Unit 8 and 9 Flashcards Preview

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Flashcards in Unit 8 and 9 Deck (33):
1

Short acting insulin-regular (Humulin R, Novalin R)

onset within 30-60 min, peaking in 2-4 hours, duration of 5-7 hours

2

Intermediate acting: NPH (Humalin N, Novalin N)

onset within 1-2 hours, peaking in 4-12 hours, duration of 18-24 hours

3

Mixed- NPH 70%/ regular 30%, or NPH/regular 50%

Onset of 0.5-1 hours, peaking in 1.5-16 hours, duration of 24-36 hours.

4

Rapid acting: insulin lispro (humalog), aspart (novolog), glusisine (apidra)

onset 5-30 min, peaking in 1-3 hours, duration of 3-5 hours

5

Long acting glargin (lantus), detemir (levemir)

onset 1 hour, no peak, duration about 24 hours.

6

sulfonylureas:

Glimepride: Mechanism of action: stimulates release of insulin B cells and increased sensitivity to insulin, common adverse effects: weight gain, hypoglycemia, Gi disterss, hepatotoxicity. Contraindications: Hypersensitivity, Type 1 diabetes.

7

Alpha-Glucosidase inhibitors

Acarbose: Mech of action: blocks breakdown of glucose so it can't break down in GI, Common side effects: D, flatulence, abdominal distress, borborygmi, anemia (iron), erythema. Contraindications: Inflammatory bowel disease, Type 1 diabetes

8

Biguanide

metformin- Mechanism of action: lowers hepatic production of glucose, increases the binding of insulin on receptors. common adverse effects: N,V,A,D, abdominal pain, metallic taste, H2O retention. contraindications: no alcohol, kidney functions, type 1, resp. problems.

9

Glitazones (thiazolidinedones)

Rosiglitazone: Mechanism of actions: improves cell sensitivity to insulin and decreases insulin sensitivity. common side effects: fluid retention and edema, HA, upper resp infections. Contraindications: heart failure, hepatic disease, type 1

10

Meglitinides

Nateglinide- Mechanism of actions: stimulates the release of insulin from pancreatic islets. common side effects: hypoglycemia, GI problems. Contraindications: Insulin dependent, lactation, Type 1

11

Incretin therapies

Sitagliptin- mechanism of actions: slows down inactivation of incretin, which stimulates release of insulin. Common adverse effects: HA, D, nasopharyngitis, hypoglycemia, constipation, upper respt tract infections. contraindications: type 1 DKA, renal disorders or failure.

12

Congenital hypothyroidism

inadequate thyroid hormone at birth, cretanism

13

primary hypothyroidism

dysfunction of the thyroid gland

14

secondary hypothyroidism

dysfunction of the pituitary gland

15

tertiary hypothyroidism

Dysfunction of the hypothalmus

16

Levothiroxine

therapeutic effects: mimics the action of thyroid hormone, increases O2 use, resp, HR, nutrient metabolism, promotes growth and maturation. contraindications: thyrotoxosis, CV disease, MI, adrenal insufficiency, allergy to aspirin, Potential adverse effects: D,N,V, tremors, HA nervousness, insomnia, palpitations, tachycardia, angina, cardiac arrest, allergic skin reaction.

17

Mineralcorticosteroid: sodium and H2O retention

Fludrocortisone: treatment of addison's disease, contraindications: CHF, HTN, renal or hepatic impairment, infection, Adverse effects: edema, HTN, CHF, cardiomegaly, hypocalemia, N,V, muscle cramps, heart dysrythmias. Nursing/teaching: weight gain, I&O's, Hypokalemia

18

Glucocorticoid:

Prednisone: anti inflammatory and immunosuppressant, asthma, allergies, cancer, gout, arthritis, IBD, skin conditions, Contraindicaitons: fungal infections, live vaccines, diabetes, osteoporosis, psychosis, liver dysfunction, heart failure, HTN, PUD Adverse effects: low, localized doses little effect, high doses Na and sodium retention, cusings, N,V, muscle weakness, delays healing, cataracts leukocytosis.

