NURS 3210 Pharmacology and Nursing Active Learning Guide PDF

NURS 3210 Pharmacology and Nursing Active Learning Guide - Module 10 – Antidiabetic, Other Endocrine and Reproductive Agents Purpo...

NURS 3210 Pharmacology and Nursing Active Learning Guide - Module 10 – Antidiabetic, Other Endocrine and Reproductive Agents Purpose/Overview Active learning guides help students to focus their study time. They include knowledge level questions as well as those focusing on the application and analysis of information to provide greater context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content, then work to complete the guide during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate course or module content. Instructions Quickly review the active learning guide (ALG) before you begin reading and engaging with other content in the module. Looking at the questions beforehand will provide a preview of the information you should be alert to as your work through your reading or module resources. As you work through the module content, complete the active learning guide, topic-by-topic. You should use the resources provided and linked on the “Prepare” page in Canvas as the primary source for answering the questions in the active learning guide Specific Agents for Module 10 Fill in the table with the drug’s classification/s. The drugs in the table are those you will be asked about on quizzes and exams. Keep in mind your assigned reading may include information about individual agents not listed here. You can check your work in the practice activity (flashcards) for each module. Common endings or other clues about the drug’s classification are italicized. Antidiabetic Agents (Ch. 32) Agent Name Classificatio Agent Name Classificatio Agent Name Classificatio n n n Lispro Rapid-acting Glucagon Hyperglycemi Humalin Combination  NURS 3210 Pharmacology and Nursing Agent Name Classificatio Agent Name Classificatio Agent Name Classificatio n n n insulin c agent (used 70/30 insulin (70% for severe NPH, 30% hypoglycemi regular a) insulin) Exanatide Incretin Glipizide Sulfonylurea Metformin Biguanide mimetic (GLP-1 receptor agonist) Acarbose Alpha- Pioglitazone Thiazolidined Sitagliptin DPP-4 glucosidase ione (TZD) inhibitor inhibitor Regular Short-acting NPH Intermediate- Glargine Long-acting Insulin insulin acting insulin insulin Repaglinide Meglitinide Cangliflozin SGLT2 D50 Hyperglycemi inhibitor c agent (used for severe hypoglycemi a) Other Endocrine and Reproductive Agents (Chapters 30, 31, 33, & 34: Agent Name Classificati Agent Name Classificati Agent Name Classificati on on on Prazosin Alpha-1 Hydrocortisone Corticostero Desmopressin Antidiuretic adrenergic id hormone blocker (glucocortic (ADH) oid) analog Methimazole Antithyroid Methylergonovine Ergot Misoprostol Prostagland agent alkaloid in E1 (used for analog postpartum bleeding) Norethindrone Progestin Ethinyl estradiol/ Combinatio Dexamethaso Corticostero norethindrone n oral ne id contraceptiv (glucocortic e (estrogen oid) and progestin) Indomethacin Nonsteroida Choriogonadatropi Gonadotrop Finasteride 5-alpha l anti- n- Alfa in (used for reductase inflammator infertility) inhibitor y drug (NSAID) Oxytocin (Pitocin) Uterotonic Levothyroxine Thyroid Propylthiourac Antithyroid agent hormone il (PTU) agent (T4)  NURS 3210 Pharmacology and Nursing Agent Name Classificati Agent Name Classificati Agent Name Classificati on on on Clomiphene Selective Sildenafil Phosphodie Fludrocortison Corticostero estrogen sterase-5 e id receptor (PDE5) (mineraloco modulator inhibitor rticoid) (SERM) Methylprednisolon Corticostero Prednisone Corticostero Cosyntropin Synthetic e id id adrenocorti (glucocortic (glucocortic cotropic oid) oid) hormone (ACTH) analog Testosterone Androgen Octreotide Somatostati Fluticasone Corticostero n analog id (glucocortic oid) Conjugated Estrogen Prednisone Corticostero Somatropin Human estrogens hormone id growth (glucocortic hormone oid) (recombina nt) Dinoprostone Prostagland in E2 analog Reading: Chapter 32 1. Describe the action of insulin in the body. A naturally occurring hormone secreted by the beta cells of the islets of Langerhans in the pancreas in response to increased levels of glucose in the blood. Exogenous insulin functions as a substitute for the endogenous hormone. It serves to replace the insulin that is either not made or is made defectively in a diabetic patient. The drug effects of exogenously administered insulin involve many body systems. They are the same as those of normal endogenous insulin. That is, exogenous insulin restores the patient’s ability to metabolize carbohydrates, fats, and proteins; to store glucose in the liver; and to convert glycogen to fat stores. Unfortunately exogenous insulin does not reverse defects in insulin receptor sensitivity. Insulin pumps are a very attractive way to administer insulin to patients. The insulin pump provides an alternative to multiple daily subcutaneous  NURS 3210 Pharmacology and Nursing injections and allows patients to match their insulin intake to their lifestyle. When an insulin pump is used, insulin is administered constantly over a 24-hour period, and the patient is then allowed to give bolus injections based on the amount of food ingested. Insulin pumps are described further in the Nursing Process section later in the chapter. 