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230 Cards in this Set
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list general characteristics of diabetes mellitus
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disorder of carbohydrate metabolism
deficiency of insulin resistance to action of insulin sustained hyperglycemia, polyuria, polydipsia, ketonuria, and weight loss |
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what percentage of diabetes is type 1
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5-10%
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what is the primary defect of diabetes type 1
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problem with the beta cells of the pancreas
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what is almost always present with type 2 diabetes
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obesity
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what are the hallmarks of type 2 diabetes related to insulin
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insulin resistance and impaired insulin secretion
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list some systemic complications of diabetes mellitus
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retinopathy
nephropathy sensory & motor neuropathy gastroparesis erectile dysfunction |
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what two types of insulin have been removed from the market
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beef and pork derivatives
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what appearance do most insulins have
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clear/colorless suspensions
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when mixing insulins, which should you draw up first
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short acting
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how do we prepare insulin for withdrawal
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roll bottle gently; do NOT shake as it can dislodge the insulin from its protein carrier
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list the rapid acting insulins
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insulin lispro
insulin aspart insulin glulisine |
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what is another name for insulin lispro?
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humalog
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when is insulin lispro given; list time and duration of action
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right before meal or after a meal
rapid acting; short duration |
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when is another name for insulin aspart
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novolog
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when is insulin aspart given; list time and duration of action
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5-10 mins before meal
short duration, rapid acting |
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another name for insulin glulisine
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apidra
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time and duration of action for insulin glulisine
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short duration
rapid acting |
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which insulins can you mix with nph
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lispro, aspart, glulisine
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how many minutes without oxygen before the brain is injured
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4 minutes
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what is another name for regular insulin
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humulin R, Novolin r
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when should regular insulin be given
list duration and time of action |
30-60 mins before meal
short duration, slower action |
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how can regular insulin be administered
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subq, im, po, off label iv
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in what form is regular insulin also available that others are not
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U-500
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list the insulins of intermediate duration
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NPH (neutral protamine Hagedorn) and Insulin determir
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what is another name for insulin determir
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Levemir
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can you mix insulin determir
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NO
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what are intermediate duration insulins NOT intended for
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postprandial hyperglycemic control
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another name for insulin glargine
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Lantus
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duration of insulin glargine
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long duration; 24 hour
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大筋
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/(n) outline/summary/
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[おおすじ]
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list the subq injection sites for insulin
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abdomen, upper arm
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how should insulin be stored
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refrigerated; do not freeze
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can a vial be kept at room temp
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yes if current use vial and only for 1 month
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how should pre filled syringes be stored
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refrigerate; needle up; agitate before injection
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what are the two types of insulin therapy
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tight control
conventional therapy |
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what are the prerequisites for tight control therapy of diabetes
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careful attention to elements of treatment program
defined glycemia target self monitoring of blood glucose 3-5 times daily high degree of patient motivation extensive patient education |
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list some adverse effects of tight control insulin therapy
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hypoglycemia
lipodystrophies |
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list some signs of hypoglycemia
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acute tachycardia, palpitations, sweating, nervous, headache, drowsiness, fatigue, confusion
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list the treatment for hypoglycemia
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if conscious - OJ, sugar cubes, honey, non diet soda, glucose tabs, corn syrup
if unconscious - IV glucose or glucagon |
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値する
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/(vs-s) to be worth/to deserve/to merit/(P)/
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[あたいする]
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describe the effects of glucagon
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exact opposite of insulin
relaxes GI smooth muscle (used in endoscopy) stimulates body to make sugar out of own reserves in the liver |
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why do people suffering from starvation not benefit from glucagon therapy
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they don't have any extra stores to use
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when should we use oral hypoglycemics; list the MOA
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only used in type 2 diabetes
use only after diet and exercise fail stimulate existing capacity of pancreas to secrete insulin |
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what is diabetic ketoacidosis
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hyperglycemia with ketones in urine
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list treatments for diabetic ketoacidosis
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insulin replacement
