Pharm Review Part 1.
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Questions and Answers

What is the primary goal of administering insulin to diabetic patients?

  • To enhance the sensation of hunger
  • To increase protein synthesis in the liver
  • To decrease blood pressure
  • To enable the body to metabolize carbohydrates, fats, and proteins (correct)

    • Which of the following statements about rapid-acting insulin is true?

  • Patients should avoid eating immediately after injection.
  • It has the fastest onset of action among insulin types. (correct)
  • It has a peak action of 3 to 5 hours.
  • It can be administered intravenously for quick action.

    • What is the duration of action for rapid-acting insulins?

  • 12 to 24 hours
  • 6 to 8 hours
  • 3 to 5 hours (correct)
  • 1 to 2 hours

    • Which of the following is not a type of rapid-acting insulin?

    <p>Insulin glargine</p> Signup and view all the answers

    How is human insulin primarily produced in modern medicine?

    <p>Derived using recombinant DNA technologies</p> Signup and view all the answers

    Which medication is commonly administered in a case of pulseless cardiac arrest?

    <p>Vasopressin</p> Signup and view all the answers

    What does it mean if a patient is described as 'euthyroid'?

    <p>The patient’s thyroid hormone levels are within normal limits.</p> Signup and view all the answers

    What is the most significant adverse effect of replacement hormonal therapy?

    <p>Cardiac dysrhythmia</p> Signup and view all the answers

    What is a common symptom of congenital hypothyroidism in children?

    <p>Short stature</p> Signup and view all the answers

    Which hormone is secreted by the thyroid gland to help regulate metabolism?

    <p>Thyroxine (T4)</p> Signup and view all the answers

    Which of the following is an essential nursing implication for patients undergoing thyroid replacement therapy?

    <p>Monitor for drug allergies and contraindications.</p> Signup and view all the answers

    What should the nurse instruct patients regarding the timing of their thyroid medication?

    <p>Take the medication once daily in the morning.</p> Signup and view all the answers

    What characterizes myxedema in adults?

    <p>Decreased metabolic rate</p> Signup and view all the answers

    In patients with diabetes receiving thyroid replacement therapy, what adjustment may be necessary?

    <p>Increase dosages of hypoglycemic medications.</p> Signup and view all the answers

    What condition results from overstimulation by elevated levels of thyroid-stimulating hormone (TSH)?

    <p>Goiter</p> Signup and view all the answers

    Which of the following symptoms could indicate potential overdose of thyroid medication?

    <p>Tachycardia and palpitations</p> Signup and view all the answers

    Which of the following is a synthetic thyroid hormone?

    <p>Liothyronine (Cytomel)</p> Signup and view all the answers

    What is a potential outcome of untreated maternal hypothyroidism during pregnancy?

    <p>Retarded fetal growth</p> Signup and view all the answers

    What is the primary function of calcitonin?

    <p>Decrease blood calcium levels</p> Signup and view all the answers

    What effect might thyroid replacement medication have on serum digoxin levels?

    <p>Decrease serum digoxin levels</p> Signup and view all the answers

    What is a common misconception regarding the dosage adjustment of thyroid medication during treatment?

    <p>Dosage should remain the same throughout treatment.</p> Signup and view all the answers

    What is the primary characteristic of Type 1 Diabetes?

    <p>Patients do not produce insulin or produce defective insulin.</p> Signup and view all the answers

    Which of the following is NOT a common symptom of diabetes mellitus?

    <p>Dizziness</p> Signup and view all the answers

    What is the glycemic goal of treatment for diabetic patients?

    <p>An HbA1c of less than 7% and fasting blood glucose of 4 to 7 mmol/L</p> Signup and view all the answers

    Which condition is associated with Type 2 Diabetes?

    <p>Insulin deficiency and insulin resistance</p> Signup and view all the answers

    What defining characteristic differentiates gestational diabetes from other types of diabetes?

    <p>It develops only during pregnancy.</p> Signup and view all the answers

    Which of the following is a primary long-term complication of diabetes?

    <p>Diabetic nephropathy</p> Signup and view all the answers

    What is the onset time for regular insulin when administered subcutaneously?

    <p>30 minutes</p> Signup and view all the answers

    All of the following are components of metabolic syndrome EXCEPT?

    <p>Weight gain</p> Signup and view all the answers

    Which type of insulin is described as having a cloudy appearance?

    <p>Insulin isophane suspension</p> Signup and view all the answers

    What is the role of nonpharmacological treatment in managing Type 2 Diabetes?

    <p>It includes lifestyle changes like weight loss and exercise.</p> Signup and view all the answers

    What is the typical duration of action for long-acting insulins?

    <p>24 hours</p> Signup and view all the answers

    Which of the following insulins has no peak action?

    <p>Insulin glargine</p> Signup and view all the answers

    What is a significant disadvantage of sliding-scale insulin dosing?

    <p>It may delay insulin administration until hyperglycemia occurs</p> Signup and view all the answers

    In fixed-combination insulins, what types of insulins are usually combined?

    <p>One intermediate-acting and one rapid-acting insulin</p> Signup and view all the answers

    What might be the most likely cause of elevated blood glucose in a patient using glargine insulin who is also receiving corticosteroids?

    <p>Corticosteroid use</p> Signup and view all the answers

    How often is long-acting insulin typically dosed for consistent insulin levels?

    <p>Once daily</p> Signup and view all the answers

    What is the primary mechanism of action of sulfonylureas?

    <p>Stimulates β-cells to release insulin</p> Signup and view all the answers

    Which of the following is NOT an adverse effect of sulfonylureas?

    <p>Renal failure</p> Signup and view all the answers

    For which type of diabetes are incretin mimetics primarily used?

    <p>Type 2 diabetes</p> Signup and view all the answers

    What is a common side effect of the amylin agonist pramlintide?

    <p>Anorexia</p> Signup and view all the answers

    Which of the following is true regarding thiazolidinediones?

    <p>They inhibit glucose production.</p> Signup and view all the answers

    How do α-glucosidase inhibitors function?

    <p>Delay glucose absorption in the intestine</p> Signup and view all the answers

    What is the mechanism of action of DPP-4 inhibitors?

    <p>Delay the breakdown of incretin</p> Signup and view all the answers

    What effect do Sodium Glucose Cotransporter 2 inhibitors have on glucose levels?

    <p>Increase renal glucose excretion</p> Signup and view all the answers

    What is the primary use of somatropin?

    <p>Promote growth in children</p> Signup and view all the answers

    What is the half-life of levothyroxine?

    <p>24 hours</p> Signup and view all the answers

    What is the antidote for levothyroxine toxicity?

    <p>Beta-blockers</p> Signup and view all the answers

    What is a key adverse effect of beta-blocker overdose?

    <p>Bradycardia</p> Signup and view all the answers

    What type of diuretic is mannitol?

    <p>Osmotic diuretic</p> Signup and view all the answers

    What is the therapeutic range of digoxin?

    <p>0.5–2 ng/mL</p> Signup and view all the answers

    What is the mechanism of action of Singulair (montelukast)?

    <p>Leukotriene receptor antagonist</p> Signup and view all the answers

    Which drug class does guaifenesin belong to?

    <p>Expectorants</p> Signup and view all the answers

    What is a primary effect of stimulation of α-Adrenergic receptors?

    <p>Vasoconstriction of blood vessels</p> Signup and view all the answers

    What is the primary therapeutic use of β2-Adrenergic agonists?

    <p>Promote bronchodilation</p> Signup and view all the answers

    Dobutamine Hydrochloride primarily affects which type of adrenergic receptor?

    <p>β1-Adrenergic</p> Signup and view all the answers

    Which of the following is a consequence of α-Adrenergic receptor stimulation?

