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NUR 325 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

rapid acting insulin (lispro)

A

onset: 15 mins
peak: 1 hour
duration: 2-4 hours

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2
Q

regular insulin (short acting)

A

onset: 30-60 mins
peak: 2-6 hours
duration: 3-8 hours

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3
Q

intermediate insulin (NPH)

A

onset: 2-4 hours
peak: 4-10 hours
duration: 10-20 hours

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4
Q

long acting insulin (glargine)

A

onset: 70 mins
peak: NONE
duration: 24 hours

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5
Q

regulating glucose depends on the

A

liver
-extracts glucose
-synthesizes it into glycogen (energy storage)
-glycogenolysis (breakdown glycogen)

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6
Q

pancreas

A

controls body’s fuel supply (glucose/insulin)
2 major functions:
-exocrine: pancreatic cells secrete directly into ducts NOT bloodstream
-endocrine: cells secrete INSULIN directly into blood stream

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7
Q

islet of langerhans

A

pancreatic islets are small islands of cells within the pancreas that make up the endocrine function

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8
Q

alpha cells

A

secrete glucagon in response to low blood sugar
-glucagon stimulates the liver to release stored glucose into the blood

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9
Q

beta cells

A

produce insulin, which lowers glucose levels by stimulating the movement of glucose into body tissues

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10
Q

hormones that RAISE blood glucose levels

A

-glucagon (islet of langerhans)
-epinephrine (adrenal medulla and other chromafin tissues)
-glucocorticoids (adrenal cortex)
-growth hormone (anterior pituitary)

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11
Q

insulin

A

-hormone secreted by the pancreas (beta cells)
-stimulates uptake, utilization, and storage of glucose
-stimulates the liver to store glucose (as glycogen)

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12
Q

polyphagia

A

increased hunger
-catabolism of fat and protein and cellular starvation

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13
Q

polydipsia

A

excessive thirst
-increased serum osmolality

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14
Q

polyuria

A

excessive urination
-osmotic diuresis, excreting water, loss of electrolyte

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15
Q

somogyi effect

A

overdose of insulin causes hypoglycemia and counter regulatory mechanisms cause hyperglycemia and ketosis
-bc poor diabetes management, must talk about ways to fix it

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16
Q

dawn phenomenon

A

hyperglycemia in the morning due to natural hormonal release
-don’t do anything

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17
Q

glipizide and glyburide are what class of meds

A

sulfonylureas

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18
Q

adipose tissue

A

provides insulation and mechanical support for the body
-secretes hormone-like molecules=adipokines
-contributes to immune cell function

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19
Q

adipocytes

A

fat-storing cells
-store calories as triglycerides
-can increase in number and HYPERTROPHY to increase fat mass

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20
Q

adipokines

A

secreted by adipose tissue (ENDOCRINE organ)
-cell-signaling proteins
-help regulate: appetite, food intake, energy expenditure, lipid storage, insulin secretion/sensitivity, etc

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21
Q

adiponectin

A

good adipokine
-inverse relationship with fat content in the body
-increased fat content=less adiponectin produced

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22
Q

what does adiponectin do

A

-increase energy expenditure
-enhance cell sensitivity to insulin
-anti-inflammatory effects
-protects against arteriosclerosis

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23
Q

leptin

A

good adipokine
-more fat, more leptin
-obese ppl become leptin resistant
-normally tells body that you’ve had enough to eat (satiety)
-works with adiponectin to increase insulin sensitivity, reduce triglyceride levels, and inhibit fat accumulation

