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Name 2 short-acting regular insulins
And the primary uses
- Acute illness ( emergency) ex. DKA, surgery
- Pregnancy
Type 2 uncontrolled oral hypoglycemia
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How to give Regular Insulin Short acting
Only type of insulin that can be given IV push or IV gtt
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Timing of Short Acting Regular Insulin
- Starts 30 min-1 hr
- Peak 2-4 hrs
- Duration 3-6 hrs
- Max 6-8 hrs
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When to give Regular short acting insulin
- 30 min before a meal sliding scale
- Subcut
- insulin syringe
- -- eat a snack at peak times ( 2-4 hrs )
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Name 2 Long Acting Insulins
For what kind of use?
- Glargine ( lantus)
- Detemir ( levemir)
Long term use
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Long Acting Insulin timing
- Starts 1-2 hrs
- No Peak
- Lasts 20 hrs
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How to give long acting insulin
- Dont dilute
- Dont mix
- Normally given at bedtime
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Name 2 intermediate insulins
The primary use
NPH insulins
Long term admin
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Adverse effects of intermediate insulin
Hypoglycemia mostly in the mid late afternoon
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How to give intermediate insulin
- Only give Sub Q usually before breakfast or dinner
- Can be mixed with short-acting ( clear to cloudy)
- Air into NPH ( cloudy)
- Air into Regular
- Draw up Regular
- Draw up NPH
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The timing of Intermediate Insulin
- Starts 2-4 hrs
- Peak 8-10 hrs
- Lasts 10-18 hrs
- Max 14-20 hrs
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What to do if you have too much insulin ( hypoglycemia)
- hypoglycemia= below 70,
- dangerous below 40
- signs: tachy, palpitations, diaphoresis, headache, weakness)
- Conscious:
- foods with 15g carbs, liquid fruit juice
- 4tsps sugar
- symptoms should go in 5-20 min if not give more carbs
- Unconscious:
- Dont call MD 1st. treat with 25-50% dextrose IV push
- or at home Sub Q or IM glucagon
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What makes hypoglycemia worse?
- sufonylureas
- meglitinides
- beta-blockers
- alcohol
- tetracyclines
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What drugs raise glucose levels
- thiazide diuretics
- glucocorticoids
- pheynytoin
- levothyroxine
- estrogen/oral contraceptives
- adrenergics
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What drugs can mask symptoms of hypoglycemia ( tachy tremors)
beta blockers ex propranolol
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3 Drugs in the sulfonylurea class
and how they work
when to give
- Glyburide
- glimepiride
- glipizide
insulin release from the pancreas
give 30 min before meals
older adults are sensitive to glyburide
check A1C ( should be less than 7%)
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Drug in the class of biguanides
how it works
when to take
metformin ( glucophage)
increases the use of glucose by muscle and fat cells, decreases liver glucose production and GI absorption of glucose
- absorbed in the liver
- taken with meals
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Metformin considerations/ adverse effects
Least likely to cause hypoglycemia
can cause lactic acidosis ( hyperventilation, myalgia, sluggishness) -- stop treatment then--> not for people over 80!
- GI upset ( lose weight )
- B12 + folic acid deficiency
Held at least 24 hrs before tests and 48 hrs after tests with contrast dye to avoid renal failure
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Name 2 alpha glucosidase inhibitors
when to take
how do they work?
acarbose
miglitol
Take at the start of each meal
The med works in the GI and delays the digestion of complex carbs ( glucose lowers after meals)
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What drugs do alpha glucosidase inhibitors not work with?
which ones do they work well with?
- Acarbose can decrease digoxin levels
- and when used with metformin can increase the risk of hypoglycemia and GI effects
- Works well with sulfonylureas
- (glyburide, glimepiride, glipizide)
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2 Drugs in Thiazolidinediones
how they works
- Rosiglitazone
- Pioglitazone
- Stimulates insulin receptors on muscle, fat, and liver cells
- ( used for insulin resistance)
- - meds should be taken with meals
- -can take up to 12 weeks to work
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Adverse effects of Thiazolidinedione
- Hepatotoxicity
- CHF
- Weight gain ( 2-3 lbs in 2-4 hrs)
- don't give to people with heart failure
- monitor liver function
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2 drugs in Meglitinides
When to take?
