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Exam 3 > Agents to Control Blood Glucose Levels > Flashcards

Agents to Control Blood Glucose Levels Flashcards

1
Q

What is a sign or symptom that a patient is hypoglycemic?

A

The act similar to someone who is drunk.

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2
Q

What are the three types of drugs that increase blood sugar?

A
  1. Steroids
  2. Epinephrine
  3. Diuretics-HCTZ
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3
Q

What is the definition of insulin?

A

A hormone produced by beta cells of the islets of langerhans.

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4
Q

Where is insulin produced?

A

In the beta cells in the pancreas

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5
Q

When is insulin released into circulation?

A

When the levels of glucose around these cells rise.

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6
Q

What does insulin do?

A
  • Stimulates the synthesis of glycogen
  • The conversion of lipids into fat stored in the form of adipose tissue
  • The synthesis of needed proteins from amino acids.
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7
Q

What are the 2 different forms of concentration that insulin comes in?

A

100 u/mL

500 u/mL

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8
Q

Preparations of insulin vary as to what three things?

A
  • Onset of action
  • Time to peak effect
  • Duration
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9
Q

True or False:

Almost all insulin used today is human insulin.

A

True

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10
Q

How is insulin made?

A

By recombinant DNA technology

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11
Q

Why is almost all insulin used today human insulin?

A

It is more effective, fewer allergies, and less resistance.

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12
Q

What are the two ways that insulin can be modified?

A
  • To be more rapid

- To have a prolonged action

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13
Q

What is the generic rule on angling an insulin needle?

A

Put the needle in at a 90 degree angle.

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14
Q

If a patient has very little fat what angle should you use when sticking them with an insulin needle?

A

45 degrees

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15
Q

What are the two routes of administering insulin?

A

Subcutaneous or intravenous

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16
Q

If a patient is being put on insulin intravenously what kind is given and where would the patient most likely be?

A

Regular insulin and they will likely be in the ICU on an insulin drip.

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17
Q

What is the trade name for insulin glulisine?

A

Apidra

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18
Q

How fast is the action of Insulin Glulisine?

A

Rapid

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19
Q

What is the onset of Insulin Glulisine?

A

15-30 minutes

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20
Q

What is the peak of Insulin Glulisine?

A

1 hour

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21
Q

What is the duration of Insulin Glulisine?

A

3-4 hours

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22
Q

When should you administer Insulin Glulisine?

A

15 minutes before a meal or within 20 minutes after starting a meal.

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23
Q

What is Insulin Glulisine compatible with?

A

Can give with Insulin Isophane (NPH)

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24
Q

When mixing Insulin Glulisine with Insulin Isophane (NPH): which medication do you draw up first?

A

Glulisine

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25
Q

What is the trade name for insulin regular?

A

Humulin R

Novolin R

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26
Q

How fast is the action of Insulin Regular?

A

Short

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27
Q

What is the onset of Insulin Regular?

A

30-60 minutes

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28
Q

What is the peak of Insulin Regular?

A

2-4 h

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29
Q

What is the duration of Insulin Regular?

A

5-7 hours

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30
Q

When should you administer Insulin Regular?

A

30-60 minutes before a meal

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31
Q

Which ways can you administer Insulin Regular?

A

Subcutaneous or IV

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32
Q

What can you mix Insulin Regular with?

A

Insulin isophane (NPH), sterile water, or normal saline.

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33
Q

What can you NOT mix Insulin Regular with?

A

Insulin glargine

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34
Q

When is insulin detemir usually given?

A

In the PM

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35
Q

What is the trade name of insulin detemir?

A

Levemir

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36
Q

How fast is the action of Insulin Detemir?

A

Long

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37
Q

What is the onset of Insulin Detemir?

A

Gradual over 24 hours

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38
Q

What is the peak of Insulin Detemir?

A

6-8 hours

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39
Q

What is the duration of Insulin Detemir?

A

To 24 hours

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40
Q

When do you administer Insulin Detemir?

A

With evening meal or at bedtime

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41
Q

What can be mixed with Insulin Detemir?

A

No other insulins

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42
Q

What can be mixed with Insulin Glargine?

A

No other insulins?

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43
Q

What is the trade name for Insulin Glargine?

A

Lantus

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44
Q

How fast is the action of Insulin Glargine?

A

Long

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45
Q

What is the onset of Insulin Glargine?

A

1.1 h

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46
Q

What is the peak of Insulin Glargine?

A

3-4 h

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47
Q

What is the duration of Insulin Glargine?

