Endocrine Medications – Flashcards

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Thyroid Hormones
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Thyroxine (T4) Triiodothyronine (T3) Calcitonin
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Thyroid Function
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Control the rates of cellular metabolism Required for normal growth and development, critical for brain and skeletal development regulates the body's metabolism, increases the rate of glucose, fat, protein metabolism in many tissues increasing body temp
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Hypothyroidism
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Decrease in thyroid hormone secretion
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Hypothyroid Symptoms
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↓ HR, BP, Temp, ↓Cardiac Output Weakness Fatigue Cold intolerance Constipation Weight gain from fluid retention Depression Joint or muscle pain Brittle fingernails Slow speech Decreased concentration Dry, flaky skin Thickening of the skin Puffy face, hands, and feet Decreased hearing Thinning of eyebrows Hoarseness Menstrual disorders-irregular of heavy
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Levothyroxine Action
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Increase metabolism body growth
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Levothyroxine Use
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Treat hypothyroidism, myxedema, cretinism
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Levothyroxine Contraindications
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Thyrotoxicosis, MI, severe renal diseas
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Levothyroxine Interactions
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Increased cardiac insufficiency with epinephrine Increased effects of anticoagulants, TCAs, vasopressors, decongestants Decreased effects of antidiabetics, digitalis Decreased absorption with cholestyramine, colestipol
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Levothyroxine Half-life
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6-7 days
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Levothyroxine BLACK BOX WARNING
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Do not Rx for weight loss or obesity
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Levothyroxine Side effects/adverse effects
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Nervousness, insomnia, weight loss , tremors, Headache Nausea, vomiting, diarrhea, cramps Tachycardia, palpitations, hypertension, dysrhythmias, angina Thyroid crisis
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Levothyroxine Patient teaching
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Take daily at same time each day-preferably on empty stomach before absorption Report any symptoms of hyperthyroidism
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Levothyroxine Laboratory evaluation
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Laboratory monitoring (@6 weeks after initiation or change in dose) Resolution of symptoms
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Hyperthyroidism
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Increase in T4 and T3
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Graves Disease (Thyrotoxicosis)
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the most common type of hyperthyroidism, results from hyperfunction of the thyroid gland-may have mild symptoms
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Thyroid Storm (Thyrotoxic crisis)
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rare but life threatening, emergency situation that can be caused by infection, thyroid surgery in patients with overactive thyroid gland, Stopping medications for hyperthyroidism, excess thyroid hormone replacement, treatment with radioactive iodine
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Symptoms of Mild-Thyrotoxicosis
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Tachycardia and palpitations Excessive perspiration Heat intolerance Nervousness Irritability Exophthalmos Weight loss
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Symptoms of Severe-Thyroid Strom
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Greatly increased body temperature - major sign that differentiates it from ordinary hyperthyroidism -may be as high as 105-106 F Tachycardia and palpitations Chest pain Shortness of breath Anxiety and irritability Disorientation Increased sweating Weakness Heart failure
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Propylthiouracil (PTU) Use
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Hyperthyroidism, Graves Disease, Treat thyrotoxic crisis, Prior to thyroid surgery or radioactive iodine treatment
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Propylthiouracil (PTU) Drug Class
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Thioamide (antithyroid drug)
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Propylthiouracil (PTU) Action
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Inhibits production of Thyroid hormones and the peripheral conversion of T4 to T3
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Propylthiouracil (PTU) Interactions
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Increase ↑effect of Anticoagulants Decrease ↓effect of antidiabetics Digoxin and lithium increase action of thyroid drugs Phenytoin increases T3 level
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Propylthiouricil (PTU) Nursing Considerations
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Monitor vital signs, weight, labs, Side effects- urticaria, headache and GI upset and s/s of hypothyroidism. Administer with meals to prevent GI symptoms Check labels before using OTCs. Advise reporting of symptoms of hypothyroidism and hyperthyroidism.
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Propulthiouracil (PTU) BLACK BOX WARNING
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BLACK BOX WARNING: may cause severe liver damage or liver failure→ DEATH
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Function of Parathyroid Hormone
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Regulates calcium levels in the blood and the bones PTH secreted when calcium levels are decreased Promotes calcium reabsorption from the GI Tract and the renal tubules, and activate Vitamin D.
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Function of Vitamin D
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A fat soluble vitamin that functions as a hormone, must be converted in the liver and the kidney to the active form 1,25-dihydroxyvitamin D or calcitriol Its main action is to raise serum Ca+ by ↑intestinal absorption of Ca+ and mobilizing calcium from bone Low levels causes inadequate absorption of Ca+ and phosphorus
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Function of Calcatonin
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A hormone is produced by the C-cells of the thyroid It has the opposite effect of parathyroid hormone regulates calcium levels in the blood and stimulates bone mineralization Acts to reduce the blood level of calcium and to inhibit bone resorption of calcium Calcitonin helps control bone formation and blood calcium levels
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Hypoparathyroidism
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Most often caused by the removal of or damage to the parathyroid glands during neck surgery— thyroidectomy, parathyroidectomy, or radical neck dissection Results in hypocalcaemia and hyperphosphatemia
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Hypoparathyroidism Treatment
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Prescription form of Vitamin D with Calcium Supplementation Currently no hormone replacement therapy
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Hypoparathyroidism Action
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Correct blood calcium deficit Vitamin D to help body absorb Ca+ and eliminate phosphorus
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Calcitriol (Rocaltrol) Use
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Hypoparathyroidism hypocalcemia associated with chronic renal failure
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Calcitriol (Rocaltrol) Drug Class
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Vitamin D analogue
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Calcitriol (Rocaltrol) Side Effects
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anorexia, nausea, vomiting, diarrhea, cramps, drowsiness, headache, dizziness, lethargy, photophobia (Most common w/ high daily doses)
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Calcitriol (Rocaltrol) Contraindications
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Hypercalcemia, hyperphosphatemia, Vit D toxicity, malabsorption syndrome
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Calcitriol (Rocaltrol) Drug/Food interactions
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Increases cardiac dysrhythmias with digoxin and verapmil Increases serum calcium with thiazide diuretics and calcium supplements.
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Calcitriol (Rocaltrol) Caution
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CV disease renal calculi (kidney stones)
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Calcitriol (Rocaltrol) Nursing Indications
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Monitor calcium levels weekly when beginning treatment
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Calcitriol (Rocaltrol) nursing interventions
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monitor calcium levels Advise reporting of symptoms of hypocalcemia which is tetany (twitching of mouth, tingling and numbness of fingers, carpopedal spasm, spasmodic contraction, laryngeal spasms) Advise reporting of symptoms of hypercalcemia which is bone pain, anorexia, n&v, thirst, constipation, lethargy, bradycardia, polyuria warn about checking OTC drugs for calcium content-contact healthcare provider before use
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Calcium
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Absorption occurs in the small intestines PTH and Vitamin D increase the amount of CA+ absorbed Supplementation is needed when intake does not meet the body's requirements and for chronic hypocalcemia Hypocalcemia is uncommon in the elderly Used to treat hyperphosphatemia
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Hypocalcemia signs and symptoms
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Numbness and tingling sensations in the perioral area or in the fingers and toes Muscle cramps Irritability Impaired intellectual capacity depression fatigue seizures
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Hypercalcemia Signs and symptoms
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Stones Bones:Bone pain Groans: Abdominal pain, nausea and vomiting Thrones: Polyuria Psychiatric overtones: Insomnia Anorexia confusion
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Hyperparathyroidism
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Most often due to a tumor or hyperplasia of parathyroid gland
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Hyperparathyroidism Treatment
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Parathyroidectomy Hydration therapy Encourage mobility Encourage fluid, reduce dietary calcium, and Vitamin D intake
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Alendronate (Fosamax) drug class
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Bisphosphonate
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Alendronate (Fosamax) Action
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Suppresses osteoclast activity
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Alendronate (Fosamax) Use
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Prevent and treat osteoporosis
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Alendronate (Fosamax) Caution
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Not recommended in severe renal impairment
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Alendronate (Fosamax) Adverse effects
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esophagitis, dysphagia, esophageal ulcers and erosion, heachache, musculoskeletal pain, hypocalcemia.