- Takes 30 minutes before meals
- Not commonly prescribed
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Drug in Amylin Analogs
how it works?
How to give?
Pramlintide acetate
Suppresses postprandial glucagon secretion which slows gastric emptying
Comes in pen form, given subcut before meals ( dont admin if skipped meal)
- associated with weight loss
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3 drugs in the dipeptidyl peptidate 4 inhibitor
how they work?
when to take?
- sitagliptin phosphate
- linigliptin
- saxagliptin
balance the release of insulin and limit the release of additional glucose from liver ( helps with insulin resistance)
take daily with no regard to meals ( po)
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Adverse effects of dipeptidyl peptidate -4 inhibitors
- Not for type 1 at all
- not for heart failure, or renal disease
can cause upper resp infection, stuffy runny nose
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2 drugs that are incretin mimetics
How to take it?
how does it work?
- Exenatide
- Liaglutide
- Other 2 drugs: albigutide, dulaglutide
Sub cut BID within 1 hr of breakfast & dinner
Stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten ( it increases the feeling of fullness/ weight loss)
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Contraindications of Incretin Mimetics
- Do not lactate
- C-cell thyroid cancer link
- -- Make sure to refrigerate and protect from light
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Drug thats a Sodium glucose cotransporter 2 inhibitor
When to take it
How it works?
Canagliflozin
Take it with breakfast
Works by inhibiting glucose reabsorption in proximal renal tubules
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What to check while on Cenagliflozin
Assess K+ and blood pressure levels
Avoid salt substitutes, st johns wort
Check for dehydration, hypotension, syncope, genital mycotic( yeast infection)
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3 hormones produced by the thyroid
thyroxine ( T4), triiodothyronine ( T3), calcitonin ( high blood Ca = more calcitonin)
T4, and T3 depend on the amount of iodine and tyrosine in the thyroid gland
thyroid hormones are released when its stimulated by TSH from the anterior pituitary gland
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Signs of hyperthyroidism
- lab signs
- physical signs
include a thyroid storm
- TSH goes down
- T3, T3 is high
Caused by graves disease: where thyrotropin receptor antibodies simulate TSH
thyroid storm ( severe): extreme symp, heart fail, coma
other signs: goiters, thyroditis, thyroid carcinoma, pituitary adenoma, thyroid storm
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Whats propylthiouracil ( PTU) used for
what to remember
contraindications
A beta blocker for hyperthyroidism
taken around the clock q8hr
PTU may increase the effects of anticoagulants = risk of bleeding goes up
Monitor live functions tests
If the HR is 100+ the dose isnt high enough
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Methimazole is used for
what to remember beforehand
hyperthyroidism
take a pregnancy test before starting
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What are Lugols Solution
Potassium iodide
Sodium iodide used for?
Hyperthyroidism
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How doses should be on hyperthyroidism
Higher at the start because of a rapid metabolism
need to restrict seafood/salt
some OTC have iodine : cough syrup, asthma meds, and multivit
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Describe hypothyroidism
-labs
-causes
TSH is high ( trying to compensate): T3, T4 normal
Cause: cretinism ( child born without a thyroid gland)
myxedema ( low basal temp, and low hr, card dysrh)
Hashimoto ( autoimmune)
Goiter radiation
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Points to remember about hypothyroid pts
Need a low dose for pain and anesthesia
- Increase the effects of levothyroxine:
- Antidepressants
- asthmatic agents
- nasal decongestants
- Decrease the effects..
- antacids, iron
- antihypertensives, proppranolol
- estrogen, oral contraceptives
If the pts has Addisons treat that first
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Drug for hypothyroidism
Levothyroxine/synthroid
Give PO empty stomach 30 minutes before meals or IV ( IV dose in half)
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Hormones made by the anterior pituitary gland
and the related conditions
GH/Somatropin
Dwarfism= not enough GH
Acomegaly= too much GH
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Somatropin is for?