    <p>Contraction of bladder sphincter</p> Signup and view all the answers

    The indication for using dipivefrin hydrochloride is primarily for which condition?

    <p>Open-angle glaucoma</p> Signup and view all the answers

    What is the primary purpose of administering glycopyrrolate before surgery?

    <p>To control secretions during surgery</p> Signup and view all the answers

    What should patients do to manage dry mouth caused by anticholinergics?

    <p>Chew gum and consume hard candy</p> Signup and view all the answers

    What significant risk do older adults face when using anticholinergics?

    <p>Higher risk for heatstroke</p> Signup and view all the answers

    What is the antidote for atropine overdose?

    <p>Physostigmine</p> Signup and view all the answers

    Which of the following strategies should patients adopt to cope with sensitivity to light caused by anticholinergics?

    <p>Wearing dark glasses or sunglasses</p> Signup and view all the answers

    What is a common adverse effect of cholinergic medications?

    <p>Bradycardia</p> Signup and view all the answers

    Which condition should be considered a contraindication for cholinergic drug therapy?

    <p>Hypotension</p> Signup and view all the answers

    What is the main therapeutic use of direct-acting cholinergic agents like carbachol and pilocarpine?

    <p>Reduce intraocular pressure</p> Signup and view all the answers

    Which of the following medications is used as an antidote for anticholinergic poisoning?

    <p>Physostigmine</p> Signup and view all the answers

    Which symptom is characteristic of a cholinergic crisis?

    <p>Cardiac arrest</p> Signup and view all the answers

    Which patient is most likely to experience immediate life-threatening effects from a nonselective β-blocker?

    <p>Patient with asthma</p> Signup and view all the answers

    What is a common adverse effect of β-blockers?

    <p>Bradycardia</p> Signup and view all the answers

    Which of the following is a primary use of Esmolol (Brevibloc®)?

    <p>Control of supraventricular tachydysrhythmias</p> Signup and view all the answers

    How should patients be instructed to manage their position to prevent adverse effects of β-blockers?

    <p>Change positions slowly</p> Signup and view all the answers

    What additional instruction should be given to patients taking β-blockers regarding caffeine?

    <p>Caffeine can cause excessive irritability.</p> Signup and view all the answers

    Which of the following is NOT a common CNS adverse effect of α-adrenergic medications?

    <p>Sleepiness</p> Signup and view all the answers

    What is the mechanism of action for cardioselective β-blockers such as Atenolol?

    <p>Blocking β1-receptors primarily</p> Signup and view all the answers

    What is a common cardiovascular adverse effect associated with β-adrenergic medications?

    <p>Tachycardia</p> Signup and view all the answers

    What is a critical consideration when administering β-blockers to patients with diabetes?

    <p>They may mask signs of hypoglycemia.</p> Signup and view all the answers

    What should patients be educated on regarding the abrupt cessation of β-blockers?

    <p>It should never be stopped abruptly.</p> Signup and view all the answers

    Which of the following drugs is NOT listed as having potential interactions with adrenergic medications?

    <p>Insulin</p> Signup and view all the answers

    What should be assessed before administering adrenergic medications?

    <p>Renal function</p> Signup and view all the answers

    What is an uncommon adverse effect from adrenergic medications?

    <p>Severe hypertension</p> Signup and view all the answers

    During an asthma attack, what should be prioritized when administering salbutamol to a child?

    <p>Monitor blood oxygen saturation</p> Signup and view all the answers

    Which of the following minimizes the risk of severe cardiovascular effects from adrenergic drugs?

    <p>Careful monitoring and adherence to administration guidelines</p> Signup and view all the answers

    What is NOT a common gastrointestinal side effect of adrenergic medications?

    <p>Diarrhea</p> Signup and view all the answers

    What is a primary use of phentolamine (Rogitine®)?

    <p>To reduce systemic vascular resistance</p> Signup and view all the answers

    Which adverse effect is most commonly associated with tamsulosin (Flomax®)?

    <p>Abnormal ejaculation</p> Signup and view all the answers

    What characterizes nonselective β-blockers compared to cardioselective β-blockers?

    <p>They block both β1-receptors and β2-receptors.</p> Signup and view all the answers

    In what situation might β-blockers be contraindicated?

    <p>Asthma</p> Signup and view all the answers

    What is the primary mechanism by which β-blockers help in treating myocardial ischemia?

    <p>Decrease myocardial oxygen demand</p> Signup and view all the answers

    Which scenario best describes an application of β-blockers in clinical practice?

    <p>Treatment of dysrhythmias</p> Signup and view all the answers

    What impact do nonselective β-blockers have on the respiratory system?

    <p>They can lead to bronchoconstriction.</p> Signup and view all the answers

    Which statement about the cardiovascular effects of beta-blockers is true?

    <p>They reduce heart rate and myocardial contractility.</p> Signup and view all the answers

    What is the primary receptor activity of dopamine at low dosages?

    <p>Increases blood flow via dopaminergic receptor activity</p> Signup and view all the answers

    Which of the following best describes the use of norepinephrine betartrate?

    <p>It causes vasoconstriction and is used to treat hypotension and shock.</p> Signup and view all the answers

    In emergency situations, which drug is considered a prototypical nonselective adrenergic agonist?

    <p>Epinephrine Hydrochloride</p> Signup and view all the answers

    What is the primary effect of stimulating α-Adrenergic receptors?

    <p>Vasoconstriction of blood vessels</p> Signup and view all the answers

    What is a major effect of upping the infusion rate of dopamine?

    <p>Improvement in cardiac contractility and output</p> Signup and view all the answers

    Which statement is true about the actions of norepinephrine compared to epinephrine?

    <p>Epinephrine can stimulate both α- and β-adrenergic receptors, unlike norepinephrine.</p> Signup and view all the answers

    Which of the following actions is a result of stimulating ß2-Adrenergic receptors?

    <p>Bronchodilation</p> Signup and view all the answers

    What is a therapeutic indication for the use of α-Adrenergic agonists?

    <p>Reduction of intraocular pressure in glaucoma</p> Signup and view all the answers

    Which drug is an example of a selective vasoactive ß1-adrenergic agent?

    <p>Dobutamine Hydrochloride</p> Signup and view all the answers

    What effect does stimulation of ß1-Adrenergic receptors have on the heart?

    <p>Increased force of contraction</p> Signup and view all the answers

    What is a possible cardiovascular adverse effect of β-adrenergic medications?

    <p>Tachycardia</p> Signup and view all the answers

    Which interaction is considered dangerous when using adrenergic drugs?

    <p>Monoamine oxidase inhibitors (MAOIs)</p> Signup and view all the answers

    What should the nurse assess before administering adrenergic medications?

    <p>History of allergies and asthma</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with β-adrenergic medications?

    <p>Muscle cramps</p> Signup and view all the answers

    Which adrenergic receptor is primarily located on postsynaptic effector cells?

    <p>α1-Adrenergic receptors</p> Signup and view all the answers

    Which cardiovascular event requires immediate attention when a patient is on a dobutamine drip?

    <p>Chest tightness</p> Signup and view all the answers

    What should be monitored after a nebulizer treatment with salbutamol in a child experiencing an asthma attack?

    <p>Blood oxygen saturation (SpO2)</p> Signup and view all the answers

    What physiological response is chiefly caused by ß1-Adrenergic agonists?

    <p>Glycogenolysis and cardiac stimulation</p> Signup and view all the answers

    What is the role of α2-Adrenergic receptors in neurotransmitter release?

    <p>Control the release of neurotransmitters</p> Signup and view all the answers

    In patients receiving adrenergic drugs, which organ systems should be assessed for proper function?

