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51 Cards in this Set

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Insulins
R - Humulin and Novolin O-30m-1h, peak- 2-4h, d-5-7h
NPH - Humulin and NovolinO-1-2 h, P- 8-12h, D-18-24h
Lispro- Humalog- O-15m, P-30-90 m, D - 5 h - less hypogl
Lantus - insulin glargine- sustained release - SQ at bed-never mix!
inhaled - O-15m, P-30-90m, D-4-6h
-----------------------------
increase: Ace inhibitors,alcohol,anaboli steroids,antidiabetic drugs,oral, beta blockers
decrease: adrenergics, corticosteroids, estrogens, glucagon, propranolol/Inderal thiazide diuretcs
Oral Hypoglycemics Agents

use with pts with Type 2 with some insulin - never on type 1
Biguanides-metformin/Glucophage works at cell level- Mala
Glitazones- rosiglitazone/Avandia - cell level - may cause CHF - liver dysfunctions -
Meglitinides- repaglinide/Prandin - excreted by kidney not liver
drug intera & not elderly pt
neuroendocrine Hormone- symlin/amylin - CNS requlates bld. glucose levels-do not mix in same syr
P1-2h, D3-5h
Thyroid Hormones

+O2, +heat prod, +CO, -Chol.,lose wgt
Thyroid & Parathyroid
Anterior & Posterior Pituitary
Gonadal
-----------------------------drugs that decrease the effect: antihypertensives, estrogens, propranolo (inderal) phenytoin, rifampin
Hypothyroidism

Hyperthyroidism
levothyroxine sodium/Synthroid-T4, life long, requlated based on TSH levels cause +BP, +Diarrhea, Tachycardia/palpitations, Exopthalmus
increase-capillary fragility
decrease CO, BP & HR
cardiac enlargement
CHF
anemia
-----------------------------
tachycardia, Increases CO,BV,systolic BP dysrythmias, CHF
antithyroid drugs- PTUs Iodine, propranolol/Inderal
anti-thyroid drugs
propylthiouracil (PTU) -inhibits thyroid hormones- takes 1 yr to decrease- assess for agranulocytosis (sore throat & fever)-can't fight infection
Iodine- inhibits release-accumulate in thyroid gland -
radioactive Iodine- destroys thyroid tissue-warn family members
propranolol/Inderol
Calcium Regulators
Hypocalcemia- treat with Vitamin D analogues
1.alters absorption of Ca from GI tract
2.alters renal excretion of Ca
3. reabsorbs bone
Chvosteks sign or Trousseaus sign- can cause osteoporosis, kidney stones
-----------------------------
increase effects: Vit.D, Thiazide diuretics
decrease eff: corticosterooids,
Acute Hypocalcemia
IV Calcium Gluconate - ER drug - when parathyroid glands removed
Hypercalcemia
calcitonin/Miacalcin- promotes buildup of calcium in bone- monitor serum ca levels-drink lots of fluids
Growth Hormone
anterior pituitary hormone
given IM -may cause allergic reaction-skin sensitivity test b4 admin
watch for severe hip or knee pain or for limp
Posterior Pituitary Hormone
ADH- Anti-Diuretic hormone'used in treatment of Diabetes Insipidus- watch for, hypertension/angina, pulmonary crackles, peripheral edema, increased specific gravity
drugs: Oxytocin/Pitocin - induces labor, stimulates uterine cont.