2. Describe the pathophysiology of Diabetes Mellitus (DM), and compare and contrast the changes typical of insulin and insulin production in Type 1 DM and Type 2 DM. Pathophysiology of Diabetes Mellitus (DM) Diabetes Mellitus is a number of metabolic disorders (syndromes) that are caharacterized by the presence of chronic hyperglycemia. This is the result of a defect in the secretion of insulin, the action of insulin and or both. Type 1 Diabetes Mellitus (DM) This is an autoimmune disorder where the immune system destroyed the beta cells in the pancrease that leads to the 100% deficiency of insulin. These patients need and require exogenous (external source) of insulin for survival. Type 2 Diabetes Mellitus (DM) These patients are insulin resistant and are relatively deficient in insulin production or how it is being used. The pancrease may or may not produce enough insuling to maintain homeostasis of normal blood glucose levels. Type 2 Diabetes Mellitus (DM) can be managed with PO hypoglycemic agents (Metformin) and lifestyle modifications like increased physical activity and diet changes. 3. What are some of the short-term consequences of acutely elevated blood glucose values? Hyperglycemia can manifest as the following: Polyuria→ Increased frequency or volume of urinary output; it is a common symptom of diabetes. Polydipsia→ Chronic excessive intake of water; it is a common symptom of uncontrolled diabetes.  NURS 3210 Pharmacology and Nursing Polyphagia→ Excessive eating; it is a common symptom of uncontrolled diabetes. Blurred Vision→ Blurred vision is. It can affect one or both eyes, and can cover part or all of your visual field. Fatigue→ Weariness from bodily or mental exertion. 4. What are some examples of long-term consequences of chronically elevated blood glucose? (Name at least 4 complications associated with DM.) Cardiovascular Disease→ Leading to heart attack and or stroke. Diabetic Nephropathy→ Leading to kidney failure. Diabetic Retinopathy→ Leading to blindness. Diabetic Neuropathy→ Leading to nerve damage, foot ulcers, and or amputations. 5. What dietary changes are typically recommended for patients with both Type 1 and Type 2 DM? Dietary Modifications  A balanced diet that controls the intake of carbohydrates in order to manage blood glucose.  Increase intake of dietary fiber.  Inhibit the intake of refined carbohydrates and sugars  Sustain a healthy body weight.  Schedule meals while considering insulin therapy, medications and the timing of administration. 6. A. What pharmacologic therapy is required for patient’s diagnosed with Type 1 DM? Type 1 Diabetes Mellitus (DM) Therapy requires the use of insulin due to the body not being able to produce it on its own. These patients need and require exogenous (external source) of insulin for survival.  NURS 3210 Pharmacology and Nursing B. Why are other types of pharmacologic and non-pharmacologic therapies effective in the management of Type 2 DM (but not Type 1 DM)? The therapies used for Type 2 Diabetes Mellitus (DM) are used to improve sensitivity to insulin and to improve endogenous production of insulin. These therapies are not effective in the use for Type 1 Diabetes Mellitus (DM) due to there is no endogenous production of insulin to improve sensitivity to. The PO hypoglycemic medications, metformin, sulfonylureas, non-insulin inectables, GLP-1 agonists, 7. What is the normal range for a fasting blood sugar? Normal Range 70-99 mg/dL. 8. A. What is the Hemoglobin A1c, what is its normal range, and how does its assessment aid in evaluating pharmacologic management of DM?  Hemoglobin A1c: Will measure the average blood glucose levels over the duration of 2-3 months.  Normal Range: is below 5.7%  Assessment aid: The diagnostic test helps to ascertain the long term glycemic management and the efficacy of that diabetes management. B. What A1C value indicates good glycemic control in a patient with DM?  Good glycemic control is measured with a value that is below 7%. 9. A. Explain the difference between basal insulin levels and post-prandial insulin levels. Basal Insulin levels: Are the consistent, steady low levels of insulin that is secreted to control blood glucose levels during a fasting state. Post-prandial Insulin Levels: The increase in the secretion of insulin in the response to food intake to manage the rise in blood glucose.  NURS 3210 Pharmacology and Nursing B. Based on the predict onset, peak, and duration of insulin, which insulin type would most closely mimic basal insulin levels? Basal Insulin Basal-bolus insulin Long Acting therapy is now the preferred method of treatment for hospitalized diabetic patients. Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering a long-acting insulin constantly as a basal and then giving short- acting insulin when glucose levels rise above a predetermined range as a bolus. The basal insulin is a long-acting insulin (insulin glargine) administered constantly to keep the blood glucose from fluctuating because of the normal release of glucose from the liver. C. Which would most closely mimic post-prandial insulin levels? Post-pradial Insulin Bolus insulin Fast Acting (insulin lispro or insulin aspart) mimics the burst secretions of the pancreas in response to increases in blood glucose levels. Bolus insulin is broken up into meal and correction boluses. Meal boluses are given to reduce blood glucose with the intake of carbohydrates. Correction boluses are any boluses taken to bring blood glucose back to normal. Blood glucose levels are monitored frequently when using basal-bolus insulin. This method of treatment is far superior to the traditional sliding scale. Still, patients who need to receive nothing by mouth for therapeutic or diagnostic reasons are not good candidates for basal insulin, because of the risk for hypoglycemia and the unpredictability of insulin needed for glucose control while not eating. 