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36 Cards in this Set

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Name 2 rapid acting human recombinant insulins:
1)Insulin aspart or Novalog
2)Insulin Lispro or Humalog
What is one short acting regular human recombinant insulin?
Humulin R or Novolin R or Velosulin VR
aka Regular Insulin
What are 2 intermediate acting NPH & Lente Human Recombinant Insulins?
Insulin isophane suspension = NPH (Neutral Protamine Hagedorm)
Insulin Zinc Suspension = Lente
Humulin N, Novolin N
What are 2 long acting Human Recombinant Insulins.
Extended Insulin Zinc Suspension = Humulin U Ultralente
Insulin Glargine = Lantus
What 2 drugs are indicated in the treatment of hypoglycemia?
Glucagon & Diazoxide
What are signs and symptoms of hypoglycemia?
weakness, nervousness, cold clammy skin, sweating, paleness, shallow rapid breathing, confusion, irritability. Later: tremors, hypothermia, seizures
How long should insulin be stored at room temperature?
1 month if it will be used. Otherwide refrigerated.
When should Regular insulin and Lispro insulin be given in relation to meals?
Regular - 30 to 60 minutes before meals
Lispro - 15 minutes before meals
Which insulins may be given with regular insulin?
NPH 70%/reg 30%
or
NPH 50%/Reg 50%
What are 3 types of pre-mixed insulins? (Hint: chart on p. 519).
NPH Humulin 70/30
NPH 50/50
Lispro protamine suspension 75/lispro 25 (Humalog 75/25)
What are signs and symptoms of hyperglycemia?
polyphagia, polyuria, polydipsia, blurred vision, fatigue, weight loss, poor wound healing, dry mouth, impotence, recurrent infections.
What conditions impact blood glucose? (Hint: p. 531).
illness, infection, vomiting, unable to eat, under stress.
What is the MOA for : sulfonylureas
Stimulates insulin secretion from the beta cells of the pancreas
What is the MOA for : Prandin?
meglitinide: stimulate the release of insulin from pancreatic beta cells
What is the MOA for : Glucophage (Metformin)?
biguanide: inhibits hepatic glucose production
What is the MOA for Rosiglitazone (Avandia)?
glitazone or thiazolidinedione derivative: decreases insulin resistance. May be used w/ sulfonylurea, metormin, or insulin
Which oral anti-diabetic agents do not cause hypoglycemia?
Biguanide metformin and alpha-glucosidase inhibitors (acarbose and miglitol)
What instructions should the nurse give to patients Prandin and when to take it? How do these instructions differ from the Sulfonyureas and Metformin?
Prandin given 30 minutes before breakfast. Dose is skipped if meal is skipped.
Sulfonyureas and Metformin are to be taken w/ breakfast to minimize mause or diarrhea
What instructions should the nurse give patients about how to inject insulin and rotate injection sites?
draw clear insulin 1st
give insuling SubQ
rotate sites w/in same location for 1 week before moving to new site.
Inj s/b 1/2" to 1" away from previous injection
What laboratory value should be obtained before beginning and during treatment with glitazones?
ALT liver function test for hepatic toxicity. Baseline and Q2Months for 1 year then periodically.
What is the mechanism of action of thyroid agents?
change metabolic rate, stimulate CV system, increase O2 consumption, body temp, blood volume, growth, & cellular growth
What should patients be told about how long they will need to take thyroid medications?
Taken for life unless stopped for radioactive isotope studies or MD order
What are CV signs and symptoms of overdose in patients taking thyroid agents?
dysrhythmia, tachycardia, palpitations, angina, HTN, cardiac arrest
What is a natural thyroid medication?
derived from cattle or hogs.
When should patients take their thyroid medication? (Hint: p. 511)
given at same time each day. best given in QAM to decrease liklihood of insomnia.
What are 2 anti-thyroid agents and their mechanism of action?
Methimazole and Propylthiouracil
MOA: inhibit incorporation of iodine into tyrosine, which is required to make thyroid hormone. Propyl inhibits conversion of thyroid precursors into thyriod hormone
What are 2 of the most damaging adverse effects of anti-thyroid medications?
Liver and bone marrow toxicity
What are geriatric considerations in patients taking anti-thyroid medications?
>40 risk agranulocytosis.
don't eat foods high in iodine.
agranolocytosis can occur if taken w/ bone marrow depressnts
What therapeutic changes should parents expect to see in children taking anti-thyroid medications?
decreased pulse, return to normal B/P, decreased serum levels of T4 contraceptives
What is the mechanism of action of the ECPs?
inhibits ovulation, disrupts corpus luteum, decreases function of endometrial hormones.
When should ECPs be taken?
Within 72 hours of unprotected sex. afterwards, effectiveness declines to <85%
A 25 year old female is prescribed an oral contraceptive. What drugs reduce the effectiveness of oral contraceptives (OCs)?
anticonvulsants, beta-blockers, guanethidine, hypnotics, hypoglycemic agents, oral anticoagulants, theophylline, TCAs, Vitamins
What are contraindications in the use of oral contraceptive agents?
known drug allergies, pregnancy, Hx of thromboembolic events such as MI, venous thrombosis, PE, or stroke
What is Depo-Provera
Progestin injectable contraceptive give IM Q3 monthts
What is a transdermal contraceptive
fixed combo of estrogen and progestin. Applied weekly 3 weeks per month
What is the intravaginal contraceptive?
fixed combo of estrogen & progestin in ring. Insertied into vagina, kept in place 3 wks then removed for 1 week. new ring inserted after 1 week off for menses.