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70 Cards in this Set
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Insulin mixtures
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onset - 30 min
peak - 4-8 duration - 24 hrs |
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When insulin mixtures are made...
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Draw up regular insulin b4 NPH
regular insulin should be clear all insulins should be free of particles don't shake the vial b4 withdrawing meds. can gently roll don't inject cold insulin When using inhaled insulin 1 or 3 mg blister packs are used |
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Adverse effects of Insulin
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HYPOGLYCEMIA
below normal blood glucose levels, symptoms usually appear when blood glucose falls below 50mg/dl: symptoms include: nervousness, diaphoresis (sweating), weakness, lightheadness, confusion, irritability |
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Below normal glucose levels..
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results from: too much insulin, too little food consumption, too much exercise, or a combination of these
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Treating Hypoglycemia
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1. if patient is alert: give 4 oz of sweetened drink (cola, juice) or 2 tsp sugar in tea/coffee,
2. follow up with protein or complex carbohydrate to eat |
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Secondary Hypoglycemia: how to avoid
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to prevent, after giving the sweetened drink, follow up with a complex carbohydrate or protein = 1 T. peanut butter, 1 oz cheese, cheese cracker, peanuts
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If patient with hypoglycemia is unable to swallow safely
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Give glucagon IV, IM or SC as ordered. when blood glucose level is stabilized (ex: 60 mg/dl) then give sweetened drink and food
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How does Glucagon work?
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1. Hormone produced by alpha cells in the pancreas
2. Stimulates glycogenolysis, Not effective in malnourished patients (they have no glycogen stores) 3. Increases blood glucose levels (opposite of insulin) |
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Indications for use of Glucagon
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1.Used for emergency treatment of severe hypoglycemia, usually when glucose cannot be given by mouth.
2. Cannot be given orally (destroyed in GI tract) 3. May be repeated in 15 min if the patient has not aroused after the 1st injection |
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when to expect hypoglycemic reaction with regular insulin
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if regular insulin is given b4 breakfast the most likely reaction would be at end of the peak, prior to the next meal - so give a carb. snack between meals
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With NPH insulin when to expect hypoglycemic reaction
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if given b4 breakfast then since it peaks 8-12 hrs then expect reaction before supper or bedtime
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LIPODISTROPHY (lipod - fat, trophy - growth)
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Disturbance in fat metabolism caused by multiple SQ injections- prevent by rotating injection sites - insulin absorption is decreased if injected into affected area
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Drug interactions of Insulin
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1. Cigarette smoking decreases the absorption of insulin (causes vasoconstriction
2. Many drugs increase glucose levels and would increase insulin requirements. Most common is corticosteroids (glucocortisteroids and mineralcortisteroids-hydrocortisone & fludrocoritosone) ( they elevate blood sugar) |
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Nursing Implications of Insulin
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1. Assess for S & S of hypoglycemia
2.observe for signs of hyperglycemia (polyuria, polydipsia, polyphagia, wgt loss, fatigue) 3. monitor blood glucose (as ordered) 4. Avoid delays in patient's meals (coordinate meds with meals) 5.keep a source of glucose or glucagon availible 6. patients should always wear med. id and have ready access to a source of glucose |
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Sequence of treatment when ER visit for diabetes
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1. take blood glucose level
2. then treat 3. if emergency: inject immedialtly (with doctor's orders) |
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Nursing Implication for Insulin con't
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during times of stress, pts may need increased doses of insulin and those who were previously controlled with oral hypoglycemic agents may require insulin until the stressor is eliminated (hospitalization would be stressor)
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Misc. fact on insulin
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old treatments promoted "pancreatic exhaustion" new treatments include a variety of ways to promote glucose transport and use. Focus is to treat insulin resistance, more focus on the cell
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Classifications of oral hypoglycemic agents