10. A. Which types of insulin cannot be mixed? Long-acting insulins cannot be mixed. B. What kind of insulin can be administered intravenously? Regular Insulin can be IV administered during extreme/severe cases. 11. A. List 6 signs and symptoms of hypoglycemia.  NURS 3210 Pharmacology and Nursing Hypoglycemia: A blood glucose level of less than 70 mg/dL, or above 50 mg/dL with signs and symptoms of hypoglycemia. Because the brain needs a constant amount of glucose to function, early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, irritability, tremor, and sweating. Later symptoms include hypothermia and seizures. Without adequate restoration of normal blood and CNS glucose levels, coma and death will occur. Signs and Syptoms ◦ Sweating ◦ Confusion ◦ Rapid Heartbeat ◦ Dizziness ◦ Shakiness ◦ Hunger B. What action should the nurse take if the patient has lost consciousness secondary to hypoglycemia? In the hospital setting or when the patient is unconscious, intravenous glucose is an obvious option to treat hypoglycemia. Concentrations of up to 50% dextrose in water (D50W) are most often used for this purpose. Administer IV dextrose or glucagon immediately. C. How might taking a Beta-blocker impact usual signs and symptoms of hypoglycemia? Mechanism: Masks the tachycardia from hypoglycemia. Result: Risk for not noticing hypoglycemic symptoms. 12. Based on onset and peak, which type of insulins would you expect to most commonly cause hypoglycemia? Rapid-Acting Insulins  NURS 3210 Pharmacology and Nursing This insulin then facilitates the uptake of the excess glucose at hepatic insulin receptor sites for storage in the liver as glycogen. In people with diabetes, the insulin response to meals is often impaired; therefore a rapid-acting insulin product is often used within 15 minutes of mealtime. This corresponds to the time required for the onset of action of these products. It is essential that patients with diabetes eat a meal after injection. Otherwise profound hypoglycemia may result. 13. Insulin therapy and drugs that promote insulin creation by the Beta-cells are frequently associated with weight gain and hypoglycemic events. a. What normal physiologic effect of insulin would be associated with this adverse drug effect? The mechanism of action for insulin is to pull the glucose from the blood and to push it into the cell, then to store the extra into the adipose tissue for storage. Leading to weight gain. b. What pharmacologic therapies for Type-2 DM, do NOT have this effect? List those and briefly (in a few words) describe their mechanisms of action. Metformin Metformin is currently the only drug classified as a biguanide. It is considered a first- line drug and is the most commonly used oral drug for the treatment of type 2 diabetes. It is not used for type 1 diabetes. Metformin works by decreasing glucose production by the liver. It may also decrease intestinal absorption of glucose and improve insulin receptor sensitivity. This results in increased peripheral glucose uptake and use, and decreased hepatic production of triglycerides and cholesterol. Unlike sulfonylureas, metformin does not stimulate insulin secretion and therefore is not associated with weight gain and significant hypoglycemia when used alone. Sodium Glucose Cotransporter Inhibitors (Sglt2 Inhibitors)  NURS 3210 Pharmacology and Nursing Approximately 180 g of glucose is filtered by the kidney daily. Most of this glucose is reabsorbed into the circulation by sodium glucose–linked cotransporters (SGLTs). SGLTs transport sodium and glucose into cells using sodium/potassium ATPase pumps and are responsible for 90% of glucose reabsorption. Inhibition of SGLT2 leads to a decrease in blood glucose as a result of an increase in renal glucose excretion. Glucagon-Like Peptide-1 (GLP-1) Agonists GLP-1 agonists act on the endogenous hormone incretin. Incretins are hormones released by the gastrointestinal tract in response to food. Incretins stimulate insulin secretion, reduce postprandial glucagon production, slow gastric emptying, and increase satiety. The most important incretin hormones that have been identified so far are GLP-1 and GIP. These hormones are rapidly deactivated by the enzyme DPP-IV. The incretin mimetics enhance glucose-dependent insulin secretion, suppress elevated glucagon secretion, slow gastric emptying, and increase first- and second-phase insulin secretion. Currently there are six type injectable GLP-1: exenatide (Byetta, Bydureon), dulaglutide (Trulicity), liraglutide (Victoza), albiglutide (Tanzeum), lixisenatide (Adlyxin), and semaglutide (Ozempic). Semaglutide was also approved as an oral form, with the trade name of Rybelsus. This class of drug all have a pregnancy category of C. New combination products combining long-acting insulin glargine and one of the GLP-1 agonists are available. Soliqua (insulin glargine and lixisenatide) and Xultophy (insulin degludec and liraglutide) are the two combination products available at the time of this writing. Dipeptidyl Peptidase IV Inhibitors (DPP-IV) DPP-IV inhibitors work by delaying the breakdown of incretin hormones by inhibiting the enzyme DPP-IV. By inhibiting the enzyme responsible for incretin breakdown  NURS 3210 Pharmacology and Nursing (DPP-IV), the DPP-IV inhibitors reduce fasting and postprandial glucose concentrations. Currently there are four DPP-IV inhibitors: sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Nesina). There are several DPP-IV inhibitors currently under investigation. This class of drugs are also referred to as the gliptins. 