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Questions and Answers
What is one primary use of thyroid hormones?
Which symptom is NOT an adverse reaction associated with thyroid replacement medications?
What should be monitored to assess the therapeutic response to thyroid replacement medications?
Which condition is a contraindication for the use of thyroid replacement medications?
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What is a common thyroid replacement medication?
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For effective absorption, when should thyroid replacement medications be taken?
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In which situation might insulin be used in non-diabetic patients?
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What is a key effect of insulin on the body?
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Which type of insulin can be given intravenously?
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What is a common adverse effect associated with Sulfonylureas?
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When should short-acting insulins such as Insulin Lispro or Insulin Aspart be administered?
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What is the primary intervention for hypoglycemia?
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Which medication should not be taken for 48 hours after a CT scan with IV contrast?
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What symptom is typically associated with hyperglycemia?
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Which type of oral hypoglycemic medication is known to cause flatulence?
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What is an appropriate route of administration for long-acting insulin?
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What should a diabetic patient do if they miss a dose of meglitinides?
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What is a key patient education point regarding insulin therapy?
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What effect do thyroid hormones primarily have on metabolic activity?
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Which of the following is a potential adverse reaction to thyroid hormone replacement therapy?
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Why should thyroid hormone replacement medication be administered on an empty stomach?
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What is the time frame in which patients might first notice therapeutic effects from thyroid hormone replacement?
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Which of the following symptoms characterize diabetes mellitus?
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Which type of insulin has an onset of 1.5 hours?
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What is a major reason for not changing brands of thyroid medication without consulting a doctor?
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Which type of diabetes primarily requires insulin for management?
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How does insulin affect the storage of fat in the body?
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What should a patient monitor weekly while on thyroid hormone replacement therapy?
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What is the recommended action when mixing different types of insulin?
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Which insulin type is typically administered once a day?
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What should a patient do immediately after experiencing symptoms of hypoglycemia?
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What is a common symptom of hyperglycemia?
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Which medication should be held for 48 hours prior to a CT scan with contrast?
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What adverse effect is commonly associated with Sulfonylureas?
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Which type of insulin should be given just before a meal?
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What is a recommended nursing intervention for hypoglycemia?
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How should oral hypoglycemics be taken to ensure optimal effectiveness?
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Which condition can result from repeated insulin injections at the same site?
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Study Notes
Thyroid Replacement Medications
- Thyroid hormones are used to treat hypothyroidism and thyroid cancer.
- They increase the metabolic rate of tissues, which means they increase the rate at which cells produce energy.
- Adverse reactions include palpitations, tachycardia, nervousness, insomnia, weight loss, sweating, and flushing.
- These reactions can be remembered by thinking of someone who exercises 24 hours a day.
- Contraindications include thyrotoxicosis (high thyroid hormone levels) and myocardial infarction (heart attack).
- Thyroid replacement medications should be taken on an empty stomach first thing in the morning, at least 30 minutes before eating.
- Monitor for therapeutic response, which includes:
- Weight loss
- Diuresis (increased urination)
- Increased appetite
- Decreased puffiness in the face, hands, and feet
- Improved sense of well-being
- Patient education:
- Do not change brands of thyroid hormone without consulting a doctor.
- Do not increase, skip, or decrease the dose.
- Weigh weekly to monitor weight stability.
- Follow up with a doctor for regular lab work.
- Therapeutic effects may take 1-2 weeks to appear.
- Common thyroid replacement medications include Synthroid (levothyroxine) and Cytomel.
Insulin
- Insulin is a hormone that is essential for glucose to enter cells.
- It acts like a key that opens the door for glucose to enter muscle cells and fat cells.
- Insulin also promotes protein synthesis and helps the body store fat.
- Uses for insulin include:
- Type 1 diabetes: Individuals with type 1 diabetes cannot produce insulin.
- Type 2 diabetes: Insulin may be used if diet and oral anti-hyperglycemic medications are ineffective.
- Hyperkalemia: Insulin, in conjunction with glucose, can be used to treat high potassium levels.