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1. biguanides
2. glitazones 3. alpha-glucosidase inhibitors 4. meglitinides 5. sulfonylureas |
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Biguanides
metformin/Glucophage Oral Hypoglycemic agent |
metformin/Glucophage
- increases glucose transport into cells (does not stimulate insulin secretion- does nothing to the pancreas) -inhibits hepatic production of glucose (works at cell level) |
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Advantages of Biguanides- metformin/Glucophage
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1.decrease insulin resistance
2.decreases LDL & triglycerides 3. increases HDL 4.no hypoglycemia 5.often called an antihyperglycemic rather than a hypoglycemic agent 6. excellent drug for the pt with some insulin production! |
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Disadvantages of Biguanides
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1. GI effects (bloating, DNV) 30% of pts
2. MALA - can be fatal-occurs mostly in pt w/renal disfunction & elderly - occurs when pt receives rediologic dye tests. must quit Metformin 2 days prior & after tests |
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MALA
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Metformin Associated Latic Acidosis -
fatal- precipitated by the admin of radiologic dyes. withhold 2 days b4 and after tests- more common in pts with renal and hepatic dysfunction |
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GLITAZONES
rosiglitazone/Avandia Oral Hypoglycemic agent |
rosiglitazone/Avandia
similar to Metformin-works at cell level 1. increases insulin receptor sensitivity, specifically in muscle and fat cells 2. may cause liver dysfunction. follow liver studies 3. may cause CHF (and heart arythmeas)as a result of increasing blood volume |
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Alpha-Glucosidase Inhibitors
acarbose/Precose Oral Hypoglycemic agent |
acarbose/ Precose
1.delays absorption of CHO from the intestines when taken with meals 2. good choice for pts with elevated post prandial blood glucose (after meals) |
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Advantages of Alpha-Glucosidase Inhibitors
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1. decrease blood glucose level
2.decreases complications related to diabetes by preventing hyperglycemic episodes |
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Disadvantage of A-G Inhibitors
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1. GI effects-diarrhea, extreme bloating and flatulence (may cause compliance problems)
2. contraindicated in pts with Irritable Bowel syndrome, etc. |
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Meglitinides
repaglinide/Prandin Oral Hypoglycemic agent |
repaglinide/ Prandin
1.stimulates insulin secretion (w/pancreas) but has a short half life and therefore causes less hypoglycemia and less beta cell stimulation 2. should be given immediately b4 a meal 3. especially useful in clients with renal dysfunction because it is excreted by the liver instead of the kidneys - not a common drug |
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Sulfonylureas
chloropropamide/Diabenese Oral Hypoglycemic agent |
chloropropamide/Diabenese
1. causes increased pancreatic secretion of insulin and decreased glucose production by the liver |
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Disadvantages of Sulfonylureas
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Not the drug of choice for:
the elderly - has mult. drug reactions and it is protein binding (90%) - the non-compliant pt. - needs to be taken 30 min b4 a meal and has a side effect of hypoglycemia |
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Neuroendocrine Hormone
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Symlin/Amylin
1.acts via the CNS to regulate postprandial blood glucose levels; slows gastric emptying and increases satiety 2. injected SQ into abdomen or thigh immediately prior to the meal 3. don't mix with other insulins (in the same syringe) 4.peak-1-2 hrs 5. duration- 3-5 hrs |
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Treatment Algorithm for insulins
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(when 1st started)
1.drug that increases insulin transport 2. if pt has increased postprandial blood glucose add Precose or Prandin 3. when pancrease insulin production decreases, add sulfonylurea 4. may add insulin if pancreas production is insufficient Result: pt may be on 1-4 meds |
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Thyroid Hormones produce:
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thyroid gland produces T3 & T4 (on negative feedback system)
1. anterior pituitary gland secretes TSH (thyroid stimulating hormone)which stimulates thyroid gland to produce T3 & T4 2.iodine is required to produce thyroid hormones. 3.thyroid hormone production works on negative feedback mechanism |
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Thyroid Hormones cause:
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1.increased metabolic rate
2.increased cardiac output (stimulation of heart) 3.increased carbohydrate metabolism and protein synthesis 4.decreased serum cholesterol 5.in children growth and development retardation |
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Physiologic effects of Thyroid hormones are:
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1. increased O2 production
2.increased heat production 3.increased cardiac output (rate/force) 4. loss of wgt 5. decreased cholesterol |
