NUR 210, 242 Exam 3 pharm study ,100% CORRECT

NUR 210, 242 Exam 3 pharm study guide Loop,potassium-sparing, and thiazide diuretics Drug classification Thiazides Thiazide-like diuretics Loop High ceiling diuretics Thiazide Action Potassium-spa ...

NUR 210, 242 Exam 3 pharm study guide Loop,potassium-sparing, and thiazide diuretics Drug classification Thiazides Thiazide-like diuretics Loop High ceiling diuretics Thiazide Action Potassium-sparing Potassium sparing diuretics Acts on the distal convoluted renal tube. Promotes sodium, chloride, and water excretion Indications Hydrochlorothiazide Decrease blood pressure Decrease amount of fluid within the body Treats peripheral edema Side effects Hyperglycemia Hypercalcemia Hypokalemia Dizziness Vertigo Adverse reactions Cardiac dysrhythmias Orthostatic hypotension Severe hypokalemia Contraindications Renal failure Diabetes Interactions Digoxin Herbal products Loop diuretics Action Act on the loop on henle by inhibiting chloride transport of sodium and passive reabsorption of sodium. As more fluid is passed out by the kidneys, less fluid remains in the bloodstream Indications Furosemide HF Renal dysfunction Hypertension Peripheral and pulmonary edema Side effects Electrolyte imbalances Decrease in potassium, magnesium, sodium, calcium Hyperglycemia Dizziness Headache Adverse reactions Hypokalemia Hyponatremia Hypomagnesemia Orthostatic hypotension Renal failure Contraindications Severe electrolyte imbalance Hypovolemia Anuria Diabetes mellitus Hypotension Interactions Digoxin-risk for digitalis toxicity Lithium Potassium-sparing Action Blocks the action of aldosterone Promotes sodium and water excretion and promotes potassium retention Indications Spironolactone Edema/fluid retention Hypertension Congestive heart failure Kidney disease Side effects Dizziness GI upset Weakness Headache Adverse reactions Hyperkalemia Hepatoxicity Contraindications Severe kidney and liver disease Interactions Potassium supplements Ace inhibitors Diuretics and the nursing process Assessment (for all diuretics) Baseline vitals Weight pt Look for third spacing Medical history Peripheral edema Baseline labs Electrolytes, potassium, magnesium, and glucose Urine output Interventions Monitor urine output Daily weight Monitor vitals Loop diuretics IV very slowly to avoid hearing loss Thiazide and loop diuretics Watch for hypokalemia (low potassium) Potassium sparing diuretics Watch for hyperkalemia (high potassium) Hypokalemia ( low potassium) s/s Muscle weakness Cramps Cardiac dysrhythmias Hyperkalemia (high potassium) s/s Nausea Diarrhea Abdominal cramping Tingling In hands and feet Pt evaluation Decrease in bp or within normal limits Increase urine output Decrease in fluid retention Weight goes down Pt teaching Diet-either high or low potassium Loop or thiazide: eat more potassium Potassium sparing: eat less potassium s/s of hyper or hypokalemia teach pt to stand up slowly pt should take meds in the morning daily weights: 1 or 2lbs daily shift is normal loop diuretics: stronger and not self-limiting thiazide diuretics: self-limiting Summary Thiazide Diuretics It is important to monitor electrolytes in patients taking thiazide diuretics. Patients should see decrease in BP and peripheral edema. Teach the patient about signs and symptoms of hypokalemia. Loop Diuretics Loop Diuretics are used to treat Heart failure, HTN, and peripheral edema. During the nursing intervention, it is important to monitor electrolytes. Signs and symptoms of hypokalemia are muscle weakness/cramps and cardiac dysrhythmias. Potassium-Sparing Diuretics Potassium sparing diuretics are used to treat hypertension, edema, and heart failure. During a nursing intervention, it is important to monitor electrolyte levels, at risk for hyperkalemia. Potassium sparing diuretics may not be given with ACE inhibitors. Osmotic diuretics Classifications Osmotic diuretic Action more water. Increases osmolality and sodium reabsorption in the proximal tubule, drawing in Kidneys excrete sodium, chloride, potassium, and water Indications Mannitol Increased cranial pressure Cerebral edema Increased ocular pressure Prevent renal failure Side effects Electrolyte imbalances GI problems Adverse reactions Pulmonary edema Tachycardia Acidosis Contraindications Heart disease Heart failure Renal failure Interactions Hypokalemia; increase risk of digoxin toxicity Nursing process: osmotic diuretics Overview: mannitol Normally used to remove large amounts of fluids in emergency situations and ICU Also used to prevent kidney failure Diuresis usually happens 1-3hrs after medication is administered Assessment v/s dehydration baseline labs interventions monitor patient closely strict Is and Os measure fluids going in, and output of fluid keep checking lab values monitor for dehydration monitor for side effects and adverse reactions pulmonary edema listen to lungs for sounds monitor n/v, tachycardia, acidosis do not administer if vial contains crystals (usually when exposed to cold temperature) not for pts with HF or renal failure evaluation dramatic increase in urination summary osmotic diuretics are used in emergency situations they are very potent diuretics they may cause pulmonary edema and tachycardia due to extreme fluid shifts Alpha adrenergic blockers Classifications Alpha adrenergic blockers Alpha blockers Action Block alpha adrenergic receptors Cause vasodilation resulting in decreased blood pressure Indications Prazosin Used to control hypertension especially those who have Lipid abnormalities Diabetes Side effects Dizziness Headache Drowsiness Nausea Edema/weight gain Dry mouth Tinnitus Blurred vision Adverse reactions Orthostatic hypotension Tachycardia Pancreatitis Elevated liver enzymes Contraindications Orthostatic hypotension Breastfeeding Pregnancy Interactions Alcohol Nitrates and other antihypertensive medications increase risk for hypotension NSAIDs can cause decreased effects Nursing process: alpha adrenergic blockers Depress sympathetic nervous system, resulting in vasodilation and decreased blood pressure Used for hypertension Good for pt with lipid abnormalities and diabetes Assessment v/s daily weights medication history interventions continue to monitor v/s and weight check for bp decrease, without substantial increase in HR weight should stay the same check for edema in extremities be sure pt is taking medication as prescribed help pt change positions slowly evaluation blood pressure should be decreasing HR Should be within normal limits Pt should not have edema or have any side effects or adverse reactions Notify physician of side effects or adverse reactions, especially syncope Pt education Teach pt to change positions/stand up slowly Pt should monitor weight daily Advise pt to continue to take this medication Summary The effect of vasodilation causes a decrease in blood pressure During nursing assessment, it is important to obtain baseline vital signs prior to administration Monitor for tachycardia and orthostatic hypotension ACE