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55 Cards in this Set

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Describe the difference between the action of loop diuretics and Thiazide diuretics.
-Loop Diuretics inhibit sodium (Na) and chloride (Cl) reabsorption through direct action primarily in teh ascending loop of Henle, but also in teh proximal and distal tubules

-thiazide diuretics act primarily on the distal tubules, inhibiting Na and Cl reabsorption
What are the uses of Loop diuretics and Thiazide diuretics?
-Treats edema that involves fluid volume excess resulting from a number of disorder of the heart, liver or kidney (CHF, cirrhosis, renal disease)
-Hypertension.
What is the most commonly used loop diuretic?
Furosemide (Lasix)
What is a commonly used thiazide diuretic?
Hydrochlorothiazide (HydroDIURIL).
What is important to be aware of for a patient taking loop or thiazide diuretics?
Decrease in: BP, Na, Cl and K
-Weight change, I&O balance, dehydration, hyperglycemia
What are the most common side effects of loop and thiazide diuretics?
-Dehydration, hyponatremia, hypochloremia, hypokalemia
-Unusual tiredness, weakness
-Hearing loss (Lasix)
What is important to teach a client who is taking a loop or thiazide diuretic?
-Take teh medication early in the day to decrease nocturia
-Teach client to report any hearing loss (Lasix) or signs of gout.
What type of conditions is Osmitrol (Mannitol) used for?
-Oliguric phase of renal faiure
-Renal Disease with decreased GFR
-Increased Intraocular Pressure
-Contraindicated in Pulmonary Edema
-Increased intracranial pressure, or edema due to spinal cord injury.
What is important to watch for when taking care of a patient on Osmitrol (Mannitol)?
-Headaches, edema, CHF, fluid and electrolyte imbalance
What are the most common side effects of Mannitor (Osmitrol)?
Dizziness, tachycardia, headache, N/V
What type of drug is Mannitol (Osmitrol)?
Osmotic diuretic
What are the important nursing implications of a patient taking Mannitol (Osmitrol)?
-Check vital signs before administering the dose
-Assess urinary output, hydration status, electrolytes (hypokalemia), blood urea nitrogen, and renal and hepatic panels
-Evaluate for symptoms of congestive heart failure and pulmonary edema
-Intravenous (IV) medicatiosn may crystallize; need to warm to put inot solution. Draw up medication with a filter needle and administer with an in-line filter to prevent any crystals from entering circulation.
What type of medication is Spironolactone (Aldactone)?
Potassium sparing diuretic.
What is the basic action of Spironolactone (Aldactone)?
It blocks aldosterone in the kidney. Get rid of the sodium and water but saves the potassium.
<>This is done because it has a direct effect on the distal tubules in the kidney. Spironolactone competes with aldosterone for cell receptor sites in the distal tubules while inducing urinary excretion of sodium and reducing excretion of potassium and hydrogen ions.
What is important to watch for with a patient taking Spironolactone (Aldactone)?
Heahache, diarrhea, HYPERKALEMIA, electrolyte imbalance, fatigue, Gi disturbance.
What are the nursing implications when caring for a patient taking Spironolactone (Aldactone)?
-Monitor I&Os,
-Watch for cardiac dysrhythmias
-Monitor levels of electrolytes (Potassium and sodium)
-Teach client to report cramps, weakness ,fatigue, or nausea.
What is the onset, peak and duration of Insulin glarine (Lantus)?
Long Duration Insulin

Onset: 70 min
Peak: none
Duration: 24 hours
What is the onset, peak, and duration of Exubera?
Inhaled (Slow Duration: Slow acting) Insulin

Onset: 15-30 minutes
Peak: 0.5 -1.5 hours
Duration: 6.5 hr
What is the onset, peak, and duration of NPH Insulin (Humulin N)?
Intermediate Duration Insulin

Onset: 60-120 min
Peak: 6-14 hours
Duration: 16-24 hr
What is the onset, peak and duration of Insulin detemir (Levemir)?
INtermediate Duration Insulin

Onset: ---
Peak: 6-8 hr
Duration: 12-24 hr
What is the onset, Peak and duration of Regular Insulin (Humulin R)?
Short Duration: Slow Acting

Onset: 30-60 min
Peak: 1-5 hours
Duration: 6-10 hours
What is the onset, peak and duration of Insulin lispro (Humalog)?
Short Duration: Rapid Acting

Onset: 15-30 min
Peak: 0.5-2.5 hr
Duration: 3.0-6.5 hr
What is the onset, peak and duration of Insulin aspart (NovoLog)?
Short DUration: Rapid Acting Insulin

Onset: 10-20 min
Peak: 1.0-3.0 hr
Duration: 3.0-5.0 hr
What is the onset, peak and duration of Insulin glulisine (Apidra)?
Short Duration: Rapid Acting

Onset: 10-15 min
Peak: 1.0-1.5 hr
Duration: 3.0-5.0 hr
How should Regular and Intermediate insulin be drawn up when being given together?
Draw up clear (regular, lispro--short acting) before the cloudy (intermediate) insulin to prevent contaminating a short-acting insulin with a long acting insulin.

