NU 578 Exam 4 Study Guide
ENDOCRINE AND STEROIDS Ch. 48-49, 57-58
Uses and SE for drugs for diabetes including: Insulins, metformin, sulfonylureas, DPP-4 inhibitors
(sitagliptin), SGLT-2 inhibitors (canagliflozin, empagliflozin), GLP-1 receptor antagonists (exenatide),
acarbose, nateglinide
Insulin use, duration of action; understanding of basal (some have duration up to 72 hrs) vs bolus insulin;
when is each type used?
• Rapid acting insulin: Lispro & Aspart
• Intermediate: NPH
• Long acting insulin: Glargine
Metformin uses, SE, monitoring, contraindications, long-acting vs short acting, benefits
• ADA recommends Metformin for DM2
• Benefits: lowers BG, BP, favorable effects of serum lipids, wt loss
• Risk: poor renal function (GFR < 30), alcoholic, receiving contrast → ACIDOSIS → Cardiac Fxn
Sulfonylurea: older drug, not 1st choice drug, cross ALLERGIES (sulfa meds, abx, ASA)
DPP-4 inhibitors: sitagliptin drugs, can cause fluid shift → increase fluid status. Not 1st choice for CHF
SGLT-2 inhibitors (canagliflozin, empagliflozin): Good for cardiac comorbidities, use as part of quad
therapy even in pre-heart failure. Enhance renal excretion of glucose, fluid follows → lower fluid status
• Renal excretion of glucose more prone to infections (bladder, kidney, urinary tract, necrosis of
genital area)
Glucagon use: for hypoglycemia. Enhance glucose release from sites where stored (muscles, liver, fat)
Which antidiabetic agents cause marked hypoglycemia? Insulin Which
antidiabetic agents are safe to use in pregnancy?
Which antidiabetic agents are used to also treat heart/CV disease? Which ones should be avoided?
• Treat: SGLT-2 inhibitors (gliflozin), will lower fluid status
• DDP-4 inhibitors (gliptin), cause fluid shift, increase fluid status
Synthroid: mix of T3/T4
• T4 portion metabolized to T3 (active form) in the liver. DDI of any other drug that uses same
metabolic enzyme will affect the drug or thyroid hormone efficacy o DDI: Warfarin high risk
drug, can metabolize when given with Synthroid → bleed
Thyroid hormones are permissive with catecholamines. Hyperthyroidism makes patients more sensitive
to epinephrine → dysrhythmia, increase BP (from vasculature enhanced sensitivity to norepi).
• Thyroid hormones dosing varies across lifespan, dosing of levothyroxine for….
o More thyroid hormone for pregnancy
o Less thyroid hormone for elderly, frail pt o Compromised circulation or other
comorbidities
Treatment of thyroid storm: CV instability, LOC, inflammation. May use steroid.
, 2
• May need to modulate thyroid hormones
Treatment of Graves’ disease: make antibodies to the thyroid and stimulate thyroid hormone release.
Surgical tx, radioactive iodine, or antithyroid drugs (methimazole, propylthiouracil)
Treatment of hyper/hypothyroidism with considerations of age, pregnancy status, DDIs;
Methimazole vs PTU use
Steroid use: topical, taper, PO, IM, IV (more emergent issues, asthma, autoimmune, inflammation)
• High dose steroids require taper. Shut own adrenal cortical steroids off. None produce.
o Need steroid for stress response to help modulate blood sugar and blood pressure. DDIs
with steroids
• Diabetes medications
• Thyroid hormones
• May affect efficacy of contraceptives
Meloxicam uses, SE
NSAID uses (help with inflammation), allergy (sulfa), SE, DDI, effects on clotting, cross-allergy with?
• Uses: Pain, inflammation, fever, clotting (ASA most effective) o Platelets alive for about 7 days,
ASA makes platelets non-sticky
o Ibuprofen make PLT temporary non-sticky, drug wears off → hyper sticky (promotes clot)
NSAIDS impact renal blood flow. High risk for DDI. Kidneys cant excrete → drug accumulation
Knowledge of COX-1 vs COX-2 inhibitors; use of celecoxib
• ASA (& other NSAIDs) inhibits COX-1 & 2 •
Celecoxib specific COX-2 inhibitors.
o More effective for anti-inflammatory, less impactful on bleeding (still can but not likely)
o Might be a better option for patients that need NSAIDs daily (osteoarthritis)
Which NSAIDs should be avoided in a cardiac patient? Diclofenac, high clot potential as drug wears off.
May use acetaminophen for alternative for pain relief. How to treat moderate pain in a patient with
renal disease, liver disease
Dexamethasone use: dx of adrenal disorders (Cushing) via dex suppression, cyclosporine use suppress
inflammation associated with rejection of organ or tissue in transplant patients. Cross-allergy with
sulfa drugs (antibiotics, sulfonylurea antidiabetic drugs, aspirin)
Do not forget the DDIs of these drugs with each other; steroids cause high blood glucose, NSAIDs may
compromise renal function (also a SE of many drugs for diabetes); Synthroid may interact with some
diabetes meds and make them less effective;
IMMUNIZATIONS Ch. 54-55
Vaccines in pediatric patients—reasons for withholding; schedules
Vaccine SE, age, contraindications; (varicella, HPV, MMR, hep B, hep A – schedule)
• SE: sore, erythema at site, inflammation, stiffness.
• Contraindications: Allergies to protein (albumin or other) in manufacturing
If a child has a runny nose and a fever of 99.9, should immunizations be given or held?
• Not a reason for withholding, high fever 101+, fussy, allergy to component vaccine.