inhibitors and ARBs Drug classification Angiotensin converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Action ACE inhibitors Inhibits angiotensin II, blocks aldosterone, promotes potassium retention and excretion of water and sodium, results in vasodilation and lower blood pressure. ARBs Prevent the release of aldosterone by blocking angiotensin II form receptors Indications ACE inhibitors-end in “pril” Lininopril Lower blood pressure Treat HF ARBs-end in “sartan” Valsartan Lower blood pressure Treat HF Side effects ACE ARBs Dry cough, fatigue, insomnia, GI upset, hyperkalemia Dizziness, hypotension, headache, hyperkalemia, hyperglycemia Adverse reactions ACE ARBs Hypotension Hyperkalemia Angioedema Orthostatic hypotension Hyperkalemia Elevated liver enzymes Renal dysfunction Contraindications ACE ARBs African Americans do not respond to this drug alone Pregnancy/HF Pregnancy/breast feeding HF Interactions ACE inhibitors: Potassium-sparing diuretics Salt-substitutes (has potassium in them) Afican americans usually do not respond to this med Nursing process: ACE inhibitors and ARBs Assessment v/s drug history what they’ve taken when they took it did it work how di they react to the medication interventions monitor v/s and labs ask pt about side effects education advise pt about orthostatic hypotension (stand up slowly) evaluation blood pressure lower hr will be within normal limits side effects will subside summary ace inhibitors and ARBs cause vasodilation’s and decrease peripheral resistance, resulting in decreased blood pressure during a nursing intervention, it is important to monitor bun/crt., potassium, and liver enzymes advise pts to change positions slowly dry cough common side effect of ace inhibitors Anti-tubercular drugs Classification Anti-tuberculosis agents (isoniazid, rifampin) Action Bactericidal Kills the tuberculosis bacteria Bacteriostatic Inhibits tubercle cell-all synthesis, preventing bacteria from multiplying Indications for anti-tubercular Active TB infection Prophylactic treatment from TB Isoniazid side effects Rash Photosensitivity GI upset Isoniazid adverse reaction Peripheral neuropathy Hepatotoxicity Isoniazid Contraindications Renal/hepatic disease Alcoholism Isoniazid interactions Alcohol Antacids Nursing process Assessment Pat med hist and allergies PPD test results Chest x-ray results Last ophthalmic exam Signs and symptoms of paresthesia Lab values: liver function, BUN, creatinine, bilirubin Interventions Take isoniazid 1 hr before or 2hr after meals. Other antitubercular can be taken without regard to meals Give w/pyridoxine Monitor serum liver enzymes Collect sputum specimens early in the morning on 3 consecutive days Encourage regular eye exams Pt education Compliance to tx and medical appointments is necessary for effective treatment transmission Take isoniazid 1 hr before or 2 hrs after meals Do not take antacids or drink alcohol while taking antitubercular Sun precautions to avoid photosensitivity Rifampin may turn body fluids orange Report signs of peripheral neuropathy Check w/physician before becoming pregnant All contacts should be placed on prophylactic treatment Good hygiene for hand tissues and dishes Summary TB is one of the worlds leading causes of deaths form infectious disease Prompt treatment for active infection as well as latent TB helps prevent Adherence to treatment is essential. Noncompliance or intermittent treatment leads to drug resistance Medications for upper respiratory disorders Classifications Antihistamines (H1 blocker) Decongestants (nasal and systemic) Intranasal Glucocorticoids Antitussives Expectorants Action of anti-histamines Blocks the affects of histamine by occupying receptors Diphenhydramine (Benadryl) Blocks all receptors Loratadine (Claritin) Neglects to block receptors in the brain, resulting in less drowsiness Indications for anti-histamines Allergic rhinitis First generation antihistamines Diphenhydramine May be given PO, IM, OR IV Second generation antihistamines (non-sedating) Loratadine Given PO only Anti-histamines side effects Drowsiness, hypotension, disturbed coordination, dry mouth, urinary retention, palpitations Anti-histamines adverse reactions Thrombocytopenia Anti-histamines Contraindications Acute asthmatic attack COPD Severe liver disease Use w/caution Narrow-angle glaucoma Anti-histamines interactions Alcohol, CNS depressants, MAOIs Decongestants action (Oxymetazoline HCL) Stimulants alpha-adrenergic receptors causing vasoconstriction of nasal mucosa Decongestants Indications Nasal congestions due to infection, inflammation, or allergy Decongestants side effects Nervousness or restlessness Decongestants adverse reactions Hypertension Hyperglycemia Decongestants contraindications HTN Cardiac disease Diabetes Decongestants interaction Increases effect of beta blockers Use with caffeine increases restlessness and palpitations Intranasal Glucocorticoid action Fluticasone Anti-inflammatory action decreases symptoms of rhinorrhea, sneezing and congestion Intranasal glucocorticoid indications Allergic rhinitis Intranasal glucocorticoid side effects Candidiasis Headache Pharyngitis Nasal mucosae dryness w/ use of nasal spray Intranasal glucocorticoid adverse reactions Systemic effects may occur after 30 days Possible immunosuppressant Intranasal glucocorticoid contraindications Immunocompromised pt Adrenal gland dysfunction Intranasal glucocorticoid interactions Pregnancy cat C Anti-tussive action (Dextromethorphan Hydrobromide) Acts on cough-control center in brain to suppress cough reflex Anti-tussive indications Non-productive, irritating cough Anti-tussive side effects Drowsiness Confusion Nervousness Anti-tussive adverse reactions Respiratory depression Anti-tussive contraindications Asthma Bronchitis Heart failure Anti-tussive interactions There are no significant drug interactions w/ Anti-tussive Expectorants action (Guaifenesin) Loosens bronchial secretions so they can be eliminated by coughing Expectorants indications Cough associated with common cold Expectorants side effects Drowsiness Nausea Headache Irritability Expectorants adverse reactions n/a Expectorants contraindications N/a Expectorants interactions Pregnancy cat c Nursing process upper respiratory drugs Antihistamines URIs include Common cold Acute rhinitis Allergic rhinitis Sinusitis Acute pharyngitis Anti histamines Assessment History of environment exposures (drugs, foods, stress) Before and during treatment v/s Monitor UOP Assess cardiac and respiratory status Interventions CBC for thrombocytopenia Oral; give w/food to decrease GI upset Injections: administer in large muscle, not to be given subq Pt teaching Don’t drive or operate heavy machinery if drowsiness occurs Avoid alcohol and other CNS depressants Breast feeding not recommended while taking (children susceptible to side effects Evaluation Pt will have decreased nasal congestion, mucosal secretions, and cough All others Indications Nasal congestion due to infection, inflammation, or allergy MOA: stimulate alpha-adrenergic receptors and cause vasoconstriction of nasal mucosa. This shrinks nasal membranes and reduces fluid secretion Use w/ caution: HTN, cardiac disease, diabetes Interactions increase effect of beta blockers, caffeine increases restlessness and palpitations SE nervousness or restlessness Decongestants Assessment v/s (before and during) blood glucose (if pt is diabetic ) interventions monitor blood glucose if pt is diabetic pt teaching frequent use may lead to tolerance and rebound nasal congestion limit use to <3 days (to avoid rebound) use caution with OTC cold meds if history of hypertension proper use of nasal spray do not take at bedtime (insomnia) evaluation pt will have decreased nasal congestion summary upper respiratory disorders include common cold, acute and allergic rhinitis, sinusitis, and acute pharyngitis common cold and acute and allergic rhinitis often have many of the same symptoms drug commonly used to treat these conditions may include antihistamines, decongestants, glucocorticoids, antitussives, and expectorants Medications for lower respiratory disorders Drug classification Adrenergic agonist/sympathomimetic (albuterol) Anticholinergic (tiotropium) Leukotriene modifier (montelukast) Mucolytic (acetylcysteine) Albuterol action Selective to beta 2 adrenergic receptors Relaxes smooth muscle which promotes bronchodilation Albuterol indications Treatment of asthma Prophylaxis and treatment of bronchospasm Albuterol side effect Tremors Anxiety Sweating Agitation Nervousness Albuterol adverse reactions Palpitations Tachycardia Hyperglycemia Hypokalemia Bronchospasm Cardiac dysrhythmia Albuterol contradictions Use w/caution Cardiac disease HTN DM MAOI therapy Albuterol interactions MAOIs and TCAs may increase effect Beta blockers antagonistic effect Glucose slight increase Potassium decrease Tiotropium action Bocks muscarinic cholinergic receptors and antagonizes acetylcholine, relaxing smooth bronchial muscle (bronchodilation) Tiotropium indications Maintenance treatment of asthma and COPD Tiotropium side effect Dry mouth Cough Oral ulceration Urinary retention Constipation Blurred vision Tiotropium adverse reactions Dehydration Chest pain Anaphylaxis Cardiac dysrhythmias Tiotropium contraindications Narrow-angle glaucoma Renal impairment Older adults Tiotropium interactions Phenothiazines-increased anticholinergic effects Metoclopramide- decreased action Montelukast action Binds with leukotriene receptors to inhibit smooth muscle contraction and bronchoconstriction Montelukast indications Allergic rhinitis and asthma Prevention of exercise induced bronchospasm Montelukast side effect Headache Insomnia Confusion Bruising Montelukast adverse reactions Angioedema Elevated liver enzymes Anaphylaxis Stevens-johnson syndrome Montelukast contraindications Severe asthmatic attack Status asthmaticus Acute bronchospasm Montelukast interactions Aspirin and NSAIDs block drug action Abnormal liver function test Mucolytics: acetylcysteine action Liquefies and loosens thick secretions so they can be expectorated Mucolytics: acetylcysteine indications Liquefies and loosens thick secretions so they can be expectorated Treatment of acetaminophen overdose Mucolytics: acetylcysteine side effects n/v stomatitis runny nose Mucolytics: acetylcysteine adverse reactions Chest tightness Tachycardia Bronchospasm Mucolytics: acetylcysteine contraindications History of bronchospasm Respiratory insufficiency Mucolytics: acetylcysteine interactions Do not mix with other drugs in nebulizer If given with bronchodilator, give bronchodilator 5 min before the mucolytic Nursing process lower respiratory drugs Albuterol Use with caution Cardiac disease HTN DM MAOI therapy Tiotropium Use w/caution Narrow angle glaucoma Renal impairment Older adults Assessment v/s baseline oxygen sat repspiratory assessment nursing interventions monitor v/s monitor BG continued meds monitor hydration pt education monitor pulse correct way to use equipment and med medic alert bracelet proper oral hygiene increase awareness of hydration report unusual behavior or suicidal thoughts evaluation breathing without wheezing no harmful side effects Montelukast assessment Obtain medical and drug history v/s baseline respiratory assessment liver enzymes baseline planning the pt will have significant improvement in wheezing and lung sounds will be clear within 205days interventions monitor respirations and lung sounds monitor liver function tests pt teaching taking in evening for max effectiveness if chewable tablet, must chew thoroughly (swallowing may alter absorption) if pt has known aspirin sensitivity avoid aspirin and NSAIDs while taking montelukast to avoid bronchoconstriction not for use of acute asthmatic attack no do take st john wort may decrease drug concentration or black or green tea evaluation the pt should be breathing without wheezing and should experience no harmful effects mucolytics assessment med history respiratory assessment planning pt will experience clearing of lung sounds and decreased work of breathing pt will effectively self-administer prescribed medications interventions increase fluid 2000-3000ml;day to thin out secretions do not mis with other drugs in nebulizer if given with bronchodilator, give bronchodilator 5 mins before mucolytic teaching rinse mouth after use-to prevent stomatitis evaluation the pt should be breathing without wheezing and should experience no harmful side effects Summary COPD is a condition caused by several disorders, all of which have similar s;s Drugs commonly used to treat COPD include adrenergic antagonist (bronchodilators), anticholinergics, leukotriene modifiers, and mucolytics Acute asthma can be treated using albuterol Anti-Diabetics Classification Insulins Oral antidiabetics Sulfonylureas Biguanides Insulin Action Promotes the use of glucose by body cells Promotes uptake of glucose, amino acids, and fatty acids Converts to glycogen in liver and muscle for future glucose needs Insulin indications Lower blood glucose levels Control diabetes mellitus Insulin side effects Hypoglycemia symptoms Agitation/shaky Cold/clammy skin Confusion Light headedness Headache Weakness/loss of energy Weight gain Lipodystrophy (skin changes at injection site) Insulin adverse reactions Tachycardia Palpitations Hypoglycemic reaction Insulin contraindications Hypoglycemia Caution Renal impairment Hepatic impairment Insulin interactions Increased hypoglycemia effect Oral anticoagulants Beta blockers Oral hypoglycemic agents Decreased hypoglycemic effect Thyroid medications Steroid (raise blood glucose thereby counteract the effect of insulin Thiazides and loop diuretics (raise blood glucose thereby counteract the effect of insulin) Glipizide action Directly stimulates beta cells in the pancreas to secrete insulin Indirectly alters sensitivity of peripheral insulin receptors, allowing increased insulin binding Glipizide indications Used to treat ty pe 2 diabetes Glipizide side effects Hypoglycemia symptoms