NUR2474 Pharmacology for Professional Nursing – Examination Blue Print – Final Exam Rasmussen College

NUR2474 Pharmacology for Professional Nursing – Examination Blue Print – Final Exam Rasmussen College Insulin: DM 1, DM 2, Gestational Diabetes HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH PRIORITY FOR TREATMENT 1. What types of insulin are ordered before meals and at bedtime? Lispro and Regular are not ordered before bedtime; Lispro and Regular are usually given before meals; Lantus is given before bedtime; In the elderly especially, lantus is sometimes split into a morning and evening dose. Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at bedtime; NPH is often given only in the morning. 2. 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 doesn’t 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. 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, Don’t 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 (be specific)? 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, ipation, nausea, vomiting, upset stomach, loss of appetite. Headache, weight gain, o What are contraindications? o low blood sugar. o pituitary hormone deficiency. o a condition where the adrenal glands produce less hormones called Addison's disease. o glucose-6-phosphate dehydrogenase (G6PD) deficiency. o hepatic porphyria. o a type of blood disorder where the red blood cells burst called hemolytic anemia. o alcoholism. o o Are there drug-drug interactions? o 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 o Please note that 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 (be specific)? 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 (be specific)? 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 very 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 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? No grapefruit juice D50W Emergency Med Given IV o How does it work? What diagnosis is it effective for (be specific)? 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 (be specific)? 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 (be specific)? 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? o Who should not take Levothyroxine Solution? • 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, T3, T4 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 the hypothyroidism. Sulfamethoxazole/Trimethoprim o How does it work? Separately, they are only bacteriostatic; together, they are bactericidal. What diagnosis is it effective for (be specific)? Really good for tough UTIs o What classification(s) does it fit into? Sulfa antibiotics Does this classification have many look alike/sound alike drugs? Yes. Many have the “sulfa” prefix o What are the side/adverse effects? Decreased appetite, N/V, painful or swollen tongue/spinning sensation, ringing in your ears, feeling tired, kidney stones o What prefix tells you this belongs to the classification it is in? Sulfamexazole o Why does one teach patients to drink plenty of water with this? To prevent the formation of kidney stones. Cephalexin, Cefoxitin: o How does it work? bactericidal and have the same mode of action as other β-lactam antibiotics (such as penicillins), but are less susceptible to β-lactamases. Cephalosporins disrupt the synthesis of the peptidoglycan layer forming the bacterial cell wall. o What diagnosis is it effective for (be specific)? Strep (and other infections) o What classification(s) does it fit into? Cephalosporins Does this classification have many look alike/sound alike drugs? Many of these start with ceph and cef and are famous for error because of the look alike/sound alike issue. o What are the side/adverse effects? N/V/D o How does it interfere with warfarin? Cephalexin causes warfarin levels to be higher and make the INR even higher. This may mean that the warfarin needs reduction while on cephalexin, but the provider will look at the INR before making this determination. Anticipate this, so that it can be watched closely. o Why is it important to observe for side effects if someone has had an allergic reaction to penicillins? This is not a penicillin. Observe them. Sometimes, a cross allergy can occur. Metronidazole: o How does it work? What diagnosis is it effective for (be specific)? This is given for C. Diff (clostridium difficile) which is often induced by other antibiotics like cephalosporins, penicillins, etc…. When the c. diff infection starts, they discontinue the other antibiotic and can start one on metronidazole. o What classification(s) does it fit into? Nitroimidazoles o What are the side/adverse effects? Dizziness, headache, stomach upset, nausea, vomiting, loss of appetite, diarrhea, constipation, or metallic taste in your mouth may occur o Can it be mixed with alcohol? Why or why not? No. Effects of this can include a sudden drop in blood pressure, rapid heart rate, and liver damage. Acyclovir: o How does it work? Antiviral What diagnosis is it effective for (be specific)? Herpes o What classification(s) does it fit into? Antiviral (many of these end with the suffix –vir) o What are the side/adverse effects? Serious: Kidney Failure, Hepatitis…Common:Agitation, Diarrhea, Dizziness, Drowsiness, Hair Loss, Headache, Irritation Of The Stomach Or Intestines, Muscle Pain, Nausea, Stomach Cramps, Vomiting o Pregnancy implications? Can be used during pregnancy. The risk of passing it on to baby is high the control of an outbreak reduces that risk. Nephrotoxicity (labs that indicate kidney function: creatinine, BUN). How can one decrease the risk of kidney damage while on this medication? Hydrate the client for two full hours after the infusion to reduce the risk of kidney damage. Amoxicillin How does it work? β-lactam antibiotics disrupt the synthesis of the peptidoglycan layer forming the bacterial cell wall.