Antidiabetics
Insulin
The RN understands that the therapeutic response to taking any of the antihypertensive medications (BBs, CCBs, ACEis, ARBs, & prazosin) is a decrease in what vital sign?
blood pressure
When administering a diuretic in order to reduce either BP or peripheral edema, the RN knows to monitor this in order to know that the drug is effective for either indication.
urine output
Calcitriol
What oral diabetic drug needs to be stopped at least 48 hours before administration of IV contrast due to the increased risk of lactic acidosis and acute kidney injury/renal failure?
Metformin
2 parts:
1) what is the adverse reaction to taking an antihypertensive in order to decrease blood pressure?
2) what is the best nursing intervention for ensuring safety with regard to this ADR?
1) orthostatic hypotension
2) rising and changing positions slowly
3 Parts:
1) Which diuretic(s) is potassium-sparing?
2) Which diuretic(s) is potassium-wasting?
3) TRUE or FALSE. Both hypokalemia and hyperkalemia can be life-threatening ADRs of diuretics.
1) spironolactone
2) thiazides (HCTZ) and loops (furosemide)
3) TRUE
2 parts:
1) taking too much levothyroxine can result in which life-threatening ADR?
2) taking too much PTU (or MMI or other thioamide) can result in which life-threatening ADR?
1) thyroid crisis/storm
2) myxedema coma
What is the only respiratory medication that can be used for acute asthma attacks and/or status asthmaticus?
albuterol
Which of the following 2 oral diabetic drugs increases insulin by stimulating the beta cells to make more insulin? Glipizide or Metformin.
Glipizide.
2 parts.
1) The RN is giving a patient an antihypertensive and notes the BP has been 140/90 for the past 4 weeks after starting therapy. Is this drug effective for reducing HTN?
2) The RN is giving a patient an antihypertensive and notes the BP has fallen from 140/90 to 115/75 over 4 weeks of therapy. Is this drug effective? (NOTE: please know "normotensive" AKA normal BP).
1) No
2) Yes
The RN needs to instruct the patient on which diuretic(s) to avoid using salt-substitutes like Mrs. Dash because they contain high potassium?
Spironolactone
Glucocorticoids are the most potent steroid hormones made in the body (i.e. cortisol) and they have anti-inflammatory properties. What is the expected outcome if the RN is giving prednisone for INFLAMMATION only (and NOT for Addison's)?
A decrease in inflammation and/or inflammatory symptoms.
What is the MOA for ALL antitussive medications, regardless of narcotic vs. non-narcotic?
Act on the cough center in the medulla to suppress cough
TRUE or FALSE. The peak times of insulin are as follows:
rapid-acting: 30-90 mins
short-acting: 1.5-3.5 hours
intermediate-acting: 4-12 horus
TRUE
The RN notes increased renal function values in a patient taking these 2 classes of medications and knows that this is an indication to stop therapy.
ACEis and ARBs
2 parts: Diuretics have two main indications for use. Name them AND how we would know they are having a therapeutic effect?
1) HTN- a decrease to BP <120/<80
2) peripheral edema- a reduction in edema
***both happen as a result of an increase in urine output***
2 parts:
1) what is the MOA of levothyroxine?
2) what is the MOA of PTU?
1) this is synthetic T4; so, replacing the T4 means more T4 is available for conversion into T3
2) PTU inhibits the peripheral conversion of T4 into T3
Why does the RN need to instruct the patient to rinse their mouth out after taking inhaled medications for COPD and/or asthma?
BOTH- levothyroxine (HYPOthyroidism) and PTU (HYPERthyroidism).
Both thyroid drugs decrease the effectiveness of diabetic medications (insulin AND PO diabetics).
Levo increases the amount of blood sugar b/c the metabolic rate of the body increases from the increased thyroid hormone.
PTU is thought to destroy the beta cells, which decreases any sort of insulin secretion that still exists.
ACEis and ARBs can cause what potentially life-threatening electrolyte imbalance?
hyperkalemia
2 parts: ACEi's and ARB's work to inhibit this end product of the RAS cascade. Name that end product. Also describe why inhibiting this end-product results in a decreased BP.
BONUS: what OTHER electrolyte do we need to monitor here?
1) aldosterone (a mineralocorticoid made by the adrenal cortex)
2) normally, aldosterone holds on to sodium, which then holds on to water. this is to increase vascular volume to improve hypotension. with HYPERtension, blocking aldosterone means we get rid of sodium and therefore water, which decreases vascular volume and reduces BP!
BONUS: potassium! normally, aldosterone gets rid of K+. but, but inhibiting it, we actually hold on to K+! which means we need to monitor for HYPERkalemia!
3 part scenario:
1) a pt is taking levothyroxine for hypothyroidism & calls the RN reporting: tachycardia, palpitations, sweating, hyperthermia/feeling hot/not tolerating the heat, etc. What is the pt experiencing as an ADR?
2) a pt is taking PTU for hyperthyroidism & calls the RN reporting: bradycardia, bradypnea, hypothermia/cold interolence/feeling cold, confusion, lethargy, etc. What is the pt experiencing as an ADR?
3) a pt is taking prednisone & fludrocortisone for Addison's disease & calls reporting: buffalo hump, moon face, edema, muscle wasting, thinning skin with easy bruising, etc. What is the pt experience as an ADR?
1) hyperthyroidism from overmedication (with thyroid storm/crisis being life-threatening)
2) hypothyroidism from overmedication (with myxedema coma being life-threatening)
3) Cushing Syndrome from overmedication
Which adventitious lung sound would indicate to the RN that the pt is experiencing a SE after giving a first-generation or a second-generation antihistamine?
wheezing