    <p>Renal, hepatic, and cardiac systems</p> Signup and view all the answers

    Which drug class acts indirectly by releasing catecholamines from storage sites?

    <p>Indirect-acting sympathomimetics</p> Signup and view all the answers

    Which drug category is most likely to interact adversely with anticholinergics?

    <p>Cholinesterase inhibitors</p> Signup and view all the answers

    Which physiological effect is NOT associated with dopaminergic receptors?

    <p>Increase in heart rate</p> Signup and view all the answers

    What is the primary mechanism of indirect-acting cholinergic agonists?

    <p>Inhibit acetylcholinesterase</p> Signup and view all the answers

    What is the main function of catecholamines in the body?

    <p>To produce a sympathomimetic response</p> Signup and view all the answers

    What describes a direct-acting sympathomimetic?

    <p>Binds directly to receptors and causes a response</p> Signup and view all the answers

    Which of the following symptoms could indicate a cholinergic crisis?

    <p>Bradycardia</p> Signup and view all the answers

    What is a potential concern when using β-blockers in a patient with type 2 diabetes?

    <p>Hypoglycemia unawareness</p> Signup and view all the answers

    Which adrenergic drug is synthetic?

    <p>Dobutamine</p> Signup and view all the answers

    Which of the following effects is NOT associated with stimulation of muscarinic receptors?

    <p>Increased heart rate</p> Signup and view all the answers

    What should be monitored when a patient is taking a cholinergic drug for several days?

    <p>Changes in blood pressure</p> Signup and view all the answers

    Which receptor type is primarily targeted by direct-acting cholinergic agonists?

    <p>Muscarinic receptors</p> Signup and view all the answers

    What is a common adverse effect of cholinergic drugs?

    <p>Diarrhea</p> Signup and view all the answers

    In which scenario should atenolol be used with caution?

    <p>A patient suffering from asthma</p> Signup and view all the answers

    What is the primary use of esmolol?

    <p>Emergency treatment of supraventricular tachydysrhythmias</p> Signup and view all the answers

    Which of the following nonselective β-blockers can lead to the most significant adverse effects in patients?

    <p>Propranolol</p> Signup and view all the answers

    Which condition is NOT a common adverse effect of β-blockers?

    <p>Tachycardia</p> Signup and view all the answers

    What potential complication should be monitored in patients taking β-blockers?

    <p>Bronchial spasms</p> Signup and view all the answers

    Which patient is at a heightened risk of experiencing hypotension while on α-blockers?

    <p>A patient with congestive heart failure</p> Signup and view all the answers

    What should patients be advised to avoid while taking β-blockers?

    <p>Caffeine consumption</p> Signup and view all the answers

    Which β-blocker is considered a cardioselective β-blocker?

    <p>Metoprolol</p> Signup and view all the answers

    Which blood product is most appropriate for a patient with an estimated loss of 30% blood volume in hypovolemic shock?

    <p>Whole blood</p> Signup and view all the answers

    What is the role of cryoprecipitate in clinical practice?

    <p>For management of acute bleeding</p> Signup and view all the answers

    Which of the following is a potential adverse effect of blood transfusions?

    <p>Incompatibility with the recipient's immune system</p> Signup and view all the answers

    What is the primary characteristic of packed red blood cells as a blood product?

    <p>They primarily increase oxygen-carrying capacity</p> Signup and view all the answers

    Which electrolyte is critically abundant inside human cells?

    <p>Potassium</p> Signup and view all the answers

    Which condition can lead to hyperkalemia?

    <p>Kidney failure</p> Signup and view all the answers

    What is a common symptom of hypokalemia?

    <p>Lethargy</p> Signup and view all the answers

    Which medication is indicated to treat severe hyperkalemia?

    <p>Calcium chloride</p> Signup and view all the answers

    What is the main function of sodium in the body?

    <p>Controlling water distribution</p> Signup and view all the answers

    Which of the following is a potential adverse effect of potassium oral preparations?

    <p>Vomiting</p> Signup and view all the answers

    What serum level defines hyponatremia?

    <p>&lt; 135 mmol/L</p> Signup and view all the answers

    Which electrolyte imbalance might be caused by excessive corticosteroid use?

    <p>Hypokalemia</p> Signup and view all the answers

    What is a symptom of hypernatremia?

    <p>Dry, sticky mucous membranes</p> Signup and view all the answers

    What is a primary action of ACE inhibitors?

    <p>They prevent the conversion of angiotensin I to angiotensin II.</p> Signup and view all the answers

    Which of the following is an indication for ACE inhibitors?

    <p>Hypertension</p> Signup and view all the answers

    Which ACE inhibitors are not classified as prodrugs?

    <p>Captopril and lisinopril</p> Signup and view all the answers

    What role does oncotic pressure play in fluid movement between blood vessels and tissues?

    <p>It regulates the balance of fluids by pulling them into the vessels.</p> Signup and view all the answers

    What is a consequence of inhibiting ACE in the context of heart failure?

    <p>Decreased preload and afterload</p> Signup and view all the answers

    Which intravenous solution is classified as hypotonic?

    <p>0.45% NaCl</p> Signup and view all the answers

    What characteristic sets apart the action of α1-receptor blockers from β-receptor blockers?

    <p>β blockers are primarily involved in cardiac output reduction.</p> Signup and view all the answers

    What is a significant advantage of crystalloids over colloids in patient treatment?

    <p>They are better for treating dehydration.</p> Signup and view all the answers

    Which of the following describes a potential adverse effect of prolonged administration of crystalloids?

    <p>Electrolyte imbalances due to dilution.</p> Signup and view all the answers

    What is the primary function of colloids in fluid therapy?

    <p>To increase colloid oncotic pressure.</p> Signup and view all the answers

    Which of the following blood products carries oxygen and increases tissue oxygenation?

    <p>Red blood cell products</p> Signup and view all the answers

    What risk is associated with the use of colloids such as albumin?

    <p>Altered coagulation leading to bleeding.</p> Signup and view all the answers

    Which of the following is an indication for the use of crystalloids?

    <p>Fluid replacement in burns.</p> Signup and view all the answers

    What is the primary reason for using hypertonic solutions like 3% NaCl?

    <p>To draw fluids into the intravascular space.</p> Signup and view all the answers

    How does the hydrostatic pressure in capillaries contribute to fluid movement?

    <p>It pushes fluids out of capillaries into surrounding tissues.</p> Signup and view all the answers

    What is the principal action of potassium-sparing diuretics?

    <p>Promote the excretion of sodium and water.</p> Signup and view all the answers

    Which adverse effect is specifically associated with spironolactone?

    <p>Gynecomastia</p> Signup and view all the answers

    At what creatinine clearance level should thiazide diuretics not be used?

    <p>Less than 30 mL/min</p> Signup and view all the answers

    What is the mechanism of action of thiazide diuretics?

    <p>Inhibit tubular resorption of sodium and chloride ions.</p> Signup and view all the answers

    Which electrolyte imbalance is commonly associated with thiazide diuretics?

    <p>Hypokalemia</p> Signup and view all the answers

    What is a potential nursing implication for patients receiving diuretics?

    <p>Regularly check for signs of dehydration.</p> Signup and view all the answers

    Which class of diuretics primarily promotes the excretion of water through osmotic action?

    <p>Loop diuretics</p> Signup and view all the answers

    What should a nurse assess before administering thiazide diuretics?

    <p>Baseline fluid volume status</p> Signup and view all the answers

    What is the maximum rate at which IV potassium can be administered to patients not on cardiac monitors?

    <p>10 mmol/hr</p> Signup and view all the answers

    Which type of diuretic works by inhibiting carbonic anhydrase?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    What percentage of sodium is reabsorbed in the distal convoluted tubule?

