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86 Cards in this Set
- Front
- Back
Adrenal Cortex
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Hormone: Corticosteroids
Hyper: Cushing's - Cytaden Hypo: Addison's - hydrocortisone, prednisone |
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Ovaries - Estrogen
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Hypo: menstrual and metabolic dysfunction - conjugated estrogen and estriol
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Ovaries - Progesterone
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Hypo: Dysfunctional uterine bleeding - testosterone
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Testes - Testosterone
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hypo: hypogonadism - testosterone
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pancreatic islets
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Insulin
Hypo: Diabetes Mellitus - Insulin and oral hypoglycemic |
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parathyroid
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parathyroid hormone
hyper: hyperparathyroidism - surgery hypo: hypoparathyroidism - Vit D and Ca+ supplements |
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pituitary - ADH
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hypo: Diabetes insipidus - vasopressin and desmopressin
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pituitary - growth hormone
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hypo: small stature - somatrem and somatropin
hyper: acromegaly - sandostatin |
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pituitary - oxytocin
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hypo: delayed delivery or lack of milk ejection - oxytocin
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thyroid
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thyroid hormone
hyper: Grave's dz - propylthiouracil (PTU) hypo: Myxedema - thyroid hormone and levothyroxine (T4) |
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growth hormone disorders
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Gigantism - prior to puberty
acromegaly - after puberty |
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parlodel
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gigantism/acromegaly- activates dopamine receptors to inhibit the release of GH and prolactin (may cause drowsiness, use alternate contraception)
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sadostantin
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gigantism/acromegaly - blocks GH secretion in the anterior pituitary, inhibits growth hormone
SQ - TID, long acting IM q4wks given by injection form, usually at HS |
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Growth Hormone
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dwarfism - must be used before closure of bone epiphyses.
antibodies may develop resulting in failure to respond to therapy, namely failure of drug to produce growth. Somatropin SQ/IM in PM to mimic body response, rotate sites, may be abused by athletes |
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Antidiuretic Hormone Disorders
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SIADH - excess secretion of ADH
Diabetes Insipidus - deficiency of ADH (neurogenic) |
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SIADH
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marked fluid retention
increased urine osmolality low serum osmolality sodium loss in urine hyponatremia and water retention resulting in muscle cramps, weakness, HA, N/V, lethargy, coma TX: remove excess fluid Diuretic: Lasix, Mannitol |
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Diabetes Insipidus
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Large volume of dilute urine
increased thirst TX: desmopressin (DDAVP) - increases permeability of renal tubules to water, increases the reabsorption of water, produces vasoconstriction of blood vessels at higher doses intranasally, SQ, IV, PO monitor BP store in refrigerator, monitor for water intoxication also used for enuresis |
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Osmolality
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the number of dissolved particles, or solutes, in a fluid. As water is lost, the osmolality, or concentration of the blood, increases and the hypothalamus directs the posterior pituitary gland to release ADH
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Hypothyroidism - meds
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Thyroid Hormone - Levothyroxine (T4), liothyronine (T3)
PO, IM, IV(levothyroxine) actions: increases metabolic rate throughout body, increase O2 consumption, resp rate, blood volume, cardiac output, temp, protein, fat, and CHO metab, weight loss drug interactions - potentiated by use of ASA, increased effects of stimulants, decrease oral anticoagulants may require increase in insulin or oral hypogycemics |
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Hyperthyroidism - meds
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antithyroid drugs: tapazole and propylthioruracil (PTU)
actions: inhibit manufacture of of thyroid hormone, may take 3-4 wks to see results, may not be therapeutic (results in thyroidectomy or radioactive iodine tx) SE: agranulocytosis, oxfoliative dermatitis, granulocytopenia, aplastic anemia, hypoprothrombinemia, and hepatitis, N/V, and paresthesias |
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hyperthyroidism - iodine solutions
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Iodism (excessive amounts of iodine in body), metallic taste, swelling and soreness of parotid glands, burning of mouth and throat, sore teeth and gums, symptoms of head cold, and GI upset, also symptoms of iodine allergy
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Radioactive Iodine
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used for hyperthyroidism - SE: sore throat, swelling of neck, n/v, cough, pain on swallowing, bone marrow depression, anemia, leukopenia, thrombocytopenia, tachycardia
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radioactive iodine - nrsg considerations
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may have difficulty swallowing tablet
add iodine solutions to juice or water before administration has strong salty taste drink through straw to prevent tooth discoloration radioactive iodine is given by MD as single dosage only radiation safety precautions should be followed |
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androgens
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indications: replacement therapy in androgen deficient males
