Pharmacology 1950 Unit 8 1 1 define hormone Maintain homeostasis within the blood system Example 2 List the endocrine glands Pineal hypothalmus pituitary Parathyroid thyroid thymus ID: 775780
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Drugs that affect the Endocrine System
Pharmacology 1950Unit 8
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Slide21. define hormoneMaintain homeostasis within the blood systemExample: 2. List the endocrine glandsPineal hypothalmus pituitaryParathyroid thyroid thymusAdrenal pancreas gonad
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Slide33. Identify ant. Pituitary hormones
ACTH
TSH
GH
ProlactinFSHLH
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Slide4ADHOxytocin5. Identify main thyroid hormonesCalcitoninthyroid
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4. Identify post. Pituitary hormones
Slide5Thyroid glandRegulates BMRIodine is essential for synthesis of T3 and T4Negative feedback mechanism to limit secretion as needed.Thyroid hormone attaches to a carrier pro-TBGWhen it reaches the tissue level thyroxin converts to T3 where it enters the cell level.
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6. Describe how the body synthesizes the thyroid hormones
Slide6Objective 7: identify the actions of drugs used to treat hyperthyroidismInterferes with synthesis of T3 T4 and prevents conversion to target tissuesDelayed action from several days to weeks.
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Slide8Objective 8: list the anti-thyroid agents used to treat hyperthyroidism (Graves Disease)S/S: increased BMR, tachycardia, wt loss, 4-8x more common in womenDrugs are:Iodine-131 (131I)Propylthiuracil (PTU, Propacil)prototypeMethimazole (Tapazole
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Slide9Radioactive iodine Taken up by thyroidDestroys hyperactive thyroid tissueEssentially no other tissue is affectedTakes 3-6 months for fully assess effectIf more than one dose needed, three months between doses is needed
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Slide10Dosing is oralAdd to waterNo colorNo taste Be very careful not to spill (hazardous)Client can not be pregnantBecomes euthyroid stateAvoid children/preg women for 1 week..others for few days
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Slide11Side effectsTenderness in thyroid glandHyperthyroidism in 40%, second dose neededHypothyroidism
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Slide12Drug interactionsLithium carbonate Hypothyroidism develops
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Slide13PTU and TapazoleBlock synthesis of T3 and T4Takes days to 3 weeks to see effectCan use long termCan use short term pre subtotal thyroidectomy
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Slide14Side effectsPurpuric, maculopapular rashHeadaches, salivary and lymph node enlargementBone marrow suppression HepatotoxicityNephrotoxicity
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Slide15Hypothyroid condition in adults called myxedema General s/sWeakness, muscle cramping, slurred speech, intolerance to coldCongenital hypothyroidism called cretinism
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Objective 9: identify the hypothyroid conditions
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Slide17Objective 10: list the thyroid agentsLevothyroxine replaces T3 and T4prototype
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Slide18Liothyronine synthetic T3Onset of action more rapid than levothyroxineLiotrix synthetic mixture levothyroxine and liothyronine (4 to 1 ratio)Provides consistent levels of T3 and T4
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Slide19Thyroid USPFrom beef, pork, or sheep thyroid glandsOldest form available, cheapestLacks purity, uniformity, stabilityClients should avoid changing agents
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Slide20Side effectsHyperthryoidismDrug interactionsWarfarin: larger doses neededDigitalis: smaller doses neededHyperglycemia can occur early in therapy
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Slide21Objective 11: describe the nursing process associated with administering thyroid or anti-thyroid preparations
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Slide22Assessment importantClients sensitive to replacement therapy, monitor for adverse effectsLevothyroxine started low and dose increased over weeks
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Slide23Safe handling, storage and disposal of radioactive materials via institution policyBlood levels need to be monitoredClients need to be alert to side effects and reportClients need to report if no improvement
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Slide24Objective 12: name the parts of the adrenal glandMedullacortexObjective 13: list the types of hormones secreted by the adrenal glands
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Slide25Two hormones from adrenal glandMineralcorticoidsGlucocorticoids
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Slide26MineralcorticoidsMaintain fluid and electrolyte balanceUsed to treat adrenal insufficiency Fludrocortisone (Florinef)Aldosterone(prototype)Act on distal tubules, causes water and sodium retentionCauses excretion of potassium and hydrogen
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Slide27Objective 14: describe the metabolic effects of the glucocorticoids, and the consequences of these effects
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Slide28Increase blood sugarIncrease protein breakdownSuppress immune responsesIncrease sensitivity of smooth muscle to norepinephrineAffects mood and brain excitability
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Slide29Objective 15: describe how glucocorticoids suppress inflammationCorticosteroids secreted by adrenal cortex of adrenal gland Glucocorticoids