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Alendronate (Fosamax) Contraindication
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Esophageal abnormalties causing delayed esophageal emptying inability to stand or sit upright for 30 minutes Hypocalcemia needs to be corrected prior to beginning treatment
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Alendronate (Fosamax) Nursing implications
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Administer on empty stomach with full glass of water 30 minutes before breakfast Patient must remain upright for at least 30 minutes after administration Teach to report symptoms to healthcare provider
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Glucocorticoids (cortisol)
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(SUGAR) Promote Na+ retention and K+ excretion Hyposecretion; Addison's disease Hypersecretion: Cushings
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Mineralocorticoids (Aldosterone)
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(SALT) Promotes sodium and water retention to control blood pressure and balance fluid and electrolytes
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Adrenocorticotropic Hormone
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flows through the blood to the adrenal glands to tell them to produce more cortisol.
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Cushing's Syndome
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Excess levels of circulating glucocorticoids
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Addison's Disease
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Deficiency of glucocorticoids and mineralocorticoids
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Difference in Cushing's Disease and Syndrome
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Disease: Hypersecretion of ACTH from the pituitary gland Caused by a tumor of the pituitary gland Syndrome: when the ACTH is secreted by a tumor of the adrenal gland or some drugs that may cause it (Corticosteriods) Caused by overproduction of cortisol for any reason
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Treatment of Cushing's Disease
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Depends upon the cause with surgical being the most common treatment Surgical resection of the tumor the treatment of choice Primary therapy for Cushing's disease is transsphenodial surgery. Primary therapy for adrenal tumors is adrenalectomy
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Nizoral (Ketoconazole) Use
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Control cortisol secretion
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Nizoral (Ketoconazole) Adverse effects
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Pruritus, Headache, abdominal pain, n/v, gynecomastia
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Nizoral (Ketoconazole) Nursing Implications
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Stomach acid enhances absorption Monitor blood glucose Monitor for adverse effects
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Nizoral (Ketoconazole) Black Box Warning
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Can cause hepatotoxicity
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Most common cause of Addison's disease
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abrupt cessation of long term, high dose glucocorticoid therapy
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Treatment of Addison's Disease
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Hydrocortisone (Solu-Cortef) Fludrocortisone (Florinef)
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Hydrocortisone (Solu-Cortef) Use
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Used for adrenal insufficiency, inflammation, Addison's disease
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Hydrocortisone Adverse effects
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shock, MI, vertigo, H/A, depression, fragile skin, petechiae and eccymoses, peptic ulcers, decrease in appetite and weight gain, hyperglycemia, osteoporosis, impaired wound healing
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Hydrocorisone (Solu-cortef) Containdications
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Hypersensitivity and serious infection
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Hydrocortisone (Solu-cortef) Nursing considerations
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Needs to weaned off Abrupt withdrawl can cause severe adrenocortical insufficienty Monitor serum potassium levels monitor blood sugar
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Hydrocortisone (Solu-cortef) patient teaching
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avoid alcohol administer with food monitor for side effects
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Hydrocortisone (Solu-cortef0 Black Box Warning
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Do not administer live vaccines to patients receiving treatment with hydrocortisone
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Side Effects of Medications to treat adrenal insufficiency
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from prolonged or high dose: Hyperglycemia and hypertension Diabetes Osteoporosis Thinned Skin, easy bruising, impaired wound healing immunosuppresion and masking of infections abnormal fat deposits in face and trunk growth retardation decreased extremity size
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Medications to treat Adrenal Insufficiency drug/Herb interaction
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Herbal laxatives: Hypokalemia Diuretic: hypokalemia Ginseng-CNS stimulation and insomnia Echinacea Licorice: Potentiate effects and worsen K+ loss
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Drug/drug interaction with medications to treat adrenal insufficiency
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Increase requirements of insulin and hypoglycemic agents NSAIDS and Aspirin- Increase risk for GI Bleeding and ulcers K+ Wasting diuretics: Increase K+ loss Barbiturates, phenytoin and Rifampin decrease the effects
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Gigantism
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the onset of growth hormone hyper-secretion before puberty Skeletal changes permanent Cause: frequently due to a pituitary tumor Treatment : Surgical Intervention or Somatostatin
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Acromegaly
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growth hormone hyper-secretion after puberty and closure of growth plates in bone Increased skeletal thickness Hypertrophy of the skin Enlargement: Heart Liver
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Dwarfism
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Growth hormone deficiency Congenital- Pituitary abnormality; Certain syndromes Acquired: Tumor Infection Injury Surgery Radiation to head
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Idiopathic Short Stature
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when a child's stature falls below 2 standard deviations of the mean for age with no endocrine, metabolic, or condition to account for the GH deficiency
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Somatropin (human GH) (Humatrope) Use
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Growth hormone deficiency
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Somatropin (human GH) (Humatrope) Action
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promotes bone growth at epiphyseal plates of long bones, also ↑ lean body mass and bone mass, ↓ fat mass, stimulates erythropoietin increasing RBCs, ↑ protein syntheses and hepatic glucose output and improves GI tract absorption of nutrients
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Somatropin (human GH) (Humatrope) Side Effects
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hyperglycemia, insulin resistance, hypersensitivity;
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Somatropin (human GH) (Humatrope) Contraindications
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children who have growth deficiency due to Prader-Willi syndrome, severely obese children and those with respiratory impairment
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Somatropin (human GH) (Humatrope) Nursing Implications
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monitor blood sugar and electrolytes
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Somatropin (human GH) (Humatrope) Patient Teaching
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Diabetic patients-closely monitor blood sugar, monitor growth, must be given prior to epiphyses fusion
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Diabetes Insipidus
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Disorder of water metabolism problem caused by a deficiency of ADH: Produce large amount of urine (polyuria) 4-30 Liters Drink large volumes of fluid (polydipsia) The kidneys filter water but do not reabsorb it Hypernatremia with an > serum osmolality
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Cause of Diabetes Insipidus
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Stroke, Head injury or Brain tumor resulting in trauma to the hypothalamus and pituitary gland
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Side Effects of Diabetes Insipidus
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Dehydration - most manifestations of DI are related to dehydration Fatigue Headache Muscle weakness and pain Polydipsia Polyuria Tachycardia Weight loss Dizziness If untreated, DI can result in circulatory collapse and CNS depression or damage
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Treatment of Diabetes Insipidus
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ADH replacement Vasopressin [Pitressin]
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Nursing Interventions for Diabetes Insipidus
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Fluid and electrolyte imbalance must be closely monitored Monitor vital signs, Monitor Intake and output Early detection dehydration and maintenance of adequate hydration Daily weights
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Desmopressin acetate (DDAVP) Action
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Promotes reabsorption of water from renal tubules
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Desmopressin acetate (DDAVP) Use
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Treatment of Diabetes Insipidus
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Desmopressin acetate (DDAVP) Side Effect
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most common is Redness, swelling and burning of the parenteral site
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Desmopressin acetate (DDAVP) Nursing Implications
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Desired effect is urine specific gravity, < s/s of dehydration and < thirst Monitor pt for hyponatremia and hypokalemia and s/s of rehydration Pt teaching: pt needs to report drowsiness, H/A, dizziness, lethargy, SOB, abd cramping, gastric irritation, nasal congestion & irritation
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Desmopressin acetate (DDAVP) Black Box Warning
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HYPONATREMIA MAY DEVELOP DUE TO MEDICATION CAUSING SEIZURES and CHANGE IN FLUID VOLUME STATUS MAY RESULT IN CARDIAC IN ARREST IN PATIENTS WITH KNOWN CVD
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Oral hypoglycemic drugs
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appropriate for patient whose pancreas is still producing some insulin and in insulin resistance. They work in different ways to help maintain normal glucose levels
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Sulfonylureas
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stimulate the pancreas to secrete more insulin, increase the tissue response to insulin, or decrease the glucose production by the liver.
