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NURS 365 - Pharmacology in Nursing > Week 16: Endocrine Meds > Flashcards

Week 16: Endocrine Meds Flashcards

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1
Q

How fast does rapid acting insulin take to work

A

10-15 minutes

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2
Q

How long do long acting insulins work

A

at least 24 hours

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3
Q

Endocrine drugs are generally used to do what things

A
  1. Supply addtl hormone because glands are not producing enough
  2. prevent release of addtl hormone because the gland produced too much (negative feedback mechanisms)
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4
Q

Prototype Endocrine Drugs

A
  1. ACTH (crticotropin)
  2. Vasopressin (ADH, pitressin)
  3. Oxytocin (Pitocin)
  4. Vitamin D (Hytakerol)
  5. Calcitonin (Calcimar)
  6. Alendronate (Fosamax)
  7. Levothyroxine (Synthroid)
  8. Sodium iodide 131
  9. Insulin
  10. metformin (Glucophage)
  11. Pioglitazone (Actos)
  12. Cortisone
  13. Testosterone
  14. Progesterone
  15. Estrogen
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5
Q

Corticotropin (ACTH) Classification

A

Hormone, Anterior Pituitary

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6
Q

Action fo Cortiotropin

A

stimulates the cortex of the adrenal gland - when stimulated it produced cortisol

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7
Q

What is the reason corticotropin is often given

A

Usually to diagnose adrenal insufficiency

Helps us figure out if the gland is not working or if there is not enough hormone being made

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8
Q

What does it mean if, after giving corticotropin, the cortisol levels fail to rise? What does it mean if the cortisol levels would rise?

A

If cortisol levels fail to rise then it is primary adrenal insufficiency

If cortisol levels do rise that means the anterior pituitary is not making enough ACTH

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9
Q

ADRs of Corticoptropin (ACTH)

A

Same as those for cortisone

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10
Q

Vasopressin (Pitressin, ADH) Classification

A

Post Pituitary Hormone

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11
Q

Action of Vasopressin

A
  1. Fxns as ADH - enhances water permeability of tubular epitherlial membranes of distal convoluting ducts and collecting ducts so water can be absorbed by osmotic flow - PROMOTES RENAL CONSERVATION OF WATER ( HOLD ONTO WATER)
  2. Causes contraction of smooth muscle of vascular beds enhancing motility and tone of GI tract (2nd action less strong)
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12
Q

ADRs of Vasopressin

A
  1. EXCESSIVE VASOCONSTRICTION (2ndary effect)
  2. WATER RETENTION AND INTOXIFICATION

Other: arrhythmias, decreased CO, intestinal and uterine cramps, marked facial pallor (from cutaneous vasoconstriction), allergic rxns

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13
Q

What is vasopressin used to treat

A
  1. Diabetes Insipidus - loss of /urinating large amounts og dilute urine
  2. Gaseous Distention - rarer use - increases GI tone
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14
Q

Oxytocin (Pitocin, Syntocinon) Classification

A

Posterior Pituitary Hormone

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15
Q

Action of Oxytocin

A

Stimulate uterine smooth muscle though non pregnant uterus is relatively insensitive

Does have SOME VASOPRESSOR ACTIVITY (some contracture of vasculature)

Stimulates let down reflex - milk

Has limited ADH effect (may hold some water) - get baby out but a non pregnant uterus does not act like that

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16
Q

Absorption/Route of Oxytocin

A

Mostly IV infusion, IM, Subcutaneous, Intranasal, Buccal (NOT ORAL)

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17
Q

ADRs of Oxytocin

A
  1. WATER INTOXICATION (with large doses over long periods)
  2. ALLERGIC RXNs INJUDICIOUS USE

Other: uterine rupture, HTN crisis (high BP from vasoconstriction), cerebral hemorrhage, pelvic hematomas, bradycardia, arrhythmias

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18
Q

Oxytocin is often used in what situations

A

Stop postpartum bleeding

Induction of labor

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19
Q

Cholecalciferol and Ergocalciferol Classification

A

Parathyroid:

Vitamind D (Modified Form)

Cholecalciferol - D3
Ergocalciferol - D2

(MORE A HORMONE THAN VITAMIN)

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20
Q

Action of Cholecalciferol and Ergocalciferol

A
  1. Stimulate intestinal Ca absorption
  2. Decrease Ca excretion
  3. Bone Ca mobilization (resorption) in absence of parathyroid hormoen and fxning renal tissue - analog of Vitamin D
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21
Q

