By Yura Casanas Gonzalez
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August 6, 2024
Pharmacology key points (NCLEX type questions, key points and epidemiology facts) : Diabetes Mellitus, anti-coagulation, and Reproductive medications: According to CDC (2024) approximately 30 million people in the United States have been diagnosed with diabetes, about 98 million (adults) more than 1 in 3—have been diagnosed with prediabetes and it’s one the leading cause of death (7th ). Healthy People 2030 focuses on reducing diabetes cases, complications, and deaths. WHO(2024) points out that this chronic endocrino-metabolic disease is the principal cause of blindness, kidney problems and failure, cardiovascular disorders, and stroke. Diabetes during pregnancy usually doesn't have any symptoms. In the United States, Caucasian people are more likely to develop type 1 diabetes than African American and Hispanic or Latino people. Cultural beliefs and values can influence the diet, nutritional habits and lifestyle (this last is relative) Type 1 diabetes 5-10% of people with diabetes have type 1(less common that type 2 diabetes (CDC, 2024) Read the ATI chapters, Karch chapters (Prep-U) Key points: nursing or NCLEX exam 1. If a question asks to choose the correct Insulin for an emergency situation such as hyperglycemia or ketoacidosis : Regular Insulin that is a short acting (IV): onset less than 30 min. 2 . How to store the Insulin : questions clues: if it is an open vial (at room temperature up to 1 month ) to minimize the tissues injuries. If it is an unused Insulin (should store it in the refrigerator), prevent exposure to sunlight, inhibit bacterial growth, and maintain potency 3. It is not necessary to aspirate the Insulin or medication prior administration, the client or nurse should mix compatible solutions (regular or short with NPH) to reduce risk for additional injection. 4. Remember sites for SC injections of insulin (abdomen and thighs) and rotate the sites for each injection. 5. Before administer Insulin: assess Vital signs, symptoms, signs, Glucose (fast glucose Accu-chek) : 6. If a meal is skipped, the insulin(mealtime dose)should not be given. (patient self-care: adjusting the amount of insulin based on blood glucose. Kids the electronic device CGM sensors such as Dexcom G6, Guardian sensor 3 inserting a minuscule device on the arm or stomach and read the glucose around the clock paired to smartphone: reduce finger-stick glucose meter, and improve self-care (school nurses should know about it) 4. Steps for mixing and administering the insulin: Inspect vials or recipient's labels Roll NPH vial between palms or hands Inject air into NPH insulin vial Inject air into regular insulin vial Withdraw short acting (clear/rapid) insulin into syringe Add NPH (cloudy) to syringe (remember caution/precautions) Remember the question that ask in what options the patient or client need for further teaching: Example: a client who explain that if he/she skip a mealtime I will use insulin Glargine in my Insulin pump (The Insulin pump is designed to administer rapid acting or short acting during 24 hrs. Glargine is a long acting and is administered at the same time each day. Thus this statement needs further explanation and teaching by the nurse or health provider. 2. If I skip lunch, I will skip my mealtime dose of Insulin. 3. I will change the needle every 3 days 4. I will store the unused Insulin in the refrigerator. Type 2 diabetes: Education on self-care: a healthy diet Regular physical activity, maintaining a normal body weight, also it’s recommended avoiding tobacco, alcohol, to delay onset and/or complications of type 2 diabetes. For regular exercise: 150 is the magic number (150 minutes weekly): You could aim for 50 minutes of exercise (three times a week),also recommended 30 minutes five times a week or 25 minutes six times a week. For the blood thinners medications: Remember: Assess the patient or client for bleeding, Heart rate, decrease blood pressure, petechiae, hematoma, black tarry stool. Heparin pathway Affects intrinsic pathway Uses: prophylaxis and treatment: DVT, PE, (does not dissolve clots that have already formed) Use in pregnancy Heparin and LMW heparins (monitor thrombocytopenia) route IV (infusion) or SubQ onset Rapid Drug interactions Few drug interactions Aspirin, NAIDS,: increases risk of bleeding with Heparin 4 G: garlic, ginger, glucosamine, ginkgo: increase risk bleeding Resveratrol, saw palmetto: antiplatelet effects Assess bleeding and: therapeutic range APTT : Keep at 1.5 to 2 times the baseline Effectiveness evidence by: APTT 60 to 80 sec antidote Protamine(IV): 20mg/min Heparin (prophylaxis): 5000 Unit (fixed) SC every 8 or 12 hours is an effective and safe form of prophylaxis in medical