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Lack of thyroid hormones cause:
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1.wgt gain
2. decreased appetite 3.lethargy 4.cold intolerance 5.dry,course skin 6.decreased HR 7.decreased CO 8. low BP 9. subnormal temp 10. decreased metabolic rate 11. decreased cardiac stimulation |
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Thyroid Disorders
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Hypothyroidism & Hyperthyroidism
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Hypothyroidism
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treatment: levothyroxine sodium/Synthroid
T4 action is similar to natural thyroid hormone requires life-long treatment and dosage is regulated based on TSH levels |
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Adverse effects of Thyroid hormones
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1.diarrhea
2.wgt loss 3.increased BP tachycardia/Palpitations 4.heat intolerance exopthalmus-protrusion of eyeball 5. increased metabolism 6. increased cardiac stimulation |
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Nursing Interventions for Thyroid Hormones
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1.notify MD if pt c/o chest pain (overdose)
2.assess for side effects 3.monitor TSH, T4, T3 levels 4.use over the counter meds cautiously because they may contain stimulants 5.bioavailability differs among generics 6.do not stop abruptly!!may cause a myxedema coma - because of negative feedback, natural hormones stop and they will have none |
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Hyperthyroidism
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1.anti-thyroid agents- propylthiouracil (PTU)-inhibits production of thyroid hormones (therapeutic effects may take days or weeks until stored hormones have been used) -(takes one year for these drugs to decrease hormone levels to normal) (not life-long drug-once regulated then can stop taking)
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Nursing Interventions for Thyroid hormones
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1. assess for agranulocytosis (decreased granulocytic WBC- neutrophils, basophils, eosinophils - cannot fight infections)
2.this is the most serious side effect and may be lethal 3. s & s -sore throat (agranulocytosis) and fever |
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Radioactive Iodine
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1.used to destroy thyroid tissue
- urine, saliva & vomitus is radioactive for up to 24 hrs after admin - Warn family members!! |
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Calcium Regulators
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1. alters absorption of calcium from the GI tract
2. alters renal excretion of calcium 3. reabsorbs or deposits of bone calcium |
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Side effect of Calcium regulators
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Hypocalcemia & hypercalcemia
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Hypocalcemia
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treated with Vitamin D analogues which increase bone resorption (destruction) and increases absorption of CA from the GI tract)
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Side effects of Calcium regulators
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1. Osteoporosis (caused by resorption of bone)
2.kidney stones (caused by increased serum levels of calcium - drink lots of water) |
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Nursing implications of side effects of Calcium regulators
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Acute Hypocalcemia
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Acute Hypocalcemia
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treated with IV Calcium Gluconate in emergencies
this often occurs after surgery to remove the thyroid gland and the parathyroid glands are inadvertently removed. (parathyroid glands regulate calcium) |
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Hypercalcemia
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S&S
1. generalized decrease in the ability of nerves and muscles to respond to stimuli 2. may include constipation, depression, drowsiness, lethargy, dysphagia, cardiac arrythmias 3.increased serum calcium may cause kidney stones. hypercalcemia treat with calcitonin/Miacalcin (makes calcium leave blood stream and enter the bone) |
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calcitonin/Miacalcin
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for Hypercalcemia
1. lowers serum calcium levels by inhibiting bone resorption. used to treat osteoporosis (promotes buildup of calcium in bone) not administered orally only IM, SQ or by nasal spray |
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Nursing implications of Hypercalcemia
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1. monitor serum calcium levels
2.observe for allergic reaction to calcitonin 3.low calcium diet 4. drink lots of fluids to prevent kidney stones |
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Growth Hormone
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given to children who lack hormone
1.anterior pituitary hormone used to treat hormone deficit/growth failure 2. given IM 3.adverse effects- hyperglycemia, hypothyroidism |
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Nursing implications of growth hormone
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1.anterior pituitary hormones may cause allergic reactions. Often a skin sensitivity test is performed b4 admin.
