Podcast
Questions and Answers
A patient with hypothyroidism is prescribed levothyroxine. Which assessment finding would suggest the drug is exerting its therapeutic effect?
A patient with hypothyroidism is prescribed levothyroxine. Which assessment finding would suggest the drug is exerting its therapeutic effect?
- Increased heart rate
- Increased cold intolerance
- Weight gain
- Decreased TSH levels (correct)
A patient is prescribed levothyroxine 50 mcg daily. Which instruction is most important for the nurse to provide to the patient?
A patient is prescribed levothyroxine 50 mcg daily. Which instruction is most important for the nurse to provide to the patient?
- "If you miss a dose, take two tablets the next day."
- "Take the medication with food to enhance absorption."
- "Expect to see a full effect from this dose within 24 hours."
- "Take this medication on an empty stomach, preferably before breakfast." (correct)
Which adverse effect is most closely associated with excessive doses of levothyroxine?
Which adverse effect is most closely associated with excessive doses of levothyroxine?
- Weight gain
- Bradycardia
- Cardiac dysrhythmias (correct)
- Lethargy
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What should the nurse teach the patient to immediately report to the health care provider?
A patient with hyperthyroidism is prescribed propylthiouracil (PTU). What should the nurse teach the patient to immediately report to the health care provider?
A patient is receiving antithyroid medication for hyperthyroidism. Which dietary instruction should the nurse include in the patient's teaching?
A patient is receiving antithyroid medication for hyperthyroidism. Which dietary instruction should the nurse include in the patient's teaching?
What is the expected outcome of radioactive iodine therapy in a patient with hyperthyroidism?
What is the expected outcome of radioactive iodine therapy in a patient with hyperthyroidism?
A patient undergoing thyroid hormone replacement therapy reports feeling nervous and having palpitations. Which nursing action is most appropriate?
A patient undergoing thyroid hormone replacement therapy reports feeling nervous and having palpitations. Which nursing action is most appropriate?
When administering levothyroxine to an elderly patient, which of the following considerations is most important for the nurse?
When administering levothyroxine to an elderly patient, which of the following considerations is most important for the nurse?
A patient with hypothyroidism also has a history of cardiovascular disease. What is the rationale for initiating thyroid replacement therapy at a low dosage?
A patient with hypothyroidism also has a history of cardiovascular disease. What is the rationale for initiating thyroid replacement therapy at a low dosage?
Which statement accurately describes the action of thioamide derivatives, such as methimazole, in treating hyperthyroidism?
Which statement accurately describes the action of thioamide derivatives, such as methimazole, in treating hyperthyroidism?
A patient taking levothyroxine reports concurrent use of calcium carbonate for osteoporosis. What adjustment to the medication regimen may be necessary?
A patient taking levothyroxine reports concurrent use of calcium carbonate for osteoporosis. What adjustment to the medication regimen may be necessary?
Which assessment parameter is most important for the nurse to monitor in a patient recently started on antithyroid medication?
Which assessment parameter is most important for the nurse to monitor in a patient recently started on antithyroid medication?
A patient with a known allergy to gluten is prescribed a thyroid replacement medication. What additional action should the nurse take?
A patient with a known allergy to gluten is prescribed a thyroid replacement medication. What additional action should the nurse take?
What mechanism explains how thyroid hormones influence the cardiovascular system?
What mechanism explains how thyroid hormones influence the cardiovascular system?
In a patient with hypothyroidism, what is the expected effect of thyroid hormone replacement on lipid and carbohydrate metabolism?
In a patient with hypothyroidism, what is the expected effect of thyroid hormone replacement on lipid and carbohydrate metabolism?
A patient who has been taking levothyroxine for several years reports feeling well but admits to occasionally skipping doses. What potential long-term consequence should the nurse discuss with the patient?
A patient who has been taking levothyroxine for several years reports feeling well but admits to occasionally skipping doses. What potential long-term consequence should the nurse discuss with the patient?
Which strategy is most appropriate to minimize the fluctuations in thyroid hormone levels for a patient on thyroid replacement therapy?
Which strategy is most appropriate to minimize the fluctuations in thyroid hormone levels for a patient on thyroid replacement therapy?
A patient prescribed methimazole (Tapazole) for hyperthyroidism develops a rash. What is the most appropriate initial nursing action?
A patient prescribed methimazole (Tapazole) for hyperthyroidism develops a rash. What is the most appropriate initial nursing action?
A patient with type 1 diabetes mellitus is ordered a 10 units of regular insulin via subcutaneous injection. When should the nurse administer this medication in relation to mealtimes?
A patient with type 1 diabetes mellitus is ordered a 10 units of regular insulin via subcutaneous injection. When should the nurse administer this medication in relation to mealtimes?
A patient receives 5 units of lispro (Humalog) insulin subcutaneously at 0730. At what time should the nurse instruct the patient to eat?
A patient receives 5 units of lispro (Humalog) insulin subcutaneously at 0730. At what time should the nurse instruct the patient to eat?
What specific physiological process is primarily targeted by metformin in the management of type 2 diabetes mellitus?
What specific physiological process is primarily targeted by metformin in the management of type 2 diabetes mellitus?
A patient taking metformin is scheduled for a CT scan with contrast dye. Which instruction is most critical for the nurse to communicate to the patient?
A patient taking metformin is scheduled for a CT scan with contrast dye. Which instruction is most critical for the nurse to communicate to the patient?
A patient with type 2 diabetes mellitus is prescribed glipizide. What mechanism of action does this oral antidiabetic agent primarily utilize to achieve glycemic control?
