RP

Vocabulary flashcards from Prader-Willi, thyroid, diabetes, and insulin therapy notes

Prader-Willi syndrome (PWS) and somatropin therapy

  • Context: PWS is a genetic disorder in which growth hormone (somatropin) may be prescribed to improve growth, body composition, and overall development.
  • Teaching point from transcript: The parent states, “We will use a different spot for injection each time we give the medication.”
    • Indicates understanding of the need to rotate injection sites.
    • Rationale for rotation: prevents lipodystrophy and tissue damage at repeated sites; maintains absorption consistency; track site used and keep a schedule for rotation.
  • Additional considerations (broad clinical context): monitor growth response and IGF-1 levels; watch for potential adverse effects (e.g., edema, scoliosis progression, glucose intolerance) and contraindications (e.g., active malignancy). Coordinate with pediatric endocrinology for dosing and monitoring.

Propylthiouracil (PTU) adverse effects in hyperthyroidism treatment

  • Question context: A nurse instructs a client starting PTU to treat hyperthyroidism to report adverse effects.
  • Correct adverse effects to report (select all that apply):
    • sore throat
    • joint pain
    • rash
  • Rationale for each:
    • Sore throat: could indicate agranulocytosis or infection; agranulocytosis is a rare but serious adverse effect requiring immediate evaluation (CBC monitoring if symptoms develop).
    • Joint pain: can reflect hypersensitivity or inflammatory reactions; warrants assessment and reporting.
    • Rash: may indicate hypersensitivity or allergic reaction; requires assessment.
  • Additional notes on PTU safety (general context): monitor for signs of liver toxicity and fever, malaise, or abdominal pain; educate about reporting any unusual symptoms promptly; consider baseline and periodic liver function tests and CBCs as per protocol.

Metformin-associated lactic acidosis and muscle pain

  • Question context: A client on metformin reports muscle pain; which adverse reaction should the nurse suspect?
  • Correct answer: lactic acidosis
  • Key points about lactic acidosis with metformin:
    • Mechanism: metformin reduces hepatic gluconeogenesis and can, in rare cases, lead to lactic acid buildup when efficacité of lactate clearance is impaired.
    • Clinical signs of lactic acidosis to monitor for: malaise, abdominal discomfort, weakness, rapid breathing (tachypnea), dizziness, hypotension, and confusion; elevated lactate with an anion-gap metabolic acidosis on labs.
    • Risk factors and situations to exercise caution: renal impairment (reduced clearance of metformin), hepatic impairment, congestive heart failure, hypoxic states, dehydration, excessive alcohol use.
    • Action if lactic acidosis suspected: discontinue metformin immediately; provide supportive care; consider bicarbonate therapy if indicated; aggressive hydration; in severe cases, dialysis may be needed.
  • Practical nursing implications: assess for symptoms beyond muscle pain (e.g., hyperventilation, fatigue); verify renal function (creatinine clearance or eGFR); educate on when to hold metformin (e.g., before procedures with contrast media or significant illness) and when to contact healthcare provider.

Insulin glargine and concomitant beta-adrenergic blockers

  • Question context: A nurse identifies the need for precautions because the client also takes beta-blockers.
  • Key interaction: Beta blockers (especially nonselective ones) can mask early signs of hypoglycemia and may complicate recognition by the patient.
  • Why this matters for insulin therapy:
    • Beta-blocker effects can blunt typical adrenergic symptoms of hypoglycemia (tremor, palpitations, anxiety), potentially delaying recognition and treatment of low blood glucose.
    • They may also blunt glycogenolysis and gluconeogenesis responses in the liver, potentially increasing the risk or severity of hypoglycemia in the setting of insulin use.
  • Nursing implications:
    • Emphasize frequent self-monitoring of blood glucose (SMBG) and auscultation for non-adrenergic hypoglycemia symptoms (e.g., confusion, diaphoresis).
    • Educate patient on recognizing alternative hypoglycemia cues and ensuring carry emergency glucose sources.
    • Coordinate with the prescriber about timing and dosing interactions; consider closer glucose monitoring when starting or changing beta-blocker regimens.

Pramlintide with regular insulin: peak action timing and hypoglycemia risk

  • Question context: A patient with type 1 diabetes mellitus receives pramlintide and regular insulin at 0800. The question asks when pramlintide is expected to peak and increase hypoglycemia risk.

  • Provided answer in transcript: 1100

  • Mechanism and clinically relevant details about pramlintide:

    • Pramlintide is an amylin analog administered mealtime to slow gastric emptying, suppress glucagon secretion, and promote satiety; it helps reduce postprandial glucose excursions.
    • When used with mealtime insulin, pramlintide can increase the risk of hypoglycemia, particularly during periods of maximal pramlintide effect and insulin activity.
    • Dosing considerations: start pramlintide with a reduced insulin dose (often around 50% reduction in mealtime rapid-acting insulin) and adjust based on glucose monitoring; administer pramlintide subcutaneously before meals, ensuring dosing separation from insulin as recommended by guidelines.

  • Peak action timing (contextualized to the provided scenario):

    • In the scenario described, the peak action and associated increased hypoglycemia risk are indicated at (1100), i.e., 3 hours after the 0800 dosing (
      note: pramlintide action is most impactful when insulin action is present to lower postprandial glucose and can contribute to hypoglycemia during overlapping activity). This reflects the exam item’s stated peak timeframe.

  • Nursing implications and patient education:

    • Monitor for signs of hypoglycemia, especially during the hours after morning dosing when pramlintide and insulin actions overlap.
    • Educate on timing: pramlintide should be taken with meals before eating; ensure patient understands the administration sequence relative to insulin dosing.
    • Reinforce the need for SMBG before meals and up to several hours afterward to detect hypoglycemia.
    • Adjust insulin dosing as prescribed when starting pramlintide to minimize hypoglycemia risk.

  • Connections and practical relevance:

    • These questions emphasize core nursing priorities: safe drug administration, recognition of adverse effects, drug-drug interactions, and appropriate patient education to prevent complications.
    • They illustrate the importance of understanding pharmacodynamics (onset, peak, duration) and how combinations of agents (e.g., insulin with pramlintide or beta blockers with insulin) influence safety and effectiveness.