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92 Cards in this Set
- Front
- Back
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How should insulin be stored?
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keep extra supply in the fridge. never freeze it. keep unrefrigerated insulin as cool as possible (below 86 degrees farenheit) & keep away from heat & light.
never shake your insulin or let it get tossed around. insulin that gets handled roughly is more likely to clump or frost. |
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how should sharps be disposed of at home?
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place needles, syringes, lancets, & other sharp objects in a hard-plastic or metal container w/ a screw-on or tightly secured lid.
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tips for going home on insulin
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-date bottle when opened-usually good for 28 days
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insulin pump
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small, externally worn device that closely mimic the functioning of a normal pancreas
-the pt inserts the needle or catheter into subcutaenous tissue & secures it w/ tape or transparent dressing -insulin is delivered at a basal rate -when a meal is consumed, the pt calculates a dose of insulin to metabolize the meal -most common risk of insulin pump therapy is ketoacidosis |
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oral agents for diabetes
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may be effective for stable type 2 w/ no ketones who cannot be treated by diet alone
-they are used w/ meal planning & exercise -if client does not respond to oral agents then insulin may be used |
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oral agents may be temporarily stopped & insulin started in these situations:
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1. infections
2. trauma 3. major surgery, hospitalizations *appropriate only for those who secrete their own insulin *not used by type 1 |
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How do sulfonylureas work?
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they stimulate the release of insulin from the pancreas
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what is the difference b/w 1st & 2nd generation sulfonylureas?
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2nd gen has less side effects, lower risk of drug interaction, higher potency
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name some 1st gen sulfonylureas
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they are not common.
acetohexamide chlorpropamide tolazamide tolbutamide |
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name some 2nd gen sulfonylureas
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glimepiride
glipizide glyburide |
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what are the side effects of sulfonylureas?
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*hypoglycemia is the most common side effect (bring carb when exercising)
rash, pruritis, heightened sun sensitivity heartburn, loss of appetite, N/V antabuse like reaction when taken w/ alcohol-most common w/ chlorpropamide |
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when should sulfonylureas be administered?
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30 mins before meals
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how do meglitinides work?
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stimulate release of insulin from the pancreas
**shorter action time than sulfonylureas rapid & short-lived different binding site from sulfonylureas used w/ type 2 w/ diet & exercise |
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name some meglitinides
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repaglinide (Prandin)
nateglinide (Starlix) |
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when should meglitinides be administered?
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w/i 15 mins of a meal
*only administer if the meal is eaten |
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what is a side effect of meglitinides?
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hypoglycemia
precaution: pregnant, breast-feeding |
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what is the action of biguanides?
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reduce hepatic glucose production (gluconeogenesis) & increase cellular uptake
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name some biguanides
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metformin (Glucophage)
metformin & glyburide (Glucovance) metformin & Januvia (Januvamet) Riomet-liquid metformin *only agent in liquid form |
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how are biguanides used?
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may be used alone or w/ sulfonylureas for type 2 w/ diet & exercise
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what are some side effects of biguanides?
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serious side effects are rare if liver & kidneys are functioning normally
*serious side effect lactic acidosis-a serious & potentially fatal metabolic complication due to excess drug accumulation liver & kidney function tests are recommended before starting the drug & every 6-12 months thereafter *should be stopped immediately when client is at risk for lactic accumulation from dehydration, stroke, severe infection, surgery, x ray studies that use contrast dye, excessive use of alcohol, or kidney/liver problems **most common side effects: GI symptoms; diarrhea, N/V, bloating, flatulence, anorexia, metallic tyaste *hypoglycemia is not a problem when used alone but it may be used w/ a sulfonylurea, excessive ETOH, elderly, or malnourished |
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why should contrast dye not be used in biguanides?
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x ray studies that use contrast dye
contrast media used in pyelograms & angiograms may increase the risk of renal dysfunction & should be discontinued 48 hours before test caution clients to report symptoms that may be associated: fatigue, general weakness, difficulty breathing, stomach discomfort, dizziness, bradycardia or irregular heartbeat |
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when should biguanides be administered?