    <p>5 to 10%</p> Signup and view all the answers

    What should potassium oral forms be diluted with to minimize GI distress?

    <p>100 to 250 mL of water or fruit juice</p> Signup and view all the answers

    Which diuretic class is commonly the first choice for treating hypertension in Canada?

    <p>Thiazide and thiazide-like diuretics</p> Signup and view all the answers

    What is a primary effect of diuretic drugs?

    <p>Acceleration of urine formation</p> Signup and view all the answers

    Which statement is true about the effects of sodium reabsorption?

    <p>Water follows sodium reabsorption in the nephron.</p> Signup and view all the answers

    What precaution should be taken when administering potassium via IV?

    <p>Infusions must be monitored closely to prevent complications.</p> Signup and view all the answers

    What is the primary component of intracellular fluid in the body?

    <p>Electrolytes and glucose</p> Signup and view all the answers

    Which hormone is responsible for promoting sodium retention in the kidneys?

    <p>Aldosterone</p> Signup and view all the answers

    What factor exerts oncotic pressure to maintain fluid balance in blood vessels?

    <p>Plasma proteins</p> Signup and view all the answers

    How does interstitial fluid primarily differ from intravascular fluid?

    <p>It has a lower concentration of proteins.</p> Signup and view all the answers

    What stimulates fluid intake in response to low blood volume or high osmolarity?

    <p>Thirst mechanism</p> Signup and view all the answers

    Which condition is characterized by excessive serum potassium?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is a common cause of hypokalemia?

    <p>Increased secretion of mineralocorticoids</p> Signup and view all the answers

    Which electrolyte is primarily responsible for controlling water distribution in the body?

    <p>Sodium</p> Signup and view all the answers

    What potential effect can excessive potassium administration lead to?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which symptom is commonly associated with hypernatremia?

    <p>Water retention (edema)</p> Signup and view all the answers

    Which of the following is an indication for potassium treatment?

    <p>Treatment of potassium depletion</p> Signup and view all the answers

    Which treatment may be used for severe hyperkalemia?

    <p>Calcium chloride</p> Signup and view all the answers

    What is the maximum infusion rate of IV potassium for patients who are not on cardiac monitors?

    <p>10 mmol/hr</p> Signup and view all the answers

    What is the primary action of diuretic drugs?

    <p>Accelerate urine formation</p> Signup and view all the answers

    What is the recommended practice when administering oral potassium supplements?

    <p>Dilute in 100 to 250 mL of water or juice</p> Signup and view all the answers

    Which part of the nephron reabsorbs approximately 60 to 70% of sodium and water back into the bloodstream?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    Which type of diuretic drug primarily inhibits the action of carbonic anhydrase?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    What should a nurse monitor for when administering potassium intravenously?

    <p>IV infusion rate and site appearance</p> Signup and view all the answers

    What is a common complication a nurse should observe for during IV potassium administration?

    <p>Infiltration at the IV site</p> Signup and view all the answers

    In the treatment of hypertension, which type of diuretic is typically the first choice in Canada?

    <p>Thiazide and thiazide-like diuretics</p> Signup and view all the answers

    What is the primary mechanism of action of ACE inhibitors?

    <p>Inhibit angiotensin-converting enzyme</p> Signup and view all the answers

    Which of the following is true regarding captopril and lisinopril?

    <p>They can be used in patients with liver dysfunction.</p> Signup and view all the answers

    Which condition is NOT an indication for ACE inhibitors?

    <p>Asthma</p> Signup and view all the answers

    What effect do ACE inhibitors have on bradykinin levels?

    <p>They prevent bradykinin breakdown.</p> Signup and view all the answers

    Which of the following is a common adverse effect of ACE inhibitors?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the primary action of loop diuretics in the ascending limb of the loop of Henle?

    <p>Block chloride and sodium resorption</p> Signup and view all the answers

    Which of the following is a common indication for the use of loop diuretics?

    <p>Edema associated with heart failure</p> Signup and view all the answers

    What is a significant adverse effect of loop diuretics?

    <p>Hypokalemia</p> Signup and view all the answers

    What is the mechanism of action for osmotic diuretics like mannitol?

    <p>Produces an osmotic effect to pull water into renal tubules</p> Signup and view all the answers

    Which of the following describes a clinical use of mannitol?

    <p>Reduction of intracranial pressure</p> Signup and view all the answers

    What should be done if mannitol is observed to have crystals in the IV tubing?

    <p>Warm the vial to dissolve the crystals before administering</p> Signup and view all the answers

    What is a potential effect of loop diuretics on blood pressure?

    <p>Reduce blood pressure</p> Signup and view all the answers

    Which of the following does NOT typically result from the use of osmotic diuretics?

    <p>Electrolyte reabsorption</p> Signup and view all the answers

    Which vasodilator is typically used in critical care settings for severe hypertensive emergencies?

    <p>Sodium Nitroprusside</p> Signup and view all the answers

    What is a common contraindication for the use of Eplerenone?

    <p>Drug allergy</p> Signup and view all the answers

    What is an important nursing implication when administering antihypertensive medications?

    <p>Educate patients about timely medication adherence</p> Signup and view all the answers

    Why should antihypertensive drugs not be stopped abruptly?

    <p>It may cause rebound hypertensive crisis</p> Signup and view all the answers

    In which scenario should oral antihypertensive medications be administered?

    <p>With meals for gradual absorption</p> Signup and view all the answers

    Which lifestyle modification should patients taking antihypertensives be encouraged to make?

    <p>Reduce alcohol intake</p> Signup and view all the answers

    What should be monitored closely in patients receiving intravenous antihypertensive medications?

    <p>Blood pressure</p> Signup and view all the answers

    Which antihypertensive medication might lead to impotence as a side effect?

    <p>Clonidine</p> Signup and view all the answers

    Study Notes

    Endocrine Medications

    • Endocrine medications regulate physiological stability through hormone communication.
    • Hormones use chemical signals.
    • Endocrine function is regulated by a negative feedback loop.
    • These medications maintain physiological stability and communication via hormones that utilize chemical signals throughout the endocrine system.

    Housekeeping

    • Students should prepare for a midterm exam.
    • Students should review the remainder of the course content.
    • Review any material from the midterm exam, including appropriate exam preparation and review for continued success.

    Endocrine System

    • The endocrine system maintains physiological stability.
    • Hormones facilitate communication via chemical signals, regulated by a negative feedback loop.
    • The system regulates bodily reactions based on stimuli and internal homeostasis.
    • The endocrine system's integrated activities incorporate the function of the nervous system, with several feedback loops to continuously monitor and regulate levels of hormones and other biological factors.

    Pituitary Drugs

    • The mechanism of action varies based on the drug.
    • Drugs can either augment or antagonize the natural effects of pituitary hormones.
    • Examples of anterior pituitary drugs include cosyntropin, somatropin, menotropin, bromocriptine mesylate, and thyrotropin alfa—used based on specific underlying medical needs.
    • Posterior pituitary drugs include vasopressin and desmopressin acetate.
    • Pituitary drugs have diverse mechanisms of action aimed at either increasing or decreasing natural hormone responses to specific conditions or pathophysiological processes as part of a tailored treatment regimen.

