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Pharmacology Exam 3 > Blood Glucose Agents > Flashcards

Blood Glucose Agents Flashcards

1
Q

What is Adiponectin?

A

Hormone that increases insulin sensitivity, decreases glucose release from the liver and protects blood vessels from inflammation.

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2
Q

Explain Diabetes mellitus.

A

Chronic condition characterized by higher blood sugar levels due to either insufficient insulin production or the body’s inability to effectively use insulin.

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3
Q

What is Dipeptidyl-peptidase-4 (DPP-4) ?

A

Enzyme that breaks down incretin hormones which helps regulate blood sugar levels by stimulating insulin release after eating. DDP-4 inhibitors prevents DDP-4 from breaking down incretin, allowing it to work for longer

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4
Q

What are the Endocannabinoid receptors?

A

Receptors part of Endocannabinoid system. Involved in regulating appetite, mood and metabolism.

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5
Q

What is Glucagon - like polypeptide - 1 (GLP-1) ?

A

Hormone released from intestines that help regulate insulin secretion, glucose metabolism and appetite.

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6
Q

What is Glycogen?

A

Stored form of glucose found in the liver and muscles and used by the body for enegy when blood sugar is low.

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7
Q

What is Glycosuria?

A

Excess glucose in the urine. Sugar is spilled into the urine and is an indication of poorly managed diabetes.

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8
Q

What is Glycosylated hemoglobin A?

A

Hemoglobin bound to glucose - used to measure long term blood sugar control. (A1C)

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9
Q

What is Hyperglycemia?

A

Increased blood sugar levels (over 126)

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10
Q

What is Hypoglycemia?

A

Low blood sugar levels (under 70)

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11
Q

What are Incretins?

A

Hormones (GLP 1) that are released by the gut after eating to enhance insulin secretion and help regulate blood glucose.

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12
Q

What is Insulin?

A

Hormone produced by pancreas that help regulate blood glucose levels by promoting glucose uptake into cells for energy.

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13
Q

What is Ketosis?

A

Metabolic state where body produces ketones for energy due to lack of sufficient glucose - seen in uncontrolled diabetes or starvation.

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14
Q

What is Polydipsia?

A

Increased thirst - commonly associated with hypoglycemia or diabetes.

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15
Q

What is Polyphagia?

A

Increased hunger - can occur when body cells are not receiving enough glucose.

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16
Q

What is Sulfonylureas?

A

Class of oral medication used to treat type 2 diabetes by stimulating the pancreas to produce more insulin.

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17
Q

Which gland produces Insulin?

A

The Pancreas in the endocrine part.

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18
Q

Where in the Pancreas is insulin produced?

A

The islets of Langerhans (by beta cells)

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19
Q

Is the Pancreas an endocrine or exocrine gland?

A

It is both.

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20
Q

What does the exocrine part of the Pancreas do?

A
  • Releases sodium bicarbonate and pancreatic enzymes directly into the common bile
    duct to be released into the small intestine.
  • Neutralizes the acid chyme from the stomach and aids digestion.
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21
Q

What is the dual function of the pancreas important for?

A

Metabolic regulation and proper digestion.

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22
Q

When is Insulin released into circulation?

A

When levels of glucose around the Islet of Langerhans cells rise. (usually after eating)

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23
Q

When does the pancreas release glucagon?

A

When blood glucose levels are low. This signals the liver to break down stored glycogen into glucose and release it into the bloodstream.

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24
Q

What does insulin do?

A

Stimulates glycogen synthesis conversion of lipids into fat stored
as adipose tissue, and synthesis of proteins from amino acids.

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25
Q

What does insulin ensure?

A

That blood glucose does not get too high or too low.

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26
Q

Why is insulin released after a meal?

A

So that the blood glucose levels can fall.

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27
Q

Where is Glucagon released from?

A

The alpha cells into the islets of Langerhans

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28
Q

What is Glucagon released in response to?

A

Low blood glucose

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29
Q

What does Glucagon do?

A

Causes immediate mobilization of glycogen stored in the liver and raises blood glucose levels. It does the opposite of insulin.

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30
Q

What does Adipocytes secrete?

A

Adiponectin

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31
Q

What does adiponectin do?

A

Increases insulin sensitivity, decreases release of glucose from liver, and protects blood vessels
from inflammation.

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32
Q

What does Endocannabinoid receptors do in the body?