14. What long-term complication of DM is an absolute contraindication to Metformin? Metformin is contraindicated in patients with renal disease or renal dysfunction (calculated creatinine clearance of less than 30 mL/min). Because metformin is primarily excreted by the kidneys, it can accumulate in these individuals, increasing the risk for development of lactic acidosis. Other contraindications include alcoholism, metabolic acidosis, hepatic disease, heart failure, and other conditions that predispose to tissue hypoxia and increase the risk for lactic acidosis. 15. Patients taking Metformin often experience GI symptoms like bloating, abdominal cramping, and diarrhea when they first begin therapy. These typically resolve with continued use. A. What things can be done to alleviate the GI distress caused by the medication? Take Metformin with meals. Start at a low dose and slowly increase. Use a prescription for extended release. B. Why would it be important to educate the patient that the adverse GI effects are expected to improve? Encourage medication adherence. 16. Glitazones like pioglitazone can also cause weight gain from fluid retention. As a result, patients with what other diseases (co-morbidities) must be especially cautious using medications in this class? Co-morbidities: Right side heart failure. Initiation of therapy with thiazolidinediones is contraindicated in patients with New York Heart Association class III or IV heart failure and are to be used with caution in patients with liver or kidney disease.  NURS 3210 Pharmacology and Nursing 17. There are two classes of diabetic agents that interact with another group of hormones called incretins. A. Which classes affect incretins? DPP-4 Inhibitors GLP-1 Receptor agonist B. Explain what incretins do and why increasing their action is useful in patients with diabetes. Incretins are hormones released by the gastrointestinal tract in response to food. Incretins stimulate insulin secretion, reduce postprandial glucagon production, slow gastric emptying, and increase satiety. Increasing their action would enhance glycemic control. 18. How might NPO status effect pharmacologic management of DM? NPO status will require and adjustment to the insulin prescription to avoid an hypoglycemic due to the decreased calories being eaten or adminstered. 19. A. How do SGLT-2 inhibitors work and what adverse effects are caused by this mechanism of action? SGLT-2 inhibitors prevent the reabsorption of glucose I the kidneys. This will cause gluycosuria or sweet pea. 20. Complete the Diabetes Case Study Questions #1, #2, and #3 found in Chapter 32 on p. 510: 1. Before his surgery, B.G.’s hemoglobin A1C level was 9%. What does this value imply regarding his glycemic control? A percentage over 7% during a 2-3 month span is an indicator of poor glucose control. 2. While reviewing the instructions for the lispro insulin, B.G. states, “I took my regular insulin shots about 30 minutes before my meals. Hopefully I can keep that same routine.” How will the nurse respond to this statement?  NURS 3210 Pharmacology and Nursing Patient Education,Lispro insulin is a rapid response and needs to be administered no more than 15 minutes before or immediately after a meal to correspond with the postprandial glucose levels. 3. After his discharge, B.G. wakes up one morning feeling nauseated. He gives himself the lispro insulin injection, but then after eating breakfast he vomits and cannot keep any food down. What must he do at this time? Closely assess/monitor blood glucose and take in some carbohydrates if hypoglycemic event. Then consult HCP for additional instructions. 21. Complete Critical Thinking Question #1 found in Chapter 32 on p. 515: 1. A patient diagnosed with type 1 diabetes mellitus has been placed on a 1500-calorie diabetic diet and is to be started on insulin glargine. Today she has received teaching about her diet, about insulin injections, and about management of diabetes. She received the first dose of insulin glargine at 9 p.m.; the next morning she complained of feeling “dizzy.” The nurse assesses that she is diaphoretic, weak, and pale, with a heart rate of 110 beats/min. What is the nurse’s priority action at this time? What is the best explanation for these symptoms? Priority action is to assess/monitor blood glucose level at once administer some carbohydrates/sugars if hypoglycemic event. The likely cause of these symptoms is the 1500 calorie diet plus the timing of the administration of the long acting insulin glargine. Reading: Chapter 30, 31, & 33: 22. Explain the physiologic roles (basic actions) of the following hormones: a. Growth Hormone  NURS 3210 Pharmacology and