    Glossary

    • Negative Feedback Loop: A regulatory system where the body's response to a hormone counteracts the initial stimulus, effectively maintaining homeostasis.
    • Thyroid Stimulating Hormone (TSH): A hormone that regulates thyroid function, often indicating the status of the thyroid hormones (T3 and T4).
    • Tyroxine (T4): A thyroid hormone crucial for metabolism, protein, CHO and lipid metabolism, necessary for normal bodily function and cell development.
    • Diabetic Ketoacidosis (DKA): A serious complication in diabetes, characterized by high blood glucose levels, necessitating appropriate treatment and intervention.
    • Hemoglobin A1c (HbA1c): Indicates average blood sugar levels over a period (usually 3 months). (A measure of long-term blood sugar control.)
    • Polydipsia: Excessive thirst.
    • Polyphagia: Excessive hunger.
    • Polyuria: Excessive urination.
    • Hypothalamic-pituitary-adrenal (HPA) axis: A complex network of interactions between the hypothalamus, pituitary, and adrenal glands, regulating hormones, critical for mediating appropriate stress response and maintaining bodily homeostasis.

    Anterior Pituitary

    • Octreotide (Somatostatin) reduces carcinoid tumor-related diarrhea and severe hypotension. It also stimulates skeletal growth in patients with growth hormone deficiency.
    • Somatropin and Somatrem are recombinant growth hormones used to stimulate skeletal growth in cases of deficiency .
    • Octreotide, Somatropin, and Somatrem may be indicated in circumstances of growth hormone deficiency or severe consequences resulting from endocrine pathology, requiring careful monitoring of the patient's response to the treatment regimen.

    Posterior: Vasopressin

    • Mimics the action of antidiuretic hormone (ADH) to increase water reabsorption in the nephrons, reducing water excretion and concentrating urine.
    • It reduces water excretion, and functions in treating diabetes insipidus and in managing hypotensive emergencies, such as septic shock.
    • Also used to stop potentially dangerous bleeding, especially gastrointestinal bleeds or esophageal varices, to control and stop active bleeding and promote hemostasis.

    Posterior: Desmopressin

    • A synthetic form of vasopressin with similar functions, 10x the ADH ability, with less vasoconstriction.
    • It's available in various forms (spray, oral, injection) and is utilized to treat nocturnal enuresis and conditions requiring support for clotting factors/coagulation, including but not limited to those with bleeding disorders or conditions related to abnormal water regulation or for those experiencing bleeding or increased bleeding risk, following appropriate medical guidance.

    Nursing Implications (Endocrine)

    • Conduct a comprehensive nursing assessment and medication history.
    • Determine contraindications and possible drug interactions, considering any allergies and/or pre-existing or current conditions, to ensure consistent and accurate care.
    • Note possible adverse drug effects according to the individual medication being given.
    • Utilize specific instructions for any nasal spray forms of medication, including specific and timely instructions.
    • Rotate injection sites to prevent issues with medication absorption or tissue damage, following care protocol.
    • Patient education and instruction are crucial for effective patient-focused treatment adherence to improve overall health.

    Question (Endocrine) -

    • A patient receiving somatropin likely has hypopituitary dwarfism, and somatropin is a hormone therapy indicated in this circumstance.

    Nursing Implications (General)

    • Ensure thorough assessment, including drug allergies, contraindications, and interactions.
    • Obtain baseline vital signs and weight, as a part of continuous health maintenance and monitoring.
    • Cautious administration required with cardiac disease, hypertension, pregnancy, recognizing the complexities associated with these conditions.
    • Maternal hypothyroidism, during pregnancy should be closely monitored and treated appropriately throughout the course of pregnancy.
    • Monitor and adjust dosage to maintain thyroid-stimulating hormone at the bottom end of the normal range for consistency and optimal patient outcome.
    • Instruct patients on proper administration and timing of medications, adhering to the consistent and appropriate timing regimen to ensure optimal patient response and avoid complications associated with inconsistencies in treatment.
    • Advise clients of drug interactions with other drugs and avoidance of abrupt discontinuation of medications, including warnings about interactions.
    • Understand patients' ability to consume food or potential side effects like nausea or vomiting when taking medication, especially in a hospitalized setting, and make note of patient's NPO status or other medical guidelines, especially to prevent possible complications.

    Question (Endocrine) - Another

    • The nurse should expect a patient receiving hydrocortisone (Solu-Cortef®) to demonstrate a reduction in scar tissue formation, reflecting the drug's anti-inflammatory action. This should be part of the overall assessment and monitoring process.

    Question (Endocrine) - Another

    • Vasopressin is the most appropriate choice for a patient in pulseless cardiac arrest as it has potent vasoconstricting properties, important for maintaining blood pressure in critical or life-threatening conditions requiring emergency intervention.

    Thyroid and Antithyroid Drugs

    • Thyroid gland-secretes three essential hormones for proper metabolic regulation: thyroxine (T4), triiodothyronine (T3), and calcitonin.
    • These hormones control protein, carbohydrate, and lipid metabolism.
    • They regulate oxygen consumption and body temperature.
    • Also increase blood flow to the kidneys and glomerular filtration rate (GFR) increasing diuresis.
    • These hormones have significant roles in metabolic processes throughout the body, including but not limited to those regulating cell development, and maintenance of homeostasis.

    Hypothyroidism (Slow Metabolic Rate)

    • Congenital hypothyroidism (present from birth) involves abnormal thyroid hormone production, leading to decreased metabolism and often significant developmental delays.
    • Signs include low metabolic rate, short stature, and delayed sexual development, along with intellectual disabilities, such as myxedema (characteristic adult hypothyroidism).
    • Myxedema includes severe, edema-like swelling and changes in skin appearance from the reduced metabolism.
    • Goiter, an enlarged thyroid gland, is a consequence of ongoing stimulation by TSH, because of lowered hormone levels.
    • Diagnosis and treatment are important to ameliorate the effects of under-production of essential hormones, particularly when related to growth and development.

    Thyroid Replacement Drugs

    • Levothyroxine (Synthroid®, Eltroxin®, Euthyrox®): a synthetic T4 hormone replacement, often used to consistently maintain and control blood levels of T4, essential in managing metabolic needs.
    • Liothyronine (Cytomel®): a synthetic T3 hormone replacement, used when a rapid onset is desired.
    • Thyroid replacement therapies utilize either T4 or T3 replacements, used to consistently and regularly maintain adequate blood levels of critical hormones.

    Questions (Thyroid)

    • Euthyroid means the patient's thyroid hormone levels are within normal limits, representing a balanced and appropriate level of thyroid hormone in the body.
    • This is a critical assessment benchmark for evaluating the effectiveness of the therapy and preventing or mitigating potential adverse effects.

    Indications & Adverse Effects (Thyroid)

    • Thyroid replacement therapy is indicated for patients with surgically removed or destroyed thyroid glands, or hypothyroidism of pregnancy.
    • Cardiac dysrhythmias are the most significant adverse effect of thyroid replacement therapy, and requires prompt and correct intervention and identification.
    • Other potential adverse effects include tachycardia, palpitations, angina, dysrhythmias, hypertension, insomnia, tremors, headaches, anxiety, nausea, diarrhea, cramps, menstrual irregularities, weight loss, sweating, heat intolerance, fever, and other symptoms related to thyroid disorders.
    • Recognizing and treating potential adverse effects is vital for patient safety.

    Nursing Implications (Thyroid)

    • Assess for drug allergies, contraindications, and interactions.
    • Obtain baseline vital signs and weight.
    • Cautious administration when associated with cardiac disease, hypertension, or pregnancy.
    • Adhere to the prescribed dosage schedules, providing consistent guidance to the patient about timing and routes of administration, and emphasizing regular compliance to the treatment regimen to maximize benefits and minimize complications.
    • Instruct patients regarding the importance of adherence to maintain and regulate thyroid hormone levels and to report unusual symptoms or concerns to healthcare providers for guidance.
    • Patient education is crucial for effective treatment adherence and well-being.

