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59 Cards in this Set
- Front
- Back
H1 receptors
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smooth muscle ctx & capillary dilation
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H2 receptors
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gastric acid secretion & acceleration of heart rate.
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H1 antagonists (blockers)
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called antihistamines, used for nasal allergies & common cold S&S
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H2 antagonists or blockers
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act on GI tract
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H1 antihistamines-
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Have an anticholinergic effect- drying effect.
Antihistamines are more effective in blocking an allergic reaction than stopping one. histamine & other substances released from mast cells, basophils, etc. in response to antigens. histamine then binds to other cells in nose, eyes, respiratory tract, GI tract & skin. This produces S&S of an allergy attack |
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Antihistamines Side Effects
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Drowsiness
Anticholinergic (drying) anesthetic effect causes-arrhythmias, hypotension, syncope, dizziness |
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Antihistamines- nursing
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Antihistamines are also used for motion sickness and vertigo
Offer hard candy, gum etc. if dry mouth Take with meals to decrease GI effect Caution with heavy machinery- drowsiness Caution with ETOH |
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Decongestants
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PO
Slower onset but longer relief e.g. pseudoephedrine (Sudafed) OTC Usually not a problem with rebound congestion Inhaled intranasal steroids Usually not a problem with rebound congestion Topically (nasal spray) Problems with rebound congestion |
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Decongestants Side effects
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nervous or jittery with adrenergic agents (stimulate sympathetic nervous system- adrenaline)
Intranasal steroids- dryness or mucosal irritation Caution with pts. with diabetes, cardiac, thyroid. Usually small amount of systemic effects Caution with ETOH, caffeine |
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Antitussives
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2 main categories-
Opioid antitussives- act on cough center, drying Codeine (Robitussin A-C) hydrocodone Non-opiod antitussives- combinations and OTC dextromethorphan (Vicks Formula 44, Robitussin-DM)- acts on cough center & dries. |
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Antitussives Side Effects
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Side effects:
codeine- & hydrocodone- sedation, N/V, lightheadedness, constipation. Potentially addictive. dextromethorphan- dizziness, drowsiness & nausea diphenhydramine- sedation, dry mouth, other anti-cholinergic effects benzonatate- dizziness, H/A, sedation, nausea, constipation, pruritus, & nasal congestion If taking lozenges avoid fluids for 30” to keep from washing away effect. Watch for change in color of sputum Caution with heavy machinery- drowsiness Caution with ETOH |
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Expectorants
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Encourage fluids to help loosen secretions
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Asthma attack
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- mediated by antibodies- specialized immune proteins = immunoglobulins (IgE usual)
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Bronchodilators
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Beta agonists- acute phase of asthma- quickly reduces airway constriction. Imitate effect of NE on receptors.
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Bronchodilators- Xanthines
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Xanthine derivatives- stimulates CNS- includes caffeine. Cause bronchodilation by increasing levels of cAMP, by inhibiting phosophodiesterase (use to breakdown cAMP). cAMP helps maintain open airways. More prevention than acute.
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Bronchodilators-Anticholinergics
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Prevents bronchoconstriction by blocking ACh receptors-indirectly causing airway dilation
Side effects: dry mouth/throat, GI distress, H/A, coughing & anxiety |
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Antileukotriene agents
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Leukotrine receptor antagonist-
Prophylaxis & chronic treatment > than 12. See improvement in one week Side effects: Zileuton- H/A, dyspepsia,nausea, dizziness, insomnia Zafirlukast- H/A, nausea, diarrhea. Montelukast- destruction of blood vessels, (may use > 2 yrs old.) Nursing, monitor liver enzymes, offer hard candies, gum for dry mouth, teach to take even without symptoms |
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Corticosteroids/glucocorticoids
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Enhances activity of beta-agonists, reduces inflammation. Stabilize WBC’s, keep leukocytes from releasing bronchoconstricting histamine
Inhaled avoids the systemic effects of steroids, works in lungs Side effects: Pharyngeal irritation, cough, dry mouth, oral fungal infections Nursing: if on systemic steroids, wean slowly, may die from adrenal gland failure! Inhaled agents do not usually wean! Teach rinse mouth with water, don’t swallow after inhalers. Nursing, have pt. wear med alert bracelet. Cushingoid S&S: moon face, acne, edema, increase in fat pads. Report. Addison’s S&S (adrenal insufficiency): nausea, dyspepsia, joint pain, weakness, fatigue. Report. |
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Pituitary
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Anterior lobe- Pituitary controlled by the hyperthalmus to either release or not release a specific hormone.
