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By the end of this section, you should be able to:
- 22.2.1 Identify the characteristics of drugs used to treat cardiac emergencies.
- 22.2.2 Explain the indications, actions, adverse reactions, and interactions of drugs used to treat cardiac emergencies.
- 22.2.3 Describe nursing implications of drugs used to treat ... | {
"Header 1": "CHAPTER 22 Cardiac Emergency and Shock Drugs",
"Header 2": "**LEARNING OUTCOMES**",
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Nitrates can cause hypotension. In an emergency situation, make sure the client is sitting or lying down before administering nitroglycerin.
[Table 22.2](#page-645-0) is a drug prototype table for nitroglycerin use in emergency situations. It lists drug class, mechanism of action, adult dosage, indications, therapeut... | {
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"Header 2": "Nitroglycerin",
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Refer to [Antihypertensive and Antianginal Drugs](#page-528-1) for a full list of nursing implications for clients prescribed nitrates. In the event of suspected AMI or unstable angina, the health care provider may order sublingual nitroglycerin until an IV line is in place. If the client is receiving IV nitroglycerin,... | {
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"Header 2": "**Nursing Implications**",
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Morphine can cause respiratory depression, respiratory arrest, cardiac arrest, and shock. Nurses must monitor the client frequently (reassess at least every 5–10 minutes) when using morphine to control pain.
[Table 22.3](#page-647-0) is a drug prototype table for opioid agonists featuring morphine. It lists drug clas... | {
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"Header 2": "Opioid Analgesics",
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There is a saying in cardiac nursing that there are only three problems with the conduction system: The heart can beat too fast, too slow, or not at all.
This is an oversimplification, but each one of these problems can lead to hemodynamic instability and potentially death. Once again, the importance of cardiac outpu... | {
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"Header 2": "FDA BLACK BOX WARNING",
"Header 3": "**Dysrhythmia Drugs**",
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Amiodarone can cause hypotension, bradycardia, atrioventricular block, hepatic injury, heart rhythm disturbances, pulmonary injury, loss of vision, thyroid injury, hypersensitivity, anorexia, nausea, vomiting, and photosensitivity. It is important to note that the benefit of amiodarone in a life-threatening event outwe... | {
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"Header 2": "CLIENT TEACHING GUIDELINES",
"Header 3": "**Adverse Effects and Contraindications**",
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Diltiazem can cause asystole; atrial flutter; first-, second-, and third-degree atrioventricular block; bradycardia; chest pain; congestive heart failure; sinus pause; sinus node dysfunction; syncope; ventricular dysrhythmia; ventricular fibrillation; ventricular tachycardia; dizziness; allergic reaction; Stevens–Johns... | {
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"Header 3": "**Adverse Effects and Contraindications**",
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Epinephrine can cause anxiety and excitability, headache, fear, heart palpitations, tachycardia, supraventricular tachycardia, ventricular arrhythmias, hypertension, cerebral hemorrhage, hemiplegia, subarachnoid hemorrhage, anginal pain in clients with angina, pulmonary edema, hypoglycemia, hypokalemia, and lactic acid... | {
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"Header 3": "**Adverse Effects and Contraindications**",
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Lidocaine can cause respiratory depression and arrest, unconsciousness, convulsions, tremors, twitching, vomiting, blurred or double vision, drowsiness, dizziness, light-headedness, agitation, confusion, paresthesia, and dysarthria. It is important to note that the benefit of lidocaine in a life-threatening event outwe... | {
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"Header 3": "**Adverse Effects and Contraindications**",
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Endogenous (naturally occurring in the body) dopamine is a hormone that plays a role in stimulating the SNS. Dopamine, an **inotropic agent**, is converted into epinephrine within the bloodstream. Dopamine binds to alpha-1, alpha-2, beta-1, and dopaminergic receptors. Adrenergic stimulation of alpha-1 and alpha-2 recep... | {
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"Header 2": "FDA BLACK BOX WARNING",
"Header 3": "**Dopamine**",
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Dopamine may cause peripheral ischemia in clients with a history of occlusive vascular disease.
Dopamine is a potent drug. It should be administered only in an intensive care area with proper monitoring available.
[Table 22.11](#page-662-0) is a drug prototype table for dopamine use in emergency situations. It list... | {
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"Header 2": "SAFETY ALERT",
"Header 3": "Dopamine",
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Dobutamine should not be mixed with any other drug in the same solution because it is incompatible with many other drugs.
[Table 22.12](#page-664-0) is a drug prototype table for dobutamine. It lists drug class, mechanism of action, adult dosage, indications, therapeutic effects, drug and food interactions, adverse e... | {
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"Header 2": "CLINICAL TIP",
"Header 3": "Dobutamine",
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By the end of this section, you should be able to:
- 22.3.1 Identify the characteristics of drugs used to treat anaphylactic, hypovolemic, and cardiogenic shock.