A

Keeps the body in a state of energy gain to prepare for stressful situations

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33
Q

Which nervous system decreases insulin release?

A

The sympathetic nervous system.
It also increases release of stored glucose and increases fat breakdown.

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34
Q

What effect does epinephrine have on blood glucose?

A

Increases glucose levels in the blood so that the body has energy to face the threat or run away from it.

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35
Q

What does Corticosteroids reduce?

A

Insulin sensitivity.

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36
Q

What does Corticosteroids increase?

A

The release of stored glucose and fat breakdown for immediate use during stress.

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37
Q

What does growth hormone decrease?

A

Insulin sensitivity

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38
Q

What does growth hormone increase?

A

Free fatty acids and protein building.

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39
Q

Why does Glycosuria occur with unmanaged Diabetes?

A

Due to abnormally high blood sugar the body cannot absorb it all and it spills out in the urine. Urine may appear frothy.

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40
Q

What can glucose in the urine lead to?

A

Cystitis, due to glucose allow bacteria to thrive.

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41
Q

What is Polyuria?

A

Increased urination. This happens because the glucose in the urine pulls more water from the body into the nephrons of the kidney.

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42
Q

Why does polydipsia occur with unmanaged diabetes?

A

Due to more water being excreted in urine due to the high glucose level, the hypothalamic cells signal that the body needs more water and this causes excessive thirst.

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43
Q

Why does polyphagia occur with unmanaged diabetes?

A

The body cannot use the glucose that is available. This causes fatigue and the body thinks that it is starving and so it signals to the person to eat more.

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44
Q

Why is Lipolysis activated with unmanaged diabetes?

A

The body thinks that there is no energy or glucose, and therefore initiates lipolysis which uses fat as energy. The body goes into ketosis because of the use of fat as energy.

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45
Q

Why does acidosis occur with unmanaged diabetes?

A

The ketones that are a result from lipolysis cannot be cleared from the body and muscles starts to be broken down for energy and a state of acidosis begins because the waste products of ketones, proteins and glucose are acidic. This leads to elevated BUN and protein in urine.

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46
Q

What is Diabetes Mellitus?

A

Chronic condition where the body have difficulty in breaking down blood sugar.
The body may not produce enough insulin (type 1)
Body gotten resistant to insulin effect (type 2)

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47
Q

What happens if diabetes is left untreated?

A

Heart disease, Kidney damage and nerve problems.

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48
Q

What are the most common signs of Diabetes?

A

Glucose in urine and fasting glucose greater than 126 mg/dl

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49
Q

What are the Characteristics of Diabetes Mellitus?

A

○Complex disturbances in metabolism
○Affects carbohydrate, protein, and fat metabolism

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50
Q

What are some clinical signs of Diabetes Mellitus?

A
  • Hyperglycemia (fasting blood sugar level greater than 126 mg/dL)
  • Glycosuria (the presence of sugar in the urine)
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51
Q

What are the long term risk of Diabetes Mellitus ?

A

vascular damage due to glucose in vessels

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52
Q

What are 6 symptoms of diabetes mellitus?

A
  • Increased thirst
  • Slow- healing cuts and sores
  • fatigue
  • Blurred vision
  • Frequent urination
  • Unexplained wight loss
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53
Q

What are 6 disorders that are associated with Diabetes?

A

Atherosclerosis
Retinopathy
Neuropathies - nerve damage
Nephropathy
Infections
Foot ulcers

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54
Q

Explain Atherosclerosis

A

Plaque build up in blood vessels and increases the risk of heart attacks and stroke.

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55
Q

Explain Retinopathy.

A

Can cause loss of vision as tiny vessels in the eye are narrowed and closed

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56
Q

Explain Neuropathies.

A

Affect nerves in the feet and legs and progressive changes in other nerves as the oxygen is cut off. This causes motor and sensory changes as well & foot ulcers are common and poor circulation and nerve damage lead to decreased wound healing and decreased ability to feel pain, which makes it harder to detect infection.

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57
Q

Explain Nephropathy.

A

Damage to the glomerulus impairs the kidneys ability to filter blood and infections become more frequent due to reduced blood flow and immune function.

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58
Q

Explain Infections r/t diabetes

A

Increases in frequency and severity due to decreased blood flow and altered neutrophil function

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59
Q

Explain Foot ulcers r/t diabetes.