    Question (Thyroid) - Another

    • Inadequate dosage of the thyroid replacement drug is a potential cause for the noted symptoms of cold intolerance, depression, brittle nails, and fatigue.
    • Accurate dosage and patient response to the treatment regimen are important and may require adjustment (increasing or decreasing) based on ongoing monitoring and evaluations.

    Hyperthyroidism (Increased Metabolic Rate)

    • Graves' disease, multinodular goiter, Plummer’s disease (rare) are indicated causes, induced by stress or infection. Recognize hyperthyroidism as a potentially life-threatening condition needing prompt diagnosis and treatment with consistent and regular therapy regimens.

    Treatment of Hyperthyroidism

    • "Ablation," utilizing radioactive iodine or surgery to destroy the thyroid gland, along with lifelong thyroid hormone replacement—used appropriately in cases of hyperthyroidism.
    • Antithyroid drugs (e.g., thiamazole and propylthiouracil) and potassium iodine may also be indicated, alone or in combination.

    Nursing Implications (Hyperthyroidism)

    • Should be given with food to minimize gastric distress and promote consistent blood levels to maintain homeostasis in this circumstance.
    • Ingested daily, at the same time to keep and maintain consistent and stable blood levels of administered medication.
    • Avoidance of foods high in iodine (seafood, soy, tofu, iodized salt) is critical for management and appropriate treatment regimen.
    • Monitor therapeutic response, including the absence of ongoing hyperthyroidism or progression of existing symptoms.
    • Be vigilant regarding possible adverse effects like leuopenia.

    Question - Menu Choice (Hyperthyroidism)

    • Foods that are lower in iodine content, such as pasta with marinara sauce, or similar bland food options low in iodine, are suitable for patients taking antithyroid medications.

    Antidiabetic Drugs

    • The pancreas has endocrine and exocrine functions and is essential for regulating blood sugar levels.
    • Endocrine function involves producing and secreting hormones like insulin, glucagon, and somatostatin—all with critical roles in glucose homeostasis.

    Understanding Diabetes

    • The body's ability to use glucose as a source of energy is hindered when the body's systems resist or fail to produce sufficient insulin. This leads to hyperglycemia (abnormally high blood glucose levels) and requires careful management.

    Diabetes Mellitus

    • Elevated fasting blood glucose (higher than 7 mmol/L) or hemoglobin A1c (HbA1c) level greater than or equal to 6.5% are diagnostic metrics.
    • Polyuria (increased urination), polydipsia (extreme thirst), polyphagia (extreme hunger) are common associated symptoms in addition to weight loss, fatigue, and blurred vision.

    Type 1 Diabetes

    • Lack of insulin production, or the production of insulin that is defective—meaning the body does not produce adequate and functional insulin, essential for glucose homeostasis.
    • Patients require exogenous insulin.
    • Potential complications associated with type 1 diabetes include diabetic ketoacidosis and hyperosmolar hyperglycemic state.

    Type 2 Diabetes

    • Most common type of diabetes (90% of cases).
    • Caused by insulin resistance and/or insufficient insulin production.
    • Tissues develop a resistance to insulin action, often caused by genetic or lifestyle elements.
    • Comorbidities are frequent, including obesity, hyperlipidemia, hypertension, microalbuminuria, and increased thrombotic events.
    • Proper management and consistent treatment protocol are key in diabetes management.

    Gestational Diabetes

    • Hyperglycemia that develops during pregnancy, when the body needs higher levels of insulin to manage the increased blood sugar levels.
    • Insulin usage is often necessary to prevent birth defects during pregnancy, and often associated with long-term metabolic disturbances; management is prioritized for patients experiencing this type of diabetes.

    Long-Term Complications (Diabetes)

    • Macrovascular complications (atherosclerotic plaque) involve coronary and cerebral arteries and peripheral vessels.
    • Microvascular complications (capillary damage) involve retinopathy, neuropathy, and nephropathy.
    • Identifying and managing long-term complications is essential to preventing long-term morbidity and mortality.
    • Recognizing and understanding the severity of the conditions associated with specific long-term complications are important for patients and/or care providers.

    Nonpharmacological Treatment (Type 2 Diabetes)

    • Weight loss, improved dietary habits, smoking cessation, reduced alcohol consumption, and regular physical activity are crucial nonpharmacological components for managing type 2 diabetes.
    • lifestyle modifications should be part of the overall treatment strategy. These techniques are often recommended alongside pharmacological treatment strategies.

    Glycemic Goal of Treatment (Diabetes)

    • HbA1c of less than 7%.
    • Fasting blood glucose goal for diabetic patients: 4 to 7 mmol/L.
    • Two-hour post-prandial target of 5 to 10 mmol/L.
    • These targets are essential for managing glucose levels in diabetes and must be carefully monitored.

    Types of Antidiabetic Drugs

    • Combination of oral antihyperglycemic and insulin controls glucose levels.
    • Several new injectable hypoglycemic drugs may supplement treatment regimens to consistently control blood glucose levels.

    Insulins

    • Substitutes endogenous insulin, restoring the body's carbohydrate, fat, and protein metabolism for patients with diabetes.
    • Needed for storage of glucose in the liver and conversion to energy stores.

    Rapid-Acting Insulin

    • Shortest onset of action (10–15 minutes)
    • Peak effect 1-2 hours
    • Duration of effect 3-5 hours
    • Examples: Humalog®, NovoRapid®, Apidra®.
    • Critical for managing postprandial glucose spikes for better glycemic control.

    Short-Acting Insulin

    • Regular insulin (Humulin R®, Novolin ge Toronto®)
    • Clear in appearance
    • Onset 30 minutes subcutaneous
    • Peak 2– 3 hours
    • 6.5 hour duration subcutaneous
    • Useful for managing blood glucose levels, requires consistent administration.

    Intermediate-Acting Insulin

    • Insulin isophane suspension (NPH)
    • Cloudy appearance
    • Usually combined with regular insulin
    • Duration up to 18 hours
    • Provides longer-duration glucose control compared to rapid acting.

    Long-Acting Insulin

    • Insulin glargine (Lantus®) or detemir (Levemir)
    • Clear, colorless solution, constant level of insulin.
    • Dosed once daily or every 12 hours, providing a consistent baseline of glucose control.

    Question (Insulin Administration)

    • The nurse’s priority is to inform the patient about the delay in the breakfast trays, recognizing the importance of appropriate blood glucose management. Appropriate food options for the patient should be discussed, with recognition of possible hypoglycemia if meals are noticeably delayed or otherwise not a suitable option.

    Fixed-Combination Insulins

    • Humulin 30/70
    • Novolin 30/70, 40/60, 50/50
    • NovoMix® 30
    • Humalog Mix25®
    • Humalog Mix50®
    • These are premixed insulins, generally providing better diabetic control due to the combination of insulins and reducing the number of injections that may be required per day.

    Sliding-Scale Insulin Dosing

    • Subcutaneous rapid-acting (lispro or aspart) or short-acting (regular) insulins, usually adjusted by the healthcare team according to blood glucose test results.
    • Used typically in hospitalized patients for diabetic control or those reliant on feeding tubes.
    • Disadvantage: delays insulin administration until hyperglycemia occurs leading to large swings in glucose control; less effective long-term management strategy than other methods.

    Basal-Bolus Insulin Dosing

    • Preferred method of treatment for hospitalized patients with diabetes; mimics a healthy pancreas, delivering insulin constantly (basal) and as needed (bolus) to help regulate blood glucose effectively.
    • Basal insulin - long-acting (insulin glargine) maintains glucose regulation (basal) and bolus insulin (insulin lispro or insulin aspart) gives consistent control when needed (bolus).
    • This regimen is used to better regulate blood glucose levels and prevent swings for optimal patient outcomes.