bicarbonate for acidosis water and sodium replacement potassium replacement normalization of glucose levels |
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what are RDAs
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recommended dietary allowances for vitamins; set by Food and Nutrition Board of the Nation Academy of Sciences; represents average daily dietary intake sufficient to meet the nutrient requirements of nearly all healthy individuals in a particular life stage or gender
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what is the tolerable upper intake limit
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highest average daily intake that can be consumed by nearly everyone wo significant risk of adverse effects; index of safety
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how do we classify vitamins
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fat soluble
water soluble |
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list the fat soluble vitamins
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A, D, E, K
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list the water soluble vitamins
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C, B complex
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what is the exception to water soluble vitamins in b complex
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B12
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deficiency of vitamin A results in what
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night blindness
xerophthalmia keratomalacia blindness |
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benefits of vitamin A
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enables adaptation to dim light, plays role in embryogenesis, spermatogenesis, immunity, growth, and skin/mucous membrane integrity
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adverse effect of too much vitamin A
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highly teratogenic
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another name for vitamin A
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retinol
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another name for vitamin E
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alpha-tocopherol
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vitamin d deficiency results in
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rickets, soft bone, increased risk of breast, colon cancer, type 1 diabetes, falls in elderly and overall mortality
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deficiency of vitamin e can result in what
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neuro defecits
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benefits of vitamin e
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antioxidant properties
reduce incidence of colds in elderly may delay macular degeneration and Alzheimers |
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risk of too much vitamin e
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heart failure
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dietary sources of vitamin e
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fresh greens
seeds vegetable oils |
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another name for vitamin k
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phytonadione
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vitamin k uses
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synthesis of prothrombin and other clotting factors to prevent spontaneous bleeding from hypothrombinemia and to treat warfarin overdose
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adverse effects of vitamin k
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hypersensitivity reaction to IV
hyperbilirubinemia in infants with parenteral application |
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how is vitamin k typically given
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IM injection
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another name for vitamin c
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ascorbic acid
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uses for vitamin c
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required to produce collagen and other compounds that bind cells together and participatesin biochemical reactions
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what biochemical reactions does vit c participate in
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synthesis of adrenal steroids
conversion of folic acid has antioxidant properties facilitates GI iron absorption |
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deficiency of vitamin c can lead to what
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scurvy
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adverse effects of vitamin c
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nausea
abdominal cramps diarrhea |
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claims are made that vitamin c helps with these things; does it really
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colds, asthma, osteoporosis, advanced cancer, schizophrenia, wound healing, atherosclerois
does NOT actually benefit |
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list the b complex vitamins
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niacin (nicotinic acid), riboflavin (vitamin b2), thiamin (vitamin B1), pyridoxine(vit B6), cyanocobalamin (vit B12), folacin (folic acid)
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list benefits/negatives of niacin
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lowers cholesterol
can cause flushing/dizziness in large doses lowers triglyceride levels deficency will give you dry cracked flaky skin |
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benefit of riboflavin
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migraine uses
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uses for thiamin
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carbohydrate metabolism
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lack of pyridoxine causes
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seborrheic dermatitis, microcytic anemia, peripheral neuritis, convulsions, depression
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lack of these causes megoloblastic anemia
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cyanocobalamin, folacin
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actions of folic acid
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neural tube defects
reduces homocysteine levels protects against colorectal cancer |
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define enteral nutrition
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provision of nutrients by way of the GI tract
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uses for enteral and parenteral nutrition
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promotes wound healing
prevents loss of body mass restores body mass |
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contraindications for enteral nutrition
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bowel obstruction, ileus, vomiting, malabsorption
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list common components of enteral nutrition
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amino acids
carbohydrates fats electrolytes vitamins trace elements water poor |
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adverse effects of enteral nutrition
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aspiration pneumonia
diarrhea vomiting insufficient emptying GI bleeding metabolic disturbances |
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list the schedules of admin for enteral feedings
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continuous
cyclic intermittent bolus |
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complications associated with enteral feedings
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increased BUN
glucose intolerance hyperlipidemia allergy hypokalemia hypoglycemia from abrupt cessation |
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routes for parenteral nutrition
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peripheral vein
central venous catheter (including PICC) |
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components of TPN
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amino acids, dextrose, fats, carbohydrates, vitamins, electrolytes, trace elements
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complications of parenteral therapy
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infection
metabolic disturbances catheter related complications pneumothorax venous thrombosis |
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define herbal medicine
