Pharmacology Exam 4

somatropin MOA

- used when a patient has a growth deficiency
- trying to make the patient grow taller and their organs grow bigger
- acs like a "fertilizer"

somatropin contraindications

- Closed epiphysis (if their bones are done growing they can take it; catch it earlier)
- Brain tumor (will cause the tumor to grow) can increase intercranial pressure
- Diabetic retinopathy

somatropin adverse reactions

- Hyperglycemia
- Muscle pain
- Headache
Mild edema

somatropin nursing considerations

- Pt would be on continuous glucose monitor
- Injected medication (looks clear and is given IM in (ex.) the vastus lateralis)
- Swirl medication, don't shake it
- Needs to be refrigerated
- Rotate sites
- LABS: Cr, LFT, serum and urine calcium levels

octreotide MOA

- given to patients to keep them from growing too tall
- want to prevent a large heart and large organs in this patient
- inhibits serotonin release

octeotride precautions/contraindications

Interact w drugs that prolong the UT interval

octeotride adverse reactions

- Hepatotoxicity
- Headache
- Fatigue
- Dizziness
- Heart failure
- Bradycardia

octeotride nursing considerations

- Pt has to get 50% of the dose
- Need an accurate list of meds
- Given IM or in a pill (ampule- have to break the pill; it is glass so be careful)
- Has to be refrigerated
- Taken in between meals

demopressin MOA

- Causes vasoconstriction to help them not pee a lot
- Pt loses electrolytes (sodium) with the water that they lose

demopressin adverse reactions

Hyponatremia (black box warning)

demopressin nursing considerations/lab assessment

- Used intranasally
- Can be given to kids for bed wetting
- Look for confusion in the patients
- STRICT I&Os (tells if the medication is working)
- should see a decrease in urination
- if the pt has heart failure with this they have to weight themselves
- LABS: serum sodium, Cr, LFT

corticosteroids

- hydrocortisone
- prednisone
- triamcinolone

prednisone

most common/most administered corticosteroid

dexamethasone

high potency

corticosteroids adverse reactions

- Insomnia
- Peptic ulcers
- Nonhealing wounds
- Diplopia, blurry vision
- Myopathy
- Hypertension (sodium retention)
- Moon face (due to fluid retention)
- Buffalo hump (due to fluid retention)
- Tachycardia
- Skin changes
- Petechiae
- Hyperpigmentation
- Menstrual issues
- Cushing's like syndrome (goes away when medication is stopped)
- Causes growth suppression in children
- Hyperglycemia
- Makes patients extremely HUNGRY

corticosteroids nursing considerations

- Don't take if they have profound GI disease, osteoporosis (can exacerbate), schizophrenia, or psychosis of any kind (can exacerbate the condition), diabetes
- Pt should not be around sick people
- Cannot have live vaccines or toxoids
- Take with food in the MORNING
- Behavioral changes: People generally aren't happy, can cause anxiety, more emotionally labile
- Check BS
- ACUTE: Do not abruptly stop the medication especially if they are on a taper because their adrenal gland is not working properly and won't be releasing cortisone it should
- CHRONIC: For someone who is taking it for a longer time, take it every OTHER day so that their adrenal gland doesn't fall asleep; it is safer
- Check their weight and BP every day
CMP, Cr, LFT

levothyroxine

- used to treat hypothyroidism
- When a pt has hypothyroidism, they have a HIGH TSH
- hypothyroidism S/S: wt gain, low HR, low BP, constipation, edema, apathy, intolerant to cold

levothyroxine client teaching

- Taken in the morning on an empty stomach with water or juice (no milk)
- Need to wait at least 30 min before they eat
- Should not be switching from brand to generic pills or pharmacy to pharmacy drugs (can effect TSH)
- If pts TSH is high ask them first if they are taking their meds, if they are taking it in the morning, if they switched pharmacies, etc.
- Relief/feel better in 5-7 days, 4-6 weeks for their labs to look better though
Usually start with 25 micrograms

