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190 Cards in this Set
- Front
- Back
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3 types of Lipids
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Triglycerides
Cholesterol Lipoproteins |
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Tricglycerides
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Comprise 90% of the lipids in the body (energy)
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Cholesterol
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Produced by the liver
Dietary sources=animal products |
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Lipoprotiens
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proteins +lipid compounds
consist of HDL's and LDL's |
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HDL
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"Good" cholesterol...transports cholesterol from tissues to liver
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LDL
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"bad" cholesterol...transports cholesterol from liver to tissues
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Antihyperlipidemics
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treating hyperlipidemics
Lipid lowering agents |
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Classes of antihyperlipidemics
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HMG-CoA
Bile Acid Sequestrants Nicotinic Acid |
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HMG CoA
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Statins ( most used)
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Bile Acid Sequestrants
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Resins
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Nicotinic Acid
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Niacin/ Vitamin B3
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Statins
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Lipitor
inhibits choloesterol productionin the liver by interfering with the enzyme used to synthesize cholesterol |
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COntraindications of statins
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Pregnancy x
breast feedings active liver diseas |
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Adverse side effects of statins
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GI: cramps, constipation, diarreaha, flatus , HB, elevated liver enzymes,
MS: myopathies, rhambdomyloysis |
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rhambdomyloysis
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break down of skeletal muscle tissue
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nursing implications with statins
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assess for: muscle weakness/pain, etoh, abuse and liver d/s monitor LFT's triglceride, LDL adn HDL
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Bile acid resins
(Welchol, Questran, Colestid) what is the MOA |
binds to bile acidsm the complex is too large to be absorbed by the intestine and so cholesterol is excreted in the feces
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Contraindications of Bile acid resins
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Bowel obstructions
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1st line...Better Reductase Inhibitor
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Statins
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grapefruit juice
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increases the absorption and can cause toxicities in Statins..Large amounts
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Indications of Resins
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hypercholesterolemia
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Indications of Statins
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decrease blood lipid levels when lifestyle changes fail
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Indications of Nicotnic acids
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for pts that cannot tolerate statins
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indications of fibric acid derivatives
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Lowers triglycerides
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indications of cholesterol absorption inhibitor
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decreases LDL and total cholesterol levels, increases HDL
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example of cholesterol inhibitor
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Zetia
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example of fibric acid derivatives
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Lobid and tricor
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contraindications of Nicotnic acid
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Diabetes
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Side effects of Nictonic acid/ niacin/ vitamin B3
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N/D increase in blood sugar and increase in uric acid
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Side effects with Fibric Acid derivititves
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N/V/D, abdominal pain
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side effects of Cholesterol absorption inhibitor (Zetia)
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Gallstones, increase liver enzymes, nausea
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Patient teaching for Resins
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take before meals, increase fluids and fiber to prevent constipation, take a multivitamin
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Patient teaching for Fibric acid derivitives
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RUQ pain, change in stool color, muscle cramping
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MOA for cholesterol absorption inhibitors (Zetia)
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prevents the small intestine from absorbing cholesterol
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Contraindications of cholesterol absorption inhibitors ( Zetia)
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Acute Liver disease, hypersensitivity
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Resins have no_______
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Systemic side efffects
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Side effects to Nicotinic acids (Niacin)
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Pruritis (itching) and Flushing
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Nurse implications with Niacin
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take aspirin 30 minutes before med. and take with cold water ( will help with flushing)
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test to run while on Niacin
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LFT and uric acid levels...uric acid levels tested because of gout
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platelets + fibrin =
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blood clots (thrombus)
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anticoagulants
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medications that interfere with the clotting cascade to prevent clot formation (blood clotting time is prolonged) anticoagulants do not get rid of blood clots
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Indications of anticoagulants
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prevention of post op DVT and PE
Prevention of thrombus associiated with a-fib and heart valve replacement |
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DVT
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Deep Vein Thrombosis
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what is DVT?
