Endocrine And Respiratory Pharm PDF

○ 0.45% sodium chloride; 0.33% sodium chloride; 10% dextrose in water; 2.5% dextrose in water ○ This is DANGEROUS in cerebral edema. Endocrine Drugs ( 3 content hours & 15 questions [multiple choice & select all that apply]). Taxonomy: knowledge, understanding, appli...

○ 0.45% sodium chloride; 0.33% sodium chloride; 10% dextrose in water; 2.5% dextrose in water ○ This is DANGEROUS in cerebral edema. Endocrine Drugs ( 3 content hours & 15 questions [multiple choice & select all that apply]). Taxonomy: knowledge, understanding, application, and analysis - Diagnosing diabetes - Prediabetes - FBG 100-125 mg/dL - Impaired glucose tolerance (2hrOGTT) 140-199 mg/dL - Hg A1C: 5.7%-6.4% - Diabetes - Glucose blood levels (2 separate days) - FBG greater than equal to 126 mg/dL - Random BG greater than equal to 200 mg/dL - OGGT greater than equal 200 mg/ dL - Hemoglobin A1C: greater than equal to 6.5% - Normal Diabetes Serum Values - Fasting Blood Glucose (FBG): less than equal to 99 mg/dL - Random BG < 200 mg/dL - OGGT: less than equal to 140 mg d/L - Hemoglobin A1C: less than equal to 5.6% (may not be accurate with some people) - Diabetes 1 & 2 pharmacological and non-pharmacological treatment - Insulin treats ALL type 1 DM and SOME type 2 DM - Precursor= proinsulin (insulin and peptide loop running from A to B chains). This loop is called C- peptide (enzymatically clipped from a proinsulin molecule). C-peptide can be measured in the blood to determine if the pancreas is producing insulin - Secretion-> rise in BG= insulin secretion - Inhibits insulin release: alpha- adrenergic receptors in pancreas - Complications of insulin= hypoglycemia (BS 6 mU/L - Free T4 < 0.9 ng/dL - TPO antibody for Hashimoto’s Disease - Normal Thyroid Serum Values - TSH: 0.3- 6 mU/L - Free T4: 0.9-2 ng/dL  - Free T3: 230-620 ng/dL - Thyroid peroxidase (TPO) antibody: negative - Levothyroxine pharmacokinetics, administration, patient education, and adverse reactions/SE - T4 (synthroid/levoxyl) - Drug choice no matter the cause - Taken 4 Life - Oral - IV for myxedema coma - Absorption - reduced by food - give 30-60 minutes in AM prior to eating - Pregnancy may increase dose requirement - Take 4 hours apart from antacids, rion, calcium supplements, or foods because it may compete with absorption - NO GRAPEFRUIT juice - SE= tachycardia, angina, tremor, hyperthermia, heat intolerance, sweating - Monitor= TSH levels 6-8 weeks after starting therapy and then yearly when stabilized (target 0.5-2 mU/L) - Half-life and plasma levels= highly protein bound= prolonged half-life is 7 days. Fairly stable steady state with once/day dosing. Bad news- it takes 4 half lives (4 weeks) to reach to plateau - Assess= apical HR, BP, tachydysrhythmias, chest pain Mental Health ( 3 content hours & 15 questions [multiple choice & select all that apply]). Taxonomy: knowledge, understanding, application, and analysis Atypical 2nd generation antipsychotic names Bipolar meds: mood stabilizer names (may cause weight gain) o Mood Stabilizer: (may use multiple ▪ Lithium (old but common) ▪ Valproic acid/divalproex ▪ Carbamazepine ▪ Lamotrogine o Antipsychotics: (also a mood stabilizer, have a lot of reasons to use) ▪ first generation (typicals) ▪ second generation (atypicals) ▪ third generation (atypicals) Antipsychotic extra-pyramidal signs/symptoms (s/s) Pseudo-Parkinsonism: Mask-like facies, resting tremor, shuffling gait, bradykinesia Tardive Dyskinesia: Lip smacking, tongue movements, facial grimacing Akathisia: Restlessness, inability to sit still Dystonia: Involuntary muscle contractions o Albuterol and Levalbuterol (short-acting beta2- agonist (SABA) bronchodilators (rescue medications) ▪ Albuterol given to relax the airway smooth muscles ▪ Action- (1) binds to beta2 adrenergic receptors in airway smooth muscle. Increases in cAMP activates kinases → decreases intracellular calcium → relaxes smooth muscle → bronchodilation (2) relatively selective to beta2 (pulmonary) receptors ▪ Use cautiously: cardiac disease, hyperthyroidism ▪ Adverse Reactions/Effects: chest pain, palpitations, nervousness, restlessness, tremor, PARDOXICAL BRONCHOSPASMS ▪ Nursing assessment: Lungs, HR, BP Sputum color, amount, characteristics Paradoxical bronchospasms (withhold med & notify provider) May cause transient hypokalemia ▪ Education: Shake inhaler well At least 1 minute between inhalations New inhaler- prime first (4 sprays into the air/away from face) Discard after 200 sprays Do not double or increase doses If using other inhalers, use albuterol first and then other med after 5 minutes o Inhaled corticosteroids- use with LABA anti inflammatory ▪ Action- (1) Potent, locally acting anti-inflammatory & immune modifier ▪ Use cautiously in: diabetes, glaucoma ▪ Adverse Reactions/Effects: otitis media, headache, oropharyngeal fungal infections, ANAPHYLAXIS ▪ Nursing Assessments: S/S of life-threatening adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia increase in glucose ▪ Education: Allow 1 minute in between inhalations Do not use w/ spacer, do not shake inhaler Gradual decrease is required If using a rescue inhaler, wait five minutes after to administer corticosteroid  Rinse mouth w/ water after treatment Side effects of albuterol & ipratropium o Ipratropium (short-acting muscarinic antagonists (SAMA) anticholinergics, bronchodilation) ▪ Action- (1) blocks muscarinic receptors in bronchi and produces local bronchodilation ▪ Contraindicated: ipratropium, atropine, belladonna, alkaloids, bromide ▪ Use cautiously: urinary retention, glaucoma, bladder neck obstruction, prostatic hyperplasia ▪ Adverse Reactions/Effects: minimal Dizziness, headache, cough, bronchospasms, blurred vision, hypotension, palpitations ▪ Nursing assessments : Assess for atropine, belladonna allergies Also soy & peanut allergies (if using with ipratropium/albuterol MDI) Respiratory system ▪ Education: Not to exceed 12 doses within 24 hours Rinse mouth after inhaler use Sugarless candy/gum for dry mouth Know drug generic names if they are bronchodilator vs anti-inflammatory ▪ Bronchodilators ▪ Levalbuterol (Xopenex) ▪ Albuterol ▪ Salmeterol ▪ Formoterol ▪ Indacaterol ▪ Arformoterol (nebulizer) ▪ Olodaterol o Anti-inflammatory ▪ budesonide ▪ fluticasone ▪ Peak flow meter, colored zones, and spacers o Peak Flow (for asthma and COPD) ▪ Handheld device measuring movement of air out of the lungs ▪ Identifies airway narrowing before having symptoms ▪ Use at least daily in the a.m. (especially) before taking medications ▪ Peak flow zones- Green, Yellow, Red  ▪ Review Canvas video and read more about PFM o Colored zone o Spacers ▪ helpful for metered-dose inhalers that require hand breath coordination  Respiratory rescue for asthma vs COPD o All patients need a rescue inhaler o Levalbuterol and Albuterol are rescue medication for COPD o formoterol and corticosteroid (budesonide) or symbicort are rescue medication for ASTHMA