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w/ meals to decrease stomach upset
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what is the action of alpha glucosidase inhibitors ("starch blockers")?
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slows carb digestion & glucose absorption
carbohydrase inhibitor, blocks carbohydrase, which is the body's digestive enzyme that breaks down carbs. by slowing down the body's absorption of carbs, it prevents surges in blood sugar |
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name some alpha glucosidase inhibitors
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acarbose (Precose)
miglitol (Glyset) |
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side effects of alpha glucosidase inhibitors
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GI symptoms-diarrhea, flatulence, abdominal discomfort
often called the gas pill by clients hypoglycemia when used w/ sulfonylurea increased liver enzymes be careful w/ IBS |
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precautions for alpha glucosidase inhibitors
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administer w/ 1st bite of meal
hypoglycemia: need to use oral glucose tablets or milk cane sugar. sucrose will not help b/c acarbose & miglitol may delay digestion & absorption slowing its effect on BG. |
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what is the action of thiazolidinediones (insulin sensitizers)?
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decrease insulin resistance at the cellular level by increasing the uptake of glucose by skeletal muscles & decreasing production of glucose by liver. overall it increases the effectiveness of circulation insulin. it does not stimulate insulin secretino
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when are thiazolidinediones (insulin sensitizers) used?
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for type 2 diabetic currently on insulin whose hyperglycemia is inadequately controlled (HbA1C >8.5%) despite insulin therapy of over 30 units per day given as multiple injections
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name some thiazolidinediones (insulin sensitizers)
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rosiglitazone (Avandia)
pioglitazone (Actose) |
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what are side effects & precautions of thiazolidinediones (insulin sensitizers)?
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does not cause hypoglycemia
liver damage liver enzyme levels should be measured at start of therapy, every month for the 1st 8 months of therapy, every other month for the next 6 months & then periodically after per FDA use carefully w/ class #3+4 cardiac clients actos may reduce the action of oral contraceptives |
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incretin mimetics action
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improve glycemic control in type 2 diabetics by reducing fasting & post-prandial glucose concentrations. it does this by:
1. stimulating glucose dependent insulin secretion 2. restoring 1st phase insulin response 3. lower serum glucagons concentrations during periods of hyperglycemia 4. slowing gastric emptying 5. reducing food intake |
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name an incretin mimetic
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exenatide (Byetta)
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indications for incretin mimetic
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type 2 diabetes as adjunct to Metformin &/or sulfonylurea in clients w/o adequate glycemic control
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how is exenatide administered?
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SC injection into thigh, abdomen, or upper arm w/i 60 mins before AM & PM meals
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precautions for exenatide
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exenatide (Byetta) is not a substitute for insulin in insulin-requiring clients. it should not be used in clients w/ type 1 or ketoacidosis
clients receiving exenatide in combination w/ a sulfonylurea may have an increased risk of hypoglycemia treatment w/ exenatide may result in decreased appetite, food intake, body weight, nausea particularly at start of therapy |
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what is the action of DDP-4 (dipeptidyl petidase 4) inhibitors?
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slows inactivation of incretin hormones
enhances the incretin system stimulates release of insulin B cells & decreases hepatic glucose production adjunct to diet & exercise to improve glycemic control in type 2 may be used alone or w/ metformin or TZDs |
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name some DDP-4 inhibitors
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sitagliptin (Januvia)
saxagliptin (Onglyza) |
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side effects of DDP-4 inhibitors
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headache
URI-sore throat diarrhea |
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administration of DDP4 inhibitors
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oral once a day
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symlin
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see packet near back
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action of glucagon
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hormone produced in pancreas
raises BG by causing breakdown of glucose stored in the liver as glycogen |
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uses for glucagon
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treat severe hypoglycemia in a client who cannot be treated w/ oral glucose due to drowsiness, confusion, unconscious seizures
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route for glucagon
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IM or subq
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dose for glucagon
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1mg; may repeat in 20 mins
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what is an opioid?
