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Pharmacology
Unit 9
| Question | Answer |
|---|---|
| Regular Insulin | Blood Glucose Control -Short acting |
| Insulin: Actions | -Facilitates transport of various metabolites and ions across cell membranes -Stimulates synthesis/storage of glycogen from glucose -Decelerates breakdown of glycogen, protein, fat -Reacts w/ specific receptor sites cells liver, adipose tissue, muscle |
| Insulin: Promotes fluid and electrolyte balance | -Osmotic diuresis via polyuria and polydipsia (not an antidiuretic) -Facilitates movement of K+ from extracellular fluid into cell |
| Insulin: Parenteral | -IV,SQ,Shot -GI tract breaks down protein molecule -SQ for intermittent and pump -Regular insulin used IV and in PD -Nasal spray in future |
| Insulin: Adverse Effects | -Hypoglycemia (decrease BS) -Somogyl effect (decrease BS followed by increased BS) -Hypersensitivity reactions -Lidoystrophy - fat deposits -Insulin resistance |
| Insulin: Drug-Drug | -Many interactions -Increase hypoglycemic effects of insulin -Reduce effectiveness of insulin -Prolong hypoglycemic effect and mask symptoms of hypoglycemia |
| Insulin: Nursing Considerations | -ALWAYS VERIFY DOSAGE -Check label for type, concentration,exp.date -Don't shake vial,rotate bw palms -Use app syringe -Withdraw exact dose -Rotate sites to prevent lidodystrophy -Discard if change in color/clumped -Mix with NPH,give immed -Wear |
| Insulin: Indications | -Treatment of type 1 diabetes -Treatment of type 2 diabetes when other agents have failed |
| Chlorpropamide | First-Generation Sulfonylureas |
| First-Generation Sulfonylureas: Actions | -Stimulate beta cells to release insulin (good for patients who still have pancreatic function) -Improve binding to insulin receptors |
| First-Generation Sulfonylureas: Indications | -Adjunct to diet and exercise to lower blood glucose level in type 2 diabetes |
| First-Generation Sulfonylureas: Contraindications | -Diabetic complications -Type 1 DM -pancreas doesn't produce insulin -Pregnancy, lactation -Renal disease -Infection -Ketoacidosis |
| First-Generation Sulfonylureas: Adverse Effects | -Hypoglycemia -GI distress -Allergic skin reactions |
| First-Generation Sulfonylureas: Drug-Drug | -Drugs that acidify urine -Beta Block(mask signs of hypoglycemia) -Alcohol (alters glucose levels) |
| Glyburide | Second Generation Sulfonylureas |
| Glynase | Second Generation Sulfonylureas |
| Second Generation Sulfonylureas: Actions | -Stimulates insulin release from functioning beta cells in the pancreas -Improve insulin binding to insulin receptor sites or increase the number of insulin receptor sites |
| Second Generation Sulfonylureas: Indications | -Adjunct to diet and exercise in the management of type 2 diabetes |
| Second Generation Sulfonylureas: Adverse Effects | -GI discomfort -Anorexia -N,V,D -Heartburn -Allergic skin reactions -Hypoglycemia |
| Sulfonylureas: Nursing Considerations | -Dosing-30m b/f morning meal and b/f evening meal if 2xd -Monitor:blood glucose, hemoglobin A,liver enzymes every two months,appropriate food intake and exercise -Hypoglycemia-rapidly absorbed carb (ice cream,pb on cracker,milk) glucagon or IV if neces |
| Metformin | NonSulfonylurea -Biguanide |
| Biguanide: Actions | -Decreases liver production of glucose -Decrease intestinal absorption of glucose -Improves insulin sensitivity |
| Biguanide: Indications | -Adjunct to diet and exercise for treatment of type 2 diabetes older than 10 years of age -Extended release for pts. older than 17 -Adjunct treatment w/ polycystic ovary syndrome |
| Biguanide: Adverse effects | -Hypoglycemia -Lactic acidosis -GI upset -N,D -Anorexia -Heartburn -Allergic skin reaction |