- 22.3.2 Explain the indications, actions, adverse reactions, and interactions of drugs used to treat anaphylactic, hypovolemic, and cardiogenic shock.
- 22... | {
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"Header 2": "**LEARNING OUTCOMES**",
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Albuterol can cause paradoxical bronchospasm, tachycardia, and an immediate hypersensitivity reaction.
Hypersensitivity is the only contraindication to albuterol.
[Table 22.14](#page-667-0) is a drug prototype table for albuterol. It lists drug class, mechanism of action, adult dosage, indications, therapeutic effe... | {
"Header 1": "CHAPTER 22 Cardiac Emergency and Shock Drugs",
"Header 2": "**Albuterol**",
"Header 3": "**Adverse Effects and Contraindications**",
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Norepinephrine can cause cardiac arrhythmias, severe peripheral ischemia in clients who are hypovolemic, gangrene in clients with occlusive or thrombotic vascular disease (in high doses), and rebound hypotension after discontinuation. Norepinephrine may cause decreased sensitivity to insulin, so clients with diabetes m... | {
"Header 1": "CHAPTER 22 Cardiac Emergency and Shock Drugs",
"Header 2": "**Cardiogenic Shock Drugs**",
"Header 3": "**Adverse Effects and Contraindications**",
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- **acute myocardial infarction (AMI)** death of cardiac tissue due to lack of oxygen
- **adrenergic agonist** a drug that stimulates adrenergic receptors, resulting in sympathetic nervous system stimulation
- **anaphylaxis** systemic and overwhelming immune response to an antigen
- **angina** discomfort in the front o... | {
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"Header 2": "**Key Terms**",
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Common cardiac emergency and shock drugs were presented. Medications used include nitrates, opioid agonists, multiple types of antiarrhythmic drugs, adrenergic agonists, anticholinergics, and intravenous fluids to increase intravascular volume in a client in shock.
- **inotropic agent** a drug that causes the heart t... | {
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- 23.1 [Introduction to the Upper Respiratory System](#page-675-0)
- 23.2 [Introduction to the Lower Respiratory System](#page-677-0)
- 23.3 [Oxygenation and Gas Exchange](#page-680-0)
**INTRODUCTION** The respiratory system allows the body to breathe, talk, and smell. The respiratory system is primarily responsible ... | {
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The upper respiratory tract consists of these structures (Cleveland Clinic, 2023):
- Nose: This is the entrance to the respiratory tract. It contains a small patch of tissue that is home to **olfactory** sensory neurons. These neurons allow for recognition of scents. The nose contains mucus and cilia. The mucus traps... | {
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**Rhinitis** is inflammation and swelling of the mucous membranes in the nose. It can be caused by a variety of factors including allergens such as pollen and animal dander, smoke, temperature, viral infection, and certain drugs. The inflammatory response that is triggered by these irritants causes the mucous membranes... | {
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**Pharyngitis** is inflammation of the pharynx. It is more commonly known as a sore throat. A diagnosis of pharyngitis is nonspecific and does not convey the etiology of the illness. It is typically caused by viral or bacterial infections such as the common cold, influenza, or strep throat. Strep throat is an infection... | {
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"Header 3": "**Pharyngitis and Laryngitis**",
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The lower respiratory tract consists of these structures:
- Trachea (windpipe): This carries inhaled air into the lungs.
- Lungs: These include the bronchi, bronchioles, and alveoli. Air enters the lungs for oxygen and carbon dioxide to be exchanged.
- Bronchi: Major air passages that branch off from the trachea
- Br... | {
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**Asthma** is a condition in which airways swell and become narrow. The airways may also produce extra mucus. The combination of these characteristics can make breathing difficult and cause coughing and wheezing (a whistling sound) when breathing out. Asthma often causes clients to feel short of breath. (Mayo Clinic, n... | {
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**Emphysema** is characterized by shortness of breath. In clients with emphysema, the alveoli are damaged and do not work properly. Because of this damage, when the client exhales, old carbon dioxide–rich air becomes trapped and reduces room for fresh, oxygen-rich air. Emphysema is a progressive disorder. As time goes ... | {
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**Chronic bronchitis** is a type of COPD characterized by inflammation and irritation of the bronchial tubes. This causes mucus buildup and difficulty moving air into and out of the lungs.
Chronic bronchitis is usually caused by exposure to irritants over a long period. In the United States, cigarette smoking is the ... | {
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"Header 3": "**Chronic Bronchitis**",
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**Gas exchange**, shown in [Figure 23.5](#page-681-0), occurs when oxygen moves from the lungs to the bloodstream. For gas exchange to happen, the alveoli must be ventilated, gases must be diffused, and perfusion must take place. The pulmonary arteries bring venous blood from the right side of the heart to be oxygenate... | {
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"Header 2": "**Gas Exchange**",
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**Ventilation** is the process of moving air into and out of the lungs. It helps ensure that oxygen-rich air is brought into the lungs and carbon dioxide is expelled. The ventilation process also helps to maintain blood pH in the normal range by regulating the amount of carbon dioxide in the body.
