Test 6 Flashcards
desmopressin (DDAVP) mechanism of action
MOA: increase renal tubule permeability (reabsorption of water)
hydrocortisone (Solu-Cortef) indication, side effects
I: used to suppress the inflammatory and immune response.
Side Effects: Hypertension, osteoporosis, PUD, irritability, moodiness, weight gain
* Cushing syndrome occurs when high levels of corticosteroids are present in the body over a prolonged period of time
ketoconazole (Nizoral) indication, mechanism of action
I: treatment for cushing syndrome (when high corticosteroids)
MOA: decreased ACTH secretion
tadalafil (Cialis), sildenafil (Viagra) contraindications, side effects
c: contraindications; if taking nitrates, (dangerous hypotension-death),
s/e: hypotension, priapism (erection for more than 4 hrs.)- dangerous blood flow.
Contact dr!
Causes of male erectile dysfunction
o vascular: smoking, HTN, obesity, cardiovascular disease (30-60% of cause)
o medications: SSRIs, TCA, ACE inhibitors, beta blockers, alpha blockers, thiazide
diuretics
o psychogenic: depression
finasteride (Proscar) indication, mechanism of action
o I: Tx for benign prostatic hyperplasia
o MOA: 5-alpha reductase inhibitor: blocks conversion of testosterone to the more potent
hormone (DHT) which prostate gland enlargement is dependent on.
Oral contraception patient teaching
o combination of estrogen and progesterone. acts by preventing ovulation via negative
feedback to the pituitary which suppress LH and FSH.
o No smoking (high risk for blood clots)
o SE: weight gain, breast tenderness, N/V
o can cause increast breast cancer risks
o must take pill daily, if missed pill- use another form of protection during that cycle.
o watch for blood clots- contraindicated if Hx of blood clots
progestin (Minipill) indication, mechanism of action
o I: progestin only (used when estrogen is contraindicated) - hx of blood clots, hx of thromboembolism, lactating, smoking.
o MOA: thickens cervical mucosa and thins endometrial lining
o 91% effective
Oxytocics indication
o I: uterine stimulant for labor (inducing)
o reduces postpartum hemorrhage
▪ Emergency contraception administration
ASAP- (levonorgestrel): 2 doses 12 hours apart; given within 72 hrs.
Preven: give with antiemetic; another morning after pill. Affects progesterone and estrogen
Another emergency contraceptive: Paraguard IUD; prevent ovulation, not abortive
Abortive drugs: mifepristone (Mifeprex) before 7 weeks and misoprostol good any time.
▪ Magnesium Sulfate mechanism of action, indication
o I: type of tocolytic (prevents pre-term labor)
o MOA: slows uterine contractions
▪ Hormone replacement therapy patient teaching
o HRT provides relief from menopause symptoms and to prevent the long-term
consequences of estrogen loss (osteoporosis)
o combinations of estrogen and progesterone
o SE: DVT, PE (blood clot risks)
o smoking increases risks of MI and stroke
o increased estrogen= increased clotting factors
o estrogen- endometrium growth
conjugated estrogen (Premarin): progesterone not needed if Hx of
hysterectomy
conjugated estrogens/medroxyprogesterone (Prempro): may start bleeding
again
Hyperthyroidism and Hypothyroidism S/S, and treatment goals
thyroid hormones stimulate the basal metabolic rate of nearly all tissue
o Hypothyroidism: congenital or acquired disorder. Congenital hypothyroidism results
in a condition known as cretinism
causes: thyroid gland or pituitary dysfunction, iodine deficiency, use of some
medications (lithium, amiodarone, radiographic dye with iodine, kept
tablets), and radiation.
Hashimoto’s thyroiditis is an autoimmune disorder of the thyroid gland and is
the most common cause in the US
affects nearly all major organ systems, and this hypometabolic state is marked by a gradual onset of these s/s:
weakness, fatigue, weight gain, decreased appetite, cold intolerance, bradycardia, hypotension, subnormal body temp, rough skin, memory issues, constipation, myxedema (swelling c waxy skin)
levothyroxine (Synthroid)- thyroid hormone replacement
start c low dose, low and slow to avoid cardiovascular disease
take in the morning
o Hyperthyroidism (Graves disease) is autoimmune disorder accompanied by
ophthalmopathy and goiter. Tx surgery or drugs that reduce production of thyroid
hormone
goiter: over or under activity of gland- often times not obvious
iodine deficiency or gland inflammation
s/s: weight loss, irritability, hunger, tachycardia, sweating, muscle cramps,
exophthalmos, vision loss, unable to close eyes (corneal ulcerations)
▪ Diabetes Mellitus Type 1 &2, who is at risk, pathophysiology
o type 1:
Risk: Children, young adults, usually younger than 35yrs
Patho: caused by absolute lack of insulin due to autoimmune destruction of
pancreatic islet cells. If untreated, results in serious chronic conditions due to
damage of the cardiovascular and nervous system.
