Podcast
Questions and Answers
Which of the following factors is essential for helping patients achieve glycemic control?
Which of the following factors is essential for helping patients achieve glycemic control?
What is the onset of action for rapid-acting insulin such as Lispro (Humalog)?
What is the onset of action for rapid-acting insulin such as Lispro (Humalog)?
Which insulin classification has the longest duration of action?
Which insulin classification has the longest duration of action?
What is a potential adverse effect of using NPH (Humulin N)?
What is a potential adverse effect of using NPH (Humulin N)?
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Which insulin should be administered 30 - 45 minutes before meals?
Which insulin should be administered 30 - 45 minutes before meals?
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In what circumstance should the hypoglycemia protocol be enacted?
In what circumstance should the hypoglycemia protocol be enacted?
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What is a major drawback of premixed insulin like Regular/NPH (30/70)?
What is a major drawback of premixed insulin like Regular/NPH (30/70)?
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What is a commonly recognized form of medication therapy for glycemic control?
What is a commonly recognized form of medication therapy for glycemic control?
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What is the primary goal of thyroid replacement therapy?
What is the primary goal of thyroid replacement therapy?
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What mechanism of action does Levothyroxine have?
What mechanism of action does Levothyroxine have?
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Which of the following is a contraindication for using Levothyroxine?
Which of the following is a contraindication for using Levothyroxine?
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What adverse effect might indicate an overdose of Levothyroxine?
What adverse effect might indicate an overdose of Levothyroxine?
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What should patients be monitored for when taking Cytomel?
What should patients be monitored for when taking Cytomel?
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Which is the appropriate time to administer thyroid replacement medication?
Which is the appropriate time to administer thyroid replacement medication?
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What is the primary glucocorticoid secreted by the adrenal gland?
What is the primary glucocorticoid secreted by the adrenal gland?
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How should patients manage missed doses of thyroid replacement medication?
How should patients manage missed doses of thyroid replacement medication?
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What is a potential interaction to be aware of when administering thyroid replacement drugs?
What is a potential interaction to be aware of when administering thyroid replacement drugs?
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What is the daily secretion amount of glucocorticoids from the adrenal gland?
What is the daily secretion amount of glucocorticoids from the adrenal gland?
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Which of the following is NOT a physiological role of endogenous corticosteroids?
Which of the following is NOT a physiological role of endogenous corticosteroids?
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Which symptom could indicate the development of hyperthyroidism in a patient taking thyroid replacement therapy?
Which symptom could indicate the development of hyperthyroidism in a patient taking thyroid replacement therapy?
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What is the primary mineralocorticoid produced by the adrenal glands?
What is the primary mineralocorticoid produced by the adrenal glands?
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What should be avoided when taking thyroid replacement medication to ensure its effectiveness?
What should be avoided when taking thyroid replacement medication to ensure its effectiveness?
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In what medical conditions are corticosteroids commonly indicated?
In what medical conditions are corticosteroids commonly indicated?
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How does the secretion of glucocorticoids typically vary throughout the day?
How does the secretion of glucocorticoids typically vary throughout the day?
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Which of the following corticosteroids is commonly used to prevent respiratory distress syndrome in premature infants?
Which of the following corticosteroids is commonly used to prevent respiratory distress syndrome in premature infants?
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Which of the following is a role of mineralocorticoids?
Which of the following is a role of mineralocorticoids?
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What is the primary action of Metformin?
What is the primary action of Metformin?
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What should be done before administering insulin if the blood glucose level is below 4.0 mmol/L?
What should be done before administering insulin if the blood glucose level is below 4.0 mmol/L?
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Which of the following medications does NOT cause lactic acidosis as a side effect?
Which of the following medications does NOT cause lactic acidosis as a side effect?
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Which condition is a contraindication for the use of Vassopressin?
Which condition is a contraindication for the use of Vassopressin?
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Which hormone is primarily increased by Somatropin?
Which hormone is primarily increased by Somatropin?
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What is a common adverse effect of Gliclazide?
