NUR 2474 Pharmacology for Professional Nursing

NUR2474 Exam 3 Review (Final)

Please review general tips from Quiz review document (test taking strategies,

select all that apply questions, etc.). The test will utilize Respondus browser

and monitor (using webcam). No notes or textbook allowed on the test.

Calculator will be enabled in the browser

General tips for studying:

1. Memorize names of medication categories from the presentation

2. Memorize key drugs from categories above (there are many questions

with specific drug names)

3. Use generic names

4. When reviewing particular drugs note category, indications, common side

effects, toxicity signs (if applicable), reversal agents, mechanism of action

(e.g. agonizing or antagonizing which receptors)

5. Read question instructions (there will be ‘select all that apply’ questions)

Topics to review:

1. What to monitor in patients on insulin therapy, NPO status and insulin

therapy

a. Blood glucose level: 70-110 is optimal. Above 110 is hyperglycemic

and less than 70 is hypoglycemic.

b. If above a certain range, we may give insulin on a sliding scale.

c. If NPO and hypoglycemia, the nurse should prepare to administer

IV D50 so the patient does not have anything to eat or drink but is

still able to get a sugar glucose solution quickly to increase the

blood glucose level. After this is done, the BG level should be

rechecked. 

d. If you give insulin and the patient don’t want to eat it, is a big dealhypoglycemia

e. If you have a patient who is NPO and they just received insulin and

their blood sugar drops below 70 that is a cause of concern.

2. Signs of hypoglycemia

a. S/S: BG level less than 70, mild shakiness, mental confusion,

sweating, palpitations, headache, lack of coordination, blurry

vision, seizures, coma, cold, pale, irritable, hungry. “Cold and

Clammy needs candy”

b. Hypoglycemia rule of 15: check BG level, if less than 70- give 15 g

carb or IV D50 if unable to take PO carbs, wait 15 mins and

recheck. Upon recheck, if still less than 70- give another 15 g

carbs and wait 15 mins and recheck and call HCP. If still under 70

after 3rd BG recheck, give IV D50 and call HCP as this could mean

something serious is occurring.

c. Good sources of 15 g carbs: 4 oz fruit juice, 1 cup milk, 1 tbsp

honey, 1 tbsp sugar, 6-8 pieces of candy, soda.

d. Once the blood sugar returns, give a complex carb like peanut

butter crackers.

3. Memorize insulin names by categories (rapid, short, intermediate, longacting, and mixed)

a. Rapid Acting Insulin

i. Common examples: Aspart (NovoLog), Lispro (Humalog),

Glulisine (Apidra)

1. Onset: 5-15 minutes. Administer with meals. DO NOT

administer unless a meal is readily available.

2. Peak: 1-3 hours

3. Duration: 3-5 hours.

ii. Monitor for hypoglycemia, hypokalemia, lipodystrophy.

iii. Always have oral carbohydrate available.

iv. May be given as a short-term IV therapy with very close

monitoring

b. Short Acting Insulin (Regular)

i. Common examples: Humulin R, Novolin R,

1. Onset: 30 minutes to 1 hour

2. Peak: 2-4 hours

3. Duration: 6-8 hours.

ii. Used for dosing patients with Sliding Scale

iii. Can be administered IVP or via continuous infusion.

iv. Monitor for hypoglycemia, hypokalemia, lipodystrophy.

v. Always have oral carbohydrate available.

c. Intermediate Acting Insulin

i. Common examples: Isophane suspension (NPH, Humulin N,

Novolin N)

1. Onset: 1-1.5 hours,

2. Peak: 6-12 hours

3. Duration: 18-24 hours.

ii. Cloudy suspension. Can mix with Regular or Rapid Acting

Insulin, draw up clear

1. (Regular or Rapid Acting) then cloudy (NPH), “Clear to

Cloudy.”

iii. Monitor for hypoglycemia, hypokalemia, lipodystrophy.

iv. Always have oral carbohydrate available.

