triglyceride
adverse- hypoglycemia
may decrease serum potassium, calcium, magnesium
drug interactions and diabetes
furosemide or thiazide diuretics may increase glucose levels
beta blockers may mask effects of hypoglycemic reactions
hypoglycemia symptoms
tachycardia, confusion, sweating, drowsiness, convulsions, coma, death
hyperglycemia symptoms
polyuria, polydipsia, polyphagia, glucosuria, weight gain/loss. fatigue
insulin shots
insulin special syringe
To avoid multiple shots; can draw together: Draw up clear first (usually regular), then cloudy looking insulin, which could be intermediate
Long action cannot be mixed!!
treatment goals for type II DM
preprandial (before eating) blood sugar below 110
HbA1C< 6.5%
Oral hypoglycemic drugs
not effective for type I DM, they need insulin
oral hypoglycemic drug that has adverse effect for hypoglycemia
sulfonylureas, , meglitinides
oral hypoglycemia drug that can help treat obesity
increntin enhancers
metformin (fortamet, glucophage, glumetza)
ther- antidiabetic
pharm- biguanide
Preferred oral antidiabetic drug due to effectiveness and safety
Decreases hepatic production of glucose and reducing insulin resistance. A major advantage of this drug is that it doesn’t cause hypoglycemia
does not promote insulin release.
Does not cause hypoglycemia
adverse- GI related. Black box- lactic acidosis
contraindicated when using IV radiation
May decrease B12 and folic acid absorption
progressive loss of brain function characterized by memory loss, confusion and dementia
alzheimer’s disease
demyelination of neurons in the CNS resulting in weakness
multiple sclerosis
progressive loss of dopamine in CNS causing tremor, muscle rigidity, and abnormal movements
parkinson’s disease
degenerative disease of motor nuerons
ALS
levodopa, carbidopa, and entacapone (stalevo)
ther- antiparkinson
pharm- dopamine precursor; dopamine-enhancing drug combination
action- Restores neuromuscular dopamine in extrapyramidal areas of the brain, relieving some Parkinson’s symptoms such as tremor, bradykinesia, and muscle rigidity, combined with drugs to prevent enzymatic breakdown.
adverse- Uncontrolled and purposeless movements, loss of appetite, nausea, orthostatic hypotension.
Psychosis develops in 20% patients taking levodopa
considerations- discontinue gradually; liver function test may be elevated
encourage increase in fiber and fluids
Benztropine (Cogentin)
ther-Antiparkinsonian drug
pharm- Centrally acting cholinergic receptor blocker
action- Blocks excessive cholinergic stimulation of neurons. Used for relief of Parkinson like symptoms
adverse-dry mouth, constipation, tachycardia
avoid alcohol
donepezil (Aricept)
ther- Alzheimer disease drug
pharm- Cholinesterase inhibitor
action- AChE inhibitor improves memory by enhancing acetylcholine in neurons
adverse-Vomiting, diarrhea, dark urine, CNS side effects such as depression, headache, musculoskeletal such as cramps, arthritis
overdose- anticholinergic like atropine
memantine (namenda)
approved for treatment of moderate to severe alzheimer’s
-reduces abnormally high levels of glutamine
drugs for MS
interferon beta
glatiramer
what to watch for with immunosuppressants
infection
non-pharm treatments of muscle spasms
RICE, pain management, surgery, PT, message
cyclobenzaprine (Amrix)
ther- Centrally acting skeletal muscle relaxant
pharm- Catecholamine reuptake inhibitor
action- Relieves muscle spasms by depressing motor activity primarily in brainstem. This drug also increases circulating levels of norepinephrine, blocking presynaptic uptake.