Nursing Regulates anabolic processes related to growth and adaptation to stressors; promotes skeletal and muscle growth; increases protein synthesis; increases liver glycogenolysis; increases fat mobilization. Somatropin: Human GH for treatment of hypopituitary dwarfism Octreotide: A synthetic polypeptide structurally and pharmacologically similar to GH release–inhibiting factor; inhibits GH. b. Adrenocorticotropic Hormone (ACTH) Targets adrenal gland; mediates adaptation to physical and emotional stress and starvation; redistributes body nutrients; promotes synthesis of adrenocortical hormones (glucocorticoids, mineralocorticoids, androgens); involved in skin pigmentation. Cosyntropin: Used for diagnosis of adrenocortical insufficiency c. Cortisol Regulates meabolism, decreases inflammation, manages the sleep/wake cycle and assists with the bodies response to stress by increasing the secretion of blood glucose and suppressing the immune response. Cortisol has many antiinflammatory effects, including reduction of inflammatory leukocyte functions and scar tissue formation. Cortisol promotes renal retention of sodium, which can result in edema and hypertension. d. Aldosterone Controls potassium and sodium levels in the blood to manage blood pressure and fluid balance by increasing sodium reabsorption and potassium excretion in the kidneys. e. Anti-Diuretic Hormone (ADH)  NURS 3210 Pharmacology and Nursing Increases water resorption in distal tubules and collecting duct of nephron; concentrates urine; causes potent vasoconstriction. Vasopressin: ADH; performs all the physiologic functions of ADH Desmopressin: A synthetic vasopressin f. Thyroid Stimulating Hormone (TSH) Stimulates secretion of thyroid hormones T3 and T4 by the thyroid gland Thyrotropin: Increases production and secretion of thyroid hormon. g. Thyroxine (T3 and T4) Levothyroxine is a synthetically prepared levo-isomer of the thyroid hormone thyroxine (T4, a tetra-iodinated tyrosine derivative) that acts as a replacement in deficiency syndromes such as hypothyroidism. T4 is the major hormone secreted from the thyroid gland and is chemically identical to the naturally secreted T4: it increases metabolic rate, decreases thyroid-stimulating hormone (TSH) production from the anterior lobe of the pituitary gland, and, in peripheral tissues, is converted to T3. Thyroxine is released from its precursor protein thyroglobulin through proteolysis and secreted into the blood where is it then peripherally deiodinated to form triiodothyronine (T3) which exerts a broad spectrum of stimulatory effects on cell metabolism. T4 and T3 have a relative potency of ~1:4. 23. In three to five sentences describe the role of the hypothalamus, the pituitary gland, and the effector organs within a negative feedback loop common to endocrinologic functioning. The hypothalamus secretes hormones that regulate the pituitary gland. The pituitary gland releases hormones the control the effector organs. An example is the hypothalamus will release TRH to stimulate the pituitary gland to secrete TSH. The release of TSH then will stimulate the thyroid gland to secrete thyroid hormones. T3 and T4 (Thyroid Hormones) will  NURS 3210 Pharmacology and Nursing send feedback to the hypothalamus and pitiuitary glands to stop secreting TRH and TSH. The feedback (negative) will maintain hormone balance within the body. 24. Describe what happens to pituitary hormones, like TSH and ACTH, in the setting of inadequate effector organ hormone secretions (the effector organ is not producing the hormone it is supposed to produce). When the effector organ, like the thyroid gland, is not producing enough of its hormone (T3/T4), the negative feedback tot he pituitary/hypothalumus is decreased. This action leads to an increase in secretions of pituitary hormones (TSH for the thyroid and/or ACTH for the adrenal gland) in an effort to stimulate the organ that is not active to produce more of its hormone. This will lead to an elevated level of TSH or ACTH in the blood when the need effector organ hormones are low. 25. Describe the disease processes and symptoms characteristic of BOTH deficiencies and excesses of the following hormones: Hormone Deficiency Symptoms Excess Symptoms (Disease (Disease Process) Process) Somatotropin Growth Hormone Children Acromegaly (in Adults: (human growth Deficiency (GHD) Slow growth, adults) / Enlarged hormone) short stature, Gigantism (in bones:In the delayed children) skull, face, sexual jaw, hands, development, and feet immature Soft tissue appearance, swelling:In prominent the hands forehead, and and feet underdevelop ed bridge of Facial the nose features:Larg er lips, nose, Adults and tongue Higher body fat, especially Skin around the changes:Thic waist, less k, coarse, oily muscle, less skin, skin strength and tags, stamina, increased  NURS 3210 Pharmacology and Nursing reduced bone sweating, density, bone and body fractures, odor anxiety and Other depression, changes:Dee decreased per voice, sexual thicker body function and hair, and interest, larger glands fatigue, in the skin feeling isolated from Joint others, and pain:Includin sensitivity to g heat and cold degenerative arthritis Headaches: Caused by pressure from a growing tumor on surrounding brain tissue Vision problems:Ca used by pressure from a growing tumor on surrounding brain tissue Gigantism Children: