Unit 4 pharm

Thyroid and diabetes

What does the thyroid do for the body?

Controls our basal metabolic. Also helps with growth in children.

What does basal metabolic rate influence?

energy level, body temp, mood, sleep cycle, hair growth, skin, heart rate

What is basal metabolic rate?

baseline speed at which cells perform their function.

Hypothyroidism

not enough thyroid stimulating hormones or the thyroid hormones itself.

Lab Values to watch for with hypothyroidism

High TSH and low T3 and T4

s/s of hypothyroidism

dry skin/coarse hair, constipation, weight gain, cold, bradycardia, lathargic, muscle aches, low HR and RR, low LOC, myxedema coma

Thyroid replacement meds

levothyroxine- T4

Liothyronine- T3

Causes of hypothyroidism

Hashimotos disease, not enough iodine, pituitary tumor, radiation, thyroidectomy, overtreatment of hyperthyroidism

Hypothyroidism medication patient education

-take medication first thing in the morning on an empty stomach (30-60 min before breakfast)

-watch for s/s of hyperthyroidism

-check pregnancy status

-drug interactions (check with HCP before taking any other medications)

-do not stop abruptly

-lifelong drug

-takes about a month for full effect

hyperthyroidism

too much thyroid hormone being produced.

Hyperthyroidism Labs

Low TSH, High T3 and T4

Hyperthyroidism S/S

anxious, insomnia, nervous, tachycardia, palpitations, Hypertensive, diarrhea, hot flashes, exothalamus, goiter, thyroid storm

Medications for hyperthyroidism

methimazole, potassium iodide, radioactive iodide, propylthiourical (PTU)

Causes of hyperthyroidism

overtreatment of hypothyroidism, autoimmune disease (Grave's disease), tumor in the thyroid, iodine excess

hyperthyroidism patient education

-take TID

-make take up to 6-12 to fully work

-therapeutic effect can take up to 6-12 weeks

-watch for s/s of hypothyroidism

-drug interactions (consult HCP before taking any other medications)

-can be taken with food

hyperthyroisism treatments

radioactive iodine and thyroidectomy

how does radioactive iodine work

destroys thyroid gland cells. (stay away from people, pregnant women)

what are corticosteroids used for?

adrenocortical insufficiency and to dampen inflammatory and immune repsonse.

corticosteroid drugs

cortisone, hydrocortisone, methylprednisone, prednisone, dexamethasone

s/e of corticosteroids

high blood sugar, abnormal deposits, buffalo hump, muscle wasting and thin fragile skin, euphoria/jitters/insomnia, peptic ulcers, mask infections, increased risk for infections, moon face

corticosteroid patient education

-never abruptly stop medication, taper doses down (taper down over 1-2 weeks, sudden stopping can cause circulatory collapse and death)

-Monitor for GI bleeding

-Take medication with food in AM

-mood changes

adrenal disorders excess steroid

Cushing's Syndrome

adrenal disorders deficient steroid

Addison's Disease (can be caused by sudden/abrupt withdraw of steroid therapy)

Insulin

lowers blood sugar

Glucagon

raises blood glucose

what does glucose do for the body?

body's primary energy source

What does insulin do in the body?

allows glucose to leave the bloodstream and enter the cell for energy

Type 1 diabetes

body does not produce any insulin

type 2 diabetes

pancreas is not producing insulin like it should and cells are resisting.

