Unit 8 and 9 Flashcards
Short acting insulin-regular (Humulin R, Novalin R)
onset within 30-60 min, peaking in 2-4 hours, duration of 5-7 hours
Intermediate acting: NPH (Humalin N, Novalin N)
onset within 1-2 hours, peaking in 4-12 hours, duration of 18-24 hours
Mixed- NPH 70%/ regular 30%, or NPH/regular 50%
Onset of 0.5-1 hours, peaking in 1.5-16 hours, duration of 24-36 hours.
Rapid acting: insulin lispro (humalog), aspart (novolog), glusisine (apidra)
onset 5-30 min, peaking in 1-3 hours, duration of 3-5 hours
Long acting glargin (lantus), detemir (levemir)
onset 1 hour, no peak, duration about 24 hours.
sulfonylureas:
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.
Alpha-Glucosidase inhibitors
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
Biguanide
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.
Glitazones (thiazolidinedones)
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
Meglitinides
Nateglinide- Mechanism of actions: stimulates the release of insulin from pancreatic islets. common side effects: hypoglycemia, GI problems. Contraindications: Insulin dependent, lactation, Type 1
Incretin therapies
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.
Congenital hypothyroidism
inadequate thyroid hormone at birth, cretanism
primary hypothyroidism
dysfunction of the thyroid gland
secondary hypothyroidism
dysfunction of the pituitary gland
tertiary hypothyroidism
Dysfunction of the hypothalmus
Levothiroxine
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.
Mineralcorticosteroid: sodium and H2O retention
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
Glucocorticoid:
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.
Potassium sparing Diuretics
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.
Thiazide diuretics:
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.
Loop diuretic
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.
ACE inhibitors
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
What does the enzyme ACE do?
decreases bradykinin which decreases inflammation
What happenes when Block ACE?
increase bradykinin which increases inflammation mostly in the lungs which causes cough.
Angiotension 2 receptor blockers (ARB’s)
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.
What do Dihyropyridines effect?
Arterial smooth muscle, are a calcium channel blocker.
What do Nondiydropyridines effect?
Cardiac muscle and arterial smooth muscle. are calcium channel blocker.
Dihydropyridines prototype
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.
Nondihydropyridines
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.
Beta adrenergic blocking agent
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.
Central alpha agonist
Methyldopa: Last resort med, dilate large central blood vessels, used in pregnancy to lower BP, AE: CNS effects,
Alpha adrenergic blockers
prazosin: dilation of peripheral blood vessels, decreased BP
Direct acting vasodilators
Hydralazine: potent antihypertensive works on arterial muscles directly.