Growth Hormone- GH Follicle Stimulating Hormone (FSH), LH- Luteinizing Hormone TSH- Thyroid Stimulating Hormone ACTH- Adrenal Gland (Glucocorticoids) PRL- prolactin (milk production) Posterior Lobe- stores & secretes two effector hormones (produce an effect when stimulated) made in hypothalmus stored in pituitary Oxytocin Vasopressin = ADH – antidiuretic Hormone- tells kidneys to conserve water. |
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Hypothyroidism
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Primary- abnormal thyroid gland cannot perform it’s function- most common
Secondary- pituitary gland decreases the secretion of TSH Tertiary- decreased levels of TRH (thyrotropin releasing hormone) from hypothalamus |
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Antileukotriene agents
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Leukotrine receptor antagonist-
Prophylaxis & chronic treatment > than 12. See improvement in one week Side effects: Zileuton- H/A, dyspepsia,nausea, dizziness, insomnia Zafirlukast- H/A, nausea, diarrhea. Montelukast- destruction of blood vessels, (may use > 2 yrs old.) Nursing, monitor liver enzymes, offer hard candies, gum for dry mouth, teach to take even without symptoms |
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Corticosteroids/glucocorticoids
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Enhances activity of beta-agonists, reduces inflammation. Stabilize WBC’s, keep leukocytes from releasing bronchoconstricting histamine
Inhaled avoids the systemic effects of steroids, works in lungs Side effects: Pharyngeal irritation, cough, dry mouth, oral fungal infections Nursing: if on systemic steroids, wean slowly, may die from adrenal gland failure! Inhaled agents do not usually wean! Teach rinse mouth with water, don’t swallow after inhalers. Nursing, have pt. wear med alert bracelet. Cushingoid S&S: moon face, acne, edema, increase in fat pads. Report. Addison’s S&S (adrenal insufficiency): nausea, dyspepsia, joint pain, weakness, fatigue. Report. |
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Pituitary
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Anterior lobe- Pituitary controlled by the hyperthalmus to either release or not release a specific hormone.
Growth Hormone- GH Follicle Stimulating Hormone (FSH), LH- Luteinizing Hormone TSH- Thyroid Stimulating Hormone ACTH- Adrenal Gland (Glucocorticoids) PRL- prolactin (milk production) Posterior Lobe- stores & secretes two effector hormones (produce an effect when stimulated) made in hypothalmus stored in pituitary Oxytocin Vasopressin = ADH – antidiuretic Hormone- tells kidneys to conserve water. |
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Hypothyroidism
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Primary- abnormal thyroid gland cannot perform it’s function- most common
Secondary- pituitary gland decreases the secretion of TSH Tertiary- decreased levels of TRH (thyrotropin releasing hormone) from hypothalamus |
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Hypothyroidism
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Cretinism- hyposecretion of thyroid hormones during youth. Decreased basal metabolic rate.
Myxedema- hyposecretion of thyroid hormones as an adult. Decreased basal metabolic rate. Goiter- increased levels of TSH d/t lack of T3/T4 enlarges thyroid gland. Used to be caused by a lack of iodine in the diet. |
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Overactive Thyroid (Hyperthyroidism)
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Trouble sleeping
Eye protrusion Diarrhea Nervousness Hair loss Weight loss Intolerance to heat |
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Under active Thyroid (Hypothyroidism)
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Sleepiness
Constipation Puffy face Lethargy Thick, rough, dry skin Weight gain Intolerance to cold |
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Hypothyroid (replacement) agents
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Natural thyroid replacement from animals (beef, pigs) = thyroid desiccated (dried)
Synthetic- **Levothyroxine (Synthroid)- once a day dosing, T4, ½ life is 10 days, peak at 4 weeks |
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Side effects of hypothyroid agents:
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CV: dysrrthymias, tachycardia, palpitations, angina, hypertension, cardiac arrest
CNS: Insomnia, tremors, H/A, anxiety GI: Nausea, diarrhea, change in appetite, cramps |
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Side effects of anti-thyroid (HYPER-THYROID) agents
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CNS: drowsiness, H/A, vertigo, fever
GI: N/V, diarrhea, jaundice, hepatitis, loss of taste GU: smoky colored urine, decreased urine output Blood: agranulocytosis, leukopenia, thrombocytopenia, lymphadenopathy, bleeding Musculoskeletal: myalgia, arthralgia, nocturnal muscle cramps Liver and bone marrow problems |
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Thyroid Agents, Nursing
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Nursing
Give same day every day, AM preferred Antithyroid with meals, don’t use iodized salt, soy, fish etc. Never stop either abruptly- usually life long therapy Don’t switch brands unless ordered No OTC medications without MD approval |
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Glucocorticoids
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are synthesized as needed, controlled by a negative feedback loop. Regulated by the Hypothalamus/Pituitary
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Mineralocorticoids
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regulate electrolytes. Maintains K+ levels and pH of blood
Side Effects: Edema and HTN |
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Corticotropin
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from pituitary-ACTH (adrenal cortex stimulating hormone) – makes adrenal gland secrete cortisol.