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Biguanides
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decrease production of glucose by the liver and decrease the absorption of glucose from the small intestine.
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Alpha glucosidase inhibitors
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inhibit the enzyme that facilitates the release of glucose from complex carbohydrates in the small intestine.
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Thiazolidinedione
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work by decreasing insulin resistance by the body tissues.
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Meglitinides
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help the pancreas secrete more insulin. These are short-acting drugs and should not be prescribed for clients with liver dysfunction.
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Incretin modifiers
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increase insulin secretion by the pancreas and decrease the secretion of glucagon, which decreases glucose production.
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2nd generation sulfonylurea
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Glyburide (DiaBeta); Glipizide (Glucotrol)
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2nd generation sulfonylurea action
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stimulates pancreatic beta cells to secrete insulin
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2nd generation sulfonylurea Use
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treatment of Type 2 diabetes
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2nd generation sulfonylurea Contraindication
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Sulfa allergy Diabetic ketoacidosis Type 1 diabetes pregnancy and lactation
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2nd generation sulfonylurea side effects
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hypoglycemia leukopenia thrombocytopenia weight gain
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Caution in 2nd generation sulfonylurea
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in older adults hepatic or renal dysfunction adrenal or pituitary insufficiency
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Interactions in 2nd generation sulfonylurea
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Alcohol ↑the half-life of sulfonylureas and may > hypoglycemia, flushing
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Drug Interactions when using sulfonylurea
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alcohol, cimetidine (Tagamet), phenytoin, and some NSAIDS-may ↑risk for hypoglycemia; Glucocorticoids, thiazide diuretics, and estrogen ↑ blood glucose, beta blockers-mask effects of hypoglycemia, oral hypoglycemics
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meglitinide drug
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Repaglandine (Prandin)
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Meglitinide use
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Type 2 Diabetes
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Meglitinide Side Effect
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hypoglycemia, nausea, headache
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Caution when using meglitinide
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Impaired liver function
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drug Interactions when using Meglitinide
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Gemfibrozil and Itraconazole (co-administration with Prandin resulted in a 19-fold higher repaglinide AUC and prolonged repaglinide half-life to 6.1 hr)
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Meglitinide Contraindications
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impaired liver function, non-functioning beta cells, Type 1 DM, DKA
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Meglitinide Nursing Implications
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take medication within 15 -30 minutes of the meal (15 is preferable, 30 minutes maximum), if skipping a meal -do not take medication that meal
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Biguanide Class drug
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Metformin (Glucophage)
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Biguanide Action
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It improve the utilization of glucose by:↑binding of insulin to insulin receptors, improves insulin sensitivity, ↑glucose transport to muscle and fatty tissue, ↓glucose production in the liver, ↓glucose absorption from the intestines
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Biguanide Use
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Type 2 Diabetes
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Biguanide Side Effects
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diarrhea and abdominal cramps, nausea, vomiting
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Biguanide Adverse Reactions
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Lactic acidosis-rare but can be life-threatening, malabsorption of amino acids, vitamin B12 and folic acid
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Biguanide Contraindication
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Concurrent infection, hepatic or renal dysfunction, hx of Lactic acidosis, serious heart, renal or liver impairment, alcoholism
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Caution when using Biguanide
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pregnancy and lactation
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Drug/drug interactions when using Biguanide
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Cimetidine (Tagamet), Furosemide (Lasix)
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Interactions when using Biguanide
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IV contrast dye may > lactic acidosis or acute renal failure-should be held 48 hrs before and after patient receives IV contrast dye, alcohol, steroids
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Nursing Indications when
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BUN and creatinine prior to beginning med, Hold metformin prior to diagnostic test using IV contrast, BUN and creatinine should be checked prior to resuming metformin after IV contrast dye, does not produce hypo or hyperglycemia, it is not metabolized in the liver and is excreted unchanged in the urine, monitor liver function tests (hepatotoxicity in <1%)
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BLACK BOX WARNING for Biguanide
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THOSE 80 years of age and up should not take metformin due to > risk of lactic acidosis
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Thiazolidinediones (TZDs) Class drugs
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Rosiglitazone (Avandia) Pioglitazone (Actos)
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Thiazolidinediones (TZDs) Action
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insulin sensitizer, insulin resistance and glucose production by the liver, uptake of glucose by peripheral tissue and stimulates receptors on muscle, fat and liver cells
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Thiazolidinediones (TZDs) Use
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Type 2 DM
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Thiazolidinediones (TZDs) Adverse Effects
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liver injury
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Thiazolidinediones (TZDs) Contraindications
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Heart failure, MI
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Thiazolidinediones (TZDs) Nursing Implications
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administer with meals, monitor cardiopulmonary status, monitor liver enzymes. Teach patient s/s to report-dyspnea, fatigue, edema
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Thiazolidinediones (TZDs) Black Box Warning
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Heart failure and MI for Rosi, HF for Pio
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DPP-4 inhibitor Class drug
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Sitagliptin phosphate (Januvia)
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Sitagliptin phosphate (Januvia) Action
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They work by affecting the incretin hormone GLP-1, they decreasing the rate that the incretin hormones are deactivated causing an insulin release in response to food intake. This increases and lengthens the release of insulin and decreases hepatic glucose production
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Sitagliptin phosphate (Januvia) Use
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Type 2 D
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Sitagliptin phosphate (Januvia) Adverse Effects
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Upper Respiratory Infection
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Sitagliptin phosphate (Januvia) Contraindications
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Type 1 DM, Insulin use, end-stage renal disease
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Sitagliptin phosphate (Januvia) Nursing Implications
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may take with or without food, monitor blood glucose and HgbA1C levels, monitor renal function Caution in use with Renal Insufficiency-requires dose adjustment
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incretin mimetic class drugs
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Exenatide (Byetta)
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Exenatide (Byetta) Use
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Type 2 DM
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Exenatide (Byetta) Action
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stimulates the pancreas to secrete insulin based on food intake, stops gluconeogenesis by the liver, slows gastric emptying, increases satiety
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Exenatide (Byetta) Adverse Effects
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nausea, Rare but serious- acute pancreatitis
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Exenatide (Byetta) Contraindications
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lactation, use with caution in patients with elevated liver enzymes and taking statins
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Exenatide (Byetta) Nursing implications
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may delay the absorption of concurrent medications due to slowed gastric emptying, administer SC bid within 60 minutes of am and pm meal and at least 6 hours apart, do not administer after a meal
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amylin analog Class Drug
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Pramlintide (Symlin)
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Pramlintide (Symlin) Action
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slows gastric emptying, suppresses postprandial glucagon secretion, > satiety
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Pramlintide (Symlin) Use
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type 2 DM ( Symlin is indicated as an adjunctive treatment in patients with type 1 or type 2 diabetes who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy)
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Pramlintide (Symlin) Contraindications
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allergy gastroparesis
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Pramlintide (Symlin) Nursing Implications
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`↑effects of other meds that delay gastric emptying (anticholinergics and drugs that slow gastric absorption), It is given SC prior to meals- hold if patient NPO or skipping meal, Inject into thigh or abdomen at least 2" away from the insulin site injection, DO NOT mix in syringe with insulin, patients taking oral hypoglycemics need to separate these meds by 1 hr before or 2 hours after injecting pramlintide.