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Slide30Glucocorticoids includeCortisone, hydrocortisone, prednisone etc.Have antiinflammatory, antiallergic activity
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Slide31Also affect glucose, protein and fat metabolismGlucocorticoids secreted in response to stressorsCause release of epinephrine
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Slide32Objective 16: identify therapeutic uses of glucocorticoidsGlucocorticoids used for replacement therapy when adrenal gland not functionalHigh doses used for inflammation, allergy, asthma
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Slide33Use of corticosteroidsUsed with caution in those withDiabetes mellitusHeart failureHypertensionPeptic ulcerMental disturbanceSuspected infection
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Slide34After one week, discontinue drug slowly (wean off)Interacts with many drugsMay need to administer every other dayAbrupt discontinuationFever; Malaise; FatigueWeakness; orthostatic dizziness, hypotensionDyspnea; hypoglycemia
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Slide35Topical: apply as directed, may use occlusive dressingAlternate –day therapy: give between 6 & 9 AM; give with meals
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Slide36Side EffectsElectrolyte imbalance, fluid accumulationSusceptibility to infectionBehavioral changesHyperglycemiaPeptic ulcer formationDelayed wound healing
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Slide37Drug interactionsLoop diuretics: can enhance electrolyte lossWarfarin: can have increased or decreased effectHyperglycemia: diabetics and children need to be monitored
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Slide38Objective 17: list the glucocorticoid preparations
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Slide39Various drugs for topical, oral, injection, inhalationCortisoneDexamethasone (Decadron, Dexone)Fludrocortisone (Florinef)-also mineralcorticoid
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Slide40Hydrocortisone (Cortef, Solu-Cortef)prototypeMethlprednisolone (Solu-Medrol, Depo-Medrol)Prednisolone (Delta-Cortef)Prednisone (Deltasone, Apo-Prednisone)prototypeTriamcinolone (Aristocort, Kenalog)
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Slide41Objective 18: describe nursing care responsibilities associated with administering glucocorticoidsProvide education, VS, glucose levels, long term use may lead to osteoporosis, Cushing syndrome
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Slide42Objective 19: identify the functions of insulin in the bodyGlucose transportAffects carbohydrate, lipid and pro metabolismObjective 20: define diabetes mellitusGroup of metabolic diseases with decreased insulin production or decrease in receptor cells
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Slide43Objective 21: identify the site of insulin production in the bodypancreasObjective 22: list the types of diabetesInsulin dependent Type I10% of population; onset 11-13 years of ageInsuline dependent Type 2Deficient amounts of insulin production or insulin resistant cellsGestational Associated with pregnancy
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Slide44Objective 23: explain the functions of insulinHormone from beta cells of the pancreas (islets of Langerhans)Normally: 0.5 – 1 unit per hour secretedAdult: 30-50 units per day Insulin transports glucose into cells; helps metabolize protein and fat.Diabetes is a metabolic disorder: all body systems affected
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Slide45Objective 24: identify the onset, the peak, and the duration of action for rapid, intermediate, long acting and fixed combinations of insulin
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Slide46Lispro and AspartMost rapid acting of insulinsThey are synthetic insulin analogsGive within 10-15 minutes of a mealOnset: 10 minutesPeak: 30 to 60 minDuration: 5 hours
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Rapid-Acting Insulin
Slide47Regular insulinHuman regular insulin available, not just animal derivationGive within 30-60 minutes of mealsOnset: 30 minutesPeak: 2.5-5 hoursDuration: 5-10 hoursAdministration: subcutaneous or IV
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Short-Acting Insulin
Slide48Neutral protamine Hagedorn (NPH)Contains regular insulin and protamineProtamine binds to insulin: slow releaseOnset: 1-4 hours (pork is 1-1.5 hrs)Peak: 8-12 hours (pork: 8-12 hrs)Duration: 18-24 hours (pork: 24 hrs)
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Intermediate-Acting Insulin
Slide49Lispro: can be mixed with protamineHumalog mix 75/2575% Lispro with protamine25% LisproRapid acting insulin with intermediate duration of action (12-24 hours)
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Slide51Humulin UltralenteCrystalline form of Lente insulinOnset: 4-8 hoursPeak: 12-18 hoursDuration: 24-28 hours
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Long-Acting Insulin
Slide52Insulin-Glargine solution (Lantus)Biosynthetic Absorbed in a uniform manner-no large fluctuations of insulin levels = reduction in possible hypoglycemiaOnset: 5 hoursPeak: no pronounced peak activityDuration: 24 hours Do NOT mix with other insulins
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Slide59Objective 25: describe the local tissue responses that can occur with repeated insulin injections
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Slide60Two problems can occurAllergic reactionsFrom proteins in insulin, alcohol, the insulin itselfSwitch types of insulinUse unscented alcoholWill resolve
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Slide61LipodystrophiesAtrophy or hypertrophy of subcutaneous fatUse the area because of anesthesia effect
