Wind_ unit 8_ exam 3

Unit 8

Drugs to know glipizide, metformin, exenatide, glucagon, lispro, regular insulin, NPH, glargine, 70/30
insulin, Levothyroxine, Propylthiouracil, Calcitriol, Prednisone, Fludrocortisone

Insulin

Action: promotes use of glucose by body cells, stores glucose as glycogen in muscle

Use: reduce blood glucose in diabetics

Side effects: redness/ irritation of injection site

Adverse reactions: palpitations, tachycardia, shock, anaphylaxis, ketoacidosis, hypoglycemic reaction

S/S hypoglycemia: headache, dizziness, confusion, slurred speech, hunger, weakness, nervousness,
anxiety, agitation, tremors, sweating, flushing, lethargy.

Interactions: aspirin decreases glucose, oral anticoagulants, alcohol, other hypoglycemics, beta blockers.
Thiazides increase glucose, glucocorticoids, oral contraceptives, thyroid drugs, smoking

Contraindications: hypoglycemia, allergy

Types of insulins:

Rapid acting, Short acting, Intermittent acting ,Long acting ,Combination

Type Name Onset Peak Duration Food

Rapid acting Lispro / Humalog 15-30 minutes 30 min -1.5 HR 3-5 HR Food tray must be
present when
administering
Short acting Regular insulin 30-60 min 2.5-5 HR 4-12 HR Give insulin then go
get meal tray

Intermittent NPH 1-2 HR 4-12HR 14-24 HR If give at breakfast, it

acting will peak at lunch.
Give at lunch peak at
dinner – need food
tray when peak
Long acting Glargine / Lantus 1HR 24HR NONE Eat regular at
*give @ mealtimes.
bedtime Do not mix with
other insulin!
Combination  short- and NPH 70%,
intermediate- insulin regular
acting or 30%.
rapid- and Can be mixed
intermediate- in other
acting strengths
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Combination: short+ intermittent acting insulins / rapid + intermittent (70/30 or 50/50 NPH+ regular
insulin)

Types of administrations:

Insulin pump, insulin pen injector, insulin jet injector

Rotate administration sites: back of arm, outer thighs, stomach (2 inch away from belly button)

Sliding scale:

Adjusts dose according to individuals blood glucose levels

Done before eating + bedtime

Uses rapid/ short acting insulin

Insulin storage:

Unopened in fridge – remove 30 minutes prior to administering to reduce irritation

Opened insulin- in fridge for 3 months or room temperature for 30 days

Do not put in direct sunlight or hot places

Assessment:

Medication/ medical history, type of insulin + dosages, vitals, blood glucose/ A1C, s/s
hypo/hyperglycemia

Nursing interventions:

Monitor vitals, glucose, A1C, monitor for s/s hypo/hyperglycemia

Patient teaching:

Hypoglycemia is more likely to happen during peak time of insulin.

Teach s/s hypo/ hyperglycemia

What to do to stop hypoglycemic event

Compliance with diet, exercise, drug regimen

Wear medical alert tag

How and when to check blood glucose

How and when to inject insulin and rotation of sites

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Glipizide -sulfonylureas

Action: increases insulin, stimulate pancreatic beta cells to secrete more insulin, decreases glucose
production, makes cells more receptive to insulin

Use: diabetics

Side effects: drowsy, headache, confusion, visual disturbances, GI upset, anxiety

Adverse: hypoglycemia, tachycardia, seizures, coma, resp. depression

Contraindications: liver/ kidney dysfunction

Interactions: alcohol, beta blockers, green tea (causes hypoglycemia) , sulfa drugs/ allergy

Metformin – Biguanides

Action: decreases hepatic production of glucose from stored glycogen, diminishes increased serum
glucose after meals, decreases post prandial hyperglycemia, decreases glucose absorption in small
intestine, increases insulin receptor sensitivity, increases peripheral glucose uptake cellularly

