Exam 3 Flashcards
(34 cards)
Promethazine
Phenothiazine
Indications: prevnts chemo induced emesis
Condraditions: gluacome, older adults, kidney and liver disease, children
Adverse effects: blurred vision, urinary retnetion, dry mouth, photosensitivity, drowsiness, confusion, Q and T chnages on EKG, EPS, nueroleptic maligant syndrome
Monitor: tissue injury
BB warning: do not give to kids with reyes disease, premature kids or kids under 2. Do not take with respiratory depressants, older adults have an increased risk of death
Hydroxyzine
Antihistamine
- blocks H2 recpetos and action of acetylcholine in the brain
Indications: moring sickness/vertigo, anxiety, N/V
Contradictions: renal impairment, hepatic impairment, early pregnancy, PIMS( potentially inappropriate med) prolonged QT intervals
Adverse effects: drowsiness, dizziness, confusion, dry mouth, thick resp secretions, blurred vision, urinary retention, tachycardia
* Give IM, do not take with sedatives,
5 Hydroxytrtptamine3
Used for chemo and post of N/V, early preg,
Antagonizes serotonin receptors to stop emetogenic drugs or toxins
Contradictions: hepatic impairment
Adverse effects: disrrhea, headache, dizziness, constipation, fatigue, elevation of liver enzymes, prolonged QT intervals
* dissolving tab wont work if pt has phenoketouria, st wart increases levels, grape fruit juice decreases levels
Aprepitant
substance P/ Neurokinin 1 antagonist
Blocks activity of P at NK1 in the brain that causes nasuea
Indications: Chemo N/V
* check albumin levels, cant bind with no protein
Contraditions: dont use with ranolazine, pimozide, or cisapride
Adverse effects: fatigue, weakness, dizziness, abnormal heart rhythm, headache, hiccups
* no st john wart of grapefruit juice, use non oral birth control, 1 hr before chemo and for 2 days after
Marijauana
Synthetic cannabinoids
_ not FDA approved, common for abuse, synthetic approved by FDA
Euphoria, paranoia, can cause withdrawal symptoms: insomnia, irritability, nausea, sweating, loose stools, anorexia
Non pharm for N/V
acupuncture, ginger
if pregnant: small frequent meals, dry crackers, high in protein, clear liquid diet
How insulin works
Stimulates carbohydrate metabolism in skeletal muscle, cardiac muscle, and adipose tissue for energy
- facilitates glucose storage in the liver
- moves glucose into fat cells to be broken down
- stimulates protein synthesis
- beta blocker and alcohol effect this process
Type one diabetes
- only 10% of cases
auntoimmune disorder that destorys pancreatic beta cells
usually begins after age 4 and peaks at 10-12 for males and 12-14 for females - symptoms start when 20% beta cells are left
- insulin administered when no beta cells are left
Higher risk for DKA
Diabetes types two
- 90% of cases
insulin resistence usually impaired at a cellular level - formally developed around 40 but now in younger people
- more gradula onset
- usually starts with oral antidiabetics (metformin)
- Risks: genetics, obesity, sedentary lifetstyle, metabolic syndrome
S/S of diabetes
More likely in type 1
Polydipsia: increased thirst
Glucosuria: glucose in urine
Polyphagia: increased hunger
Less obvious s/s: fatigue, weight loss, vaginitis, erectile dysfunction, numbness, slow or poor wound healing, intermittent blurred vision
Diagnostics for diabetes:
HbA1c: N: 5.7, PD: 5.7-6.4, D: 6.5+
Fasting plasma glucose: N: under 100, PD: 100-125, D: 126+
75g oral glucose tolerance test: N; 140, PD: 140-199, D: 200+
Random: should always be under 200 or diabetes is assumed
Complications: DKA
ketones in blood stream and cause acidemia
- body tires to compensate
- no insulin and illness
Early s/s: blurred vision, anorexia, N/V, thirst, polyuria
- check BG, urinalysis, and blood work
Tx: continuous IV insulin, IV fluids, K=, sodium bicarb, identify and treat infection
Complications: HHS
no ketosis
- excessive amount of glucose and electrolytes in the blood stream
- occurs when client unaware of DM
s/s: glucosuria, dehydration, altered mental status, seizures, come
- Can lead to HHNC (coma)
- same treatment as. DKA
Exogenous insulins
- lowers blood glucose by increasing uptake by body cells and decreasing production by liver
- Use: only drug effective for type 1, uncontrolled DM tyoe 2, gestational diabetes, and hyperkalemia
Pharm: give sub Q ( only reg can be given IV)
Hypoglycemia
Bg: 60-70 and under, cold and clammy, tachycardia, palpitations, diaphoresis, shakineess, chnage in mental status, headache, weakness
Awake and alert: 15 grams of carbs
Unresponsive: push 25-50% dextrose IV
- retest and repeat if needed
Mixing insulins
put air in each dose before combining
- clear rapid or short acting should be pulled up first
- NEVER MIX LONG ACTING
How is each class different
Liver: Biguanide, reduces hepatic glucose production
Pancreas: sulfonylureas, meglitinides, stimulate insulin secretion
Cells/tissues: Thiazolidinediones, biguanide, insulin sensitizers
Gut: GLP1 recptor agonist, DPP 4 inhibitor: mimic incretions
Kidneys: SGLT-2 transporters, reduce renal glucose reabsorption
Glyburide
Sulfonylureas
Action: insulin secretion by the pancreatic beta cells
Condraidtioms: hepersnitivity to sulfa drugs, renal and hepatic impairment
Cautions: pregnancy, lactaion, pituitary, thyroid disorders
- high risk of hypoglycemia
BB warning: lactic acidosis
Metformin
Biguanides, 1st line for type II diabetes
Action: decreases heatptic glucose production
Contraditions: hepatic or renal disease, over 80, crdiac or resp, insuffiencency, hx of lactic acidosis
AE: lactic acidosis( can cause kidney failure with this medication) , dizziness, N/V, abd crmaping, malabsorption of amino acids
- Does NOT cause hypoglycemia
Edu: may be head with IV contrast, no alc, w meals in evening
Acarbose
Alpha- glucosidase ingibitor
Action: inhibits enzymes that digest carbs
- usually prescibed with a drug that enhances insulin (sulfa)
Contraditions: DKA, cirrhosis, inflammatory /malabsorp intestinal disease, severe abdominal kidney function
AE: bloating, diarrhea
- does NOT cause hypoglycemia
- glucgon must be taken if hypoglycemia occurs w other medication in combination w this one
- CANNOT GIVE CARBS
Rosiglitazone maleate ( Avandia)
Thiazolidinediones
Action: decreases insulin resistance (needs betas to work)
- not common, high risk of heart failure and atherosclerotic CV events
Repaglinide (Prandin)
Meglitinides
Action: stimulates pancreatic secretion of insulin
- better reduction of AlC when given with insulin or metformin
AE: hypoglycemia
GLP-1 nd GIP therapies
stimulates release of insulin and improves sensitivity
decreases slow gastric emptying
may increase formation of new beta cells
decreased glucagon production
Dipeptidyl- peptidase 4 ( DPP4)
- Gliptins
Action: prevents activation of incretins by inhibiting DPP4 enzymes
Contraditions: insulin, urine ketones, kidney failure, heart failure - dont mix with other drugs causing hypoglycemia
AE: URI symptoms, joint pain
