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Pharmacology II exam 1 > Antidiabetic drugs > Flashcards

Antidiabetic drugs Flashcards

1
Q

A chronic disease of the deficient glucose metabolism due to insufficient insulin secretion from what type of cells or d/t impaired insulin use is described as:

A
  • Diabetes mellitus
  • insulin is secreted from beta cells of the pancreas
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2
Q

A patient that is dependent on insulin is described as having what type of DM:

A

Type one (insulin/dependent DM)

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3
Q

A patient that is non-insulin-dependent is described as having what type of DM:

A

Type two (non-insulin-dependent DM)

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4
Q

When the insulin receptors of body tissues are unresponsive or deficient in numbers this is described as:

A

Insulin resistance

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5
Q

DM is characterized by what three Ps:

A

Polyuria (increase urine output), polydipsia (entry stairs), and polyphagia (increased hunger)

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6
Q

Where is insulin release from and what is its functions:

A

Insulin, in response to an increase in blood glucose, is released from the beta cells of islets of Langerhans of the pancreas, lowers the blood glucose level by promoting the uptake of glucose, stores glucose as glycogen in muscles and liver

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7
Q

If a patient takes insulin while on ASA, anticoagulants, alcohol, beta blockers, TCAs, tetracyclines, what happens to the glucose levels in the blood

A

Increased hypoglycemia: less insulin keys needed blood sugar

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8
Q

If a patient takes insulin while on thiazides, glucocorticoids, OCP’s, thyroid drugs, or smokes, what happens to the glucose levels in the blood:

A

more insulin keys needed to lower blood sugar

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9
Q

How does increase blood glucose affect urine:

A

Polyuria (increase glucose levels acts like a diuretic)

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10
Q

As most insulins are usually administered subQ at a 45-90 degree angle, what injection site causes insulin to be absorbed faster than any other body site and why is insulin not administered orally:

A
  • Abdomen
  • insulin is a protein
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11
Q

When is insulin usually given and how do you prevent lipodystrophy:

A

Insulin is usually given before breakfast in the morning and to prevent lipodystrophy (tissue atrophy or hypertrophy) injection sites should be rotated

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12
Q

How much insulin is needed for increased exercise and for illness or stress:

A
  • Increase exercise: less insulin
  • infections/illness: more insulin
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13
Q

What are the types of rapid acting insulin and what is the peak duration and when should it be given:

A

Rapid acting insulin Causes rapid reduction of blood glucose

  • Lispro: 5-15 minutes of breakfast/meal, 30-90, 2-5
  • meal tray needs to be in front of pt
  • Aspart: 5 – 15 minutes of breakfast/ meal, 1-3, 3-5
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14
Q

What are the types of short acting insulin and what is the peak, duration, and when should it be given:

A
  • Regular (CZI): 30 minutes before meal, 2-4,6-8
  • sidenote: only regular insulin can be given either subQ or IV, all other insulin is given subQ
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15
Q

What are the types of intermediate acting insulin and what is the peak, duration, and when is a given:

A

Intermediate acting insulin is usually taken after meals

  • NPH: 1-2, 6-12,18-24
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16
Q

What are the types of very long acting insulin and what is the peak, duration, and when is it given:

A
  • **Very long acting insulin is administered once a day usually at bedtime to prevent nocturnal hypoglycemia due to its continuous sustained release of insulin **
  • Lantus: 1hr onset, 24 h duration with no peak
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17
Q

How many insulin resistance occur:

A

If a patient takes an animal insulin, antibodies develop over time which causes insulin resistance/insulin allergy. Obesity can also cause insulin resistance.

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18
Q

A patient complains of hypoglycemic (insulin shock) reaction: what are the signs and symptoms stated and when would a patient taking insulin experience a hypoglycemic reaction:

A
  • Hypoglycemia causes a hyperactive response: Headache, nervousness, sweating, tachycardia, tremors, cold, clammy skin, slurred speech, confusion, memory lapse, seizures
  • Hypoglycemic reaction occurs during peak times
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19
Q

A patient complains a hyperglycemic reaction. What are the stated symptoms:

A
  • Hyperglycemic reaction (a.k.a. diabetic acidosis): polydipsia, polyuria, dry mucous membranes, kussmaul breathing (Deep, rapid, dyspnea, labored), sweet, fruity breath odor
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20
Q

What are the signs and symptoms of diabetic acidosis/ ketoacidosis/ diabetic coma and what levels of glucose causes this:

A

The signs and symptoms of diabetic acidosis: polydipsia, polyuria, Kussmaul breathing (deep, rapid, labor, distress, dyspnea), dry mucous membranes/poor skin turgor, sweet fruity breath; DKA left untreated leads cerebal edema. This occurs when a patient is hyperglycemic

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21
Q

What nonpharmacological methods can a patient initiate upon feeling or before feeling a hypoglycemic reaction:

A
  • Tell the patient to drink orange juice, sugar containing drinks, or eat hard candy if they hypoglycemic reaction begins
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22
Q

What do you tell a family member to do if the patient cannot drink sugar containing fluids during a hypoglycemic episode:

A

Teach the family member to administer glucagon by injection if a patient has a hypoglycemic reaction and cannot drink sugar containing fluids

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23
Q

What is the medical term for administering insulin to a patient that has extreme variances and insulin requirements (such as stress from hospitalization, surgery, illness, infection) where blood glucose testing is performed several times a day at specified intervals:

A

Sliding scale insulin coverage

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24
Q

What is the medical term for a DM patient that experiences a hypoglycemic condition that usually occurs 2-4am and what causes it:

A

The Somogyi effect is caused by an increase in blood glucose during 2-4am (as a response to a higher than needed bedtime dose of insulin) and can be prevented if glucoses is monitored within those hours and reducing bedtime insulin dosage

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25
Q

What is the medical term for when a DM patient wakes up with a headache and reports night sweats/nightmares and how is this managed:

A

The dawn phenomenon occurs when DM patient awakens with hyperglycemia and is managed by increasing the bedtime dose of insulin

26
Q

What is the difference in managing insulin with patients that have either Dawn phenomenon or Somogyi effect:

A

Both are due to a hyperglycemic reaction

  • Somogyi effect=decrease bedtime insulin
  • Dawn phenomenon=increased bedtime insulin
27
Q

What is the medical term for DM patients with an inadequate amount of insulin (glucose cannot be metabolized) causing fats to be catabolized instead:

A

Diabetic ketoacidosis/ acidosis/diabetic coma/hyperglycemic reaction

28
Q

Which of these insulin side effects can kill a patient:

  1. Lipodystrophy
  2. Somogyi effect
  3. Dawn phenomenon
  4. Insulin shock
  5. Diabetic ketoacidosis
A

4: insulin shock

Hypoglycemia kills faster than hyperglycemia

29
Q

What are the signs and symptoms of insulin shock:

A

Insulin shock/hypoglycemic reaction:

  • Decreased LOC, headache, nervousness, apprehension, tremor, excess sweat, cold clammy skin, tachycardia, slurred speech, seizures
30
Q

Calculate the unit amount for premixed insulin:

  • The M.D. orders 30 units of 70/30 NPH
A
  1. 30 units x .7%= 21 units of NPH
  2. 30 units x .3%= 9 units of regular

** sidenote: the first number Will always represent NPH and the second number Will always represent Regular**

31
Q

How is sliding scale insulin used:

A

Sliding scale insulin depends on adjusting dosages according to an individual’s blood glucose. It is usually done before eating and at the bedtime utilizing rapid or short acting insulin due to stress

32
Q

What are the methods of insulin administration other than subQ or IV:

A
  • 2 types of insulin pumps
  • insulin pen injectors
  • Oral inhaled insulin
33
Q

What are the types of insulin pumps used, what type of insulin is used, and what type of diabetes does this benefit:

A
  • Implantable (internal) or CSII Portable (external)
  • Only regular insulin is use
  • Benefits type 1 DM patients: check levels q.4h

Sidenote: decreases the risk of hypoglycemic reactions

34
Q

What is great about Insulin pen injectors:

A

Increases compliance in the elderly d/t the pre-filled/reusuable portable pens that causes LESS pain, but is EXPENSIVE

35
Q

What is so great about insuling JET injectors:

A

NOTHING d/t causing painful bruising/stinging/burning PAIN that is not Rx for children/elderly

36
Q

What is the common ingredient Rx to what type of DM pts and when is it contrainindicated and common S/S:

A

Exubera is a powder packet inserted into a handheld oral inhaler for TYPE 1 and 2 DM

Contrainindicated in COPD/SMOKERS >6mo

CHEST DISCOMFORT/DRY COUGH=spirometry reading required prior to Rx

37
Q

How do the herbs rosemary/stinging nettle/cocao affect insulin and antiDM drugs:

A

Hyperglycemic effect d/t decreased insulin effect (all other herbs cause HYPOGLYCEMIA EFFECT)

38
Q

How do garlic/bitter melon/aloe affect insulin and antiDM meds:

A

Increases insulin levels causing hypoglycemia except chromium which reduces need for insulin

39
Q

How is insulin stored:

A

After insulin (clear and colorless) has been opened:

  1. 1 mo in rm temp
  2. 3 mo fridge before loosing insulin strength
  3. syringes in fridge in 1-2 wk

Side note: causes less skin irritation when given in rm temp

40
Q

Mr. Gates receives NPH insulin at 0700. When is he more apt to develop a hypoglycemic episode:

  1. mid morning
  2. mid afternoon
  3. midnight
  4. next morning
A

2: hypoglycemia occurs at peak

NPH: 6-12, 18-24

41
Q

Oral antidiabetic meds are used on what type of DM patients:

A

Type 2 only (some insulin is produced by these pts) NEVER type 1

42
Q

What is the criteria for OHA (oral antiDM meds) Rx:

A

40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver receives OHA

43
Q

What is the main difference between first and second generation sulfonylurea and which generation is better to use:

A
  • 1st generation sulfonylureas is divided into short/intermediate/long acting
  • 2nd generation sulfonylureas have a greater hypoglycemic potency requiring small doses with longer duration and less side effects
44
Q