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Pramlintide (Symlin) BLACK BOX WARNING
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SEVERE INSULIN INDUCED HYPOGLYCEMIA
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Rapid Acting Insulin Drugs
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Insulin Aspart (Novolog) Insulin Lispro (Humalog) and Insulin Glulisine (Apidra)
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Rapid Acting Insulin Onset
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Insulin Lispro (Humalog) 15 minutes Insulin Aspart (Novolog) 15 minutes Insulin Glulisine (Apidra) 5-10 minutes
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Rapid Acting Insulin Peak
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Insulin Lispro (Humalog) 1-1.5 hours Insulin Aspart (Novolog) 1-3 hours Insulin Glulisine (Apidra) 1 hour
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Rapid Acting Insulin Duration
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Insulin Lispro (Humalog) 6-8 hours Insulin Aspart (Novolog) 3-5 hours Insulin Glulisine (Apidra) 4 hours
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Regular or Short-Acting Insulin Drugs
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Humulin R and Novolin R
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Regular or Short-Acting Insulin Onset
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30 minutes
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Regular or Short-Acting Insulin Peak
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2-4 hours
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Regular or Short-Acting Insulin Duration
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6-8 hours
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Intermediate Insulin Drugs
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NPH, Humulin N, Novolin N
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Intermediate Insulin Onset
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1-2 hours
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Intermediate Insulin Peak
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8-12 hours
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Intermediate Insulin Duration
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18-24 hours
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Long Acting Insulin Drugs
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Insulin Levemir (Detemir) Insulin Glargine (Lantus)
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Insulin Levemir (Detemir) Onset
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1 hour
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Insulin Levemir (Detemir) Peak
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There is no peak
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Insulin Levemir (Detemir) Duration
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6-23 hours
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Insulin Glargine (Lantus) Onset
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1 hour
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Insulin Glargine (Lantus) Peak
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There is no peak
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Insulin Glargine (Lantus) Duration
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24 hours
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Insulin Indications
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Type 1 diabetes or Type 2 diabetes uncontrolled by lifestyle modifications and oral hypoglycemics, Gestational Diabetes
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Insulin Action
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Promotes use of glucose by body cells, storage of glucose as glycogen
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Insulin Side effects
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confusion, agitation, tremors, headache, flushing, hunger, weakness, lethargy, fatigue, urticaria, redness, irritation or swelling at injection site
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Insulin Adverse Effects
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Hypoglycemic reactions, rebound hyperglycemia, lipodystrophy, Insulin shock, anaphylaxis
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Drug Interactions with Insulin
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Increased hypoglycemic effect with: Aspirin, oral anticoagulants, alcohol, oral hypoglycemics, beta blockers, tricyclic antidepressants, MAOIs, tetracycline. Decreased effect of Insulin with: thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking
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Short-Acting Insulin Nursing Implications
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Used alone as sliding scale coverage or in combination with NPH Insulin (Clear→Cloudy) or (RN Regular then NPH) Generally given 30 minutes prior to meal Only Insulin administered IV
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Intermediate Acting Insulin Nursing Implications
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Used alone or in combination with short acting insulin
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Long-Acting Insulin Nursing Implications
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Given once daily-Usually at bedtime
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Signs and Symptoms of Hypoglycemia
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Headache Hunger Lightheadedness, weakness, fatigue Nervousness, Apprehension Moody, irritable Tremor, trembling Sweating cold, clammy skin Tachycardia Slurred speech Memory lapse Confusion, incoherent, difficulty concentrating Seizures Coma
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Glucagon
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Medication that treats hypoglycemia
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Glucagon Use
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treatment of Insulin shock, severe hypoglycemia administer 0.5-1 mg; beta blocker and calcium channel blocker overdose (reverses effects-3mg IV then a continuous infusion)
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Glucagon Action
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elevates blood sugar by stimulating glucogen breakdown (glycogenolysis)
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Glucagon Nursing Implications
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may be given subQ, IM or IV, Use when Dextrose 50% is unavailable
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Glucagon Side Effects
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uncommon but may have nausea, vomiting, allergic reaction
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Pituitary Hormones
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FLAGTOP ♦Follicle stimulating hormone ♦Luteinizing hormone ♦Adrenocorticotropic hormone ♦Growth hormone ♦Thyroid stimulating hormone ♦Oxytocin ♦Prolactin
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Steroid Side Effects
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♣Buffalo hump ♣Easy bruising ♣Cataracts ♣Larger appetite ♣Obesity ♣Moonface ♣Euphoria ♣Thin arms & legs ♣Hypertension/ Hyperglycaemia ♣Avascular necrosis of femoral head ♣Skin thinning ♣Osteoporosis ♣Negative nitrogen balance ♣Emotional liability
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Signs of CUSHINGS
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♣Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne) ♣Urinary free corisol and glucose increase ♣Striae/ Suppressed immunity ♣Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism ♣Iatrogenic (Increased administration of corticosteroids) ♣Noniatrogenic (Neoplasms) ♣Glucose intolerance/ Growth retardation
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Factors of Diabetic Ketoacidosis
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♣Infection ♣Ischaemia (cardiac, mesenteric) ♣Infarction ♣Ignorance (poor control) ♣Intoxication (alcohol)
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signs of diabetic Ketoacidosis
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Dehydrated ♣Ketones/ Kussmaul breathing/ K drops ♣Acidosis
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6 Causes of Hypernatremia
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♣Diuretics ♣Dehydration ♣Diabetes insipidus ♣Docs (iatrogenic) ♣Diarrhea ♣Disease: kidney, sickle cell, etc
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Thyroid Hormones
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Thyroxine (T4) Triiodothyronine (T3) Calcitonin
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Thyroid Function
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Control the rates of cellular metabolism Required for normal growth and development, critical for brain and skeletal development regulates the body's metabolism, increases the rate of glucose, fat, protein metabolism in many tissues increasing body temp
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Hypothyroidism
answer
Decrease in thyroid hormone secretion
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Hypothyroid Symptoms
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↓ HR, BP, Temp, ↓Cardiac Output Weakness Fatigue Cold intolerance Constipation Weight gain from fluid retention Depression Joint or muscle pain Brittle fingernails Slow speech Decreased concentration Dry, flaky skin Thickening of the skin Puffy face, hands, and feet Decreased hearing Thinning of eyebrows Hoarseness Menstrual disorders-irregular of heavy
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Levothyroxine Action
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Increase metabolism body growth
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Levothyroxine Use
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Treat hypothyroidism, myxedema, cretinism
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Levothyroxine Contraindications
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Thyrotoxicosis, MI, severe renal diseas
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Levothyroxine Interactions