Ventilation consist... | {
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"Header 3": "**Ventilation**",
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**Histamines** are chemicals in the immune system. Histamines are released by the body as part of the immune
response to a foreign substance such as an allergen or pathogen. Histamine receptors are activated, and reactions occur. H1 receptors are found in smooth muscle cells, endothelial cells, and nerve endings. Act... | {
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"Header 2": "**Antihistamines**",
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Antihistamines belonging to the first generation are extensively accessible and frequently used for managing allergy and cold symptoms. They were among the earliest antihistamines developed. These medications impact the histamine receptors present in the brain and spinal cord. Because they can penetrate the blood–brain... | {
"Header 1": "CHAPTER 24 Upper Respiratory Disorder Drugs",
"Header 2": "**Antihistamines**",
"Header 3": "**First-Generation Antihistamines**",
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First-generation antihistamines can cause drowsiness, dizziness, confusion, and urinary retention. Clients with a history of urinary retention or prostatic hyperplasia should use first-generation antihistamines cautiously. Firstgeneration antihistamines should be avoided in older adults because they can increase the ri... | {
"Header 1": "CHAPTER 24 Upper Respiratory Disorder Drugs",
"Header 2": "**Antihistamines**",
"Header 3": "**Adverse Effects and Contraindications**",
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Loratadine is also a second-generation antihistamine and is available over the counter. It is effective in pruritus, allergic rhinitis, and sneezing related to seasonal allergies. Loratadine should not be used if a client is pregnant or breastfeeding until they have consulted with their health care provider (MedlinePlu... | {
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"Header 2": "Antihistamines and Older Clients",
"Header 3": "**Loratadine**",
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The latest type of antihistamines, known as third-generation antihistamines, are among the newest antihistamines available. They were designed to effectively treat the same conditions as previous antihistamines but without the potential risk of cardiac toxicity that was observed in clients with metabolic issues. This n... | {
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"Header 3": "**Third-Generation Antihistamines**",
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Third-generation antihistamines, much like second-generation antihistamines, have a lower incidence of adverse
effects than first generation, but they can still cause fatigue, dizziness, nausea, and insomnia. Third-generation antihistamines should be used cautiously in clients with impaired renal function, and those ... | {
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"Header 3": "**Adverse Effects and Contraindications**",
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Phenylephrine is another common nasal decongestant. This drug is an alpha-adrenergic agonist. It can be administered via tablet, liquid, or dissolving strip. It works as other decongestants do by reducing the swelling of the blood vessels in the nose. As with pseudoephedrine, those with blood pressure issues should con... | {
"Header 1": "CHAPTER 24 Upper Respiratory Disorder Drugs",
"Header 2": "**Decongestants**",
"Header 3": "**Phenylephrine**",
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Systemic decongestants can cause increased blood pressure as well as nervousness, dizziness, and sleeplessness. Those clients with a hypersensitivity should avoid their use, and clients with heart disease and high blood pressure should use the drugs with caution and under the guidance of their health care provider.
[... | {
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"Header 3": "**Adverse Effects and Contraindications**",
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The nurse should do the following for clients who are taking antihistamines or decongestants:
- Prior to administering, assess the client's medical history, current drug list, and allergies for potential interactions and contraindications.
- Educate the client on adverse effects of antihistamines including drowsiness... | {
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"Header 2": "Decongestants",
"Header 3": "**Nursing Implications**",
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**Antitussives** are drugs that are used to treat nonproductive coughs. They are more commonly referred to as cough suppressants. Although their exact mechanism of action is unknown, it is thought that these medications inhibit the cough center in the brain or soothe nerve receptors around airways to reduce transmissio... | {
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"Header 2": "**24.2 Antitussives**",
"Header 3": "**Opioid Antitussives**",
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Opioid antitussives can cause drowsiness, dizziness, confusion, and hypotension. Dependence is also a concern due to the opioid portion. Those who are hypersensitive to them should avoid their use. Clients with angle-closure glaucoma, pyloric stenosis, peptic ulcer disease, and prostatic hyperplasia should also avoid o... | {
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"Header 2": "**24.2 Antitussives**",
"Header 3": "**Adverse Effects and Contraindications**",
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Dextromethorphan acts to suppress cough by acting on the cough center in the medulla. This drug is a common choice for relief of cough because it does not cause addiction and has little to no CNS depression. Clients should inform their health care provider if their cough lasts longer than 1 week or is accompanied by ot... | {
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"Header 2": "**Nonopioid Antitussives**",
"Header 3": "**Dextromethorphan**",
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Adverse effects of nonopioid antitussives include rash, itching, confusion, nausea, and constipation. Some clients
may also experience lightheadedness, dizziness, and drowsiness. Clients with a hypersensitivity to nonopioid antitussives should avoid their use, and they should be used with caution in clients who are s... | {
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"Header 2": "**Nonopioid Antitussives**",
"Header 3": "**Adverse Effects and Contraindications**",
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The nurse should do the following for clients who are taking antitussives:
- Prior to administering, assess the client's medical history, current drug list, and allergies for potential interactions and contraindications.