19

Potassium sparing Diuretics

Spironalactone- counteracts K loss caused by other diuretics, used with thiazide diuretics to treat edema or HTN, Side effects; Hyperkalemia, hyponatriemia, Drowsiness, Nursing: monitor electrolites, BP, edema, I&O, effects may take several weeks, do not take with breast feeding.

20

Thiazide diuretics:

Hydrochlorothiazide- increase urine output, treat HTN, edema related to CHF, cirrhosis, renal dysfunction. acts on distal tubules to promote H2O, Na, and K excretion. AE: hypotension, dizziness, HA, N, V, D, hyperglycemia, rash, photosensitivity, hypokalemia, NC&T: complete blood panel, eat K rich food.

21

Loop diuretic

Furosemide: works in loop of henley, treats fluid overload: HTN, CHF, cirrhosis, renal dysfunction, Pulmonary edema. AE: electrolyte imbalance, hypotension, etc. NC&T: monitor VS and I&O's, eat K rich food, orthostatic hypotension, give in AM.

22

ACE inhibitors

Lisinopril: Prevents angiotensin 2 from being formed, decrease BP, treats heart failure, improves heart function post MI. AE: cough, HA, dizziness, orthostatic hypotension, rash, hyperkalemia, NC&T- monitor BP before and after, get baseline LTF's and kidney function, avoid OTC NSAID's, first dose effects

23

What does the enzyme ACE do?

decreases bradykinin which decreases inflammation

24

What happenes when Block ACE?

increase bradykinin which increases inflammation mostly in the lungs which causes cough.

25

Angiotension 2 receptor blockers (ARB's)

Losartan: prevents Angiontensin 2 from acting on target organs, decreased BP, CVA prophylaxis, tx of heart failure. AE: hypotension, dizziness, HA, fatigue, nasal congestion, insomnia, angioedema, acute renal failure. NC&T: monitor BP and drug trough, Monitor LFT's and kidney function tests, avoid OTC cold meds.

26

What do Dihyropyridines effect?

Arterial smooth muscle, are a calcium channel blocker.

27

What do Nondiydropyridines effect?

Cardiac muscle and arterial smooth muscle. are calcium channel blocker.

28

Dihydropyridines prototype

Nifedipine: dilates vascular smooth muscle decreasing BP and workload of heart. It does not slow down HR. AE: peripheral edema, hypotension, dizziness, HA, increased HR. NC&T: monitor BP before and after, wean of to prevent rebound HTN, alcohol causes severe hypotension, don't breastfeed, not as useful for geriatric.

29

Nondihydropyridines

Verapamil: dilates vascular smooth muscle and coronary arteries, slows HR and decreases BP. AE: hypotension, dizziness, HA, flushing, constipation, peripheral edema, HF, bradycardia, contrainindicated in heart block. NC&T: Monitor BP before and after, baseline lft's and renal function labs, orthostatic hypotension, keep pt lying down 1 hour after IV dose, take pulse before taking med.

30

Beta adrenergic blocking agent

Metoprolol: selective for heart and blood vessels, decreased BP, HR, and CO. AE: fatigue, weakness, dizziness, N,V,D, menatl changes, nasal stuffiness, impotence, decreased libido, depression, bradycardia, complete heart block, laryngospasm, agranulocytosis, NC&T: take apical and hold if less than 60, take BP at trough, monitor diabetic BS closely, sudden D/C can cause severe HTN or MI, do not take pregnant or breastfeeding.

31

Central alpha agonist

Methyldopa: Last resort med, dilate large central blood vessels, used in pregnancy to lower BP, AE: CNS effects,

32

Alpha adrenergic blockers

prazosin: dilation of peripheral blood vessels, decreased BP

33

Direct acting vasodilators

Hydralazine: potent antihypertensive works on arterial muscles directly.