NUR2474 Pharmacology for Professional Nursing – Examination Blue
Print – Final Exam
Insulin: DM 1, DM 2, Gestational Diabetes
HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH PRIORITY FOR TREATMENT
1. What types of insulin are ordered before meals and at bedtime? Lispro and Regular are not
ordered before bedtime; Lispro and Regular are usually given before meals; Lantus is given
before bedtime; In the elderly especially, lantus is sometimes split into a morning and evening
dose. Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at bedtime;
NPH is often given only in the morning.
2. What type of insulin is sometimes given at bedtime, has the longest duration of all the insulins,
CANNOT BE MIXED WITH OTHER INSULINS, and for elderly patients is often split into two doses
(one in the morning and one at bedtime)? Insulin Glargine (Lantus) is usually given once a day at
bedtime. Elderly individuals often have their dose split in two and are administered one dose in
the morning and one dose at night; In addition, sometimes insulin lispro is given in a sliding scale
with a snack in the evening. It doesn’t last throughout the night-that’s what we want to avoid.
*Insulin aspart protamine in combo with insulin aspart would NOT be given in the evening, as it
lasts too long.
*NPH would peak at exactly the WRONG TIME. Do not give that one at bedtime.
Why is a nurse concerned for a beta-blocker/insulin combination? Beta Blockers can mask some
of the symptoms of hypoglycemia
What do you assess for? What symptoms could be concealed by taking a beta blocker while on
Symptoms of hypoglycemia:
Being nervous or anxious.
Sweating, chills and clamminess.
Irritability or impatience.
Feeling lightheaded or dizzy.
You will need to know the following chart:
12. Know these concepts: Toxicity- a drug is toxic when its level is high enough to cause harm to a
patient, Half-Life-time it takes for half the drug to be metabolized, distribution- , absorption,
13. Hypoglycemia (Know the Signs and Symptoms, Know when to hold insulin and call the provider.
Know when to give orange juice vs. glucagon vs. D50W) tremors, pallor, agitation, confusion,
14. Allergic Reaction (What is the difference in treatment of a mild allergic reaction and an
anaphylactic reaction? What are the signs and symptoms?
15. What is the difference between “Red Man Syndrome” and “Steven’s Johnson Syndrome?” What
16. Know these terms and why the routes may be utilized: intrathecal, intraspinal, oral, buccal,
sublingual, intramuscular, intravascular, rectal. Compare and contrast intrathecal and intraspinal.
Why is intrathecal used so commonly in obstetrics?
17. Why are infants and the elderly at risk for toxicity (and subject to severe) symptoms of toxicity
from numerous medications?
Infants have low weight. Infants have immature liver and kidney.
Elderly have degrading liver and kidney and are on multiple medications. Are there other factors
that can lead to increased risk of toxicity and adverse reactions? Name them. Weight. Liver
maturity or degredation. Kidney maturity or degredation. That’s why some meds are weight
based and some are adjusted for age, kidney function, or liver function.
18. Please note that organs can be affected by toxic levels of drugs. Please monitor patients for end
organ damage if toxic levels of a medication are reached. For example, if a Tylenol
(acetaminophen) overdose occurs, one would watch for the effects on one’s liver (Tylenol is hard
on the liver).
19. Definition of Bacteriostatic/Bactericidal Activity. The definitions of “bacteriostatic” and
“bactericidal” appear to be straightforward: “bacteriostatic” means that the agent prevents the
growth of bacteria (i.e., it keeps them in the stationary phase of growth), and “bactericidal”
means that it kills bacteria.
20. PLEASE MAKE SURE TO KNOW THAT CALCIUM INHIBITS THE ABSORPTION OF MOST
ANTIBIIOTICS; THEREFORE, CALCIUM CONTAINING PRODUCTS, LIKE MILK AND CALCIUMCONTAINING
21. ***Please note that pain during labor is treated with an epidural because this:
a. Keeps the medication away from the placenta
b. Infants’ blood-brain barriers, liver, and kidneys are not fully developed yet.
c. Once born, the infant will not be able to tolerate and respiratory suppression will ensue.
22. Please remember that Tylenol is okay during pregnancy and during breastfeeding. Ibuprofen is
NOT okay during pregnancy, but is fine while breastfeeding.
23. More infant stuff:
a. Infants breastfeeding can become toxic if lipid soluble drugs are being taken by mom
b. Immature kidneys cause slow excretion
c. Immature livers slow metabolism
d. Very sensitive to meds that affect the CNS.
24. Stuff that affects the physiological response to medications: gender, genetics, age