Unit 8 and 9

Question 1

Short acting insulin-regular (Humulin R, Novalin R)

Answer 1

onset within 30-60 min, peaking in 2-4 hours, duration of 5-7 hours

Question 2

Intermediate acting: NPH (Humalin N, Novalin N)

Answer 2

onset within 1-2 hours, peaking in 4-12 hours, duration of 18-24 hours

Question 3

Mixed- NPH 70%/ regular 30%, or NPH/regular 50%

Answer 3

Onset of 0.5-1 hours, peaking in 1.5-16 hours, duration of 24-36 hours.

Question 4

Rapid acting: insulin lispro (humalog), aspart (novolog), glusisine (apidra)

Answer 4

onset 5-30 min, peaking in 1-3 hours, duration of 3-5 hours

Question 5

Long acting glargin (lantus), detemir (levemir)

Answer 5

onset 1 hour, no peak, duration about 24 hours.

Question 6

sulfonylureas:

Answer 6

Glimepride: Mechanism of action: stimulates release of insulin B cells and increased sensitivity to insulin, common adverse effects: weight gain, hypoglycemia, Gi disterss, hepatotoxicity. Contraindications: Hypersensitivity, Type 1 diabetes.

Question 7

Alpha-Glucosidase inhibitors

Answer 7

Acarbose: Mech of action: blocks breakdown of glucose so it can’t break down in GI, Common side effects: D, flatulence, abdominal distress, borborygmi, anemia (iron), erythema. Contraindications: Inflammatory bowel disease, Type 1 diabetes

Question 8

Biguanide

Answer 8

metformin- Mechanism of action: lowers hepatic production of glucose, increases the binding of insulin on receptors. common adverse effects: N,V,A,D, abdominal pain, metallic taste, H2O retention. contraindications: no alcohol, kidney functions, type 1, resp. problems.

Question 9

Glitazones (thiazolidinedones)

Answer 9

Rosiglitazone: Mechanism of actions: improves cell sensitivity to insulin and decreases insulin sensitivity. common side effects: fluid retention and edema, HA, upper resp infections. Contraindications: heart failure, hepatic disease, type 1

Question 10

Meglitinides

Answer 10

Nateglinide- Mechanism of actions: stimulates the release of insulin from pancreatic islets. common side effects: hypoglycemia, GI problems. Contraindications: Insulin dependent, lactation, Type 1

Question 11

Incretin therapies

Answer 11

Sitagliptin- mechanism of actions: slows down inactivation of incretin, which stimulates release of insulin. Common adverse effects: HA, D, nasopharyngitis, hypoglycemia, constipation, upper respt tract infections. contraindications: type 1 DKA, renal disorders or failure.

Question 12

Congenital hypothyroidism

Answer 12

inadequate thyroid hormone at birth, cretanism

Question 13

primary hypothyroidism

Answer 13

dysfunction of the thyroid gland

Question 14

secondary hypothyroidism

Answer 14

dysfunction of the pituitary gland

Question 15

tertiary hypothyroidism

Answer 15

Dysfunction of the hypothalmus

Question 16

Levothiroxine

Answer 16

therapeutic effects: mimics the action of thyroid hormone, increases O2 use, resp, HR, nutrient metabolism, promotes growth and maturation. contraindications: thyrotoxosis, CV disease, MI, adrenal insufficiency, allergy to aspirin, Potential adverse effects: D,N,V, tremors, HA nervousness, insomnia, palpitations, tachycardia, angina, cardiac arrest, allergic skin reaction.

Question 17

Mineralcorticosteroid: sodium and H2O retention

Answer 17

Fludrocortisone: treatment of addison’s disease, contraindications: CHF, HTN, renal or hepatic impairment, infection, Adverse effects: edema, HTN, CHF, cardiomegaly, hypocalemia, N,V, muscle cramps, heart dysrythmias. Nursing/teaching: weight gain, I&O’s, Hypokalemia

Question 18

Glucocorticoid:

Answer 18

Prednisone: anti inflammatory and immunosuppressant, asthma, allergies, cancer, gout, arthritis, IBD, skin conditions, Contraindicaitons: fungal infections, live vaccines, diabetes, osteoporosis, psychosis, liver dysfunction, heart failure, HTN, PUD Adverse effects: low, localized doses little effect, high doses Na and sodium retention, cusings, N,V, muscle weakness, delays healing, cataracts leukocytosis.