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use of plant derived products to promote health and relieve symptoms of disease
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how are herbal medicines regulated
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under dietary supplements
Dietary Supplement Health and Education Act of 1994 |
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what are some disadvantages to herbal meds
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presumed safe until proven hazardous
DSHEA does not regulate manufacturing so impurities and adulterants are common |
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what is the major concern with herbal meds
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increases or decreases effect of prescribed meds
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what herbs suppress platelet aggregation
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ginkgo
feverfew garlic |
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what herbs increase BP and HR
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ma huang
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what herbs accelerate metabolism of multiple drugs causing decreased effects
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st. johns wort
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what has black cohosh been used for
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menopause
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what is feverfew used for
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migraines
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what is echinacea used for
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allergic reactions and autoimmune clients
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list effects and disadvantages of garlic
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lowers LDL, increases HDL, lowers cholesterol, suppresses platelets, decreases bp, increases insulin levels
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list benefits of ginger root
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suppress n&v with motion and morning sickness/chemo nausea, improves appetite, reduces stomach upset and flatulence, anti inflammatory properties
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disadvantage of ginger root
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suppress platelet aggregation
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advantages of ginkgo biloba
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improve memory, concentration, relieve dizziness, tinnitus, headace, counteract ED from antidepressants esp Prozac (fluoxetine); improves blood flow via vasodilation; scavenges free radicals
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benefits/AE of goldenseal
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bactericidal, bacteriostatic; used for NVD, CNS stim, HTN, convulsions, resp depression
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ma huang is also known as
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ephedrine
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adverse effects of ephedrine
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hypertension, increased bp and heart rate
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benefits of saw palmetto
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helps in benign prostatic hypertrophy
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benefits of valerian
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sleep; drowsiness
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list the actions of bulk forming laxatives
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behave like dietary fiber; swell to form viscous solution/gel; soften fecal mass; increase transit
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prototype for bulk forming laxative
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metamucil
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公演
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/(n) public performance/(P)/
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[こうえん]
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adverse effects of bulk forming laxatives
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esophageal and intestinal obstruction if not enough fluid
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how do surfactant laxatives work
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lower surface tension of stool and softens by facilitating penetration of water into the feces; act on intestinal wall to inhibit fluid absorption and stimulate secretion of water and electrolytes into the intestinal lumen
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what is the prototype for surfactant laxative
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Colace
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generic name for colace
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docusate sodium
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what do we need to do with surfactant laxatives
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full glass of water
sit upright for 30 min |
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adverse reactions with surfactant laxative
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rare
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dosage for surfactant laxatives
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50-500 mg daily
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prototype drug for stimulant laxatives
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Dulcolax, Senekot
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action of stimulant laxatives
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directly stimulate gut motility, increase secretion of water and ions into intestine, reduce water and electrolyte absorption
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legitimate uses for stimulant laxatives
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treatment of opioid induced constipation and slow transit constipation
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adverse reactions with stimulant laxatives
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bowel rupture
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which laxatives are most addictive and why
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stimulants bc they work faster
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dulcolax generic name
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bisacodyl
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Senekot generic name
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senna
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when should we take bisacodyl
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no sooner than 1 hour after ingesting milk or antacids; do not crush
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prototype drug for osmotic laxatives
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Fleet, magnesium salts
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Fleet generic name
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sodium phosphate
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action of osmotic laxatives
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non absorbable and retains water in the colon
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adverse reactions with osmotic laxatives
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dehydration, diarrhea and loss of water; magnesium can accumulate to toxic levels in renal failure; sodium can retain fluid; acute renal failure
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an osmotic laxative with fewer side effects and safer
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Miralax (glycol)
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when are osmotic laxatives contraindicated
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heart failure, HTN, edema
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action of lactulose
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poorly absorbed and cannot be digested-byproduct of breakdown results in osmotic action-stool in 1-3 days
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side effects of lactulose
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flatulence, cramping
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what laxative is safe for dehydrated or electrolyte sensitive
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GoLytely (polyethylene glycol-electrolyte)
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what kind of suppository is used for laxative
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glycerin suppository