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a clot that forms deep in the vein
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Anticoagulant drugs
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Coumadin
Heparin Low Molecular Weight heparin (LMWH) |
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effects of anticoagulants
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prevent venous thrombi formation or prevent existing thrombi from enlarging
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PE
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Pulmonary Embolism
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MOA of Coumadin
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inhibits the synthesis of Vitamin K (depending clotting factors in the liver)
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coumadin has the half life of ___
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1-3 days
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Coumadin has the Onset of____
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2-3 days...therapuetic affect....pt needs to be on it 2-3 days before it starts working
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ROute of COumadin
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Oral
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Lab tests with Coumadin
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INR and or PT
Therapeutic INR: 2.0-3.5 Therapeutic PT: 1.5-2x's baseline PT |
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Antagonist of Coumadin
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Vitamin K
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PT =
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Prothrombin Time
12-15 seconds |
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Contraindications of Coumadin
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uncntrolled bleeding, recent surgery, bleeding disorders, sever HTN, Vitamin K deficiencies
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Adverse/Side Effects with coumadin
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bleeding, and do not take with antibiotics
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Nursing implications with coumadin
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do not start or stop any medications w/o contacting MD
Avoid etoh get lab work as directed consume consistent amounts of Vitamin K ( milk, yogurt, asparagus and brocoli) |
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Interactions with coumadin
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Many!!!! ( drugs, etoh, herbals)
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MOA of Heparin
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at low doses prevents conversion of prothrombin to thrombin and at high doses prevents conversion of fibrinogen to fibrin
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Route of Heparin
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Subcut and IV...acts immediately
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Lab tests with Heparin
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aPTT, LFT
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aPTT
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activated partial prothrombin time....25-40 seconds
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Therapeutic level for heparin
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1.5-2x's the baseline aPTT
baseline is 25-40 secs |
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contraindications of heparin
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uncontrolled bleeding
severe thrombocytopenia concurrent administration of LMWH |
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thrombocytopenia
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disorder where there are not alot of platelets
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Adverse/Side effects of heparin
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bleeding, HIT (heparin induced thrombocytopenia)
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Heparin incuded thrombocytopenia
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an immune response that destroys platelets
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Antagonist for Heparin
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protamine sulfate
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nursing implications with heparin
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administer low dose ...used to maintain IV patency
Subcut injection Continuous IV infusions ( heparin can not be given IM....risk of bleeding) |
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Labs for heparin
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aPTT (25-40 secs)
Monitor platelets for HIT therapeutic level (1.5-2.5 x's baseline aPTT) |
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LMWH
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Low Moleclar Weigh Heparin
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example drug of LMWH
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Lovenox
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MOA of LMWH
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same as heparin
Indications: goven to post op pts at risk for DVT and PE |
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Contraindications of LMWH
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concurrent administration of heparin
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advantages of LMWH
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less incidence of bleeding and low platelets
more stable response than heparin safe for pregnant women |
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Route of LMWH
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subcut injection
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adverse/side effect of LMWH
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bleeding
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Nursing Implications of LMWH
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Adminiter same time every day
assess for bleeding monitor lab work apply pressure to venipucture site |
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lab work for heparin
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CBC
INR aPTT PT |
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Patient teaching with warfarin and heparin
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avoid otc nsaids and aspirin
avoid risk of injury may need to stop taking medcation before dental work take meds at same time evey day Report S/S of bleeding |
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Classes of antiplatelets
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ASA
ADP receptor blockers |
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Indications of ASA
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decrease for MI and CVA
reduces rate and complications in pts with S/S of MI |
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Indications of ADP receptor blockers
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prevents platelet aggregation by altering the cell membrane of platelets
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***MOA of ASA***
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prevent platelet aggregation, DO NOT DECREASE NUMBER OF PLATELETS!!!!!!
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Antiplatelets are effective in the _______where_____ have little effect
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arterial circulation
anticoagulants |
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Adverse/Side Effects of ASA
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GI distress
Bleeding and ulcers |
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Contraindications of ASA
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Hypersensitivity
Breastfeeding Bleeding Disorders Recent Surgery |
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Contraindications of ADP receptor blockers
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Bleeding
Neutropenia |
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Adverse/Side Effects of ADP receptor blockers
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bruising
nosebleeds increased menstrual flow coffee ground emesis black tarry stool] dizziness fatigue increased HR decreased BP back pains and HS |
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Example of ADP receptor blocker
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Plavix
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Patient teaching with Plavix
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Stop taking before invasive procedure
avoid taking ASA and NSAIDS(GI bleeding happens) |
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Labs for Plavix (ADP receptor blocker)
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CBC
Monitor for bleeding |
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Cautions with ADP receptor blockers (plavix)
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history of PUD and etoh abuse
concurrent use with NSAIDS, heparin and coumadin (increased risk of bleeding) TTP |
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TTP
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thrombotic thrombocytopenia purpura (decreases WBC's)
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The body systems involved in regulation of glucose are?
