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What drug therapy is used to treat Cushing’s syndrome (too much glucocorticoid)?
Aminoglutethimide (Cytadren) and metyrapone (Metopirone)
Hydrocortisone/prednisone-- addison disease
Octreotide (Sandostatin)--acromegaly & GI bleeding
Propylthiouracil (PTU) and l-131--graves
Aminogluethimide (Cytadren)
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What is the treatment for hypoparathyroidism? Vitamin D and calcium supplements
Surgery (no drug therapy)
Somatrem (Protropin) and somatropin (Genotropin) Aldactone (Spironolactone)
Vit D & Ca supplements
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Somatotropin
- Pituitary hormone/human growth hormone
- has same amino acid sequence as endogenous human growth hormone
- Produces same effects as naturally occurring form of growth hormone
- Uses: growth failure, cachexia (severe wasting of the muscles)
- Multiple contraindications: Epiphyseal closure (children), severe obesity, respiratory impairment, sleep apena due to potentially fatal respiratory
- impairment, sleep apena intracranial tumor, sensitivity to glycerinserious
- adverse effects: Severe respiratory impairment in obese patients with Prader-Willi syndrome, Diabetes, Pancreatitis, Scoliosis, Papilledema,
- Intracranial tumor
- Rotate injection sites
- report joint pain immediately
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Octreotide
- growth hormone antagonistproduces same effects as natural hormone somatostatin (not a “statin”); suppresses secretion of GH
- Suppresses secretion of serotonin, gastrin, secretin, motilin, insulin, glucagon, vasoactive, intestinal peptides, and pancreatic peptiedesuses:
- tx: acromegaly intestinal bleeding, portal HTN
- serious: dysrhythmias, sinus bradycardia, CHF
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Desmopressin
- “pressin”
- ADH replacement, pituitary hormone has vasoconstricor activity that causes contraction of smooth muscles in vascular system, uterus, and GI tract
- Produces increases in plasma factor VIII and Von Willebrand’s factor
- multiple effects-serious: water intoxicity, coma, hyponatermia & anaphlaxis, thrombolytic disorder
- tx: Diabetes Insipudis (deficiency and ADH-caused by brain injury or viral
- pneumonia) shock (off-label) & upper GI bleeding (off-label)
- Note diabetes insipudis not related to diabetes melitus
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Glucagon
- pancreatic hormone: increases glucose levels by increasing glycogenolysis
- uses: emergency tx of hypoglycemia when pt can’t swallowits the antidote/reversal for beta blockers
- serious: tachycardia & hypokalemiamonitor bg closely before during and after giving this med
- administer IV if the pt fails to respond, if this fail they will be put on continuous dextrsoe 50 (make sure line is patent and give slowly)
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Human Regular Insuline
- short acting
- hypoglycemic agentinsulin
- decreases blood glucose levels by increasing cellular uptake of glucose & stim. storage of glucose as glycogeninhibits release glucagon
- use: DM I & II and gestational diabetes
- contr: hypoglycemiaInteracts w/ oral antidiabetic agents and many other interactions
- serious: hypoglycemia, hypokalemia, rebound hyperglycemia. can cause weight gain.
- monitor food intake, rotate injection sites, check bg’s (peak times),
- doc. carefully & provide education. best practice is to check w/ 2nd nurse.
- Lower the dose of insulin if you are unable to eat, but do not omit the dose.
- An increased dose may be necessary during periods of high stress or illness.
- if someone comes in w/ hyperkalemia insulin can be given to lower it.
- only regular insulin can be given be IV
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Insulin Aspart (NovoLog)
- similar to regular insulin
- Rapid actingshort duration of action that regular
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Insulin Detemir (Levemir)
- Long-acting
- slow onset and dose-dependent duration of action
- used to provide basal glycemic control
- not injected before meals to control postprandial (after meals) hyperglycemia
- cannot be mixed w/ any other type of insulin
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Insulin Glargine (Lantus)
- recombinant insulin analogconstat (no peak)
- long duration insulin activity
- provides for the maintenance of steady blood levels
- may also help improve the lipid profiles and A1C levles of type II when added to therapy
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Insulin Glulisine
- Rapid onset and short duration (3-5 horus)
- Given by SC injectin only
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Insulin Lispro
- rapid acting analog of regular insulin
- helps control rise in bg brought on by meals
- not given IV
- oftern used w/ insulin infusion pumps
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Isophane insulin/ NPH
- only intermediate-acting
- has slower onset of action than regular insular
- has slower action
- Used to provide a basal level of insulin coverage
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Glyburide
- hypoglycemic agent (lowers bg to cause hyperglycemia)
- sulfonylureastimulates release of insulin from panceeatic beta cells
- increases sensitivity of peripheral tissues to insulin
- uses: lower BG in pts w/ type II
- contra: sensitivity to sulfa (antibiotics) drugs or thiazide diuretics
- many drug interactions
- serious adverse effects: hypoglycemia, heptatoxicity, cholestatic jaundince,
- aplastic anemia, leucopenia, thrombocytopenia (leuko+thrombo= agranulocytosis)
- monior BG’s, monitor liver function labs
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Nursing responsibility all oral antidiabetic agents
- identify patients at increased risk for adverse effects of drug therapy:
- sulfonylureas: contraindicated in women who are prego or breast; feeding; persons w/ renal or liver disease
- Metformin: contraindicated in persons who consume excessive alcohol, or who have
- renal or liver disease or any condition predisposing them to lactic acidosis (with-hold if we know they will have dye injected before and after)
- Meglitinedes: used w/ caution in persons w/ liver disease
- Giltazones: contraindicated for pts w/ HF
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Metformin
- Hypoglycemic agent
- biguanide
- reduces bg levels by reducing gluconeogenesis, thereby suppressing hepatic production of glucosedecrease
- intestinal re-absorption of glucose & increase the cellular uptake glucose
- multiple contradications: HF, Liver failure, Renal failure, current infection hx of lactic acidosis, any condition that predisposes pt to hypoxemia
- Serious adverse effect: lactic acidosis
- not as at risk for hypoglycemic event
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Repaglindie (Prandin)
- hypoglycemic agent
- Meglitinide
- lowers glucose levels by stimulating insulin release from pancreatic beta cells
- CYP sustrate= many interactions
- serious adverse effects: hypoglycemia (at risk for hypoglycemic event)
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Rosiglitzone
- “glitazone”
- Thiazolidinedione (TZD)
- lowers bg levels by increasing cellular sensitivity to insulin, thereby reducing insulin resistance
- decrease gluconeogenesis by the liver
- also a CYP substrate: many interatctions
- Serious: Hypoglycemia, Hepatotoxicity, Bone fracture, Heart failure, Myocardial infarction
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Sitagliptin
- Hypoglycemia agent
- DPP-IV inhibitor
- inhibts dipepidyl peptidase-IV (DDP-IV)
- inhibition of DPP-IV reduces the destruction of incretins, which increases levels of incretin hormones bg level decrease
- Serious adverse: hypoglycemia if used w/ sulfonylurea or insulin
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Insulin Aspart: name the action, onset, peak, duration, adminstration and timing, and compatibility.