A patient with type 2 diabetes mellitus is prescribed glipizide. What mechanism of action does this oral antidiabetic agent primarily utilize to achieve glycemic control?
Which adverse effect is a primary concern for patients initiating therapy with sulfonylureas, such as glipizide?
Which adverse effect is a primary concern for patients initiating therapy with sulfonylureas, such as glipizide?
A patient newly diagnosed with type 2 diabetes is prescribed repaglinide. When should the nurse instruct the patient to take this medication?
A patient newly diagnosed with type 2 diabetes is prescribed repaglinide. When should the nurse instruct the patient to take this medication?
Which statement accurately describes the mechanism of action of thiazolidinediones (TZDs) like pioglitazone in treating type 2 diabetes mellitus?
Which statement accurately describes the mechanism of action of thiazolidinediones (TZDs) like pioglitazone in treating type 2 diabetes mellitus?
A patient with type 2 diabetes mellitus and heart failure asks if pioglitazone is a good choice to treat their diabetes. What is the most appropriate response by the nurse?
A patient with type 2 diabetes mellitus and heart failure asks if pioglitazone is a good choice to treat their diabetes. What is the most appropriate response by the nurse?
What is the primary mechanism through which dipeptidyl peptidase-4 (DPP-4) inhibitors, such as sitagliptin, improve glycemic control in type 2 diabetes melitus?
What is the primary mechanism through which dipeptidyl peptidase-4 (DPP-4) inhibitors, such as sitagliptin, improve glycemic control in type 2 diabetes melitus?
Which instruction is most important for the nurse to provide to a patient who is prescribed a sodium-glucose cotransporter-2 (SGLT2) inhibitor, such as canagliflozin?
Which instruction is most important for the nurse to provide to a patient who is prescribed a sodium-glucose cotransporter-2 (SGLT2) inhibitor, such as canagliflozin?
How do amylin agonists, such as pramlintide, assist in managing postprandial hyperglycemia in patients with diabetes mellitus?
How do amylin agonists, such as pramlintide, assist in managing postprandial hyperglycemia in patients with diabetes mellitus?
Which action should the nurse prioritize when caring for a patient experiencing severe hypoglycemia?
Which action should the nurse prioritize when caring for a patient experiencing severe hypoglycemia?
A patient taking insulin reports experiencing the Somogyi effect. How should the nurse advise the patient to address this phenomenon?
A patient taking insulin reports experiencing the Somogyi effect. How should the nurse advise the patient to address this phenomenon?
A patient with a history of cardiovascular disease is newly diagnosed with type 2 diabetes mellitus. Which oral antidiabetic medication might be considered the safest initial choice, considering its cardiovascular effects?
A patient with a history of cardiovascular disease is newly diagnosed with type 2 diabetes mellitus. Which oral antidiabetic medication might be considered the safest initial choice, considering its cardiovascular effects?
A patient with type 1 diabetes mellitus develops a cold and reports difficulty maintaining stable blood glucose levels. What adjustment to the insulin regimen should the nurse anticipate or advise?
A patient with type 1 diabetes mellitus develops a cold and reports difficulty maintaining stable blood glucose levels. What adjustment to the insulin regimen should the nurse anticipate or advise?
Which action should the nurse implement to minimize the risk of lipohypertrophy in patients who receive repeated subcutaneous insulin injections?
Which action should the nurse implement to minimize the risk of lipohypertrophy in patients who receive repeated subcutaneous insulin injections?
A patient with a hemoglobin A1c (HbA1c) level of 9% is prescribed lifestyle and dietary modifications, as well as metformin. What additional intervention might be considered if the HbA1c goal is not achieved within 3 to 6 months?
A patient with a hemoglobin A1c (HbA1c) level of 9% is prescribed lifestyle and dietary modifications, as well as metformin. What additional intervention might be considered if the HbA1c goal is not achieved within 3 to 6 months?
In a patient with primary hypothyroidism, which pathophysiological mechanism is the primary cause of the condition?
In a patient with primary hypothyroidism, which pathophysiological mechanism is the primary cause of the condition?
A patient with tertiary hypothyroidism would exhibit which specific hormonal imbalance?
A patient with tertiary hypothyroidism would exhibit which specific hormonal imbalance?
Which clinical manifestation would be most indicative of myxedema in a patient with long-standing hypothyroidism?
Which clinical manifestation would be most indicative of myxedema in a patient with long-standing hypothyroidism?
What is the rationale behind advising patients to avoid switching levothyroxine brands?
What is the rationale behind advising patients to avoid switching levothyroxine brands?
Which adverse effect is most likely to develop in an elderly patient who is aggressively treated with levothyroxine?
Which adverse effect is most likely to develop in an elderly patient who is aggressively treated with levothyroxine?
What pre-existing condition would necessitate the most cautious approach when initiating thyroid hormone replacement therapy?
What pre-existing condition would necessitate the most cautious approach when initiating thyroid hormone replacement therapy?
Why is it important to monitor for concurrent use of medications like calcium carbonate in patients on levothyroxine?
Why is it important to monitor for concurrent use of medications like calcium carbonate in patients on levothyroxine?
A patient on antithyroid medication presents with a sore throat and fever. What is the most appropriate initial action?
A patient on antithyroid medication presents with a sore throat and fever. What is the most appropriate initial action?
Which dietary instruction is most crucial for a patient taking antithyroid medication?
Which dietary instruction is most crucial for a patient taking antithyroid medication?
What is the primary concern with using thioamide derivatives, such as methimazole, during the first trimester of pregnancy?
What is the primary concern with using thioamide derivatives, such as methimazole, during the first trimester of pregnancy?