Vasopressin/Pitressin-& Desmopressin -diabetes insipidus
Androgenic & Anabolic Steriods
Sch. III
anab. used for muscle wasting
cause-liver-tumor & hepititus
Cns-aggression
acne, Na & fluid retention, cardiac disease, wgt gain
-----------------------------
do not use with calcitonin & barbiturates
Estrogens
Estrogen/Estace- produced by ovaries, long bone growth, treats prostate cancer, menopause
+ breast cancer, +bl.clotting
+hypertension, edema
Progestins
medroxyprogesterone/Provera
prod. by ovaries, bl.clot risk, -do not smoke, migraines, thrombosis-contraindicators
drug interaction do not use with Rifampin (TB), anticonvulsants, antibiotics
Caton-Exchange Resins
Sodium polystyrene/Kayexalate
decreases K+ levels in pts with hyperkalemia, Monitor K+ levels and Na levels
Ammonia Detoxicating Agents
lactulose (laxative)/Cephulac
caused by liver disease
lowers serum ammonia levels with pts with hepatic encephalopathy & to treat constipation
Cardio Drugs
Inotropic-Contraclitity
Chronotropic-Automaticity
Dromotropic-Conductivity
Exitability-Readiness to respond
Low CO
releases renin from Kidneys, which release angiotension 1 & 2 which cause vasodilation and aldosterone secretion which increase P. resistence and water retention which cause high BP & angina
Glycosides
Lanoxin/digoxin - increase contractions (inotropic), decrease HR (chronotropic), decrease conductivity (dromotropic)so +CO, -renin release, +NA excretion, + urine - BV, -Preload,-workload,-angina,-arrythmia
toxcity- anorexia, NVD, Visual distur, bradycardia (low HR
anti-dig med
Digibind- reverses the affects of Dig, but levels remain high,
------------------------------increase eff. Adrenergic drugs, antidysrhythmics, calcium preparations, ca channel blockers
decrease: antacids, cholestyramine, laxatives, oral aminoglycosides
Antiarrythmics
Sodium channel blockers - 1A Quinidine Sulfate - decrease all 4 ...tropics -does not sustain survival - given sustained release-
work by decreasing the O2 need of the heart which decreases the workload and/or increasing the O2 supply to the heart which stops angina and arrythmia
Antiarrythmic con't
Lidocaine 1B- ER med, IV push, decreases automaticity in the ventricles, stops arrythimia - S&S - paresthesias, light head., visual and hearing distur. confusion,
do not give if: allergy to local anesthestics, or heartblock
Antiarrythimic con't 2
class II- Beta Adrenergic Blockers (or BB or beta adrenergic antagonists or beta antagonists) stop arrythimia - gives negative: chronotro.,inotro., dromot., decreases renin response (beta 1) decreases glucose release (beta 2)
Antiarrythimic con't 3
Cardioselective Beta Blockers - only work on beta 1 receptors (cardiac cells) it does not cause bronchoconstriction (no wheezing)
non-selective BB- cause, bradycardia, hypoten. bronchconstriction (will have wheezing) hypoglycemia, impotence- do not stop abruptly causes rebound.
hold if BO <90, or HR <60,do not give to asthmatics
Antiarrythimics con't 4
class IV calcium channel blockers - verapamil/Isoptin
dilates perip.& coronary art. -decrease workload and increase O2 to heart to stop arrythimias, assess for hypotension, bradycardia (low HR) pedal edema and flushing
-----------------------------
for all antiarrythemia
drugs that increase: other antiarrythemic/antidysrhythimic drugs, antihypertensives, diurecitcs,
Antianginals
not enough oxygen to heart
Nitrates
Beta Blockers
Calcium Channel Blockers- work by decreasing workload and increase O2 or both
-----------------------------
drug that increase: antiarrythmics, antihypertensive, diuretics, digoxin
decrease: adrenergic drugs(epinephrine), calcium salts, rifampin
Antianginal- Nitrate
Nitroglycerin - dilates periph.vessels, causes decreaded preload and afterload-dilates healthy cardiac arteries, can give many ways- most sublingual- replace tabs ev.3mths, keep cool and dark, expect stinging under tongue, max-3 tabs ev 5 min,
side eff. hypotension, headache, flushing
cause vasodilation
Antianginal - Beta Blockers and Ca channel blockers
lower HR, workload, contractivity, oxygen demand, stops angina-
Ca channel bl. work same way but also cause coronary vasodilation
Antihypertensives, blood pressure regulation
A ce Inhibitors
B eta Blockers
C a channel blockers
D iuretics
-----------------------------increase eff: other antihypertensives, alcohol, digoxin
decrease: adrenergics, antacids, oral contraceptives
BP reg.
Ace -Angiotensin Converting Enzyme Inhibitors - use for hypertension, heart failure, decreae renal impairment in diabetic pts
side eff: persistent cough, hyperkalemia in pts with renal dysfunction- do not use with lithium,
ARBs Angiotension II receptor antagonist, block angiotenstion II at receptor sites, does not cause cough and rarely causes hyperkalemia
Antihypertensives, BP regs con't
Beta Blokers - propranolol/Inderal- decreases BP by decreasing HR and contractility(volume)
Antihypertensives/BP regs con't 2
Ca channel blockers - Procardia/nifedipine -decreases BP by dilating peripheral vessels
1. Alpha 1 blocker- prazosin/Minipress- cause dilation of bl. vessels, decrease perph.resistance, 1st dose often causes orthostatic hypotension
2. Alpha 2 blockers- clonidine/Catapres- stilmulates alpha 2 receptors in brain, peripheral bl.vess.dilation, decreases HR and BP
Antihypertensives/BP regs
con't 3
Diurectics: decrease BP by decreasing blood volume
Antihyp/BP regs/Diurectics
Thiazides- Diuril/chlorothiazide
Loop Diurectics-Lasix/furosemide
Aldosterone Antagonist
Osmotic Diuretics-Mannitol
-----------------------------
drugs not to be used with:
increase: antihypertensive agents
decrease: oral contraceptives, vasopressors (epinephrine,norep.)