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liver
pancreas skeletal muscle tissue |
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Glucose
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one of the primary sources of energy in the body
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pancreas gland
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minute to minute control of glucose is the function of
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We have a ____amount of ____ in our ___ ____ for quick energy and the rest is stored mainly in the _____and ______.
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small
glucose blood stream liver glycogen |
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The excess glucose we dont need is stored in ______
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the skeletal muscle and also in the body as fat
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Pacreas secretes 2 hormones...
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Glucogen
Insulin |
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Glucagon
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(alpha cells) helps increase the glucose levels.
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Insulin
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(beta cells) responds to high or low blood glucose
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Antagonist to Insulin
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Glucagon
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Glucagon
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antagonist to INsulin that have actions opposite to insulin. It is released when blood glucose levels fall.
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Primary function of Glucagon
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to mainitain the blood glucose level between meals by stimulating the liver to break down glycogen.
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Hyperglycemia
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too much glucose glucose
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glucagon has a _____ _____because the presence of blood glucose to rise.
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hyperglycemic effect
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Diabetes Mellitus
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is the result of either deficient insulin secretion by beta cells on the pancreas or decreased sensitivity of receptors on target cells to the action of insulin.
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Chronic Hyperglycemia can result in damage to blood vessels, which can cause....
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Atherosclerosis(heart disease, CVA)
Retinopathy (Blindness) Neuropathy(nerve degeneration) Nephropathy(kidney disease) |
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High levels of ketoacids cause...
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fruity, acetone-like odor to the breath and can lwer the ph of the blood, causing diabetic ketoacidosis. DKA can lead to a coma and even death
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ketoacids
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waste products produced because glucose is ubable to enter cells, lipids are utilized as an energy source
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Symptoms of DM
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Polyuria
Polydipsia Polyphagia Unexplained weightloss Fatigue Hyperglycemia, fasting glucose >126 on 2 separate occasions Glycosuria |
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Polyuria
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pee a lot
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Polydipsia
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very thirsty
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Plyphagia
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hungry all the time
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Glycosuria
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Glucose in the urine
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normal range of blood sugar
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80-120
100-125 pre diabetes |
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Drugs that cause Hyperglycemia
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Epinephrine
thyroid Hormones Growth hormones Corticosteroids Thiazide diuretics Estrogen |
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Drugs that cause Hypoglycemia (low blood sugar)
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Beta Blockers/ACE inhibitors....they mass the signs and symptoms of hypoglycemia
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Type 1 Diabetes
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lack of insulin production or production of defective insulin
Affected patients need exogenous insulin *** ORAL ANTIDIABETIC DRUGS NOT EFFECTIVE**** |
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Type 2 Diabetes
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Most common type
Caused by insulin deficiency and insulin resistance. Controlled with oral drugs |
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Many tissues are resistant to insulin due to......
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Reduced # of insulin receptors
Insulin receptors less responsive |
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Complications include comorbidities which are collectively refferred to as...
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Metabolic Syndrome
Insulin-Resistance Syndrome Syndrome X |
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The right amount of insulin must be available to maintain a normal physiologic amount of glucose..
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ADMINISTERING INSULIN WHEN THERE IS INADEQUATE GLUCOSE IN THE BODY CAN RESULT IN HYPOGLYCEMIA AND EVEN COMA OR DEATH
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other adverse effects of insulin...
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Localized allergic reaction
generalized urticaria Swollen lymph glands *somogyi phenomenon |
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Somogyi Phenomenon
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a rapid decrease in blood glucose, usually during the night, which stimulates the release of hormones (epinepherine, cortisol, glucagon) that elevate blood glucose resulting in elevated a.m. BG.
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Insulin functions as a substitute for the ____ _____.