inoperable metastatic carcinoma or the breast in women fibrocystic breast dz endometriosis Testosterone (transdermal, intramuscular - oil based: ASPIRATE) adverse effects/nrsg care: acne, flushing of skin gynecomastia change in libido edema virilization in females priapism |
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androgen inhibitors
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drugs that block the effects of androgens
excessive androgens - BPH which may respond to inhibitor medication Finasteride - Proscar, Propecia - has been found to also promote hair growth SE/Nrsg considerations: pregnant women or women who may become pregnant should avoid skin contact with drug (birth defects) monitor urine output for decreased output or decreased flow impotence and decreased libido may occur during therapy advise patient to avoid exposing a pregnant women or one who may become pregnant to his semen |
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Estrogens
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replacement therapy in menopause or when deficient in estrogens, postpartum breast engorgement, androgen dependent tumors (prostate cancer), contraception
DES, estradiol, conjugated estrogens SE/Nrsg care: cholasma, nausea, elevated BP, clotting problems, gall stones, cholestatic jaundice, breakthrough bleeding, depression, given cyclically if the woman has a uterus |
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Progestins
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progestins transform a proliferative endometrium into a secretory one and stimulate the growth of mammary alveolar tissue - the hormone of pregnancy
Amenorrhea, abnormal uterine bleeding caused by hormonal imbalance, endometrial cancer, combination bc pills hydroxyprogesterone (Duralutin), Medroxyprogesterone (Provera), Progesterone (Gestrol) SE/Nrsg care: breakthrough bleeding, changes in menstrual flow, edema, thromboembolic disorders, increased BP |
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Evista
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estrogen agonist-antagonist: used for postmenopausal osteoporosis. Reduces resorption of bone and decreases bone turnover. also used in breast cancer prophylaxis.
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contraceptive patch
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applied anywhere except breasts, palms, soles of feet
patch applied each week for three weeks on same day called "patch change day" patch free week - menstruation usually occurs (4th week) emergency contraception if patch is off for more than one or two days |
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depo provera
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usually injected within the first 7 days of menstruation
reinject every 3 months emergency contraception if late for injection 99.7% effective not coitus dependent, not associated with estrogen-caused cardiovascular SE decreases dysmenorrhea, cramping reduces risk ectopic pregnancy, anemia, endometrial cancer, uterine cancer and PID safe for breast feeding does not affect long-term fertility |
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The Pill
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taken daily at same time for 21 days followed by hormone free period of 7 days - menstruation
can be taken up to 84 days on/7 off emergency contraception if one or two pills missed |
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progestin-only
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similar to depo provera
mini-pill begins with menses or post-partum while BF take pill same time each day - 3 hrs late requires emergency contraception for women who cannot use estrogen, bf'ing women |
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depo provera, mini pill, norplant, implanon
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prevent pregnancy by inhibiting ovulation by suppressing FSH and LH, and eliminating the LH surge. Thickening the cervical mucous and preventing sperm penetration. Producing changes in the endometrial lining. Mirena IUD also contains progestin
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Vaginal Ring - NuvaRing
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left in place for 21 days, then ring-free week - menstruation
emergency contraception if ring is out of place for more than three hours or if new ring is late |
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norplant and implanon
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Norplant - D/C'd in late 1990s.
Implanon progestin-only implant in europe but not US. like Depo provera levonorgestrel up to 7 years |
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FSH and LH
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influence the secretion of sex hormones, development of secondary sex characteristics, and reproductive cycle
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menotropins and urofollitropin
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purified preparations of the gonadotropins extracted from urine of postmenopausal women
menotropin - used to induce ovulation and preg in anovulatory female, in male to induce prod of sperm Urofollitropin - used to induce ovulation in women with PCOD |
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menotropin adverse rxn
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ovarian enlargement, hemoperitoneum and febrile rxns.
Multiple births and birth defects. |
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urofollitropin adverse rxn
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mild to moderate ovarian enlargement, n/v, breast tenderness, ectopic pregnancy
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chorionic gonadotropin
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hCG - extracted from human placentas and contains FSH and LH. Used to induce ovulation and pregnancy. Also used for prepubertal cryotorchism (failure of testes to descend into the scrotum)
Adverse rxn: HA, irritability, restlessnes, fatigue, edema, and precocious puberty |
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Clomid (clomiphene citrate)
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binds to estrogen receptor sites, reducing the number of sites available for circulating estrogens. The receptors send back signals to hypothalmus and pituitary gland, telling it that there is a lack of circulating estrogens. They hypothalmus responds by increasing secretions of hypothalamic releasing factor. This stimulates pituitary gland to release LH and FSH which in turn stimulates the ovaries to release eggs for fertilization.