- Action: rapid
- Onset: 10-20 mins
- Peak: 1-3 hr
- Duration: 3-5 hr
- Admin & tim: SC: 5-10 min before meal
- Compatibility: can give w/ NPH: draw aspart first, give immediately
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Insulin Lispro: name the action, onset, peak, duration administration and timing and compatibility
- Action: Rapid
- Onset: 5-15 min
- Peak: 1-1.5 hr
- duration: 3-4 hr
- admin & tim: SC: 5-10 min before meal
- Compatibility: can give w/ NPH, draw lispro first, give immediately
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Insulin Gluisine: name action, onset, peak, duration, time and admin, compatibility
- Action: rapid
- Onset: 15-30
- Peak: 1 hr
- Duration 3-4 hr
- Admin & tim: SC 15 min before meals
- Compatibility: can give w/ NPH, draw glulisine first, give immediately
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Insulin Regular: name action, onset, peak, duration, admin and timing, compatibility
- Action: short
- onset: 30-60 min
- peak: 1-5 hr
- duration: 6-10 hr
- Admin and tim: SC: 30-60 min before meal; IV
- compatibiity: can mix w/ NPH, sterile water, NS; don't mix w/ glargine
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NPH: action, onset, peak, duration, admin & timing, compatibility
- Action: intermediate
- Onset: 1-2 hr
- Peak: 6-14 hr
- Duration: 16-24 hr
- Admin & tim: SC: mix (cloudy)
- Compatibility: can mix w/ aspart, lispro, reg; don't mix w/ glargine
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Insulin Determir (Levemir): action, onset, peak, duration, admin & timing, compatibility
- action: long
- onset: gradual
- peak: 6-8 hr
- duration: 24 hr
- admin and timing: SC: 1/day or 2/day
- compatibility: don't mix w/ any insulin
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Insulin Glargine: action, onset, peak, duration, admin and timing, compatibility
- action: long
- onset: 1.1 hr
- peak: no peak
- duration: to 24 hr
- admin and time: SC 1/day, same time each day
- Compatibility: don't mix w/ any insulin
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Sulfonylureas: name the drug in this class, its action, and nursing considerations
- drug: Glyburide
- action: stimulates insulin release; increase cellular sensitivity to insulin; decrease insulin resistance
- Nursing consideration: can cause hypoglycemia, GI disturvances, rash, cross sensitivity w/ sulfa drugs and thiazide diuretics, possible disulfiram response w/ alcohol
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Biguanides: name the drug in this class, its actin, and nursing considerations.
- Drug: Metformin
- Actions: decreases hepatic glucose production & release; increase cellular uptake of glucose: lowers lipid levels; promotes weight loss
- Nursing considerations: common GI adverse effects; risk for lactic acidosis; avoid alchol; hold 2 days before and after IV contrast; less risk for hypoglycemia
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Meglitindes: name drug in this class, action, and nursing considerations
- Drug: Repaglinide
- action: stimulates insulin release; decreases postprandial glucose & hemoglobin A1C; little effect on fasting glucose
- Nursing considerations: can cause hypoglycemia, GI effects, well tolerated; administer shortly before meals
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Thiazolidinediones: name drugs in class, action and nursing considerations
- Drug: Rosiglitazone
- actions: decreases hepatic glucose production and secretion; increases cellular sensitivity to insulin
- nursing considerations: can cause edema, worsening of HF; monitor liver fx test; theraputic effects take several weeks to develope
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Alpha-glucosidase inhibitors; name drug in class, action and nursing considerations
- Drug: acarbose
- Action: interferes w/ carb breakdown & absorption; acts locally in Gi w/ little systemic absorption
- Nursing consideration: common GI efects; hypoglycemia can occur if combined w/ another oral agent; if this occurs, tx w/ glucose, not sucrose; take w/ meals
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Incretin Enhancer (DPP-IV inhibitor): name drug in class, action and nurisng considerations
- Drug: Sitagliptin
- Action: increases synthesis and release of insulin; decreases glucagon production & glucose secretion; increases satiety; support wieght loss
- Nursing considerations: Well tolerated; can cause H/A, diahrea, nasopharyngitis; can cause hypoglycemia if used in combo w/ another oral agent
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