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24
Q

glipizide class

A

sulfonylureas

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25
glyburide class
sulfonylureas
26
sulfonylureas (glipizide and glyburide) MOA
binding and closing K-ATP channels in the pancreatic beta cells thereby stimulating secretion of insulin -increase body's sensitivity or response to insulin -reduces the release of glucose from the liver
27
sulfonylureas (glipizide and glyburide) side effects
hypoglycemia (in pts with liver or kidney dysfunction)
28
sulfonylureas (glipizide and glyburide) nursing considerations
-do not take during pregnancy -teach patients to avoid or limit ETOH, NSAIDS, Tagamet, sulfa-based abx taking these makes it more likely to experience side effect of hypoglycemia
29
metformin class
biguanides
30
biguanides (metformin) MOA
-lowers blood glucose by decreasing production of glucose in the liver -enhances glucose uptake and utilization by muscle -does not promote insulin release from the pancreas -does not cause hypoglycemia
31
biguanides (metformin) side effects
-abdominal bloating, N/V/D, risk for acidosis in patients with elevated creatinine, do not use in patients with elevated ALT levels
32
biguanides (metformin) nursing considerations
-monitor serum glucose levels, give 30 minutes before meals -must be held for 48 hours post IV contrast usage
33
linagliptin class
DPP4 inhibitor
34
sazagliptin class
DPP4 inhibitor
35
sitagliptin class
DPP4 inhibitor
36
DPP4 inhibitors (-gliptin) MOA
inhibits DPP4, an enzyme that inactivates the incretin hormone
37
DPP4 inhibitors (-gliptin) side effects
GI problems, N/V, stomach pain, flu-like symptoms, skin reactions, increased risk of pancreatitis
38
dulaglutide class
GLP-1 receptor agonist
39
exenatide class
GLP-1 receptor agonist
40
semaglutide class
GLP-1 receptor agonist
41
GLP-1 receptor agonist (-tide) MOA
-enhances glucose dependent insulin secretion -stimulates glucose-dependent release of insulin, inhibits postprandial release of glucagon, and suppresses appetite -slowed gastric emptying
42
GLP-1 receptor agonist (-tide) side effects
-N/V/D, injection site reactions, headache, upper respiratory infections, weight loss
43
GLP-1 receptor agonist (-tide) nursing considerations
-do not use for pts with history of pancreatitis -black box warning: risk of thyroid c-cell tumors -not recommended for people with ESRD or severe renal disease -subq
44
dapagliflozin class
SLG-2 inhibitors
45
SLG-2 inhibitors (dapagliflozin) MOA
-prevents kidneys from reabsorbing glucose back into the blood -kidneys lower BG, excess BG removed via urine
46
SLG-2 inhibitors (dapagliflozin) side effects
-increased UTI risk, genital mycotic infections -hypotension, fainting, dizziness, fatigue
47
SLG-2 inhibitors (dapagliflozin) nursing considerations
-oral -do not give to someone with ESRD or severe kidney disease -only type 2
48
orlistat is
OTC
49
orlistat MOA
binds to gastric and pancreatic enzymes and BLOCKS these enzymes; reduces fat absorption by 30%
50
orlistat side effects
-black box: liver injury -GI symptoms: oily spotting, flatulence, and fecal incontinence…reduce by reducing fat intake to less than 30% -decreases vitamin concentrations…MUST TAKE multi-vitamin with this medication
51
orlistat nursing considerations
-MUST TAKE FOR 3 MONTHS TO START SEEING EFFECT
52
glucagon
hypoglycemia antidote
53
glucagon MOA
activates hepatic glucagon receptors, stimulates glycogenolysis and release of glucose -check finger stick 15 minutes post
54
donepezil class
cholinesterase inhibitors
55
cholinesterase inhibitors (donepezil) MOA
-works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase
56
cholinesterase inhibitors (donepezil) side effects
-normally none to mild, resolve on their own -GI upset, drowsy, dizzy, insomnia, muscle cramping -bradycardia, reflex tachycardia, syncope -PO at bedtime, best with food
57
cholinesterase inhibitors (donepezil) nursing considerations