How does severe hyperthyroidism impact the cardiovascular system, leading to potential complications?
How does severe hyperthyroidism impact the cardiovascular system, leading to potential complications?
In the management of type 1 diabetes, what is the rationale for using a combination of basal and bolus insulin?
In the management of type 1 diabetes, what is the rationale for using a combination of basal and bolus insulin?
A patient is prescribed both metformin and glipizide for type 2 diabetes. What is the primary rationale for this combination therapy?
A patient is prescribed both metformin and glipizide for type 2 diabetes. What is the primary rationale for this combination therapy?
In a patient with type 2 diabetes and established renal impairment, which class of oral antidiabetic agents should be used with extreme caution or avoided?
In a patient with type 2 diabetes and established renal impairment, which class of oral antidiabetic agents should be used with extreme caution or avoided?
What mechanism explains why thiazolidinediones (TZDs) are contraindicated in patients with heart failure?
What mechanism explains why thiazolidinediones (TZDs) are contraindicated in patients with heart failure?
What is the primary advantage of using dipeptidyl peptidase-4 (DPP-4) inhibitors over sulfonylureas in managing type 2 diabetes?
What is the primary advantage of using dipeptidyl peptidase-4 (DPP-4) inhibitors over sulfonylureas in managing type 2 diabetes?
How do sodium-glucose cotransporter-2 (SGLT2) inhibitors contribute to weight loss in patients with type 2 diabetes?
How do sodium-glucose cotransporter-2 (SGLT2) inhibitors contribute to weight loss in patients with type 2 diabetes?
What is the critical teaching point regarding the administration of amylin agonists, such as pramlintide, in relation to insulin?
What is the critical teaching point regarding the administration of amylin agonists, such as pramlintide, in relation to insulin?
Which of the following is the most appropriate initial treatment for a conscious patient experiencing mild hypoglycemia (glucose 3.5 mmol/L)?
Which of the following is the most appropriate initial treatment for a conscious patient experiencing mild hypoglycemia (glucose 3.5 mmol/L)?
What is the most important step to prevent lipohypertrophy in patients receiving subcutaneous insulin injections?
What is the most important step to prevent lipohypertrophy in patients receiving subcutaneous insulin injections?
Which long-term microvascular complication of diabetes is directly related to diminished peripheral circulation, often leading to foot ulcers and potential amputations?
Which long-term microvascular complication of diabetes is directly related to diminished peripheral circulation, often leading to foot ulcers and potential amputations?
What is the primary reason that a patient with diabetes might experience the Somogyi effect?
What is the primary reason that a patient with diabetes might experience the Somogyi effect?
A patient with type 1 diabetes and a recent diagnosis of celiac disease may require what modification to their insulin regimen?
A patient with type 1 diabetes and a recent diagnosis of celiac disease may require what modification to their insulin regimen?
What is the rationale for a healthcare provider to order a glycosylated hemoglobin (HbA1c) test for a patient with diabetes?
What is the rationale for a healthcare provider to order a glycosylated hemoglobin (HbA1c) test for a patient with diabetes?
A patient who is prescribed metformin reports abdominal bloating, nausea, and cramping. What intervention should the nurse suggest to manage these side effects?
A patient who is prescribed metformin reports abdominal bloating, nausea, and cramping. What intervention should the nurse suggest to manage these side effects?
A patient with type 2 diabetes who is prescribed glipizide consistently skips meals. What potential adverse effect is the patient at higher risk for?
A patient with type 2 diabetes who is prescribed glipizide consistently skips meals. What potential adverse effect is the patient at higher risk for?
Which instruction is most appropriate for the nurse to provide to a patient who is prescribed acarbose?
Which instruction is most appropriate for the nurse to provide to a patient who is prescribed acarbose?
For a diabetic patient taking insulin who plans to start a new exercise program, what adjustment may be necessary to prevent hypoglycemia?
For a diabetic patient taking insulin who plans to start a new exercise program, what adjustment may be necessary to prevent hypoglycemia?
A patient with type 2 diabetes who is taking an oral antidiabetic medication develops a severe upper respiratory infection. What adjustment to their medication regimen might be required?
A patient with type 2 diabetes who is taking an oral antidiabetic medication develops a severe upper respiratory infection. What adjustment to their medication regimen might be required?
How can a nurse best educate a patient on the prevention and management of hypoglycemia while taking insulin?
How can a nurse best educate a patient on the prevention and management of hypoglycemia while taking insulin?
When mixing regular and NPH insulin in the same syringe, why is it essential to draw up the regular insulin first?
When mixing regular and NPH insulin in the same syringe, why is it essential to draw up the regular insulin first?
What is the most crucial assessment for a nurse to perform before administering a dose of insulin to a patient with diabetes?
What is the most crucial assessment for a nurse to perform before administering a dose of insulin to a patient with diabetes?
A patient with diabetes is scheduled for a surgical procedure requiring them to be NPO (nothing by mouth). What adjustment to their antidiabetic medication regimen should the nurse anticipate?
A patient with diabetes is scheduled for a surgical procedure requiring them to be NPO (nothing by mouth). What adjustment to their antidiabetic medication regimen should the nurse anticipate?
Which sign or symptom indicates the MOST immediate need for intervention in a patient with diabetes?
Which sign or symptom indicates the MOST immediate need for intervention in a patient with diabetes?
When caring for a patient receiving insulin therapy, what specific instruction should the nurse provide regarding the storage of insulin vials?
When caring for a patient receiving insulin therapy, what specific instruction should the nurse provide regarding the storage of insulin vials?