ENDOCRINE AND STEROIDS Ch. 48-49, 57-58
Uses and SE for drugs for diabetes including: Insulins, metformin, sulfonylureas, DPP-4 inhibitors
(sitagliptin), SGLT-2 inhibitors (canagliflozin, empagliflozin), GLP-1 receptor antagonists (exenatide),
acarbose, nateglinide
Insulin use, duration of action; understanding of basal (some have duration up to 72 hrs) vs bolus insulin;
when is each type used?
• Rapid acting insulin: Lispro & Aspart
• Intermediate: NPH
• Long acting insulin: Glargine
Metformin uses, SE, monitoring, contraindications, long-acting vs short acting, benefits
• ADA recommends Metformin for DM2
• Benefits: lowers BG, BP, favorable effects of serum lipids, wt loss
• Risk: poor renal function (GFR < 30), alcoholic, receiving contrast → ACIDOSIS → Cardiac Fxn
Sulfonylurea: older drug, not 1st choice drug, cross ALLERGIES (sulfa meds, abx, ASA)
DPP-4 inhibitors: sitagliptin drugs, can cause fluid shift → increase fluid status. Not 1st choice for CHF
SGLT-2 inhibitors (canagliflozin, empagliflozin): Good for cardiac comorbidities, use as part of quad
therapy even in pre-heart failure. Enhance renal excretion of glucose, fluid follows → lower fluid status
• Renal excretion of glucose more prone to infections (bladder, kidney, urinary tract, necrosis of
genital area)
Glucagon use: for hypoglycemia. Enhance glucose release from sites where stored (muscles, liver, fat)
Which antidiabetic agents cause marked hypoglycemia? Insulin Which
antidiabetic agents are safe to use in pregnancy?
Which antidiabetic agents are used to also treat heart/CV disease? Which ones should be avoided?
• Treat: SGLT-2 inhibitors (gliflozin), will lower fluid status
• DDP-4 inhibitors (gliptin), cause fluid shift, increase fluid status
Synthroid: mix of T3/T4
• T4 portion metabolized to T3 (active form) in the liver. DDI of any other drug that uses same
metabolic enzyme will affect the drug or thyroid hormone efficacy o DDI: Warfarin high risk
drug, can metabolize when given with Synthroid → bleed
Thyroid hormones are permissive with catecholamines. Hyperthyroidism makes patients more sensitive
to epinephrine → dysrhythmia, increase BP (from vasculature enhanced sensitivity to norepi).
• Thyroid hormones dosing varies across lifespan, dosing of levothyroxine for….
o More thyroid hormone for pregnancy
o Less thyroid hormone for elderly, frail pt o Compromised circulation or other
comorbidities
Treatment of thyroid storm: CV instability, LOC, inflammation. May use steroid.
, 2
• May need to modulate thyroid hormones
Treatment of Graves’ disease: make antibodies to the thyroid and stimulate thyroid hormone release.
Surgical tx, radioactive iodine, or antithyroid drugs (methimazole, propylthiouracil)
Treatment of hyper/hypothyroidism with considerations of age, pregnancy status, DDIs;
Methimazole vs PTU use
Steroid use: topical, taper, PO, IM, IV (more emergent issues, asthma, autoimmune, inflammation)
• High dose steroids require taper. Shut own adrenal cortical steroids off. None produce.
o Need steroid for stress response to help modulate blood sugar and blood pressure. DDIs
with steroids
• Diabetes medications
• Thyroid hormones
• May affect efficacy of contraceptives
Meloxicam uses, SE
NSAID uses (help with inflammation), allergy (sulfa), SE, DDI, effects on clotting, cross-allergy with?
• Uses: Pain, inflammation, fever, clotting (ASA most effective) o Platelets alive for about 7 days,
ASA makes platelets non-sticky
o Ibuprofen make PLT temporary non-sticky, drug wears off → hyper sticky (promotes clot)
NSAIDS impact renal blood flow. High risk for DDI. Kidneys cant excrete → drug accumulation
Knowledge of COX-1 vs COX-2 inhibitors; use of celecoxib
• ASA (& other NSAIDs) inhibits COX-1 & 2 •
Celecoxib specific COX-2 inhibitors.
o More effective for anti-inflammatory, less impactful on bleeding (still can but not likely)
o Might be a better option for patients that need NSAIDs daily (osteoarthritis)
Which NSAIDs should be avoided in a cardiac patient? Diclofenac, high clot potential as drug wears off.
May use acetaminophen for alternative for pain relief. How to treat moderate pain in a patient with
renal disease, liver disease
Dexamethasone use: dx of adrenal disorders (Cushing) via dex suppression, cyclosporine use suppress
inflammation associated with rejection of organ or tissue in transplant patients. Cross-allergy with
sulfa drugs (antibiotics, sulfonylurea antidiabetic drugs, aspirin)
Do not forget the DDIs of these drugs with each other; steroids cause high blood glucose, NSAIDs may
compromise renal function (also a SE of many drugs for diabetes); Synthroid may interact with some
diabetes meds and make them less effective;
IMMUNIZATIONS Ch. 54-55
Vaccines in pediatric patients—reasons for withholding; schedules
Vaccine SE, age, contraindications; (varicella, HPV, MMR, hep B, hep A – schedule)
• SE: sore, erythema at site, inflammation, stiffness.
• Contraindications: Allergies to protein (albumin or other) in manufacturing
If a child has a runny nose and a fever of 99.9, should immunizations be given or held?
• Not a reason for withholding, high fever 101+, fussy, allergy to component vaccine.