A

10-24 h

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48
Q

When should you administer Insulin Glargine?

A

Once daily given at the same time each day- usually in the AM

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49
Q

What is the trade name of Insulin Aspart?

A

NovoLog

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50
Q

How fast is the action of Insulin Aspart?

A

Rapid

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51
Q

What is the onset of Insulin Aspart?

A

15 minutes

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52
Q

What is the peak of Insulin Aspart?

A

1-3 h

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53
Q

What is the duration of Insulin Aspart?

A

3-5 h

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54
Q

When should you administer Insulin Aspart?

A

5-10 minutes before a meal

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55
Q

What can you give Insulin Aspart with?

A

insulin Isophane (NPH)

56
Q

When mixing Insulin Apart with Insulin Isophane (NPH) which do you draw up first?

A

Insulin Aspart

57
Q

What is the trade name of Insulin Lispro?

A

Humalog

58
Q

How fast is the action of Insulin Lispro?

A

Rapid

59
Q

What is the onset of Insulin Lispro?

A

5-15 minutes

60
Q

What is the peak of Insulin Lispro?

A

0.5-1 h

61
Q

What is the duration of Insulin Lispro?

A

3-4 h

62
Q

When do you administer Insulin Lispro?

A

5-10 minutes before a meal

63
Q

What can you mix Insulin Lispro with?

A

Insulin Isophane (NPH)

64
Q

When mixing Insulin Lispro with Insulin Isophane (NPH) which do you draw up first?

A

The Insulin Lispro

65
Q

What are the four actions times of insulins?

A
  • Rapid
  • Short
  • Intermediate
  • Long
66
Q

What is the action of Regular Insulin?

A

Short acting
Clear
Colorless

67
Q

When is Regular Insulin from?

A

Pork pancreas or DNA modified

68
Q

What does Regular Insulin function like?

A

Endogenous insulin

69
Q

What is the primary use of Regular insulin?

A

To provide control of blood glucose in a diabetic patient.

70
Q

What is the two adverse effects of regular insulin?

A

Hypoglycemia and allergic reaction

71
Q

When should you use caution when prescribing Regular Insulin?

A

Renal or hepatic impairment

72
Q

A patient who is pregnant and has diabetes what does that mean?

A

They need a tighter control of their blood sugar levels.

73
Q

What is the dawn phenomenon?

A

The body knows when it is waking up and a patient tends to wake up with signs and symptoms of hypoglycemia. They usually need a higher dose of insulin before bed.

74
Q

Why is a sliding scale used for administering insulin?

A

Because stress and exercise may affect the patients blood sugar needing either less or more insulin.

75
Q

What should you be teaching the patients about hyper and hypo glycemia?

A

They should know the signs and symptoms of each especially after administration of insulin.

76
Q

True or false:

Clear insulin must be drawn into the syringe first

A

True

77
Q

What is Glyburide normally taken with?

A

Metformin

78
Q

What are the actions of Glyburide?

A
  • Stimulate insulin release from the beta cells in the pancreas
  • They improve insulin binding to insulin receptors
79
Q

What are the indications a patient needs Glyburide?

A

They need an adjunct to diet and exercise to lower their blood glucose levels.

80
Q

What must the diabetic patient have in order to be on Glyburide?

A

Working beta cells in pancreas

81
Q

Where is Glyburide rapidly absorbed?

A

In the GI tract and undergoes hepatic metabolism

82
Q

What is Glyburide only used for?

A

Type 2 diabetes

83
Q

How is the Glyburide excreted?

A

In the urine and feces

84
Q

What are the contraindications or cautions when prescribing Glyburide?

A
  • Severe trauma
  • Major Surgery
  • Renal/hepatic impairment
  • Cardiovascular disease
  • Pregnancy
  • Type 1 diabetes
85
Q

What are the adverse effects of Glyburide?

A
  • Hypoglycemia
  • GI distress
  • Possible cardiovascular effects
86
Q

What are the drug to drug interactions of Glyburide?

A
  • Beta blockers
  • Anticoagulants
  • Alcohol
  • Ginseng
  • Garlic
87
Q

What is the route that Glyburide is administered?

A

Oral

88
Q

What is the onset of Glyburide?

A

1 hour

89
Q

What is the duration of Glyburide?

A

24 h

90
Q

How does alcohol interfere with Glyburide?

A

It makes the drug metabolize faster.

91
Q

What class does Glyburide belong to?

A

Sulonylureas

92
Q

When is Glyburide normally taken?

A

1 time a day in the morning

93
Q

What class does Metformin belong to?