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Increased cardiac insufficiency with epinephrine Increased effects of anticoagulants, TCAs, vasopressors, decongestants Decreased effects of antidiabetics, digitalis Decreased absorption with cholestyramine, colestipol
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Levothyroxine Half-life
answer
6-7 days
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Levothyroxine BLACK BOX WARNING
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Do not Rx for weight loss or obesity
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Levothyroxine Side effects/adverse effects
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Nervousness, insomnia, weight loss , tremors, Headache Nausea, vomiting, diarrhea, cramps Tachycardia, palpitations, hypertension, dysrhythmias, angina Thyroid crisis
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Levothyroxine Patient teaching
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Take daily at same time each day-preferably on empty stomach before absorption Report any symptoms of hyperthyroidism
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Levothyroxine Laboratory evaluation
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Laboratory monitoring (@6 weeks after initiation or change in dose) Resolution of symptoms
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Hyperthyroidism
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Increase in T4 and T3
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Graves Disease (Thyrotoxicosis)
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the most common type of hyperthyroidism, results from hyperfunction of the thyroid gland-may have mild symptoms
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Thyroid Storm (Thyrotoxic crisis)
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rare but life threatening, emergency situation that can be caused by infection, thyroid surgery in patients with overactive thyroid gland, Stopping medications for hyperthyroidism, excess thyroid hormone replacement, treatment with radioactive iodine
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Symptoms of Mild-Thyrotoxicosis
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Tachycardia and palpitations Excessive perspiration Heat intolerance Nervousness Irritability Exophthalmos Weight loss
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Symptoms of Severe-Thyroid Strom
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Greatly increased body temperature - major sign that differentiates it from ordinary hyperthyroidism -may be as high as 105-106 F Tachycardia and palpitations Chest pain Shortness of breath Anxiety and irritability Disorientation Increased sweating Weakness Heart failure
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Propylthiouracil (PTU) Use
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Hyperthyroidism, Graves Disease, Treat thyrotoxic crisis, Prior to thyroid surgery or radioactive iodine treatment
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Propylthiouracil (PTU) Drug Class
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Thioamide (antithyroid drug)
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Propylthiouracil (PTU) Action
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Inhibits production of Thyroid hormones and the peripheral conversion of T4 to T3
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Propylthiouracil (PTU) Interactions
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Increase ↑effect of Anticoagulants Decrease ↓effect of antidiabetics Digoxin and lithium increase action of thyroid drugs Phenytoin increases T3 level
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Propylthiouricil (PTU) Nursing Considerations
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Monitor vital signs, weight, labs, Side effects- urticaria, headache and GI upset and s/s of hypothyroidism. Administer with meals to prevent GI symptoms Check labels before using OTCs. Advise reporting of symptoms of hypothyroidism and hyperthyroidism.
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Propulthiouracil (PTU) BLACK BOX WARNING
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BLACK BOX WARNING: may cause severe liver damage or liver failure→ DEATH
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Function of Parathyroid Hormone
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Regulates calcium levels in the blood and the bones PTH secreted when calcium levels are decreased Promotes calcium reabsorption from the GI Tract and the renal tubules, and activate Vitamin D.
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Function of Vitamin D
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A fat soluble vitamin that functions as a hormone, must be converted in the liver and the kidney to the active form 1,25-dihydroxyvitamin D or calcitriol Its main action is to raise serum Ca+ by ↑intestinal absorption of Ca+ and mobilizing calcium from bone Low levels causes inadequate absorption of Ca+ and phosphorus
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Function of Calcatonin
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A hormone is produced by the C-cells of the thyroid It has the opposite effect of parathyroid hormone regulates calcium levels in the blood and stimulates bone mineralization Acts to reduce the blood level of calcium and to inhibit bone resorption of calcium Calcitonin helps control bone formation and blood calcium levels
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Hypoparathyroidism
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Most often caused by the removal of or damage to the parathyroid glands during neck surgery— thyroidectomy, parathyroidectomy, or radical neck dissection Results in hypocalcaemia and hyperphosphatemia
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Hypoparathyroidism Treatment
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Prescription form of Vitamin D with Calcium Supplementation Currently no hormone replacement therapy
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Hypoparathyroidism Action
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Correct blood calcium deficit Vitamin D to help body absorb Ca+ and eliminate phosphorus
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Calcitriol (Rocaltrol) Use
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Hypoparathyroidism hypocalcemia associated with chronic renal failure
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Calcitriol (Rocaltrol) Drug Class
answer
Vitamin D analogue
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Calcitriol (Rocaltrol) Side Effects
answer
anorexia, nausea, vomiting, diarrhea, cramps, drowsiness, headache, dizziness, lethargy, photophobia (Most common w/ high daily doses)
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Calcitriol (Rocaltrol) Contraindications
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Hypercalcemia, hyperphosphatemia, Vit D toxicity, malabsorption syndrome
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Calcitriol (Rocaltrol) Drug/Food interactions
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Increases cardiac dysrhythmias with digoxin and verapmil Increases serum calcium with thiazide diuretics and calcium supplements.
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Calcitriol (Rocaltrol) Caution
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CV disease renal calculi (kidney stones)
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Calcitriol (Rocaltrol) Nursing Indications
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Monitor calcium levels weekly when beginning treatment
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Calcitriol (Rocaltrol) nursing interventions
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monitor calcium levels Advise reporting of symptoms of hypocalcemia which is tetany (twitching of mouth, tingling and numbness of fingers, carpopedal spasm, spasmodic contraction, laryngeal spasms) Advise reporting of symptoms of hypercalcemia which is bone pain, anorexia, n&v, thirst, constipation, lethargy, bradycardia, polyuria warn about checking OTC drugs for calcium content-contact healthcare provider before use
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Calcium
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Absorption occurs in the small intestines PTH and Vitamin D increase the amount of CA+ absorbed Supplementation is needed when intake does not meet the body's requirements and for chronic hypocalcemia Hypocalcemia is uncommon in the elderly Used to treat hyperphosphatemia
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Hypocalcemia signs and symptoms
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Numbness and tingling sensations in the perioral area or in the fingers and toes Muscle cramps Irritability Impaired intellectual capacity depression fatigue seizures
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Hypercalcemia Signs and symptoms
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Stones Bones:Bone pain Groans: Abdominal pain, nausea and vomiting Thrones: Polyuria Psychiatric overtones: Insomnia Anorexia confusion
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Hyperparathyroidism
answer
Most often due to a tumor or hyperplasia of parathyroid gland
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Hyperparathyroidism Treatment
answer
Parathyroidectomy Hydration therapy Encourage mobility Encourage fluid, reduce dietary calcium, and Vitamin D intake
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Alendronate (Fosamax) drug class
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Bisphosphonate
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Alendronate (Fosamax) Action
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Suppresses osteoclast activity
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Alendronate (Fosamax) Use
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Prevent and treat osteoporosis
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Alendronate (Fosamax) Caution
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Not recommended in severe renal impairment
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Alendronate (Fosamax) Adverse effects
answer
esophagitis, dysphagia, esophageal ulcers and erosion, heachache, musculoskeletal pain, hypocalcemia.