Use: controls blood sugar in type 2 diabetes

Side effects: dizziness, fatigue, agitation, headache, bitter/ metallic taste, weight loss, gi symptoms
(abdominal pain, bloating)

Adverse: lactic acidosis, hypoglycemia

Contraindications: hold 48 HR prior + after receiving contrast dye (can cause lactic acidosis/ renal
failure), hepatic/ renal dysfunction

Interactions: cardiac drugs, contrast dye, green tea, can cause liver dysfunction

Exenatide – incretin mimetics

Action: increases the level of incretin hormones, increases insulin secretion, decreases glucagon
secretion to reduce glucose production

Use: type 2 diabetes (does not replace insulin)

Side effects: same as oral hypoglycemics

 Give x2 daily SQ to reduce A1C

Assessment:

Medication/ medical history, alcohol intake, vitals, blood glucose, A1C, kidney/ liver disease, patient
knowledge

Nursing interventions:

Monitor vitals, cardiac status, administer with food, monitor blood glucose, monitor liver/ kidney
function , monitor for side effects/ adverse reactions , prepare teaching plan

Teaching:
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s/s hypoglycemia, how to stop it, how to prevent it

Insulin can be used as well when stressed, surgery, meds

Diet + exercise

How to monitor BG

Do not drink alcohol

Take as schedules with food to minimize GI upset

Glucagon -hyperglycemic drug

Action: hyperglycemic hormone secreted by the alpha cells in the islet of Langerhans, increases blood
sugar by stimulating glycogenolysis in the liver

Use: treats insulin induced hypoglycemia when patient cant eat/ drink or in unresponsive

Routes: SubQ, IV, IM, works within 10 minutes

Thyroid drugs
Assessment:
Baseline vitals, T3 +T4+ TSH levels, medical/ medication history, history of diabetes, allergies
Nursing interventions
Monitor vitals, monitor weight, administer thyroid replacement BEFORE breakfast on empty
stomach, take antithyroid medications with meals,
Teaching:
check labels before using OTC drugs, report symptoms of hyper/hypothyroidism, encourage
medical bracelet alert , do not stop abruptly , take same time each day , diabetic patients need
to know that thyroid drugs increase effectiveness of antidiabetic drugs
Levothyroxine – thyroid replacing hormone

Action: increases metabolic rate ,oxygen consumption and body growth (increases T3+T4)

Use: hypothyroidism (drug of choice)

Myxedema- severe hypothyroidism in adults

Cretinism – severe hypothyroidism in children

S/S: lethargy, memory impairment, slow thinking, cold intolerance, dry skin, constipation, weight gain

Side effects: GI distress, tremors, nervous, insomnia, weight loss

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Adverse: tachycardia, hypertension, palpitations, osteoporosis, thyroid storm

Contraindications: severe renal disease,

Caution: cardiovascular disease, hypertension, diabetes (increases BG)

Interactions: anticoagulants, vasopressors, decongestants (increases effect), antidiabetics drugs

(decreases effect), digoxin (decreases effect)

FOOD- take ½-1 HR prior to eating

Hyperthyroidism

Increases T3 +T4 levels

Graves disease or thyrotoxicosis s/s: tachycardia palpitations, excessive perspiration, heat intolerance,
nervous, irritability, exophthalmos (bulging eyes), weight loss

Treatment:

antithyroid drugs that will inhibit synthesis or release thyroid hormone

surgical removal of part of the thyroid gland

radioactive iodine therapy

*thyroid storm = propanol works the best for these patients (decreases BP+ HR)

Propylthiouracil – hyperthyroidism drug

Action: reduces excessive secretion of thyroid hormone T3+T4

Use: hyperthyroidism

*can take about a week to work

*may need to include beta blockers (propranolol) to control BP +HR

Side effects/ adverse: sore throat, rash, fever

Interactions: anticoagulants (increases effect), antidiabetic (decreases effect), digoxin + lithium increase
thyroid medication effect