What is the most important nursing action to ensure accuracy when administering insulin?
What is the most important nursing action to ensure accuracy when administering insulin?
A patient with type 2 diabetes is prescribed an injectable incretin mimetic (GLP-1 receptor agonist). Which statement accurately describes the action of these medications?
A patient with type 2 diabetes is prescribed an injectable incretin mimetic (GLP-1 receptor agonist). Which statement accurately describes the action of these medications?
What should a nurse prioritize when providing education to a patient newly diagnosed with diabetes?
What should a nurse prioritize when providing education to a patient newly diagnosed with diabetes?
In patients taking thyroid replacement drugs, which laboratory value should a nurse prioritize monitoring to ensure appropriate therapeutic response and avoid adverse effects?
In patients taking thyroid replacement drugs, which laboratory value should a nurse prioritize monitoring to ensure appropriate therapeutic response and avoid adverse effects?
A patient with primary hypothyroidism is prescribed levothyroxine. Which statement best describes the underlying cause the medication addresses?
A patient with primary hypothyroidism is prescribed levothyroxine. Which statement best describes the underlying cause the medication addresses?
A patient with tertiary hypothyroidism is under your care. How would you describe the hormonal imbalances to another healthcare worker?
A patient with tertiary hypothyroidism is under your care. How would you describe the hormonal imbalances to another healthcare worker?
Which clinical manifestation is most indicative of myxedema in a patient with long-standing uncontrolled hypothyroidism?
Which clinical manifestation is most indicative of myxedema in a patient with long-standing uncontrolled hypothyroidism?
What is the physiological rational for advising patients to maintain the same brand of levothyroxine whenever possible?
What is the physiological rational for advising patients to maintain the same brand of levothyroxine whenever possible?
Which of the following adverse effects is most concerning in an elderly patient who is aggressively treated with levothyroxine?
Which of the following adverse effects is most concerning in an elderly patient who is aggressively treated with levothyroxine?
What pre-existing condition would require the most cautious and gradual approach when initiating thyroid hormone replacement therapy in a patient with hypothyroidism?
What pre-existing condition would require the most cautious and gradual approach when initiating thyroid hormone replacement therapy in a patient with hypothyroidism?
Which statement best explains why it is important to inquire about concurrent use of medications like calcium carbonate in patients prescribed levothyroxine?
Which statement best explains why it is important to inquire about concurrent use of medications like calcium carbonate in patients prescribed levothyroxine?
A patient taking antithyroid medication exhibits signs of a sore throat and fever. What is the most appropriate and immediate initial nursing intervention?
A patient taking antithyroid medication exhibits signs of a sore throat and fever. What is the most appropriate and immediate initial nursing intervention?
When educating a client on antithyroid medication, which of the following dietary instructions has the highest priority?
When educating a client on antithyroid medication, which of the following dietary instructions has the highest priority?
What specific risk is associated with using thioamide derivatives, such as methimazole, during the first trimester of pregnancy?
What specific risk is associated with using thioamide derivatives, such as methimazole, during the first trimester of pregnancy?
How does severe hyperthyroidism primarily impact the cardiovascular system, potentially leading to which complication?
How does severe hyperthyroidism primarily impact the cardiovascular system, potentially leading to which complication?
In the management of type 1 diabetes, what is the primary rational for using a combination of basal and bolus insulin?
In the management of type 1 diabetes, what is the primary rational for using a combination of basal and bolus insulin?
A patient with type 2 diabetes and established renal impairment, which class of oral antidiabetic agents should be used with extreme caution or avoided due to the increased risk of lactic acidosis?
A patient with type 2 diabetes and established renal impairment, which class of oral antidiabetic agents should be used with extreme caution or avoided due to the increased risk of lactic acidosis?
What mechanism explains why thiazolidinediones (TZDs) are contraindicated or used with extreme caution in patients with heart failure?
What mechanism explains why thiazolidinediones (TZDs) are contraindicated or used with extreme caution in patients with heart failure?
What is the primary advantage of using dipeptidyl peptidase-4 (DPP-4) inhibitors over sulfonylureas in the management of type 2 diabetes?
What is the primary advantage of using dipeptidyl peptidase-4 (DPP-4) inhibitors over sulfonylureas in the management of type 2 diabetes?
Which of the following is the most appropriate immediate treatment for a conscious patient experiencing mild hypoglycemia (glucose 3.5 mmol/L)?
Which of the following is the most appropriate immediate treatment for a conscious patient experiencing mild hypoglycemia (glucose 3.5 mmol/L)?
Flashcards
Thyroid Gland Function
Thyroid Gland Function
The thyroid gland secretes thyroxine (T4), tri-iodothyronine (T3) and calcitonin, essential for metabolism regulation. It communicates with the parathyroid gland for calcium level maintenance. T4/T3 production needs iodide, acquired from diet.
Hypothyroidism Types
Hypothyroidism Types
Primary hypothyroidism is due to the thyroid gland itself. Secondary hypothyroidism arises from pituitary gland dysfunction. Tertiary hypothyroidism occurs when the hypothalamus fails to secrete thyrotropin-releasing hormone.
Congenital Hypothyroidism
Congenital Hypothyroidism
Congenital hypothyroidism results from hyposecretion of thyroid hormone during youth, leading to low metabolic rate, short stature, delayed sexual development and potential intellectual disabilities.