Vitamin D

A

“Sunshine Vitamin”

Can get from food or sun

Stimulates calcium absorption in the intestines and decreases Calcium excretion

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22
Q

Cholecalciferol/Ergocalciferol may be used when a person…

A

has low aprathyroid hormone

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23
Q

What is unique about the metabolism of Cholecalciferol/Ergocalciferol

A

It is activated in the liver AND kidneys

Kidney is pretty unique (plays a big part in bones)

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24
Q

What happens with Cholecalciferol/Ergocalciferol if there is no kidney function

A

No kidney function –> cannot activate Vitamin D –> Renal Osteodystrophy (bad kidneys means bad bones)

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25
Q

ADRs of Cholecalciferol/Ergocalciferol

A
  1. Hypercalcemia
    * Hypercalcemia causes - anorexia, NV, weakness, constipation, lethargy, depression, amnesia, disorientation, hallucination, syncope, diarrhea, vertigo, HA, polyuria, thirst ataxia*
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26
Q

Calcitrol

A

Drug for renal patients on dialysis with hypocalcemia

Increase GI absorption of Ca when you have renal disease

It is already activated Vitamin D since the kidneys would normally do this

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27
Q

Calcitonin-Salmon (MIacalcin, Calcimar) Classification

A

(Fish Form)

Hypocalcemic Hormone (from thyroid)

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28
Q

Action of Calcitonin-Salmon

A

Direct inhibition of osteoclasts

Decreases tubular resorption leading to increased excretion of Ca

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29
Q

When is calcitonin-salmon used

A

in diseases like osteoporosis, Pagets disease, or Hypercalcemia

It is going to save the bones and inhibit resorption/osteroclast breakdown

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30
Q

Parathyroid Hormone v Calcitonin

A

PH will pull Ca from bone while Calcitonin keeps it in the bone

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31
Q

ADRs of Calcitonin Salmon

A
  1. HYPOCALCEMIA (with tetany)

Other: NV, allergy, tenderness and swelling of hands, flushing

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32
Q

What is the max amount of calcitonin-salmon given IM and SubQ?

A

IM - no more than 2 cc per site

SubQ - no more than 1 cc

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33
Q

Alendronate Sodium (Fosamax) Classification

A

Bone resorption inhibitor, Biphosphonate

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34
Q

Action of Alendronate Sodium

A

Inhibits osteoclast activity

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35
Q

Absorption/Route of Alendronate Sodium

A

Oral

FOOD GREATLY DELAYS ABSORPTION

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36
Q

Biphosphonates

A

class fo drugs inhibiting osteoclast activity

ex: Alendronate Sodium

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37
Q

ADRs of Alendronate Sodium

A
  1. MOST ARE MILD - MAY HAVE SOME MILD GI DISTRESS, ULCERS, ESOPHAGITIS/ESOPHAGUS ULCER
  2. BRONJ ? JAW NECROSIS

Other: A fib concerns (may be correlation not causation

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38
Q

BRONJ

A

Biphosphonate related osteonecrosis of the jaw

There is concern with a higher incidence of bone death in the jaw / jaw necrosis with dental procedures when taking alendronate sodium

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39
Q

When is alendronate sodium taken

A

AT LEAST 30 minutes before FIRST intake of the day

Taken with a full glass of water

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40
Q

What must not be done up to 30 minutes after taking alendronate sodium

A

you must not lay down (prevent esophagus ulcers)

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41
Q

What is the Alendronate Sodium drug holiday

A

This drug can stay in bones for a long time so sometimes people can take breaks from taking it

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42
Q

Levothyroxine Sodium (Synthroid, Levothroid) Classification

A

Thyroid Hormone

Synthetic T4 (which converts to T3 in the body)

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43
Q

Action of Levothyroxine Sodium

A
  1. Regulate growth/dev through control of PROTEIN SYN
  2. Calorigenic effect - increase metabolic rate
  3. Metabolic - increase metabolic rate by various modes
  4. Inhibition of thyrotropin secretion by pituitary
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44
Q

Absorption/Route of Levothyroxine Sodium

A

Oral

Food delays absorption - give on empty stomach

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45
Q

When is levothyroxine sodium given

A

it is used as hypothyroidism hormone replacement therapy

treatment for this is lifelong

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46
Q

ADRs of Levothyroxine Sodium

A

(Look like Hyperthyroidism)