Excessive growth:Childr en with gigantism grow quickly in height, muscles, and organs Physical characteristic s:Children may have large hands and feet with  NURS 3210 Pharmacology and Nursing thick fingers and toes, a large head, a prominent forehead and jaw, and coarse facial features like an enlarged nose, lips, and tongue Other symptoms:Ch ildren may also experience excessive sweating, joint pain, muscle weakness, headaches, delayed puberty, irregular menstruation, double vision, and fatigue Thyroid Hormone Hypothyroidism Fatigue:Feeli Hyperthyroidis Heart:Rapid ng tired or m (e.g., or irregular sluggish, Graves' heartbeat, even after disease) palpitations, enough sleep or Sensitivity to arrhythmias cold:Feeling Weight:Unin cold when tended others are weight loss comfortable despite an in a t-shirt increased appetite Weight gain:Storing Temperatur more calories e:Heat as fat instead intolerance or of burning trouble them for tolerating activity heat Constipation Nervous  NURS 3210 Pharmacology and Nursing :Difficulty system:Anxie having a ty, irritability, bowel nervousness, movement or trouble sleeping Dry skin: Skin Muscles:Mu that feels scle coarse, scaly, weakness or or thickened shaky hands Hair and nail Bowel changes:Brittl movements:F e, thin, or requent or sparse hair loose bowel and nails movements Slowed Skin:Sweati movements ng, clammy and skin, or itchy thoughts:Slo or irritated w speech, skin droopy Other:Goiter eyelids, and or thyroid muscle nodules, hair cramps loss, difficulty Other concentrating symptoms:Du , or feeling ll facial faint when expressions, raising your hoarse voice, hands joint or muscle pain, and hand tingling or pain Cortisol Addison's Fatigue Disease (Adrenal Muscle Insufficiency) weakness Low mood Loss of appetite and unintentional weight loss Increased thirst Dizziness  NURS 3210 Pharmacology and Nursing 26. Describe the disease process and associated symptoms of deficiencies in Anti-Diuretic Hormone. ADH deficiency (vasopressin), will lead to diabetes insipidus (DI). ADH controls the body’s water retention by increasing the reabsorption in the kidneys. Signs/Symptoms ◦ Increased Thirst (polydipsia) ◦ Increased Urination (polyuria) ◦ Dehydration ◦ Low Urine Specific Gravity ◦ Increased Serum Osmolality in response to the inability to concentrate urine 27. A. Name the body’s primary glucorticoid: Cortisol B. Name the body’s primary mineralocorticoid: Aldosterone C. Distinguish between the physiologic function of glucocorticoids and mineralocorticoids. Physiologic Function of: Glucocorticoids: Controls metabolism of carbohydrates, fats and proteins. Reduces inflammation. Suppresses the immune response. Aids the body in response to stress by increasing the amount of glucose in the blood. Mineralocorticoids: Sustain fluid and electrolyte balance by controlling sodium and potassium levels in the kidneys, resulting in the control of blood pressure. 28. In three to five sentences compare and contrast inhaled and systemic (oral and parenteral) corticosteroids. Inhaled Corticosteroids: Are primarily used for the chronic respiratory syndromes like asthma and COPD. The medication is delivered directly into the lungs. This application will minimize the systemic side effects and provide a targeted anti-inflammatory action. Systemic Corticosteroids: Orally/parenterally administered for an increased widespread inflammatory condition or an extreme asthma exacerbation. They will affect the entire body  NURS 3210 Pharmacology and Nursing and can have substantial side effects, that can include immunosuppression, hyperglycemia, adrenal suppression and osteoporosis. 29. Complete the Octreotide Case Study Questions #1, #2, and #3 found in Chapter 30, on p. 480: 1. How does the octreotide work to control the VIPoma-related diarrhea? The mechanism of action for Octreotide is to inhibit the secretion of vasoactive intestinal peptide (VIP) from the tumor, decreasing intestinal secretion and motility, resulting in a control of the diarrhea. 2. As J.R. begins therapy with octreotide, the nurse should continue to assess which parameters? Assess/Monitor blood glucose levels, liver function tests, electrolyte levels and thyroid function. Assess/Monitor for signs/symptoms of gallstones or cholecystits is essential due to the medications effect on the gallbladder. 3. After 2 days of treatment, the episodes of diarrhea have become less frequent. However, the nurse notes that J.R.’s blood glucose levels are elevated. What is the best explanation for this elevation? Octreotide can prevent the secretion of insulin from the pancreas, resulting in hyperglycemia. The nurse will need to assess/monitor and control blood glucose accordingly. 