| Biguanide: Nursing Considerations | -Take with morning and evening meal -Monitor:blood glucose, hemoglobin A,liver enzymes every two months,appropriate food intake and exercise -Hypoglycemia-rapidly absorbed carb (ice cream,pb on cracker,milk) glucagon or IV if neces |
| Glucagon | Glucose-Elevating Agents |
| Glucose-Elevating Agents: Actions | -Increase blood glucose levels -Decrease insulin release -Accelerate breakdown of glycogen in liver to release glucose |
| Glucose-Elevating Agents: Indications | -Counteracts sever hypoglycemic reactions in diabetic patients treated with insulin |
| Glucose-Elevating Agents: Contraindications | -Hepatic dysfunction -Cardiac disease |
| Glucose-Elevating Agents: Adverse Effects | -Hypotension -Hypertension -N,V -Resp. Distress w/ hypersensitivity reactions -Hypokalemia w/ overdose |
| Glucose-Elevating Agents: Drug-Drug | -Thiazide diuretics -Anticoagulants |
| Glucose-Elevating Agents: Nursing Considerations | -IM and SQ:dilute 1 unit w 1 ml diluent -IV: can use D5W but not chloride solutions; give over 2-5 min -Provide carbohydrates as soon as possible -Be alert for overdose (severe hyperglycemia) |
| Levothyroxine | Thyroid Hormone |
| Thyroid Hormone: Actions | -Increase metabolic rate of body tissue -Increase oxygen consumption, respiration, HR -Rate of fat, protein, carb metabolism -Growth and maturation |
| Thyroid Hormone: Indications | -Replacement therapy in hypothyroidism -Pituitary suppression of TSh to treat euthyroid goiter -Management of thyroid cancer -Thyrotoxicosis in conjunction with other therapy -Myxedema coma |
| Thyroid Hormone: Contraindications and Cautions | -Thyrotoxicosis -Acute MI -Lactation -Hypoadrenal conditions such as addison's |
| Thyroid Hormone: Adverse Effects | -Tremors -HA,D,V,N -Nervousness -Palpitations -Tachycardia -Allergic skin reactions -Loss of hair in 1st few months in children |
| Thyroid Hormone: Drug-Drug | -Cholestyramine & colestipol (d absorption) -Oral anticoagulants (I bleeding) -Digitalis (D digoxin) -Theophylline (I theophylline) -Phenytoin (I T4) -Carbamazepine,phenobarbital, rifampin (I thyroid hormone metabolism) |
| Thyroid Hormone: Nursing Considerations | -Take same time of day (morning to avoid insomnia) -Overdose: sweating, nervousness, palpitations, chest pain -Check labels (mcg or mg) -Thyroid function tests altered (DC 4 wks b/f radioactive iodine uptake test) -Never stop drug abruptly |
| Thyroid Hormone: Changing Agents | -When switching TO liothyronine, stop the other thyroid med first then administer; When switching FROM liothyronine start the other med 1st and then discontinue so there is still a therapeutic dose in the body |
| Propylthiouracil | Antithyroid Agents |
| Antithyroid Agents: Actions | -Thiomides prevent formation of thyroid hormone within thyroid cells -Lowers serum level of thyroid hormone -Partially inhibit conversion of T4 to T3 |
| Antithyroid Agents: Indications | -Hyperthyroidism (Graves disease) |
| Antithyroid Agents: Contraindications and Caution | -Pregnancy -Lactation |
| Antithyroid Agents: Adverse Effects | -Thyroid suppression |
| Antithyroid Agents: Drug-Drug | -Oral anticoagulants -Theophylline -Metoptolol -Propanolol -Digitalis |
| Antithyroid Agents: Nursing Considerations | -Watch for hypothyroidism (cold intolerance, depression, hard edema) -Monitor blood: Normal T4 w/in 24h;T3 level 3X high in 3d;leukopenia,thrombocytopenia,agranulocytosis (fever, sore throat, mouth sores) -No OTC or herbals w/out consultation |
| Strong Iodine Products | Iodine Solutions |
| Iodine Solutions: Actions | -Thyroid cells become oversaturated with iodine -Stop producing thyroid hormone |
| Iodine Solutions: Indications | -Pre-surgical suppression of thyroid gland -Acute thyrotoxicosis |
| Iodine Solutions:Contraindications | -Pregnancy -Pulmonary edema -Pulmonary tuberculosis |
| Iodine Solutions: Adverse Effects | -Rash -Hypothyroidism -Allergic Reactions -Iodism -Swelling of salivary glands |