Antihyp/BP regs/Diurectics
con't
Thiazides- Diuril/chlorothiazide- & Loop- Lasix/furosemide (more powerful of the two) inhibits Na reab. increases K+ excretion
side effect- hypokalcemia, hyponatremia, intravascular volume depletion resulting in hypotension
contraindicators: oliguria (no urine), hypokalemia, hyponatremia
Antihyp/BP regs/Diurectics
con't 2
Aldosterone Antagonist- K+ sparing - increases excretion of Na without excreting K+, blocks hypokalemia when used with other diuretics-its major use
Antihyp/BP regs/Diurectics
con't3
Osmotic diuretic- Mannitol
increases osmolatily of plasma and renal tubular fluids, use in ICP, & oliguria, IV only,
Antihyp/BP regs/Diurectics
con't 4
nursing intervention:
I&O
monitor labs-K+ & Na
assess for S&S of Hypo/hyperkalemia and hyponatremia
assess BP
Antilipemics- statins
used to treat elevated serum lipid levels
Antilipemics- statins
HMG-COA Reductase Inhibitors
Cholesterol Synthesis Inhibitors- Mevacor/lovastatin
block enxyme required for hepatic synthesis of cholesterol - reduces LDL chol, after 4-6 wks therapy
side eff: NCD (cramp), hepatotoxicity and muscle destruction, monitor liver function studies
Antilipemics - not statin
Bile Sequestering agents- cholestyramine/Questran- -binds with bile acids in the intestines and exc. in feces - reduces LDL, often used with statins
side eff- bloating, flatulence, constipation, drug interactions
Antilipemics - not statin
Fibrates- gemfibrozil/Lopid- decreases triglycerides,
side eff: GI discomfort, diarrhea, gallstones
Antilipemics - not statin
Niacin- B vitamin- decrease chol. and trigly. only high doses so causes flushing, pruritus and gastric irritation, most eff. when used with another antilipemic
Hematology agents
Iron preps. used to treat iron deficiency anemia, oral admin except with pts with ulcers or intestinal problems, give by straw, causes dark stools and consti. IM inject admin via Z-tract to stop discoloration of skin, if given by Z-tract can give to pts with stomach problems
Hematology agents- con't
Vitamin B12- IM injection- treats pernicious anemia, monthly for life of pts who had gastrectomy b/c they no longer have the intrinsic factor to absorb B12-
Hematology agents con't 2
Anticoagulants - Heparin- parenteral- prevents thrombosis form or enlargement and embolization
for ER- IV or SQ, use pump for IV, Abdomen site for SQ
contraindication: PUD, bowel dis. server hypertension, and bleeding
side eff: bleeding, thromobocytopenia (hits)
Antidote: Protamine Sulfate
short half-life
monitor Ptt
Hematology agents - con't 3
Lovenox/enoxaparin- cousin to heparin- prevent thrombosis in knee and hip surgery- and other conditions that make pt at risk for thrombosis
labs not requ. does not bleed
given SQ
onset longer than heparin
do not use with parenteral anticoagulants
Hematology agents - con't 4
Coumadin/warfarin- by PO - used long-term to prevent thrombosis formation- atrial fib, thromboembolic disorders, prosthetic heart valves-
onset 2-7 days so can give with heparin
acts as K+ antagonist, stops clotting factors
major side eff: bleeding
proteinbound- drug reactions
monitor PT and/or INR data
PT 1.5x control, INR 2-3 x control
antidote: vit K or fresh frozen plasma
nursing imp: any thing that is traumatic and will cause bleeding-also green leafy vegs
Hematology agents- antiplatelite agents
aspirin- prevents thrombosis formation, blocks enzyme in platelets which causes platelet aggregation,
side eff: bleeding PUD
dosage 81 mg
Hematology agents- Thrombolytic agents
streptokinases/Streptase- IV med, used to dissolve or breakdown thrombi in an active situation- used to dissolve clots in IV catherers
side eff: bleeding-may be severe because fibrinolysis is non-selective
contraindicaitons-severe HTN- recent trauma or CVA, PUD
Drugs not to use with Anticoagulants, antiplatelet and thrombolylic agents
any other drug that affects homestatis,
increase the eff. of heparin:
antiplatlet drugs, warfarin, parenteral penicillins
decrease eff. of heparin:
antihistamines, digoxin, tetracyclines
increase eff. of warfarin:
analgesics, androgens and ana. steriods, cardiovascular drugs of all kinds
thyroid preparations
gastrointestinal drugs
Drugs that affect Statins,
niacin, , bile acid drugs, rifampin, antacids, isradipine