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endogenous hormone
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When insulin is given....it restores the diaabetic patients ability to...
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Metabolize CHO,PRO and lipids
Store glucose in the liver as GLYCOGEN Convert glycogen to fat stores |
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Routes of administration for insulin...
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SQ-most common
Insulin pump - SQ IV- ONLY REGULAR INSULIN CAN BE GIVEN IV, THOUGH IT CAN ALSO BE GIVEN SQ. |
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Insulin Pumps
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abdominally anchored
Programmed to release small SQ doses of insulin at predetermined intervals, with larger boluses administered manually at mealtime if necessary. |
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Regular insulin
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is fast acting and lasts a short time. Used before meals to control the post meal rise in blood sugar, and to lower blood sugar when an immediate correction is needed...can be given IV
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Semi-Lente Insulin
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has a short duration, but twice as long as Regualr insulin, used to control post meal rises in blood sugar and may be combined with Lente insulin
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NPH Insulin
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Humalin-N
Longer acting provides basal amount of insulin. Two injections a day are usually prescribed. --before breakfast --before bedtime |
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Lente Insulin
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similar to NPH
two injections a day are usually prescribed |
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Ultra Lente INsulin
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longest acting effect
has a shorter peak given before meals |
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Lispro Insulin ( Humalog)
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man made
a shorter duration of action than human regualr insulin. within 15 minutes of eating a meal and in combination with longer acting insulin. |
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70/30 Insulin
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70% NPH
30% regular insulin Two injections a day are usually recommended |
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storage tips for insulin
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insulin will keep for 1 month at room temp. if kept cooler than 86 degrees and out of direct sunlight
unopened bottles of insulin should be stored in a refrigerator BE SURE TO ROLL THE SYRINGES BEFORE USE TO MIX THE INSULIN |
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storage tips for insulin
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insulin will keep for 1 month at room temp. if kept cooler than 86 degrees and out of direct sunlight
unopened bottles of insulin should be stored in a refrigerator BE SURE TO ROLL THE SYRINGES BEFORE USE TO MIX THE INSULIN |
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*Humalog*
Type Onset Peak Duration |
Type- rapid
Onset: 5-18 minutes Peak: 30-75 minutes Duration: 2-3 hours |
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*Regular*
Type Onset Peak Duration |
Type: Short acting
Onset: 30 minutes Peak: 2-5 hours Duration: 5-8 hours |
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*NPH*
Type Onset Peak Duration |
Type: Intermediate
Onset: 1-3 hours Peak: 6-12 hours Duration: 16-24 hours |
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*Glargine Lantus*
Type Onset Peak Duration |
Type: Very Long Acting
Onset: 1 hour Peak: Evenly for 24 hours Duration: 24-28 hours |
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*30/70 Mix*
Type Onset Peak Duration |
Type: Premixed
Onset: 30-60 minutes Peak: 2-12 hours Duration: up to 18 hours |
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Hypoglycemic Effect
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Insulin causes glucose to leave the blood and serum glucose to fall
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INSULIN IS.....
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Always double checked with a 2nd Nurse!!!!!
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Oral Hypoglycemics for type 2 diabetes
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Sulfonylureas
Biguandines Meglitinides Thiazolidinediones Alpha-glucosidase inhibitors |
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Sulfonylureas
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example Glucatrol
1st available |
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Adverse effect with Sulfonylureas
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Hypoglycemia....caused by taking too much medicine and not eating enough food.
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Hypoglycemia is most likely to occur when ____reaches its peak effect, during____, or during an _____ ______,
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insulin
exercise acute illness |
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Hypoglycemia
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abnormally low BG level....below 50mg/dl
Mild cases can be treated with diet---increased intake of PRO and lower intake of CHO--to prevent a rebound postprandial hypoglycemia |
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Signs and Symptoms of Hypoglycemia
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Early signs
--Confusion --Irritability --Diaphoresis Late signs --Seizures --Coma --Death ***pale, cool, moist skin |
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Glucose-elevating Drugs
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Ex: Orange Juice
Oral forms of concentrated glucose are available in buccal tablets or semi solid gell caps. --50% Dextrose in H2O can be given IV --Glucagon IV, IM or SQ |
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Nursing considerations with Diabetes
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*WATCH POTASSIUM LEVELS*
Know the onset, peak and duration of action of teh insulin administered |
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Contraindications with Diabetes
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sensitivities
hypoglycemia |
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Drug interactions with diabetes
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Beta Blockers
*Always should wear a medic alert bracelet* |
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Side effects of sulfonylureas
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Weight gain
Hypersensititvity reactions to meds GI distress Hepatoxicity |
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Biguanides
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most common diabetic drug
Redused insulin resistance Does not promote insulin release from the pancreas Does not cause weightgain or hypoglycemia |
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Contraindications of Biguanides
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Hold this med if you are planning on having a test with iodine contrast up to a week. Will cause Kidney failure.