levothroxine labs

- TSH (0.5-4.5!)
- want pt to be in between 2-3, free T4

levothyroxine adverse reactions

- The signs and symptoms of HYPERthyroidism are the adverse effects of HYPOthyroidism because it means that the pt was given too much levothyroxine\~~~increased HR, increased temp, diarrhea, HTN, tremors, anxiety, insomnia, intolerance to heat

propylthiouracil (PTU) and methimazole

- Making too much thyroid hormone
- When a pt has hyperthyroidism, they have a LOW TSH
- Taken longterm (more chronic): methimazole
- Used for surgery: PTU

propylthiouracil (PTU) and methimazole patient teaching

- Pt will be given levothyroxine after surgery because it has been removen
- TSH (0.5!-4.5)- want pt to be in between 2-3, free T4, CBC, LFT

PTU and methimazole adverse effects

The signs and symptoms of HYPOthyroidism are the adverse effects of HYPERthyroidism because it means that the pt was given too much PTU or methimazole: wt gain, low HR, low BP, constipation, edema, apathy, intolerant to cold

Cortef/solu-cortef

used for addisons disease

Cortef/solu-cortef patient teaching

- Need to take the medication forever
Can make them look like they have cushings

ketoconazole

used for cushings disease

ketoconazole client teaching

- Need to take forever
- Look like an Addison's pt if they get too much
- No alc
- LABS: LFT

corrective factor insulin (sliding scale insulin)

supplemental insulin that can be given under certain circumstances; standing order

rapid-acting insulin (aspart, lispro, glulisine)

onset: 15 minutes
- peak: 1 hour
- duration: 3 - 5 hours
- administration: 5-15 min before a meal or within 20 min after starting a meal (glulisine)
- compatibility: can give with NPH give (aspart, lispro, glulisine) drug first immediately

short acting insulin (insulin regular)

- onset: 30-60 min
- peak 2-4 hours
- duration: 5-7 hours
- administration: subQ, 30-60 min before a meal; IV (only one that can be given IV because it is long acting and will lower the pts BS- for pts who have DKA)
- compatability: Can mix with N P H, sterile water, or normal saline; do not mix with glargine

intermediate acting insulin (NPH)

- onset: 1-2 hours
- peak: 4-12 hours
- duration: 18-24 hours
- administration: subcutaneous; 30 min before first meal of the day, and 30 min before supper,
- compatibility: can mix with aspart, lispro, or regular; do not mix with glargine
*cloudy looking*

long acting insulin (detemir, glargine)

- onset: gradual over 24 or begins at 1.1hr (glargine)
- peak: 6-8 hours, no peak (glargine)
- duration: over 24 hours
administration: Subcutaneous; with evening meal or at bedtime (demetir), ; once daily, given at the same time each day (glargine)
- compatibility: dont mix with any other insulin

Major adverse effect of insulin

- hypoglycemia
- CHECK BS before giving sugar
- Cool clammy skin, confused
- A1C should be below 7

drawing up insulin

Nancy Reagan RN
- air into NPH
- air into Regular
- draw up Regular
- draw up NPH

sulfonylureas

glyburide, glimepiride

sulfonylureas (glyburide, glimepiride) MOA

Increases insulin secretion in pancreas

sulfonylureas (glyburide, glimepiride) precautions

sulfa allergy

sulfonylureas (glyburide, glimepiride) adverse reactions

hypoglycemia

sulfonylureas (glyburide, glimepiride) patient teaching

Teach pt to report or check their BS when they are experiencing signs of diaphoresis

alpha-glucosidase inhibitors (acarbose)

acarbose

alpha-glucosidase inhibitors (acarbose) MOA

- Delays digestion of carbs
- used for patients whose BS spikes then drops abruptly continuously; the drug allows the pt to reach a plateau
*Can be used in T1DM*

alpha-glucosidase inhibitors (acarbose) precautions

- Diabetic gastrophoresis
- Renal impairment
- Liver disease

alpha-glucosidase inhibitors (acarbose) adverse reactions

- Bloated
- Gassy
- Diarrhea
- Liver disease

alpha-glucosidase inhibitors (acarbose) nursing considerations

- Can be taken by both type 1 and type 2
- Take 3 times a day wth the first bite of every meal
- Don't take the drug if you are not eating