    Nursing Implications: Insulin

    • Always check blood glucose levels before administering the medication for appropriate and consistent patient care.
    • Use calibrated insulin syringes, always ensuring proper storage.
    • Ensure proper timing of insulin administration relative to meals and other care protocols/treatments, such as other medications.
    • Second-check administration protocol to improve patient safety.
    • When drawing up multiple insulin types, prioritize the short and rapid-acting insulins first.
    • These guidelines are to ensure consistent, safe, and effective insulin regimens, with a focus on consistent patient care.

    Type 2 Diabetes Treatment Protocol

    • Lifestyle interventions
    • Oral biguanide-metformin
    • If lifestyle modifications & maximum metformin dose are inadequate, add DPP-4 inhibitors, glucagon-like peptide 1 receptor agonists, or insulin.
    • The combination therapies are utilized based on medical necessity and patient response.

    Biguanide: Metformin (Glucophage)

    • First-line medication for type 2 diabetes, usually used in conjunction with lifestyle changes.
    • Mechanism of action includes decreasing hepatic glucose production while improving insulin sensitivity for patients with Type 2 Diabetes, used in conjunction with lifestyle modifications.
    • Key considerations such as contraindications, including kidney dysfunction or renal disease, should be carefully considered prior to treatment initiation.
    • Potential adverse effects such as gastrointestinal symptoms (abdominal bloating, nausea, cramping, diarrhea) and decreased vitamin B12 levels should be carefully considered as part of the assessment (monitoring) and overall treatment plan.
    • Patient monitoring and identification of potential effects should be part of the care plan.

    Sulfonylureas

    • Second-generation medications used to stimulate insulin release from beta cells and reduce glucagon secretion, helping to effectively regulate blood glucose levels.
    • Examples include glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (DiaBeta).
    • Considerations include potential adverse effects such as hypoglycemia, weight gain, and skin rashes, with careful monitoring required.

    Injectable Antidiabetic Drugs: MOA (Amylin agonist - pramlintide)

    • Amylin agonist - pramlintide (Symlin®) mimics the natural hormone amylin.
    • The drug slows gastric emptying, and the effect is a reduction in digestion and absorption of nutrition and/or food.
    • Suppresses glucagon secretion and reduces hepatic glucose output for patients with Type-2 Diabetes, thus helping to maintain and regulate blood glucose.

    Injectable Antidiabetic Drugs: MOA (Incretin mimetic - exenatide, semaglutide)

    • Exenatide (Byetta®) and semaglutide (Ozempic) mimic incretin hormones.
    • Enhancing glucose-driven insulin secretion from beta cells.
    • Primarily for type 2 diabetes treatment.
    • Used with injection pens.
    • Potential side effects, including nausea, vomiting, diarrhea, and pancreatitis, should be closely monitored and managed with appropriate medical interventions.

    Glinides and Thiazolidinediones

    • Specific names of oral medications with specified MOA and indications.
    • Contraindications and potential adverse effects are noted, and careful clinical monitoring is crucial.

    α-Glucosidase & DPP - 4 Inhibitors

    • These medications inhibit specific enzymes in the gut, reducing glucose absorption in the intestine, often with a slower digestion and absorption of carbohydrates, thus having significant effects on blood glucose response.
    • These agents or medication classes may be used alone or in combination for the management of the metabolic needs of patients with Type 2 diabetes.

    Sodium Glucose Cotransporter 2 Inhibitors

    • Increase renal glucose excretion by preventing reabsorption from the glomeruli leading to a reduced blood glucose level, and is essential as an additional treatment strategy.
    • Newer class of oral drugs for type 2 diabetes, enhancing glucose control and promoting weight loss through altering renal glucose reabsorption, crucial in properly managing and regulating blood glucose level homeostasis.

    Question (Drug Administration/Education) - Another

    • Clarification of the situation with the charge nurse or a physician clarifies any confusion and inconsistencies between the two shifts staff personnel ensuring patient safety and adherence to a detailed and thorough treatment plan.
    • Prompt and appropriate action minimizes the possibility of ongoing complications associated with errors in administration and/ or compliance to the treatment regimen.

    DM: Nursing Implications (General)

    • Thorough patient education regarding disease process, dietary recommendations, self-administration of medications, potential complications, including those from the medication regimen, and glucose changes during various conditions or changes or needs in the patient care plans including stress, pregnancy/lactation, and infection, and appropriate testing guidelines.

    Nursing Implications (General - Drug Administration)

    • Monitor glucose levels consistently prior to administering oral or injected antidiabetic drugs, following the established policies of the medical facility, to ensure appropriate and consistent patient care.
    • Obtain and document a thorough history, baseline vital signs, blood glucose levels, and HbA1c levels before and throughout the course of pharmacological treatment, noting any and all adverse effects that may accompany use of the medication.
    • Educate the patient and their family about possible complications and drug interactions (e.g., with food or other medications), and provide proper instruction.
    • Understand patients' ability to consume food or potential side effects like nausea or vomiting when taking medication, especially in a hospitalized setting, and make note of patient's NPO status or other medical guidelines, especially to prevent possible complications.

    Nursing Implications (General – Hypoglycemia)

    • Assess for signs of hypoglycemia and recognize possible complications.
    • For a conscious patient with hypoglycemia, provide a fast-acting carbohydrate source, such as glucose tablets, fruit juice, honey, or crackers or a half-sandwich, to help raise the glucose level.
    • For an unconscious patient with hypoglycemia, give 50% dextrose in water (D50W) or an injection of glucagon promptly, as this may be a life-saving intervention in the appropriate setting and/ or time frame.
    • Ongoing monitoring and appropriate medical interventions when needed will maintain stable glucose levels, ensuring a safe and consistent level of glycemic control.

    Chapter 34: Adrenal Drugs

    • The adrenal glands are crucial endocrine glands regulating metabolism, the stress response, and electrolyte balance through the production of multiple hormones with multiple functions.

    Adrenal Gland

    • The adrenal medulla produces catecholamines (epinephrine and norepinephrine) directly involved in mediating the stress response (flight or fight).
    • The adrenal cortex produces corticosteroids (e.g., glucocorticoids), with diverse functions, including maintenance of normal body functions and response to stress.
    • Glucocorticoids manage and regulate inflammatory responses, and play important roles.
    • Mineralocorticoids, such as aldosterone, regulate electrolyte balance, including sodium and potassium levels.

    Glucocorticoids

    • These drugs are used in the body's natural endocrine signaling, are also helpful as therapeutic agents for their anti-inflammatory and immunosuppressive effects.
    • Corticosteroids are used to effectively manage conditions characterized by inflammatory or immune responses that need regulation or control.
    • These powerful hormones impact nearly every bodily system, including the CV, CNS, Endocrine, GI, and more.

    Mechanism of Action (Glucocorticoids)

    • The mechanism of action of most corticosteroids involves modifying enzyme activity—in turn affecting and regulating diverse cellular functions associated with metabolism, the immune system and others.
    • Varying potencies, durations of action, and effects on salt and fluid balance occur among different forms of corticosteroids in clinical use as well as in the natural bodily response, requiring careful selection of the appropriate type and dosage.

    Indications (Glucocorticoids)

    • Indications include adrenocortical insufficiency, allergic disorders, autoimmune diseases, bacterial meningitis, cancer, cerebral edema, specific collagen diseases, dermatological diseases (e.g., exfoliative dermatitis, or pemphigus) , endocrine disorders such as thyroiditis (including but not limited to exacerbation of chronic respiratory illnesses such as asthma, chronic obstructive pulmonary disease or COPD and selected hematological disorders that may present with impaired bleeding tendencies).
    • Nonrheumatic inflammation, ophthalmic disorders, organ transplantation, leukemias and lymphomas, spinal cord injury, and rheumatic disorders—such as rheumatoid arthritis, psoriatic arthritis, acute gouty arthritis, and ankylosing spondylitis (often as adjunctive therapy) are also important.

