Endocrine Meds

Question 1

Indication:

Insulins

Answer 1

To treat high blood sugar for clients:

• with diabetes mellitus
• taking steroids

Question 2

Generic names:

Rapid-acting insulin

Answer 2

Lispro, Aspart, Glulisine

(LAG)

Question 3

Onset, Peak, Duration:

Rapid-acting insulin

Answer 3

Onset: 5 - 30 minutes (closer to 15 minutes)

Peak: 1 - 2 hours

Duration: 3 - 5 hours

The peak is when hypoglycemic reactions can occur.

Question 4

Generic names:

Short-acting insulin

Answer 4

Regular insulin

Brand name: Humulin R

Question 5

Onset, Peak, Duration:

Short-acting insulin: Regular subcutaneous

Answer 5

Onset: within 30 minutes

Peak: 2 - 4 hours

Duration: 8 hours

Question 6

Onset, Peak, Duration:

Short-acting insulin: Regular IV infusion or IV push

Answer 6

Onset: 10 - 15 minutes

Peak: unknown

Duration: 4 hours

Question 7

Why is it important to teach the client when insulin peaks?

Answer 7

The peak action time of insulin is when hypoglycemic reactions can occur. If the blood sugar gets too low, coma can occur.

Question 8

Which insulin can be given IV infusion or IV push?

Answer 8

ONLY regular insulin is given IV.

Question 9

What types of insulins should a meal be readily available before administration?

Answer 9

Rapid-acting and short-acting insulin.

This type of insulin works very quickly and can cause hypoglycemia if food is not consumed shortly after administration.

Question 10

Indication:

Regular IV insulin

Answer 10

To treat diabetic ketone acidosis.

(DKA)

Question 11

What electrolyte should be checked while the client is receiving IV insulin?

Answer 11

Potassium level.

Insulin lowers the potassium level.

Question 12

Generic names:

Intermediate insulin

Answer 12

NPH and isophane

Brand name: Humulin N

Question 13

Onset, Peak, Duration:

Intermediate insulin

Answer 13

Onset: 1 - 2 hours

Peak: 4 - 12 hours

Duration: up to 24 hours

Question 14

Generic names:

Long-acting insulin

Answer 14

glargine, detemir

Can be given at bedtime.

Question 15

Onset, Peak, Duration:

Long-acting insulin

Answer 15

Onset: 3 - 6 hours

Peak: none

Duration: up to 24 hours

Question 16

What types of insulins can be mixed and drawn up into the same syringe?

Answer 16

It’s fine to mix intermediate insulin with rapid or short-acting.

Question 17

What insulin is drawn up first and what insulin is drawn up second when drawing up the insulins that can be mixed?

Answer 17

• draw up rapid-acting or short-acting first, which is clear
• draw up intermediate-acting second, which is cloudy

“Clear before cloudy”

Question 18

Sick day rules for insulin:

Answer 18

1. check blood sugar every 4 hours - still give insulin if indicated
2. drinks fluids every hour - to prevent dehydration
3. assess for signs of hyperglycemia - ketones in urine, fruity breath, deep and rapid respirations

Question 19

Where are insulin bottles stored?

Answer 19

In the refrigerator until ready to be opened.

After opening, bottles can be stored in refrigerator or at room temperature for 28 days.

Question 20

How is subcutaneous insulin administered?

Answer 20

Guidelines:

• clean skin with alcohol before injection
• choose one area on the body to keep absorption rate the same
• use 25-30 gauge needle at 45-90 degree angle and typically in abdomen or upper arm
• rotate around that site to prevent lipodystrophy
  
  • move at least 1.5” (4 cm) away from previous injection site

Question 21

What is lipodystrophy?

Answer 21

Fibrous fatty areas of the skin caused by repeated use of injections.

Avoid these areas for subcutaneous shots.

Question 22

Most common adverse reactions:

metformin (oral antidiabetic)

Answer 22

• lactic acidosis
• nausea/vomiting/diarrhea

This is due to toxicity and kidneys unable to get rid of acid build-up.

Question 23

What are the signs and symptoms of lactic acidosis?

Answer 23

1. dyspnea; deep and rapid respirations - to blow off extra CO₂ gas
2. dizziness, headache, lethargy, coma - acidosis affects the brain
3. muscle weakness - due to increased potassium with acidosis

Question 24

How long should metformin be held if the client is to receive IV contrast?

Answer 24

Hold metformin before and up to 48 hours afterwards for a client getting IV contrast for tests that end in -gram or -graphy.

Taking both together can cause kidney failure.

Question 25

Nursing considerations:

levothyroxine

Answer 25

1. assess for chest pain and tachycardia - too much medicine can cause cardiac problems
2. take in the morning on an empty stomach - better for absorption

Question 26

Nursing considerations:

pancreatic enzymes

Answer 26

Take right before meals to help with food digestion in clients with cystic fibrosis or pancreatitis.

Question 27

Indication:

vasopressin, desmopressin

Answer 27

Anti-diuretic hormone (to treat shock and diabetes insipidus).

Question 28

Nursing considerations:

vasopressin, desmopressin

Answer 28

Monitor blood pressure, heart rate, and EKG.

Can cause vasoconstriction.

Question 29

What condition are these meds for?

canaGLIflozin
linaGLIPtin
liraGLUtide
pioGLItazone
sitaGLIptin
GLImepiride
GLIpizide
GLYburide

Answer 29

Diabetes Mellitus

Notice that all the meds have GLI, GLU, or GLY in them.