HARD TIME Flashcards by Hanabi San

Which antiparkinsonian drug is contraindicated in hot weather/ exercise?

Benztropine/ antichollinergic

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Which antiparkinsonian drug is contraindicated in angle-closure glaucoma?

Levodopa (DOPAMINE REPLACEMENT DRUGS)

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Which antiparkinsonian drug is contraindicated in ischemic/ PVD and erythromycin?

bromocriptine (non dopamine dopamine receptor agonists)

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Which antiparkinsonian drug is contraindicated to antichollinergic drugs?

amantadine and antichollinergic (benztropine)

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What is contraindicated to selegiline and rasagiline?

Meperidine

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Which antihyperglycemic medication can cause hypoglycemia when given with DPP4 enzymes?

Sulfonylureas

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Which antihyperglycemic medication increases HDL and LDL?

Sodium-glucose cotransporter 2 inhibitor (dapagliflozin)

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Drugs that cause hyperglycemia when given with insulin? (antagonizes insulin)

corticosteroids
diuretics
sympathomimetic
niacin
thyroid drugs

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Drugs that cause hypoglycemia when given with insulin?

alcohol
sulfa antibiotics
anabolic steroids
MAOIs
salicylates

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Drugs that mask hypoglycemia symptoms when given with INSULIN?

non-selective beta blockers

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Functions of the drug INSULIN

metabolize carbohydrates, fats, and proteins
stores glucose in the liver
convert glycogen into fat stores
substitute for endogenous insulin

Does not reverse defects in insulin receptors

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OA and malnourished patients may adversely affect which antihyperglycemic medication?

Biguanides

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What is important to note when giving sulfonylureas and glinides?

Baseline glucose
Conditions that may predispose patients to hypoglycemia [drop in caloric intake, alcohol use, exercise]
Allergy to sulfonamides
Not allowed in patients with type 1 diabetes

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What is a major contraindication in thiazolidinediones/ glitazones?

Class III or IV heart failure

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Contraindication for a glucosidase inhibitor

IBS
Malabsorption

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Incretin mimetics are used to treat?

Typer 2 diabetes
Poor control with metformin, sulfonylutreas, or glitazones

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Glucagon injection may induce?

vomiting so assess for LOC and prevent aspiration

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If insulin is is to be used within 1 month

it may be stored at room temperature

administer at room temperature

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angle to administer insulin?

90 degrees unless they are emaciated (thin) do 45 degrees

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Injecting air into vial process of mixing insulin?

Inject air into intermediate-acting acting then into rapid-acting

BUT always draw up rapid/ regular acting insulin first then intermediate acting (clear before cloudy)

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If lispro is mixed with NPH, when would you give it?

give combination 15 minutes before meals because lispro has an onset of 10 to 15 minutes.

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When to give (meals) in intermediate-acting insulin with an onset of 1 to 2 hours?

meals should be given 30 to 45 minutes prior to administration

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In hospital settings, give insulin when?

when tray arrives

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How often to check glucose when a patients is on SC?

every 4 hours, 6, or several times per day to obtain fasting/ preprandial glucose levels

Used in variable caloric intake, drastic changes to glucose levels due to infections/ stress, receives TPN

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Insulin in BBT

Long acting Rapid acting

Oral antihyperglycemic are usually given __ minutes before meals?

30 minutes

Glitazones adverse effect

It causes weight gain/ edema so weigh patients

Incretin mimetics (exenatide) are not given with?

Insulin

Sitagliptin (DPP 4 I) is not given with? May be given with or without?

Insulin Food

Key diagnostic criterion of hyperglycemia

Fasting glucose: greater than 7mmol/L Non-fasting glucose: greater than 11.1 mmol/L A1C of equal to/ greater than 6.5% [A1C of 6.5% is the threshold for micro and macrovascular complications]

Diabetes Canada Reccomends

A1C of less than 7% F PG of 4 to 7 mmol/L 2 hour postprandial of 5 to 10 mmol/L

Bowel assessment

Inspection Auscultation (1st to prevent stimulation of peristalsis and BS) Percussion Palpation

Hypoactive BS Normoactive

less than 6 sounds per minute 6 to 32 sounds per minute

Overuse of diphenoxylate hcl with atropine sulphate may cause?

dry mouth abd pain tachycardia blurred vision

Prior to use of hyperosmotic laxatives, assess for?

baseline fluid and electrolyte imbalances thorough and assessment Older adults react adversely to hyperosmotic so avoid use