  1. CNS - Nervous, insomnia
  2. CV - arrhythmia, palpitation
  3. GI - WEIGHT LOSS, cramp, diarrhea
  4. GU - menstrual irregularities

OVERDRIVE OF SNS

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47
Q

Levothyroxine sodium will enhance the effect of oral ____

A

anticoagulants

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48
Q

Caution using levothyroxine sodium in what patients

A

patients with heart disease, esp. coronary insufficiency

patients with diabetes

patients on tricyclic antidepressants

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49
Q

Levothyroxine cannot be taken within 4 hours of taking…

A

calcium carbonate (TUMS and other local antacids)

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50
Q

How big are the Levothyroxine Sodium doses

A

thyroid hormone is given in mcg (tiny doses)

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51
Q

If there is not enough T4 being made and a patient needs levothyroxine sodium, what lab value will be different?

A

TSH (Thyroid Stimulating Hormone) will be high

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52
Q

Iodine 131 Classification

A

Radioactive Thyroid Hormone

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53
Q

Action of Iodine 131

A

Destroy thyroid tissue mainly through Beta rats

Goal to produce clinical remission without complete thyroid destruction - in hyperthyroidism/Graves dx

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54
Q

ADRs of Iodine 131

A
  1. DELAYED HYPOTHYROIDISM (10% a year after)

Other: Depressed hematopoietic system, anemia, thyroiditis

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55
Q

What is another, more uncommmon use, of Iodine 131

A

since it is uptook by the thyroid gland it can be given in miniscule non damaging amounts for diagnostic purposes

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56
Q

Iodine 131 should not be used on what patients

A

Pregnant Patients

children

lactating patients

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57
Q

Insulin

A

drug used for management of hyperglycemia by promoting cellular uptake of glucose

varies in onset peak and duration of action

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58
Q

What are the routes of insulin administration

A

Mostly IV, SubQ, IM - does have inhaled version but iffy rn

59
Q

___ Units/mL are the most common form for SubCu insulin

A

100

60
Q

Action of Insulin

A

increase cellular uptake of amino acids, glucose, and other monosaccharides

61
Q

What is important to know about the absorption of insulin

A

It is inactivated by gastric enzymes so must be given subcu or IV

62
Q

ADRs of Insulin

A
  1. HYPOGLYCEMIA (most common)
  2. ALLERGIC MANIFESTATIONS (if from an animal rather than synthetic source)
  3. INSULIN RESISTANCE DEVELOPMENT
63
Q

Why does insulin resistance develop in some diabetics taking insulin

A

it will only occur in Type 2 diabetics probably due to development of antibodies

64
Q

The only insulin that can be given IV is ___ insulin since it is unbound

A

regular

65
Q

Always use insulin syringes measured by ____

A

units

66
Q

Can pregnant women have insulin

A

yes, it does not cross membranes

67
Q

Too much insulin causes ____

A

hypoglycemia

68
Q

Too little insulin causes ___

A

hyperglycemia

69
Q

Rapid insulins work in 10-15 minutes so they are oftne called

A

mealtime insulins

70
Q

Regular insulin is ___ acting and ___ lasting

A

fast acting and short lasting

71
Q

NPH

A

intermediate acting insulin

works in 8-10 hours

appears as a cloudy / milky suspension

72
Q

Long Acting Insulins

A

Insulin Glargine/Detemir

Not a real peak, a flat level in the body

given once daily and never mixed with other insulins

73
Q

Metformin (Glucophage) Classification

A

Biguanide Oral Hypoglycemic

74
Q

Action of metformin

A

decreases hepatic glc production and intestinal absorption of glucose

also increases peripheral glucose intake

75
Q

Absorption of Metformin

A

Oral Route - ER form absorbed v slowly

Often given in 1500-2550 mg PO in divided doses

76
Q

ADRs of metformin

A
  1. GI EFFECTS (Metal Taste, NV, Abdominal pain, Mod Weight Loss)
  2. LACTIC ACIDOSIS

Other: Cognitive decline?