- Diabetic ketoacidosis (DKA): Regular insulin can be used to treat severe DKA.
- Diabetes Mellitus (DM):
- Three P's of DM: Polyuria, Polydipsia, Polyphasia
- Polyuria: Increased urination due to high blood sugar levels.
- Polydipsia: Increased thirst to dilute the sugar in the urine.
- Polyphasia: Increased hunger due to the inability of cells to use glucose for energy.
- Three P's of DM: Polyuria, Polydipsia, Polyphasia
- Insulin Types:
- Short-Acting:
- Regular Insulin (Humulin R, Novolin R)
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Intermediate-Acting:
- Humulin N (Novolin N)
- Long-Acting:
- Insulin Glargine (Lantus)
- Insulin Detemir (Levemir)
- Combination Insulin:
- Humulin 70/30
- Novolin 70/30
- Short-Acting:
- Important Notes on Insulin:
- Regular insulin is the only type that can be given intravenously.
- Insulin Glargine (Lantus) cannot be mixed with other insulin types.
- Insulin Administration:
- Regular Insulin: Usually given within 30 minutes of a meal.
- Short-acting Insulin (Lispro, Aspart): Must be given before meals.
- Intermediate-Acting Insulin: Typically given in two doses (morning and afternoon) and should be accompanied by meals.
- Long-Acting Insulin: Given once a day, usually at bedtime.
- Hypoglycemia:
- Causes: Not enough food for insulin dose, too much insulin, incorrect insulin dose, exercise, illness.
- Symptoms: Sudden onset, blood glucose < 60 mg/dL, fatigue, weakness, nervousness, confusion, seizures, hunger, nausea, pale, moist, and cool skin, numbness of lips and tongue.
- Hyperglycemia:
- Causes: High blood sugar levels.
- Symptoms: Slow onset, blood glucose > 200 mg/dL, drowsiness, deep rapid respirations, thirst, nausea and vomiting, loss of appetite, dry, flushed, and warm skin, acetone breath, excessive urination.
- Hypoglycemia Interventions:
- Give quick-acting glucose (sugar, orange juice).
- Follow with a complex carbohydrate and protein (peanut butter sandwich, cheese and crackers).
- Hyperglycemia Interventions:
- Administer insulin as ordered.
- May include regular insulin or insulin infusion.
- May include normal saline infusion at a rapid rate to dilute glucose.
- Insulin Administration Interventions:
- Only regular insulin can be given intravenously.
- Use an insulin syringe and rotate injection sites.
- Give rapid-acting insulin only after the meal tray is available.
- When mixing insulins, draw up short-acting first, then intermediate-acting.
- Always have another nurse check the insulin dose.
- Monitor for hypoglycemia, especially during peak times.
- Diabetes Management:
- Teach clients how to check their blood sugar.
- Follow up with a doctor every 3-6 months.
- Educate clients on self-administration of insulin.
- Advise on a diabetic diet and glycemic index, which measure the effect of food on blood sugar.
- Emphasize the importance of wearing a medic alert bracelet.
- Insulin Storage:
- Room temperature for up to 28 days away from heat and light.
- Refrigerate if stored for longer than 28 days.
Oral Hypoglycemic Medications
- Used for type 2 diabetes, where the body still produces insulin but has insulin resistance.
- Do not work if the body cannot produce insulin.
Sulfonylureas
- Adverse Effects: Nausea, hypoglycemia.
- Medications: Amaryl (glimepiride), Glucotrol (glipizide).
Alpha-Glucosidase Inhibitors
- Adverse Effects: Flatulence, diarrhea, hypoglycemia.
- Medications: Precose (acarbose).
Biguanides
- Adverse Effects: Nausea, diarrhea, flatulence.
- Medications: Metformin (Glucophage).
- Important Note: Metformin should be held for 48 hours after a CT scan with IV contrast dye.