- Prior to administering, assess the client's respiratory status for signs of respiratory distres... | {
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"Header 3": "**Nursing Implications**",
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Guaifenesin does not cause many adverse effects, but dizziness, headache, nausea, and vomiting may occur.
[Table 24.13](#page-700-1) is a drug prototype table for expectorants featuring guaifenesin. It lists drug class, mechanism of action, adult and pediatric dosage, indications, therapeutic effects, drug and food i... | {
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"Header 2": "**Adverse Effects and Contraindications**",
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Dornase alfa is another mucolytic used most often to lower the number of lung infections and help lung function in cystic fibrosis. Dornase alfa acts like an enzyme naturally found in the lungs to help thin out thick, sticky mucus. Removing mucus in these clients helps to reduce the number of infections that they may h... | {
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"Header 2": "**Adverse Effects and Contraindications**",
"Header 3": "**Dornase Alfa**",
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Mucolytics can cause tachycardia, nausea, and vomiting. Some clients may experience voice changes, hoarseness, and sore throat. Clients with hypersensitivity to mucolytics and those with peptic ulcer disease should avoid these drugs.
[Table 24.15](#page-702-0) is a drug prototype table for mucolytics featuring acetyl... | {
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"Header 2": "**Adverse Effects and Contraindications**",
"Header 3": "**Adverse Effects and Contraindications**",
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The nurse should do the following for clients who are taking expectorants and mucolytics:
- Prior to administering, assess the client's medical history, current drug list, and allergies for potential interactions and contraindications.
- Assess the client's respiratory status for signs of respiratory distress that in... | {
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"Header 2": "**Nursing Implications**",
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25.1 [Adrenergics and Anticholinergics](#page-707-0) 25.2 [Corticosteroids](#page-714-0) 25.3 [Xanthines, Leukotriene Modifiers, and Mast Cell Stabilizers](#page-717-0)
**INTRODUCTION** The lower respiratory system (shown in [Figure 25.2\)](#page-707-1) plays a crucial role in respiration, allowing the exchange of ox... | {
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"Header 2": "**CHAPTER OUTLINE**",
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**Beta-adrenergic** drugs target beta-adrenergic receptors in the sympathetic nervous system. These receptors are found in various tissues, including the heart, lungs, and smooth muscles, and lead to smooth muscle relaxation.
One type of beta-adrenergic receptor, beta 2, is predominantly found in the smooth muscles o... | {
"Header 1": "CHAPTER 25 Lower Respiratory Disorder Drugs",
"Header 2": "**Beta Adrenergics**",
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Ephedrine can cause an increase in heart rate and blood pressure, insomnia, and tremors. Clients who have hypersensitivity or who have been taking a monoamine oxidase inhibitor (MAOI) should not use ephedrine (DailyMed, Ephedrine hydrochloride, 2022).
Epinephrine can cause anxiety, restlessness, and headache. Clients... | {
"Header 1": "CHAPTER 25 Lower Respiratory Disorder Drugs",
"Header 2": "**Beta Adrenergics**",
"Header 3": "**Adverse Effects and Contraindications**",
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Anticholinergics should be used with caution due to potential side effects, especially in older adults, who may be more susceptible to adverse reactions like cognitive impairment and increased risk of falls.
Two commonly used respiratory anticholinergics are ipratropium bromide and tiotropium. Ipratropium bromide, of... | {
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"Header 2": "Side Effects of Anticholinergics",
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By the end of this section, you should be able to:
- 25.2.1 Identify the characteristics of corticosteroid drugs used to treat respiratory disorders.
- 25.2.2 Explain the indications, actions, adverse reactions, and interactions of corticosteroid drugs used to treat respiratory disorders.