| Iodine Solutions: Drug-Drug | -Anticoagulants -Theophylline -Digoxin -Meoprolol -Propanolol |
| Prednisone | -Glucocorticoids |
| Glucocorticoids: Actions | -Enter target cells, bind to cytoplasmic receptors -Initiate reactions resp. for anti-inflammatory and immunosupression -Prevent leakage of plasma from capillaries -Prevent cell mediated immune response -Reduce leukocytes,monocyte, eosinophils |
| Glucocorticoids: Indications | -Short term treatment for inflammatory disorders -Relieve discomfort -Give body chance to heal from effects of inflammation |
| Glucocorticoids: Contraindications and Cautions | -Acute infection -Lactation -Diabetes -Acute peptic ulcer -Toxicity in certain populations (Asians, AA, Indians) |
| Glucocorticoids: Adverse Effects | -Insomnia -Na & H2O retention, K+ excretion -Decreased immune & inflammatory response -Peptic ulcers,intestinal perforation -Osteoporosis -Hyperglycemia,hyperlipidemia -Cushingoid signs: moon face,buffalo hump,ab fat |
| Glucocorticoids: Drug-Drug | -Increase action with erythromycin, ketoconazole -Decrease action with salicylates, barbiturates, phenytoin, rifampin |
| Glucocorticoids: Nursing Considerations | -Dosing:Take 8-9a,mimic normal body production;space doses throughout 24h;taper dose;don't double dose -Wear med id -Avoid live vaccine |
| Glucocorticoids: Report | -Report stress as may need high dose, sudden weight gain/ swelling,slow healing,bruising bleeding black tarry stools, blurred vision, emotional changes or depression |
| Fludrocortisone | Mineralcorticoids |
| Mineralcorticoids: Actions | -Hold sodium and water in body -Causes excretion of K+ by acting on renal tubule |
| Mineralcorticoids: Indications | -Replacement in primary and secondary adrenal insufficiency |
| Mineralcorticoids: Contraindications and Cautions | -Hypertension -CHF -Cardiac disease -Pregnancy -Any infection -High Sodium on intake |
| Mineralcorticoids: Adverse Effects | -Frontal and Occipital HA -Weakness -Increased blood volume -Edema -Hypertension -Heart Failure -Rash -Anaphylaxis |
| Mineralcorticoids: Drug-Drug | -Decrease effectiveness with salicylates, barbiturates, hydantoins, rifampin, anticholinesterases |
| Calcitrol | Antihypocalcemic Agents |
| Antihypocalcemic Agents: Actions | -Stimulate osteoclasts to release calcium from bone -Increase intestinal absorption of calcium -Increase calcium resorption from kidneys -Stimulate cells in kidney to produce calcitrol |
| Antihypocalcemic Agents: Indications | -Manage hypocalcemia in chronic renal dialysis -Treat hypoparathyroidism |
| Antihypocalcemic Agents: Contraindications and Cautions | -Allergic to Vit D -Hypercalcemia -Vit D toxicity -Pregnancy -History of renal stones |
| Antihypocalcemic Agents: Adverse Effects | -Weakness -HA,N,V,C -Dry mouth -Muscle pain -Bone pain -Metallic taste |
| Antihypocalcemic Agents: Drug-Drug | -Magnesium containing antacids -Cholestyramine -Mineral oil |
| Antihypocalcemic Agents: Nursing Considerations | -Use in pregnancy only if warranted -Patient teaching - Metallic taste, periodic serum calcium levels, how to manage GI side effects |
| Alendronate | Antihypercalcemic Agents: Biophosphonates |
| Antihypercalcemic Agents Biophosphonates: Actions | -Slows normal and abnormal bone resorption without inhibiting bone formation and mineralization |
| Antihypercalcemic Agents Biophosphonates: Indications | -Treatment and prevention of osteoporosis in postmenopausal women and men |
| Antihypercalcemic Agents Biophosphonates: Adverse Effects | -HA,N,D -Increased or recurrent bone pain -Esophageal erosion |
| Antihypercalcemic Agents Biophosphonates: Nursing Considerations | -Patient teaching: Take first thing in morning,full glass water; wait 30 min to eat; remain upright for at least half hour; slow bone resorption but have side effects; not for use in pregnancy and lactation -Dosing: 1x wk,1x month,Every 3mos,1x yr |
