NUR2474 Pharmacology for Professional Nursing – Examination Blueprint – Final Exam
Insulin: DM 1, DM 2, Gestational Diabetes – HYPOGLYCEMIA IS A DANGEROUS ADVERSE
EFFECT AND HIGH PRIORITY FOR TREATMENT
o What types of insulin are ordered before meals and at bedtime? Lispro and Regular; Lantus (hs, not
with meals) Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at
bedtime
o What type of insulin is sometimes given at bedtime, has the longest duration of all the insulins,
CANNOT BE MIXED WITH OTHER INSULINS, and for elderly patients is often split into two doses
(one in the morning and one at bedtime)? Insulin Glargine (Lantus) is usually given once a day at
bedtime. Elderly individuals often have their dose split in two and are administered one dose in the
morning and one dose at night; In addition, sometimes insulin lispro is given in a sliding scale with a
snack in the evening. It does not last throughout the night - that’s what we want to avoid.
*Insulin aspart protamine in combo with insulin aspart would NOT be given in the evening, as it
lasts too long.
*NPH would peak at exactly the WRONG TIME. Do not give that one at bedtime.
o Why is a nurse concerned for a beta-blocker/insulin combination? Beta Blockers can mask some of
the symptoms of hypoglycemia What do you assess for? What symptoms could be concealed by
taking a beta blocker while on insulin? Symptoms of hypoglycemia:
Feeling shaky.
Being nervous or anxious.
Sweating, chills, and clamminess.
Irritability or impatience.
Confusion.
Fast heartbeat.
Feeling lightheaded or dizzy.
Hunger.
You will need to know the following chart:
Onset: When the medicine starts to work (when the blood sugar is going to start to go down).
Peak: Usually when the medicine is at its highest level, and you get the highest effect (in this
case it equates to the times when you see the lowest blood sugars).
Duration: How long the medication is going to last in effectiveness (how long is it going to
affect blood sugars).
MOST ORAL ANTI-DIABETICS (ORAL HYPOGLYCEMICS): Type 2 Diabetes. Most do not work for
type 1 diabetes, do not risk it with babies we use regular insulin for gestational diabetes.
,Glipizide (Glucotrol):
o How does it work? is in a class of medications called sulfonylureas. Glipizide lowers blood sugar by
causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the
body) and helping the body use insulin efficiently.
o What diagnosis is it effective for? Type 2, less than 5 years, no end organ damage, young enough
o What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic,
o What are the side/adverse effects? Hypoglycemia, diarrhea.constipation, nausea, vomiting, upset
stomach, loss of appetite. Headache, weight gain,
o What are contraindications?
low blood sugar.
pituitary hormone deficiency.
a condition where the adrenal glands produce less hormones called Addison's disease.
glucose-6-phosphate dehydrogenase (G6PD) deficiency.
hepatic porphyria.
a type of blood disorder where the red blood cells burst called hemolytic anemia.
alcoholism.
o Are there drug-drug interactions? Do not take if allergic to sulfa
o Are there drug-alcohol interactions? Do not take with alcohol
o Are there drug-food interactions? Take with breakfast (this person will still need to be checking their
BS at least once a day)
Metformin:
o How does it work? works by reducing the amount of sugar your liver releases into your blood. It also
makes your body respond better to insulin.
o What diagnosis is it effective for? Type 2, less than 5 years, no end organ damage, young enough
o What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic
o What are the side/adverse effects? Can be harsh on end organs, esp. kidneys. It's best to take
metformin with a meal to reduce the side effects. IF SOMEONE IS GOING TO HAVE CONTRAST
FOR A CT: THE METFORMIN IS STOPPED PRIOR TO HAVING THE CONTRAST. If they are
taking metformin, and they come into an ER and a CT with contrast is ordered, do not blindly send
the patient to CT, LET THE PROVIDER KNOW AND THEY WILL ORDER IT WITHOUT
CONTRAST. Since it is so hard on the kidneys, drink plenty of water.
o What are contraindications? Kidney disease, heart attack; stroke; diabetic ketoacidosis (blood sugar
that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or
heart or liver disease
Acarbose:
o How does it work? What diagnosis is it effective for? by slowing the action of certain chemicals that
break down food to release glucose (sugar) into your blood. Slowing food digestion helps keep blood
glucose from rising extremely high after meals
o What classification(s) does it fit into? alpha-glucosidase inhibitors, which also includes miglitol
(Glyset); anti-diabetic, oral hypoglycemic agent
o What are the side/adverse effects? Diarrhea, flatulence
o What are contraindications? hypersensitivity, diabetic ketoacidosis, liver cirrhosis, inflammatory
bowel disease, or colonic ulceration
, o Are there drug-drug interactions? Avoid taking a digestive enzyme such as pancreatin, amylase, or
lipase at the same time you take acarbose.