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Alendronate (Fosamax) Contraindication
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Esophageal abnormalties causing delayed esophageal emptying inability to stand or sit upright for 30 minutes Hypocalcemia needs to be corrected prior to beginning treatment
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Alendronate (Fosamax) Nursing implications
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Administer on empty stomach with full glass of water 30 minutes before breakfast Patient must remain upright for at least 30 minutes after administration Teach to report symptoms to healthcare provider
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Glucocorticoids (cortisol)
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(SUGAR) Promote Na+ retention and K+ excretion Hyposecretion; Addison's disease Hypersecretion: Cushings
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Mineralocorticoids (Aldosterone)
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(SALT) Promotes sodium and water retention to control blood pressure and balance fluid and electrolytes
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Adrenocorticotropic Hormone
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flows through the blood to the adrenal glands to tell them to produce more cortisol.
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Cushing's Syndome
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Excess levels of circulating glucocorticoids
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Addison's Disease
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Deficiency of glucocorticoids and mineralocorticoids
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Difference in Cushing's Disease and Syndrome
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Disease: Hypersecretion of ACTH from the pituitary gland Caused by a tumor of the pituitary gland Syndrome: when the ACTH is secreted by a tumor of the adrenal gland or some drugs that may cause it (Corticosteriods) Caused by overproduction of cortisol for any reason
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Treatment of Cushing's Disease
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Depends upon the cause with surgical being the most common treatment Surgical resection of the tumor the treatment of choice Primary therapy for Cushing's disease is transsphenodial surgery. Primary therapy for adrenal tumors is adrenalectomy
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Nizoral (Ketoconazole) Use
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Control cortisol secretion
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Nizoral (Ketoconazole) Adverse effects
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Pruritus, Headache, abdominal pain, n/v, gynecomastia
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Nizoral (Ketoconazole) Nursing Implications
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Stomach acid enhances absorption Monitor blood glucose Monitor for adverse effects
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Nizoral (Ketoconazole) Black Box Warning
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Can cause hepatotoxicity
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Most common cause of Addison's disease
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abrupt cessation of long term, high dose glucocorticoid therapy
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Treatment of Addison's Disease
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Hydrocortisone (Solu-Cortef) Fludrocortisone (Florinef)
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Hydrocortisone (Solu-Cortef) Use
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Used for adrenal insufficiency, inflammation, Addison's disease
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Hydrocortisone Adverse effects
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shock, MI, vertigo, H/A, depression, fragile skin, petechiae and eccymoses, peptic ulcers, decrease in appetite and weight gain, hyperglycemia, osteoporosis, impaired wound healing
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Hydrocorisone (Solu-cortef) Containdications
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Hypersensitivity and serious infection
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Hydrocortisone (Solu-cortef) Nursing considerations
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Needs to weaned off Abrupt withdrawl can cause severe adrenocortical insufficienty Monitor serum potassium levels monitor blood sugar
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Hydrocortisone (Solu-cortef) patient teaching
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avoid alcohol administer with food monitor for side effects
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Hydrocortisone (Solu-cortef0 Black Box Warning
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Do not administer live vaccines to patients receiving treatment with hydrocortisone
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Side Effects of Medications to treat adrenal insufficiency
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from prolonged or high dose: Hyperglycemia and hypertension Diabetes Osteoporosis Thinned Skin, easy bruising, impaired wound healing immunosuppresion and masking of infections abnormal fat deposits in face and trunk growth retardation decreased extremity size
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Medications to treat Adrenal Insufficiency drug/Herb interaction
answer
Herbal laxatives: Hypokalemia Diuretic: hypokalemia Ginseng-CNS stimulation and insomnia Echinacea Licorice: Potentiate effects and worsen K+ loss
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Drug/drug interaction with medications to treat adrenal insufficiency
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Increase requirements of insulin and hypoglycemic agents NSAIDS and Aspirin- Increase risk for GI Bleeding and ulcers K+ Wasting diuretics: Increase K+ loss Barbiturates, phenytoin and Rifampin decrease the effects
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Gigantism
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the onset of growth hormone hyper-secretion before puberty Skeletal changes permanent Cause: frequently due to a pituitary tumor Treatment : Surgical Intervention or Somatostatin
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Acromegaly
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growth hormone hyper-secretion after puberty and closure of growth plates in bone Increased skeletal thickness Hypertrophy of the skin Enlargement: Heart Liver
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Dwarfism
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Growth hormone deficiency Congenital- Pituitary abnormality; Certain syndromes Acquired: Tumor Infection Injury Surgery Radiation to head
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Idiopathic Short Stature
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when a child's stature falls below 2 standard deviations of the mean for age with no endocrine, metabolic, or condition to account for the GH deficiency
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Somatropin (human GH) (Humatrope) Use
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Growth hormone deficiency
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Somatropin (human GH) (Humatrope) Action
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promotes bone growth at epiphyseal plates of long bones, also ↑ lean body mass and bone mass, ↓ fat mass, stimulates erythropoietin increasing RBCs, ↑ protein syntheses and hepatic glucose output and improves GI tract absorption of nutrients
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Somatropin (human GH) (Humatrope) Side Effects
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hyperglycemia, insulin resistance, hypersensitivity;
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Somatropin (human GH) (Humatrope) Contraindications
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children who have growth deficiency due to Prader-Willi syndrome, severely obese children and those with respiratory impairment
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Somatropin (human GH) (Humatrope) Nursing Implications
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monitor blood sugar and electrolytes
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Somatropin (human GH) (Humatrope) Patient Teaching
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Diabetic patients-closely monitor blood sugar, monitor growth, must be given prior to epiphyses fusion
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Diabetes Insipidus
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Disorder of water metabolism problem caused by a deficiency of ADH: Produce large amount of urine (polyuria) 4-30 Liters Drink large volumes of fluid (polydipsia) The kidneys filter water but do not reabsorb it Hypernatremia with an > serum osmolality
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Cause of Diabetes Insipidus
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Stroke, Head injury or Brain tumor resulting in trauma to the hypothalamus and pituitary gland
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Side Effects of Diabetes Insipidus
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Dehydration - most manifestations of DI are related to dehydration Fatigue Headache Muscle weakness and pain Polydipsia Polyuria Tachycardia Weight loss Dizziness If untreated, DI can result in circulatory collapse and CNS depression or damage
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Treatment of Diabetes Insipidus
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ADH replacement Vasopressin [Pitressin]
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Nursing Interventions for Diabetes Insipidus
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Fluid and electrolyte imbalance must be closely monitored Monitor vital signs, Monitor Intake and output Early detection dehydration and maintenance of adequate hydration Daily weights
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Desmopressin acetate (DDAVP) Action
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Promotes reabsorption of water from renal tubules
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Desmopressin acetate (DDAVP) Use
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Treatment of Diabetes Insipidus
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Desmopressin acetate (DDAVP) Side Effect
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most common is Redness, swelling and burning of the parenteral site
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Desmopressin acetate (DDAVP) Nursing Implications
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Desired effect is urine specific gravity, < s/s of dehydration and < thirst Monitor pt for hyponatremia and hypokalemia and s/s of rehydration Pt teaching: pt needs to report drowsiness, H/A, dizziness, lethargy, SOB, abd cramping, gastric irritation, nasal congestion & irritation
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Desmopressin acetate (DDAVP) Black Box Warning
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HYPONATREMIA MAY DEVELOP DUE TO MEDICATION CAUSING SEIZURES and CHANGE IN FLUID VOLUME STATUS MAY RESULT IN CARDIAC IN ARREST IN PATIENTS WITH KNOWN CVD
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Oral hypoglycemic drugs
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appropriate for patient whose pancreas is still producing some insulin and in insulin resistance. They work in different ways to help maintain normal glucose levels
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Sulfonylureas
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stimulate the pancreas to secrete more insulin, increase the tissue response to insulin, or decrease the glucose production by the liver.