GI distress Flatulence, n/v, diarrhea/constipation Drowsiness Dizziness Headache Weight gain Glipizide adverse reactions Hypoglycemia Glipizide contraindications Type 1 diabetes Caution-liver and kidney impairment Glipizide interactions Green tea Alcohol (cause disulfiram-like reaction) Some NSAIDs Thyroid hormone Oral anticoagulants Metformin Action Decrease hepatic production of glucose from store glycogen Decrease glucose absorption from small intestine Increase insulin receptor sensitivity Metformin indications Used to treat type 2 diabetes Metformin side effects GI distress N/V/D Weight loss Hypoglycemia not as likely as sulfonylureas Metformin adverse reactions Renal failure (eliminated unchanged in the urine) Liver dysfunction Vitamin b12 deficiency ( causes alteration in absorption of b12 Lactic acidosis Metformin contraindications Type 1 diabetes Radiographic contrast Renal impairment Hepatic impairment Metformin interactions Radiographic contrast Green tea Some NSAIDs Alcohol Oral anticoagulants Thyroid hormone Exenatide and glucagon Exenatide indications Improves beta cell responsiveness which improves glucose control in pts with type 2 diabetes Not a substitute for insulin and not given to pts with type 1 diabetes Administered by injectable, prefilled pens twice a day Glucagon indications Hyperglycemic hormone that increases blood glucose by stimulating glycogenolysis (glycogen breakdown) in liver Emergency medication used to treat hypoglycemia when other methods of providing glucose are not available (unconscious, NPO) Given subcutaneous, intramuscular, and IV Works fast-blood glucose levels begin to increase within 10 minutes of administration Nursing process antidiabetic/insulin Assessment Identify drugs that a pt currently takes Determine the pts knowledge of dm and use of insulins Check signs and symptoms of hypoglycemia and hyperglycemia Planning The pt will self-administer insulin correctly Assess blood glucose levels Planning diet Nursing interventions and teaching Determine blood glucose levels and report changes Monitor the pts HbA1c to provide feedback of diabetic control Teach pt to recognize and report hypoglycemia and hyperglycemia Teach pt how to counter-act w/food or medicine Teach how to take medication Teach diet and exercise regiment Insulins Rapid acting insulin (logs) Short acting insulin (regular)(lins R) Intermediate acting insulin (NPH)(lins N) Long acting insulin (Lantus, Levemir) Combination insulin Evaluation Blood sugar in normal limits HbA1c is <7 No side effects or hypoglycemia Summary have Pts are prescribed different types of anti-diabetic drugs due to the type of diabetes they During the nursing process, it is important to note pts glucose levels and monitor for hypoglycemia and hyperglycemia Pt education is also important when treating a pt with diabetes; this includes educating the pt how to administer their insulin and how eating a proper diet can decrease diabetic symptoms Medications for thyroid, parathyroid, and adrenal disorders Drug classification Thyroid replacement hormone (levothyroxine) Vitamin D analogue (calcitriol) Corticosteroid (prednisone) Anti-thyroid drug-propylthiouracil (PTU) Levothyroxine sodium action Increases metabolic rate Increases oxygen consumption Promotes glycogenesis and body growth Utilizes and mobilizes stored glycogen Stimulates protein synthesis Levothyroxine indications Drug of choice of replacement therapy to treat primary hypothyroidism Used in the treatment of myxedema Used in the treatment of goiter Used in the treatment of thyroid cancer Levothyroxine side effects GI upset Weight loss Nervousness Irritability Insomnia h/a levothyroxine adverse reactions cardiac palpitations tachycardia hypertension thyroid crisis levothyroxine contraindications MI Caution w/ Cardiovascular disease DM Adrenal insufficiency Levothyroxine interactions Decreases effect of insulin and oral antidiabetic agents (causes increased blood glucose levels) Food (take on empty stomach) Anticoagulants (increases effect and increases risk of bleeding Propylthiouracil (PTU) Conditions treated Hyperthyroidism Graves disease (overactive thyroid) Works by inhibiting thyroid secretion which leads to lower thyroid hormone levels Hyperthyroidism can cause tachycardia, palpitations, excessive perspiration, heat intolerance, nervousness, bulging eyes, weight loss Propylthiouracil (PTU) action Inhibits thyroid secretion, which leads to lower thyroid hormone levels Propylthiouracil (PTU) side effects Rash Drowsiness Weight gain Alopecia (hair loss) Loss of hair pigment Propylthiouracil (PTU) adverse reactions Agranulocytosis (low white blood cells) Bradycardia (medication working too well or too high of dose) Propylthiouracil (PTU) interactions Increases effects of anticoagulants (increased risk of bleeding) Decreases effects of insulin and antidiabetic agents (can lead to hyperglycemia) Propylthiouracil (PTU) contraindications Caution w/ Cardiovascular disease DM Thyroid disorders nursing process Hypo means low Metabolism slows down Increase in weight, but not diet Pt feels cold and tired Constipated Hyper means high Weight loss Heart palpitations Sweating Diarrhea and creased motility of GI tract Assessment Check thyroid levels (T3,T4,TSH) Assess for symptoms of thyroid crisis Pt evaluation Hypothyroidism Energy levels should be restored Hyperthyroidism Heart rate should return to normal Diarrhea should subside They should gain weight back Pt education Take medication at same time every day in relation to meals Check labels on OTC medications Pt should discuss all medications with their doctor Pt should carry medic-alert bracelet or card Calcitriol Action Promotes calcium absorption from the GI tract through dietary consumption Promotes secretion of calcium from bone to blood Enhances calcium deposits into bones Calcitriol indications Treatment for disorders such as hyperparathyroidism and hypoparathyroidism Used to manage hypocalcemia in chronic renal failure Calcitriol side effects Weakness Bone pain Drowsiness Diarrhea Calcitriol adverse reactions Late signs of hypercalcemia Bone pain Bradycardia Calcitriol contraindications Hypercalcemia Pregnancy Caution w/ Renal disease Cardiovascular disease Calcitriol interactions Digoxin Calcium supplements & calcium rich food (increases serum calcium levels) OTC medications that contain calcium Parathyroid disorders nursing process Calcium is vital for electrical impulses in the body Assessment Assess serum calcium levels Report abnormal results assess for symptoms of tetany in hypocalcemia Diarrhea related to calcitriol Fluid volume, deficient related to fluid loss from vomiting, diarrhea, and polyuria Pt evaluation Serum calcium levels should return to normal Pt education Pregnancy is a contraindication Teach pt to read labels on OTC medications, especially for calcium content Pt should avoid calcium in their diet Prednisone action Suppresses inflammatory response Affects carbohydrate, protein, and fat metabolism Affect muscle