Myxedema Symptoms
Myxedema Symptoms
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Goiter Cause
Goiter Cause
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Hypothyroidism Symptoms
Hypothyroidism Symptoms
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Thyroid Replacement Meds
Thyroid Replacement Meds
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Euthyroid Goal
Euthyroid Goal
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Levothyroxine (T4)
Levothyroxine (T4)
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Thyroid Supplement Contraindications
Thyroid Supplement Contraindications
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Thyroid Supplement Adverse Effects
Thyroid Supplement Adverse Effects
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Causes of Hyperthyroidism
Causes of Hyperthyroidism
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Hyperthyroidism Treatment
Hyperthyroidism Treatment
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Anti-thyroid Drugs
Anti-thyroid Drugs
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Methimazole Use
Methimazole Use
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Thyroid Drugs: Nursing
Thyroid Drugs: Nursing
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Thyroid Medication Education
Thyroid Medication Education
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Anti-thyroid Drug Tips
Anti-thyroid Drug Tips
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Pancreas' Dual Role
Pancreas' Dual Role
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Hormone & Cell Source
Hormone & Cell Source
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Insulin's Role
Insulin's Role
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Insulin Deficiency
Insulin Deficiency
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Diabetes Diagnostic Criteria
Diabetes Diagnostic Criteria
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Type 1 Diabetes
Type 1 Diabetes
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Type 2 Diabetes
Type 2 Diabetes
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Diabetes Nonmedical Treatment
Diabetes Nonmedical Treatment
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Glycemic Goals
Glycemic Goals
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Insulins
Insulins
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Insulins: why is it Human?
Insulins: why is it Human?
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Insulin: Rapid-acting
Insulin: Rapid-acting
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Insulin: Short-Acting
Insulin: Short-Acting
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Insulin: Intermediate
Insulin: Intermediate
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Insulin: Long-Acting
Insulin: Long-Acting
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Scale Insulin Injection
Scale Insulin Injection
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Basal-Bolus
Basal-Bolus
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Injectable Anti-Diabetic Mechanism
Injectable Anti-Diabetic Mechanism
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Oral Antidiabetic Metformin
Oral Antidiabetic Metformin
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Oral Antidiabetic Mechanism
Oral Antidiabetic Mechanism
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Oral Anti-diabetic
Oral Anti-diabetic
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Sulfonylureas Effects
Sulfonylureas Effects
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Hypoglycemia
Hypoglycemia
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Elevating Glucose Mechanism
Elevating Glucose Mechanism
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Oral and Drug Effects
Oral and Drug Effects
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Monitor Therapeutic Response
Monitor Therapeutic Response
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Study Notes
Thyroid and Antithyroid Drugs
Thyroid Gland
- Secretes three essential hormones that regulate metabolism:
- Thyroxine (T4)
- Tri-iodothyronine (T3)
- Calcitonin
- Located near the parathyroid gland, with which it communicates
- The parathyroid gland maintains calcium levels in extracellular fluid by mobilizing calcium from bone
- Iodide, acquired through diet, assists in T4/T3 production
Thyroid Hormones
- Involved in numerous bodily processes
- Regulate basal metabolic rate, lipid, and carbohydrate metabolism
- Essential for normal growth and development
- Control the heat-regulating system in the brain
- Affect the cardiovascular, endocrine, and neuromuscular systems
- Hyperfunction or hypofunction has serious consequences
Hypothyroidism
- Body does not produce enough thyroid hormone
- Three classifications:
- Primary: Abnormality of the thyroid gland itself
- Secondary: The pituitary gland is dysfunctional and does not secrete thyroid-stimulating hormone (TSH)
- Tertiary: The hypothalamus gland does not secrete thyrotropin-releasing hormone, reducing TSH and thyroid hormone levels
Congenital Hypothyroidism
- Hyposecretion of thyroid hormone during youth results in:
- Low metabolic rate
- Short stature
- Severely delayed sexual development
- Possible intellectual disabilities
Myxedema
- Hyposecretion of thyroid hormone during adulthood results in:
- Decreased metabolic rate
- Loss of mental and physical stamina
- Weight gain
- Loss of hair
- Firm edema
- Yellow dullness of the skin
Goiter
- Enlargement of the thyroid gland
- Occurs due to overstimulation by elevated levels of TSH
- TSH is elevated because of little to no thyroid hormone in the circulation
Common Hypothyroidism Symptoms
- Cold intolerance
- Unintentional weight gain
- Depression
- Dry, brittle hair and nails
- Fatigue
Thyroid Replacement Drugs
- Offer a synthetic or natural version of the hormone
- levothyroxine (Synthroid®, Eltroxin®, Euthyrox®) is a synthetic T4 hormone
- liothyronine (Cytomel®) is a synthetic T3 hormone
- Desiccated thyroid (Thyroid®) is a natural thyroid hormone (T3 and T4)