and surgical patients at risk of venous thromboembolism. Low-dose heparin reduces the risk of venous thrombosis and fatal PE by 60% to 70%(Anticoagulation guideline) Vitamin K antagonists should be taken at the same time every day, this allow to adjust or hold the dose the same day that the INR result becomes available (Anticoagulation treatment guidelines, 2020) Heparin: Enoxaparin: Monitor vital signs, platelet count, signs of bleeding, avoid Aspirin, and monitor sensation and movement of lower extremities. Heparin and LMW heparins are used during pregnancy, if anticoagulation is desired. For pregnants who have heparin induced thrombocytopenia, Argatroban should be prescribed. Warfarin : Acts on the extrinsic pathway Uses: Prevention DVT, PE, atrial onset: slow Many: Heparin, Aspirin, Acetaminophen, Glucocorticoids, sulfonamides, Cephalosporins increases the effect of Warfarin Phenobarbital, Carbamazepines, Phenytoin, oral contraceptives, and Vitamin K decrease anticoagulants effects. Monitor Bleeding, Vital signs, INR, PT INR 2.0 to 3.0(most accurate) P.T: 18 to 24 sec Warfarin: Category D: pregnant with mechanical heart valves, Category X: for other pregnancies due to risk hemorrhage antidote Vitamin K Example questions: A client who has atrial fibrillation and receives Heparin to extend or decrease clotting time. APTT resulting in 80 seconds is double the control value and indicates effectiveness of the heparin therapy. Stop Heparin if platelet count: less than 100,000/mm3 Important: heparin does not dissolve clot. It stops new clots from forming. Clopidogrel: Inhibits platelet aggregation: nurses and health providers recommend to stop the medication 5 days before any surgery. Remember : Concepts infections: Resistant infections : when bacteria, viruses, fungi, or parasites create the ability to resist antibiotics medicines example: methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococcus (VRE) multidrug resistant. Nosocomial infections: infections acquired during the process of receiving health care (ambulatory settings, long term care facilities, hospitals) that were not present before client or patient admission or before receiving the health service. Superinfections : Acquired during or after antibiotic treatment ( by disrupting the body’s normal flora or microbiome, producing an imbalance example: Candida, MDR gram negative rods, Clostridium difficile, MRSA. Remember than a questions clues could be: symptoms and signs of a disease: for example: sudden weakness, numbness of the face and one arm or leg indicate risk for stroke and in a group of patient could be a priority to receive emergency service (anticoagulants), remember ABCD, Maslow theory needs, and other evidence based practices. Remember grapefruit juices modify and alter the activity of specific enzymes(CYP3A4 and CYP1A2), mainly in older adults These enzymes decrease the rate at which medications enter into the blood, thus grapefruit juice can increase toxicity of many drugs through this inhibition: Statin or cholesterol and lipid lower medications, Sertraline, Amioradone, Verapamil, Simvastatin and others. Anticonceptives frequents questions on ATI, Kaplan, Saunder: Example: if a patient or client complains about a missed dose, the nurse should recommend to take the missed dose immediately, then continue with the pack as ordered. Emergency oral contraceptive: Progestin with levonorgestrel (PO): Inhibits ovulation 72 hours before unprotected sexual intercourse. Estrogens: (oral, IM, IV, intravaginal, transdermal): Estrogens functions: participate in growth and maturation of the female reproductive system, follicular phase of the menstrual cycle, also blocks bone resorption, nad reduce low density lipoprotein. It used as contraceptive with progestin, acne, relief of moderate to severe menopause, treatment of dysfunctional bleeding and other (ATI book ch29) It is crucial to educate the patient or client to avoid smoking during contraceptives treatment. No interactions with anticoagulants, oral hypoglycemics, or thyroid medications. Encourage: visit the primary health provider frequent, obtain baseline of breast exam, pap smear, assess swelling, erythema of lower legs etc. Levels of diseases prevention: primary, secondary, tertiary, level of cares in relation to pharmacology. a frequent question is : If a patient or client receive treatment with Insulin: The nurses is providing tertiary prevention action because the client has a disease (Type 1 diabetes example), and the nurses is avoiding complications, and treating a disease. Remember the six rights and the assessment of the vital signs before administer any medication, and it's crucial to read carefully the health providers prescriptions (with critical thinking all the time)
