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LaGuardia Community College City University of New York Practical Nursing Program DRUGS AFFECTING THE ENDOCRINE SYSTEM SCL 103_Worksheet #4 By Anaïse Ikama Rosemarie Mayne Catherine Majorie Joseph Charles Lavern Simms Juna Lucas Zoya Poltilov Kadian Green Majorie Johnson DRUGS AFFECTING THE ENDOCRINE SYSTEM INSULINS AND ORAL HYPOGLYCEMIC AGENTS 1. Diabetes mellitus is a disease that causes abnormal metabolism of: -Kidneys -Nerves Heart and blood vessels 2. “Insulin-dependent diabetes” (IDDM) is also known as: IDDM is also referred to as a type 1 diabetes or juvenile diabetes. 3. “Type II diabetes” is also known as: A type 2 diabetes is also known as a non-insulin-dependent diabetes mellitus or adult-onset diabetes. 4. “Gestational diabetes” (GDM) is: “Gestational diabetes” is a type of diabetes that occurs during pregnancy and disappears on delivery. 5. “Hypoglycemia” is: low blood glucose, under 70mg/dl. 6. “Hyperglycemia” is high blood glucose. 7. “Polydipsia” is excessive thirst. 8. “Polyuria” is excessive urination. 9. The dietary prescription for a person with diabetes mellitus, according to the American Diabetic Association (ADA), should be composed of: According to the American Diabetic Association (ADA), the dietary prescription for a person with diabetes mellitus should be composed of: 60-70% carbohydrates, 30% fats 15-20% proteins. 10. 11. What is the source of endogenous insulin? What are the primary animal sources of exogenous insulin? The endogenous insulin derived from the beta cells in the pancreas. And the primary animal sources of exogenous insulin are pork and beef. What methods are used to produce human exogenous insulin? 2 The human exogenous insulin are commercially prepared by changing the different amino acid of pork insulin or by using deoxyribonucleic acid (DNA) technology. 12. Why can’t insulin be administered orally? Insulin cannot be administered orally because digestive enzymes destroy their effectiveness. 13. Do exogenous insulin differ in terms of onset, peak, and duration of action? Describe the differences. -The rapid-acting exogenous insulin includes lispro and regular insulins. Lispro insulin is a rapid-acting insulin…[is characterized as clear and colorless. Lispro has an immediate onset in 5 to 15 minutes after administration, a peak of effect occurs in 30 to 1 hour and the duration of action 2 to 4 hours. Whereas, the regular insulin has an onset in 0.5 to 1 minute, a peak of 2-4 hours and duration of action is 5-7 hour. -Short-acting insulin has an onset of action in 30 minutes to 1 hour. The peak of action occurs in 2-4 hours, and the duration of action is 6-8 hours. -Intermediate-acting insulins such as neutral-protamine-Hagedorn (NPH) and Humulin N, which contain a protein that prolongs the action of the insulin, have onset of action in 1-2 hours, peaks in 14-20 hours and the duration of 18-24 hours. -A long-acting insulin is Humilin U, and is absorbed slower than other insulins because of its large crystals, which dissolve slowly. Therefore, prolonging the durationtime. Long acting insulin acts in 4-8 hours, peaks in 14-20 hours and lasts 24-36 hours. -“A newer long-acting, Lantus… is the first long-acting recombinant DNA (rDNA) human insulin approved by the Food and Drug Administration (FDA) for clients with types 1 and 2 diabetes. It has a 24 - hour duration of action…” (Pharmacology book. Page 778). 14. What does “U 100” mean? “U-100” mean 100 units per milliliter, is also strength insulin commonly used in the United States. 15. What kind of a syringe is used to measure U-100 insulin? A 1-milliliter syringe is used to measure U-100 insulin. 16. Why is it important to teach the patient to rotate insulin sites? 3 Rotating insulin injection sites is important because it keeps skin and tissues healthy also prevent lipodystrophy (a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue). 17. What effects does the long-term use of one site for inject have on insulin absorption? The site needs to be rotated, if not it will become irritated, and may become infected, the area may also become so harden that it will be impossible to use. 18. With an increase in activity and exercise, what adjustment may be required .in the insulin dose? With an increase in activity and exercise, the clients must make appropriate insulin adjustments based on blood glucose level. 