Must WEAN Notify HCP for 12 months after therapy Avoid immunizations during therapy (Because is an immosuppressent) |
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Corticosteroids
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Action:
steroid hormones bind to receptor. Goes into the cell and stimulates cell to produce RNA (messenger). RNA synthesis of a specific protein which modifies enzyme activity. Contraindications: Serious infections- septicemia, varicella, Db, cataracts, PUD, mental health. May intensify Interactions: With diuretics-hypocalcemia & hypokalemia With aspirin & NSAID’s increased GI Hypoglycemics- reduce affect. Cardiovascular: heart failure, cardiac edema, hypertension (electrolyte imbalances) CNS: convulsions, H/A, vertigo, mood swings Endocrine: Cushing’s, growth suppression, GI: peptic ulcers, pancreatitis Integument: fragile skin, petechaie, ecchymosis Musculoskeletal: muscle weakness, osteoporosis Other: weight gain, increased ocular pressure |
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Hypersecretion of Glucocorticoids
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S&S: redistributes body fat from arms & legs to face, shoulders, trunk & abdomen. “Moon face”
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Hypersecretion of aldosterone
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S&S: increased water retention and muscle weakness (from potassium loss)
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Addison’s Disease
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Due to under secretion of adrenocortical hormones
All 3 adrenal corticosteroids are reduced (glucocorticoids, mineralocorticoids, androgens) Decreased blood sodium levels, decreased blood glucose, increased potassium levels, dehydration & weight loss Treat with a mineralcorticoid (fludrocortisone) & a glucocorticoid (prednisone) |
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Adrenal agents, nursing
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Assess:
Baseline weight, >2 lbs/day or >5 lbs/week report ASAP BP, regularity of pulse Suppressed immune system- avoid people with infections, Take same time every day, once a day take in AM to decrease adrenal suppression Encourage a journal of S&S, events, triggers, etc. Inhalers- rinse mouth WEAN! Can precipitate an adrenal crisis Labs: Na, K, BUN (Blood urea nitrogen), Hgb, Hct, baseline blood glucose (elevates) Mental status: aggression, depression, psychosis |
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Estrogen
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synthesized from cholesterol in ovaries
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HRT- hormone replacement therapy
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Lowest effective doses for shortest period of time d/t health risks
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Estrogen-progesterone mix
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Risk for breast cancer, heart disease, stroke & blood clots
Decreased risk of hip fractures & colon cancer |
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Estrogen only
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Increased risk of stroke
Reduced hip fracture Recommend topical Tx versus systemic Tx |
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Estrogen replacement
Side Effects and Interactions |
Adverse effects:
thrombolytic events, Stevens-Johnson syndrome, nausea, vomiting, diarrhea, constipation photosensitivity, choasma (brown face mask), hirsuitism, alopecia HTN, thrombophlebitis, edema Interactions Decrease warfarin effects TCA’s (tricyclic antidepressants) may become toxic Smoking adds to risk of blood clots |
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Progesterone- from corpus luteum
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Adverse effects
Liver dysfunction Thrombophlebitis, thromboembolytic disorders N/V, amenorrhea, edema, weight gain, |
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Women's Health- nursing
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Take hormones with food or milk to reduce GI distress
Report chest pain, leg pain, blurred vision, H/A, neck pain or stiffness, edema, abnormal vaginal bleeding, yellow coloring Report 2 lbs/day, 5 lbs/week gain Avoid sunlight, use sunscreen |
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Men’s health- androgens
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Contraindications:
To erectile drugs- Major cardiovascular disorders, esp. with nitrates like NTG Androgen responsive tumors Caution with oral anticoagulants Adverse effects: Liver- Can cause blood filled cavities Cancer, cholestatic hepatitis, jaundice Fluid retention- weight gain Priapism- abnormal prolonged erection May interfere with bone growth & elevate electrolytes |