biguanides

metformin

biguanides (metformin) MOA

Reduces production of glucose by the liver & decreases intestinal aborption of glucose

biguanides (metformin) precautions

- Renal failure or any kidney problems
- Infection
- Trauma
- Are getting surgery
- Major stress (cortisol needs glucose to work and metformin decreases BS impairing cortisol production/fight or flight)

biguanides (metformin) adverse reactions

- Profound diarrhea
- Lactic acidosis (report dark urine, fever, kussumal respirations)

biguanides (metformin) nursing considerations

- Can be given extended release (at night time only) or immediate release (morning and evening)
- Has to be stopped 24-48 hrs before any iodine containing tests (contrast dye): CT, MRI, etc

thiazolidineodiones

rosiglitazone

thiazolidineodiones:
(rosiglitazone) precautions

CHF

thiazolidineodiones
(rosiglitazone) MOA

- Liver issues
- Diarrhea
- SOB
- Rhinitis (runny nose
- Peripheral edema
- Pts with cardiac issues will retain water

thiazolidineodiones
(rosiglitazone) patient teaching

- Helps release stored insulin which only type 2 have
- LABS: LFT

meglitinides

repaglinide

meglitinides (repaglinide) MOA

Closes K+ channels in the pancreas resulting in insulin release (still has to be able to make insulin in the pancreas)

meglitinides (repaglinide) adverse effects

- Hepatotoxic
- Hypoglycemia

meglitinides (repaglinide) nursing considerations

- do a fingerstick
- LABS: LFT

DDP Inhibitors

- Sitagliptin
- Saxagliptin

DDP Inhibitors (Sitagliptin, Saxagliptin) MOA

Inactivates the breakdown of incretin mimetics and simulates insulin production as a result of a meal (must be able to make insulin in pancreas)

DDP Inhibitors (Sitagliptin, Saxagliptin) LABS

- LFT
- Amylase, lipase

DDP Inhibitors (Sitagliptin, Saxagliptin) adverse effects

- Pancreatitis
- hypoglycemia

incretin mimetics

Exenatide, liraglutide

incretin mimetics (exenatide, liraglutide) MOA

Slows gastric emptying, stimulates release of insulin, inhibits post-prandial release of glucagon

incretin mimetics (exenatide, liraglutide) adverse effects

- pancreatitis
- fluid retention and weight gain

incretin mimetics (exenatide, liraglutide) patient teaching

- Expensive
- Comes in a pen
- Injected subQ
- Change eating habits: smaller more frequent meals
- Start exercising
- OZEMPIC AND WIGOVEE: taken once a week for weight loss
- LABS: amylase and lipase

patho of type 1 DM

beta cell destruction leading to absolute insulin deficiency

patho of type 2 DM

- genetic factors
- sedentary lifestyle
- obesity
- physical inactivity

hypergylcemia

hot and dry

hypoglycemia

cool and clammy, confused, tachycardia

capillary blood glucose

- direct measure of the amount of glucose (sugar) in blood
- 70-100
- used in the moment

A1C

- blood test that measures glycosylated hemoglobin (HbA1c) to assess glucose control
- used for monitoring

GERD ans PUD

- Acid reflux, weak sphincter, esophagus perforation\=worse consequence, know the different bleeds from different GI areas
- Avoid spicy food and acidic foods and avoid large amounts of food
- Sit up for about an hour after eating
- NO ALCOHOL or SMOKING

GERD and PUD drugs

- H2 antagonists (cimetidine, famotidine)
- PPI (-prazole drugs)
- sulcrafate
- misoprostol

H2 antagonists

cimetidine, famotidine

H2 antagonists (cimetidine, famotidine) precautions

People who have allergies

H2 antagonists (cimetidine, famotidine) adverse effects

- Crosses the blood brain barrier causes CNS symptoms (seizures, etc)
- Diarrhea or constipation
- Headaches
- Fatigue
- Gynecomastia in men (cimentidine only)

