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Pharmacology > ATI section 5: Médications for the Endocrine System > Flashcards

ATI section 5: Médications for the Endocrine System Flashcards

1
Q

Oral Hypoglycemics

A

-Used in conjunction with diet and exorcist control glucose levels in clients who have type 2 DM

Precautions/Interactions:

  • Caution in clients with renal, hepatic, or cardiac disorders
  • Generally avoided during pregnancy and lactation

Nursing Interventions and Client Education:

  • Teach signs and mngt for hyperglycemia, especially with sulfonylureas
  • Encourage diet and exercise
  • Monitor glycosylated hemoglobin (HbA1C)
  • Refer to diabetic nurse educator
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2
Q

Oral Hypoglycemics
Alpha-glycosidase inhibitors:
acarbose (Precose), miglitol (Glyset)

A

Action:
-slows carbohydrate absorption and digestion

Precautions/Indications:
-contraindicated in clients with intestinal disease due to increased gas formation

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3
Q

Oral Hypoglycemics

Biguanides: metformin (Glucophage)

A

Action:

  • reduces gluconeogenesis
  • increases uptake of glucose by muscles

Precautions/Indications:

  • Withhold 48 hr prior to and 48 hr after a test with contrast media
  • Contraindicated in clients with severe infection, shock, hypoxic conditions
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4
Q

Oral Hypoglycemics

Gliptins:sitagliptin (Januvia)

A

Action:
-Promotes release of insulin, lowers glucagon secretion and slows gastric emptying

Precautions/Indications:
-Caution with impaired renal function-dose will be reduced

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5
Q

Oral Hypoglycemics

Meglitinides: repaglinide (Prandin), nateglinide (Starlix)

A

Action:

  • Reduces production of glucose within the liver through suppression of gluconeogenesis
  • Increases muscle uptake and use of glucose

Precautions/Indications:
-Should not be used with NPH insulin due to risk of angina

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6
Q

Oral Hypoglycemics

Sulfonylureas: glipizide (Glucotrol), glyburide (DiaBeta, Micronase)

A

Action:
-Promotes release of insulin from the pancreas

Precations/Indications:
-Extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders

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7
Q

Oral Hypoglycemics

Thiazolidinediones: rosiglitazone (Avandia), piglitazone (Actos)

A

Action:
-Decreases insulin resistance

Precautions/Indications:
-High risk of CHF due to fluid retention

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8
Q

Insulin

A
  • various forms available to manage diabetes

- Medication vary in onset, peak, and duration

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9
Q

Insulin

Rapid-acting: Lispro (Humalog)

A

Onset:
-less than 15 min

Peak:
-0.5-1 hr

Duration:
-3-4 hr

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10
Q

Insulin

Short-acting: Regular (Humulin R)

A

Onset:
-0.5-1hr

Peak:
-2-3hr

Duration:
-5-7hr

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11
Q

Insulin

Intermediate: NPH (Humulin N)

A

Onset:
-1-2hr

Peak:
4-12hr

Duration:
18-24hr

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12
Q

Insulin:

Long-acting: Insulin glargine (Lantus)

A

Onset:
1hr

Peak:
None

Duration:
10.5-24hr

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13
Q

Insulin

Therapeutic Use

A

Therapeutic Use:
-Glycemic control of DM (type 1,2, gestational)
-Clients taking oral hypoglycemic agents may require insulin therapy when:
Undergoing diagnostic tests
Pregnant
severe kidney or liver disease is present
Oral agents are inefficient
Tx of hyperkalemia

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14
Q

Insulin

Precautions/Interventions

A

Precautions/Interactions

  • When mixing regular with NPH insulin, draw up regular first
  • Do not mix other insulins with lisper, glargine, or combo 70/30
  • Only regular insulin is given IV (only in normal saline)
  • Admin glargine at bedtime
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15
Q

Insulin

Nursing Interventions and Client Education

A
  • Monitor serum glucose levels before meals and at bedtime or patterned schedule-specific to client
  • Roll vial of insulin (except regular) to mix; don’t shake
  • Instruct clients to rotate injection sites to prevent lipodystrophy
  • Teach signs and mngt for hypo/hyperglycemia
  • Encourage diet and exercise to follow ADA recommendations
  • Monitor glycosylated hemoglobin (HbA1c)
  • Refer to diabetic nurse educator
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16
Q

Glycemic Agent

A

-Glucagon (GlucaGen)

Therapeutic Uses:
-Emergency tx of severe hypoglycemia

Precations/Interventions:
-Do not mix with sodium chloride or dextrose solution

Side/Adverse effects:

  • N/V
  • rebound hypoglycemia

Nursing Interventions and Client Education:

  • Administer med for unresponsive client
  • Monitor blood glucose level
  • Instruct client to self-monitor for early signs of hypoglycemia
  • Instruct client to wear med alert badge
  • Advise client to teach family members how to administer meds
  • Provide carbs when client awakens from hypoglycemic reaction
17
Q

Thyroid Hormone

A

-Levothyroxine/T4 (Synthroid)
Therapeutic Uses:
-Hypothyroidism
-Emergency tx of myxedema coma

Precations/Interactions:
-Overmedication can result in signs of hyperthyroidism

Side/Adverse effects:

  • Tachycardia
  • Restlessness
  • Diarrhea
  • weight loss
  • decreased bone density
  • heat intolerance
  • Insomnia

Nursing Interventions and Client Education:

  • Monitor cardiac symptoms
  • Therapy initiated with low doses; advanced to higher doses while monitoring lab values
  • Monitor T4 and TSH levels
  • Take in early morning
18
Q

Thyroid Hormone Antagonist

A

-Methimazole (Tapazole)

Therapeutic Uses:

  • Hyperthyroidism
  • Preoperative thyroidectomy
  • Thyrotoxic crisis
  • Thyroid storm

Precautions/Interactions:

  • Administer with caution to clients who have bone marrow depression
  • hepatic disease
  • bleeding disorders
  • Discontinue prior to radioactive iodine uptake testing
  • Contraindicated with breastfeeding

Side/Adverse effects:

  • skin rash, pruritus
  • Abnormal hair loss
  • GI upset
  • periorbital edema
  • Joint and muscle pain
  • Jaundice
  • Agranulocytosis
  • Thrombocytopenia

Nursing Interventions and Client Education:

  • Admin with food same time every day
  • Increase fluids to 3L/day
  • Avoid OTC products containing iodine
  • Discontinuing dose must be tapered off
  • Monitor client for therapeutic response: weight gain, decreased pulse, BP, and T4 levels
  • Monitor for signs of overdose: periorbital edema, cold intolerance, mental depression
19
Q

Anterior Pituitary/Growth Hormones

A

-Prefix: Somat

Therapeutic Uses:

  • Treat growth hormone deficiencies
  • Turner’s Syndrome

Precautions/Interventions:

  • Contraindicated in clients who are severely obese
  • Must be discontinued prior to epiphyseal closure
  • Avoid concurrent use of glucocorticoids

Side/Adverse effects:

  • Hyperglycemia
  • Hypothyroidism

Nursing Interventions and Client Education

  • Monitor growth pattern
  • Reconstitute medication (do not shake)
  • Admin subQ
  • Dose is individualized
20
Q

Posterior Pituitary Hormones/Antidiuretic Hormones

A
  • Desmopressin (DDAVP): oral, intranasal, subQ, IV
  • Pitressin (Vasopressin): intranasal, subQ, IV

Therapeutic Uses:
-Diabetes insipidus, cardiac arrest, noctural enuresis

Precautions/Interactions:
-Contraindicated in clients with chronic nephritis or high risk for MI

Side/Adverse effects:
-Hyponatremia, seizures, coma

Nursing Interventions and Client Education:

  • Monitor urine specific gravity, BP, and urinary output
  • Prevent hyponatremia due to water intoxication
  • Instruct use of nasal spray
21
Q

Adrenal Hormone Replacement

A

-Suffix: sone

Therapeutic Uses:

  • Acute and chronic replacement for adrenocortical insufficiency (Addison’s disease)
  • Inflammation, allergic reactions, cancer
22
Q

Adrenal Hormone Replacement

Precautions/Interactions:

A
  • Contraindicated in clients who have systemic fungal infection
  • Caution in clients who have hypertension, gastric ulcers, diabetes, osteoporosis
  • Requires higher doses in acute illness or extreme stress
23
Q

Adrenal Hormone Replacement

Side/Adverse effects:

A
  • Adrenal suppression when admin for inflammation, allergic reactions
  • Infection
  • Hyperglycemia
  • Osteoporosis
  • GI bleeding
  • Fluid retention
24
Q

Adrenal Hormone Replacement

Nursing Interventions and Client Education

A
  • Do not skip doses
  • Monitor BP, fluid and electrolyte balance, weight, and output, signs of bleeding and GI discomfort
  • Teach client to take calcium supplements and maintain vitamin D levels
  • Give with food
  • Taper off dose regimen when discontinuing
  • Provide immunoprotection

Pharmacology (18 decks)

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