d. Long-Acting Insulin

i. Common examples: Glargine (Lantus), Levemir, Detemir

ii. For Long lasting remember: Levemir/Detemir “last all year”,

Glargine is Large lasting or Lantus is like a lantern that

burns all night

1. Onset: 2-4 hours. No Peak, Duration: 24 hours.

2. Once daily Subq injection provides 24 hour coverage.

3. No peak, insulin delivered at steady level, less risk of

hypoglycemia. Often for basal coverage

iii. Monitor for hypoglycemia, hypokalemia, lipodystrophy

iv. Always have oral carbohydrate available.

v. DO NOT mix with any other insulin (NO peak, NO mix)

e. Combination Insulin (Pre-mixed)

i. Common examples: Humulin 70/30, NovoLog

ii. Mix 70/30 Humalog Mix 75/25, Humalog Mix 50/50,

iii. Intermediate Acting Insulin combined with either Rapid

Acting or Short Acting

iv. (Regular) Insulin.

1. Onset and Peak depend on whether combined with a

Rapid Acting or Short Acting Insulin. All provide 24

hour duration.

v. Monitor for hypoglycemia, hypokalemia, lipodystrophy.

vi. Need Food Coverage with Insulin are Lispro and Aspart

f. Levemir/Lantus Long Acting (Once a day at bedtime)

g. Always check the insulin client first as they might go into

hypoglycemia. Normal glucose level (70-99)

4. How and when to administer different types of insulin (rapid- and shortacting before meals, intermediate twice a day, long-acting at night)

a. Regular insulin is the only insulin that can be given other than

subQ

b. Syringes have to match your concentration grading.

c. NPH insulin is cloudy- mix NPH and regular- clear before cloudy

d. What insulin for food coverage- lispro aspart, rapid acting or

regular for meals

e. Long acting insulin at bedtime once per day

f. !!Rapid acting and regular insulin must follow up with food!!

g. Rapid and short-acting before meals, intermediate twice a day,

long-acting at night)

h. Long-acting insulin (Lantus/Levemir) are given once per day at

bedtime

5. Know beta-blockers. Beta-blockers and hypoglycemia

a. Beta blockers- ends in lol- most significant side effect bradycardia,

effects asthma- no beta blockers for asthma may cause

bronchospasms

b. Beta blockers- slow heart rate and may drop BP- if BP is low do not

give beta blockers call DR; may increase AV heart blocks, monitor

c. Beta blockers can mask symptoms of hypoglycemia- very

dangerous

d. Use caution with using Beta-Blockers (-lol) in combination with

insulin because it can mask symptoms of HYPOGLYCEMIA

6. Review glipizide administration, side-effects, alcohol consumption

a. Glipizide is a sulfonylurea used to stimulate the secretion of

insulin and decrease stimulation of glucagon.

b. Used in early type 2 diabetes when the A1C is elevated after

metformin use

c. SE: hypoglycemia

d. Alcohol will cause disulfiram-like reaction - syndrome includes

flushing, palpitations, and nausea. Can potentiate the

hypoglycemic effects

e. Give 30 mins before breakfast daily if ER, or 2x daily if IR.

f. Can take if renal failure, but should not if liver disease.

7. Review acarbose administration, side-effects, interactions, etc.

a. Acarbose is used as a type 2 oral antidiabetic that blocks enzyme

alpha glucosidase decreasing and delaying intestinal absorption of

glucose. Control postprandial glucose levels.

b. Delays absorptions of carbs and reduces blood glucose rise after

meals.

c. AE: gas, diarrhea, GI upset and abdominal pain.

d. Monitor liver function as long term use can cause liver

dysfunction. Monitor liver tests every 3 months and every year

thereafter.

e. Take with the first bite of food 

8. Review levothyroxine administration (in the am), side-effects, interactions

(calcium), etc.

a. Levothyroxine is used to replace thyroid hormone in patients who

have hypothyroidism, thyroid removal or in myxedema coma

b. SE: tachycardia, chest pain, tremors, sweating, anxiety, fever,

weight loss

c. Interacts with drugs that reduce absorption or accelerate

metabolism, warfarin, calcium, catecholamines

d. Must give medication in the am 1 hr before breakfast, on an empty

stomach at the same time each day life long.

e. Space vitamins and iron pills several hours after med

administration