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class of controlled pain management medications that contain natural or synthetic chemicals based on morphine, the active component of opium
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what is a narcotic?
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any drug capable of causing physical dependence
all opioids are narcotics not all narcotics are opioids |
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classification of controlled substances
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schedule I: high potential for abuse, least medical use
schedule II-IV: decrease in abuse potential schedule V: lowest potential for abuse in relation to schedule IV, use in medicine |
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how do opioid analgesics work?
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decrease pain by stimulating opioid receptors in the CNS
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name the primary opioid receptors
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M (mu)
K (kappa) Delta |
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effects of Mu receptor stimulation
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analgesia, euphoria, sedation, respiratory depression
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effects of kappa receptor stimulation
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analgesia, sedation, decreased GI motility
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effects of delta receptor stimulation
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endogenous-mimic endorphins
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primary effects of opioids
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analgesia
drowsiness change in mood euphoria |
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indications for use of opioids
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analgesia (moderate-severe pain)
depression of cough center (morphine, codeine) decrease cardiac workload (peripheral vasodilation--morphine) antidiarrheal (romodal) reduce anxiety |
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classifications of opioid analgesics
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agonist
agonist-antagonist (partial agonist) antagonist |
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agonist opioid analgesics
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binds w/ receptors to activate & produce maximal response to individual receptor
morphine, fentanyl, meperidine, methadone, hydromorhpone, oxymorphone |
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agonist-antagonist (partial agonist) opioid analgesics
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produces mixed effects; acts as agonist at 1 type of receptor & competitive agonist at the other
binds w/ receptor to produce partial response codeine, oxycodone, hydrocodone, propoxyphene, nubain, talwin, stadol |
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antagonist opioid analgesics
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blocks the opioid receptor
inhibits pharmacological activity of the agonist (opioid analgesic) precipate withdrawal in dependent patients naloxone HCl (Narcan) naltrezone HCl (ReVia & Trexan) |
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sources of opioid analgesics
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1. purified alkaloids of opium (morphine, codeine)
2. semi-synthetic modifications of morphine or codeine 3. synthetic compounds that resemble morphine (demerol, methodone) |
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morphine
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analgesic standard for potency & side effects/adverse reactions
all new analgesics are compared to morphine oral doses must be large as morphine passes through the liver before it is systemically distributed (loses potency in 1st pass) |
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methadone
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utilized for detox & maintenance of heroin & other opioid addictions
suboxone-similar, sublingual it acts to decrease the intensity of withdrawal symptoms |
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adjuvant medications
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antihistamines (sedation & potentiate analgesia)
antidepressants (reduce pan perception, induce sleep, treat depression) anxiolytics (reduce anxiety, induce sleep, provide amnesia) antipsychotics (reduce pain perception, induce sleep, counter delirium) anticonvulsants (stabilize neuronal membranes, analgesia) |
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noninvasive pain relief measures
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positioning
pressure heat/cold massage distraction diversional activity music therapy |
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most common side effects of opioid analgesics
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resp depression
N/V drowsiness dry mouth miosis (pupil constriction) orthostatic hypotension diaphoresis pruritis urinary retention constipation |
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other side effects of opioid analgesics
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confusion
hallucinations/delirium hives hypothermia bradycardia tachycardia flushing |
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adverse reactions of opioid analgesics
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seizures
tinnitus (Tylenol) jaundice facial edema |
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define dependence
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response to ongoing exposure that can produce a withdrawal syndrome
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define tolerance
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chronic exposure to a variety of drugs characterized by the need to increase opioid doses to main same degree of analgesia
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define addiction
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syndrome characterized by compulsive drug seeking behavior desire for drug is to produce euphoria not relief
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antianginals
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are vasodilators-given to pts w/ CAD to decrease HR, BP, relieve CP or prevent CP
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what is the primary effect of vasodilators (antianginals) used in the treatment of angina?
