Diabetes, thyroid, osteoporosis

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Osteoporosis
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Osteoporosis
A condition in which the body's bones losse strength and density and become weak and break easily.
when is osteoporosis most common?
In women after menopause
Complications of osteoporosis?
fractures-wrist, hip, spine
Can osteoporosis be cured?
No, but disease progression can be delayed
What supplement should be taken with osteoporosis medications?
Vitamin D
Raloxifene
-osteoporosis medication
-strengthens bones
A/E Raloxifene
DVT, PE, stroke, MI, increased risk of blood clots!

**need detailed pt history, do not give medication to pt with history of smoking or prior clots/stroke/MI
Alenodronate
Osteoporosis medication
-most commonly used
-prevents breakdown of bone
-needs adequate vitamin d supplement
A/E alenodronate
Esophagitis, esophageal ulcer, esophageal erosions, osteocronsis

**do not give to pt with pre existing GI issues
Pt teachings alenodronate
1) take medication on empty stomach
2) sit or stand for 30 min after taking medication to avoid GI issues
CalcitoninSecondary treatment for osteoporosis **do not give to pt with fish allergyA/E calcitoninAnaphylaxis-fish allergyCitrical or Tums-supplement (osteoporosis) -used for hypocalcemia r/t insufficient dietary intake -OTC - lots of med interactions -take one hour before other medications are taken or 2 hours after other medications were taken **a/e- hypocalcemiaThyroid-regulates metabolism -pituitary gland releases t3 and t4What vitamin does the thyroid need?ThymineWhat are the two types of thyroid conditions?Hypothyroidism & HyperthyroidismHypothyroidismunderactivity of the thyroid gland, slows metabolismWhat mediation is known to cause hypothyroidism?LithiumWhat disease is r/t hypothyroidism?HashimotosSx of hypothyroidism?COLD, LOW, DRY, SLOW *constipated, low b/p, depression, hair lossComplications of hypothyroidism?myxedema coma *patient goes into coma like stateLevothyroxineused to treat hypothyroidism - mimics t3&t4 - once daily -do not give with blood thinners - monitor vitals, sx of chest pain -treatment is lifelong - takes several weeks to workSE of levothyroxineHyperthyroidismAE hyperthyroidismHeart failure, heart attack, seizureWhen do you take levothyroxine?once a day before breakfast/ any mealWhen to hold levothyroxine?When SE (hyperthyroidism) are presentHyperthyroidismexcessive activity of the thyroid glandCauses of hyperthyroidism- Most common cause is Grave's disease - Drugs that can cause hyperthyroidism include iodine, amiodarone, and interferons. - RAI-131 is the treatment of choice in Grave's disease - Beta blockers can be used first for symptom control (to reduce palpitations, tremors and tachycardia) - PTU or Methimazole can be used as temporary measure until surgery is complete - Initially, when treating with rugs, it takes 1-3 months at higher doses to control symptoms at which point the dose is reduced to prevent Hypothyroidism from occurring.Sx of hyperthyroidism?HOT HIGH WET FAST -weight loss, tachycardia, tachypnea, disarrythmias, HTN, increased appetite **bulging eyesComplications of hyperthyroidism?thyroid storm *medical emergency *sx-fever, tachycardia, HTNPropythiouracil and MethimazoleTreat hyperthyroidismA/E Propylthiouracil and MethimazoleBone marrow suppression, kidney and liver damages/e Propylthiouracil and Methimazole?HypothyroidismConsiderations for propylthiouracil and Methimazole?Do not take with bloood thinners -takes several weeks to work in body -do not give to pregnant women -avoid crowds and Ill people -monitor for sx of infection, bruising (could indicate bleed)Lugol's solution-used to treat hyperthyroidism AE- rash, agranulocytosis (extreme low wbc) - monitor for infection or bruising -do not give with anticoagulantsdiabetesEndocrine disorder in which the body is unable to produce enough insulin, the hormone required for the metabolism of sugartype 1 diabetes mellitus-diabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disorderSx of low bsCool and Clammy give them candy *bs less than 70 -confusing, shaky, nervous, clammy skin, diaphoresis, tremorstype 2 diabetesprogressive disorder in which body cells become less responsive to insulin -obesity or inactivity are main causes - pancreas makes less insulin over timeSx of high blood sugarHot and dry their bs is high! -increased thirst, increased urination, increased appetite, fruity breath, abdominal pain, NV, SOB, confusion, weight loss, diabetic comaNormal BS range70-100Labs to monitor long term control of diabetes?