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Clomid uses/dose
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to induce ovulation in women who are not ovulating because of reduced circulating estrogen levels. Pregnancy occurs 25-30% of pts treated. POTENTIAL FOR MULTIPLE BIRTHS.
50 mg tabs |
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Clomid nursing care
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make sure pt knows to have sex during ovulation - usually 6-10 days after last dose of med
start any time there has been no recent bleeding. If bleeding occurs before therapy, start on or about the 5th day for 5 days. If ovulation does't occur after first course, give 2nd course of 100 mg for 5 days. Do not start any earlier than 30 days after the previous course. Third course may be given at 100 mg for 5 days. |
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clomid - monitor for SE, report to MD
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Monitor for N/V/D and constipation, hot flashes, abdominal cramping
Report: severe abdominal cramping, visual disturbances, dizziness |
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Oxytocics - oxytocin, pitocin
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stimulates the smooth muscle of the uterus, blood vessels, and mammary glands. When administered during third trimester, active labor is induced
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oxytocics - uses
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drug of choice for inducing labor or augmenting uterine contractions during the 1st and 2nd stage of labor
routinely given immediately PP to control uterine atony and PP hemorrhage can be administered intranasally to promote milk letdown and treat breast engorgement during lactation |
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Oxytocics - dosages
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induction of labor: IV 1 to 2 mU/min.
infusion pump must be used may increase or decrease dosage according to desired response max usually 20 mU/min rate change max 20-30 min may reduce or discontinue after labor has begun to do spontaneous uterine activity augmentation of labor - IV 0.5 - 2 mU/min PP hemorrhage - IM 10U given after delivery of placenta IV - 10-40 U may be added to 100 mL to run at rate necessary to control uterine atony Milk letdown - intranasal spray, 1 spray or 3 gtts 2 to 3 min before nursing or pumping breasts |
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oxytocin - nursing care
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Monitor uterine contractions and Fetal Heart Rate
contraction > 90 sec require flow rate to be discontinued or slowed FHR >160 bpm followed by <120 bpm may indicate fetal compromise. If fetal disress noted, reduce oxytocin or d/c, turn mother on left side, admin O2 and notify MD. Water intoxication - can alter fluid balance by stimulating ADH causing the body to accumulate water. Particularly likely to occur if oxytocin is admn with electrolyte solution.. S/S: drowsiness, listlessness, HA, confusion, anuria, edema, extreme -seizures |
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anabolic steroids uses
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management of anemia or renal insufficiency, control of metastatic breast CA in women, promote weight gain
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anabolic steroids
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synthetic drug chemically related to androgens, promote tissue-building processes, minimal effect on accessory sex organs and secondary sex characteristics
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anabolic steroids - adverse effects
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virilization - DEATH
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adrenocorticotropic hormone (ACTH)
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stimulates adrenal cortex to produce and secrete adrenocortical hormones, primarily glucocorticoids
used for dx testing of adrenocortical function also used for mfmt of acute exacerbation of MS, nonsuppurative thyroiditis, and hypercalcemia associated with CA. an antiinflammatory and immunosuppresssant drug when conventional glucocorticoid therapy has not been effective |
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ACTH adverse effects
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b/c stim the release of glucocorticoids from the adrenal gland, adverse reactions are similar to glucocorticoids from the adrenal gland, adverse reactions are similar to glucocorticoids
may mask the s/s of infection including fungal or viral eye infections. May be resistant and inability to localize infection. Report: c/o sore throat, cough, fever, malaise, sores that do not heal or redness or irritation of eyes. Observe for behavioral changes: depression, insomnia, euphoria, mood swings or nervousness |
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adrenocortical hormones
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glucocorticoids and mineralcorticoids are called steroids - influence or regulate immune response and regulation of glucose, fat, and protein metabolism, control the antiinflammatory response
uses: antiinflammatory and immunosuppressants to suppress inflammation and modify the immune response |
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glucocorticoids actions/effects
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modifies or changes normal immune response, suppression of inflammation (stops or slows down heat, redness, swelling, pain and varied metabolic responses
SE: sodium and water retention, hypokalemia, suppression of normal adrenal function, muscle wasting, osteoporosis, peptic ulcers, elevated blood sugar, decreased wound healing, mood alterations, cataracts, altered fat distribution, hirsutism, mask s/s infection |
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mineralcorticoids
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replacement therapy for adrenal insufficiency (addison's)
increases reabsorption of sodium and excretion of potassium and hydrogen ions in the kidney |
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mineralcorticoids s/e, drug interactions
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sodium and water retention, hypertension, hypokalemia, HA
additive hypokalemia with other potassium depleting diuretics |
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glucocorticoids - drug interactions
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may increase the need for insulin or oral hypoglycemic agents, oral contraceptives may block drug's metabolism, phenytoin, phenobarbital, and rifampin may decrease glucocorticoid effectiveness with systemic administration, hypoglycemia may potentiate digitalis effects.