A

Decreased wound healing due to vascular insufficiency; unnoticed wounds and infections due to
neuropathy decreasing perception of pain.

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60
Q

What are the different classifications of Diabetes Mellitus.

A
  • Type 1, Insulin-Dependent Diabetes Mellitus (IDDM)
  • Type 2, Non–Insulin-Dependent Diabetes Mellitus (NIDDM)
  • Diabetes due to other causes
  • Gestational Diabetes
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61
Q

Explain Type 1 Diabetes.

A

○Usually a rapid onset; seen in younger people, usually around 5-7 yrs old and before 20 yrs old
○Caused by autoimmune destruction of the beta cells of the pancreas and they are unable to produce insulin.
○Patients need insulin replacement

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62
Q

Explain Type 2 Diabetes.

A

○Usually occurs in mature adults
○Has a slow and progressive onset
○Decreased insulin sensitivity in peripheral cells (insulin resistance)
Influenced by genetics as well as lifestyle factors.

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63
Q

Explain how diabetes can be caused due to other things.

A

○Hyperglycemia secondary to other causes
○Medications (i.e. corticosteroids), cystic fibrosis, pancreatitis

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64
Q

Explain Gestational Diabetes.

A

Diagnosed in 2nd-3rd trimester. Pregnancy itself puts the body at risk of developing gestational diabetes. the body cannot produce enough insulin to meet the increased demands of the pregnancy leading to higher blood sugar levels.
Hormones released by placenta can interfere with insulin action and cause insulin resistance.
May lead to large babies and babies may have difficulty managing blood sugar once born.

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65
Q

What are 9 s&s of Hyperglycemia?

A

●Fatigue
●Lethargy
●Irritation
●Glycosuria
●Polyuria - can case dehydration and electrolyte imbalance.
●Polyphagia
●Polydipsia
●Frequent infections
●Poor wound healing

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66
Q

What are 4 signs of impending dangerous complications of Hyperglycemia?

A

●Fruity breath as the ketones build up in the system and are excreted through the lungs
●Dehydration as fluid and important electrolytes are lost through the kidneys
●Fast, deep respirations (Kussmaul’s respirations) as the body tries to rid itself of high acid levels
●Loss of orientation and coma

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67
Q

What are Kussmaul’s respirations?

A

Fast deep breathing using accessory muscles will happen as the body is trying to blow off excess carbon dioxide to balance pH levels.

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68
Q

What is blood sugar levels for Hypoglycemia?

A

Less than 70 mg/dl

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69
Q

What is the initial response to Hypoglycemia?

A

Parasympathetic stimulation (shakiness and dizziness), followed by “fight-or-flight” reaction which involves the release of glucagon, cortisol and adrenaline which will aim to raise blood glucose.

70
Q

What are the metabolic responses to hypoglycemia?

A

Breakdown of fat and glycogen to release glucose

71
Q

Which organ releases glucagon to increase glucose levels?

A

The pancreas.

72
Q

What are 8 signs of hypoglycemia?

A

○Shakiness
○Dizziness
○Sweating
○Hunger
○Tachycardia
○Inability to concentrate
○Confusion
○Irritability or moodiness

Body is having these symptoms due to being in survival mode.

73
Q

What lifespan considerations should be taken when giving Antidiabetic agents to a child?

A

○Monitor closely for hyper- and hypoglycemia
○Insulin often needs to be diluted due to small dosages
○Two nurse check for insulin
○Challenging to treat in teens
○Team approach- family, teachers, coaches, etc.
○Metformin is the only oral DM drug approved

74
Q

What lifespan considerations should be taken when giving Antidiabetic agents to an adult?

A
  • Emphasized diet and exercise (2.5 hrs per week minimum)
  • Caution about OTC, herbal, and alternative therapies - may cause changes in glucose levels.
  • Insulin is best choice in pregnancy and lactation
  • A lot of education is needed.
75
Q

What would we do if a patient requires insulin during labor?

A

Insulin drip.

76
Q

What lifespan considerations should be taken when giving Antidiabetic agents to an older adult?

A

○Underlying problems complicate diabetic therapy (i.e. poor vision)
○Dietary deficiencies lead to fluctuations in glucose levels
○Renal or hepatic impairment may make oral agents not feasible due to the risk of organ damage and toxicity.
○Emphasize diet, exercise, skin and foot care
○More likely to experience end organ damage (i.e. kidneys)

77
Q

Explain the actions of Insulin.