What type of antiDM sulfonylureas given to a 40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver:

A

The sulfonylureas: 2 G-ides (2 for 2nd generation)

  • Glipizide and Glyburide targets the PANCREASE to secrete insulin from beta cells
45
Q

What type of antiDM med Meglitinides is given to a 40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver and what is the target organ:

A

Meglitinides

  • Repaglinide and Neteglinide targets the pancrease to secrete insulin
46
Q

What antiDM med is given to a 40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver and TARGETS THE LIVER:

A

Metaformin (Glucophage) targets the LIVER

47
Q

What are the contrainindications of Metaformin (Glucaphage) and why is it contrainindicated:

A

Any issue involving the LIVER: DKA, EtOH, KIDNEY/LIVER disease/congestive HF d/t the target organ being the LIVER

48
Q

What AntiDM med targets both pancrease and liver and is given to a 40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver:

A

Glucovance (glyburide + metformin) targets the pancrease and LIVER

49
Q

What is the antiDM med is given to a 40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver that targets the MUSCLE:

A

2 Glitazones (Glute maximus/minimus)

pioglitazone and rosiglitazone targets the Gluteus maximus and the gluteus minimus

50
Q

What antiDM med is given to a 40 (+) yo, SKINNY pt Dx w/type 2 (<5ys) with normal kidneys/liver to TARGET THE INTESTINE=flatuence:

A

Precose or Glyset causes gas d/t target organ being the intestine

51
Q

What are the NSG interventions for antiDM meds:

A
  • give with meals to eliminate GI distress, S/S of either hypo/hyperglycemia, medic alert, avoid liver issues EtOH
52
Q

What is the target organ for Glucagon and why is it used:

A

Glucagon is given to pts w/hypoglycemic/insulin shock as glucagon acts on the alpha cells to breakdown glycogen into glucose of the liver

  • emergency Tx of severe hypoglycemic episode which awakes the pt within 5-20 min if in coma
53
Q

Which timeframe would be most appropriate for administering sliding scale Lispro insulin:

  1. Within 30 minutes of consuming breakfast
  2. when the breakfast tray is served and ready to eat
  3. within one hour of obtaining blood glucose measurement
  4. within 15 minutes of obtaining blood glucose measurement
A

2: when the breakfast tray is served and ready to eat

54
Q

A patient is prescribed metformin. Which of the following is a side effect/adverse effect comment to metformin:

  1. Seizures
  2. constipation
  3. bitter or metallic taste
  4. polyuria/polydipsia
A

3: bitter or metallic taste

55
Q

A patient is diagnosed with type two diabetes. The nsg’s aware that which statement is true?

  1. Patient is most likely teenager
  2. patient is most likely a child younger than 10 years
  3. heredity is a major causitive factor
  4. Viral infections contribute most to the disease development
A

3: Heredity is a major causative factor

56
Q

Antidiabetic meds are designed to control signs and symptoms of DM. Nsg primarily expects a decrease in which?

  1. Blood glucose
  2. fat metabolism
  3. glycogen storage
  4. protein mobilization
A

1: blood glucose

57
Q

A patient is to receive insulin before breakfast and the time of breakfast tray delivery is variable. The nsg knows that which insulin should not be administered into the breakfast or has arrived and the patient is ready to eat?

  1. Humilin N
  2. Lispro
  3. Lantus
  4. Humlin R
A

2: lispro

58
Q

A patient is receiving a daily dose of Humulin N (NPH) insulin at 7:30 AM. The nsg expects the peak effect of the drug to occur at which time?

  1. 0815
  2. 1030
  3. 5:00 pm
  4. 11 pm
A

3: 5pm

59
Q

When the patient is prescribed glipizide, and is she knows which side effects/adverse effects may be expected? (Select all that apply)

  1. Tachypnea
  2. tachycardia
  3. increase alertness
  4. increased weight gain
  5. visual disturbances
  6. hunger
A

2, 5, 6: tachycardia, visual disturbances, hunger

60
Q

A nsg who’s teaching a patient how to recognize symptoms of hypoglycemia should include which symptoms in the teaching? (Select all that apply)

  1. Headache
  2. nervousness
  3. bradycardia
  4. sweating
  5. polydipsia
  6. Sweet/fruity breath
A

Headache, Nervousness, sweating

  • The other signs and symptoms describe hyperglycemia (increase gluclose levels act as a diuretic=poluria/polydypsea/kaussmaul breathing)
61
Q

The patient is newly diagnosed with type 1 DM and requires daily insulin injections. Which instructions should the nsg include in the teaching of insulin administration?

  1. Teach family members to administer glucagon by injection if the patient has a hyperglycemic reaction
  2. instruct the patient about the necessity for compliance with prescribed insulin therapy
  3. teach the patient that hypoglycemic reactions are more likely to occur at the onset of action time
  4. instruct the patient in the care of insulin container and syringe handeling
A

2: compliance is neccessary

glucagon is administered only for hypo; hypo occurs at peak;

Pharmacology II exam 1 (3 decks)

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