Week 10 and 11 & 12 - MSK and Endocrine

Question 1

• inhibits activity of osteoclast
• SE: muscle and joint pain, can be relieved by giving mild analgesics
• take with a full glass of water; sit up for 30 mins after taking meds; don’t eat or drink anything but water for 30 mints
• contraindicate pts with reflex and swallowing issues; esophagitis

Answer 1

Biphosphonate: alendronate

Question 2

• dec release of glucose from liver and inc glucose uptake into fat and muscles; dec glucose absorption in GI tract
• complications: lactic acidosis (inc RR and HR, fatigue, N/V/D, metallic taste
• ADR: lactic acidosis (ETOH use), GI upset, diarrhea
• hypoglycemia is not ad adverse effect
• Nur interv: approved for children >10 yrs old
• Contra: those w/ active infxn; contrast mediium w/ iodine inc risk of acute renal failure (wait 48hrs before and after contrast dye)
• Pt ed: avoid drinking alc

Answer 2

Biguanide: metformin

Question 3

What’s the defnition of AC and HS?

Answer 3

AC = before meals
HS = bedtime

Question 4

Which insulin can you mix and which one you can’t?

Answer 4

• Mix clear to cloudy
• Regular insulin can be mixed with other insulins, draw up first
• DONT mix short (regular insulin - Humulin R) and long acting (insulin glargine - Lantus)

Question 5

• rapid acting
• route: SQ
• onset: 15-30 mins
• peak: 30min to 3hr
• Must be given within 15-30mins of a meal

Answer 5

Lispro insulin (Humalog)

Question 6

• short acting
• route: SQ, IV
• onset: 30min to 1hr
• peak: 1-5hr
• treats DKA with IV drip
• can be mixed with other insulins, but draw up first

Answer 6

Regular insulin (Humulin R)

Question 7

• intermediate-acting
• route: SQ
• onset: 1-2hr
• peak: 4-14hr
• helps with overnight insulin
• cloudy

Answer 7

NPH insulin (Humulin N)

Question 8

• long-acting
• route: SQ
• onset: 1-4hr
• peak: none (steady lvls)
• do NOT mix with any insulin

Answer 8

Insulin glargine (Lantus)

Question 9

• For hypothyroidism - when body doesn’t produce enough thyroid
• Lifelong replacement therapy
• monitor for: T3, T4, TSH lvls: Notify MD/teach pt - heat intolerance, insomnia, tachycardia
• Nur Interv: give in the AM QD on empty stomach with a full glass of water 30-60mins before breakfast/meds; various formulations of thyroxine are not interchangeable; monitor thyroid function; monitor for hyperthyroidism; caution in diabetics
• Contra: thyrotoxicosis, recent MI
• Hyperthyroidism symptoms: anxiety, tachy, altered appetite, weight loss, insomnia, heat intolerance

Answer 9

Thyroid Hormone: levothyroxine

Question 10

• For hyperthyroid
• ADR: AGRANULOCYTOSIS (ALWAYS CHECK FEVER - infection); hepatotoxicity (jaundice, abd pain, liver enzymes, dark skin/urine, elevated LFTs; rash, arthralgia (joint pain); vertigo and drowsiness
• Too much = Hypothyroidism symptoms: lethargy, fatigue, weakness weight gain, cold intolerance, bradycardia
• Precautions: immunosuppression, bone marrow depression, infection
• Pt ed: report rash, fever or sore throat; report joint or muscle pain or HA

Answer 10

Thioamides: propylthiouracil

Question 11

• Goal: prevent excessive output/urine, helps with reabsorb of water within kidneys
• ADR: fluid overload > dilutes everything = hyponatremia = seizures, coma
• Nur Interv: monitor BP, I&O; expect life long therapy; monitor serum sodium lvls; restrict fluid intake when appropriate
• Contra: CAD; nephrogenic diabetes insipidus; cardiovascular disease; HTN; hx of hyponatremia; severe HF
• Pt ed: report pounding HA, weight gain, edema

Answer 11

Anti-diuretic Hormone: vasopressin