Saline laxatives are used in caution in OA because? May also cause?

possible dehydration and electrolyte loss MG toxicity in those with compromise renal function

Bismuth subsalicylate effects on feces?

dark or grey feces

If tablet Bismuth subsalicylate is used they must be?

chewed thoroughly before swallowing and must be taken with at least 180 mL of fluid

How to give Diphenoxylate hcl and loperamide

without regard to food but must be given with adequate fluid

Bulk forming once stirred with 240 mL of water must be

taken immediately to avoid choking never give in a dry form

Bisacodyl is best taken how to give whole tablets do not give with?

in an empty stomach whole tablets must not be crushed do not take milk, juices or antacids with the dose or an hour or taking this medication

Soft rectal suppositories

place in a medicine cup with ice, apply lubricant lay on the left side for at least 15 to 30 minutes to allow drug to dissolve

Lactulose may be given with

juice, milk, or water to increase palatability (taste) pale yellow color

Retention enema with dilution

retain 30 to 60 minutes lubricate tip of the apparatus, nozzle pointed towards the umbilicus, lying on the left side release fluid gradually discontinue if pt experiences severe abd pain

AE of dry mouth... encourage?

frequent mouth care increased fluid intake sugarless gum/ candy

Taking senna

avoid other medications within 1 hour of taking it it takes 6 to 12 hours to work

Antichollinergics for antidiarhheals mechanism of action AE

decrease peristalsis through their parasympathetic blocking effects AE: urinary retention, headache, confusion, dry skin, rash, and blurred vision

Opiates

decrease bowel motility, permits longer contact of intestinal contents, reduce pain and spasms

stool softeners and bulk forming are

preferred due to fewer problems with fluid and electrolyte loss

Oral antihyperglycemic can cause

photosensitivity, use sunblock and appropriate clothing when exposed to sun

Insulin main function

removal of glucose form the plasma and store it as glycogen in the liver

Bovin and porcine insulin are associated with?

higher incidence of allergic reaction and insulin resistance

mixing short and intermediate-acting insulin color

will appear uniformly cloudy

Antichollinergic dry mouth

artificial saliva drops/ gum mouth care drink fluids sugarless gum/ hard candy

entacapone can cause ____ urine

dark

non ergot ropinirole can cause

drowsiness fatigue syncope

COMT I must be taken with

meal or snack to minimize GI upset or without regard to food

COMT I can cause

Liver dysfunction monitor for jaundice, back/ abd pain dark urine

COMT I plus levodopa results in

reduced wearing off phenomenon

Common AE of antiparkinsonian drugs

Dyskenesias

Which medication does it require the nurse to check the BP (ORTHOSTATIC HYPOTENSION)

Amantadine Levodopa & Ropinirole

Alkaline phosphate levels are indicators of?

Liver function AST, ALT

BUN (blood urea nitrogen), creatinine

measure kidney function

Amantadine onset

delayed for several days or longer lose effectiveness after 6 to 12 months

What systems to assess when giving anticholinergic medications?

GI GU Visual Cardiac Neurological

2 prolactin inhibitor

Amantadine and bromocriptin

Amantadine can cause

dizziness, headache, insomnia, and anxiety assess CNS orthostatic hypotension and dizziness- for longterm

Selegiline or other indirect acting antiparkinson drugs

assess cardiac status due to risk of hypo or hypertension and chest pain

Entacapone (COMT inhibitor)

assess for orthostatic hypotension and syncope

Administration time of Levodopa and COMT-I

Give 1 to 2 hours after Levodopa due to bioavailability effects

Assess ALT when giving

COMT inhibitors due to increased risk of liver failure

Levodopa contraindication

control protein portion and take it an hour before eating high protein meals

Antichollinergic administration time Do not give anticholinergics to patients with?

do not take anticholinergics at the same time as other meds may take several weeks for the therapeutic effect to show take with food take at night due to sedation effects Glaucoma

MAOs what to avoid Pt instructions

avoid tyramine rich foods to reduce the risk of hypertension move slowly and purposefully due to to orthostatic hypotension

Which anti parkinson medication works peripherally and does not cross blood brain barrier

COMT I

Hot weather and exercise, alcohol is contraindicated with which anti parkinson medication?

Antichollinergic

What do anti cholinergic medications treat?

muscle rigidity and tremors

Take COMT with which kind of MAOI

non selective due to risk of HTN