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Slide63Use of the site decreases insulin absorptionCauses erratic absorption of insulinIs cosmetic problem
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Slide64Objective 26: list the symptoms of insulin shock Hypoglycemia HeadacheNauseaWeaknessHunger
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Slide65LethargyDecreased coordinationGeneral apprehensionSweatingConfusion Blurred or double visionCan progress to coma and death
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Slide66Objective 27: discuss glucose elevating drugsThe drug used to raise blood sugarGlucagon Glucose
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Slide67GlucagonHormone from alpha cells of pancreas Breaks down stored glycogen to glucoseAids in gluconeogenesisMust have glycogen available or drug will not work
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Slide68May see 50% glucose administered IVRaises blood sugarUse when no glycogen is stored
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Slide69Objective 28: describe what is meant by sliding scale insulin administration
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Slide70Sliding scale insulinPhysician orders doses of insulin based upon blood glucose levelRegular insulin is usedSliding scale is “catch-up”Read the orders carefully
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Slide71Blood sugar Insulin0-150 0 units151-200 2 units201-300 5 unitsOver 300, call physician
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Example
Slide72Objective 29: describe the action of the oral antidiabetic agentsSome act on the cells to decrease resistanceSome act on the beta cells to increase productionSome inhibit glucose absorption
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Slide73Objective 30: identify the conditions under which an oral antidiabetic agent would be usedType 2 diabetesNo control with diet/exercise
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Slide74Objective 31: list the oral antidiabetic agents
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Slide75Classifications areBiguanide oral hypoglycemic agentsSulfonylurea oral hypoglycemic agentsMeglitinide oral hypoglycemic agentsThiazolidinedione oral hypoglycemic agentsAntihyperglycemic agents
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Slide76Metformin (Glucophage)Does not stimulate insulin releaseWill not cause hypoglycemiaCan be used in combination with sulfonylureasDecreases serum triglycerides and LDLSlightly increases HDL
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Biguanide Oral Hypoglycemics
Slide77Initial dose: 500 mg BIDCan go up to 2500 mg dailyUse divided dosesIf blood sugar not controlled, add another agent
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Slide78Side effects to expectN/VAnorexiaAbdominal crampsFlatulence Will resolveTake with meals to decrease SE
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Slide79SE to reportMalaiseMyalgiasRespiratory distressHypotensionLactic acidosis can occurMore if renal failure or excess alcohol intake
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Slide80Drug interactionsDrugs that depend upon kidney for excretion can block metformin excretionCan have lactic acidosis develop
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Slide81Drugs that cause hyperglycemia with metforminOBCCorticosteroidsPhenothiazinesDiureticsThyroid replacement
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Slide82Stimulate release of insulinUse when pancreas can still secrete insulin
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Sulfonylurea Oral Hypoglycemic Agents
Slide83Two generationsFirst generationExample: Dymelor (500 mg daily)Second generationExample: Glucotrol (2.5-5 mg daily) Prototype
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Slide84Allergy: if allergic to sulfonamides, probably allergic to sulfonylureasDo not administer
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Slide85SE to expectN/VAnorexiaAbdominal crampsUsually mildDecrease with continued therapy
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Slide86SE to reportHypoglycemiaMonitor blood sugarTreat with glucose sourceHepatotoxicityAnorexia, N/V, jaundice, increased liver function tests
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Slide87Blood dyscrasiasRBC, WBCMonitor for sore throat, fever, purpura, jaundiceDermatologic reactionsRash or pruritusIf occurs: hold drug, call MD
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Slide88Drug interactionsVarious drugs can cause hypoglycemia such as Warfarin, ethanol
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Slide89Hyperglycemia with corticosteroids, phenothiazines and othersBeta-adrenergic blockers: cause hypoglycemia or mask the symptomsAlcohol: Antabuse-like reaction
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Slide90Stimulate release of insulin from pancreasCan be used alone or in combinationHave short duration of actionMust take up to QID
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Meglitinide Oral Hypoglycemics
Slide91Examples of drugsRepaglinide (Prandin)Nateglinide (Starlix)
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Slide92Dosing Can take 1-30 minutes before a mealMust take up to QID: complianceIf skip meal, skip dose
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Slide93SE to expect and reportHypoglycemiaDose adjustments may be neededMonitoring of blood glucose important
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Slide94Drug interactionsHypoglycemiaEthanol, NSAIDs, Warfarin, MAOIsHyperglycemia Corticosteroids, phenothiazines, estrogens
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Slide95B-blockers: cause hypoglycemia or mask symptomsTegretol and others: increase repaglinide metabolismSome macrolides and antifungals can inhibit repaglinide metabolism