- 25.2.3 Describe nursing im... | {
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} |
**Xanthines** are a class of drugs that have been used for many years to manage respiratory conditions, particularly asthma and COPD. Xanthines work by relaxing the smooth muscles in the airways, which helps to open the bronchial passages and improve breathing. They also have some anti-inflammatory effects and can enha... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Xanthines**",
"token_count": 846,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Close monitoring and individualized dosing are essential when utilizing xanthines in respiratory therapy. Xanthines can have a variety of potential adverse effects, including nausea, vomiting, restlessness, nervousness, increased heart rate, and tremors. The number of adverse effects is partly why xanthines are not as ... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Xanthines**",
"Header 3": "**Adverse Effects and Contraindications**",
"token_count": 784,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
**Leukotriene modifiers**, also known as leukotriene receptor antagonists or leukotriene inhibitors, are a class of medications used to manage various inflammatory conditions, particularly asthma. These medications target **leukotrienes**, which are inflammatory substances produced in the body in response to certain tr... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Leukotriene Modifiers**",
"token_count": 410,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Montelukast is typically well tolerated; side effects include fever, headache, cough, abdominal pain, and diarrhea. Clients with hypersensitivity should not take this drug. Zafirlukast can cause headache, nausea, diarrhea, dizziness, and vomiting. Zileuton's most common adverse effects are sinusitis and nausea. Both za... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Leukotriene Modifiers**",
"Header 3": "**Adverse Effects and Contraindications**",
"token_count": 432,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
26.1 [Introduction to the Adrenal Cortex, Pituitary, and Hypothalamus](#page-726-2)
- 26.2 [Growth Hormones and Suppressants](#page-730-0)
- 26.3 [Antidiuretic Hormones](#page-733-0)
- 26.4 [Glucocorticoids and Mineralocorticoids](#page-737-0)
**INTRODUCTION** The **endocrine system** serves as a crucial communicat... | {
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"Header 2": "**CHAPTER OUTLINE**",
"token_count": 201,
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The **pituitary gland** (see [Figure 26.3](#page-728-0)), or pituitary, is a small, pea-sized gland that is a vital part of the endocrine system, regulating various physiological functions in the body. The pituitary, also known as the **hypophysis**, is located at the base of the brain and is often referred to as the "... | {
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"Header 2": "**Introduction to the Pituitary Gland**",
"token_count": 459,
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The **adrenal glands**, which are located on top of each kidney, consist of two layers: the adrenal medulla and the adrenal cortex. The adrenal medulla is the inner layer of the adrenal glands and is important for producing epinephrine and norepinephrine in response to stress. This chapter, however, will focus on the *... | {
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"Header 2": "**Introduction to the Adrenal Cortex**",
"token_count": 271,
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Access multimedia content [\(https://openstax.org/books/pharmacology/pages/26-1-introduction-to-the-adrenal](https://openstax.org/books/pharmacology/pages/26-1-introduction-to-the-adrenal-cortex-pituitary-and-hypothalamus)[cortex-pituitary-and-hypothalamus\)](https://openstax.org/books/pharmacology/pages/26-1-introduct... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "The Hypothalamic-Pituitary-Adrenal Axis",
"token_count": 224,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Somatropin (different from somatotropin mentioned above) is a recombinant growth hormone that is used to treat failure to grow due to growth hormone deficiency in pediatric and adult clients; some forms of this prescription are indicated in the treatment of **Prader-Willi syndrome**. The drug is available in a subcutan... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "**Growth Hormone**",
"Header 3": "**Somatropin**",
"token_count": 201,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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The growth hormone receptor antagonist pegvisomant is indicated for the treatment of acromegaly in clients who have inadequate response to surgery or radiation therapy or for whom these therapies are inappropriate. Adverse reactions include infection, pain, nausea, diarrhea, abnormal liver tests, flu-like symptoms, and... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "**Pegvisomant**",
"token_count": 792,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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- Keep this drug in its original carton to protect it from light.
- If injectable:
- Choose injection site (thigh, abdomen, or buttock) as recommended by their health care provider, avoiding areas that are bony, bruised, sore, red, scarred, or hard.
- Cleanse injection area with an alcohol swab/pad and let dry for 30 s... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "**The client taking a growth hormone suppressant should:**",
"token_count": 232,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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By the end of this section, you should be able to:
- 26.3.1 Identify the characteristics of ADH drugs used to treat pituitary disorders.
- 26.3.2 Explain the indications, actions, adverse reactions, and interactions of ADH drugs used to treat pituitary disorders.
- 26.3.3 Describe nursing implications of ADH drugs us... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "**Learning Outcomes**",
"token_count": 379,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Tolvaptan is used to treat a condition called hyponatremia (low serum sodium levels). This drug works by blocking the action of vasopressin, which helps the body to retain water and maintain electrolyte homeostasis, and is used to treat conditions such as SIADH, heart failure, liver disease, and kidney disease. Tolvapt... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "**Desmopressin Acetate**",
"Header 3": "**Tolvaptan**",
"token_count": 688,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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Glucocorticoids and mineralocorticoids are two types of steroid hormones that are produced by the adrenal cortex and play distinct roles in regulating the body's metabolism, fluid balance, and stress response. **Glucocorticoids** are produced in response to stress and help regulate metabolism and the immune system.
T... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "**Glucocorticoids**",
"token_count": 317,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Dexamethasone is a long-acting synthetic form of cortisol that is used to reduce inflammation in the body and may also be used as an immunosuppressant. Dexamethasone, which comes in an oral and injectable form, is used to treat numerous disorders including rheumatic, respiratory, asthma, and allergic reactions. This dr... | {
"Header 1": "CHAPTER 26 Hypothalamus, Pituitary, and Adrenal Disorder Drugs",
"Header 2": "CLINICAL TIP",
"Header 3": "**Dexamethasone**",
"token_count": 593,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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The **thyroid gland** is a butterfly-shaped gland located at the front of the neck below the voice box (see [Figure 27.2](#page-747-0)). This important gland regulates metabolism in the body through the production and secretion of thyroid hormones, which require iodine for synthesis. The thyroid gland produces the acti... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Thyroid and Parathyroid Glands**",
"token_count": 1041,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Hypothyroidism arises from an inadequate secretion of T3 and T4 into the bloodstream, prompting the pituitary gland to release TSH. This dynamic is part of the hypothalamus-pituitary axis, in which the hypothalamus triggers the release of TRH to stimulate the anterior pituitary in the secretion of TSH. **Hashimoto thyr... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Hypothyroidism**",
"token_count": 429,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Hyperthyroidism occurs when the body secretes too much T3 and T4 into the blood. The autoimmune disorder **Graves' disease** is the most common cause of hyperthyroidism. In Graves' disease, the production of TSH receptor antibodies stimulate the thyroid gland to grow and secrete additional thyroid hormone. **Thyroid st... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Hyperthyroidism**",
"token_count": 434,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Hyperparathyroidism occurs when the body secretes too much PTH in the blood, leading to dangerously elevated levels of calcium in the blood. The inverse reaction of calcium and phosphate causes the phosphate levels in the body to decrease. Hyperparathyroidism is typically caused by a lack of response to the normal feed... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Hyperparathyroidism**",
"token_count": 378,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Diagnostic testing is key in determining thyroid and parathyroid conditions. Review the article Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder. The first figure in the article illustrates an algorithm commonly used when diagnosing thyroid and parathyroid disorders.
Other diagnos... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "Diagnostic Testing [\\(https://openstax.org/r/practitioner\\)](https://openstax.org/r/practitioner)",
"token_count": 209,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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Levothyroxine sodium is a synthetic thyroid hormone that is identical to T4 produced in the body. The gastrointestinal tract absorbs 40%–80% of this synthetic hormone. The drug is greater than 99% protein bound and easily distributed. It is primarily eliminated by the kidneys, with approximately 20% of T4 being excrete... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Thyroid Drugs**",
"Header 3": "**Levothyroxine Sodium**",
"token_count": 277,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Desiccated thyroid extract is a thyroid hormone developed from pig glands that is often used as an over-the-counter remedy for thyroid hormone replacement. Desiccated thyroid extract has not been approved by the Food and Drug Administration (FDA) due to a complex manufacturing process leading to issues with safety, eff... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "Similarly Named Drugs",
"Header 3": "**Desiccated Thyroid Extract**",
"token_count": 366,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Thionamides are compounds that effectively hinder the synthesis of thyroid hormones. These compounds are transported into the thyroid gland and act by inhibiting two critical processes: **organification** of iodine to tyrosine residues in **thyroglobulin** as well as coupling of **iodotyrosines**, leading to lower seru... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Thionamides**",
"token_count": 203,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Potassium iodide prevents iodine from getting into the thyroid gland. As a medication, potassium iodine is used two separate ways: 1) to treat hyperthyroidism by inhibiting thyroid hormone secretion in very acute situations, and 2) to prevent the uptake of radioactive iodine in the event of a nuclear emergency. Additio... | {
"Header 1": "CHAPTER 27 Thyroid and Parathyroid Disorder Drugs",
"Header 2": "**Thionamides**",
"Header 3": "**Potassium Iodide**",
"token_count": 405,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
In the United States, many Black and Asian people, as well as many adults experiencing poverty, aged 50 years and older, are less likely to get the recommended daily amounts of calcium (National Institutes of Health, 2023). As we age, our bodies absorb less calcium. For postmenopausal clients, a decrease in calcium abs... | {
"Header 1": "CASE STUDY",
"Header 2": "Calcium and Race/Ethnicity, Age, and Socioeconomic Factors",
"token_count": 251,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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Calcium gluconate is an injectable drug used in the treatment of acute symptomatic hypocalcemia. It increases serum ionized calcium levels. This medication is contraindicated in clients with hypercalcemia and in neonates (28 days old or younger) and should be used cautiously in clients with cardiac arrhythmias with con... | {
"Header 1": "CASE STUDY",
"Header 2": "**Calcium Acetate**",
"Header 3": "**Calcium Gluconate**",
"token_count": 540,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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Vitamin D is a fat-soluble vitamin that promotes calcium and phosphorous absorption in the intestines and helps to maintain adequate serum calcium and phosphate levels within the body. Vitamin D has other roles in the body—it reduces inflammation, and it stimulates insulin production in the modulation of cell function,... | {
"Header 1": "CASE STUDY",
"Header 2": "**Vitamin D**",
"token_count": 251,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Calcitriol is a synthetic vitamin D analog that is active in the regulation and absorption of calcium from the gastrointestinal tract. Calcitriol is readily absorbed from the intestine with peak serum concentration within 3–6 hours. It is 99.9% bound to protein in the blood and easily distributed. Calcitriol is indicat... | {
"Header 1": "CASE STUDY",
"Header 2": "**Calcitriol**",
"token_count": 353,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Common adverse effects include constipation, dry mouth, bone pain, metallic taste, polyuria, pruritis, increased liver enzymes (AST), and elevated blood urea nitrogen (BUN) levels.