H2 antagonists (cimetidine, famotidine) nursing considerations

- Taken before they eat (30 minutes)
- Know what GI bleeding looks like from the mouth to the rectum
- Used for GERD
- Can be used for really bad allergic reactions
- OTC
- LABS: AST/ALT, Cr, CBC

PPI

-prazole
- Ex. Ameprazole

PPI (-prazole) MOA

Used for people with ulcers mainly but can be used for GERD

PPI (-prazole) adverse effects

- Premature osteoporosis
- Dysphasia
- Gastric cancer
- Vitamin absorption issues

PPI (-prazole) nursing considerations

- Pt will not get immediate relief
- Causes irreversible changes with the stomach gastric acid
- Taken long term but not intended for it to be
- Has to be taken on empty stomach so that it
- doesn't interact with anything
- Don't crush pills or open them; meant to be taken one time as an extended release
- Will need a dexa scan while on this medication
- When given IV, have to use an IV filter
- Take a vitamin multisupplement
- LABS: AST/ALT, Cr, CBC

sulcrafate MOA

- Given only to a patient who has an active, identified ulcer
- Combines with the mucous membrane to protect the person when they are eating and prevent more acid from getting in

sulcrafate nursing considerations

- Liquid drug (finds the ulcer and attaches itself to it)
- Taken for 4 weeks
- Works for 6 hours at a time
- Meds have to be taken 2 hours before they take this medication
- Taken 4x a day, 30 min before each meal
- Increase fiber and fluids
- no labs; doesn't go into the bloodstream

misoprostal MOA

Have an ulcer that they got from NSAIDS or aspirin

misoprostal precautions

category x

misoprostal adverse effects

- Abdominal cramping
- Diarrhea
- Causes a bad menstrual cycle

misoprostal nursing considerations

- Can't take it if you are pregnant (will induce miscarriage)
- Use birth control!!!
- The higher the dose the worse the symptoms
- LABS: AST/ALT, Cr, CBC

antacids

- Liquid form or chewy form
- TUMS
- Causes metabolic alkalosis

perforation s/s

- Abdominal pain
- Hard like abdomen
- Diminished bowel sounds
- Hypotensive (bc bleeding a lot)
- tachy

aluminum hydroxide and calcium carbonate

- promote constipation
- need to increase fluids and fiber
- LABS: AST/ALT, Cr

antacids drugs

aluminum hydroxide, magnesium hydroxide, calcium carbonate

magnesium hydroxide (milk of magnesia)

- promotes diarrhea
- LABS: AST/ALT, Cr

H. pylori

- associated with PUD
- usually treated with a combination of antibiotics to decrease antibiotic resistance
- triple therapy: antibiotics, PPI, bismuth subsalicylate

bismuth subsalicylate (pepto bismal) precautions

asprin allergy

bismuth subsalicylate (pepto bismal) adverse effects

- Black tongue (will go away after med is stopped)
- Black stools (will go away)

bismuth subsalicylate (pepto bismal) nursing considersations

- Used 3-4 times a day everyday
- can be used to treat diarrhea
- LABS: AST/ALT, Cr

NV drugs

- serotonin receptor antagonists
(Ondansteron)
- Phenothiazines (Prochlorperazine, Metoclopramide)
- Antihistamine/Anticholinergic (Meclizine, Hydroxyzine, Scopolamine)

serotonin receptor antagonists

Ondansteron (Zofran)

serotonin receptor antagonists
(Ondansteron) adverse effects

- Serotonin syndrome
- Hyperthermia (103,104,107, etc)
- Delirium
- Confusion
- Hyperreflexia
- Muscle jerking (Myoclonus)
- Tachy
- NVD
- Decreased level of consciousness (coma)
- Extra pyremital symptoms (EPS)-uncontrolled muscle movements (pill rolling)

serotonin receptor antagonists
(Ondansteron) nursing considerations

- RAPID onset (of serotonin syndrome)
- LABS: AST/ALT, Cr