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Oral Hypoglycemia
are used for type 2 diabetic mellitus only
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Sulfonylureas
stimulate beta cell of pancreas to release insulin.
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Sulfonylureas side effect
- Hypoglycemia
- Nausea, constipation
- Agranulocytosis
- Allergic skin reaction
- Weight gain
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Alpha-glucosidase
inhibitor
oral anti-diabetic drugs used for diabetes mellitus type 2 that work by preventing the digestion of carbohydrates
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Alpha-glucosidase inhibitor side effect
- Flatulence and diarrhea
- Hypoglycemia
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Biguanides
lower blood sugar by blocking glucose production from the liver and increasing sensitivity of body cells to insulin
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Biguanides side effect
- Hypoglycemia
- Abdominal discomfort, nausea and diarrhea
- Metallic taste in the mouth may occur at
- first as your body adjusts to the medication. This okay tell patient it will go away Can cause lactic acidosis-
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Biguanides contraindicated
- Diabetic ketoacidosis
- Liver diseases
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Thiazolidinediones
they increase cell sensitivity to insulin thus allowing insulin to push more glucose into the cell
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Thiazolidinediones side effect
hypoglycemia
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Nursing Teaching in Oral Hypoglycemia
- Teach patient to avoid Aspirin, alcohol they also cause hypoglycemic effect
- Teach the patient to avoid Glucocorticoids, thiazide diuretics, and estrogen because they increase blood glucose levels
- Patient with hypersensitivity reaction to sulfur or urea containing medication cannot take sulfonylurea
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Types of insulin
- Rapid Insulin
- Short acting Insulin
- Intermediate Acting Insulin
- Long Acting Insulin
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Administration of Insulin
- Usually given subcutaneously except regular or rapid insulin that can be given IV under emergencyRotation should be 1.5 inches apart within the
- anatomical site.
- Insulin syringe come in 27 to 29 gauge needle which is
- approximately 0.5 inches long
- DO NOT aspirate when giving the injection
- Administer insulin subcut at 90 degree angle, but If the patient is too thin at 45 degree angle
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Insulin injection site
- Abdomen- best site
- Arm- posteriorsurface
- Thigh- anterior surface
- Hips
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Mixture of insulin
- Draw the Regular insulin into syringe FIRST before drawing the intermediate acting
- Insulin zinc suspension can only be mixed with each other or with regular insulin
- Mixed insulin must be administered within 5 to 15 minutes of preparation otherwise regular insulin will bind to NPH thereby decreasing the action
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Steps involved in mixing insulin in ascending order
- Wipes off vials with alcohol swab
- Inject 12 units of air into NPH (cloudy)vial
- Inject 6 unit of air into Humalog (clear) vial
- Withdraw 6 unit of humalog (clear) insulin
- Withdraw 12 units of NPH (cloudy)insulin
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Storing Insulin
- Do not expose insulin to sunlight or extreme of temperature
- Keep insulin in cool place (refrigerator) but should not be frozen.
- Before administration let it warm to room temperatur Label vial with date, time opened and when due to expire
- Mixture of insulin in prefilled syringes should be kept in the refrigerator flat or with the needle in upright position to avoid clogging the needle
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Complications of insulin therapy
Local allergic reactions
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Insulin complication Nursing intervention
- Instruct the client to avoid the use of alcohol to cleanse the skin prior to injection
- Give antihistamine to be taken 1 hour prior to injection
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Insulin lipodystrophy
Lipoatrophy is loss of subcutaneous fat and appears as slight dimpling or pitting
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Lipohypertrophy
is the development of fibrous fatty masses at the injection site; caused by repeated use of an injection site
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Insulin resistance
occurs when the client receiving insulin develops immune antibodies that bind the insulin, thereby decreasing the insulin available for use in the body.
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Insulin resistance Nursing intervention
Administering a pure form of insulin preparation-Human is the purest
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Dawn phenomenon
- Morning blood glucose levels
- blood glucose level may rise between 4 am and 8am.
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Dawn phenomenon nursing intervention
- includes administering an evening dose of intermediate-acting insulin at 10 PM
- by checking the blood glucose level in the middle of the night (around 3 AM).
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Somogyi's phenomenon
- this occurs during the night when there is rapid drop of blood glucose
- hypoglycemia occurs at 2 to 3 AM
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Insulin waning
- the gradual increase in blood glucose levels from bedtime to morning.
- blood sugars must be checked 3 times over night
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Glucagon-(GlucaGen)
Increases blood glucose level by stimulating glycogenolysis
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Glucagon-(GlucaGen) nursing intervention
All patients with diabetes should have a glucagon emergency kit available.