What is a common adverse effect of Gliclazide?
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In treating hypothyroidism, which hormone is typically administered?
In treating hypothyroidism, which hormone is typically administered?
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What mechanism of action does Canagliflozin utilize?
What mechanism of action does Canagliflozin utilize?
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Which contraindication applies to the use of Menotropins?
Which contraindication applies to the use of Menotropins?
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Why must Metformin be held before and after IV contrast dye?
Why must Metformin be held before and after IV contrast dye?
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What hormone does Oxytocin primarily stimulate?
What hormone does Oxytocin primarily stimulate?
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Which of the following is an adverse effect of GLP-1 receptor agonists like Semaglutide?
Which of the following is an adverse effect of GLP-1 receptor agonists like Semaglutide?
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What is a potential side effect of Acetate for treating Acromegaly?
What is a potential side effect of Acetate for treating Acromegaly?
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What condition indicates a need for Clomiphene Citrate treatment?
What condition indicates a need for Clomiphene Citrate treatment?
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Which corticosteroid is preferred for treating cerebral edema associated with brain tumours?
Which corticosteroid is preferred for treating cerebral edema associated with brain tumours?
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What is a common indication for the use of Prednisone?
What is a common indication for the use of Prednisone?
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What is a potential adverse effect of long-term use of systemic corticosteroids on the endocrine system?
What is a potential adverse effect of long-term use of systemic corticosteroids on the endocrine system?
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Which condition requires cautious use of systemic corticosteroids due to the potential for infection?
Which condition requires cautious use of systemic corticosteroids due to the potential for infection?
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What should be monitored in patients receiving long-term corticosteroid therapy?
What should be monitored in patients receiving long-term corticosteroid therapy?
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What is the primary reason for tapering down corticosteroid therapy?
What is the primary reason for tapering down corticosteroid therapy?
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In the context of systemic corticosteroids, which of the following are contraindications?
In the context of systemic corticosteroids, which of the following are contraindications?
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For patients on long-term corticosteroid treatment, which of the following supplements is often recommended?
For patients on long-term corticosteroid treatment, which of the following supplements is often recommended?
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Study Notes
Achieving Glycemic Control
- Encourage patient & their family to be involved in their care. This includes understanding treatment goals, self-monitoring blood glucose, and participating in medication adherence.
- Nutritional therapy is critical for glycemic control, focusing on balanced meals, portion control, and mindful snacking.
- Regular exercise helps to improve insulin sensitivity and blood glucose regulation.
- Maintaining a desired body weight can significantly impact glycemic control.
- Self-monitoring of blood glucose empowers patients to understand their glucose levels and adjust their management as needed.
- Encourage adherence to medication therapy as prescribed, including insulin, oral hypoglycemic agents, and non-insulin injectable agents.
Insulin Therapy
- Rapid-acting insulins (Lispro, Aspart) have a fast onset of action (10-15 minutes for Lispro, 4 minutes for Aspart). They are typically used at mealtimes.
- Short-acting insulin (Regular) has an onset of action of 30-60 minutes and is used at mealtimes.
- Intermediate-acting insulin (NPH) has an onset of action of 2-4 hours and reaches peak action after 4-10 hours. It can lead to hypoglycemia.
- Long-acting insulins (Glargine, Degludec) have a steady and continuous action over 24 hours. They are typically administered once daily at bedtime.
- Premixed insulins (combination of short or rapid-acting insulin with intermediate-acting insulin) have a flexible dosing schedule but may not provide adequate glucose control.
- Sliding scales are used to adjust insulin doses based on blood glucose readings.
- Contraindications to insulin administration include hypoglycemia (blood glucose levels below 4.0 mmol/L), severe allergic reactions, and certain medical conditions.
- Nursing implications for insulin administration include checking blood glucose levels, double-checking with another nurse, ensuring meal availability, rotating injection sites, and following agency hypoglycemia protocol.