30. Complete the Critical Thinking Questions #1 and #2 found in Chapter 31, on p. 490: 1. A patient has been taking thyroid drugs for about 16 months and has recently noted palpitations and some heat intolerance. What are the nurse’s priority actions at this time? The nurse will need to assess/monitor the patients thyroid hormone levels to monitor for signs/symptoms of hyperthyroidism as a result of the possibility of overmedication. The  NURS 3210 Pharmacology and Nursing nurse will need to obtain a health history that is detailed and may need to think about adjusting the thyroid medication dose. 2. A patient with a history of hypothyroidism is in her first trimester of pregnancy. She asks the nurse, “How often will they check my thyroid hormone levels? I’m very worried about how this will affect my baby.” What is the nurse’s best response? The nurse should educate the patient that thyroid hormone levels will be assessed/monitored on a regular basis during pregnancy. The usual interval between diagnostics is every 4-6 weeks. This will ensure a correct adjustments to the dosage and to monitor the effects mother and baby. 31. Complete the Antithyroid Case Study Question #1 and #2, found in Chapter 31, on p. 488: 1. What laboratory studies will be performed before drug therapy with propylthiouracil is started? Explain your answer. Baseline liver function tests, thyroid function tests and complete blood count with differential, to assess/monitor for the potential of adverse side effects and to direct therapy. 2. R.C. asks, “What do I need to know while I’m taking this drug?” List pertinent patient teaching points. Patient Education: The patient will need to know about how important it is for routine blood tests, assess/monitor signs/symptoms of liver dysfunction (jaundice, dark urine), signs/symptoms of agranulocytosis (sore throat, fever), medication adherence to maintain therapeutic levels as prescribed. The patient will also need to avoid foods that have a high level of iodine, like seafood and iodized salt. 32. Complete Critical Thinking Questions #1 and #2 found in Chapter 33, on p. 526: 1. A patient has been taking high doses of oral prednisone for 1 week because of an exacerbation of asthma symptoms. He is about to go home and is given a prescription for another week of prednisone therapy, but with doses tapering downward before the  NURS 3210 Pharmacology and Nursing medication is stopped. The patient asks, “Why do I need to bother with this drug if it’s only for a week? Can’t I just stop it now?” What is the priority when the nurse answers this patient’s questions? Explain your answer. The priority will be to educate on the importance of taper off to prevent adrenal insufficiency. A sudden stop of prednisone can result in a dangerous drop on cortisol levels. The patient will not have enough time to start creating their own after an abrupt stoppage. 2. A patient with type 2 diabetes mellitus will be receiving intravenous doses of methylprednisolone (Solu-Medrol) to prevent cerebral edema after a head injury from a fall. A nursing student is working with you as you prepare to give this medication. The student asks, “Isn’t this drug going to cause problems for this patient? Should we be giving it?” What priority do you consider when answering the nursing student? The nurse will also need to educate the patient on how prednisone can increase blood glucose levels. The benefits of inhibiting cerebral edema override the risks. The consistent assessment/monitoring of blood glucose is crucial. 33. Complete the Corticosteroid Case Study Questions found in Chapter 33, on p. 524. (You’ve answered these before, so there is no need to write your response here. Reading: Chapters 34 & 35 & NAMS article 34. Describe the basic physiologic functions of each of the following hormones for both males and females as appropriate and identify where the hormones are manufactured in the body. a. Follicle Stimulating Hormone (FSH): follicle-stimulating hormone: a peptide, produced by the anterior lobe of the pituitary gland, that regulates the development of the Graafian follicle in the female and stimulates the production of spermatozoa in the male. b. Luteinizing Hormone (LH): luteinizing hormone: a hormone produced by the anterior lobe of the pituitary gland that, in the female, stimulates maturation of the  NURS 3210 Pharmacology and Nursing ovarian follicle and formation of the corpus luteum: chemically identical to ICSH of the male. c. Estrogen: Any of several major sex hormones produced primarily by the ovarian follicles of mammals, capable of inducing estrus, developing and maintaining secondary female sex characteristics, and preparing the uterus for the reception of a fertilized egg: used, especially in synthetic form, as a component of oral contraceptives, in certain cancer treatments, and in other therapies. d. Progesterone: a commercial form of this compound, obtained from the corpus luteum of pregnant sows or synthesized: used in the treatment of dysfunctional uterine bleeding, dysmenorrhea, threatened or recurrent abortion. e. Testosterone: A commercially prepared form of the sex hormone C 19 H 28 O 2 , originally isolated from bull's testes and now also produced synthetically, used in medicine chiefly for treatment of testosterone deficiency and for certain gynecological conditions. 35. Explain how changes in FSH, LH, Estrogen, and Progesterone levels interact with the female menstrual cycle. FSH triggers follicle development, that will increase estrogen production. The increase in estrogen levels can trigger an increase in LH, resulting in ovulation. After ovulation the corpus luteum will create progesterone to sustain the uterine lining. If a pregnancy does not happen, the estrogen and progesterone levels will fall, resulting in menstruation. 36. What medications are typically used in the management of preterm labor and what are their basic mechanisms of action? Tocolytics will suppress uterine contractions. Nifedipine (calcium channel blocker), Indomethacin (NSAIDS) and Terbutaline (beta- agonist).  