o Are there drug-alcohol interactions? Do not mix, it may cause sudden hypoglycemia
o Are there drug-food interactions? Do not drink grapefruit juice
D50W: Emergency Med Given IV
o What diagnosis is it effective for? Direct Sugar for Body
o What classification(s) does it fit into? Hyperglycemic agent
o What are the side/adverse effects? Hyperglycemia
Glucagon: Emergency Med Given IM or SUBQ
o How does it work? What diagnosis is it effective for? Glucagon's role in the body is to prevent blood
glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the
conversion of stored glycogen (stored in the liver) to glucose, which can be released into the
bloodstream. This process is called glycogenolysis.
o What classification(s) does it fit into? Hyperglycemic agents
o What are the side/adverse effects? Hyperglycemia
Levothyroxine:
o How does it work? What diagnosis is it effective for? Hypothyroid. Works as hormone replacement.
o What classification(s) does it fit into? Thyroid hormone replacement therapy
o What are the side/adverse effects? Insomnia, tremors, increased heart rate (might be overtreatment, so
contact provider)
o What are contraindications? People with the following:
overactive thyroid gland.
thyrotoxicosis crisis.
diabetes.
pituitary hormone deficiency.
a condition where the adrenal glands produce less hormones called Addison's
disease.
osteoporosis.
a condition of weak bones.
decreased calcification or density of bone.
o What laboratory value is used to manage dosing and hypothyroidism management? TSH
o What time of day should a person take this medication and why? Early in am. Usually 6am. People
should really take this at least 30 minutes before breakfast.
o Are there drug-drug interactions and what are they? Heartburn medications (PPI, H2 blocker,
antacids) interact so talk to MD before taking them with Levothyroxine, Iron must be taken four
hours afterwards
o Why is this medication important for a hypothyroid patient while pregnant? To avoid the negative
neuro and psychiatric effects of not treating the hypothyroidism.
Sulfamethoxazole/Trimethoprim
o How does it work? Separately, they are only bacteriostatic; together, they are bactericidal.
o What diagnosis is it effective for? Really good for tough UTIs
o What classification(s) does it fit into? Sulfa antibiotics
Insulin: DM 1, DM 2, Gestational Diabetes – HYPOGLYCEMIA IS A DANGEROUS ADVERSE
EFFECT AND HIGH PRIORITY FOR TREATMENT
o What types of insulin are ordered before meals and at bedtime? Lispro and Regular; Lantus (hs, not
with meals) Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at
bedtime
o What type of insulin is sometimes given at bedtime, has the longest duration of all the insulins,
CANNOT BE MIXED WITH OTHER INSULINS, and for elderly patients is often split into two doses
(one in the morning and one at bedtime)? Insulin Glargine (Lantus) is usually given once a day at
bedtime. Elderly individuals often have their dose split in two and are administered one dose in the
morning and one dose at night; In addition, sometimes insulin lispro is given in a sliding scale with a
snack in the evening. It does not last throughout the night - that’s what we want to avoid.
*Insulin aspart protamine in combo with insulin aspart would NOT be given in the evening, as it
lasts too long.
*NPH would peak at exactly the WRONG TIME. Do not give that one at bedtime.
o Why is a nurse concerned for a beta-blocker/insulin combination? Beta Blockers can mask some of
the symptoms of hypoglycemia What do you assess for? What symptoms could be concealed by
taking a beta blocker while on insulin? Symptoms of hypoglycemia:
Feeling shaky.
Being nervous or anxious.
Sweating, chills, and clamminess.
Irritability or impatience.
Confusion.
Fast heartbeat.
Feeling lightheaded or dizzy.
Hunger.
You will need to know the following chart:
Onset: When the medicine starts to work (when the blood sugar is going to start to go down).
Peak: Usually when the medicine is at its highest level, and you get the highest effect (in this
case it equates to the times when you see the lowest blood sugars).
Duration: How long the medication is going to last in effectiveness (how long is it going to
affect blood sugars).
MOST ORAL ANTI-DIABETICS (ORAL HYPOGLYCEMICS): Type 2 Diabetes. Most do not work for
type 1 diabetes, do not risk it with babies we use regular insulin for gestational diabetes.