increased BG damages nerves, weakens walls of small vessels, reduces nitric
oxide (vasodilator)
usually children, young adults, usually younger than 35 yrs
s/s: polyuria, polydipsia, polyphagia, weight loss, fruity breath (DKA), body
uses fat and muscle for energy instead, so ketones in blood (very acidic) and
DKA
o type 2: much more common (90-95% of DM), caused by:
At risk: usually older than 35 yrs
Patho: lack of sensitivity of insulin receptors at target cells (insulin resistance)- signal
not sent to cells
deficiency in insulin secretion: beta cells burn out over time bc pancreas
works too hard
if untreated results in same chronic conditions as type 1 DM
s/s: same as type 1, plus blurred vision, fatigue, recurrent infections
Hemoglobin A1c test, glucose lab values
o used to understand long-term glycemic control (glucose sticks to hemoglobin and
becomes glycosylated)
o normal level <5.7
o prediabetic 5.7-6.4
o diabetic >6.5
BG 60-110
Insulin glargine (Lantus) nursing care, administration
o prolonged action
MOA: MOA: stimulates glucose uptake, decrease hepatic glucose production
o be familiar with onset, peak, and duration of action of prescribed insulin
o not all types of insulin are compatible
o major adverse effect of insulin is hypoglycemia- know signs and symptoms of
hypoglycemia and hyperglycemia (fruity breath, polyuria)
o fingerstick to monitor blood glucose levels AC and HS for most diabetics
o normal doses of insulin- listen to diabetic pts
o know where to administer insulin- ask the pt where they want it
lipodystrophy- indented skin from repeated injections in same spot (if giving in a new spot, could cause hyperglycemia bc insulin better absorbed)
health promotion and optimal glucose management
eye exams/cholesterol exams, foot checks
micro-albumin- check for protein in urine
▪ Insulin types, action, when to give, onset, peak, and duration
o lispro (Humalog): rapid- 5-15min, 15min, 1-3 hrs, 3 hrs
o regular insulin (Novolin R): short- 30min-60, 30min, 2-4 hrs, 5-7 hrs
o isophane insulin suspension (NPH): intermediate twice a day, 1-2 hr, 4-12 hrs, 18 hrs
o insulin glargine (Lantus): long acting-, once a day-evening, 2 hr, no peak, 24 hrs
▪ lispro (Humalog) timing of administration
o rapid- don’t mix c any insulin
o give 5-15 minutes before a meal
metformin (Glucophage) mechanism of action
o management of type 2 diabetes
o MOA: decreases hepatic production of glucose
(gluconeogenesis) and reduces insulin resistance. protects pt against cardiac disease
other info:
o doesn’t promote insulin release from pancreas
o only drug in this class
o new extended-release formulation of metformin (Glumetza) allows for once-daily
dosing
o GI related SE, avoid alcohol, low risk for hypoglycemia
Effects of alcohol of blood sugar
o when liver is processing alcohol, it stops producing glucose which can cause BG to drop and fall too low. Can affect liver up to 12 hours.
o alcohol c some drugs like Sulfonylureas (glyburide/Diabeta) may cause disulfiram (Antabuse) response- makes you sick c alcohol. Avoid alcohol on Biguanides (metformin) due to risk of blood sugar drop (hypoglycemia)
How is synthetic insulin made, insulin mechanism of action
o MOA: promotes entry of glucose into cells
stimulates glucose uptake, especially skeletal muscle and fat
o Made via: almost all insulin used today is human insulin- made by recombinant DNA technology making it more effective, fewer allergies, less resistance
o only regular insulin can be given IV to manage DKA and hypokalemia (only one
approved)
o cannot be given PO- destroyed by stomach acid
Diabetes drugs when patient is NPO
no DM meds if NPO (check c dr)
Sulfonylurea contraindication
o Tx for type 2 DM
Contraindication: NO alcohol (may cause disulfiram [Antabuse] response
o stimulate release of insulin from pancreatic islet cells, decreases insulin resistance by
increasing sensitivity of insulin receptors on target cells (2 effects)
o most common adverse effect is hypoglycemia that is usually caused by taking too
much medication or not eating enough food
Medications for eye exam
o mydriatic drugs- sympathomimetics (dilate pupil)
o cycloplegic drugs- anticholinergics (paralyze ciliary muscle, dilates pupil)
allopurinol (Zyloprim) mechanism of action
Tx for gout (acute arthritis caused by and accumulation of uric acid (urate) crystals in
the joints and other body tissues, causing inflammation)
MOA: inhibits uric acid (waste product of RNA and DNA metabolism) buildup