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Diazoxide (Proglycem)
Increases blood glucose level by inhibiting insulin release from the beta cells and stimulating the release of epinephrine from the adrenal medulla
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Medication used in Growth Hormone disorders ends in
Tropin
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Medication used in Growth Hormone disorders side effects
body can dev antibodies to the growth hormone
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Somatropin (Humatrope)
Used for-Growth failure in children
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Bromocriptine (Parlodel)
inhibit growth hormone
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Somatropin (Humatrope) Side effect
hyperglycemia, hypertension, allergic reaction(rash,swelling), pain at injection site
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Octreotide (Sandostatin)
Uses
inhibit secretion of growth hormone treatment of Acromegaly
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Octreotide (Sandostatin)-Side Effect
Diarrhea, nausea, abdominal discomfort, increased or decreased glucose level
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Octreotide (Sandostatin)- Nursing Interventions
- Teach client how to document monthly height and weight measurements and to report any
- less-than-expected growth to physician
Monitor blood and urine glucose levels and teach the client about the importance of follow-up regarding blood and urine glucose testing
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ANTIDIURETIC HORMONES uses
used in diabetes insipidus
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ANTIDIURETIC Side effects
- tachycardia and Hypertension
- Nasal congestion with nasal administration
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ANTIDIURETIC Contraindication
congestive heart failure ; coronary artery or vascular disease and vasoconstriction causes blood pressure elevation
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THYROID HORMONES
- Used to replace thyroid hormone deficit in the treatment of hypothyroidism, myxedema, or cretinism
- Used to diagnose thyroid deficiency and myxedema
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Tyroid hormone Side effects
- drug over dose can manifiest as signs and symtoms of hyperthyrodism
- hypertension,tachycardia, dysrthmias
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tyroid homone Interventions
- level of thyroxine -T3 and T4 and TSHavoid asprine and tartrazinesavoid food that can inhibit tyroid secretiontyroid has no treatment care so tyroid homones is life long
- i
ntruct patient no to change brand of tyroid medicaton with out doctor approvalintruct client to wear a medi-alert braclet
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ANTITHYROID MEDICATIONS
These are medication that Inhibit the synthesis of thyroid hormone
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anti-thyroid medication side effect
- Agranulocytosis with leucopenia
- Hypothyroidism
- loss of hair- alopecia
- nausea, jaundice, loss of taste
- Diarrhea
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Medication used in Diseases of Adrenal Gland
- Glucocorticoid
- Mineralocorticocoid
- Adrenal androgen
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Glucocorticoid (Corticosteroid)
are medication that have same effect as cortisone produced in the adrenal gland
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Glucocorticoid (Corticosteroid) ending name
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Glucocorticoid (Corticosteroid) Side effects
- decrease immunity
- Fluid and electrolyte imbalance
- Poor wound healing
- direct bone loss leading to increase risk of osteoporosis
- peptic ulcer
- Hyperglycemia
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Glucocorticoid (Corticosteroid) Contraindications
- patient with immunosuppressive condition
- avoid immunizations
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Glucocorticoid (Corticosteroid) Nursing intervention
- Never discontinue or stop the use of glucocorticoid medication abruptly this could lead to a serious adrenal insufficiency. Dosage should be tapered off gradually
- Patient must not increase or decrease dose without consulting the doctor.
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Mineralocorticoid –steroids
acts on kidneys to retain sodium and water but facilitate loss of potassium and hydrogen
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Mineralocorticoid –steroids side effect
- hypertension, tachycardia, edema, weight gain and heart failure
- Hypokalemia
- Metabolic alkalosis- due to loss of hydrogen
- Hypocalcemia
- Thromboembolism
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Adrenocorticotropic hormones
stimulate the adrenal cortex to secrete cortisol.
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PARATHYROID MEDICATIONS
Drug used to treat low calcium –hypocalcemia
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Risedronate (Actonel)
Alendronate (Fosamax)
CALCIUM REGULATORS
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CALCIUM REGULATORS Side Effects
- renal stones
- fatigue, ataxia, irritability, somnolence and seizure. Hypotonia in infant
- Bone-bone decalcification
- distress or constipation
- hypertension, dysrhythimias in a client taking digoxin
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CALCIUM REGULATORS Nursing Intervention
- maintain an adequate intake of vitamin D, because vitamin D enhances absorption of calciumswallow tablet whole with water at least 30 minutes before breakfast and not to lie down for at least 30 minutes after taking medication
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Medications to treat Hypercalcemia
- Promote urinary excretion of calcium
- Inhibit mobilization of calcium from bone to the blood
- Decrease intestinal absorption of calcium
- Bind with free calcium in blood to form complexes that are not calcium
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Side/adverse effects of hypocalcmia
low serum calcium level, which increases neuromuscular excitability
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