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Biguanides
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decrease production of glucose by the liver and decrease the absorption of glucose from the small intestine.
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Alpha glucosidase inhibitors
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inhibit the enzyme that facilitates the release of glucose from complex carbohydrates in the small intestine.
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Thiazolidinedione
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work by decreasing insulin resistance by the body tissues.
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Meglitinides
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help the pancreas secrete more insulin. These are short-acting drugs and should not be prescribed for clients with liver dysfunction.
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Incretin modifiers
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increase insulin secretion by the pancreas and decrease the secretion of glucagon, which decreases glucose production.
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2nd generation sulfonylurea
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Glyburide (DiaBeta); Glipizide (Glucotrol)
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2nd generation sulfonylurea action
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stimulates pancreatic beta cells to secrete insulin
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2nd generation sulfonylurea Use
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treatment of Type 2 diabetes
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2nd generation sulfonylurea Contraindication
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Sulfa allergy Diabetic ketoacidosis Type 1 diabetes pregnancy and lactation
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2nd generation sulfonylurea side effects
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hypoglycemia leukopenia thrombocytopenia weight gain
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Caution in 2nd generation sulfonylurea
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in older adults hepatic or renal dysfunction adrenal or pituitary insufficiency
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Interactions in 2nd generation sulfonylurea
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Alcohol ↑the half-life of sulfonylureas and may > hypoglycemia, flushing
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Drug Interactions when using sulfonylurea
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alcohol, cimetidine (Tagamet), phenytoin, and some NSAIDS-may ↑risk for hypoglycemia; Glucocorticoids, thiazide diuretics, and estrogen ↑ blood glucose, beta blockers-mask effects of hypoglycemia, oral hypoglycemics
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meglitinide drug
answer
Repaglandine (Prandin)
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Meglitinide use
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Type 2 Diabetes
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Meglitinide Side Effect
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hypoglycemia, nausea, headache
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Caution when using meglitinide
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Impaired liver function
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drug Interactions when using Meglitinide
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Gemfibrozil and Itraconazole (co-administration with Prandin resulted in a 19-fold higher repaglinide AUC and prolonged repaglinide half-life to 6.1 hr)
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Meglitinide Contraindications
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impaired liver function, non-functioning beta cells, Type 1 DM, DKA
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Meglitinide Nursing Implications
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take medication within 15 -30 minutes of the meal (15 is preferable, 30 minutes maximum), if skipping a meal -do not take medication that meal
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Biguanide Class drug
answer
Metformin (Glucophage)
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Biguanide Action
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It improve the utilization of glucose by:↑binding of insulin to insulin receptors, improves insulin sensitivity, ↑glucose transport to muscle and fatty tissue, ↓glucose production in the liver, ↓glucose absorption from the intestines
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Biguanide Use
answer
Type 2 Diabetes
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Biguanide Side Effects
answer
diarrhea and abdominal cramps, nausea, vomiting
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Biguanide Adverse Reactions
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Lactic acidosis-rare but can be life-threatening, malabsorption of amino acids, vitamin B12 and folic acid
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Biguanide Contraindication
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Concurrent infection, hepatic or renal dysfunction, hx of Lactic acidosis, serious heart, renal or liver impairment, alcoholism
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Caution when using Biguanide
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pregnancy and lactation
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Drug/drug interactions when using Biguanide
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Cimetidine (Tagamet), Furosemide (Lasix)
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Interactions when using Biguanide
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IV contrast dye may > lactic acidosis or acute renal failure-should be held 48 hrs before and after patient receives IV contrast dye, alcohol, steroids
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Nursing Indications when
answer
BUN and creatinine prior to beginning med, Hold metformin prior to diagnostic test using IV contrast, BUN and creatinine should be checked prior to resuming metformin after IV contrast dye, does not produce hypo or hyperglycemia, it is not metabolized in the liver and is excreted unchanged in the urine, monitor liver function tests (hepatotoxicity in <1%)
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BLACK BOX WARNING for Biguanide
answer
THOSE 80 years of age and up should not take metformin due to > risk of lactic acidosis
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Thiazolidinediones (TZDs) Class drugs
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Rosiglitazone (Avandia) Pioglitazone (Actos)
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Thiazolidinediones (TZDs) Action
answer
insulin sensitizer, insulin resistance and glucose production by the liver, uptake of glucose by peripheral tissue and stimulates receptors on muscle, fat and liver cells
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Thiazolidinediones (TZDs) Use
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Type 2 DM
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Thiazolidinediones (TZDs) Adverse Effects
answer
liver injury
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Thiazolidinediones (TZDs) Contraindications
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Heart failure, MI
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Thiazolidinediones (TZDs) Nursing Implications
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administer with meals, monitor cardiopulmonary status, monitor liver enzymes. Teach patient s/s to report-dyspnea, fatigue, edema
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Thiazolidinediones (TZDs) Black Box Warning
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Heart failure and MI for Rosi, HF for Pio
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DPP-4 inhibitor Class drug
answer
Sitagliptin phosphate (Januvia)
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Sitagliptin phosphate (Januvia) Action
answer
They work by affecting the incretin hormone GLP-1, they decreasing the rate that the incretin hormones are deactivated causing an insulin release in response to food intake. This increases and lengthens the release of insulin and decreases hepatic glucose production
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Sitagliptin phosphate (Januvia) Use
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Type 2 D
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Sitagliptin phosphate (Januvia) Adverse Effects
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Upper Respiratory Infection
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Sitagliptin phosphate (Januvia) Contraindications
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Type 1 DM, Insulin use, end-stage renal disease
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Sitagliptin phosphate (Januvia) Nursing Implications
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may take with or without food, monitor blood glucose and HgbA1C levels, monitor renal function Caution in use with Renal Insufficiency-requires dose adjustment
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incretin mimetic class drugs
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Exenatide (Byetta)
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Exenatide (Byetta) Use
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Type 2 DM
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Exenatide (Byetta) Action
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stimulates the pancreas to secrete insulin based on food intake, stops gluconeogenesis by the liver, slows gastric emptying, increases satiety
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Exenatide (Byetta) Adverse Effects
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nausea, Rare but serious- acute pancreatitis
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Exenatide (Byetta) Contraindications
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lactation, use with caution in patients with elevated liver enzymes and taking statins
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Exenatide (Byetta) Nursing implications
answer
may delay the absorption of concurrent medications due to slowed gastric emptying, administer SC bid within 60 minutes of am and pm meal and at least 6 hours apart, do not administer after a meal
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amylin analog Class Drug
answer
Pramlintide (Symlin)
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Pramlintide (Symlin) Action
answer
slows gastric emptying, suppresses postprandial glucagon secretion, > satiety
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Pramlintide (Symlin) Use
answer
type 2 DM ( Symlin is indicated as an adjunctive treatment in patients with type 1 or type 2 diabetes who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy)
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Pramlintide (Symlin) Contraindications
answer
allergy gastroparesis
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Pramlintide (Symlin) Nursing Implications
answer
`↑effects of other meds that delay gastric emptying (anticholinergics and drugs that slow gastric absorption), It is given SC prior to meals- hold if patient NPO or skipping meal, Inject into thigh or abdomen at least 2" away from the insulin site injection, DO NOT mix in syringe with insulin, patients taking oral hypoglycemics need to separate these meds by 1 hr before or 2 hours after injecting pramlintide.
