Insulin
What will insulin do to blood glucose?
Lower glucose!
Observe for hypoglycemia when blood glucose is below 70 mg/dL (tachycardia, diaphoresis, shakiness, hunger, confusion).
Used for glycemic control of Diabetes Mellitus (Type 1, Type 2, and Gestational).
What type of diabetes mellitus do oral antidiabetic medications treat?
ONLY TYPE 2 Diabetes Mellitus! They will lower blood glucose.
This is because orals increase available insulin or modify carbohydrate metabolism. A patient must have some of their own insulin for these meds to work.
What are the main hormones regulated by the thyroid gland located in the neck?
T3 and T4.
Calcitonin is also released by the thyroid gland.
What drug class replaces adrenal hormones for acute and chronic adrenocortical insufficiency (Addison's disease) and treats nonendocrine disorders (cancer, inflammation, and allergic reactions)?
Steroids! Both glucocorticoids and mineralocorticoids.
Which medication is used to increase blood glucose levels for hypoglycemic patients?
glucagon!
Effectiveness is observed by an elevation in blood glucose to above 70 mg/dL
What is the only insulin type that can be given IV?
Regular insulin (Short-acting)! This is used in critical cases.
All other insulins are given subcutaneously.
What are oral antidiabetics used in conjunction with?
Diet and exercise lifestyle changes!
What is the prototype medication to treat hypothyroidism or myxedema coma?
Replaces thyroid hormone.
Med should be taken daily on an empty stomach before breakfast.
What is the name commonality for steroid medications?
They mostly end in -sone or -lone!
prednisone, dexamethasone, hydrocortisone, fludrocortisone, methylprednisolone
Which two medications are antidiuretic hormones?
vasopressin - treats shock states to raise BP, more potent than vasopressin.
desmopressin - treats diabetes insipidus (DI)
List types of insulin for each of the following:
- Rapid-acting:
- Short-acting:
- Intermediate-acting:
- Long-acting:
Rapid-acting: lispro, aspart, glulisine
Short-acting: regular (clear insulin)
Intermediate-acting: NPH (cloudy insulin - just roll don't shake!)
Long-acting: glargine, detemir
Please review onset, peak, duration times for each. ATI pharm text pg. 307
List 2nd generation sulfonylureas?
glipizide, glyburide, glimepiride
What are two complications associated with levothyroxine?
Overmedication (anxiety, tachycardia, chest pain, nervousness, tremors, heat intolerance, fever, weight loss)
Chronic Overtreatment (atrial fibrillation, fracture risk)
What are possible complications of steroids?
glucose intolerance (high BG), osteoporosis, adrenal suppression, peptic ulcer, GI discomfort, infection, Cushing's syndrome, sodium/water retention
What is the main complication with ADH replacement therapy like desmopressin or vasopressin?
Water intoxication!
Retention of too much water (overhydration, sleepiness, pounding headache, high BP)
In what order to you mix regular and NPH insulin?
Air injection: NPH first, then regular.
Drawing up: Regular first, then NPH.
It's an NPH sandwich! NPH-Regular-Regular-NPH or...cloudy-clear-clear-cloudy
What is the prototype biguanide oral antidiabetic medication?
metformin!
Typically, the 1st choice medication for Type 2 DM.
Observe for GI effects: anorexia, nausea, diarrhea, weight loss.
What are medications in the thioamide drug class that treats hyperthyroidism, Graves' disease, and thyrotoxicosis?
methimazole and propylthiouracil!
Observe for hypothyroidism (drowsiness, depression, weight gain, edema, bradycarida, anorexia, cold intolerance, dry skin)
What can patient's do to prevent adrenal suppression from being on long-term steroids?
Taper!
Tapering dose when discontinuing to allow body time to rebalance natural steroids.
Don't stop abruptly!
What is the prototype medication to replace growth hormone from the anterior pituitary gland?
somatropin! (so-much-growin')
Treats growth hormone deficiencies.
Complications = hyperglycemia, inactivation
Treatment should be stopped prior to epiphyseal closure (growth plate closure). Patients will need periodic long bone x-rays to monitor.
Which two insulin types should be timed with meals?
Short-acting (regular): usually need to eat within 30 minutes.
When is metformin contraindicated?
It is contraindicated in clients who have severe infection, shock, KIDNEY IMPAIRMENT, and hypoxia.
Should not be used in clients with alcohol use disorder.
Avoid concurrent use of iodine-containing contrast used in CT scan - can cause acute kidney failure!
What other medication, beyond thioamides, is used to treat hyperthryoidism?
Radioactive iodine (I-131)
Observe for radiation sickness, bone marrow depression, and hypothyroidism
What is the specific prototype medication name for mineralocorticoids?
fludrocortisone
What are two possible medications that will suppress growth hormone release and treat gigantism or acromegaly?
bromocriptine and octreotide!
Also, lanreotide and pegvisomant.