Put air in cloudy, clear...then draw up clear, cloudy.
What site is best for rapid, even absorption of insulin?
The abdomen.
What is important to remember about administering NPH insulin?
It is the only cloudy insulin; roll vial gently between palms to mix.
What is Acarbose (Precose) used for??
It works with insulin, metformin or a sulfonylurea, or on its own. It is administred with the first bites of each meal and interferes with absorption of carbohydrates.
How does Acarbose (Precose) work?
-Inhibits the alpha-glucosidase enzyme. This action slows the digestion of carbohydrates, reducing the postprandial rises in blood glucose.
What is important to watch for with a client taking Acarbose (Precose)?
Diarrhea, flatulence, cramps and abdominal distention.
What is the mechanism of action of sulfonylureas?
Stimulates the beta cells of the pancreas to increase release of insulin. It also increases the sensitivity of peripheral insulin receptors, which increase insulin binding in the peripheral tissues.
What are the first generation sulfonylureas?
Orinase, Dymelor, Diabinese, Tolinase
What are the second generation sulfonylureas?
Glucotrol, DiaBeta, Amaryl
When are sulfonylureas used?
-With mild-to-moderate type II diabetes mellitus (noninsulin-dependent)
-When diet and exercise programs are unable to maintain glucose control.
What is the major side effects of sulfonylureas?
Hypoglycemia
What are important patient teaching points when they are taking sulfonylureas?
-Instruct client to take the drug 15 to 30 minutes before meals, do not take medication and skip meals
-Call the doctor for signs of hypoglycemia (fatigue, hunger, cool moist skin, increased anxiety, dizziness, palpitations)
What type of drugs are Prednisone, Cortisone and dexamethasone?
Antiinflammatory Corticosteroids.
Describe the action of Corticosteroids.
-Suppresses the inflammatory and immune system by inhibting synthesis of chemical mediators (prostaglandins, leukotrienes, and histamine). Action is to decrease inflammation, which then reduces swelling, warmth, redness and pain.
What are the main uses for corticosteroids?
-Addison's disease, hormone replacement, cancer therapy.
-To decrease inflammation (systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, allergic condtions, asthma, chronic obstructive pulmonary disease, respiratory distress syndrome in infants)
-To suppress graft rejection
What are the major side effects of corticosteroids?
Peptic ulcers, GI bleeding, hyperglycemia, delayed wound healing, Cushing's syndrome.
What are the important nursing implications if a nurse is caring for a patient on corticosteroids?
-Check fluid balance and potassium and glucose levels.
-Warn client to take as prescribed and not to discontinue therapy suddenly.
What are the signs that the dose is too low when a patient is taking Levothyroxine Sodium (Synthroid)?
-Bradycardia
-Lethargy
-Constipation
-Excessive fatigue
-Excessive sleeping
What are the signs that the dose is too high in a patient taking Levothyroxine Sodium (Synthroid)?
-Irritability
-Hyperthermia
-Tachycardia
-Diarrhea
-Dysrhythmias
What is Levothyroxine Sodium (Synthroid) used for?
-Replacement in decreased or absent thyroid function
-Hypothyroidism
-Management of thyroid cancer
-Thyroid suppression test
What is the mechanism of action of levothyroixine sodium (synthroid)?
increases basal metabolic rate, enhances gluconeogenesis, stimulates protein synthesis.
What are the major side effects of Levothyroxine Sodium (Synthroid)?
-Hyperthyroid symptoms--irritability, insomnia, hyperthermia
-Weight loss
-Tachycardia
What are important teaching points for a patient taking Levothyroxine Sodium (Synthroid)?
-Replacement for hypothyroidism is lifelong. Do not discontinue.
-Instruct client to have thyroid-stimulating hormone levels drawn periodically.
-Takes about 1 month for the full effects of the medication to be seen.
-Teach client to take the medication in the morning, preferably 30 minutes before meals.
What are important nursing implications when taking care of a patient on Levothyroxine Sodium (Synthroid)?
-Monitor for increased pulse rate and rhythm
-Report abnormal vital signs and pulse of >100 beats/min.
What is Methimazole (Tapazole) used for?
-Helps to control hyperthyroidism and thyrotoxicosis (thyroid storm), by suppressing the production of thyroid hormone, especially prior to surgery or radioactive iodine treatment.
What is the mechanism of action of Methimazole (Tapazole)?
Inhibits the synthesis of thyroid hormone by interfering with iodine and tyrosine residue. Does not destroy existing stores of thyroid.
What type of medication is Methimazole (Tapazole)?
Antithyroid
What are the major side effects of Methimazole (Tapazole)?
Rash (most common), agranulocytosis (Leukopenia); toxic effect may occur as long as 4 months after therapy (Serious/life-threatening).
-Paresthesia, dyspepsia, hepatitis, N/V
What is important nursing implications when taking care of a patient on Methimazole (Tapazole)?
-weight gain and decreased HR are indications of the development of hypothyroidism.
What is important patient teaching for someone taking Methimazole (Tapazole)?
-Report any illness; sore throat and fever may be first indications of leukopenia
-Report any unusual bleeding or bruising immediately; may be indicative of adverse affects on the liver
-Teach client to avoid seafood and iodine products
-Teach client to schedule doses evenly throughout the day.
What is the difference between Methimazole (Tapazole) and Propylthiourical (PTU)?
Tapazole is 10 times more potent than propylthiourical, which is the prototype of this class.