adverse- Drowsiness, blurred vision, dry mouth, rash. tachycardia
nursing considerations- Only meant for 2-3 weeks
no alcohol
skeletal muscle relaxant
neuromuscular junction drug
has -toxin at end
direct acting antispasmodic
Dantrolene sodium (Dantrium, revonto)
ther- skeletal muscle relaxant
pharm- direct acting antispasmodic, calcium release blocker
Often used for spasticity
action- It directly relaxes muscle spasms by interfering with the release of calcium ions from storage areas inside skeletal muscle cells
adverse- Muscle weakness, drowsiness, dry mouth, dizziness, diarrhea, tachycardia
Black box- hepatitis and death due to liver failure
neuromuscular blockers
used to relax muscles during surgical procedures- Diaphragm is paralyzed, need to vent or ambu bag
patients still feel pain, they need to be sedated as well
Somatic pain
sharp, localized sensation
visceral pain
dull, throbbing, aching
nerve cords received pain impulse through A fibers (sharp) or C fibers (dull)
nociceptor stimulation
endogenous opioids
in our body naturally; interrupts pain
ex- endorphins, dynorphins, enkephalins
stimulates mu and kappa
opioid agonist drugs
block mu and kappa receptors
opioid antagonist
what does mu do
analgesia, decreased GI motility, resp depression, sedation, physical dependance
what does kappa do
analgesia, decreased GI motility, sedation
morphine (Astramorph PF, duramorph)
ther- opioid analgesic
pharm- opioid analgesic receptor
action- Morphine binds with mu and kappa receptor sites to produce profound analgesia. It causes euphoria, constriction of the pupils, and stimulation of cardiac muscle. Used for symptomatic relief of serious and acute chronic pain
causes peripheral vasodilation
adverse- Orthostatic hypotension, hallucinations, nausea, dizziness, itching. OD may result in resp depression or cardiac arrest. Black box- when given epidural, 24 hour watch
schedule II drug
monitor o2 stat and respirations
monitor liver and kidney functions
OD treatment- naloxone
naloxone (evzio, Narcan)
ther-Drug for treatment of acute opioid od and misuse
pharm- Opioid receptor antagonist
action- Pure opioid antagonist, blocking both mu and kappa receptors. Used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected
adverse- not many, relates to withdrawal of opioids like increased BP, temor, hyperventilation
admin for a resp rate lower than 10 breaths/min
treatment for opioid dependency
no cure but avoids withdrawal- methadone drug
NSAIDs
nonopioid analgesic
-used for fever, inflammation and analgesia
aspirin (acetylsalicylic acid, ASA)
ther-Nonopioid analgesic; non-steroid anti-inflammatory drug (NSAID); antipyretic
pharm- Salicylate; cyclooxygenase (COX) inhibitor
action- Inhibits prostaglandin synthesis involved in the processes of pain and inflammation and produces mild to moderate relief of fever. Also causing vasodilation, significant anticoagulant ability
platelet inhibition caused by this is irreversible
adverse- Gastric discomfort and bleeding; salicylism may occur
act by constricting certain intracranial vessels; serotonin agents
triptans
acts as vasoconstrictors; interacts with adrenergic, dopaminergic, and serotonin receptors; terminates ongoing migraines
ergot alkaloids
sumatriptan (Imitrex, onzetra)
ther- antimigraine drug
pharm- Triptan, 5-HT (serotonin) receptor drug, vasoconstrictor of intracranial arteries
action- Causes vasoconstriction of cranial arteries. Moderately selective and doesn’t usually affect all of blood pressure
adverse- Dizziness, drowsiness, warming sensation
May produce cardiac ischemia (due to vasoconstriction), or HTN
Ergot alkaloids adverse effects
GI upset, tachycardia, angina like pain, numbness/tingling in fingers and toes
contains injury, destroys microorganisms
inflammation
signs of inflammation and basic steps
redness, warmth (vasodilation)
swelling(vascular permeability)
pus (cellular infiltration)
clots (thrombosis)
pain (stimulation of nerve endings)
histamine
responsible for symptoms of anaphylaxis
produces vasodilation- capillaries become leaky and tissue swells
h1 receptors found in vascular smooth muscle, in bronchi, and on sensory nerves
ibuprofen (Advil, Motrin)
ther-Analgesic, anti-inflammatory, antipyretic
pharm- NSAID
Action- For treatment of mild to moderate pain, fever and inflammation. Its actions are primary due to inhibition of prostaglandin synthesis
adverse- Nausea, heartburn, epigastric pain, dizziness. Rare- peripheral edema, anaphylaxis, aplastic anemia, GI ulcer. Black box- may cause increase risk of thrombotic event
best with food to prevent stomach pain
MONITOR hydration (kidneys), cardio events, GI bleeds
cyclooxygenase-1 (COX-1)
present in all tissues
- reduces gastric acid secretion, promotes renal blood flow, promotes platelet aggression
inhibiting this can cause bleeding, GI upset, reduced renal function
cyclooxygenase-2 (COX-2)
formed only after tissue injury
- promotes inflammation, sensitizes pain receptors, mediated fever in brain
inhibiting this results in suppression of inflammation
salicysm
tinnitus, dizziness, headache, excessive perspiration
prednisone (meticorten)
ther-Anti-inflammatory
pharm- corticosteroids
action-Synthetic corticosteroid. When used for inflammation, only used for 4-10 days
adverse- Long term- Cushing’s disease
