Pharm: PUD, DB, Respiratory, Endo Module 4

Which medications treat PUD?

proton pump inhibitor (-prazole/pantoprazole)
histamine receptor antagonist (-tidine/famotidine/ranitidine)

PPI prevents/treats

stomach ulcers, peptic ulcer disease

Complications of PPI

PNEUMONIA, OSTEOPOROSIS and fractures, rebound acid hyper-secretion, hypomagnesemia,
C-DIFF

Which ppi complication is common in females?

osteoporosis and fractures

What should be monitored when taking a ppi?

GI bleed

What should be avoided when taking a ppi?

alcohol, steroids, and nsaids

labs for ppi

ast, alt, bun, creatinine

client education for ppi

- take in the morning
- notify provider of bleeding
- increase vitamin D and calcium

Histamine 2 receptor antagonists treat/prevent

- stomach ulcer (h.pylori), GERD, and heart burn

Complications of histamine 2 receptor antagonists

- GYNECOMASTIA and CONFUSION
- constipation, diarrhea, nausea
- decrease libido
- impotence
- lethargy, hallucination

Labs for H2RA

ast, alt, bun, creatinine

Pt education for H2RA

- long-term > maintenance dose, once a day until ulcer is filled

I am a class of drugs used for stomach ulcers that can cause pneumonia, osteoporosis, and C Diff.

proton pump inhibitors (-prazole)

I am a class of drugs used to prevent or treat stomach ulcers, GERD, and heartburn. I cause gynecomastia and confusion.

histamine 2 receptor antagonists (-tidine)

Rapid acting insulin: onset, peak, duration

onset: 15 - 30 min
peak: 30 min - 3 hrs
duration: 3 - 5 hrs

Short acting insulin: onset, peak, duration

onset: 30 min - 1 hr
peak: 1 - 5 hr
duration: 6 - 10 hr

Intermediate acting insulin: onset, peak, duration

onset: 1 - 2 hrs
peak: 4 - 14 hrs
duration: 14 - 24 hrs

Long term insulin: onset, peak, duration

onset: 1 - 4 hrs
peak: none
duration: 24 hrs

What does long acting insulin not have?

a peak >> continuous amount - non highs or lows >> not at risk for hypoglycemia

Priority action of long acting insulin

cannot be mixed w/other insulins

rapid-acting insulin name

lispro insulin

short-acting insulin name

regular insulin

Use of short-acting insulin

- to cover meals/before meals
- give when the meal tray is there

intermediate acting insulin name

NPH

How long does NPH last?

throughout the day

What does NPH solution look like?

cloudy

Long acting insulin name

glargine

Who can take insulin?

- mainly used for type 1 diabetes but can be used for type 2 if other methods are do not work
- hyperkalemia

Insulin complications

hypoglycemia, (70 mg/dL), hypokalemia, lipohypertrophy (rotate site)

Gradual s/sx of hypoglycemia

headache, tremors, weakness, lethargy, disorientation

Abrupt s/sx of hypoglycemia

cold and clammy (give them candy), tremors, dizziness, tachycardia, diaphoresis

Hyperglycemia 3Ps

polyurea, polyphagia, polydipsia

How to treat a conscious pt experiencing hypoglycemia?

15g/carb of oj, grape jucie, milk, glucose tabs

How to treat a unconscious pt experiencing hypoglycemia?

IM glucagon or IV glucose

safety alter for insulin

allow 50 mL of solution to flow through Iv tube to prevent insulin binding to the tube

Which drug is a 1st line DM type 2 oral anti-diabetic?

metformin

Indications for metformin

- type 2 diabetes w/ diet and exercise

If a patient taking metformin is having a procedure (involving contrast media), when should the pt. stop taking metformin?

- 24 to 48 hr before
- can take 48 hrs after surgery, only if BUN is normal

Metformin complications

GI, vitamin b12 and folic deficiency, lactic acidosis, hypoglycemia (NPO)

lactic acidosis s/sx

hyperventilation, myalgia, sluggishness, somnolence (50% mortality)

When should a pt hold metformin

if experiencing lactic acidosis

pt education for metformin

avoid alcohol

Which drug is a thyroid hormone?

levothyroxine

Indications for levothyroxine

hypothyroidism

Hypothyroidism s/sx

- hashimotos
- freezing > everything slowing down

Complications of levothyroxine

- overmedicated
- chronic over-treatment

Over-medicated levothyroxine s/sx

hyperthyroidism s/sx: TACHYCARDIA, anxiety, PALPITATIONS, heat intolerance, weight loss > report to provider

Chronic over treatment of levothyroxine s/sx

atrial fib and increased fractures (accelerated bone loss)

Nursing actions for levothyroxine

- lifelong drug, never discontinue, give before breakfast on an empty stomach, monitor tsh and t4
- obtain baseline vitals, height, weight

Priority alert for levothyroxine

do not change brands

Which drug is an adrenal hormone replacement?

prednisone

Indication for prednisone

- adrenal insufficiency > ADDISON'S DISEASE
- prevent inflammation

Complications of prednisone

OSTEOPOROSIS
ADRENAL SUPPRESSION
peptic ulcer
INFECTION
cushing syndrome
HYPERGLYCEMIA

adrenal suppression s/sx

fatigue, muscle weakness, weight loss, N/V

How to prevent adrenal suppression?

do not stop suddenly, taper dose

Which drug is an inhaled anticholinergic?

ipratropium (short-acting)

Indication for ipratropium

bronchospasm associated w/COPD
EXERCISE INDUCED bronchospasm

Anticholinergic effects

dry mouth and hoarseness
- can't see, can't pee, can't spit, can't poop
- mad a hatter, hot as a hare, dry as a bone, blind as a bat, red as a beet

Contraindications for ipratropium

peanut or soy allergy

Pt education for ipratropium

wash mouth after use

Indications of beclomethasone

- long-term prophylaxis of asthma > prevent inflammation in airways
- inhaled glucocorticoid

Complications of beclomethasone

candidiasis, difficulty speaking, hoarseness

Pt education for beclomethasone

- rinse mouth after each use to avoid thrush
- this is a maintenance drug so take even if no s/s
- monitor for white patches

Which drugs are antihistamines?

loratadine (2nd generation) and diphenhydramine (1st generation)

Complications of loratadine

sedation (LESS EFFECT), anticholinergic, GI, acute toxicity

What does loratadine and diphenhydramine treat?

seasonal allergies: relieves itching, sneezing, and runny nose

What can loratadine cause?

a false negative allergy test

Complication of diphenhydramine

SEDATION!, anticholinergic effects,

Pt education for diphenhyramine

avoid alcohol and driving > sedation effect

Which drug treats acute asthma attacks?

albuterol

Complications of albuterol

tachycardia, tremors, and sometimes chest pain

What is an expected finding of albuterol

mild tachycardia

What should be reported when taking albuterol?

increased heart rate greater than 20-30 bpm

Contraindication for albuterol

pt w/tachydysrhythmias

Pt education for albuterol

- take albuterol first then beclomethasone (glucocorticoid)
- avoid alcohol