-A1C -blood sample -want to have less and 6%GlucagonAntidote to insulin- releases glucose into bodyDKADiabetic Ketoacidosis (DKA): hyperglycemic crisis (bs over 300) -life threatening -damages kidneys and turns fat into ketones, blood becomes acidicLabs to monitor with DKA?Potassium -elevated K+ indicates ketoacidosis -also monitor bun and creatineSx of DKAHyperglycemia, dehydration, fruity breath, thirst, acidosis, kussmalsInterventions for DKA1) normal saline (0.9%) 2) regular insulin 3) monitor cardiac 4) monitor electrolytes 5) frequent glucose testing!When is patient most at risk for hypoglycemia?During peak insulin activity! -administer fast acting glucoseComplications of uncontrolled diabetes?1. retinal change leading to blindness 2. kidney disease 3. nerve damage 4. circulatory disorders 5) foot damage/ necrosis 6) hearting impairment 7) depression 8) Alzheimer'sDrugs affecting glucose (hyper)1) steroids 2) thiazides/diuretics 3) thyroid hormoneDrugs affecting glucose (hypo)Ace inhibitors Beta blockers Oral hypoglycemics WarfarinWho can insulin be given to?Type 1 or 2Insulin safety-always double check medications -monitor BS before given med -monitor weight, bs, vitals, K+levels -patient needs more insulin when stressed -when patient is sick you need to increase bs checks and may possibly have to increase insulinOrder when mixing NPH and Regular insulin?"not ready right now" 1) NPH air 2) regular air 3) draw regular 4) draw NPHAE of all insulins?HypoglycemiaHumalog, Novolog, Apidra-rapid acting insulin -meal time insulin -work is in 15 min and lasts 2-4 hours *always give medication to pt with a meal or food sourceRegular (Humulin R)Short acting -working in one hour and lasts 5-7hours -cause use with sliding scale -mainly used with pts who have TPN OR TUBEFEEDNPH (Humulin N)intermediate acting insulin -working in one hour and lasts 16 hoursLantus, Levemirlong acting insulin -working in two hours and lasts 24 hours -long term med -once daily -cannot be mixed with any other drug or insulinWhat insulin's can be taken together ?-NPH &Regular 1) NPH air 2) regular air 3) draw regular 4) draw NPHWhat insulin's cannot be mixed?Lantus of Levemir (Long acting)Who can take oral diabetic medications?Type II diabeticsMetforminoral diabetic medicine -most common used -take with food, med works in one hour -interacts with contracts dye -harsh on kidneys -causes GI issues AE- lactic acidosis (n/v, weakness) *will place this med on hold in hospital and replace with insulin to control BS levelsWhat medication interacts with contrast dye?MetforminGlucotrol and AmarylAE- hypoglycemia *take within 30 min eating food *oral diabetic medicationproglitazone, rosiglitazone-oral diabetic medication AE-fl retention, cardiac effects, macular edema *monitor for cardiac changes *caution with cardiac ptsPrecose, Glyset-oral DM Medication -take with first bite every meal! AE- liver damage, colitis, intestinal obstructionWhat to always access before giving insulin?Blood sugarsis insulin a high alert medication?YesA/E of insulin?HypoglycemiaWhat to check vial if insulin for?Color and clarityWhat is insulin should never be mixed with other medications?Lantus or LevemirInsulin considerations?-with fast acting, always have food source readily available -do not shake vial -rotate sites -always have glucose source w/ patient at all times (in the event of hypoglycemic episode) -always monitor for SX of diabetic ketoacidosisSymptoms of diabetic ketoacidosis?deep rapid breathing, dry skin/mouth, flushed face, fruity smelling breath, nausea, vomiting, stomach pain, HTN