S/S of type 1 diabetes

polyuria, polydipsia, polyphagia, elevated BS, elevated AIC, cold, clammy, tired, weight loss, slow healing wounds, blurry vision, sexual problems, vaginal infections, numb/tingling of hands or feet

Diabetes Ketoacidosis

when blood sugar is so high the patient goes into a coma.

normal blood sugar

70-110

Normal Hgb AIC

>7%, average of BS over three months

Rapid Insulin Drugs

lispro, aspart, glulisine

Rapid Insluin onset, peak, and duration

onset- 15 min; peak- 30min-3h; duration- 3-5h

short-acting onset, peak, duration

onset- 30-60min; peak- 1-5 hours; duration- 6-10h

What color should regular insulin be?

clear

intermediate acting insulin drugs

isophane (NPH)

intermediate acting insulin onset, peak, duration

onset- 1-2 hours; peak- 4-14 hours; duration- 14-24 hours

what color should intermediate acting insulin be?

cloudy, roll between hands don't shake

long acting insulin drugs

glargine (Lantus); detemir (Levemir)

long acting insulin onset, peak, duration

onset- 1-4h; peak- no peak; duration- up to 24h

long acting insulin rule

never mix long acting insulin, it's its own injection

s/s of hypoglycemia

sweating, blurry vision, dizziness, anxiety, hunger, irritability, shakiness, fast HR, headache, weak, fatigue

When is a patient at highest risk for hypoglycemia?

at peak insulin times

causes of hypoglycemia

too much insulin, wrong dose, wrong time, take insulin and not eat, more active than usual

causes for hyperglycemia

undiagnosed diabetes, poorly managed diabetes, not taking insulin and eating, not following diet, sickness, steroids, stress

where is glucagon stored?

liver

what kind of milk is okay to take with insulin?

skim milk- okay

whole milk- not okay

Causes of type 2 diabetes

sedentary lifestyle, familial tendency, average age 50 years, increased BP, fatigue, decreased energy, obese, recurrent infections, polyuria, polydipsia

most common age for type 1 diabetes

pediatrics

most common age for type 2 diabetes

adults

What are the steps in administering NPH and regular insulin for a patient?

Check your order, gather your supplies, wash your hands, identify patient with two identifiers, check patients blood glucose, alcohol the site you plan to inject, roll the NPH between your hands, inject air into cloudy and then into clear, draw out clear, draw out cloudy, check dose with a second nurse, inject insulin, document, wash your hands.

treatment of hypoglycemia

quick acting/simple sugar, 4oz oj, 4oz soda, 8oz skim milk, if pt goes unconscious give glucagon

Medications in the Biguanides Class

Metformin (Glucophage)

How does metformin work?

decreases hepatic production of glucose and reduces insulin resistance.

Metformin pt education

-most s/e minor and GI related

-hold 48 hours prior to and after IV contrast dye

How do sulfonylureas work?

Stimulate release of insulin from the pancreas. They also increase sensitivity of insulin receptors on target cells.

medications in the sulfonylureas class

glipizide and glimepiride

pt education for glipizide and glimepiride

s/e hypoglycemia

Medications in Meglitinides class

nateglinide (Starlix), repaglinide (Prandin)

How do meglitinides work?

act by stimulating release of insulin from pancreatic islet cells.

pt education for nateglinide and repaglinide

-short duration of action 2-4 hours

-s/e hypoglycemia

Alpha-glucosidase inhibitors class drugs

acarbose (Precose), miglitol (Glyset)

How do alpha-glucosidase inhibitors work?

block enzymes in the small intestine responsible for breaking down complex carbohydrates so carb digestion is delayed.

acarbose and miglitol pt education

most side effects are GI related, N/V/D

Medications in the Thiazolidinediones (Glitazones) class

Rosiglitazone (Avandia), pioglitazone (Actos)

How do thiazolidinediones (Glitazones) work?

decreasing insulin resistance and by inhibiting liver production of glucose

Rosiglitazone and pioglitazone pt education

-hepatoxic, fluid, and heart problems

-hypoglycemia does not occur

how does Incretin-glucose control mechanism work?

stimulate the pancreas to increase insulin secretion and the liver to stop making glucagon.

incretin-glucose control mechanism pt education

reduces appetite

incretin-glucose control mechanism drug

sitagliptin

pt education for antidiabetic drugs

-take same time daily, usually with meals

-lab testing: hemoglobin, AIC, liver function

-avoid alcohol

-monitor for hypoglycemia

-diet

-exercise