Contraindications include hypersensitivity to the drug or any of its components, malabsorption disorders (such as Celiac disease or Crohn... | {
"Header 1": "CASE STUDY",
"Header 2": "**Calcitriol**",
"Header 3": "**Adverse Effects and Contraindications**",
"token_count": 686,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Risedronate is also a nitrogen-containing bisphosphonate that is indicated in the treatment of postmenopausal osteoporosis. It is available as a delayed-release and immediate-release tablet and should be taken in the morning immediately following breakfast. The client should be able to sit/stand for at least 30 minutes... | {
"Header 1": "CASE STUDY",
"Header 2": "**Bisphosphonates**",
"Header 3": "**Risedronate**",
"token_count": 476,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
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Adverse effects of bisphosphonates drug class include gastrointestinal symptoms (such as abdominal pain, dyspepsia, nausea, vomiting, and diarrhea), esophageal irritation (leading to heartburn and difficulty swallowing), musculoskeletal pain, **osteonecrosis** of the jaw (death of bone tissue in the jaw leading to pain... | {
"Header 1": "CASE STUDY",
"Header 2": "**Bisphosphonates**",
"Header 3": "**Adverse Effects and Contraindications**",
"token_count": 612,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Calcitonin salmon is a synthetic peptide hormone that is used in the treatment of hypercalcemia, postmenopausal osteoporosis when alternative therapies are not suitable, and symptomatic Paget's disease. Calcitonin salmon is available as an injectable and nasal spray and is contraindicated in clients with hypersensitivi... | {
"Header 1": "CASE STUDY",
"Header 2": "**Peptide Hormones**",
"Header 3": "**Calcitonin Salmon**",
"token_count": 213,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Adverse effects of peptide hormones include nasal dryness and irritation, nausea with or without vomiting, injection site inflammation, and flushing of hands or face.
Contraindications for peptide hormones include hypersensitivity to the drug or any of its components.
[Table 27.14](#page-767-0) is a drug prototype ... | {
"Header 1": "CASE STUDY",
"Header 2": "**Peptide Hormones**",
"Header 3": "**Adverse Effects and Contraindications**",
"token_count": 732,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
28.1 [Introduction to Diabetes](#page-772-2) 28.2 [Insulin and Non-Insulin Injectable Diabetes Drugs](#page-778-0) 28.3 [Oral Antidiabetic Drugs](#page-786-0)
**INTRODUCTION Diabetes** is a long-term chronic health condition that affects millions of people worldwide. It alters how the body regulates glucose from food... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "**CHAPTER OUTLINE**",
"token_count": 227,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
By the end of this section, you should be able to:
- 28.1.1 Describe the pathophysiology of type 1 and type 2 diabetes.
- 28.1.2 Identify clinical manifestations of diabetes.
- 28.1.3 Identify the etiology and diagnostic studies related to diabetes.
The islets of Langerhans are clusters of cells located in the panc... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "**LEARNING OUTCOMES**",
"token_count": 297,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
The U.S. Food and Drug Administration (2023) approved [Lantidra \(donislecel-jujn\)](https://openstax.org/r/fdagovnewsevents) (https://openstax.org/r/ [fdagovnewsevents\)](https://openstax.org/r/fdagovnewsevents), the first allogeneic (donor) pancreatic islet cellular therapy made from deceased donor pancreatic cells t... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "Type 1 Diabetes and Lantidra",
"token_count": 291,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
**Type 2 diabetes** occurs when the pancreas does not produce enough insulin or the body is not using insulin effectively. [Figure 28.2](#page-773-0) shows the mechanism of normal blood sugar absorption versus insulin resistance with type 2 diabetes. The β cells in the pancreas continue to have some degree of functiona... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "**Type 2 Diabetes**",
"token_count": 302,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
**Hypoglycemia** occurs when the blood glucose level in the body falls below the normal range. The expected values for normal fasting blood glucose concentration are between 70 mg/dL and 100 mg/dL (World Health Organization [WHO], n.d.). When blood glucose levels are too low, the brain does not get enough glucose to fu... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "**Hypoglycemia**",
"token_count": 313,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
**Hyperglycemia** occurs when the blood glucose level in the body is above the normal range and the body has too little insulin or is too insulin resistant to lower the blood glucose level on its own. This causes a disruption in glucose homeostasis. If a blood glucose level is above 110 mg/dL, it is considered hypergly... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "**Hyperglycemia**",
"token_count": 311,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
More than one in three U.S. adults have prediabetes. As defined by the CDC, "a person with prediabetes has a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes. He or she is at higher risk for developing type 2 diabetes and other serious health problems, including heart disease and st... | {
"Header 1": "CHAPTER 28 Diabetic Drugs",
"Header 2": "TRENDING TODAY",
"Header 3": "Prediabetes",
"token_count": 329,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Premixed insulin combines intermediate- and short-acting insulin into a single injection. These injections are usually taken 10 to 30 minutes before breakfast and dinner to provide both basal and mealtime coverage.