NURS 3210 Pharmacology and Nursing 37. What class of medication is used to promote fetal lung development, when preterm delivery is anticipated? Corticosteroids, Betamethasone or Dexamethasone are utilized to promote fetal lung maturity by triggering the production of surfactant. 38. All of the following drugs are uterine stimulants; describe the circumstances (context for use) and priority assessments before, during, and after administration of the following. Uterine Stimulant Indication Priority Assessments Oxytocin (Pitocin) Induction or augmentation of Assess/Monitor uterine labor, control of postpartum contractions, fetal heart rate, bleeding. and maternal vital signs. Prostaglandins Cervical ripening, labor Assess/Monitor uterine (dinoprostone, misoprostol) induction, and postpartum contractions, cervical hemorrhage. dilation, and maternal vital signs. Methylergonovine Control of postpartum Assess/Monitor blood hemorrhage. pressure (risk of hypertension), uterine tone, and bleeding. 39. Based on the NAMS 2022 HRT Position Statement, what are some contraindications for hormone replacement therapy (HRT), and what are some situations where its benefits may outweigh the risks? Contraindications: Patient history of breast cancer, unepected vaginal bleeding, intra uterine cancer, sever liver disease and active thromboembolic disorders. Benefits vs Risks: Menopausal women with symptoms, HRT may resolve vasomotor symptoms, enhance bone density, and enhance quality of life. 40. Compared to combined oral contraceptives, what are some benefits of progestin-only contraceptive therapies? What are some drawbacks? Benefits: Indication for women that are not able to take estrogen, can be utilized by breastfeeding mothers and minimal cardiovascular risks.  NURS 3210 Pharmacology and Nursing Drawbacks: Not as effective in the suppression of ovulation as compared to combination contraceptives. May initiate irregular bleeding, and may require stringent or strict medication adherence to prescribed dosing schedule. 41. Complete Critical Thinking Questions #1 and #2 found in Chapter 34, on p. 546: 1. A patient in her first pregnancy has spent 14 hours in labor and has made little progress. She is becoming exhausted, and the uterine contractions have decreased in strength. The patient is now receiving an oxytocin (Pitocin) infusion. During this infusion, the nurse will perform many assessments. What are the priorities during the assessments? The priorities are to monitor uterine contractions, mather’s vital signs, signs of uterine hyperstimulation and fetal heart rate. 2. The nurse is reviewing a cephalosporin prescription for a patient who has a severe sinus infection. The patient tells the nurse that she is taking a birth control pill and asks the nurse if there will be any problems with the antibiotic. What is the nurse’s best answer? Patient Education: Some antibiotics can decrease the effectiveness of oral contraceptives. The nurse can also educate the patient on the benefits of additional non hormonal contraceptives during antibiotic therapy. 42. A. What are anabolic steroids? Man made versions of testosterone that encourage muscle and bone growth. B. What effects lead to misuse/abuse of this type of drug? The desired effects of increased muscle mass/strength, improved physical appearance and improved athletic performance are the reasons for abuse. C. What are some serious adverse effects associated with their use? Cardiovascular issues, Liver damage, Psychiatric disorders, infertility, and secondary sexual characteristics alterations.  NURS 3210 Pharmacology and Nursing 43. What is BPH and what drug classes are effective in reducing symptoms of BPH and why? BPH: Nonmalignant (noncancerous) enlargement of the prostate gland. Also called benign prostatic hypertrophy. Alpha-blockers relax the prostate muscles and the 5-alpha-reductase inhibitors decrease prostate size by stopping hormone conversion. 44. What patient teaching should be provided for patients receiving topical preparations of testosterone therapies? Apply the topical on the shoulders or upper arms due to them being clean and dry skin areas. Wash hands directly after applying and avoid contact with others. Do not swim or shower for three or four hours after application to secure absorption. 45. Complete the Erectile Dysfunction Case Study Questions #1 and #2 found in Chapter 35, on p. 555: 1. What teaching is important for Mr. S. before he starts this medication? Patient education to avoid nitrates because of the risk of severe hypotension. 2. Eleven months later, Mr. S. is admitted to the emergency department with chest pains. After a thorough examination, including a cardiac catheterization, he is diagnosed with mild coronary artery disease and is started on isosorbide dinitrate, sustained-release, 40 mg every 12 hours. He is given a follow-up appointment with his physician in 1 week. A week later, Mr. S. is back in the emergency department after falling in his bathroom one evening. He said he suddenly felt “so dizzy” and everything went black. What went wrong? What do you think could have caused this syncope? The combined use of the PDE5 inhibitor and the nitrate isosorbide dinitrate (nitrate) was the cause of the substantial drop in blood pressure resulting in syncope and dizziness.  NURS 3210 Pharmacology and Nursing