How to give it
Stimulates GH ( skeletal, linear, muscle and organ growth)
- Subcut or IM
- 2 nurses must check dose calculation
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Adverse effects and considerations for Somatropin
what to monitor
Hyperglycemia, mild edema
Monitor serum and urine calcium, glucose, and thyroid function
Avoid if Prader Willi syndrome
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Hormones made by posterior pituitary gland
ADH/Vasopressin : to regulate water
-- Diabetes inspidus: is a ADH deficiency kidneys are filtering but not reabsorbing water
Oxytocin: childbirth, lactation
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Drug for Diabetes Inspidius and how it works
how is it given
- Desmopressin acetate
- Vasopressin
synthetic ADH: increases water permeability, and osmolality and decreases urine volume
- Desmopressin: oral, intranasal, subcut, IV
- Vasopressin: subcut, IM, IV
Monitor IV sites== necrosis
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Desmopressin acetate adverse effects and considerations
hyponatremia: lethary, confusion, seizures
fluid volume shift = dysrhythmia
Assess for signs of rehydration
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Drugs that increase the effects of desmopressin
Carbamazepine and chloropropamide , tricyclic antidepressants
selective serotonin
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Drugs that decrease the effects of desmopressin
alcohol ( decreases the diuretic effect), heparin, lithium, phenytonin
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Drug that suppress GH and IGF1 for acromegaly
How to give it
Octreotide acetate
Deep IM ( not the deltoid)
between meals to prevent fat malabsorption
Med has to be withdrawn for 4 weeks out of the year
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what to consider while on octreotide acetate
prolonged QT interval
- Monitor sugar levels and for gallbladder disease
- IV gtt may be used for GI bleed
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Hypocalcemia drugs
how they are given
- oral calcium products ex. GERD
- IV : calcium chloride, calcium gluconate for acute hypocalcemia
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- Slow IV push
- PO 2 hrs apart from other meds
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Considerations for hypocalcium drugs
Increases risks of digoxin toxicity
Calcium citrate is better absorbed
Iv calcium gluconate is the antidote for calcium channel blocker overdose
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Drugs that increase the effects of calcium
thiazide diuretics
vitamin D
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drugs that decrease the effects of calcium
calcitonin
corticosteroids
phosphates
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Drugs that help with osteoporosis and pagets disease
How is it given
Bisphosphonates ( end in -dronate)
Main drug: Alendronate
PO: must take with a full glass of water 30 minutes before breakfast with no other meds
should sit or stand for 30 minutes after or esophagus erodes
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How does alendronate work?
considerations
Supresses osteoclast activity to gain bone mass
Dont take calcitonin with salmon allergy
Aspirin/NSAID: increase the risk of GI adverse effects
Antacids decrease the effectiveness
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Signs of Addisons
loss of sodium, water and chloride
cardiac output, dehydration, hyperkalemia, hypoglycemia
Acute adrenal crisis: othostatic, muscle weakenss, bronze, body hair changes
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What are 2 adrenocorticoids and what are they used for
how to give
Adrenocorticoids : bind to receptors to decrease inflammation and increase sodium retention for addisons disease
- Hydrocortisone cypionate
- hydrocortison sodium succinate
PO with food to decrease GI upset
Never stop randomly , and increase calcium intake , and montior blood sugar ( it can cause hyperglycemia)
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Considerations while taking adrenocorticoids
No live viruses if on hydrocortisone
assess for htn, chf , and decreased cardiac output
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What are mineralcorticoids used for and how do they work
what to be aware of while on them
Sodium retention and potassium excretion to increase BP
for addisions taken lifelong
limit salt intake, and assess sodium potassium levels, bp, weight
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Signs of Cushings disease
- Too much adrenocortico
- (from tumors or long term glucocorticoid uses)
moon face, facial hair , buffalo hump , thin skin
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Name a 11-Deoxycortisol inhibitor , what is it used for
how to take it
- Ketoconazole
- used to help cushings
Take with fluids to decrease stomach acid, and food
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Considerations with Ketoconazole
- Dont take with antacids
- can cause hepatotoxicity
monitor liver enzymes
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Antineoplastics drugs are used for ?
How to give them
Miotane decreases production of cortisol
used for cushings disease
its a high alert med, hold if trauma ( its just pallative not a cure)
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Miotane considerations
used for inoperable adrenocorticol carcinomas
causes lethargy
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