Oral Hypoglycemic Agents
- Biguanides (Metformin) inhibit hepatic glucose production, enhance insulin sensitivity, and decrease intestinal glucose absorption.
- Insulin Secretagogues (Sulfonylureas, Gliclazide) stimulate insulin release from pancreatic beta cells.
- Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (Sitagliptin, Linagliptin) enhance the incretin system by stimulating insulin release from pancreatic beta cells and inhibiting hepatic glucose production.
- Sodium-Glucose Co-transporter Type 2 (SGLT2) Inhibitors (Canagliflozin, Empagliflozin) enhance urinary glucose secretion by blocking tubular reabsorption of glucose in the kidneys.
Non-Insulin Injectable Agents
- GLP-1 Receptor Agonists (Semaglutide, Liraglutide) stimulate insulin release, decrease glucagon secretion, increase satiety, and delay gastric emptying.
Anterior Pituitary Gland
- Adrenocorticotropic Hormone (ACTH) (Cosyntropin) stimulates the adrenal cortex to release mineralocorticoids and cortisol.
- Follicle-stimulating Hormone (FSH) (Menotropins) stimulates oogenesis and follicular growth in females, and spermatogenesis in males.
- Growth Hormone (GH) (Somatropin) promotes skeletal and muscle growth, increases protein synthesis, and regulates liver glycogenolysis and fat mobilization.
- Luteinizing Hormone (LH) (Clomiphene Citrate) stimulates ovulation and estrogen release in females, and spermatogenesis and testosterone secretion in males.
Posterior Pituitary Gland
- Antidiuretic Hormone (ADH) (Vasopressin, Desmopressin Acetate) increases water reabsorption in the distal tubules, concentrates urine, and has a vasoconstrictive effect.
- Oxytocin (Oxytocin) stimulates uterine smooth muscle contraction, leading to labor induction.
Abuse of Growth Hormone
- Growth hormone does not increase muscle mass or strength more than seen with regular exercise.
- It is not recommended for anti-aging purposes.
- Adverse effects include acromegaly, diabetes, hypertension, increased cardiovascular disease risk, tumor growth, and cancer.
Thyroid & Anti-Thyroid Drugs
- The thyroid gland produces thyroxine (T4), triiodothyronine (T3), and calcitonin.
- T3 is more potent than T4 but has a shorter duration of action.
- Thyroid hormone production relies on iodine and tyrosine.
- Thyroid hormones control cellular metabolism, linear growth, brain function, dentition, bone development, and neural development.
Hypothyroidism
- Hypothyroidism occurs when the thyroid gland cannot produce sufficient thyroxine.
- Potential causes include lymphocytic thyroiditis (Hashimoto’s thyroiditis), treatment for hyperthyroidism, thyroid surgery, pituitary gland failure, and iodine deficiency.
Thyroid Replacement Drugs
- Levothyroxine (T4) is a synthetic thyroid hormone used to manage hypothyroidism. It induces changes in metabolic rate, cellular growth, and oxygen consumption.
- Cytomel (T3) is a synthetic thyroid hormone that replaces endogenous thyroid hormone.
Assessment for Hypothyroidism Drugs
- Monitor for signs of hyperthyroidism, including tachycardia, fever, hyperactivity, weight loss, and gastrointestinal issues.
Administration of Hypothyroidism Drugs
- Administer early in the day to avoid insomnia.
- Take on an empty stomach for optimal absorption.
- Avoid taking antacids, iron supplements, and sucralfate within 2 hours of administration.
- Missed doses should be taken as soon as possible.
- If two or more doses are missed, consult a healthcare professional.
Hyperthyroidism
- Hyperthyroidism is often called hypercortisolism.
- The major glucocorticoid produced is cortisol (approximately 95%).
- Corticosterone and cortisone are other glucocorticoids produced.
- Glucocorticoid secretion is cyclical, with peak levels in the early morning and lower levels in the evening.
- Stress can increase cortisol levels, leading to increased glucose and free fatty acid levels.
Role of Endogenous Corticosteroids
- Cardiovascular System: Cortisol regulates arterial blood pressure by modifying smooth muscle tone in blood vessels.