Question 19

Potassium sparing Diuretics

Answer 19

Spironalactone- counteracts K loss caused by other diuretics, used with thiazide diuretics to treat edema or HTN, Side effects; Hyperkalemia, hyponatriemia, Drowsiness, Nursing: monitor electrolites, BP, edema, I&O, effects may take several weeks, do not take with breast feeding.

Question 20

Thiazide diuretics:

Answer 20

Hydrochlorothiazide- increase urine output, treat HTN, edema related to CHF, cirrhosis, renal dysfunction. acts on distal tubules to promote H2O, Na, and K excretion. AE: hypotension, dizziness, HA, N, V, D, hyperglycemia, rash, photosensitivity, hypokalemia, NC&T: complete blood panel, eat K rich food.

Question 21

Loop diuretic

Answer 21

Furosemide: works in loop of henley, treats fluid overload: HTN, CHF, cirrhosis, renal dysfunction, Pulmonary edema. AE: electrolyte imbalance, hypotension, etc. NC&T: monitor VS and I&O’s, eat K rich food, orthostatic hypotension, give in AM.

Question 22

ACE inhibitors

Answer 22

Lisinopril: Prevents angiotensin 2 from being formed, decrease BP, treats heart failure, improves heart function post MI. AE: cough, HA, dizziness, orthostatic hypotension, rash, hyperkalemia, NC&T- monitor BP before and after, get baseline LTF’s and kidney function, avoid OTC NSAID’s, first dose effects

Question 23

What does the enzyme ACE do?

Answer 23

decreases bradykinin which decreases inflammation

Question 24

What happenes when Block ACE?

Answer 24

increase bradykinin which increases inflammation mostly in the lungs which causes cough.

Question 25

Angiotension 2 receptor blockers (ARB’s)

Answer 25

Losartan: prevents Angiontensin 2 from acting on target organs, decreased BP, CVA prophylaxis, tx of heart failure. AE: hypotension, dizziness, HA, fatigue, nasal congestion, insomnia, angioedema, acute renal failure. NC&T: monitor BP and drug trough, Monitor LFT’s and kidney function tests, avoid OTC cold meds.

Question 26

What do Dihyropyridines effect?

Answer 26

Arterial smooth muscle, are a calcium channel blocker.

Question 27

What do Nondiydropyridines effect?

Answer 27

Cardiac muscle and arterial smooth muscle. are calcium channel blocker.

Question 28

Dihydropyridines prototype

Answer 28

Nifedipine: dilates vascular smooth muscle decreasing BP and workload of heart. It does not slow down HR. AE: peripheral edema, hypotension, dizziness, HA, increased HR. NC&T: monitor BP before and after, wean of to prevent rebound HTN, alcohol causes severe hypotension, don’t breastfeed, not as useful for geriatric.

Question 29

Nondihydropyridines

Answer 29

Verapamil: dilates vascular smooth muscle and coronary arteries, slows HR and decreases BP. AE: hypotension, dizziness, HA, flushing, constipation, peripheral edema, HF, bradycardia, contrainindicated in heart block. NC&T: Monitor BP before and after, baseline lft’s and renal function labs, orthostatic hypotension, keep pt lying down 1 hour after IV dose, take pulse before taking med.

Question 30

Beta adrenergic blocking agent

Answer 30

Metoprolol: selective for heart and blood vessels, decreased BP, HR, and CO. AE: fatigue, weakness, dizziness, N,V,D, menatl changes, nasal stuffiness, impotence, decreased libido, depression, bradycardia, complete heart block, laryngospasm, agranulocytosis, NC&T: take apical and hold if less than 60, take BP at trough, monitor diabetic BS closely, sudden D/C can cause severe HTN or MI, do not take pregnant or breastfeeding.

Question 31

Central alpha agonist

Answer 31

Methyldopa: Last resort med, dilate large central blood vessels, used in pregnancy to lower BP, AE: CNS effects,

Question 32

Alpha adrenergic blockers

Answer 32

prazosin: dilation of peripheral blood vessels, decreased BP

Question 33

Direct acting vasodilators

Answer 33

Hydralazine: potent antihypertensive works on arterial muscles directly.