and blood cell activities Prednisone indications Inflammation Autoimmune disorders Ulcerative colitis Glomerulonephritis Allergies Drug reactions Anaphylaxis Prevent organ rejection Prednisone side effects (usually from high dose or prolonged use) GI upset Fluid and sodium retention Edema Weight gain Appetite changes Abnormal fat deposits in the face and trunk (moon face) Prednisone adverse reactions Lab changes Hypokalemia Hyperglycemia Hypernatremia Hypertension Immune function suppression (long term use) Prednisone contraindications Caution w/ DM Hypertension Renal disease Prednisone interactions NSAIDs and aspirin (increases GI side effects ) Potassium wasting diuretics (increases potassium loss) Prednisone nursing process Corticosteroids Work in adrenal system Are anti-inflammatory Assessment Baseline vitals Heart rate, blood pressure, and weight Lab values Electrolytes and blood sugar Assess for pain and swelling Interventions Monitor for fluid retention Check weight daily Pt can be at risk for infection Pt should wash hands regularly They should away from others who are sick Wash vegetables carefully Monitor for hypokalemia Monitor for osteoporosis in older pts Pt education Encourage pts to carry medical alert bracelet Pt should eat food high in potassium Summary Three types of medications were discussed in this presentation: • Levothyroxine Sodium, which is used to treat thyroid cancer. Life-threatening adverse reactions can occur when using this drug, so patient education is extremely important. • Calcitriol , which promotes calcium absorption from the GI tract through dietary consumption. • Prednisone, which is an anti-inflammatory used to treat disorders like ulcerative colitis. Chapter 38 Diuretics Purpose Reduce hypertension Decrease edema Types Thiazide and thiazide-like Loop or high ceiling Osmotic Carbonic anhydrase inhibitor Potassium-sparing Diuretics produce increased urine output by inhibiting sodium and water reabsorption from the kidney tubules Thiazide and thiazide like (hydrochlorothiazide) Action Use Act on distal convoluted renal tubule Promote sodium, chloride, and water excretion Hypertension Peripheral edema Side effects/adverse reactions Dizziness, headache, weakness, hypotension Gi distress, constipation, hyperglycemia Electrolyte imbalances, urticarial, hyperuricemia Blood dyscrasias, renal failure Contraindications Renal failure Drug interactions Assessment Assess v/s, weight, urine output, and serum chemistry values for baseline levels Check peripheral extremities for edema Planning Pt blood pressure will be decreased Pt edema will be decreased Interventions Monitor v/s and electrolytes Observe for s/s of hypokalemia Monitor the pt daily weight and urine output Suggest that the pt take the drug early in the morning to avoid sleep disturbance from nocturia may occur Instruct pt to slowly change positions from lying to standing because dizziness Loop diuretics (furosemide) Action Act on ascending loop of henle Excrete sodium, water, potassium, calcium, magnesium Side effects/adverse effects Dizziness, headache, weakness, hyperglycemia Blurred vision, photosensitivity, paresthesia Orthostatic hypotension, hyperuricemia Electrolyte imbalances, blood dyscrasias Elevated BUN, creatinine, lipids, renal failure Assessment Obtain a drug history Assess v/s, electrolytes, weight, and urine output for baseline levels Planning Pts edema and hypertension will be reduced Interventions Monitor urinary output and weight to determine body fluid gain or loss Monitor v/s and not decrease in BP Administer IV furosemide slowly, hearing loss may occur if it is rapidly injected Observe for evidence of hypokalemia Monitor potassium levels, especially when pt is taking digoxin Osmotic diuretics (Mannitol) Action Use Increase sodium reabsorption in the proximal tubule and loop of henle Excrete sodium, chloride, potassium, water Prevent kidney failure Decrease ICP and IOP Side effects/ adverse reactions Fluid and electrolyte imbalances GI distress, acidosis Pulmonary edema, tachycardia Contraindications Heart disease, heart failure, renal failure Potassium-sparing diuretics (spironolactone) Action Use Block action of aldosterone Promote sodium/water excretion and potassium retention Edema due to heart failure, cirrhosis of the liver Side effects/adverse reactions Dizziness, headache, weakness, hyperkalemia GI distress, paresthesia, muscle cramps Hyperuricemia, blood dyscrasias Assessment Assess v/s, electrolytes, weight, and urinary output for baseline levels Planning Pt fluid retention and blood pressure will be decreased Pts electrolytes will be within normal range Interventions Monitor urinary output Record vital signs and report abnormal changes Observe for signs and symptoms of hyperkalemia Administer spironolactone in the morning to avoid nocturia Advise pts with high potassium levels to avoid foods high in potassium Chapter 39 antihypertensives Selected regulators of blood pressure Kidneys via renin-angiotensin system Regulators of blood pressure Baroreceptors in the aorta and carotid sinus Vasomotor center in the medulla Hormone ADH Atrial natriuretic peptide ANP Brain natriuretic peptide BNP Physiologic risk factors Excess saturated fat and simple carbs Alcohol increases renin secretions Obesity increases cardiac output, stroke volume, and left ventricular filling Cultural responses to antihypertensive agents African Americans Asian Americans Older adults Nonpharmacologic control of hypertension Stress-reduction techniques Exercise Salt restriction Decrease alcohol ingestion Smoking cessation Guidelines for determining hypertension Normal Systolic less than 120 Diastolic less than 80 Prehypertension Systolic 120-139 Diastolic 80-89 Stage 1 Stage 2 Systolic 140-159 Diastolic 90-99 Systolic greater than 160 Diastolic greater than 100 Antihypertensive drugs Diuretics Thiazides Loop diuretics Combination of thiazide w/ potassium-sparing Combination of thiazide w/other antihypertensive drugs ACE, BB, ARBS Sympatholytic Beta-adrenergic blockers Alpha-adrenergic blockers Beta-adrenergic blockers Nonselective Inhibit beta1 and beta2 receptors Propranolol Cardio selective Block beta1 receptors Metoprolol Side effects Hypotension, dizziness, fatigue Insomnia, nightmares Depression, sexual dysfunction Assessment Obtain a medication and herbal history from the pt Obtain v/s Planning The pts blood pressure will be decreased Nursing interventions Monitor v/s Monitor laboratory results, especially BUN, creatinine, AST, and LDH. Do not abruptly stop taking beta blockers are rebound hypertension may result Advise pts to avoid over the counter drugs without first checking w/ a HCP Alpha adrenergic blockers Prazosin Action Block the alpha-adrenergic receptors Result in vasodilation and decreased blood pressure Side effects Orthostatic hypotension Headache, drowsiness Nausea, nasal congestion Edema, weight gain Assessment Obtain a medication history including current meds Obtain baseline v/s and weight for future comparisons