Pharmacology Endocrine/antidiabetes Meds

Front 1

Signs of HYPOglycemia

Back 1

• Shaky
• Sweaty
• Dizzy
• Confusion and difficulty speaking
• Hungry
• Weak or tired
• headache
• nervous or upset
• can lead to unconsciousness

Front 2

Signs of HYPERglycemia

Back 2

• Shaking
• Sweating
• Anxious
• Dizziness
• Fast heartbeat
• Impaired vision
• Weakness and fatigue
• Headache
• Unlikely to become unconscious

Front 3

Hypoglycemia - Glucagon

Back 3

• Causes- Too much insulin, over exercise, fasting, also drinking alcohol.
• Treatment- Glucagon• Immediate onset ofaction• IM, IV & SC•
• Indication: Severe hypoglycemia
• Side effects: N/V

Front 4

Insulin

Back 4

• Indication: Diabetes mellitus type 1 and type 2
• Four Types: Rapid• Short• Immediate• Long•
• Different onset, peak & durations (see syllabus pg 8)
• Adverse effect: HYPOglycemia
• Nursing Considerations: Monitor potassium

Front 5

Rapid-acting Insulin

Back 5

• Begins to work about 15 mins after injection
• Peaks in 1 hour and continues to work 2-4 hrs
• Types: Insulin glulisine (Apidra, Insulin Lispro (Humalog), and insulin aspart (Novolog)

Front 6

Regular or short-acting insulin

Back 6

• works in 30 mins
• peaks in 2 to 3 hrs
• effective for 3 to 6 hrs
• Types: Humulin R, Novolin N

Front 7

Intermediate-acting insulin

Back 7

• Reaches bloodstream 2 to 4 hrs
• Peaks in 4 to 12 hrs
• Effective for 12 to 18 hrs
• Types: NPH (Humulin N, Novolin N)
• NPH (Neil Patrick harris) will work in 2-4 hrs and works a 12-18 hr day.

Front 8

Long-acting Insulin

Back 8

• Reaches bloodstream several hours after injection.
• Lowers blood sugar evenly over 24hrs
• Types: Insulin detemir (Levemir), Insulin glargine (Lantus)
• You have comfy jeans you want to wear for the next 24 hours.

Front 9

Insulin nursing interventions

Back 9

• Want to avoid hypoglycemia
• Check blood glucose level, know when and how often!
• Stress can cause hyperglycemia
• Timing for meals
• Rotate sites
• May need extra doses in times of illness and stress
• Hypoglycemia (conscious vs unconscious)
• Teach pt & family signs of hypoglycemia
• Medication interactions- Thiazide and loop diuretics cause hyperglycemia
• Beta-blockers can mask symptoms of hypoglycemia

Front 10

Sulfonylureas (Glipizide) glucotrol

Back 10

• Therapeutic effect: simulates the release of insulin
• Side effects: hypoglycemia, nausea, diarrhea
• Contraindications: pregnancy, lactation•
• Administration: Take 30 minutes before breakfast
• Interactions
• No alcohol

Front 11

Biguanides - Metformin (glucophage)

Back 11

• Therapeutic effect:Decreased hepatic glucose production• Decreased intestinal absorption of glucose• Improved insulin sensitivity
• Side effects: diarrhea, N/V, metallic taste, flatulence, asthenia, GI upset, B12/folate deficiency, lactic acidosis
• Contraindications: renal impairment
• Nursing Considerations• Discontinue prior to contrast dye for imaging• Monitor for Vitamin B12 & folic acid deficiencies• Teach about lactic acidosis symptoms• GI effects improve over time• Take with a meal

Front 12

Thiazolidinediones- Pioglitazone (Actos)

Back 12

• Therapeutic effect: Decreases insulin resistance intissues
• Side effects: fluid retention, increased lipid levels, respiratory infections, myalgia, headaches, increased incidence of heart failure
• Contraindications: cardiovascular disease•
• Interactions: Beta-blockers and diuretics

Front 13

Gliptins-Sitagliptin (Januvia)

Back 13

• Therapeutic effect: Stimulates the release of insulin and stops the enzyme that blocks incretin hormones, which are important because that stimulates the release of insulin.
• Side effects: respiratory infection, pancreatitis, GI upset, rash, headache
• Contraindications: Type 1 diabetics because you need to have insulin for it to work!
• Nursing Considerations: Oral tablets only, with or without food• Teach signs of respiratory infection and pancreatitis

Front 14

Incretin Mimetic - Exenatide (Byetta)

Back 14

• SC injection
• Indication: Type 2 diabetes
• Therapeutic effect: Increases incretin
• Side effects: Hypoglycemia, GI upset, pancreatitis, Renal failure
• Contraindications: Type 1 diabetes, hypersensitivity to drug
• Inject 60 min prior to am and pm meals
• Take with Sulfonylureas increases the risk of HYPOglycemia

Front 15

Nursing Considerations for type 2 diabetes

Back 15

• Many drug interactions
• Complete list of medications
• Include lifestyle modifications (diet & exercise)
• Teaching
• Follow recommendations for blood sugar monitoring
• Teach signs of hypoglycemia
  

Front 16

Hypothyroid

Back 16

• Underactive thyroid
• symptoms develop slowly over time
• More obvious as time goes on
• elevated TSH
• causes: autoimmune, surgery, radiation, meds
• Fatigue, weight gain, depression, brittle hair & nails, cold intolerance.

Front 17

Levothyroxine (synthroid)

Back 17

• Indication: Thyroid replacement therapy for hypothyroid
• Side effects: hyperthyroid
• Interactions: decrease Digoxin effect, enhance oral anticoagulants, decrease insulin & antidiabetic drugs
• Nursing considerations:• Take daily, lifelong treatment• 3-4 weeks for therapeutic effects• Teach signs of hyperthyroid• Dosed in micrograms (mcg)• Take 30-60 minutes before breakfast• Brands cannot be interchange

Front 18

Hyperthyroid

Back 18

• Overactivethyroid
• Mimicsother health problems, may be difficult to diagnose
• Causes:Grave’s disease, Plummer’s disease, thyroiditis
• Symptoms: Diarrhea/frequentbowel movements, increased appetite, muscle weakness, heat intolerance,exophthalmos (bulging eyes), sleep disorders, palpitations, tachycardia, nervous/irritable,goiter
  

Front 19

Glucocorticoids Solu-Medrol, Hydrocortisone, prednisone, dexamethasone

Back 19

• Low dose = therapeutic doses & few side effects
• High dose = multiple adverse reactions
• For clients who produce insufficient cortisol• Treat pain
• Suppress inflammation
• Indications: Trauma, surgery, inflammation, allergic reactions, organ transplant
• Lower the activity of the immune system
• Long-term – secondary adrenal insufficiency

Front 20

Prednisone

Back 20

• Indication: Insufficient Cortisol
• MUST taper off
• Avoid during pregnancy
• Side effects• Increased blood sugar - Abnormal fat deposits• Muscle wasting Sodium & water retention• Thin skin Glaucoma• Psychosis / Irritability Hypertension• Increased risk of infection

Front 21

Propylthiouracil (PTU)

Back 21

• Antithyroid drug/suppress thyroid hormone production.
• used before surgery to remove the thyroid
• Side effects: agranulocytosis, hypothyroid, liver toxicity
• Nursing:

1. Monitor for hypothyroid
2. teach to report signs of infection