19. When are patients who are receiving fast-acting, intermediate-acting, or extended-action insulin most likely to develop hypoglycemia? Fast –Acting Intermediate –Acting Extended -Acting Onset: 1-2 hrs. Peak effect: 4-12 hrs. Duration: 24 hrs. Onset: 1-3 hrs. Peak effect: 6-14 hrs. Duration of effect: 24 + Onset: 6 hrs. Peak effect: 17-18 hrs. Duration: 36 hrs. 20. When are blood or urine test for glucose performed in relation to the time of insulin administration? In relation to the time of insulin administration, blood and urine need to be checked every 4 to 8 hrs. 21. Differentiate between the symptoms of hypoglycemia and hyperglycemia: HYPOGLYCEMIA Is caused by the presence of too much insulin, sometimes it is caused by too little food or too much exercise. HYPERGLYCEMIA Is the result of too little insulin (a lack of insulin). 22. What is the treatment for hypoglycemia and hyperglycemia? Hypoglycemia: The acute treatment for hypoglycemia is glucose by mouth or by rectum; dextrose intravenously, or glucagon intramuscularly or subcutaneously. 4 Hyperglycemia: High blood sugar levels can be reduced with caloric restriction, regular exercise, oral hypoglycemic agents, insulin, and withholding offending drugs. 23. If uncertain whether a patient is hypoglycemic, what action should be taken? Lower blood sugar glucose, by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. 24. Describe the procedure for mixing two insulins in the same syringe? Clean the rubber tops of the insulin bottles, draw in air and inject it into the insulin bottle then withdraw the needle. Draw up the amount of units of air and inject it in to the regular insulin bottle, first withdraw the regular insulin. Insert needle into the other insulin and withdraw the correct amount of insulin. Administer the two insulins immediately. Two different lente insulin, they will mix well together. 25. What temperature should insulin be before being administered? Insulin should be refrigerated until needed. 26. What types of insulin can be mixed in the same syringe and stored for use at a later time (e.g. a to 2 weeks later versus used immediately)? Regular insulin can be mixed with protamine or zinc insulin in the same syringe. When mixing NPH and short-acting regular insulin, you can use it right away or refrigerate it to be used at a later time. 27. How do oral hypoglycemic agents differ from insulin? Oral hypoglycemic agents are used to lower blood glucose level in the blood, while insulin is released from the beta cells of the islets of langerhans in response to an increase in blood glucose 28. Which types of diabetes mellitus requires treatment with insulin and which type may be treated with an oral hypoglycemia? Insulin I is an insulin- dependant diabetes mellitus that requires treatment with insulin. Type ii diabetes is a non-insulin dependent that can be treated with an oral hypoglycemic agent. 29. What type of allergic should you check the chart and the patient for, before initiating therapy with an oral hypoglycemic agent? Antibodies develop over time in persons taking animal insulin. This can slow the onset of insulin action and extend its duration of action. Antibody development 5 can cause insulin resistance and insulin allergy. Skin tests with different insulin preparations may be performed to determine whether there is an allergic effect. Human and regular insulin produce fewer allergens. 30. Differentiate between the terms onset, peak, and duration in relation to insulin therapy: Onset: is the length of time before insulin reaches the bloodstream and begins lowering blood glucose. Peak time: the time during which insulin is at its maximum strength in terms of lowering blood glucose levels. Duration: is the length it takes the insulin to continue lowering blood glucose. THYROID HORMONES. 1. Thyroid replacement hormones are used to replace what hormones secreted by the thyroid. The thyroid replacement hormones are used to replace the thyroxine (T4) and triiodothyronine (T3) hormones. 2. Name the thyroid replacement hormones and their ingredients: -Levothyroxine (Levothroid, Synthroid) -Leothyronine (Cytomel) synthetic T3 drug -Liotrix (Euthroid, Thyrolar) is a mixture of levothyroxine sodium and ---liothyronine sodium in a 4:1 ratio. 3. Of the thyroid products available which one has the most rapid onset of action? The most rapid onset of action of the thyroid product is Leothyronine (Cytomel). 4. Why should a patient taking Liotrix be told not to switch between Euthroid and Thyrolar? Because (Euthroid and Thyrolar) is a mixture of levothyroxine and liothyronine sodium in a 4:1 ratio. There is no significant advantage of switching one over the over and also thyroid drugs are seldom used. 6. What are the drugs used to treat hyperthyroidism? Propylthiouracil (PTU) and methymazole(Tapazol) are effective thioamide antithyroid drugs useful to treat hyperthyroidism 6 7. 