Planning The pts BP will decrease Interventions Monitor v/s Check daily for fluid retention in extremities and weight gain Advise pts to comply w/ the drug regimen Inform pts that orthostatic hypotension may occur Teach pt to monitor daily weights Angiotensin-converting enzyme (ACE) Inhibitors Lisinopril Action Inhibits formation of angiotensin 2 Block release of aldosterone Side effects Nonproductive cough, fatigue, insomnia n/v/d, hyperkalemia dizziness, tachycardia, hypotension, angioedema African American adults and older adults Do not respond w/ ACE monotherapy Contraindications Pregnancy Potassium-sparing diuretics Salt substitutes that contain potassium Angiotensin 2 receptor blockers (ARBS) Valsartan Action Prevent release of aldosterone Act on renin-angiotensin-aldosterone system Block angiotensin 2 from angiotensin 1 receptors Side effects Dizziness, hypotension, headache Hyperkalemia, hyperglycemia GI distress, Diarrhea, pyrosis Calcium channel blockers Verapamil Action Slow calcium channels in myocardium and vascular smooth muscle cells promoting vasodilation Side effects/adverse reactions Flushing, headache, dizziness Peripheral edema, fatigue GI distress, constipation Bradycardia, hypotension, palpitations Antitubercular Tuberculosis Etiology Mycobacterium tuberculosis Acid-fast bacillus Transmission Person to person via droplets Coughing, sneezing, talking Pts at risk Immunocompromised Living or working in high risk residential settings Injecting illegal drugs Health care workers w/ high risk pts Symptoms Cough, fever, night sweats GI distress, weight loss Positive acid-fast bacilli in the sputum or bloody sputum Prophylaxis recommended for those with Close contact with active TB pts HIV positive/immunosuppressed Conversion from negative to positive TB Injection drug users Recent immigrant from high prevalence country Antitubercular drugs Single drug therapy Ineffective Duration 2 years Multidrug therapy Decreases bacterial resistance to drug Treatment duration decreased 6-9 months Drug selection First line drugs Isoniazid, Rifampin More effective and less toxic than second line Combination therapy Minimum of 3-5 drugs Initial phase Lasts 2 months Continuation phase Next 4-7 months Treatment regimen Divided into 2 phases Phase 1 2 months Phase 2 4-7 months Side effects and adverse reactions Headaches, dizziness, confusion GI distress, PERIPHERAL NEUROPATHY OCULAR TOXICITY, OTOTOXICITY, NEPHROTOXICITY, HEPATOXICITY Thrombocytopenia Respiratory depression RIFAMPIN: TURNS BODY FLUIDS ORANGE SOFT CONTACT LENS MAY BE PERANENTLY DISCOLORED Pyridoxine (vitamin b6): hyperglycemia, hyperkalemia, hypophosphatemia, and hypocalcemia Isoniazid (INH) Route: oral, IM Inhibits bacterial cells wall synthesis Side effects/adverse reactions Dry mouth, GI distress, constipation Blurred vision, photosensitivity, tinnitus Drowsiness, dizziness, PERIPHERAL NEUROPATHY PSYCHOTIC BEHAVIOR, TREMORS, SEIZURES HYPERGLYCEMIA, HEPATOTOXICITY THROMBOCYTOPENIA, AGRANULOCYTOSIS Special populations Pregnancy HIV Peds Antitubular drugs nursing process Assessment Obtain a general medical history from the pt Assess for hearing changes if drug regimen includes streptomycin Planning The pt sputum test for acid-fast bacilli will be negative 2-3 month after prescribed antitubercular therapy Interventions Administer INH 1 hr before or 2 hrs after meals Give pyridoxine (vitamin B6) as prescribed with INH to prevent peripheral neuropathy Monitor hepatic function tests Emphasize importance of complying w/ drug regimen Chapter 35 Upper respiratory disorders Upper respiratory disorders Common cold Rhinovirus Affects nasopharyngeal tract Acute rhinitis Inflammation of nasal mucous membranes Sinusitis Inflammation of mucous membranes of sinuses Acute pharyngitis Inflammation of throat Contagious period of common cold 1-4 days before onset of symptoms During first 3 days of cold Transmission Touching contaminated surfaces and then touching nose or mouth viral droplets from sneezing Symptoms of common cold Nasal congestion, nasal discharge, cough, increased mucosal secretions Antihistamines Action Competes with histamine for receptor sites and prevents a histamine response By blocking the H1 receptor sites, nasopharyngeal secretions and itching decrease Antihistamine groups First generation Diphenhydramine Usually cause drowsiness, dry mouth Dizziness, fatigue, blurred vision Disturbed coordination, urine retention Second generation Loratadine Usually have less drowsiness Usually have less anticholinergic symptoms Diphenhydramine Use Acute and allergic rhinitis, pruritus, urticaria Common cold, sneezing, cough Prevent motion sickness Contraindications/cautions Narrow angle glaucoma, urinary retention Severe liver disease Interactions Increases CNS depression w/ alcohol and other CNS depressants Assessment Obtain a history of environmental exposures Assess for evidence of urinary dysfunction Assess cardiac and respiratory status Planning Pt will have decreased nasal congestion, mucosal secretions, and cough Interventions Give oral form of diphenhydramine w/ food to decrease gastric distress Warn the pt to avoid driving a motor vehicle and performing dangerous activities until stabilized on the drug Advise the pt to avoid alcohol and other CNS depressants Suggest use of sugarless candy, gum or ice chips for relief of mouth dryness Nasal congestion Dilation of nasal blood vessels Due to infection, inflammation, allergy Transudation of fluid into tissue spaces Leads to swelling nasal cavity Nasal Decongestants (Oxymetazoline HCL) Stimulate alpha-adrenergic receptors Produces nasal vascular constriction Shrinks nasal mucous membranes Reduces nasal secretion Use Allergic rhinitis, hay fever, acute coryza Administration Nasal spray, nasal drops, tablet, capsule, liquid Side effects/ adverse reactions Nervous, restless Rebound nasal congestion if use is prolonged Interactions Caffeine MAOIs Beta blockers Intranasal glucocorticoids (Fluticasone) Action Use Anti-inflammatory Decrease rhinorrhea, sneezing, and congestion Allergic rhinitis Side effects Drowsiness, dizziness, nervousness GI distress Antitussives (Dextromethorphan Hydrobromide) Action Types Act on the cough control center in the medulla to suppress the cough reflex Non-opioid Opioid Combination preparations Expectorants (guaifenesin) Action Use Loosens bronchial secretions by reducing surface tension of secretions Allows elimination by coughing Common cold Side effects Drowsiness, dizziness, irritability, nausea Nursing process: common cold Assessment Determine whether the pt has a history of hypertension Planning Pts cough will be eliminated or diminished Interventions Observe the color of bronchial secretions Teach pt the proper use of nasal sprays Caution pt not to prolong use of drug to avoid rebound congestion Tell pt to maintain adequate fluid intake Inform pt that common cold and flu viruses are transmitted frequently by hand-to- hand contact or by touching a contaminated surface Sinusitis