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Pramlintide (Symlin) BLACK BOX WARNING
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SEVERE INSULIN INDUCED HYPOGLYCEMIA
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Rapid Acting Insulin Drugs
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Insulin Aspart (Novolog) Insulin Lispro (Humalog) and Insulin Glulisine (Apidra)
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Rapid Acting Insulin Onset
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Insulin Lispro (Humalog) 15 minutes Insulin Aspart (Novolog) 15 minutes Insulin Glulisine (Apidra) 5-10 minutes
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Rapid Acting Insulin Peak
answer
Insulin Lispro (Humalog) 1-1.5 hours Insulin Aspart (Novolog) 1-3 hours Insulin Glulisine (Apidra) 1 hour
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Rapid Acting Insulin Duration
answer
Insulin Lispro (Humalog) 6-8 hours Insulin Aspart (Novolog) 3-5 hours Insulin Glulisine (Apidra) 4 hours
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Regular or Short-Acting Insulin Drugs
answer
Humulin R and Novolin R
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Regular or Short-Acting Insulin Onset
answer
30 minutes
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Regular or Short-Acting Insulin Peak
answer
2-4 hours
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Regular or Short-Acting Insulin Duration
answer
6-8 hours
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Intermediate Insulin Drugs
answer
NPH, Humulin N, Novolin N
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Intermediate Insulin Onset
answer
1-2 hours
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Intermediate Insulin Peak
answer
8-12 hours
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Intermediate Insulin Duration
answer
18-24 hours
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Long Acting Insulin Drugs
answer
Insulin Levemir (Detemir) Insulin Glargine (Lantus)
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Insulin Levemir (Detemir) Onset
answer
1 hour
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Insulin Levemir (Detemir) Peak
answer
There is no peak
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Insulin Levemir (Detemir) Duration
answer
6-23 hours
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Insulin Glargine (Lantus) Onset
answer
1 hour
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Insulin Glargine (Lantus) Peak
answer
There is no peak
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Insulin Glargine (Lantus) Duration
answer
24 hours
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Insulin Indications
answer
Type 1 diabetes or Type 2 diabetes uncontrolled by lifestyle modifications and oral hypoglycemics, Gestational Diabetes
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Insulin Action
answer
Promotes use of glucose by body cells, storage of glucose as glycogen
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Insulin Side effects
answer
confusion, agitation, tremors, headache, flushing, hunger, weakness, lethargy, fatigue, urticaria, redness, irritation or swelling at injection site
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Insulin Adverse Effects
answer
Hypoglycemic reactions, rebound hyperglycemia, lipodystrophy, Insulin shock, anaphylaxis
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Drug Interactions with Insulin
answer
Increased hypoglycemic effect with: Aspirin, oral anticoagulants, alcohol, oral hypoglycemics, beta blockers, tricyclic antidepressants, MAOIs, tetracycline. Decreased effect of Insulin with: thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking
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Short-Acting Insulin Nursing Implications
answer
Used alone as sliding scale coverage or in combination with NPH Insulin (Clear→Cloudy) or (RN Regular then NPH) Generally given 30 minutes prior to meal Only Insulin administered IV
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Intermediate Acting Insulin Nursing Implications
answer
Used alone or in combination with short acting insulin
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Long-Acting Insulin Nursing Implications
answer
Given once daily-Usually at bedtime
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Signs and Symptoms of Hypoglycemia
answer
Headache Hunger Lightheadedness, weakness, fatigue Nervousness, Apprehension Moody, irritable Tremor, trembling Sweating cold, clammy skin Tachycardia Slurred speech Memory lapse Confusion, incoherent, difficulty concentrating Seizures Coma
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Glucagon
answer
Medication that treats hypoglycemia
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Glucagon Use
answer
treatment of Insulin shock, severe hypoglycemia administer 0.5-1 mg; beta blocker and calcium channel blocker overdose (reverses effects-3mg IV then a continuous infusion)
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Glucagon Action
answer
elevates blood sugar by stimulating glucogen breakdown (glycogenolysis)
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Glucagon Nursing Implications
answer
may be given subQ, IM or IV, Use when Dextrose 50% is unavailable
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Glucagon Side Effects
answer
uncommon but may have nausea, vomiting, allergic reaction
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Pituitary Hormones
answer
FLAGTOP ♦Follicle stimulating hormone ♦Luteinizing hormone ♦Adrenocorticotropic hormone ♦Growth hormone ♦Thyroid stimulating hormone ♦Oxytocin ♦Prolactin
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Steroid Side Effects
answer
♣Buffalo hump ♣Easy bruising ♣Cataracts ♣Larger appetite ♣Obesity ♣Moonface ♣Euphoria ♣Thin arms & legs ♣Hypertension/ Hyperglycaemia ♣Avascular necrosis of femoral head ♣Skin thinning ♣Osteoporosis ♣Negative nitrogen balance ♣Emotional liability
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Signs of CUSHINGS
answer
♣Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne) ♣Urinary free corisol and glucose increase ♣Striae/ Suppressed immunity ♣Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism ♣Iatrogenic (Increased administration of corticosteroids) ♣Noniatrogenic (Neoplasms) ♣Glucose intolerance/ Growth retardation
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Factors of Diabetic Ketoacidosis
answer
♣Infection ♣Ischaemia (cardiac, mesenteric) ♣Infarction ♣Ignorance (poor control) ♣Intoxication (alcohol)
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signs of diabetic Ketoacidosis
answer
Dehydrated ♣Ketones/ Kussmaul breathing/ K drops ♣Acidosis
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6 Causes of Hypernatremia
answer
♣Diuretics ♣Dehydration ♣Diabetes insipidus ♣Docs (iatrogenic) ♣Diarrhea ♣Disease: kidney, sickle cell, etc