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Slide96Increase sensitivity of muscle and fat tissue to insulinAllows more glucose to enter cellsInhibit gluconeogenesisDecreases hepatic output of glucoseDo not increase insulin output
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Thiazolidinedione OHA
Slide97Can be used alone or in combination with other OHA’s or insulinExamples Pioglitazone (Actos)Rosiglitazone (Avandia)
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Slide98Baseline labs: liver function and alkaline phosphatase, CBC, WBC, HDL, LDL, triglyceridesPremenopausal, anovulatory femalesOvulation may resume
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Nursing Process for TZD’s
Slide99SE to expectN/VAnorexia Abdominal crampsMildResolve with continued therapy
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Slide100SE to reportHypoglycemiaHepatotoxicity Weight gain
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Slide101Drug interactionsVarious drugs can cause an increase in hypoglycemia or hyperglycemiaB-adrenergics can mask hypoglycemia or cause itPioglitazone can enhance metabolism of ethinyl estradiol and norethindroneOvulate, become pregnant
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Slide102Two drugsAcarbose (Precose)Miglitol (Glyset)They inhibit pancreatic and GI enzymes from digesting sugarsThis delays glucose absorption and decreases postprandial hyperglycemia
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Antihyperglycemic Agents
Slide103Acarbose Does not cause hypoglycemiaCan be used with sulfonylureas or metforminDosingTID at start of main meals
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Alpha
glucosidase
inhibitors
Slide104SE to expectAbdominal crampsDiarrheaFlatulenceCaused by metabolism of carbohydrates in gutUsually mild, resolve
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Slide105SE to reportHypoglycemiaHepatotoxicity Can cause increased AST, ALTHas caused hyperbilirubinemia
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Slide106Hyperglycemia can occur with some drugs such as corticosteroids, phenothiazines, OBC, thyroidDigestive enzymes and intestinal adsorbents reduce effect of acarboseAcarbose can decrease absorption of digoxin
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Slide107Miglitol (Glyset)Used alone or with sulfonylureasCheck liver function before treatmentAssess for malabsorption syndrome or obstruction in gut
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Slide108Dosing Take with first bite of foodStart with 25 mg TID
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Slide109SE to expectAbdominal crampsDiarrheaFlatulence
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Slide110SE to reportHypoglycemia
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Slide111Drug interactionsHyperglycemia with various agents such as cortisone, phenothiazinesPropranolol, Ranitidine not absorbed with concurrent miglitolDigestive enzymes, intestinal adsorbents reduce effect of miglitol
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Slide112Objective 32: describe the nursing interventions associated with teaching the diabetic about the treatment
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Slide113Objective 33: list the therapeutic uses of estrogen and progesteroneStimulate maturation of female sex organsResponsible for menstrual cycleDrugs used for replacement, birth control, control of prostate cancer, breast cancer, osteoporosis (controversial use)
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Slide114Objective 34: name the estrogen preparationsVarious estrogens Conjugated estrogen (Premarin)Esterified estrogens (Estratab)Estradiol (Estrace)Estropipate (Ogen)Ethinyl estradiol (Estinyl)
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Slide115Objective 35: name the progesterone preparationsProgestins inhibit ovulation Norethindrone Ethynodiol diacetateDesogestrelLevonorgestrel
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Slide116Objective 36: identify the most commonly used ovulatory agentsClomiphene citrate (Clomid)Structurally similar to natural estrogensStimulates ovaries to release ovaUsed for women with reduced circulating estrogen
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Slide117Objective 37: describe the actions of the oral contraceptivesEstrogens and progestins induce contraception by inhibiting ovulationEstrogen blocks pituitary release of FSHProgestin inhibits LHBoth alter cervical mucusMay change endometrial wall
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Slide118Minipill is progestin-onlyMust take every dayCombination pill Take in 21 day cycle
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Slide119Complete physical needed before therapySE expected: nausea, weight gain, spotting, changed menstrual flow, missed periods, depression, mood changes, chloasma, headaches
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Slide120SE to report: vaginal discharge, breakthrough bleeding, yeast infectionsBlurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain
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Slide121Various drugs can decrease effect of OBCBarbiturates, Tegretol, St. John’s Wort, antibacterial agentsDrugs enhance effect and toxic effectsSome antifungals, Warfain, phenytoin, thyroid hormones, benzodiazepines
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Slide122< 72 hours after unprotected intercoursePrevinAction: prevents implantation or ovulation
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Emergency Contraception
Slide123Objective 38: identify the nursing process for clients with conditions for which female hormones are usedKnowledge deficeitNauseaNoncompliance
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Slide124Blood pressure increaseDVTSmoking contributing factor
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Major S/E