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Pharmacology Workbook: NR293 Course NR293: Pharmacology Exam Exam 3: Week 7
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Pharmacology Workbook: NR293 Course NR293: Pharmacology Exam Exam 3: Week 7
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Pharmacology Workbook: NR293Course NR293: Pharmacology-ANSWER KEY
Exam Exam 3: Week 7
Concepts Chapters Student Notes
Pituitary Chapter 30
drugs
Name: Somatropin Vasopressin /Desmopressin (DDAVP)
Drug Growth hormone Pituitary drug
Classification:
Indication for Hormone replacement. VASOPRESSIN: Diabetes insipidus; Shock;
drug: Stimulate skeletal growth if hypopituitary. GI bleeding
DESMOPRESSIN: Diabetes insipidus; hemophilia;
Nocturnal enuresis (bedwetting) (DDAVP nasal spray)
Contraindications:
Common Adverse HA, HTN, peripheral edema, muscle aches, Serious adverse effect:
Effects: joint/back pain, inj. site pain, hyperglycemia; IV infiltration can cause severe tissue necrosis
hypothyrdoidism Monitor for hypertension
Major Glucocorticoids(both drug= hyperglycemia) Carbamazepine,Lithium, alcohol,Fludrocortisone
Interactions: Norepinephrine, Cyclosporine
Nursing Monitor growth (height & weight) Both: Use only clear solution
Considerations: • SQ & IM -Clear nasal passages before intra-nasal use
• Do not use after epiphyseal plate closes -Assess for THERAPEUTIC EFFECT: decreased urinary
• Precaution with diabetes, as blood glucose may output, decreased thirst; increased BP, and stabilized
elevate *Hypothyroidism: monitor for s/s fluid/ electrolyte balance
Pituitary drugs :1. List instructions for a teaching a client on how to use nasal Desmopressin (DDAVP) nasal pump: ***SEE p. 499:
provide written instructions; clear the nostrils before using; prime the nasal pump 4 times; place the spray nozzle in the nostril and
press the spray pump once. If a higher dose is ordered, half the dose is to be administered in each nostril. Then, replace cap. The pump
will stay primed for up to 1 week.
2. Identify indications for this drug (DDAVP) and what would be the therapeutic effect: used for diabetes insipidus to prevent or
control polydipsia, polyuria, and dehydration; has also been used for adolescents with nocturnal enuresis; Desmopressin can also be
used for hemophilia A & type 1 von Wildebrand’s disease..
3. Discuss nursing knowledge that is essential for safe administration for Vasopressin & Desmopressin: 1) Vasopressin for has same
indication to prevent or control polydipsia, polyuria, and dehydration for patient with diabetes insipidus; 2)also used to control various
types of bleeding (in particular GI hemorrhage). 3) Vasopressin must be given carefully via IV. IV infiltration may lead to severe
vasoconstriction and localized tissue necrosis. Use central venous access when possible. 4) The drug can also cause hypertension 5)
available as a nasal spray or injection for IM or IV use ; 5) if used for shock, close monitoring in ICU with ECK, vital signs, etc..
4. What would be the expected therapeutic effect for vasopressin & desmopressin? 1) For DI: reduced urinary output and stabilizing
of fluid volume status 2) enuresis: decrease in bedwetting and 3) ACLS/Shock: bring BP up
Key Concepts Chapters Student Notes
2/2/22222
,Thyroid & Antithyroid drugs Chapter 31
Definitions: Make sure you understand these words or write a brief definition in your own words.
Euthyroid Hyperthyroidsim Hypothyroidism Thyroid-stimulating hormone (TSH) Goiter
“Hypothyroidism is treated with thyroid hormone replacement using various thyroid preparations. Thyroid drugs work at the cellular
level to induce changes in the metabolic rate, including the rate of protein, carbohydrate, and lipid metabolism, and to increase oxygen
consumption, body temperature, blood volume, and overall cellular growth and differentiation. They also stimulate the cardiovascular
system by increasing the number of myocardial beta-adrenergic receptors. This, in turn, increases the sensitivity of the heart to
catecholamines and ultimately increases cardiac output. In addition, thyroid hormones increase renal blood flow and the glomerular
filtration rate, which results in a diuretic effect. Treatment of hyperthyroidism is aimed at treating either the primary cause or the
symptoms of the disease. Antithyroid drugs, iodides, ionic inhibitors, surgery, and radioactive isotopes of iodine are used to treat the
underlying cause, and drugs such as beta blockers are used to treat the symptoms. The focus of the discussion here is on the
antithyroid drugs.” (Lilley, Collins, & Snyder, 2014, p. 504)
Name: Levothyroxine Methimazole /Propylthiouracil
Drug Class & Synthetic thyroid med/ hypothyroidism Antithyroid drug/ hyperthyroidism
indication:
Contraindications:
Common Adverse Overdosage: Priority=can lead to serious cardiac Can cause abnormal CBC & hepatotoxicity: may induce
Effects: dysrhythmias & nervousness, insomnia, diarrhea. hypothyroidism.