- Central Nervous System: Cortisol decreases nerve excitability and slows activity in the cerebral cortex.
- Musculoskeletal System: Cortisol decreases bone formation and increases bone breakdown.
- Respiratory System: Cortisol keeps airways open but does not directly cause bronchodilation.
- Inflammatory Response: Cortisol stabilizes mast cells and other cells, inhibiting the release of inflammatory substances like histamine.
- Gastrointestinal System: Cortisol decreases gastric mucus, potentially leading to peptic ulcers.
Mineralocorticoids
- Aldosterone is the most potent mineralocorticoid.
- It regulates sodium and potassium balance.
Gonadocorticoids (Sex Hormones)
- Gonadocorticoids are weak androgens that are converted to testosterone in males or estrogen in females.
- Sex hormones help regulate sexual development and function.
Indications for Corticosteroid Use
- Corticosteroids are used to treat illnesses with inflammatory or immunologic components, such as allergies, collagen disorders, dermatologic conditions, endocrine disorders, inflammatory bowel disorders, neoplastic disease, and neurologic disorders.
- They are also used for chemotherapy-induced emesis.
Systemic Corticosteroids
- Betamethasone and Dexamethasone are systemic corticosteroids used for various conditions.
- They are used to prevent respiratory distress syndrome in premature infants.
Dexamethasone
- Preferred for cerebral edema because it crosses the blood-brain barrier and reaches high concentrations in the cerebrospinal fluid (CSF)
- The choice for cerebral edema associated with brain tumor, craniotomy, and head injury
Systemic Corticosteroids
-
Hydrocortisone and Cortisone: Choice to treat adrenocortical insufficiency (Addison’s disease)
- Requires replacement of glucocorticoids and mineralocorticoids
- Prednisone: Glucocorticoid of choice for inflammation, allergy, stress, and as immunosuppressive therapy
-
Methylprednisolone, hydrocortisone, and dexamethasone: Used in acute life-saving situations that require a corticosteroid
- Examples include anaphylaxis and spinal shock
Adverse Effects of Long-Term Use of Systemic Corticosteroids
-
Endocrine:
- Suppression of the hypothalamic-pituitary-adrenal (HPA) axis, which leads to loss of adrenocortical function
- Mood change
- Moon face
- Elevated serum glucose levels
- Reduced effect of insulin
-
GI:
- Peptic ulcer
- Abdominal distension
-
Skin:
- Hirsutism
- Thin, fragile skin
- Acne
- Bruising
-
MSK:
- Muscle wasting
- Fat deposits (Buffalo hump)
- Osteoporosis
-
CVS:
- Increased blood pressure and fluid retention
- Weight gain
Contraindications for Systemic Corticosteroids
- Systemic fungal infection
- Hypersensitivity
Use with Caution for Systemic Corticosteroids
- Increased monitoring is required for patients who are:
- At risk for infection
- Exhibit masked symptoms of infection
- Diabetic
- Have a peptic ulcer
- Have inflammatory bowel disease
- Have congestive heart failure (CHF)
- Have renal insufficiency
Nursing Assessment for Systemic Corticosteroids
- Pre-Administration:*
- Assess activity level
- Assess appetite
- Monitor weight
- Post-Administration:*
- Monitor signs of infection:
- Fever
- Sore throat
- Monitor for weight gain of ≥ 5 lb/week
- Assess activity level
- Assess appetite
- Monitor for hypertension
Patient Teaching for Systemic Corticosteroids
- For patients on long-term treatment, increase calcium and vitamin D intake
- Daily administration of 15-20 mg of hydrocortisone (or its equivalent) for 2 weeks suppresses the HPA axis and requires a gradual taper down.
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Description
This quiz explores concepts related to glycemic control and insulin therapy for diabetes management. It emphasizes the importance of patient involvement, nutritional therapy, exercise, and medication adherence. Additionally, it covers details on different types of insulin and their roles in treatment.