Metformin
- Should be held for 48 hours after CT scan with contrast (iodine contrast)
Meglitinides
- Adverse reactions: Flu-like symptoms, back pain
- Examples: Starlix, Prandin
- Dosing schedule: Take with meals
- Important: Skip a dose if you miss a meal, take a dose if you eat a meal
Insulin Sensitizers
- Examples: Actos, Avandia
- Pulled from European market
- Limited use in the US due to risk of heart attacks
Other Medications
- Meglitinides: Take 15-30 minutes before meals with each meal
- Biguanides: Take with meals
- Sulfonylureas: Glyburide: take with breakfast; All others: take with food
- Alpha Glucosidase Inhibitors: Take with the first bite of food, three times a day
- Thiazolidinediones: Take with meals
Patient Education
- Take medication as directed at the same time each day
- Follow a prescribed diabetic diet, which is not a substitute for insulin
- Avoid alcohol
- Test blood sugar regularly
- Perform foot and skin care: diabetics are prone to peripheral neuropathy, which could lead to undiagnosed foot wounds
Routine Follow Up Care
- Regular eye exams due to potential vision complications
- Engage in moderate exercise, which can help decrease blood sugar levels
- Wear a medical bracelet
Thyroid Replacement Medications
- Used to treat hypothyroidism and thyroid cancer
- Increase the metabolic rate of tissues, increasing how fast cells produce energy
- Adverse reactions: Palpitations, tachycardia, nervousness, insomnia, weight loss, sweating, and flushing
- Contraindications: Thyrotoxicosis (high thyroid hormone levels) and myocardial infarction (heart attack)
- Should be taken on an empty stomach first thing in the morning, at least 30 minutes before eating
- Monitor for therapeutic response: Weight loss, increased urination, increased appetite, decreased puffiness in the face, hands, and feet, and improved sense of well-being
- Patient education:
- Do not change brands of thyroid hormone without consulting a doctor.
- Do not increase, skip, or decrease the dose.
- Weigh weekly to monitor weight stability.
- Follow up with a doctor for regular lab work.
- Therapeutic effects may take 1-2 weeks to appear.
- Common medications: Synthroid (levothyroxine) and Cytomel
Insulin
- Essential hormone for glucose to enter cells
- Acts like a key to open the door for glucose to enter muscle and fat cells
- Promotes protein synthesis and helps the body store fat
- Uses:
- Type 1 diabetes: Individuals cannot produce insulin
- Type 2 diabetes: May be used if diet and oral anti-hyperglycemic medications are ineffective
- Hyperkalemia: Can be used in conjunction with glucose to treat high potassium levels
- Diabetic ketoacidosis (DKA): Regular insulin can treat severe DKA
- Diabetes Mellitus (DM):
- Three P's of DM: Polyuria, Polydipsia, Polyphasia
- Polyuria: Increased urination due to high blood sugar levels
- Polydipsia: Increased thirst to dilute the sugar in the urine
- Polyphasia: Increased hunger due to the inability of cells to use glucose for energy
- Three P's of DM: Polyuria, Polydipsia, Polyphasia
- Insulin Types:
- Short-Acting: Regular Insulin (Humulin R, Novolin R), Insulin Lispro (Humalog), Insulin Aspart (Novolog)
- Intermediate-Acting: Humulin N (Novolin N)
- Long-Acting: Insulin Glargine (Lantus), Insulin Detemir (Levemir)
- Combination Insulin: Humulin 70/30, Novolin 70/30
- Important Notes:
- Regular insulin is the only type that can be given intravenously
- Insulin Glargine (Lantus) cannot be mixed with other insulin types
- Administration:
- Regular Insulin: Usually given within 30 minutes of a meal
- Short-acting Insulin (Lispro, Aspart): Must be given before meals
- Intermediate-Acting Insulin: Typically given in two doses (morning and afternoon) and should be accompanied by meals
- Long-Acting Insulin: Given once a day, usually at bedtime
- Hypoglycemia:
- Causes: Not enough food for insulin dose, too much insulin, incorrect insulin dose, exercise, illness
- Symptoms: Sudden onset, blood glucose < 60 mg/dL, fatigue, weakness, nervousness, confusion, seizures, hunger, nausea, pale, moist, and cool skin, numbness of lips and tongue