,Glipizide (Glucotrol):
o How does it work? is in a class of medications called sulfonylureas. Glipizide lowers blood sugar by
causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the
body) and helping the body use insulin efficiently.
o What diagnosis is it effective for? Type 2, less than 5 years, no end organ damage, young enough
o What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic,
o What are the side/adverse effects? Hypoglycemia, diarrhea.constipation, nausea, vomiting, upset
stomach, loss of appetite. Headache, weight gain,
o What are contraindications?
low blood sugar.
pituitary hormone deficiency.
a condition where the adrenal glands produce less hormones called Addison's disease.
glucose-6-phosphate dehydrogenase (G6PD) deficiency.
hepatic porphyria.
a type of blood disorder where the red blood cells burst called hemolytic anemia.
alcoholism.
o Are there drug-drug interactions? Do not take if allergic to sulfa
o Are there drug-alcohol interactions? Do not take with alcohol
o Are there drug-food interactions? Take with breakfast (this person will still need to be checking their
BS at least once a day)
Metformin:
o How does it work? works by reducing the amount of sugar your liver releases into your blood. It also
makes your body respond better to insulin.
o What diagnosis is it effective for? Type 2, less than 5 years, no end organ damage, young enough
o What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic
o What are the side/adverse effects? Can be harsh on end organs, esp. kidneys. It's best to take
metformin with a meal to reduce the side effects. IF SOMEONE IS GOING TO HAVE CONTRAST
FOR A CT: THE METFORMIN IS STOPPED PRIOR TO HAVING THE CONTRAST. If they are
taking metformin, and they come into an ER and a CT with contrast is ordered, do not blindly send
the patient to CT, LET THE PROVIDER KNOW AND THEY WILL ORDER IT WITHOUT
CONTRAST. Since it is so hard on the kidneys, drink plenty of water.
o What are contraindications? Kidney disease, heart attack; stroke; diabetic ketoacidosis (blood sugar
that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or
heart or liver disease
Acarbose:
o How does it work? What diagnosis is it effective for? by slowing the action of certain chemicals that
break down food to release glucose (sugar) into your blood. Slowing food digestion helps keep blood
glucose from rising extremely high after meals
o What classification(s) does it fit into? alpha-glucosidase inhibitors, which also includes miglitol
(Glyset); anti-diabetic, oral hypoglycemic agent
o What are the side/adverse effects? Diarrhea, flatulence
o What are contraindications? hypersensitivity, diabetic ketoacidosis, liver cirrhosis, inflammatory
bowel disease, or colonic ulceration
, o Are there drug-drug interactions? Avoid taking a digestive enzyme such as pancreatin, amylase, or
lipase at the same time you take acarbose.
o Are there drug-alcohol interactions? Do not mix, it may cause sudden hypoglycemia
o Are there drug-food interactions? Do not drink grapefruit juice
D50W: Emergency Med Given IV
o What diagnosis is it effective for? Direct Sugar for Body
o What classification(s) does it fit into? Hyperglycemic agent
o What are the side/adverse effects? Hyperglycemia
Glucagon: Emergency Med Given IM or SUBQ
o How does it work? What diagnosis is it effective for? Glucagon's role in the body is to prevent blood
glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the
conversion of stored glycogen (stored in the liver) to glucose, which can be released into the
bloodstream. This process is called glycogenolysis.
o What classification(s) does it fit into? Hyperglycemic agents
o What are the side/adverse effects? Hyperglycemia
Levothyroxine:
o How does it work? What diagnosis is it effective for? Hypothyroid. Works as hormone replacement.
o What classification(s) does it fit into? Thyroid hormone replacement therapy
o What are the side/adverse effects? Insomnia, tremors, increased heart rate (might be overtreatment, so
contact provider)
o What are contraindications? People with the following:
overactive thyroid gland.
thyrotoxicosis crisis.
diabetes.
pituitary hormone deficiency.
a condition where the adrenal glands produce less hormones called Addison's
disease.
osteoporosis.
a condition of weak bones.
decreased calcification or density of bone.
o What laboratory value is used to manage dosing and hypothyroidism management? TSH
o What time of day should a person take this medication and why? Early in am. Usually 6am. People
should really take this at least 30 minutes before breakfast.
o Are there drug-drug interactions and what are they? Heartburn medications (PPI, H2 blocker,
antacids) interact so talk to MD before taking them with Levothyroxine, Iron must be taken four
hours afterwards
o Why is this medication important for a hypothyroid patient while pregnant? To avoid the negative
neuro and psychiatric effects of not treating the hypothyroidism.
Sulfamethoxazole/Trimethoprim
o How does it work? Separately, they are only bacteriostatic; together, they are bactericidal.
o What diagnosis is it effective for? Really good for tough UTIs
o What classification(s) does it fit into? Sulfa antibiotics