| Calcitonin Salmon | Antihypocalcemic Agents: Calcitonins |
| Antihypocalcemic Agents Calcitonins: Actions | -Inhibits bone resorption -Lowers elevated serum calcium in children and patient |
| Antihypocalcemic Agents Calcitonins: Indications | -Paget disease -Postmenopausal osteoporosis -Emergency treatment of hypercalcemia |
| Antihypocalcemic Agents Calcitonins: Adverse Effects | -Flushing of face/hands -N,V -Local inflammatory reactions at injection site -Nasal irritation if nasal form is used |
| Antihypocalcemic Agents Calcitonins: Nursing Considerations | -Need Vit D supplement -Rotate injection sites |
| Leuprolide | Hypothalamic Releasing Antagonist |
| Hypothalamic Releasing Antagonist: Actions | -LHRH agonist that occupies pituitary gonadotropin releasing hormone receptors and desensitizes them -Causes an initial increase and then profound decrease in LH and FSH levels |
| Hypothalamic Releasing Antagonist: Indications | -Treatment of advanced prostatic cancer, endometriosis, central precocious puberty, uterine leiomyomata |
| Hypothalamic Releasing Antagonist: Adverse Effects | -Dizziness -HA,N,V,C -Pain -Peripheral edema -MI -Anorexia -Urinary frequency -Hematuria -Hot flashes -Increased sweating |
| Hypothalamic Releasing Antagonist:Nursing Considerations | -Palliative treatment prostate cancer (Acts on pituitary gland to increase LH release, stimulates testosterone production at first, then see decline in men) -Patient Teaching (how to give SQ injection, hot flashes, impotence, decreases desire, NVC) |
| Somatropin | Growth Hormone Agonist |
| Growth Hormone Agonist: Actions | -Recombinant DNA origin equivalent to human growth hormone -Stimulates skeletal growth |
| Growth Hormone Agonist:Indications | -Children w/ dwarfism but not closed epiphseal plates |
| Growth Hormone Agonist: Pharmacokinetics | -Injected -Widely distributed in body |
| Growth Hormone Agonist: Contraindications | -Close epiphyses -Cranial lesions |
| Growth Hormone Agonist: Adverse Effects | -Development of antibodies to growth hormone -Insulin resistance -Swelling -Joint pain -HA -Injection-site pain |
| Growth Hormone Agonist: Nursing Considerations | -Assess growth pattern frequently -Monitor BP -Don't use amphetamines or androgens concurrently |
| Bromocriptine Mesylate | Growth Hormone Antagonist |
| Growth Hormone Antagonist: Actions | -Inhibitory factor released by hypothalamus -Not used to decrease GH -Multiple effects on many secretory systems -Acromegaly treatment |
| Growth Hormone Antagonist: Indications | -Treatment of Parkinson disease -Acromegaly |
| Growth Hormone Antagonist: Cautions | -Pregnancy -Lactation -Endocrine disorders |
| Growth Hormone Antagonist: Adverse Effects | -Dizziness -Fatigue -Light-headedness -Nasal congestion -N,V,D,C,HA -Drowsiness -Ab cramps |
| Growth Hormone Antagonist: Nursing Considerations | -Blocks lactation -Blocks dopamine (drowsiness, psotural hypotension, altered GI function) |
| Desmopressin | Posterior Pituitary Hormones |
| Posterior Pituitary Hormones: Actions | -Has pressor and antidiuretic effects -Increases levels of clotting factor VIII |
| Posterior Pituitary Hormones: Indications | -Treat neurogenic diabetes insipidus -Nocturnal enuresis |
| Posterior Pituitary Hormones: Phamacokinetics | -Reduces diuresis so increase plasma level of factor VIII excreted in kidneys |
| Posterior Pituitary Hormones: Contraindications and Cautions | -Pregnancy -Epilepsy -Asthma -Lactation |
| Posterior Pituitary Hormones:Nursing Considerations | -Watch for: hypertension, water intoxication (retention), nasal passage ulceration |
Created by:
prettyinpink7
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