Parathyroid gland

4 glands located in the back of the thyroid gland

PTH- parathyroid hormone regulates calcium levels in the blood

 Promotes calcium release from bone

 Promotes calcium absorption from GI tract
 Promotes calcium reabsorption in kidneys
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Hypoparathyroidism

Decreased level of PTH resulting in hypocalcemia

Treatment: calcitriol

Calcitriol

Action: promotes calcium absorption from GI tract , promotes secretion of calcium from bone to blood

Use: hypoparathyroidism

Side effects: anorexia, nausea, vomiting, drowsiness, headache, dizziness, metallic taste, lethargy

Adverse reaction: hypercalcemia

Contraindications/ interactions: cardiac disease, renal calculi, malabsorption syndrome

Interactions: digoxin, verapamil. thiazide diuretics + calcium supplements can increase calcium

Assessment: serum calcium levels, s/s hypocalcemia (mouth twitching, numbness of fingers, carpopedal
spasms, muscle spasms)

Nursing interventions: monitor serum calcium levels, observe for s/s hypocalcemia, teach patient to
report s/s hypocalcemia

Adrenal glands
 Adrenal medulla – produces epinephrine + norepinephrine
 Adrenal cortex – produces glucocorticoids (cortisol), mineralocorticoids (aldosterone)
Cortisol promotes sodium + water retention and potassium excretion , levels controlled by
negative feedback.
Mineralocorticoids promotes sodium + water retention and potassium excretion, controlled by
renin-angiotensin system
 Addison’s disease: Glucocorticoid hyposecretion.
 Cushing’s syndrome: glucocorticoid hypersecretion

Prednisone – glucocorticosteroids (adrenal drug)

Action: effects inflammatory response, effects carbohydrate/ protein/ fat metabolism, effects muscle +
bone cell activity

Use: inflammation, ulcerative colitis, glomerulonephritis, autoimmune disorder, drug reactions,

anaphylaxis, asthma, prevention of organ rejection

Controlled by ACTH in brain

Side effects: nausea, diarrhea, abdominal distension, increased appetite, sweating, headache, flushing,
mood changes, depression, cataracts, amenorrhea

Adverse Reaction: petechia, thin skin, ecchymosis, osteoporosis, tachycardia, hypertension,

hyperglycemia, abnormal fat deposits, muscle wasting, edema, Na+ water retention, K+ loss,
thrombophlebitis, embolism
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Contraindications: allergy, psychosis, fungal infection, peptic ulcer

Caution: diabetes, renal , CHF, MI, HTN , osteoporosis, seizures, cataracts, glaucoma

Interactions: anticonvulsants +antidiabetics (decreases effect), digoxin (high chance of dig toxicity)

Fludrocortisone – mineralocorticoids (adrenal drug)

Action: replaces aldosterone – increases water and sodium retention, excretes potassium. Controlled by
renin-angiotensin system

Use: adrenocortical insufficiency / Addison’s disease

Side effects: nausea, diarrhea, abdominal distension, increased appetite, sweating, headache, flushing,
mood changes, depression, cataracts, amenorrhea

Adverse: petechia, thin skin, ecchymosis, osteoporosis, tachycardia, hypertension, FVO, hyperglycemia,
abnormal fat deposits, muscle wasting, edema, Na+ water retention, hypokalemia- K+ loss,
thrombophlebitis, embolism

Assessment: baseline vitals, labs (sodium, potassium, BG), weight, urine output, medical/ medication
history, history of peptic ulcer, cataracts, glaucoma, DM, psych issues

Nursing interventions:

Vitals, weight, lung sounds

Monitor BG, and electrolytes + electrolyte imbalances

 Hypokalemia: nausea, vomiting, muscle weakness, abdominal distention, irregular HR

Increase diet with potassium

Monitor for side effects/ adverse reactions

Osteoporosis in elderly

Teaching:

Do not stop abruptly

s/s hypokalemia

weigh self-daily

stay away from people who are sick

Side effects: moon face, puffy eyelids, edema in the feet, bruising dizziness, bleeding, menstrual
irregularities

Take with food

Eat potassium foods