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1. dilate CA (increase blood flow, O2)
2. reduction of preload & reduction of afterload (reduce workload of heart, reduce O2 requirement of myocardium) |
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what are the 3 types of meds used to treat angina?
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nitrates
CCBs (calcium channel blockers) BBs (beta blockers) |
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Nitroglycerin
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nitroglycerin has been used to treat angina for a long time. it is fast acting, effective, inexpensive, drug of choice to treat acute angina attacks. prevents/delays worst possible outcome (MI)
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how do CCBs work?
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inhibit transport of calcium into myocardial cells-inhibit excitation & contraction; causes systemic vasodilation; reduces afterload
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name some CCBs used to treat angina
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verapamil
amlodipine diltiazem nicardipine nifedipine verapamil, diltiazem & nifedipine are most frequently used |
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what do verapamil, diltiazem, & nifedipine do?
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block calcium channels which dilate CA. also dilate peripheral arteries, decreasing PVR, increasing blood flow to the tissues & ischemic myocardium
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what do diltiazem & verapamil also do?
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block calcium channels in the heart, decreasing HR, AV conduction & contractility. used to treat arrhythmias
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what are some adverse effects of verapamil (Calan)?
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arrhythmias & heart failure
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what does nifedipine (Procardia) do?
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decreases spasms of the CA secondary to prinzmetals angina
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side effects of amlodipine (Norvasc)
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HA, dizzyness, fatigue, peripheral edema, call doctor
bradycardia, hypotension |
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adverse effects of diltiazem (Cardizem)
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peripheral edema-call doctor
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How do beta blockers work?
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block the SNS beta-adrenergic effects (increased HR, BP)
therapeutic effects: decreased BP, HR adverse effects: bradycardia, hypotension |
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beta blockers used for angina include:
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atenolol, metoprolol, nadolol, & propranolol
**atenolol—abrupt withdrawal may cause life threatening arrhythmias, HTN, MI, death |
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How are beta blockers used to treat angina?
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Reduce the myocardial O2 demand by decreasing HR & BP; decreasing workload of the heart. Decreased HR may also increase the CA filling time (during diastole)
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nursing implications for BB & CCBs
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1.) If no written parameters-hold for SBP<100, HR<60
2.) No sudden withdrawal-esp atenolol 3.) Avoid nonselective BB w/ bronchoconstrictive disease (Nadolol) 4.) Use of oral antidiabetic agents & insulin: metropolol (Lopressor) may mask hypoglycemic tachycardia 5.) May exacerbate heart failure due to decreased CO 6.) No grapefruit juice w/ CCB: decreases metabolism of CCB 7.) Constipation w/ CCB: stool softeners 8.) Do not double dose |
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action of nitrates
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Used for rapid & long term treatment of angina
Dilate smooth muscle cells of arteries & veins |
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forms of nitroglycerin available
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Nitroglycerin is available as IV, lingual aerosol, PO, buccal, transdermal, & topical paste
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nitro-stat
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Nitro-stat SL, .15-.6mg (gr 1/400m gr 1/200m gr 1/150, gr 1/100) usually administed 5 min apart x3 doses. Effects are rapid & last up to 1 hr
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nitro dur/nitro disc
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Nitro-dur, Nitro-disc: transderm nitro. Slowly released. Effects begin 30-60 mins & persist as long as the patch is in place. Place at same time q day.
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side effects of nitrates
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orthostatic hypotension, flushing, dizziness, weakness, headache, rash w/ topical/transderm
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contraindications of nitrates
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severe anemia, close-angle glaucoma, hypotension, severe head injury, & use w/ erectile dysfunction drugs
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patient education regarding nitrates
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eplace SL tablets q 6 months
Place transderm patch same time q day Call 911 after 1 tablet w/o relief from CP Use w/ CCB, BB & ETOH, erectile dysfunction drugs: increases vasodilation—syncope |
