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1
Q

Paresthesia

A

Any abnormal sensations: burning, tingling, aching, cold sensation,

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2
Q

Dysesthesia

A

Painful paresthesia

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3
Q

Allodynia

A

Pain caused by a non-painful stimulus

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4
Q

Hyperalgesia

A

Hypersensitivity to the pain stimulus, causing more pain then it should

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5
Q

4 phases of nociception

A

Transduction- transmitting action potential

Transmission- stimuli passing to brain

Perception- processing or experiencing the pain

Modulation- how each person uniquely copes with pain

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6
Q

Strong opioid agonists

A

Morphine

Fentanyl

Meperidine

Methadone

Hydromorphone

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7
Q

Moderate to strong opioid agonists

A

Codeine

Oxycodone

Hydrocodone

Tapentadol

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8
Q

Morphine

A

Mechanism of action: endogenous opioid at the mu receptors

Can cause drowsiness, reduction in anxiety

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9
Q

Nursing considerations of morphine

A

Resp depression

Orthostatic hypotension

Cough suppression

Emesis- nausea

Birth defects

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10
Q

Meperidine function

A

Strong opioid

It is not preferred anymore because of the short half-life, lots of drug interactions

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11
Q

Methadone

A

Strong opioid

Pain and treat opioid addiction
-increased QT prolongation

-very long acting- up to 72 hours

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12
Q

Codeine function

A

Less harmful effects to strong opioids but doesn’t cause as much effects

Can combine with acetaminophen

-cough suppressant

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13
Q

Pentazocine

A

Agonist antagonist med- mu antagonist, kappa agonist

Not as much risk for abuse because less affect and less consequences

Increases cardiac output- avoid in MI patients

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14
Q

Tapentadol

A

Moderate to strong opioid

Blocks reuptake of norepinephrine a little bit so there is less constipation than other opioids

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15
Q
A
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16
Q

How do opioids affect mu and kappa receptors

A

Activate mu and kappa receptors

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17
Q

Buprenorphine

A

Partial mu agonist and kappa antagonist

Used for opioid use disorder

Prolongs QT interval

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18
Q

Tramadol- more important

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A

Analog of codeine

Weak agonist activity at mu receptors

Side effect of seizures

-hard to wean- 5mg tapering opposed to morphine tapering at 0.5 intervals

19
Q

Acetaminophen

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A

Non opioid

Works at liver level so can’t have alcohol with

20
Q

NSAIDS

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A

Non steroid anti inflammatory

Can’t use with kidney issues

21
Q

Polyphagia

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A

Excessive hunger- high glucose but body not able to take that glucose for energy

22
Q

Polydipsia

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A

Excessive thirst- such high glucose in blood so water is pulled from cells stimulating thirst

23
Q

DKA

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A

Diabetic ketoacidosis

Primarily in T1D but can be T2 in extreme stress

Develops over hours to days

Presence of ketones in urine and blood

Polyuria, polydipsia, dehydration

Later manifestations severe hypotension

Kaussmaul’s respirations and fruity odour on breath

Electrolyte imbalances- hyponatremia and hypokalemia

25
HHS
Hyperosmolar hyperglycemia syndrome Usually older patients with T2D Precipitated by stressful events- illness, injury, surgery Severe hyperglycemia, profound dehydration
26
Rapid acting insulin
Lispro, aspart, glulisine Slightly modified human insulin SC, IV 15mins before meal
27
Short acting
Regular insulin Unmodified human insulin SC, IV, IM 30-45 mins before meal
28
Intermediate acting insulin
NPH (neutral protamine hagedorn) Regular insulin conjugated with protamine (large protein) which decreases solubility and slows absorption SC only 2 times dose a day- some exceptions for one Peaks 5-8 hours- lasts 18 hours
29
Long acting insulin analogues
Insulin degludec, insulin glargine, insulin glargine Modified human insulin SC Slowly over 24 hrs+ Lacks a peak -insulin glargine usually taken at bedtime -insulin detemir- slightly shorter duration of action
30
Somogyi effect
Nocturnal hypoglycemia triggers a rebound hyperglycemia via glucagon and cortisol
31
Metformin
Buguanide Reduces hepatic glucose production and increases insulin sensitivity Lowers FPG and PPG, decreases A1C 2% No hypoglycemia, no weight gain Side effect- GI intolerance, avoid in renal or liver dysfunction
32
Weight gain in response diabetes meds
Insulin therapy in general caused weight gain Sulfonylureas, meglitinide- weight gain Some t2d meds cause weight loss-
33
Sulfonylureas
T2d med End in ide: gliclazide, glimepiride, glyburide Stimulates the release of insulin from beta cells Avoid with renal dysfunction, alcohol Taken once or twice daily- just before or after meals Adverse effects: hypoglycemia, weight gain
34
DPP-4 inhibitors
End in gliptin Increase levels of in incretin hormones which are released normally in response to high glucose levels to promote insulin secretion -decreases hepatic glucose production Lowers PPG, minimal effect on FPG No hypoglycemia or weight gain Once daily dose Adverse effects- headache, infections (uti, respiratory), pancreatitis and anaphylaxis
35
36
Thiazilidinediones
End in glitazones Increased glucose uptake in muscle and fat cells and inhibits hepatic glucose production Lowers FPG and PPG Slow onset and no regard for meals Significant fluid retention (especially for HF) -rosiglitazone avoid if patient has increased risk of MI such as HF and angina
37
SGLT2i
End in flozin Blocke glucose reabsorption in kidney causing more glucose to be secreted Weight loss may occur, no hypoglycemia Lowers FPG and PPG Not effective with renal dysfunction Increased urination, genital yeast infection, UTI, postural hypotension, dizziness Dosed once daily before meals (canagliflozin best before first meal)
38
GLP-1 receptor agonists
End in tide Enhances incretin activity, increasing insulin secretion Delays gastric emptying, suppresses appetite Lowers PPG, minimal effect FPG No hypoglycemia, weight loss may occur Bad for renal dysfunction and at risk for pancreatitis, GI side effects SC injection -Rybelsus is oral
39
What are the weight loss meds
GLP-1 receptor agonists- semaglutide (wegovy)- weekly injection and liraglutide (saxenda)- daily injection
40
Meglitinide
Repaglinide- ends in ide so memorize this one- only med in class Rapid, short lived release of insulin Caution in liver dysfunction, increased risk hypoglycemia Possible weight gain but less that sulfonylureas
41
Alpha-glycosidase inhibitor
Only drug is Acarbose Inhibits gut enzyme (alpha-glycosidase) which breaks down carbs so delays absorption and gastric emptying Lowers PPG, no effect FPG No weight gain or hypoglycemia Flatulence, abdominal pain, diarrhea Taken before meals- 3 times daily
42
43
What t2d meds have a risk of hypoglycemia
Sulfonylureas, meglitides
44

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