    Adverse Effects (Glucocorticoids) - CV, CNS

    • Cardiovascular adverse effects include heart failure, cardiac edema, and hypertension, potential complications that may be caused by electrolyte imbalances, impaired glucose tolerance, dysrhythmias, pulmonary edema, syncope, and vasculitis.
    • Central nervous system adverse effects include convulsions, headache, vertigo, mood swings, nervousness, aggressive behaviors, psychotic symptoms, neuritis, peripheral neuropathy, paresthesia, arachnoiditis, meningitis, and insomnia.

    Adverse Effects (Glucocorticoids)- Endocrine, GI

    • Endocrine adverse effects include growth suppression, Cushing's syndrome, menstrual irregularities, CHO intolerance, hyperglycemia, hypothalamic-pituitary-adrenal (HPA) axis suppression, hirsutism, hypertrichosis, and glycosuria.
    • Gastrointestinal adverse effects involve peptic ulcers, pancreatitis, and ulcerative esophagitis (often GI upset and/or bleeding) in addition to abdominal distension or related issues.

    Adverse Effects (Glucocorticoids) - Skin, MSK, Eyes

    • Skin adverse effects include fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, urticaria, and hypersensitivity reactions including acne, dry skin, hyperpigmentation, striae.
    • Musculoskeletal adverse effects include myopathy, weakness, muscle loss, osteoporosis, osteonecrosis, and pathological fractures.
    • Ocular system adverse effects include increased intraocular pressure, cataracts, and glaucoma.
    • Other adverse effects noted include weight gain, leukocytosis, opportunistic infections, hypokalemia alkalosis, and impaired healing.

    Contraindications (Glucocorticoids)

    • Drug allergies, peptic ulcer disease, mental health problems, diabetes, cardiac, renal, or liver dysfunction are contraindications to using glucocorticoids.
    • Often avoided with serious infections, including septicemia, systemic fungal infections, and varicella. Exception: TB meningitis, glucocorticoids may be used when clinically necessary and/ or appropriate for short-term use.

    Drug Interactions (Glucocorticoids)

    • Non-potassium-sparing diuretics may lead to severe hypocalcemia and hypokalemia—often requiring specific monitoring by medical staff.
    • Aspirin, NSAIDs, and other ulcerogenic medications cause additive gastrointestinal effects—resulting in increased risk of ulcers, or other gastrointestinal compromise.
    • Anticholinesterase medications may exacerbate effects in myasthenia gravis, producing weakness; this is a key diagnostic and treatment point for proper care.
    • Immunizing biologics may impact immune response and other potential interactions and or effects relative to the therapy, leading to elevated blood glucose levels and potentially other disturbances.

    Prednisone

    • Most common oral glucocorticoid used for anti-inflammatory and immunosuppressant purposes, usually administered daily or as directed by a healthcare professional. A critical consideration when prescribing this type of treatment.
    • Also used to treat exacerbations of chronic inflammatory or respiratory conditions .
    • Inappropriate for adrenal insufficiency treatment, but important in managing numerous inflammatory disease scenarios.
    • Its effects in the management of numerous, potentially life-threatening conditions associated with the inflammatory response are well-recognized in multiple medical settings.

    Methylprednisolone (Solu-Medrol)

    • Most common injectable glucocorticoid, often used intravenously for anti-inflammatory or immunosuppressive purposes, including management of exacerbations of serious inflammatory conditions.
    • Not recommended for pregnant individuals, given the possible effects on developing fetal systems—which may be adverse.
    • Contains a preservative (benzyl alcohol), unsuitable for use in children under 28 days.

    Look-Alike/Sound-Alike Drugs (Glucocorticoids)

    • Solu-Cortef and Solu-Medrol are distinct glucocorticoids with different formulations, strengths, and differing potencies and should not be substituted.
    • Look-alike and sound-alike drugs present a high risk for serious errors in drug administration and must be carefully understood and managed to prevent potential harm.

    Other Adrenal Drugs

    • Mineralocorticoids, like fludrocortisone, function specifically in fluid and electrolyte balance.
    • Catecholamines, such as epinephrine and norepinephrine, mediate the stress response (a “fight-or-flight” response).
    • Certain drugs (e.g., ketoconazole) can act as adrenal steroid inhibitors.

    Nursing Implications (Adrenal Drugs)

    • Baseline weight, height, intake and output, vital signs, hydration, nutritional status, skin, and immune status should be noted and monitored, to ensure consistent delivery of effective and appropriate care.
    • Baseline laboratory studies are important for identifying and mitigating any electrolyte imbalances or other potential health-related problems.
    • Administer medications as indicated per manufacturer's or facility's directions and for the appropriate route, quantity, and timing, noting and/or documenting any patient's response.
    • Oral medications should be administered with food to reduce potential gastrointestinal upset.
    • Carefully assess for contraindications—including drug allergies and potential drug interactions—especially for medications that contain components with multiple effects on the bodily response and/ or function.
    • Be aware that these drugs may alter serum glucose, and/or electrolytes (e.g., serum potassium levels), and are monitored frequently to prevent, identify and mitigate any and all adverse effects.
    • Following and adhering to approved and standardized administration protocols is essential.
    • Teach patients to monitor and recognize symptoms of adrenal effects from any component of the treatment regimen, and to report any concerns to a healthcare professional for appropriate guidance.
    • Gradual drug discontinuation to avoid adrenal crisis (sudden drop in serum corticosteroid levels) requires a thorough understanding of how to taper medications. The patient needs support with managing, monitoring and recognizing and reporting any potential or actual issues that may present in relation to therapy.
    • With appropriate patient teaching, monitoring, care, benefits/ advantages, indications, use, and considerations, this important class of medications can be successfully utilized.

    Question (Adrenal Drugs)

    • In patients with potentially life-threatening symptoms, such as from sudden use or tapering of corticosteroids, prompt and accurate actions are essential. These include but are not limited to: monitoring vital signs and promptly alerting higher-level healthcare professionals of any concerns, including those regarding the adrenal stress-response or potential hormone-related/associated complications, to protect the health of this type of patient.

    Question (Inhaler Use)

    • The priority action following an inhaled corticosteroid for asthma is to assess the patient's breathing and respiratory status, following all required parameters for monitoring for patient safety by a healthcare professional.
    • Instructing the patient to rinse their mouth with warm water is important to prevent possible oral fungal infections—which may be associated with administering this type of medication or treatment. Other precautions may be appropriate based on the patient's specific requirements and care needs when administering corticosteroids.

    Question (Oral Corticosteroid Administration Time)

    • The nurse should have the patient take the oral corticosteroid at a consistent time each day, recognizing that this strategy is utilized due to the consistent daily needs and/ or consistent pattern/ rhythm of glucocorticoid administration to optimize benefits and minimize complications.

    Question - (Glucocorticoid Administration Instruction Points)

    • Advise against abrupt discontinuation of glucocorticoids to avoid adrenal crisis, which necessitates the use of a tapering regimen as the drug is stopped or reduced. Important to recognize and avoid this effect in the patient care plan and related instructions given to the patient by the healthcare provider in conjunction with the treatment regimen.
    • Encourage adherence to the prescribed regimen. This is essential, and should be conveyed to patients and/or their family members to help insure and/ or improve patient outcomes in this setting.

    Wrap-up

    • Questions?
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    Description

    Test your knowledge on the management of diabetes and thyroid disorders with this quiz. It covers crucial aspects such as insulin types, thyroid function, and hormonal therapies. Perfect for healthcare professionals and nursing students.

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