- Hyperglycemia:
- Causes: High blood sugar levels
- Symptoms: Slow onset, blood glucose > 200 mg/dL, drowsiness, deep rapid respirations, thirst, nausea and vomiting, loss of appetite, dry, flushed, and warm skin, acetone breath, excessive urination
- Hypoglycemia Interventions:
- Give quick-acting glucose (sugar, orange juice)
- Follow with a complex carbohydrate and protein (peanut butter sandwich, cheese and crackers)
- Hyperglycemia Interventions:
- Administer insulin as ordered
- May include regular insulin or insulin infusion
- May include normal saline infusion at a rapid rate to dilute glucose
- Insulin Administration Interventions:
- Only regular insulin can be given intravenously
- Use an insulin syringe and rotate injection sites
- Give rapid-acting insulin only after the meal tray is available
- When mixing insulins, draw up short-acting first, then intermediate-acting
- Always have another nurse check the insulin dose
- Monitor for hypoglycemia, especially during peak times
- Diabetes Management:
- Teach clients how to check their blood sugar
- Follow up with a doctor every 3-6 months
- Educate clients on self-administration of insulin
- Advise on a diabetic diet and glycemic index, which measure the effect of food on blood sugar
- Emphasize the importance of wearing a medic alert bracelet
- Insulin Storage:
- Room temperature for up to 28 days away from heat and light
- Refrigerate if stored for longer than 28 days
Oral Hypoglycemic Medications
- Used for type 2 diabetes where the body still produces insulin but has insulin resistance
- Do not work if the body cannot produce insulin
Sulfonylureas
- Adverse Effects: Nausea, hypoglycemia
- Medications: Amaryl (glimepiride), Glucotrol (glipizide)
Alpha-Glucosidase Inhibitors
- Adverse Effects: Flatulence, diarrhea, hypoglycemia
- Medications: Precose (acarbose)
Biguanides
- Adverse Effects: Nausea, diarrhea, flatulence
- Medications: Metformin (Glucophage)
- Important Note: Metformin should be held for 48 hours after a CT scan with IV contrast dye
Metformin
- Should be held for 48 hours after a CT scan with contrast (iodine contrast)
Meglitinides
- Adverse reactions: Flu-like symptoms, back pain
- Examples: Starlix, Prandin
- Dosing schedule: Take with meals
- Important: Skip a dose if you miss a meal, take a dose if you eat a meal
Insulin Sensitizers
- Examples: Actos, Avandia
- Pulled from the European market
- Limited use in the US due to the risk of heart attacks
Other Medications
- Meglitinides: Take 15-30 minutes before meals, with each meal
- Biguanides: Take with meals
- Sulfonylureas: Glyburide: take with breakfast; All others: take with food
- Alpha Glucosidase Inhibitors: Take with the first bite of food, three times a day
- Thiazolidinediones: Take with meals
Patient Education
- Take medication as directed at the same time each day
- Follow a prescribed diabetic diet, which is not a substitute for insulin
- Avoid alcohol
- Test blood sugar regularly
- Perform foot and skin care: diabetics are prone to peripheral neuropathy, which could lead to undiagnosed foot wounds
Routine Follow Up Care
- Regular eye exams due to potential vision complications
- Engage in moderate exercise, which can help decrease blood sugar levels
- Wear a medical bracelet
Thyroid Hormone Replacement
- Used for hypothyroidism and thyroid cancer
- Adverse reactions: palpitations, tachycardia, nervousness, insomnia, weight loss, sweating, and flushing
- Contraindications: thyrotoxicosis and myocardial infarction
- Administer on an empty stomach, 30 minutes before meals, for optimal absorption
- Monitor for therapeutic response: weight loss, diuresis, increased appetite, decreased puffiness in face, hands, and feet and improved overall well-being
- Never change brands without consulting a doctor
- Monitor weight weekly and have follow-up lab work every 6-12 months
- Therapeutic effects may take 1-2 weeks to appear
- Levothyroxine (Synthroid) is the most common thyroid hormone replacement
Insulin