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Insulin - uses
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Type I/II DM, DKA, also may be used to promote K+ shift from blood cells in hyperkalemia
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Types of Insulin
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pork or beef derivatives - rarely used r/t pt allergies
Human insulin - made from biosynthetic process using DNA, rDNA, less allergic rxn Insulin analogs, Insulin lispro, insulin aspart - newer forms of human insulin (made using rDNA processing) are very similar to human insulin |
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protamine, zinc
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when insulin is combined with protamine (protein) it's absorption rate is slower and its duration is prolonged
when zinc is added it changes the onset and duration of action |
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insulin classification
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rapid acting, intermediate, or long acting
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rapid acting insulin
Insulin Injection |
HUMULIN R, NOVOLIN R - only insulin that can be used intravenously
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rapid acting insulin
Insulin Lispro (insulin analog) |
Humalog, Humalog mix 50/50, Humalog mix 75/25
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rapid acting insulin
Insulin Aspart (insulin analog) |
NovoLog
eat within 5-10 minutes afer using NovoLog to avoid low blood sugar do not mix with any other insulins when used in a pump or with any insulins other than NPH when used with injections by syringe Humalog and NovoLog are used to cover meals and snacks Leaves your body faster so will not have residual insulin causing low blood sugars in the late afternoon or middle of the night |
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rapid acting insulins are
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Humulin R, Novolin R, lispro (Humalog), aspart (NovoLog)
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Intermediate Acting Insulins
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Isophane Insulin Suspension NPH (neutral protamine hegadorn)
Insulin Zinc Suspension (Lente) |
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Intermediate Acting Insulin
Isophane Insulin Suspension (NPH) |
Humulin N, Novolin N
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Intermediate Acting Insulin
Insulin Zinc Suspension (Lente) |
Humulin L, Lente Iletin II, Novolin L
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Long Acting Insulins (basal insulins)
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Insulin glargine solution (lantus)
Insulin detemir (levemir) |
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Long Acting Insulins (basal insulins)
Insulin glargine solution |
Lantus
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Long Acting Insulins (basal insulins)
Insulin detemir |
Levemir
should not be diluted or mixed with any other insulin or solution |
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Mixed Insulins
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Isophane Insulin suspension and insulin injections (NPH) and reg
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Mixed Insulins
Isophane Insulin suspension and insulin injections (NPH) |
Humulin 70/30, Novolin 70/30
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Mixed Insulins
Isophane Insulin suspension and insulin injection (reg) |
Humulin 50/50
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Mixed Insulins
70% insulin aspart protamine suspension and 30% insulin aspart injection (rDNA origin) |
NovoLog mix 70/30
it is important to take your dose within 15 minutes of a meal |
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sulfonylureas
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stimulate pancreatic B-cells to increase insulin output
Diabeta, Micronase (glyburide), Glucotrol (glipizide), Amaryl (glimepiride) |
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Meglitinides
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stimulate pancreatic B-cells to increase insulin output
Starlix (repaglinide) |
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Biguanides
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Target liver to decrease glucose production, increase insulin sensitivity in liver and muscle
Glucophage (metformin) -stopped for 48 hrs before or after radiologic tests using contrast dye |
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Alpha-glucosidase inhibitors
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inhibit intestinal enzymes that break down CHOs, which delays CHO absorption
Precose (acarbose) Glyset (miblitol) |
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Thiazolidinediones
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Increase insulin sensitivity in fat cells and muscle
Avandia (rosiglitazone) Actos (pioglitazone) |
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glucovance
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glyburide and metformin
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Rapid acting
novolog (aspart) humalog (lispro) |
onset - 10 to 30 min
peak - 30 min to 1 hr duration - 3-5 hrs |
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Short acting
NOVOLIN R HUMULIN R |
onset - 30 min to 1 hr
peak - 1.5 to 2 hrs duration - 5 - 12 hrs |
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Intermediate acting
NOVOLIN N |
onset - 1 to 2 hours
peak - 6 to 12 hrs duration - 12 to 24 hrs |
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Long Acting
LEVIMIR/LANTUS |
onset - 1 to 2.5 hrs/1 to 2 hrs
peak - no peak duration - 20 hrs20 - 24 hrs |