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[h]

Endocrine

[q] Rapid-acting Insulin

[a] Lispro insulin, Humalog, Insulin aspart, NovoLog, Insulin glulisine, Apidra

[q] Rapid-acting Insulin Onset

[a] 15 to 30 min

[q] Short-acting Insulin

[a] Regular insulin, Humulin R, Novolin R

[q] Short-acting Insulin Onset

[a] 0.5 to 1 hr

[q] Intermediate-acting

[a] NPH insulin, Humulin N – Onset 1 to 2 hr

[q] Long-acting

[a] Insulin glargine, Lantus – Onset 70 min, No peak

[q] Complications of Insulin

[a] Risk for hypoglycemia, Lipohypertrophy (rotate injection sites )

[q] Mixing Insulin

[a] Regular first, then NPH. Do not mix lantus

[q] Sulfonylureas – Help with insulin release from the pancreas

[a] chlorpropamide, glipizide, tolzamide, glyburide, glimepiride

[q] Biguanides -Reduces the production of glucose within the liver , Increases muscles’ glucose uptake and use

[a] Metformin HCl

[q] Thiazolidinediones – decrease insulin resistance

[a] Pioglitazone

[q] Alpha glucosidase inhibitors -Slows carbohydrate absorption and digestion

[a] Acarbose

[q] Metformin HCl- other use

[a] To treat polycystic ovary syndrome

[q] Metformin Side Effect

[a] Gastrointestinal effects (anorexia,nausea, vomiting, weight loss), decreases absorption of Vitamin B12 and folic acid leading to deficiency, Lactic acidosis (monitor and report hyperventilation, myalgia, sluggishness, somnolence)

[q] Pioglitazone side Effect

[a] Fluid retention, High LDL, Hepatotoxicity

[q] Acarbose side effect

[a] Intestinal effects (abdominal distention and cramping, hyperactive bowel sounds, diarrhea, excessive gas), Anemia due to decreased iron absorption, Hepatotoxicity

[q] Metformin Interaction

[a] Metformin HCl is contraindicated for clients who have severe infection, shock and hypoxic condition

[q] Acarbose Interaction

[a] Acarbose is contraindicated for clients who have gastrointestinal disorders, such as inflammatory disease, ulceration, or obstruction

[q] Oral atidiabetics and timings 1

[a] Glipizide – Best taken 30 min prior to meal. Acarbose – Instruct clients to take with the first bite of food, three times per day.

[q] Oral atidiabetics and timings 2

[a] Repaglinide – Instruct clients to eat within 30 min of taking a dose of the medication, 3 times/day

[q] Exenatide – to promote release of insulin

[a] Prefilled injector pens, given SQ, Give injection within 60 min before the morning and evening meal. Never administer after a meal. Keep the injection pen in the refrigerator and to discard after 30 days.

[q] Exenatide Side effects

[a] GI effects (nausea, vomiting, diarrhea), Pancreatitis.

[q] Glucagon Injection – Emergency management of hypoglycemic reactions

[a] Increases blood glucose levels by increasing the breakdown of glycogen into glucose

[q] Thyroid hormone – Levothyroxin

[a] Take daily on an empty stomachObtain the client’s baseline vital signs, weight, and height, T3,T4,TSH and monitor periodically, Monitor and report signs of cardiac excitability (angina, chest pain, palpitations, dysrhythmias)

[q] Antithyroid medication

[a] Propylthiouracil (PTU), Methimazole

[q] Antithyroid medication Side Effect

[a] Agranulocytosis (watch for infection), › Liver injury, hepatitis, Overmedication leading to hypothyroidm

[q] Antithyroid medication Nurse Notes

[a] Therapeutic effects may take 1 to 2 weeks, Monitor vital signs, weight, and I&O at baseline and periodically. Monitor for signs of hypothyroidism. Monitor CBC for leukopenia or thrombocytopenia

[q] Radioactive iodine

[a] High dose of thyroid-radioactive iodine destroys thyroid cells.

[q] Radioactive iodine Adverse Effect

[a] Radiation sickness (hematemesis, epistaxis, intense nausea, vomiting). Bone marrow depression,Hypothyroidism

[q] Radioactive iodine- Radioactivity precautions

[a] Void frequently to avoid irradiation of gonads. Limit contact with clients to 30 min/day/person. Encourage clients to increase fluid intake, usually 2 to 3 L/day. Instruct clients to dispose of body wastes per protocol. Avoid coughing and expectoration (source of radioactive iodine).

[q] Strong iodine solution (Lugol’s solution) – nonradioactive iodine

[a] Thyroid-nonradioactive iodine creates high levels of iodide that will reduce iodine uptake by thyroid gland, inhibit thyroid hormone production, and block the release of thyroid hormones

[q] Strong iodine solution (Lugol’s solution) – side effect

[a] Iodism due to corrosive property (metallic taste, stomatitis, sore teeth and gums, frontal headache, skin rash). Can progress to overdose (severe GI distress and swelling of the glottis)

[q] Antidot for Lugol’s

[a] Sodium thiosulfate

[q] Thyroid-nonradioactive iodine nurse notes

[a] Obtain the client’s baseline vital signs, weight, and I&O, and monitor periodically, dilute strong iodine solution (Lugol’s solution) with juice to improve taste, increase fluid intake

[q] Corticosteroids – Anti-inflammatory

[a] Methylprednisolone, betamethasone, hydrocortisone, fluticasone

[q] Corticosteroids – side effect

[a] Immunosuppression (watch for infection),Cataracts – Need yearly eye exam. Hyperglycemia  (caution in DM), Fluid retention and Weight gain (Watch for HTN, Heart failure), osteoporosis and muscle weakness, Gastric irritation : Take with food.

[q] Steroids Important Notes

[a] Do not discontinue abruptly. Report any signs and symptoms of infection to the HCP immediately (sore throat, fever, redness and swelling, discharge, pain). No live vaccines (varicella-zoster, MMR, rotavirus, yellow fever, nasal flu vaccine). TB skin test – positive if induration is more than 5 mm (usually 10 mm). GI bleed – report dark tarry stool, orthostatic vitals, Hb level

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