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.
2
Q
What are the three types of drugs that increase blood sugar?
A
- Steroids
- Epinephrine
- Diuretics-HCTZ
3
Q
What is the definition of insulin?
A
A hormone produced by beta cells of the islets of langerhans.
4
Q
Where is insulin produced?
A
In the beta cells in the pancreas
5
Q
When is insulin released into circulation?
A
When the levels of glucose around these cells rise.
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.
7
Q
What are the 2 different forms of concentration that insulin comes in?
A
100 u/mL
500 u/mL
8
Q
Preparations of insulin vary as to what three things?
A
- Onset of action
- Time to peak effect
- Duration
9
Q
True or False:
Almost all insulin used today is human insulin.
A
True
10
Q
How is insulin made?
A
By recombinant DNA technology
11
Q
Why is almost all insulin used today human insulin?
A
It is more effective, fewer allergies, and less resistance.
12
Q
What are the two ways that insulin can be modified?
A
- To be more rapid
- To have a prolonged action
13
Q
What is the generic rule on angling an insulin needle?
A
Put the needle in at a 90 degree angle.
14
Q
If a patient has very little fat what angle should you use when sticking them with an insulin needle?
A
45 degrees
15
Q
What are the two routes of administering insulin?
A
Subcutaneous or intravenous
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.
17
Q
What is the trade name for insulin glulisine?
A
Apidra
18
Q
How fast is the action of Insulin Glulisine?
A
Rapid
19
Q
What is the onset of Insulin Glulisine?
A
15-30 minutes
20
Q
What is the peak of Insulin Glulisine?
A
1 hour
21
Q
What is the duration of Insulin Glulisine?
A
3-4 hours
22
Q
When should you administer Insulin Glulisine?
A
15 minutes before a meal or within 20 minutes after starting a meal.
23
Q
What is Insulin Glulisine compatible with?
A
Can give with Insulin Isophane (NPH)
24
Q
When mixing Insulin Glulisine with Insulin Isophane (NPH): which medication do you draw up first?
A
Glulisine
25
What is the trade name for insulin regular?
Humulin R
| Novolin R
26
How fast is the action of Insulin Regular?
Short
27
What is the onset of Insulin Regular?
30-60 minutes
28
What is the peak of Insulin Regular?
2-4 h
29
What is the duration of Insulin Regular?
5-7 hours
30
When should you administer Insulin Regular?
30-60 minutes before a meal
31
Which ways can you administer Insulin Regular?
Subcutaneous or IV
32
What can you mix Insulin Regular with?
Insulin isophane (NPH), sterile water, or normal saline.
33
What can you NOT mix Insulin Regular with?
Insulin glargine
34
When is insulin detemir usually given?
In the PM
35
What is the trade name of insulin detemir?
Levemir
36
How fast is the action of Insulin Detemir?
Long
37
What is the onset of Insulin Detemir?
Gradual over 24 hours
38
What is the peak of Insulin Detemir?
6-8 hours
39
What is the duration of Insulin Detemir?
To 24 hours
40
When do you administer Insulin Detemir?
With evening meal or at bedtime
41
What can be mixed with Insulin Detemir?
No other insulins
42
What can be mixed with Insulin Glargine?
No other insulins?
43
What is the trade name for Insulin Glargine?
Lantus
44
How fast is the action of Insulin Glargine?
Long
45
What is the onset of Insulin Glargine?
1.1 h
46
What is the peak of Insulin Glargine?
3-4 h
47
What is the duration of Insulin Glargine?
10-24 h
48
When should you administer Insulin Glargine?
Once daily given at the same time each day- usually in the AM
49
What is the trade name of Insulin Aspart?
NovoLog
50
How fast is the action of Insulin Aspart?
Rapid
51
What is the onset of Insulin Aspart?
15 minutes
52
What is the peak of Insulin Aspart?
1-3 h
53
What is the duration of Insulin Aspart?
3-5 h
54
When should you administer Insulin Aspart?
5-10 minutes before a meal
55
What can you give Insulin Aspart with?
insulin Isophane (NPH)
56
When mixing Insulin Apart with Insulin Isophane (NPH) which do you draw up first?
Insulin Aspart
57
What is the trade name of Insulin Lispro?
Humalog
58
How fast is the action of Insulin Lispro?
Rapid
59
What is the onset of Insulin Lispro?
5-15 minutes
60
What is the peak of Insulin Lispro?
0.5-1 h
61
What is the duration of Insulin Lispro?
3-4 h
62
When do you administer Insulin Lispro?
5-10 minutes before a meal
63
What can you mix Insulin Lispro with?
Insulin Isophane (NPH)
64
When mixing Insulin Lispro with Insulin Isophane (NPH) which do you draw up first?
The Insulin Lispro
65
What are the four actions times of insulins?
- Rapid
- Short
- Intermediate
- Long
66
What is the action of Regular Insulin?
Short acting
Clear
Colorless
67
When is Regular Insulin from?
Pork pancreas or DNA modified
68
What does Regular Insulin function like?
Endogenous insulin
69
What is the primary use of Regular insulin?
To provide control of blood glucose in a diabetic patient.
70
What is the two adverse effects of regular insulin?
Hypoglycemia and allergic reaction
71
When should you use caution when prescribing Regular Insulin?
Renal or hepatic impairment
72
A patient who is pregnant and has diabetes what does that mean?
They need a tighter control of their blood sugar levels.
73
What is the dawn phenomenon?
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
Why is a sliding scale used for administering insulin?
Because stress and exercise may affect the patients blood sugar needing either less or more insulin.