Inflammation of mucous membranes of sinuses Treatment Decongestant, acetaminophen, fluids, rest, antibiotics Acute Pharyngitis Inflammation of throat Treatment Saline gargles, lozenges, increased fluid intake, acetaminophen Chapter 36 lower respiratory disorders COPD Airway obstruction w/ increased airway resistance of airflow to lung tissues Causes Chronic bronchitis Bronchiectasis Emphysema Asthma Restrictive lung disease tissues Decrease in total lung capacity due to fluid accumulation and loss of elasticity of lung Etiology Pulmonary edema Pulmonary fibrosis Pneumonitis Lung tumors Thoracic deformities (scoliosis) Myasthenia gravis Asthma Inflammatory disorder of the airway walls associated airway obstruction Triggers Stress Allergens Pollutants s/s bronchospasm, dyspnea, mucus secretions wheezing, coughing, tightness in the chest bronchial asthma allergens attach to mast cells and basophils causing antigen antibody reaction on mast cells mast cells stimulate release of chemical mediators inflammatory process occurs resistance to airflow from airway obstruction s/s bronchospasm, wheezing dyspnea, mucus secretions Chronic bronchitis Bronchial inflammation and excessive mucus secretions lead to airway obstruction Causes s/s Bronchiectasis Smoking Chronic lung infections excessive mucous secretion, productive cough rhonchi, hypercapnia, respiratory acidosis Abnormal dilation of bronchi and bronchioles Bronchioles become obstructed by the breakdown of epithelium of bronchial mucosa Tissue fibrosis may result Causes Emphysema Frequent infection Inflammation Proteolytic enzymes released in the lung by bacteria or phagocytic cells Terminal bronchioles become plugged with mucus leading to a loss in fiber and elastin network in alveoli Alveolar walls are destroyed Air trapped in enlarged, over expanded alveoli Resulting in an inadequate gas exchange Causes Cigarette smoking Atmospheric contaminants Lack of the alpha 1 antitrypsin protein Bronchodilators: selective beta adrenergic Albuterol Causes Bronchodilation Rapid onset of action Longer duration of action Few side effects Use Asthma, acute bronchospasm Bronchospasm prophylaxis Common side effects Headache, rhinitis, excitability tremors Bronchospasm, palpitations, tachycardia Bronchodilators: anticholinergics Tiotropium (LAMA drug) Long acting muscarinic antagonist Antagonizes acetylcholine receptors, producing bronchodilation Not a rescue drug!!! Use inhaler) Maintenance treatment of bronchospasms associated with COPD Administered by inhalation only with the handihaler device (dry-powder capsule Common side effects Dry mouth, constipation, dyspepsia, abdominal pain Depression, insomnia, headache Pharyngitis, sinusitis, infection Arthralgia, peripheral edema Nursing process bronchodilators Assessment Assess for wheezing, decreased breath sounds, cough, and sputum production Determine hydration Planning Pts wheezing will be eliminated/diminished Interventions Monitor v/s Provide adequate hydration Observe for side effects Administer medication at regular intervals around the clock to have a sustained therapeutic level Advise pt having asthmatic attacks to wear an identification bracelet or medicAlert tag Leukotriene receptor antagonists: montelukast sodium (singulair) Action Use Reduce inflammatory process and decrease bronchoconstriction Asthma, prophylaxis of exercise-induced bronchospasm Common side effects Dizziness, headache, confusion GI distress, depression, weakness, infection Nursing process: leukotriene receptor antagonists Assessment Assess for wheezing, decreased breath sounds, cough, and sputum production Determine hydration Planning Pts lung fields will be clear within 2 to 5 days Interventions Monitor liver function tests periodically Encourage pt to stop smoking Advise pts who have frequent or severe asthmatic attacks to wear an identification bracelet or medic alert tag Glucocorticoids (steroids)(fluticasone) Action Anti-inflammatory effect Administration MDI inhaler, tablet, intravenous Side effects Dry mouth, throat irritation, hoarseness Headache, euphoria, confusion, depression Hyperglycemia, GI distress, hypertension Electrolyte imbalance, fluid retention, Osteoporosis, psychosis, superinfection Mucolytics Acetylcysteine Action Liquefies and loosens thick mucus secretions Administration Administer by nebulizer 5 min after bronchodilator Should not be mixed with other drugs Side effects Stomatitis, rhinorrhea n/v Chapter 46: pituitary, thyroid, parathyroid, and adrenal disorders Thyroid Gland Thyroid gland hormones Triiodothyronine (T3) Thyroxine (T4) Calcitonin Functions Regulate metabolism and calcium Hypothyroidism Decreases in thyroid hormone secretion Primary Decreased T4 and elevated TSH levels Due to thyroid gland inflammation, radioiodine therapy, excess intake of antithyroid drugs, thyroidectomy Myxedema (adult), Cretinism (child) Secondary: lack of TSH secretion Tertiary: lace of TRH Drug therapy Levothyroxine sodium Drug of choice for replacement therapy Increases T4 levels Also treats simple goiter and chronic lymphocytic thyroiditis Action Hyperthyroidism Increases metabolism, body growth Side effects Nervousness, headache, insomnia, weight loss Tremors, GI distress, tachycardia, hypertension Dysrhythmias, palpitations, angina, thyroid crisis Increase in circulating T4 and T3 levels Graves disease or thyrotoxicosis Most common type Caused by hyperfunction of the thyroid gland Characterized by weight loss, tachycardia, palpitations, heat intolerance, excess perspiration, nervousness, irritability, exophthalmos Treatment Subtotal thyroidectomy Radioactive iodine therapy Antithyroid drugs which inhibit synthesis or release of thyroid hormone Drug therapy Propylthiouracil (PTU) Control overactive thyroid due to graves disease, toxic nodular goiter, or multinodular goiter Also used prior to radioiodine treatment or thyroid surgery Interactions Increase the effect of anticoagulants Decrease the effect of anti diabetics Digoxin and lithium increase the action of thyroid drugs Phenytoin increases T3 levels Nursing process: thyroid hormone Assessment Check T3, T4, or TSH levels Assess for the evidence of thyroid crisis Planning Pts activity level will be improved within 1-4 wks Interventions Encourage pt to take drug at the same time each day in relation to meals Teach pt to check warming on OTC drug labels Suggest pt carry medical alert identification Parathyroid Gland Enhances calcium release from bones Enhances calcium reabsorption in renal tubules Enhances calcium absorption in intestines by increasing production of vitamin D Hypoparathyroidism Parathyroid hormone deficiency Due to hypomagnesemia, hypocalcemia, vitamin D deficiency, renal impairment, diuretics Parathyroid hormone replacement Calcitriol Action Hyperparathyroidism Promote calcium absorption from the GI tract Promote secretion of calcium from bone to blood Excess parathyroid hormone secretion Due to malignancies of parathyroid glands, ectopic PTH hormone secretion from lung