A

Biguanides

94
Q

What is the only drug is in the Biguanides class?

A

Metformin

95
Q

What is the method of action for Metformin?

A
  • Decreases hepatic production of glucose

- Reduces insulin resistance

96
Q

What does Metformin NOT do?

A

Does NOT promote insulin release from pancreas

97
Q

What does Metformin usually not cause?

A

Hypoglycemia

98
Q

What are the adverse effects of Metformin?

A
  • Nausea, Vomiting
  • Metallic taste
  • Anorexia
  • Flatulence
  • Heart attack
  • Fatigue
99
Q

What is an adverse effect of Metformin that is rare but could be fatal?

A

Lactic acidosis

100
Q

What are the contraindications of Metformin?

A
  • Hepatic or renal insufficiency
  • Alcoholism
  • Cardiopulmonary insufficiency
  • Concurrent serious infection
101
Q

When should you withhold Metformin and for how long?

A

Hold 48 hours before and 48 hours after IV radiographic contrast dye.

102
Q

What age should you NOT give Metformin?

A

Any child less than 10 years old.

103
Q

What drugs increase the risk of hypoglycemia when given with Metformin?

A
  • Captopril
  • Furosemide
  • Nifedipine
104
Q

What drugs may decrease the elimination of Metformin?

A
  • Digoxin
  • Morphine
  • Vancomycin
105
Q

What is the route of administering Metformin?

A

Oral

106
Q

What is the onset of Metformin?

A

Slow

107
Q

What is the peak of Metformin?

A

2-2.5 h

108
Q

What is the duration of Metformin?

A

10-16 h

109
Q

What is the extended release form of Metformin used for?

A

For patients older than 17 years of age.

110
Q

What are the two types of Incretin Enhancers?

A
  • GLP-1 agonist: Exenatide

- DPP-4 inhibitors: Stagliptin

111
Q

What is the name of the GLP-1 agonist?

A

Exenatide

112
Q

What is the name of the DPP-4 inhibitor?

A

Stagliptin

113
Q

What does Incretin Enhancers do?

A

Mimic the effects of incretins

114
Q

What are incretins?

A

They are hormones released into the blood by intestine in response to food to signal insulin secretion and stop glucagon production.

115
Q

What does GLP-1 stand for?

A

Glucagon like polypeptide

116
Q

What does GLP-1 aka Exenatide do?

A

Increases insulin release and decreases glucagon release.

Also slows gastric emptying and increases satiety

117
Q

How is Exenatide given?

A

Subcutaneously

118
Q

When is Exenatide given?

A

within 60 minutes of morning and evening meals

-NOT after the meal

119
Q

When should you not give Exenatide?

A
  • NPO patient
  • Gastroparesis patient
  • Pregnant patients
  • Children
  • Patients with renal impairment
120
Q

Why should you not give Exenatide to a patient who is NPO?

A

Because there is no food present in the stomach to digest the drug.

121
Q

What do DPP-4 inhibitors (Sitagliptin) do?

A

Slows the breakdown of GLP-1 (Exenatide) thereby increasing insulin secretion, decreasing glucagon secretion and slowing GI emptying

122
Q

How is Sitagliptin administered?

A

PO

123
Q

When should Sitagliptin be administered?

A

Without regard to meals.

124
Q

What are the adverse effects of Sitagliptin?

A
  • Pancreatitis
  • Heart attack
  • URI
  • Nausea, vomiting, diarrhea
125
Q

How is Sitagliptin excreted?

A

Unchanged in the urine

126
Q

What may Sitagliptin increase?

A

Digoxin levels

127
Q

When should you use caution when prescribing sitagliptin?

A

With renal failure, pregnancy, and lactation

128
Q

When is glucagon administered?

A

For severely low blood sugar- in the 20s

129
Q

What class does Glucagon belong to?

A

Glucose Elevating Agent

130
Q

What are the actions of glucagon?

A

Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose

131
Q

What is the indication for glucagon?

A

Treatment of hypoglycemia

132
Q

Where is glucagon absorbed and distributed?

A

Throughout the body

133
Q

Where is glucagon excreted?

A

In the urine

134
Q

What are the contraindications or cautions for administering glucagon?

A
  • Known allergy
  • Pregnancy and lactation
  • Hepatic or renal dysfunction
  • Cardiovascular disease
135
Q

What is the adverse effect for glucagon?

A

GI upset

136
Q

What is the drug that interacts with glucagon?

A

Anticoagulant

Exam 3 (8 decks)

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