77
Q

Why does lactic acidosis occur with metformin

A

if someone has a kidney issue and getting dye studied, they can end up with renal impairment and lactic acidosis

So metformin should cease 48 hours prior to dye study and resume 48 hours after

78
Q

Black Box Warning of Metformin

A

Lactic Acidosis in Dye Studied Renal Impairment if Metformin not discontinued 48 hours prior and 48 hours after

79
Q

Does metforming cause hypoglycemia

A

NO in most cases

80
Q

Pioglitazone (Actos) Classification

A

Insulin Sensitizer, Antidiabetic Agent, Thiazolidinedione (TZD)

81
Q

-glitazone means

A

part of the TZD/Thiazolidinedione family

82
Q

Action of pioglitazone

A

increases ability of target cells to respond to insulin (DECREASES INSULIN RESISTANCE)

83
Q

Absorption /Route of Pioglitazone

A

Oral - rapidly absorbed

Food may increase absorption!!!

84
Q

ADRs of Pioglitazone

A

Nothing to dreadful!:

URI, HA, Sinusitis, Myalgia, lower TG levels, Raised LDL AND HDL

IN THE BACK OF THE MIND KEEP LIVER AND HEART CONCERNS

85
Q

Why were some other glitazone (TZD) drugs like Rosiglitazone and Troglitazone taken off the market

A

Rosiglitazone was not recommended because of risk of MI and CVA

The first ever glitazone was troglitazone and causes hepatic failure

86
Q

Pioglitazone is indicated for _____ diabetes only

A

type-2

87
Q

Cortisone and Hydrocortisone Classification

A

Corticosteroid (Glucocorticoids)

88
Q

Glucocorticoids

A

release in the stress response

role in inflammation, immune response, protein, fat and carbohydrate metabolism

89
Q

-isone / -asone means

A

glucocorticoid (corticosteroid)

90
Q

What are the 8 actions of corticosteroids like cortisone and hydrocortisone

A
  1. Anti Inflammatory
  2. Maintenance of normal BP
  3. Carbohydrate and Protein Metabolism
  4. Fat Metabolism
  5. Immunosuppressive
  6. Stress Effects
  7. Anti-diuretic
  8. CNS effects
91
Q

Anti-inflammatory action of corticosteroids

A

stabilize lysosomal membrane to inhibit proteolytic enzyme release during inflammaation

MAJOR anti inflammatory group

92
Q

Maintenance of normal BP action of corticosteroids

A

potentiate vasoconstrictor action of NEP - help keep vessels constricted

MINOR EFFECT

93
Q

Carbohydrate and Protein Metabolism action of corticosteroids

A

Facilitate muscle and extrahepatic tissue breakdown increasing plasma AA levels

Increase AA trapping by liver and deaminate them

Increase enzyme activity important to gluconeogenesis and inhibit glycolytic enzymes

MAJOR: BREAKDOWN MUSCLES LEADING TO AA RELEASE TO FORM GLUCOSE - THIS IS WHY GLUCOCORTICOIDS LEAD TO INCREASED GLUCOSE LEVEL WITH MUSCLE ATROPHY IN LONG TERM USE

94
Q

Fat Metabolism Action of Corticosteroids

A

Promote mobilization of FA from adipose tissue

Long term therapy will redistribute fat to neck, back, face, supraclavicular area, and decrease it in extremeties

95
Q

Immunosuppressive action of corticosteroids

A

Thymolytic, Lymphocytic, and eosinopenia actions - as well as atrophy of thymus and decrease # of lymphocytes, plasma cells, and eosinophils in blood

Decrease rate of conversion of lymphocytes into antibodies

This and the anti inflammatory action make them GREAT IMMUNOSUPPRESSANTS AND ANTI ALLERGENICS

96
Q

Stress effect action of corticosteroids

A

during stress, acute release of corticosteroids occurs leading to synergistic action of catecholamines

97
Q

Antidiuretic Effect of corticosteroids

A

Not as strong as a mineralo-corticoid (aldosterone)

Acts on distal tubules of kidney (ENHANCE REABSORPTION OF Na from TUBULAR FLUID)

INCREASE URINARY EXCRETION OF BOTH K AND H IONS - not as strong as aldosterone but you retain fluid

98
Q

CNS Action of corticosteroids

A

AFFECTS MOOD (euphoria, excitation, depression)