75
What should you be teaching the patients about hyper and hypo glycemia?
They should know the signs and symptoms of each especially after administration of insulin.
76
True or false:
| Clear insulin must be drawn into the syringe first
True
77
What is Glyburide normally taken with?
Metformin
78
What are the actions of Glyburide?
- Stimulate insulin release from the beta cells in the pancreas
- They improve insulin binding to insulin receptors
79
What are the indications a patient needs Glyburide?
They need an adjunct to diet and exercise to lower their blood glucose levels.
80
What must the diabetic patient have in order to be on Glyburide?
Working beta cells in pancreas
81
Where is Glyburide rapidly absorbed?
In the GI tract and undergoes hepatic metabolism
82
What is Glyburide only used for?
Type 2 diabetes
83
How is the Glyburide excreted?
In the urine and feces
84
What are the contraindications or cautions when prescribing Glyburide?
- Severe trauma
- Major Surgery
- Renal/hepatic impairment
- Cardiovascular disease
- Pregnancy
- Type 1 diabetes
85
What are the adverse effects of Glyburide?
- Hypoglycemia
- GI distress
- Possible cardiovascular effects
86
What are the drug to drug interactions of Glyburide?
- Beta blockers
- Anticoagulants
- Alcohol
- Ginseng
- Garlic
87
What is the route that Glyburide is administered?
Oral
88
What is the onset of Glyburide?
1 hour
89
What is the duration of Glyburide?
24 h
90
How does alcohol interfere with Glyburide?
It makes the drug metabolize faster.
91
What class does Glyburide belong to?
Sulonylureas
92
When is Glyburide normally taken?
1 time a day in the morning
93
What class does Metformin belong to?
Biguanides
94
What is the only drug is in the Biguanides class?
Metformin
95
What is the method of action for Metformin?
- Decreases hepatic production of glucose
| - Reduces insulin resistance
96
What does Metformin NOT do?
Does NOT promote insulin release from pancreas
97
What does Metformin usually not cause?
Hypoglycemia
98
What are the adverse effects of Metformin?
- Nausea, Vomiting
- Metallic taste
- Anorexia
- Flatulence
- Heart attack
- Fatigue
99
What is an adverse effect of Metformin that is rare but could be fatal?
Lactic acidosis
100
What are the contraindications of Metformin?
- Hepatic or renal insufficiency
- Alcoholism
- Cardiopulmonary insufficiency
- Concurrent serious infection
101
When should you withhold Metformin and for how long?
Hold 48 hours before and 48 hours after IV radiographic contrast dye.
102
What age should you NOT give Metformin?
Any child less than 10 years old.
103
What drugs increase the risk of hypoglycemia when given with Metformin?
- Captopril
- Furosemide
- Nifedipine
104
What drugs may decrease the elimination of Metformin?
- Digoxin
- Morphine
- Vancomycin
105
What is the route of administering Metformin?
Oral
106
What is the onset of Metformin?
Slow
107
What is the peak of Metformin?
2-2.5 h
108
What is the duration of Metformin?
10-16 h
109
What is the extended release form of Metformin used for?
For patients older than 17 years of age.
110
What are the two types of Incretin Enhancers?
- GLP-1 agonist: Exenatide
| - DPP-4 inhibitors: Stagliptin
111
What is the name of the GLP-1 agonist?
Exenatide
112
What is the name of the DPP-4 inhibitor?
Stagliptin
113
What does Incretin Enhancers do?
Mimic the effects of incretins
114
What are incretins?
They are hormones released into the blood by intestine in response to food to signal insulin secretion and stop glucagon production.
115
What does GLP-1 stand for?
Glucagon like polypeptide
116
What does GLP-1 aka Exenatide do?
Increases insulin release and decreases glucagon release.
| Also slows gastric emptying and increases satiety
117
How is Exenatide given?
Subcutaneously
118
When is Exenatide given?
within 60 minutes of morning and evening meals
| -NOT after the meal
119
When should you not give Exenatide?
- NPO patient
- Gastroparesis patient
- Pregnant patients
- Children
- Patients with renal impairment
120
Why should you not give Exenatide to a patient who is NPO?
Because there is no food present in the stomach to digest the drug.
121
What do DPP-4 inhibitors (Sitagliptin) do?
Slows the breakdown of GLP-1 (Exenatide) thereby increasing insulin secretion, decreasing glucagon secretion and slowing GI emptying
122
How is Sitagliptin administered?
PO
123
When should Sitagliptin be administered?
Without regard to meals.
124
What are the adverse effects of Sitagliptin?
- Pancreatitis
- Heart attack
- URI
- Nausea, vomiting, diarrhea
125
How is Sitagliptin excreted?
Unchanged in the urine
126
What may Sitagliptin increase?
Digoxin levels
127
When should you use caution when prescribing sitagliptin?
With renal failure, pregnancy, and lactation
128
When is glucagon administered?
For severely low blood sugar- in the 20s
129
What class does Glucagon belong to?
Glucose Elevating Agent
130
What are the actions of glucagon?
Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose
131
What is the indication for glucagon?
Treatment of hypoglycemia
132
Where is glucagon absorbed and distributed?
Throughout the body
133
Where is glucagon excreted?
In the urine
134
What are the contraindications or cautions for administering glucagon?
- Known allergy
- Pregnancy and lactation
- Hepatic or renal dysfunction
- Cardiovascular disease
135
What is the adverse effect for glucagon?
GI upset
136
What is the drug that interacts with glucagon?
Anticoagulant