2. MD may order pituitary hormone levels while on these agents |
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Posterior Pituitary Hormones
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1.ADH-anti-diuretic hormone (conserves water-higher blood volume)
2. used in the treatment of diabetes insipidus (profound urination) 3.causes water reabsorption (decreased urine output) 4.observe for side effects related to hypervolemia (fluid build up) 5.hypertension/angina 6.pulmonary crackles 7. peripheral edema 8. increased specific gravity |
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Posterior Pituitary hormones drugs
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Oxytocin/Pitocin
1.used to induce labor and control post-partum hemorrhage 2. stimulates uterine contractions (tightens vessels/less bleeding) |
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Adverse effects of PP hormone drugs
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if given too much
uterine rupture, fetal asphyxia must be admin by IV on infusion pump |
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Androgenic and Anabolic Steriods
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Androgens (testosterone) male hormone secreted by the testes in men and the ovaries in women and the adrenal glands of both sexes
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Anabolic steroids
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synthetic drugs causing increased anabolic activity and decreased androgenic activity when compared with testosterone
these are Schedule III so non-prescription sales are illegal can be used to treat conditions of tissue wasting |
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Androgens
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treat hypogonadism in men and in females they are used to treat breast cancer
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Abuse of Anabolic steroids
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1.liver-tumor and hepatitis
2.CNS-aggression 3.reproductive-low sperm count, impotence, hirsutism (loss of facial hair), menstrual irregularity 4.metabolic -Na & fluid retention, wgt gain, cardiac disease 5.dermatologic-acne |
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Estrogens
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1.are produced by the ovaries, promote female reproductive tract development and secondary sex characteristics
2. during puberty, they promote long bone growth 3. they were once believed to decrease heart disease but research no longer supports this theory |
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Estrogen/Estace
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1.used to treat symptoms of menopause and osteoporosis
2.in men, used to treat prostrate cancer 3.prolonged, elevated doses may cause endometrial and breast cancer 4.may cause increased blood clotting 5.may cause hypertension, edema and wgt gain |
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Progestins
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medroxyprogesterone/Provera
1.produced by the ovaries 2.used to treat various gynecologic conditions 3.patient at risk for blood clot formation |
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Oral Contraceptive Agents
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1.combination of estrogen and progesterone (nearly 100% effective)
2. estrogen only (high incidence of tubal and ectopic pregnancy) 3. mechanism of action-inhibit ovulation |
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Contraindicators of Oral Contraceptives
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1. cigarette smoking
2.past history of thrombosis 3.history of migraine headaches |
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Drug interactions of Oral Contraceptives
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1. use an alternative contraceptive method when using:
Rifampin (TB med) anticonvulsants antibiotics May require increased doses of: theophylline tricyclic antidepressants |
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Nursing Implications of Oral Contra.
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1.if pt misses one does, take one asap or take two the next day
2.if pt misses two doses, take 2 pills for the next 2 days and use an additional form of birth control 3.if client misses 3 doses, discard the pack and use a new method of birth control and then restart a new pack next month 4. should wait at least 3 months after d/c to become pregnant 5. if pt is taking pills correctly and misses one menstrual period, continue taking pills 6. if she is not taking pills correctly and misses a period, or if she misses 2 consecutive periods regardless of how she is taking them she should stop taking pills and have a pregnancy test. |
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Cation-Exchange Resins
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Sodium polystyrene/Kayexalate (Kayx- K+)
1.used to decrease potassium levels in pts who are hyperkalemic 2.may be given orally or rectally 3.works by exchanging sodium ions for K+ ions. which are then excreted in feces |
Katon K+
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Nursing Implications for Cation-Exchange Resins
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1.monitor K+ levels-this drug may cause hypokalemia
2. monitor NA levels - this drug may cause hypernatremia 3.constipation is side effect-MD may order sorbitol to be given with this drug |
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Ammonia Detoxicating Agents
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lactulose/Cephulac
caused by liver disease lactulose is a laxative-lowers ammonia levels used to lower serum ammonia levels in pts with hepatic encephalopathy and to treat constipation classifed as a laxative because it is not absorbed from the GI tract and draws water into the bowel it lowers ammonia levels by decreasing the amt of ammonia produced in the intestines |
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