*May induce hyperthyroidism
Major Interactions: Digoxin,Oral anticoagulants, Questran,
(ex. CYP450) Hypoglycemic drugs
Nurse Dose: decrease with elderly Monitor for abnormalities in the CBC and liver function
Considerations: Dose: Increase w/ pregnancy tests (LFT’s)
(Examples: Age, Advise client there are periodic lab tests for therapy -Monitor TSH, T4: see effect in about 2 weeks
renal/hepatic -Must take on empty stomach, ideally in the morning Advise client there are periodic lab tests for therapy
precautions, -Takes about 4 weeks for full effect DIET: avoid iodized salt, tofu, shellfish or soy sauce
safety with -Take with food
administration, PROPYLTHIOURACIL: Pregnancy cat D!! But, if
lab monitoring, necessary to use, PTU is preferred for 1st trimester
patient teaching, METHIMAZOLE: Pregnancy cat D!! But, if necessary,
etc.) will use this in 2nd and 3rd trimester;
Key Concepts Chapters Student Notes
Antidiabetic drugs Chapter 32
Definitions: Make sure you understand these words or write a brief definition in your own words.
Insulin Diabetes mellitus: Type 1 and Type 2 Glucagon Glycogenolysis Hemoglobin A1C Ketones
Hyperglycemia Hypoglycemia Hyperosmolar nonketotic syndrome (HNKS) Impaired fasting glucose
“The glycemic goal recommended by the ADA for diabetic patients is a hemoglobin A1C (A1C) level of less than 7%. A1C is an indicator
of glycemic control in a patient over the preceding 3 months (the average lifespan of a red blood cell) and is not affected by recent
fluctuations in blood glucose levels. The ADA recommended a fasting blood glucose goal for diabetic patients of 70 to 130 mg/dL. The
major classes of drugs used to treat diabetes mellitus are the insulins and the oral antidiabetic drugs. Several new classes of injectable
drugs with unique mechanisms of action have been developed that may be used in addition to insulin or oral antidiabetic drugs to treat
resistant diabetes. All of these drugs are referred to as antidiabetic drugs, and they are aimed at producing a normoglycemic or
euglycemic (normal blood glucose) state” (Lilley, Collins, & Snyder, 2014, p. 516 )
1
2/23/17 CJR References from the textbook & study guide of: Lilley, L. L., Collins, S. R., Snyder, J. S. (2014). Pharmacology & the Nursing
Process, 7th Edition. Mosby
, Name: Insulins Insulin lispro Regular insulin Insulin isophane suspension
Insulin aspart (NPH insulin)
Insulin glulisine
Drug Class & Diabetes type 1 & 2 Short-acting insulin//1) Blood glucose Intermediate-acting insulin//
Indication(s) 1) Blood glucose control for meal control for meal times; NPO status; or as Diabetes type 1 & 2
times; NPO status; or as a sliding scale a sliding scale correction (inexpensive- most likely the reason
correction 2) ONLY insulin given IV it is still in use)
3) CAN be used for diabetic ketoacidosis *Can mix with Regular insulin
or HHNK (draw Regular up first)
Contraindications:
Common Adverse Hypoglycemia: injection site irritation Hypoglycemia: injection site irritation or Hypoglycemia: injection site
Effects: or lipodystrophy lipodystrophy irritation or lipodystrophy
Interactions:
Nursing *Client must eat within 15 minutes *Can mix with NPH: *Cloudy suspension. Roll in hands,
Considerations: of receiving any rapid acting insulin (draw Regular up first) don’t shake!
shots Clear to cloudy!! *Need a bedtime snack if NPH
given at dinnertime
Name: Insulins Insulin glargine Humulin 70-30 Insulin
Insulin detemir Novolin 70/30 Insulin
Drug Class & Long-acting insulin (aka…basal insulin) Fixed combination insulin
Indication(s) MIMICS natural, basal insulin; no peak action Inexpensive option
Contraindications: Not for diabetic ketoacidosis Not for diabetic ketoacidosis
Common Adverse Hypoglycemia- (less of an issue with long-acting insulin): Hypoglycemia: injection site irritation or lipodystrophy
Effects: injection site irritation or lipodystrophy
Interactions:
Nurse *Give this insulin alone: no mixing. *Give this insulin alone: no mixing.
Considerations: *Teach client insulin releases slow steady amount over 24 *Need a bedtime snack if NPH given at dinnertime
(Examples: Age, hours: *Not for IV use. *Not for IV use.
renal/hepatic
precautions)
Oral antidiabetic agents: ***Avoid alcohol= increase risk for hypoglycemia with all oral antidiabetic agents!!
Oral antidiabetic Metformin Glipizide; Glyburide; & Glimepiride
Drug Class & Biguanide// Action: Decreases insulin resistance; decrease Sulfonyureas// Action: Stimulates production of insulin
indication(S) absorption of glucose from GI tract; decrease liver from pancreas//
production of glucose// INDICATION: Type 2 Diabetes
INDICATION: Type 2 diabetes; Metabolic
syndrome;prediabetes or impaired FBG
Contraindications Renal precautions! Assess for Sulfa allergy: Potential cross-allergy for
patients allergic to sulfonamide antibiotics.
Common Adverse Mostly GI (N/V/d). Hypoglycemia & weight gain. Hematologic effects
Effects RARE: but serious- Lactic acidosis (decreased RBC/WBC/Platelets)
Major Avoid alcohol= increase risk for hypoglycemia SEVERAL DRUG INTERACTIONS (see power points). Avoid
2
2/23/17 CJR References from the textbook & study guide of: Lilley, L. L., Collins, S. R., Snyder, J. S. (2014). Pharmacology & the Nursing
Process, 7th Edition. Mosby
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