- Vital for glucose entry into cells, providing energy
- Promotes protein synthesis and helps the body store fat
- Used in type 1 diabetes and to control type 2 diabetes
- Also used for hyperkalemia, severe diabetic ketoacidosis (DKA), and in conjunction with glucose
- Diabetes mellitus is characterized by the "three Ps":
- Polyuria: frequent urination due to excess sugar
- Polydipsia: excessive thirst due to the body trying to dilute sugar
- Polyphagia: increased hunger due to the cells being starved of glucose
Insulin Types
- Short-acting: Regular insulin (Humulin R or Novolin R), insulin lispro (Humalog), and insulin aspart (NovoLog)
- Intermediate-acting: NPH insulin (Humulin N or Novolin N)
- Long-acting: Insulin glargine (Lantus)
- Regular insulin is the only type given intravenously (IV)
- Other types are administered subcutaneously (SC)
Insulin Administration
- Never combine insulin glargine (Lantus) with any other type
- Air should be injected into the intermediate insulin vial first, then draw up short-acting
- Regular insulin should be given 30 minutes before a meal
- Short-acting (lispro and aspart) should be given before a meal
- Intermediate-acting is given twice a day, morning and afternoon
- Long-acting is given once a day
Insulin Adverse Reactions
- Hypoglycemia: sudden onset, glucose < 60 mg/dL
- Hyperglycemia: slow onset, glucose > 200 mg/dL
Insulin Nursing Interventions
- Hypoglycemia: give quick-acting glucose like orange juice with sugar, followed by complex carbohydrates and protein
- Hyperglycemia: administer insulin as ordered, possibly normal saline infusion
- Rotate injection sites to prevent lipodystrophy
- Use an insulin-designed syringe
- Always have another nurse check the dosage before administration
- Give rapid-acting insulin only after the meal tray is available
- Teach clients about self-administration, including proper technique and site rotation
Oral Hypoglycemics
- Used for type 2 diabetics to help the body use insulin more effectively
- The body must still produce insulin for them to work
- Types:
- Sulfonylureas: adverse effects include nausea and hypoglycemia
- Alpha-Glucosidase Inhibitors: adverse effects include flatulence, diarrhea, and hypoglycemia
- Biguanides: adverse effects include nausea, diarrhea, and flatulence
- Metformin must be stopped 48 hours prior to a CT scan with IV contrast dye
Metformin
- Hold metformin for 48 hours after a CT scan with iodine contrast
Meglitinides
- Adverse Reactions: flu-like symptoms and back pain
- Drugs: Starlix and Prandin
- Dosing Schedule: take with meals and skip doses if meals are skipped
Insulin Sensitizers
- Used for type 2 diabetes in combination with other oral hypoglycemics
- Adverse Effects: headache, hypoglycemia, fatigue, and infections
- Drugs: Actos and Avandia
- Withdrawn from the European market and limited use in the US due to the risk of heart attacks
Nursing Interventions
- Meglitinides: administer 15-30 minutes before meals with each meal
- Biguanides: administer with meals
- Sulfonylureas: Glyburide with breakfast, others with food
- Alpha-Glucosidase Inhibitors: administer with the first bite of food three times a day
- Thiazolidinediones: administer with meals
Client Teaching
- Take medications as directed at the same time each day
- Follow a prescribed diabetic diet
- Oral medications are not a substitute for insulin
- Avoid alcohol as it contains sugar
- Monitor blood sugar regularly
- Perform foot and skin care due to the risk of peripheral neuropathy
Routine Follow-Up Care
- Regular eye examinations are essential
- Engage in moderate exercise
- Wear a medical bracelet to alert medical professionals about diabetes
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Description
Test your knowledge on thyroid replacement medications, their uses in treating hypothyroidism and thyroid cancer, and the importance of patient education. Understand the effects, adverse reactions, contraindications, and monitoring therapeutic responses. Prepare to enhance your understanding of thyroid health!
