Pharm Exam 3 Study guide

Insulin Administration and Patient Education

• Insulin types vary in onset, peak, and duration.
• Rapid-acting insulins (e.g., lispro, aspart, glulisine) have a rapid onset (5-15 minutes), a short peak (1-2 hours), and a shorter duration (4-6 hours), compared to regular insulin which has an onset of 30–60 minutes, peak is 2–4 hours, and duration is 5–8 hours.
• Long-acting insulins (e.g., glargine, detemir, degludec) have a slow onset (1.5-1.6 hours), no pronounced peak, and a prolonged duration (up to 42 hours), allowing for once-daily dosing.
• Regular insulin is the only type that can be administered intravenously.
• Insulin doses affect onset, peak, and duration; larger doses generally lead to faster onset and longer duration.
• Always consider the specific type of insulin when planning administration times relative to meals, and potential drug interactions when mixing different types.
• Patient teaching should emphasize the importance of proper administration techniques, timing of administration relative to meals, and recognition of symptoms of hypoglycemia and hyperglycemia.

Other Antidiabetic Medications

• Sulfonylureas (e.g., glipizide, glyburide): stimulate insulin release and increase insulin sensitivity; common adverse effect is hypoglycemia.
• Metformin (Biguanide): decreases hepatic glucose production and insulin resistance, does not stimulate insulin release, and is less likely to cause hypoglycemia; often the first-line treatment for type 2 diabetes.
• GLP-1 receptor agonists (e.g., Ozempic, Wegovy, Exenatide, Liraglutide): slow gastric emptying, increase insulin secretion, and reduce appetite; administered as injections; potential side effect of pancreatitis.

Thyroid Medications

• Hypothyroidism: Treated with levothyroxine (Synthroid), which must be administered in the morning. Dosage should be titrated carefully in older adults to minimize coronary syndromes.
• Hyperthyroidism: Treatment aims to reduce thyroid activity using medications such as propylthiouracil (PTU) and sodium iodide (Lugol's solution).

Cancer Medications

• Antimetabolites: Drugs that block the metabolic pathways of cancer cells, preventing their division and growth (e.g., fluorouracil). These drugs require nursing vigilance during administration and post-admin.
• Antitumor Antibiotics: Medications that kill cancer cells or inhibit their growth (e.g., doxorubicin). These often have significant cardiotoxicity, necessitating careful monitoring of cardiac status.
• Alkylating Agents: Drugs that disrupt DNA replication, used for slow-growing cancers (e.g., cyclophosphamide). Important to monitor for immunosuppression, myelosuppression, and other adverse events.
• Nursing considerations related to chemotherapy regimens include close monitoring for adverse effects, which may include nausea, vomiting, mucositis, diarrhea, alopecia, photosensitivity, cardiotoxicity, persistent hiccups, and mood disorders. Support fluids, nutrition, and oral hygiene are critical nursing interventions.
• Other cancer-related considerations: Avoid antipyretics unless prescribed by an oncologist and encourage patient practices that support immune function (e.g., temperature monitoring, hygiene, avoiding crowds).

Other Medications

• Tamoxifen: Used in breast cancer treatment, blocks estrogen receptors. Can increase risk of endometrial cancer.
• Estradiol: Used for menopause symptoms, osteoporosis prevention, and certain cancers. Increased risk of blood clots, stroke, or heart attack.
• Progestins: Used for abnormal menstruation, irregular bleeding, and uterine lining overgrowth. Potential side effects include breast tenderness, menstrual flow changes, and acne.
• Finasteride: Treats benign prostatic hyperplasia (BPH).
• Sildenafil: Used for erectile dysfunction (ED) and pulmonary hypertension.
• Clomiphene citrate: Used for infertility; can result in multiple pregnancies.
• Oxytocin: Used to induce labor and control post-partum bleeding.
• Tocolytics: Used to slow labor or prevent preterm labor.
• Magnesium sulfate, nifedipine, ritodrine, albuterol: used for specific aspects of pregnancy or labor management.