-patients forgetful, must have some way to ensure patient is taking medications
58
memantine class
NMDA receptor antagonist
59
NMDA receptor antagonist (memantine) MOA
-blocks stimulation of NMDA receptors believed to be associated with AD
60
NMDA receptor antagonist (memantine) side effects
-uncommon -confusion, hypotension, headache, dizziness, CONSTIPATION
61
tramadol class
centrally acting analgesic
62
centrally acting analgesic (tramadol) MOA
-binds weakly to mu opioid receptors -inhibit reuptake of norepi and serotonin
63
side effects of centrally acting analgesic (tramadol)
-usually none -drowsy, dizzy, headache, nausea, constipation, respiratory depression -rare: seizures when combined with other CNS depressants
64
gabapentin class
anti-convulsants
65
pregablin class
anti-convulsants
66
anticonvulsants (gabapentin and pregablin) MOA
-unknown, but thought to spontaneously suppress neuronal firing-pain -to complement effects of opioids -used specifically for neuropathic pain
67
anticonvulsants (gabapentin and pregablin) side effects
-drowsy, dizzy, visual problems -can only be partially reversed with Naloxone -NEUROPATHIC PAIN
68
aspirin, ibuprofen, naproxen, ketolorac, celecoxib class
NSAIDS
69
NSAIDS MOA
-anti-prostaglandins -decreased prostaglandins by blocking key enzyme cyclooxygenase (COX) (an enzyme crucial to production of prostaglandins) -COX-1 & COX-2
70
NSAIDS side effects
NON-SELECTIVE COX: -GI upset, stomach ulcers, GI bleeding, rash, edema, kidney failure, increase in BP, inhibits platelet aggregation, SOA in asthma patients SELECTIVE COX-2 INHIBITORS: -GI mucosa still protected, and platelet function not impacted -no impact/effect on platelets -SERIOUS CARDIOVASCULAR THROMBOTIC EVENTS -cardiovascular and GI risk black box warnings
71
acetaminophen MOA
-unknown -decreases prostaglandin synthesis in the CNS possibly
72
acetaminophen side effects
-with normal doses hardly any -large amounts hepatic necrosis (acute), LIVER FAILURE with chronic-long term use, and mild nephropathy -potentially lethal when overdosed -hepatotoxicity-ceiling effect -NO-ANTI-INFLAMMATORY properties -look for jaundice, elevated LFTs, creatinine levels -adult dose restriction: 4 g/24 hrs
73
morphine MOA
-mu agonist mimics the action of endogenous opioids at the mu receptors
74
morphine side effects
-respiratory depression -CNS depression -constipation -drowsiness/fatigue -confusion, dry mouth, itching -assess LOC, BP, pulse, RR
75
when to use hydromorphone
SEVERE PAIN
76
when to use fentanyl
-moderate to severe pain -surgical induction -chronic pain -EXTREMELY POTENT
77
when to use merperidine
-moderate to severe pain -weaker than morphine and shorter duration of action -less respiratory depression -LOTS of drug/drug interactions -CNS stimulations=seizures DO NOT USE WHEN MULTIPLE DOSES NEED TO BE GIVEN
78
when to use codeine
-mild-moderate pain, reduce coughing -not for children under 18 related to life threatening breaking problems
79
oxycodone
-moderate to severe pain -10x more potent than codeine
80
hydrocodone
-mild-moderate pain and cough relief -cough suppressant -6x more potent than codeine
81
methandone
-choice for detoxification treatment in opioid addiction -longer half-life
82
naloxone
-opioid antagonist -antidote to reverse effects of morphine -abrupt reversal of opioid effects with RECURRENT PAIN, increased BP
83
phenytoin class
hydantoins
84
phenytoin uses
tonic-clonic and partial seizures
85
valproic acid
-absence, myoclonic, and tonic-clonic seizures -highly protein bound -contraindicated for liver disease and urea cycle disorders -adverse effects: hepatotoxicity, pancreatitis
86
topiramate
adjunct therapy for partial and secondary generalized seizures, tonic-clonic -side effects: general CNS depression, GI upset, watch for visual changes -can interact with contraceptives
87
levetiracetam
indicated for adjunct therapy for partial seizures with and without generalization

NUR 325 (3 decks)

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