8. 9. What are the side effects to assess when propyklthiouracil or methimazole are administered? The side effects to assess when propyklthiouracil or methimazole are administered are: drowsiness headache, vertigo. GI: diarrhea, drug- induced hepatitis, loss of taste, nausea, paratitis, vomiting, and rash skin discoloration uriticoria. What laboratory studies should be performed at periodic intervals for clients taking propylthiouracil? Client should be monitored prior to therapy, monthly during initial therapy and every 2-3 monthss throughout therapy. If a patient has hyperthyroidism, would he be most likely to require a smaller or larger dose of a digitalis glycoside? If a patient has hyperthyroidism it would be more likely to require a small dose of digitalis because digitalis glycoside is used with patient with congestive heart failure. CORTICOSTEROIDS 1. Define “corticosteroids: Corticosteroids is any several steroid hormones secreted by the cortex of the adrenal gland or manufactured synthetically for used of drug. 2. When are glucocorticoids commonly prescribed? Glucocorticoids are commonly prescribed for adrenocortical insufficiency and inflammatory to treat inflammation or immunosuppresure effect. Inhalation for treatment bronchial asthma and bronchial inflammation are also treated for seasonal rhinitis. 3. What endogenous hormone is known as a glucocorticoid? Cortisol is a potent hormone known as a glucocorticoid that affects the metabolism of carbohydrates, proteins and fat, but especially glucose. 4. Do corticosteroids cures a disease? Explain. Corticosteroids such as glucocorticoids treat many diseases and health problems including… ocular and vascular inflammation… head trauma with cerebral edema and hepatitis… allergic condition include asthma, drug reaction… and debilitation condition. On the other hand, mineralcorticoids, the second type of corticosteroid…maintains fluid balance by promoting the reabsorption of sodium from the renal tubules (page768-770). 5. What possible side effects may be observed with the administration of glucocorticoids? 7 6. Because of their many mineralorticoid effects, glucocorticoids can cause sodium absorption from the kidney, resulting in water retention, potassium loss, and increased BP. The side effects of glucocorticoids…include increased blood sugar, abnormal fat deposit in the face and trunk (moon face and buffalo hump)…muscle wasting, edema…peptic ulcer and growth retardation. Long-term use of glucocorticoid drugs can cause adrenal atrophy (loss of adrenal gland function). (Pharmacology: A Nursing Process Page 769). What time of the day is best to administer corticoisteroids? The best time of the day to administer corticoisteroids is during mealtime. 7. Why would corticosteroids and diuretics produce or enhance hypokalemia when give simultaneously? By losing water through urination (diuretics) and decrease edema inflammation (Corticosteroids), the client loses potassium, and becomes hypokalemic. 8. Why must patients, taking corticosteroids, be cautioned to avoid contact with persons with an infection? Clients are instructed to avoid persons with an infection because corticosteroid drugs suppress the immune system. 9. What instructions need to be given to a patient taking corticosteroids? Client should be advised to take the drugs as prescribed, take cortisone…with food…[because] glucocorticoids can irritate the gastric mucous and cause a peptic ulcer. Clients should eat food reach in potassium, such as fresh and dried fruits, vegetables, meats and nuts. They also should report signs and symptoms of drug overuse…to avoid possible rebound effect (page 772). 10. What baseline assessments should be completed for patients taking any type of corticosteroids? For patients taking any type of corticosteroids baseline assessment such as: vital signs (blood pressure, temperature, pulse and respirations). Pulmonary function tests may be assessed periodically during and for months after a transfer from systemic to inhalation corticosteroids, as well as client’s weight and urine output should be completed. Laboratory test results, especially serum electrolytes and blood sugar have to be monitored. 12. What types of eye disorders are treated using corticosteriods? Types of eye disorders that are treated using corticosteroids include iritis and panuveitis. 8