Mechanism of Action for Thyroid Replacement Drugs
- Thyroid preparations replace what the thyroid gland cannot produce
- The goal is to achieve normal thyroid levels (euthyroid)
- Thyroid drugs function like endogenous thyroid hormones
- Animal-derived products yield results for some patients
levothyroxine sodium (T4)
- Most commonly prescribed
- Chemically pure
- More predictable
- Has a long half-life and is dosed once daily
- Dosed in micrograms (mcg); a common error is to prescribe in milligrams (mg), resulting in a 1000-fold overdose
Indications for Thyroid Replacement Drugs
- Replace what the thyroid gland itself cannot produce (levothyroxine) in order to achieve a euthyroid condition
- A diagnosis of suspected hyperthyroidism (thyroid-stimulating hormone–suppression test)
- Prevention or treatment of various types of goiters
- Replacement therapy for patients whose thyroid glands have been surgically removed or destroyed by radioactive iodine
- Hypothyroidism of pregnancy
Contraindications for Thyroid Replacement Drugs
- Known allergy
- Recent MI
- Adrenal Insufficiency
- Hyperthyroidism
- Gluten allergy
Adverse Effects of Thyroid Replacement Drugs
- Cardiac dysrhythmia is the most significant adverse effect
- May also cause tachycardia, palpitations, angina, dysrhythmias, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, cramps, menstrual irregularities, weight loss, sweating, heat intolerance, and fever
Hyperthyroidism
- Production of excessive thyroid hormones
- Caused by several diseases:
- Graves’ disease
- Multinodular disease
- Plummer’s disease (rare), also called toxic nodular disease
- Thyroid storm (induced by stress or infection) is severe and potentially life threatening
Hyperthyroidism Symptoms
- Affects multiple body systems
- Increased metabolism leading to diarrhea, flushing, increased appetite, muscle weakness, sleep disorders, altered menstrual flow, fatigue, palpitations, nervousness, heat intolerance, and irritability
Treatment of Hyperthyroidism
- Radioactive iodine (I131) destroys the thyroid gland, referred to as ablation
- Surgery to remove all or part of the thyroid gland, and lifelong thyroid hormone replacement will be needed
Hyperthyroidism Drug Treatment
- Used to prevent the surge in thyroid hormones that occurs after surgical treatment or radioactive iodine treatment
- May cause liver and bone marrow toxicity
- Antithyroid drugs: thioamide derivatives of thiamazole (Tapazole®) and propylthiouracil
- Radioactive iodine (iodine 131)
- Potassium iodine
methimazole
- A thioamide antithyroid drug
- Symptoms may take approximately 6 weeks of therapy before improving
- Only in oral form
- Thiamazole is the only alternative drug in this class and is rarely used clinically
Pharmacokinetic Nursing Implications for Thyroid Replacement Drugs
- Nurses need to understand the pharmacokinetics of thyroid replacement drugs
- Levothyroxine (Eltroxin®, Synthroid®) has an onset of action of 3-5 days
- Peak plasma concentrations are within 3-4 days, with an elimination half-life of 6-10 days, and a duration of action of 1-3 weeks
- Levothyroxine has a narrow therapeutic margin
- Prolonged half-life increases the risk of toxicity manifested as weight loss, tachycardia, nervousness, tremors, hypertension, headache, insomnia, menstrual irregularities, and cardiac irregularities or palpitations
- Clinical and laboratory evaluations are recommended at 6- to 8-week intervals or 2- to 3-week intervals in patients who have severe hypothyroidism, adjust dosage
Additional Pharmacokinetic Nursing Implications
- Adjust until the serum TSH concentration normalizes
- Once stable, annual evaluations are recommended
- Highly protein bound drugs remain in the body longer, with greater risk for toxicity
- Consumption of foods such as soybean flour, cottonseed meal, walnuts, calcium, dietary fiber may decrease the absorption of levothyroxine sodium from the GI tract, necessitating adjustments in dosing
General Nursing Implications for Thyroid and Antithyroid medications
- Assess for drug allergies, contraindications, and potential drug interactions
- Obtain baseline vital signs and weight
- Use with caution for those with cardiac disease or hypertension, as well as for pregnant women
- During pregnancy, treatment for hypothyroidism should continue
- If maternal hypothyroidism is untreated during pregnancy fetal growth may be retarded, thus adjust dosage every 4 weeks to keep thyroid-stimulating hormone at the lower end of the normal range
- Teach patients to take thyroid drugs once daily in the morning to decrease likelihood of insomnia
- Avoid switching brands without primary care provider approval
- Report any unusual symptoms, chest pain, or heart palpitations, as well as avoid taking over-the-counter or herbal remedies without primary care provider approval
- Therapeutic effects may take several weeks to occur
- Alert health care providers of thyroid medication use
- Thyroid replacement drugs may enhance activity of anticoagulants
- Patients with diabetes may need increased dosages of hypoglycemic medications
- May decrease serum digoxin levels
- Antithyroid medications are better tolerated with food, give at the same time each day to maintain consistent blood levels, and never stop these medications abruptly
- Avoid foods high in iodine (seafood, soy sauce, tofu, iodized salt)
Monitoring Medication Effectiveness
- Thyroid drugs: decreased symptoms of hypothyroidism, improved energy levels, mental and physical stamina
- Antithyroid drugs: no evidence of hyperthyroidism
- Watch for and monitor adverse effects such as cardiac dysrhythmia with thyroid drugs
- Watch for leukopenia, manifested as fever, sore throat, and/ or lesions, with antithyroid drugs
Antidiabetic Drugs
Pancreas
- Exocrine gland, secreting digestive enzymes through the pancreatic duct
- Produces insulin and glucose
- Stores excess glucose as glycogen in liver and skeletal muscle tissue
- Also stored in adipose tissue as fat
- Excess glucose gets converted back through glycogenolysis
- Glucagon is released from the α-cells of the islets of Langerhans