Potential steroid psychosis (eager, active, hungry, hyper)_

99
Q

Route of Cortisone/Hydrocortisone

A

Oral, IM, IV Topical

100
Q

Cortisone/Hydrocortisone can be used as replacement therapy in …

A

adrenal deficiency

101
Q

Cortisone/Hydrocortisone are very important in _____ and ____ therapy

A

anti-inflammatory and immunosuppressant therapy

102
Q

Prednisone

A

the most common long term corticosteroid

103
Q

What is important to know about corticosteroid ADRs

A

THEY ARE HUGE

Common for systemic symptoms from long time use but can even occur in shorter term use where chronic issues appear

104
Q

ADRs of Corticosteroids

A

Delay in wound healing (Immunosuppression)

GI Ulceration and Perforation (disrupts lining)

Amenorrhea

Disorders of calcium metabolism (long term use suppresses bone formation and boosts resorption)

Cushings Syndrome/Hypercortisolism (Hump back, moon face, hirsutism, acne, water and Na retention, edema, restlessness, insomnia, euphoria, manic states)

Decreased resistance to infection

Masking of symptoms of inflammation and infection

Weakness

Striae

Thin Friable Skin

Lyte imbalances

Increased lymphoma (cancer) changes

higher cataract incident

can precipitate diabetes in the susceptible

Withdrawal issues

Resp issues in premautre infants

105
Q

Can corticosteroids be used in pregnant women

A

no they cross the BBB

106
Q

Sometimes steroids can be used as …

A

anti rejection drugs

107
Q

Why is withdrawal a big issue with corticosteroids

A

adrenal gland wont be ready to go back to making cortisol leading to severe adrenal insufficiency

108
Q

Diabetics on corticosteroids are at high risk for what after surgery

A

infection, dehiscence, and evisceration

109
Q

What is important to know about corticosteroids compared to aldosterone

A

the effect on Na retention and K excretion is much less than aldosterone

110
Q

Testosterone Classification

A

Androgen Hormone (Primary Male Sex Hormone)

111
Q

Action of Testosterone

A

fxns as a stimulator to promote and maintain male secondary sex characteristics

Powerful anabolic agent- stimulates formation and maintenance of muscular and skeletal protein and nitrogen retention

112
Q

Absorption/Route of Testosterone

A

Oral - rapid absorption - but actively inactivated by the liver - SO NOT GIVEN ORALLY

Sublingual will bypass the liver

113
Q

Is testosterone a scheduled drug

A

yes it is schedule III

114
Q

Why is it important to keep testosterone gel away from children

A

they can have masculazation rapidly and easy

115
Q

ADRs of Testosterone

A
  1. LIVER TOXICITY
  2. HYPERCALCEMIA
  3. CHOLESTEROL ELEVATION

Other: Retention of Na and water, Nausea, Lipid disorder, HTN from water and Na

116
Q

What are some ADRs in females taking testosterone that are unique to the gender

A

deepening of voice

hirsutism

flushing

acne

regression of breasts

enlargement of clitoris

general masculinization

117
Q

How does testosterone impact calcium levels

A

it decreases secretion of Ca so the levels of Ca are rising

118
Q

It is important to monitor what when on testosterone

A

liver function

119
Q

When is testosterone contraindicated

A

prostate cancer

serious cardiorenal dysfunction

pregnancy

120
Q

Progesterones (Provera-Medroxyprogesterone) Classification

A

Progestin Hormone

“The Hormone of Pregnancy”

121
Q

Action of Progesterones

A

Exact mechanism not completely known but it does bind to cell receptors and causes reproductive effects

122
Q

What are the reproductive effects of progesterones

A
  1. INHIBIT OVULATION (decrease LH and FSH release)
  2. Induce biochem changes in endometrium in prep for fert egg implant
  3. CAUSE CERVICAL MUCUS TO BECOME STICKY AND VISCOUS
  4. decrease sensitivity of uterus to oxytocin
  5. facilitate dev of secretory apparatus in mammary glands
  6. increase body temp
  7. elevate basal insulin levels and potentiate response to glc
  8. promote hepatic glycogen storage and ketogenesis
  9. decrease plasma levels of AA
123
Q

In essence, what is progesterone doing

A

it is preparing the endometrium for implantation

it also is decreasing uterine contractions to maintain the endometrium and making thick sticky mucus

124
Q

Progesterone has extensive..