| | Table 28.2 lists common insulins and their actions. |
|--|----------------------------------------... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Premixed Insulin**",
"token_count": 520,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Insulin typically comes as an injectable source because it needs to bypass the first pass of digestion for absorbtion due to its instability in the presence of gastric acid. Insulin is injected into the **subcutaneous** tissue via an insulin syringe, insulin pen, or insulin pump. Injection sites for insulin are located... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Administration of Insulin**",
"token_count": 219,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Most insulin is given on a carbohydrate-to-insulin ratio via a fixed-dose insulin method with an insulin syringe (American Diabetes Association, n.d.-d). Fixed-dose therapy can apply to clients who take one injection a day and to clients taking multiple injections per day. With fixed-dose insulin therapy, a client will... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Administration of Insulin**",
"Header 3": "**Methods of Insulin Dosing**",
"token_count": 369,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
An **insulin pen** is a pen-shaped injector device that combines insulin and a syringe in one unit. Insulin pens are prefilled with an insulin cartridge or have a prefilled insulin reservoir. The pens have a dial, and disposable needles can be attached to the pen. Insulin pens are relatively easy to use and convenient.... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Administration of Insulin**",
"Header 3": "**Insulin Pen**",
"token_count": 206,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
An **insulin pump** is a small, computerized infusion set device that delivers insulin. Doses of a rapid-acting insulin are supplied through a flexible catheter that has been inserted through the skin into the subcutaneous tissue. Insulin pumps are often integrated with a **continuous glucose monitor (CGM)**, which is ... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "Insulin Pens",
"Header 3": "**Insulin Pump and Continuous Glucose Monitoring**",
"token_count": 286,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Intravenous insulin is administered by a health care professional to a client in a health care setting. Insulin is administered directly into the bloodstream via an intravenous catheter. Intravenous insulin is used to treat hyperglycemic emergencies and other conditions such as diabetic ketoacidosis, hyperosmolar (extr... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Intravenous Insulin**",
"token_count": 573,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Semaglutide (Ozempic) is taken once a week at any time of the day regardless of mealtimes. It can be used in combination with sulfonylureas, non-sulfonylureas biguanides, thiazolidinediones, and insulin. Adverse effects include nausea, diarrhea, abdominal pain, decreased appetite, weight loss, and constipation (Smits &... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "GLP-1 Receptor Agonists",
"Header 3": "**Semaglutide**",
"token_count": 649,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
- Report symptoms of hypoglycemia such as headache, nervousness, sweating, clammy skin, tremor, and tachycardia.
- Report symptoms of hyperglycemia such as increased thirst, increased urine output, hot/dry skin, and sweet, fruity breath odor.
- Keep 15 grams of carbohydrates on hand in case of a hypoglycemic reaction. ... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "CLIENT TEACHING GUIDELINES",
"Header 3": "**The client using an insulin or non-insulin injectable diabetes drug should:**",
"token_count": 264,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Glipizide is a second-generation sulfonylurea that stimulates the pancreas to produce insulin, thereby lowering blood glucose levels. Glipizide is used along with diet and exercise to improve glucose homeostasis in adults with type 2 diabetes. Glipizide comes in tablet form and should be taken 30 minutes before the fir... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Second-Generation Sulfonylureas**",
"Header 3": "**Glipizide**",
"token_count": 247,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
Non-sulfonylurea biguanides are a group of oral diabetes drugs that prevent the production of glucose in the liver. They improve the body's sensitivity to insulin and reduce the amount of glucose absorbed by the intestines. Nonsulfonylurea biguanides are used to treat type 2 diabetes (Corcoran & Jacobs, 2022).
Metfor... | {
"Header 1": "UNFOLDING CASE STUDY",
"Header 2": "**Non-Sulfonylurea Biguanides**",
"token_count": 214,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Pharmacology-WEB.pdf"
} |
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