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Mens’ Health- nursing
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Special handling of some androgens d/t teratogenic effects (e.g. finasteride for BPH)
Watch for H/A, flushing, diarrhea, UTI, rashes, dizziness ED drugs- need arousal to be effective. Do NOT abruptly withdraw from androgens like testosterone May take 6-12 months to see effect of many men’s health drugs |
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Osteoporosis- Three Types of Drugs
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3 classes of drugs:
Bisphonates- e.g. alendronate Inhibit osteoclast bone resorption SERM’s- selective estrogen receptor modifiers- e.g raloxifene (Evista) & tamoxifen (Nolvadex) Stimulates estrogen receptors on bone & increase bone density Calcitonin- hormone (salmon derived) Directly inhibits osteoclastic activities |
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Osteoporisis drug side effects
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Adverse effects:
Bisphosphonates- H/A, GI distress, joint pain. SERM’s- hot flashes, leg cramps Calcitonin- flushing of face, N/V, diarrhea and anorexia Teriparatide- chest pain, N/V, dizziness, hypercalcemia, arthralgia Bisphosphonates- risk of esophageal burn, remain upright for 30” and take with water. Take 30” before other food/drink SERM’s- can drop white cell count at risk for infections Check with HCP if should take calcium/Vitamin D with these drugs |
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Laboratory Results- Diabetes
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FBS 70-100 mg/dL - Euglycemia
FBS 110-126 –impaired “pre-diabetic” Greater than 200 mg/dL - anytime problem! |
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Pancreas cell functions
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Alpha– secrete glucagon, which makes cells release stored food into the blood.
Beta cells – secrete insulin, which makes cells take up food from the blood |
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Classifications of Diabetes
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Type 1 diabetes
Beta cell destruction Immune mediated Type 2 diabetes Insulin resistance with a relative insulin secretory defect to complete insulin deficiency Vast majority are obese |
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Insulin-Human recombivent
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Rapid- subcutaneously (clear)
*aspart- (Novalog) (preg C) ** lispro- (Humalog) (preg B) Gluligine (Apidra) Regular- Short acting-(preg B) (clear) subcutaneously – may be continuous IV * **Humulin R Novalin R Intermediate-(preg B) subcutaneously (cloudy) **isophane insulin suspension (NPH, Humulin N, Novalin N) *insulin zinc suspension- (Humulin L, Novalin L) |
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Insulin glargine (Lantus)
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(preg C) (clear) must be given alone! Do NOT mix
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Side Effects-Hypoglycemia
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Hypoglycemia results from
Too much insulin or too little insulin? S & S of Hypoglycemia Blood Sugar less than 50 mg/dl Confusion, abnormal behavior or both, such as the inability to complete routine tasks Visual disturbances, such as double vision and blurred vision Seizures, though uncommon Loss of consciousness, though uncommon Hypoglycemia may also cause these other signs and symptoms: Heart palpitations Tremor Anxiety Sweating Hunger |
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Hyperglycemia S&S
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Hyperglycemia = FBS (or FBG) of >126 mg/dl
Increased pulse, abnormal breathing, fruity acetone breath confusion |
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Diabetic Ketoacidosis
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Signs:
Hyperglycemia Dehydration Low BP Hyperketonemia Ketonuria Glucosuria Electrolyte imbalances Rapid Respierations |
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Insulin Side Effects
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Cardiovascular- tachycardia, palpitations
CNS: H/A, lethargy tremors, weakness, fatigue, delirium, sweating Metabolic: hypoglycemia Other: blurred vision, dry mouth, hungre, nausea, flushing rash, urticaria, anaphyylaxis Avoid sun- wear sunglasses 90 degree angle subcutaneous, 45 degrees if emaciated 30 days in room air, 3 months in fridge. Filled syringes upright. Never use a solution that appears colored or inappropriately cloudy Never switch types of insulin- Cannot give porcine and human! ALWAYS have another nurse check your insulin dose and order! Most insulin is 100 units per mL- BUT CHECK! Be aware dosing may be in the form of a sliding scale |