- Insulin is secreted from the β-cells of the islets
- Insulin is a protein hormone composed of two amino acid chains (acidic A chain and basic B chain) joined by a disulfide linkage
- A continuous homeostatic balance exists in the body between the actions of insulin and glucagon
- Plasma glucose levels range between 4 and 6 mmol/L
Insulin
- Has important metabolic functions in the body and stimulates carbohydrate metabolism in skeletal and cardiac muscle and in adipose tissue
- Facilitates the transport of glucose into these cells
- Facilitates the phosphorylation of glucose to glucose-6-phosphate in the liver, which is then converted to glycogen for storage
- Glucose is stored in the liver as glycogen, and insulin keeps the kidneys free of glucose
- Without insulin, blood glucose levels rise
- Kidneys unable to reabsorb excess glucose, excrete glucose (critical body nutrient and energy source), ketones, and other solutes in urine
- Loss of nutrient energy sources leads to polyphagia, weight loss, and malnutrition
- Presence of solutes in the distal kidney tubules and collecting ducts also draws water into the urine through osmotic diuresis, which leads to polyuria, polydipsia, and dehydration
- Classic manifestations of type 1 diabetes
- Has a direct effect on fat metabolism, stimulating lipogenesis and inhibiting lipolysis, as well as the release of fatty acids from adipose cells
- Stimulates protein synthesis and promotes the intracellular shift of potassium and magnesium into the cells, temporarily decreasing elevated blood concentrations of these electrolytes
Diabetes
- First recognized in 1550 BCE
- Egyptians wrote of a malady called honeyed urine
- Insulin isolated in 1920s in Toronto, Ontario, by Nobel Prize winners Frederick Banting and Charles Best
- One of the greatest triumphs of 20th-century medicine
- Its use in the treatment of diabetes has proved life-saving for people affected by the disease, but is often characterized as a syndrome, rather than disease
- 11 million Canadians have diabetes or prediabetes
- Two main forms:
- Type 1
- Type 2
Diabetes Signs and Symptoms
- Elevated fasting blood glucose (higher than 7 mmol/L)
- Hemoglobin A1c (HbA1c) level greater than or equal to 6.5% and or signs such as polyuria, polydipsia, polyphagia, glycosuria, weight loss, fatigue, and blurred vision
Type 1 Diabetes
- Lack of insulin production or defective insulin
- Affected patients need exogenous insulin
- Fewer than 10% of all cases are type 1
- Complications include diabetic ketoacidosis and hyperosmolar hyperglycemic state
Type 2 Diabetes
- Most common type (90% of all cases)
- Caused by insulin deficiency and insulin resistance in many tissues:
- Reduced number of insulin receptors
- Insulin receptors less responsive
- Several comorbid conditions occur more often with Type 2, including obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminemia (protein in the urine), and increased risk for thrombotic (blood clotting) events
- Comorbidities are collectively referred to as metabolic syndrome or cardiometabolic syndrome
Gestational Diabetes
- Hyperglycemia that develops during pregnancy and insulin needs to be given to prevent birth defects
- It usually subsides after delivery
- 30% of patients may develop type 2 diabetes within 10 to 15 years
Long-Term Complications of Both Types of Diabetes
- Macrovascular, including coronary arteries, cerebral arteries, and peripheral vessels
- Microvascular, including retinopathy, neuropathy, and nephropathy
Screening for Diabetes
- Prediabetes is categorized by an increased risk that includes a Hemoglobin A1c of 6.0 to 6.4%, a fasting plasma glucose levels higher than or equal to 6.1 mmol/L but less than 6.9 mmol/L, and an impaired glucose tolerance test (oral glucose challenge)
- Screening recommended every 3 years for all patients 40 years of age and older
Nonpharmacological Interventions
- Type 1 always requires insulin therapy
- Type 2 includes weight loss, improved dietary habits, smoking cessation,reduced alcohol consumption, and regular physical exercise
Glycemic Goals of Treatment
- HbA1c of less than 7%
- Fasting blood glucose goal 4 to 7 mmol/L
- 2-hour postprandial target of 5 to 10 mmol/L'
Treatment for Diabetes
- Type 1 requires insulin therapy
- Type 2 includes lifestyle changes, with oral drug therapy
- Use insulin when the above no longer provide glycemic control
Types of Antidiabetic Drugs
- Insulins
- Oral hypoglycemic drugs
- A combination of oral antihypoglycemic and insulin controls glucose levels
- Some new injectable hypoglycemic drugs may be used in addition to insulin or antidiabetic drugs
Insulins Function
- Function as a substitute for the endogenous hormone, with the same effects as normal endogenous insulin
- Restores the diabetic patient’s ability to: metabolize carbohydrates, fats, and proteins, as well as the ability to store glucose in the liver, and convert glycogen to fat stores
- Human insulin is now derived using recombinant deoxyribonucleic acid (DNA) technologies and is produced by bacteria and yeast
- The goal is to provide tight glucose control and reduce the incidence of long-term complications
Rapid Acting Insulin
- Given for treatment for types 1 and 2 diabetes, with a Most rapid onset of action (10 to 15 minutes) Peak: 1 to 2 hours
- Duration: 3 to 5 hours
- Patient must eat a meal after injection
- Insulin lispro (Humalog®)is similar action to that of endogenous insulin
- Insulin aspart (NovoRapid®)
- Insulin glulisine (Apidra®)
- May be given subcutaneously or via continuous subcutaneous infusion pump, but not intravenously
Short-Acting Insulins
- Include regular insulin (Humulin R®, Novolin ge Toronto®)
- Routes of administration: intravenous (IV) bolus, IV infusion, intramuscular, and subcutaneous
- Onset (subcutaneous route): 30 minutes
- Peak (subcutaneous route): 2 to 3 hours
- Duration (subcutaneous route): 6.5 hours
Intermediate-Acting Insulins
- Insulin isophane suspension (also called NPH)
- Cloudy appearance and is often combined with regular insulin
- Subcutaneous route yields:
- Onset: 1 to 3 hours