cancer, hyperthyroidism, prolonged immobility Treatment Partial or full parathyroidectomy Calcitonin-salmon, calcimimetic, biphosphates Nursing process Assessment Note serum calcium level and report abnormal results Assess for symptoms of tetany in hypocalcemia Planning The pts serum calcium level will be within normal limits Interventions Monitor serum calcium level Direct pt to report symptoms of hypocalcemia and hypercalcemia Advise females to inform health care prodder about pregnancy status before takng calcitonin Encourage pt to check OTC drugs for possible calcium content, especially if pt has an elevated calcium levels Adrenal glands Adrenal medulla Produces epinephrine and norepinephrine Adrenal cortex Produces glucocorticoids (cortisol) Mineralocorticoids (aldosterone) Glucocorticoid hyposecretion Addison disease Glucocorticoid hypersecretion Cushing syndrome Drug therapy: glucocorticoids Prednisone Action Use Affect inflammatory response Affect carbohydrate, protein, and fat metabolism Affect muscle and blood cell activities Inflammation, autoimmune disorders, ulcerative colitis, glomerulonephritis, allergies, drug reactions, anaphylaxis, prevent organ rejection Side effects/adverse reactions Headache, flushing, euphoria, depression, psychosis Increased appetite, sweating, thin skin w/purpura Tachycardia, hypertension, hyperglycemia Edema, sodium and water retention, adrenal atrophy Abnormal fat deposits, muscle wasting Glaucoma, peptic ulcers, growth retardation Caution Taper off gradually upon discontinuation Fludrocortisone (oral mineralocorticoid) Action Use Facilitate sodium resorption Promote hydrogen ion and potassium excretion Adrenocortical insufficiency Side effects Negative nitrogen balance, fluid imbalance, fluid overload, hypertension, hypokalemia, GI distress Nursing process Assessment Note baseline v/s for future comparisons Assess lab results especially electrolytes and blood glucose Planning the pts inflammatory process will decrease interventions determine v/s monitor lab value watch for evidence of hypokalemia assess for side effects of corticosteroids monitor older adults for the evidence of increased osteoporosis encourage pt to carry a medical alert identification advise pt to eat food high in potassium Chapter 47 antidiabetics Insulin Released from beta cells of islets of Langerhans in pancreas Responds to increase in blood glucose Function Promotes uptake of glucose, amino acids, and fatty acids Converts to glycogen in liver and muscle for future glucose for future needs Normal range blood glucose Hemoglobin A1c Currently manufactured by using deoxyribonucleic acid Human insulin Humulin R, Novolin N Low incidence allergies, insulin resistance Human insulin analogs Insulin lispro Insulin aspart Storage Types of insulin Rapid-acting Short-acting Intermediate-acting Long-acting Combination Insulin types Rapid acting insulin Insulin lispro, insulin aspart, insulin glulisin, oral inhalation insulin Onset of action Peak Duration Short acting insulin Regular Onset Peak Duration Intermediate acting (cloudy) Insulin isophane NPH Onset Peak Duration Long acting Glargine Onset of action Duration Administered Combinations Composed of short and intermediate or rapid and intermediate NPH 70/regular 30 NPH 50/regular 50 Insulin storage Storage of insulin Keep in refrigerator until opened Avoid storing insulin in direct sunlight or at high temperatures Insulins Action Use Promote use of glucose by body cells, store glucose as glycogen in muscles Reduce blood glucose, control diabetes mellitus Interactions Increase glucose w/ thiazides, glucocorticoids, estrogen, thyroid drugs Decrease glucose w/TCAs, MAOIs, aspirin, oral anticoagulants Sliding scale insulin Sliding scale insulin coverage Adjusted doses dependent on individual blood glucose Monitor blood glucose Before meals and at bedtime Involves rapid or short acting insulin Insulin side effects Hypoglycemia, insulin shock Nervousness, tremors Lack of coordination Cold, clammy skin Headache, confusion Somogyi effect Occurs in predawn hrs Rapid decrease in blood glucose during night stimulates hormonal release to increase blood glucose Lipodystrophy Lipoatrophy Lipohypertrophy Dawn phenomenon Hyperglycemia upon awakening Symptoms Headache, night sweats, nightmares Diabetic ketoacidosis Hyperglycemia Insulin administration Methods of insulin administration Insulin pen injectors Inulin pumps Insulin jet injectors Nursing process inulin time Assessment Identify drugs that a pt currently takes Determine the pts knowledge of diabetes mellitus and use of insulins Check for s//s of hypoglycemia and hyperglycemia Planning The pt will self administer insulin correctly Interventions Determine blood glucose levels and report changes Monitor the pts HbA1c to provide feedback of diabetic control Teach pt to recognize and report hypoglycemia and hyperglycemia Teach pt how to administer insulin Advise pt that hypoglycemia reactions are more likely to occur during peak action Oral antidiabetic drugs First and second generation sulfonylureas Used to treat type 2 diabetes Stimulate pancreatic beta cells to secrete more insulin Increase tissue response to insulin Decrease glucose production Side effects/adverse reactions Hypoglycemia Gi distress, weight gain Nervousness, tremors, confusion Blood dyscrasias, seizure, coma Non sulfonylureas Biguanide: metformin Action Decrease hepatic production of glucose from stored glycogen Diminish increase in serum glucose after meals Blunt postprandial hyperglycemia Decrease glucose absorption from small intestine Increase insulin receptor sensitivity Increase peripheral glucose uptake at the cellular levels Guidelines for oral antidiabetic therapy for type 2 diabetes Criteria for use of oral antidiabetic drugs Onset of diabetes mellitus at age 40 years or older Diagnosis of diabetes for less than 5 years Normal weight or overweight Fasting blood glucose 200 mg/dL or less Less than 40 units of insulin required per day Normal renal and hepatic function Other antidiabetic agents Action of exenatide Enhance insulin secretin Increase beta cell responsiveness Suppress glucagon secretion Slow gastric emptying Reduce food intake Common side effects/adverse effects Headache, dizziness, jitteriness, GI distress Nursing process: oral antidiabetics Assessment Determine pts knowledge of diabetes mellitus and use of oral antidiabetics Identify pts current drugs Note v/s and blood glucose levels Planning The pts blood glucose will be within normal serum levels Interventions Administer oral antidiabetics w/ food to minimize gastric upset Monitor blood glucose levels and report changes Teach pt to recognize symptoms of hypoglycemia and hyperglycemia Teach pt necessity of adherence to diet and drug regimen Hyperglycemia drugs Glucagon Hyperglycemia hormone secreted by the alpha cells of the islets of Langerhans in the pancreas Action Use Increase blood glucose by stimulating glycogenolysis Insulin induced hypoglycemia when other methods are not available