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what natural substance is a natural stimulant laxative
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castor oil
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list some high risk patients for laxative use
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abdominal pain, nausea, cramps, regional enteritis, diverticulitis, ulcerative colitis, acute surgical abdomen, fecal impaction, bowel obstruction
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prototype for phenothiazine anti emetic
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phenergan
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phenergan generic name
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promethazine
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action of promethazine
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relieve nausea by blocking dopamine receptors
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adverse reactions of phenothiazine anti emetic
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extrapyramida - drooling, shuffling
orthostatic hypotension |
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when are phenothiazine anti emetics contraindicated
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children under 2 years owing to risk of fatal respiratory depression
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what damage does phenothiazine anti emetics cause when used IV
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tissue damage
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prototype for opioid anti diarrheals
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Lomotil
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Lomotil generic name
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dipheynoxylate/atropine
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action of opiod type anti diarrheal
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relieves frequency of stools by slowing GI motility at CNS level
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what combination for anti diarrheals discourages abuse
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atropine and morphine
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adverse effects of opiod type anti diarrheals
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sedation
tachycardia |
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prototype of parenteral anticoagulants
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heparin (unfractionated)
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what does unfractionated heparin mean
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connected to a protein
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sources of heparin
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cattle lungs and pig intestines
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when is heparin contraindicated
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pork or beef allergies
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adverse effects of heparin
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bleeding
heparin induced thrombocytopenia hypersensitivity |
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indications for use of heparin
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management of MI; disseminated intravascular coagulopathy; open heart surgery, dialysis, pulmonary embolisms, evolving stroke, massive deep vein thrombosis
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when is heparin the anticoagulant of choice
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pregnancy
emergencies due to rapid onset |
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which anticoagulant is a 2 nurse check drug
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heparin
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when should we use extreme caution with heparin
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peptic ulcer disease; GERD; duodenal ulcers; aneurysm; hypertension; threatened abortion, liver and kidney disease
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where can heparin NOT be given
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MUSCLE
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antidote to heparin overdose
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protamine sulfate
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prototype for low molecular weight heparin
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Lovenox
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Lovenox generic name
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enoxaparin
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action of lovenox
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heparin preparation with shorter molecules than unfractionated that selectively inactivates faxtor Xa
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uses of Lovenox
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used to prevent DVT following surgeries and ischemic complications
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when is lovenox contraindicated
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spinal cord injury, eye and brain surgeries, concurrence with anticoagulants
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how is lovenox dosage figured
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by body weight
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benefits of lovenox
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given as fixed dose once or twice daily
can be used at home less monitoring required less thrombocytopenia |
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adverse effects of lovenox
|
bleeding
immune mediated thrombycytopenia related to pork sensitivity expensive! |
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prototype for oral anticoagulants
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Coumadin
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coumadin generic name
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warfarin
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action of warfarin
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antagonist of vitamin k, blocks biosynthesis of factors vii, ix, x and prothrombin
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uses of warfarin
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prevention of venous emboli, thromboembolism in patients with artificial heart valves, prevention of thrombosis during atrial fibrillation
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adverse effects of warfarin
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hemorrhage, teratogenesis (category X), red orange urine (not bloody), alopecia
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contraindications for warfarin
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thrombocytopenia, bleeding, lumbar puncture, surgery of eye or brain or spinal cord, vitamin K deficiency, alcoholism (impairs ability to clot), liver disease
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drug drug interactions of warfarin
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any drug that increases or decreases anticoagulant effect
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foods that affect warfarin levels
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mayonnaise, canola, soy, broccoli, dark greens
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antidote for warfarin toxicity
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vitamin K, orally or subQ; whole blood if that doesn't work
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list some anti platelet drugs used to prevent arterial thrombosis
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aspirin, clopidogrel (plavix)
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prototype for thrombolytic drugs
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streptokinase (streptase)
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action of streptokinase
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binds plasminogen to make plasmin to break up clot
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major uses for streptokinase
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acute coronary thrombosis, deep vein thrombosis, massive pulmonary emboli
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adverse effects of streptokinase
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bleeding, hypotension, antibody production to streptokinase,fever
intercranial hemorrhage, cord bleeds, intraocular bleeds |
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antidote for streptokinase
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amikar (spelling?)