A

first pass

125
Q

Route of Progesterone

A

Parenteral - but too rapid to maintain efficiency

Oral - less effective

126
Q

ADRs of Progesterone are also known as …

A

Hormonal ADRs

127
Q

ADRs of Progesterone

A 
drowsiness
GI Symptoms
HA
Dizziness
Allergic Response
Irregular Vaginal Bleeding
Photosensitivity
Retinal Damage
CV Complications

Prolonged High Dose: Edema, Weight gain via fluid retention, vertigo, oligomenorrhea, breast congestion, hirsutism, rash, depression, migraine

128
Q

Most of progesterone adminsitered is used…

A

as a part of contraception with estrogen

Can also be sued for amenorrhea, threatened abortion, dysmenorrhea, endometriosis

129
Q

What is the major non contraceptive use of progesterone

A

to counteract the adverse estrogen effects

stimulation of the uterus via estrogen replacement could cause endometrial cancer if uterus is still present so this will counteract it

130
Q

Progestins

A

Synthetic Progesterone Like

For deficiencies, dysfunctional uterine bleeding, an amenorrhea

If combined with estrogen it will help prevent endometrial cancer BUT increase breast, and ovarian cancer risk and heart disease risk

131
Q

Sodium estrogen Sulfate (Premarin) Classification

A

Estrogen Hormone

Comes from urine of pregnant mare

132
Q

ER

A

estrogen replacement

133
Q

Action of Estrogen

A

Stimulate Female Characteristics

  1. Reproductive
  2. Metabolic
  3. Blood coagulation
134
Q

Reproductive Actions of Estrogen

A
  1. FACILITATE OVULATION (increase LH release)
  2. DECREASE RELEASE OF FSH (through negative feedback)
  3. Stimulate development of endometrium
  4. promote growth and cornification of vaginal epithelium
  5. increase sensitivity of uterus to oxytocin
  6. promote development of duct system in mammary glands
135
Q

Metabolic Actions of Estrogen

A
  1. DECREASE BONE RESORPTION RATE (DECREASES BREAKDOWN SO WOMEN ARE NOT AS PRONE TO OSTEOPOROSIS UNTIL AFTER MENOPAUSE)
  2. Increase protein synthesis
  3. accelerate closure of epiphyses
  4. increase serum triglycerides, and HDL
  5. decrease serum cholesterol and LDL
  6. enhance sodium and water retention
  7. increase blood glucose (anti insulin action)
136
Q

Blood Coagulation Action of Estrogen

A
  1. INCREASES LEVELS OF VITAMIN K DEPENDENT CLOTTING FACTORS
  2. PROBABLY INCREASES PLATELET AGGREGATION
  3. PROMOTES FORMATION OF BLOOD CLOTS
137
Q

Routes of Estrogen

A

Oral - prompt and complete

Also parenteral, topical, or vaginal

138
Q

ADRs of Estrogen

A

HORMONAL ADR: (Similar to progesterone):

Nausea, Anorexia (like morning sickness), Increased feminine characteristics, fluid retention, break through bleeding, changes in menstrual flow, breast tenderness, irritability, depression, HTN, HA, Cancer (ovarian and breast fed by estrogen), gallbladder disease

STRONG RELATIONSHIP TO EMBOLIC DISEASE (BLOOD CLOT ISSUES LIKE STROKE OR MI)

139
Q

Estrogen Can be used to control…

A

menopausal symptoms or dysfunctional uterine bleeding

140
Q

Contraindications of Estrogen

A

Estrogen Dependent Cancers (Breast, Ovarian, anything with estrogen receptors)

Undiagnosed Vaginal Bleeding (could be endometrial cancer)

Thrombus or Thromboembolic Dissorders (estrogen already promotes blood clots)

141
Q

What is the big concern of using estrogen without progestin

A

in post menopausal women this increases risk for uterine cancer because it will thicken the endometriumd leading to cancer

142
Q

If a patient is changed to lispro insulin (Humalog) you will teach him to administer it when:

A. 1 hour before meals
B. 1 hour after meals
C. 10-15 minutes before a meal
D. only at bedtime

A

C. 10-15 min before a meal

143
Q

Regular insulin has its peal in approximately:

A. 3-4 hours
B. 8-12 hours
C. 24 hours
D. more than 36 hours

A

A. 3-4 hours

144
Q

What is the most dangerous colmplication of prednisone therapy:

A. GI Ulceration
B. Hyperglycemia
C. Immune System Compromise
D. Vertigo

A

C. Immune System Compromise

NURS 365 - Pharmacology in Nursing (15 decks)

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