- Peak: 5 to 8 hours
- Duration: up to 18 hours
Long-Acting Insulins
- Including Insulin glargine (Lantus®)
- Clear, colourless solution and is a constant level of insulin in the body when taken Subcutaneously
- Usually dosed once daily, but Can be dosed every 12 hours
- Referred to as basal insulin
- With Subcutaneous route:
- Onset: 90 minutes
- Peak: none
- Duration: 24 hours
Fixed-Combination Insulins
- Contains two different insulins in set ratios including:
- Humulin 30/70
- Novolin 30/70, 40/60, 50/50
- NovoMix® 30
- Humalog Mix25®
- Humalog Mix50®
Fixed-Combination Makeup
- One intermediate-acting type
- Either one rapid-acting type (Humalog, NovoLog) or one short-acting type (Humulin)
Sliding-Scale Insulin Dosing
- Subcutaneous rapid-acting (lispro or aspart) or short-acting (regular) insulins-adjusted according to blood glucose test results
- Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings with differing scale ranges for Soluble insulin and If infection or insulin resistance
- Subcutaneous is ordered in an amount that increases as the blood glucose increases
- Delays insulin administration until hyperglycemia occurs, resulting in large swings in glucose control
- Recent research does not support sliding-scale use, but is still commonly used
Basal-Bolus Insulin Dosing
- Preferred method of treatment for hospitalized patients with diabetes Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus
- Basal insulin is a long-acting insulin (insulin glargine)
- Bolus insulin (insulin lispro or insulin aspart)
Injectable Antidiabetic Drugs Mechanisms
- Amylin agonists mimic the natural hormone amylin, which slows gastric emptying, while increasing satiety, and suppresses glucagon secretion to reduce hepatic glucose output
- Used when other drugs have not achieved adequate glucose control, and administered via Subcutaneous injection
- Incretin mimetics mimic the incretin hormones, that enhances glucose-driven insulin secretion from β, which will be used only for type 2 diabetes. Example injectable is: Exenatide administered via an injection pen device
Adverse Effects of Injectables
- Amylin agonists can cause Nausea, vomiting, anorexia, headache
- Incretin mimetics can causeNausea, vomiting, and diarrhea, in addition to Rare cases of hemorrhagic or necrotizing pancreatitis, or Weight loss
Hypoglycemia
- Abnormally low blood glucose level (below 4 mmol/L) for which Mild cases can be treated with diet—higher intake of protein and lower intake of carbohydrates—to prevent rebound postprandial hypoglycemia
Symptoms of Hypoglycemia
- Adrenergic signs including Anxiety, tremors, sensation of hunger, palpitations, and sweating
- Central nervous system:Difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness, and headache
- Late stage Hypothermia, seizures, and eventually Coma and death if left untreated
Glucose-Elevating Drugs
- Include Oral forms of concentrated glucose, with Gel, liquid, or tablets, in addition to 50% dextrose in water (D50W) and Glucagon.
Oral Antidiabetic Drugs
- Are used for type 2 diabetes with effective treatment involving several elements such as lifestyle changes, monitoring of blood glucose levels, therapy with one or more drugs, as well as treatment of associated comorbid conditions (high cholesterol and high blood pressure)
- The 2013 Canadian guidelines recommended New-onset type 2 treatments include Lifestyle interventions
- The Lifestyle modifications and the maximum tolerated metformin dose that do not achieve the recommended A1c goals after 3 to 6 months should be augmented with additional treatment via -4) inhibitors and glucagonlike peptide 1 (GLP-1) receptor agonists
Biguanides
- Include metformin (Glucophage)
- First-line drug and the most commonly used oral medication for the treatment of type 2 diabetes
- not used for type 1 diabetes
- Mechanism of actioninhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin Contraindications:
- not used with patients with kidney disease, alcoholism, metabolic acidosis, liver disease, or heart failure and should be used with caution if the patient has Lactic acidosis, or needs Caution with contrast dye when being administered
- Adverse effects: Nausea, cramping, a feeling of fullness, and diarrhea , metallic taste, hypoglycemia, and a reduction in vitamin are are effects
Sulfonylureas
- Oldest group of oral antihyperglycemic drugs, second-generation drugs that have better potency and adverse effect profiles compared to drugs
- Mechanism of action: Sulfonylureas bind to on β-cells in the pancreas to stimulate the release of and in addition, sulfonylureas appear to secondarily decrease the secretion of
- These drugs are best with the early stages of type 2 diabetes and are not in diabetes
- The common adverse effect : degree depends eating liver or kidney disease, and or
- Adverse Effects of the Sulfonylureas Weight as result of the , and as result of adverse such as
Glinides
- repaglinide (GlucoNorm®), nateglinide (Starlix®)
- Indication: type 2 diabetes
- Mechanism of actionincrease from they also have has a much each the 4 inhibitors, benzoate hydrochloride
Thiazolidinediones (Glitazones)
- The third major drug category
- Mechanism of Action regulates genes involved in glucose and lipid metabolism
- known as known as insulin-sensitizing, enhancing the sensitivity of directly glucose storage
- Some, are to that with
Sodium Glucose Cotransporter 2
- decreases which increase this of the diabetes
- canaglifozin Dapaglifozin Action is insulin dependent to of for with effects and a reduced
Oral Diabetes Nursing Implications
- Patients must have a thorough assessment before administration
- History:A thorough history
- Vital: Vital signs
- Check:Levels with to document: Potential Interactions and Complications
- It is essential all
- Assess the ability Assess
Care Considerations
- A nurse should be conscious with medication use, paying attention signs and symptoms (hypoglycemia,
- Keep concerns a
- Education:Thorough is for self ,
- With: Ensure: Dosage and Route Check
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