gradually stop-I f you don’t gradually stop, adrenals become atrophy, we need to wake them up slightly
Tylenol (acetaminophen)
ther-Antipyretic and analgesic
pharm-Centrally acting COX inhibitor
action- Reduces fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels. Has no anti-inflammatory properties
- enables sweating
adverse-Uncommon. high, long uses can cause acetaminophen poisoning like vomiting, dizziness, abdominal pain. Black box- can cause fatal liver injury
sedatives
gives ability to sedate or relax a patient
hypnotics
ability to induce sleep
sedative-hypnotics
calming effect at lower doses; sleep at higher doses
sedative-hypnotics
calming effect at lower doses; sleep at higher doses
EEG
sleep study; seizure study
escitalopram (lexapro) or sentraline (zoloft)
ther- Antidepressant; anxiolytic
pharm- Selective serotonin reuptake inhibitor (SSR)
action- SSRI that increases the availability of serotonin at specific post-synaptic receptor sites located within the CNS. Selective inhibition of serotonin uptake results in antidepressive activity without symptoms of sympathomimetic or anticholinergic activity
-Keeps serotonin recirculating, instead of reuptake
adverse- Dizziness, nausea, insomnia, weight gain, confusion, seizures, sexual dysfunction
Black Box- antidepressants increase risk of suicidal ideation
Typically first line drug, tends to be safest
Watch for weight gain, sexual dysfunction, serotonin syndrome, suicidal idea, steven Johnson’s syndrome (painful rash)
duloxetine (cymbalta)
serotonin norepinephrine reuptake inhibitors
second line-Not as safe as SSRI- acting on 2 neurotransmitters now
adverse- abnormal dreams, sweating, constipation, dry mouth, weight loss, loss of appetite, tremor, N/V. abnormal vision, loss of sexual desire, dizziness
amitriptyline (elavil)
or
imipramine (Tofranil)
ther- Antidepressant; treatment for nocturnal enuresis in children
pharm-TCA- tricyclic antidepressant
Blocks the reuptake of serotonin and norepinephrine into nerve terminals. It is used mainly for major depression, and sometimes used for treatment of nocturnal enuresis (bed wetting) in children
dont use with cardio issues; dont discontinue disruptly
side effects- drowsiness, sedation, orthostatic hypotension, dry mouth, constipation, weight gain, urine retention, mydriasis, dysrhythmias, blurred vision
Black box- may increase risk for suicidal thinking
phenelzine (nardil)
ther-antidepressant
pharm-Monoamine oxidase inhibitor (MAO)
action-Produces its effects by irreversible inhibition of MAO; therefore, it intensifies the effects of norepinephrine in adrenergic synapses. It is used to manage symptoms of depression that are not responsive to safer meds
adverse- Dry mouth, orthostatic hypotension, insomnia, nausea, loss of appetite. May increase HR and neural activity- leading to delirium, mania, convulsions.
Black box- increase risk of suicidal thinking
Abrupt stop could cause rebound HTN
avoid foods with tyramine
lorazepam (Ativan)
ther-Sedative-hypnotic; anxiolytic; anesthetic adjunct
pharm-Benzodiazepine; GABA receptor agonist
action-Benzodiazepine that acts by potentiating the effects of GABA, an inhibitory neurotransmitter, in the thalamic, hypothalamic, and limbic levels of the CNS. Also used as a preanesthetic medication to provide sedation and for management of status epilectus. Unlabeled uses include the treatment of chemo induced nausea/vomiting
adverse-Drowsiness and sedation is most common. IV route may cause amnesia, weakness, disorientation, ataxia, sleep disturbance BP changes, vision changes
Monitor respirations every 5-15 mins
nembutal, seconal
barbiturates
action- binds with GABA receptor chloride channel molecules; inhibits brain impulses
used as sedative, hypnotic, and anti-seizure effects
adverse-tolerance, resp depression, dependance
rarely used for anxiety and insomnia!
zolpidem (Ambien, edluar, intermezzo)
ther-Sedative hypnotic
pharm-Nonbenzodiazepine GABA receptor agonist, Nonbarbiturate CNS depressant
action-Acts in a similar fashion to facilitate GABA mediated CNS depression in the limbic, thalamic and hypothalamic regions. It preserves stage 3 of sleep and has only minor effects on REM sleep. For short term insomnia management
adverse-Daytime sedation, confusion, amnesia, dizziness, depression w suicidal thoughts, nausea, vomiting, hallucinations, sleep walking (and eating while doing), sensory distortion
Black box- schedule IV controlled substance that can lead to abuse and dependency
monitor for CNS depression
what’s needed for depression diagnosis
5 symptoms ongoing for 2 weeks
Lithium carbonate (eskalith)
mood stabilizer for bipolar disorder
affects sodium transport across cell membranes
adverse- sodium loss
Take lithium all the time, do blood checks of levels and check sodium
methylphenidate (concerta, Ritalin)
ther-Attention deficit/hyperactivity disorder drug
pharm- CNS stimulant
action-Activates the reticular activating system, causing heightened alertness in various regions of brain, particularly those centers associated with focus and attention. Activation is partially achieved by release of neurotransmitters
adverse-Irregular heartbeat, HTN, liver toxicity, loss of appetite
Black box- schedule II, high abuse potential
drug holidays are recommended
Amphetamine- will show up in drug test.
foods that contain tyramine
avocado
cheese
salami
yogurt
bananas