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MOA of Biguanides
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Acts by decreasing the hepatic production of glucose and reducing insulin resistance.
Does not promote insulin release from teh pancreas |
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Example of Biguanides..
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Metformin
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Alpha-glucoside Inhibitors
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Ex: Meglatol and Precose
Act by blocking enzymes in the small intestines responsible for breaking down complex CHO into monosaccharides |
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Side effects of Alpha-glucosidase inhibitors (precose and megatol)
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no hypoglycemia when used alone
Flatulence diarrhea abd. cramping |
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Thiazolidinediones
MOA |
reduce BG by decreasing resistance and inhibiting hepatic glucogenesis (breakdown of glycogens)
Ex: Actos, Avandia |
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Advers effects of Thiazolidinediones
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fluid retention
HA weight gain |
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Contraindications of thiazolidinediones
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clients with CHF or Pulmonary edema
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Thiazolidinediones take up to 3-4 months of therapy to reach optimal BG levels.
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no hypoglycemia and always monitor wit LFT
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Meglitnides
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newer class that act by stimulating the release of insulin from pancreatic islet cells in a manner similar to that of the sulfonylureas, with similar efficacy.
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example of Meglitinides
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Starlix and Prandin
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Side effects of Meglitinides
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well tolerated but may cause hypoglycemia
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Incretins
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hormones secreted by the intestine following a meal, when BG is elevated
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Newer Agents act by affecting the _____ -glucose control mechanism.
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incretin
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Incretins ____BG levels by signaling the _____ to increase insulin secretion and the _____to stop producing glucagon.
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Lower
pancreas liver |
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Byetta
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Injectable drug that mimics the effects of incretins by lowering BG by increasing the secretion of insulin, slowing the absorption of glucose, and redusing the action of glucagon.
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route of Byetta
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SQ often twice a day
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Side effects of Byetta
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nausea
vommitting diahhrea |
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Byetta is for what type diabetes?
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type 2
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Januvia
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DDP-4 inhibitor
type 2 diabetes med taken orally |
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januvia is classified as a ____inhibitor.
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DDP-4
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DDP-4 enzyme
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works normally to break down incretins- Januvia inhibits DDP-4, thereby reducing the destruction of incretins.
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Symlin
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Med for type 1 and type 2 diabetes
Injectable Resembles Human Amylin |
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Human Amylin
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hormone produced by the pancreas after meals that helps the body regulate blood glucose
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MOA of Symlin
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inhibits the action of glucagon
lowers BG and promotes weight loss |
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Hyperosmolar nonketotic coma
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In clients with Type 2 diabetes
Life threatening emergency! develops slowly and is caused by insufficient circulatind insulin Seen most often in older adults Flushed, dry warm skin. BG LEVELS MAY RISE >600 mg/dl, UP TO 2000mg/dl!!!! |
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Stevia
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natural sugar
sugar substitute |
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Nursing considerations with Type 2 diabetes
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careful assessment and monitoring.
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Monitor with Diabetes....
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*MONITOR*
--urinary keytones if BG >300 mg/dl --I & O, Liver functions |
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Patient education with Diabetes..
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Importance to keep BG WNL- monitor daily
Illness/Infection can affect med needs Use cautiously with hepatic or renal disease (can interfere with absorption and metabolism of oral hypoglycemics. caution in clients w/pituitary or adrenal disorders, as thier hormones affect BG. |
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contraindications of diabetes
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pregnancy and lactation
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HIT
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Heparin Induced Thrombocypenia......Immune respose to heparin that destroys platelets
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