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prototype for histamine 2 receptor agonists
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tagamet
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tagamet generic name
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cimetadine
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action/uses for cimetadine
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first choice for gastric/duodenal ulcers; promotes healing through acid reduction, GERD
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adverse effects of cimetadine
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low incidence of gynecomastia, reduced libido, impotence, CNS depression/excitement, pneumonia
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drug drug interactions with cimetadine
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inhibits hepatic drug metabolism so any drug metabilized that way will have its absorption affected (warfarin, phenytoin, theophylline, lidocaine); drugs that rely on gastric secretions for absorption
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what are histamine 2 receptor agonists generally used to treat
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peptic ulcer disease
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what is a formulary substitution
|
substituting drug in same class; works the same way (ex: pepcid for tagamet)
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pepcid generic name
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famotidine
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uses for pepcid
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heartburn, acid indigestion, sour stomach
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benefits of pepcid over tagamet
|
no antiadronergic effects
no effect on hepatic metabolism of other drugs |
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prototype for proton pump inhibitors
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prilosec
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prilosec generic name
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omeprazole
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action of omeprazole
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suppress secretion of gastric acid; superior to histamine 2 receptor agonists
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adverse effects of omeprazole
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headace, diarrhea, N&V; long term use increases risk of cancer
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when should omeprazole be given
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30 min before first meal, once daily
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prototype for antacid
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magnesium hydroxide/aluminum hydroxide
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action of antacids
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alkaline agents that neutralize acid and decrease destruction of gut wall
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when do we take antacids
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regularly to promote healing; 1 and 3 hours after each meal and at bedtime to treat PUD
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goal of antacids
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gastric pH greater than 5
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adverse effects of antacids
|
constipation (aluminun base)
diarrhea (magnesium base) sodium loading high levels in renal failure patients |
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what types of effects do histamines have on the body
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endogenous, vessel effects, bronchi effects, stomach effects, allergic reactions, PUD
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when are histamines released
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allergic response
non allergic response - direct stimulation of cells resulting in cell injury |
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what is required for an allergic response
|
IgE antibodies
prior exposure to allergen |
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What are measurable side effects of H1 stimulation
|
lowered blood pressure
edema impaired breathing itching pain mucus secretion |
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measurable side effect of H2 stimulatio
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secretion of gastric acid resulting in ulcers, GERD, etc
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what does a severe allergic reaction consist of
|
anaphylactic shock including bronchoconstriction, hypotension, edema of glottis
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symptoms of anaphylactic are caused by
|
leukotrienes
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treatment of anaphylactic shock
|
epinephrine
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symptoms of mild allergies are caused by
|
histamines
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classic antihistamines include what popular allergy med
|
benadryl
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benadryl generic name
|
diphenhydramine
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side effect of dyphenhydramine
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highly sedating
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action of H1 antagonists (classic antihistamines)
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BLOCKERs
selectively bind to histaminic receptors can also bine to muscarinic receptors |
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therepeutic effects of H1 antagonists
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vasoconstriction
reduction of edema relief of itching, pain drying of secretions |
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therapeutic effects of H1 antagonists not related to allergies
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relief of N&V, motion sickness
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clinical uses of H1 antagonists
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mild allergies, seasonal rhinitis, acute urticaria, allergic conjuntivitis, mild transfusion reactions,motion sickness, insomnia, NVD, constipation, loss of appetite
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adverse effects of H1 antagonists
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sedation, dizziness, lack of coordination, confusion
paradoxical = insomnia, excitation, tremors, convulsions |
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contraindications of antihistamines
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third trimester
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precautions with antihistamines
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asthma, children/elderly, urinary retention, HTN, OA glaucoma, prostatic hypertrophy
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adverse side effects with 2nd generation antihistamines
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cardiac dysrhythmias
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symptoms of antihistamine toxicity
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similar to atropine poisoning (anticholinergic, hyperpyrexia)
can lead to death in kids via excitation, hallucinations, convulsion, coma, CV collapse, death |
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treatment for antihistamine toxicity
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remove and support
charcoal followed by cathartics |
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2nd generation antihistamine prototype
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allegra
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allegra generic name
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fexofenadine
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precautions with 2nd gen antihistamine
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alcohol, drowsiness, liver, kidneys
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action of 2nd gen antihistamine
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antagonists of histamine to relieve symptoms of allergic rhinitis and urticarias
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what is the major advantage of 2nd gen anti histamines
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do not readily cross blood brain barrier therefore non sedating with minimized anticholinergic side effects
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major disadvantage of 2nd gen anti histamines
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expensive
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