A

*promotes storage of the body’s fuels
* Acts on specific receptors to stimulate synthesis of glycogen, fats and protein to help maintain normal blood sugar levels.
* Facilitates the transport of various metabolites and ions across cell membranes

78
Q

What would indicate the need to administer Insulin to a patient?

A

○Treatment of type 1 diabetes mellitus
○Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents

79
Q

What would contraindicate the use of insulin in patients?

A

There are no contraindications except episodes of hypoglycemia

80
Q

What are some patient conditions where we should exhibit increased caution when administering Insulin?

A

Pregnancy and lactation

81
Q

What are some known adverse reaction to Insulin treatment?

A

○Hypoglycemia and ketoacidosis
○Local site reactions (injection spots should be rotated as same spot injection can lead to lipodystrophy - decrease or build up of adipose tissue near injection site)
○Decreased blood potassium levels

82
Q

Are there any DDI’s with Insulin and if so, what are they?

A

○Beta blockers - may mask signs of hypoglycemia
○Thiazide diuretics - higher insulin doses may be needed
○Glucocorticoids - higher insulin doses may be needed
○Glucose altering medications
(salicylates, alcohol, oral antidiabetic agents, beta blockers)

83
Q

How soon after administration does short acting insulin begin to work?

A

Within 30 min and peaks at 2-3 hrs and lasts about 6-8 hrs

84
Q

When are short acting inulin injections normally used?

A

Around meals for quick glucose control - patient should eat very quickly after admin. to avoid hypoglycemia.

85
Q

how long does it take for intermediate acting insulin to work?

A

Peaks at 4-8 hr and lasts 12-16 hrs

86
Q

When are intermediate acting insulin injections normally used?

A

To manage blood sugar levels between meals.

87
Q

how long does it take for long acting insulin to work?

A

No peak and last up to 24 hrs

88
Q

What are 7 signs of Hypoglycemia?

A
  • Sweating
  • Pallor/ Paleness
  • Hunger
  • Fatigue
  • Irritability or Anxiety
  • Rapid Heart Rate
  • Lack of Concentration
89
Q

Prior to administering Insulin to a patient, what are some things that we should be assessing for?

A
  • Assess for contraindications or cautions
  • We should have a blood glucose reading from within the last hour.
  • Assess for skin lesions; orientation and reflexes; baseline pulse and blood pressure;
    respiratory status (inhaled)
  • Assess body systems for changes suggesting possible complications associated with poor
    blood glucose control
  • Investigate nutritional intake
  • Assess activity level, including amount and degree of exercise
  • Obtain blood glucose levels as ordered; monitor Hgb A1C, urinalysis, and BMP
90
Q

Prior to administering Insulin to a patient, what are some nursing diagnoses that we can expect?

A

○Glucose and electrolyte imbalance risk r/t use of insulin and underlying disease processes
○Malnutrition risk r/t changes in glucose transport
○Altered sensory perception (kinesthetic, visual, auditory, and tactile) r/t glucose levels
○Infection risk r/t injections and disease processes
○Injury risk r/t potential hyperglycemia or hypoglycemia and injection technique
○Coping impairment r/t diagnosis and the need for injection therapy
○Knowledge deficit risk regarding drug therapy

91
Q

When a patient is going though a period of increased stress should their insulin dose be increased or decreased?

A

Increased

92
Q

When administering Insulin to a patient what implementations should we do during and after administration?

A

○Ensure patient follow a dietary & exercise regimen & good hygiene
○Gently rotate the vial and avoid vigorous shaking
○Select a site that is free of bruising and scarring
○maintenance doses subq or inhaled routes only; rotate injection sites regularly
○Monitor response
○Monitor for hypoglycemia, especially during peak insulin times
○verify the name of the insulin being given

93
Q

How should insulin be stored?

A

cool place away from direct sunlight

94
Q

What drug names do we need to know for Sulfonylureas?

A

○Tolbutamide (1st gen)
○Glipizide (2nd gen)
○Glyburide (2nd gen)

95
Q

What negative association does first generation Sulfonylureas have?

A

increased risk of CV disease

96
Q

What advantages does 2nd Generation Sulfonylureas have over 1st generation Sulfonylureas?

A
  • Do not interact with as many protein-bound drugs
  • Have a longer duration of action, take only once or twice a day
97
Q

Explain the actions of Sulfonylureas.

A

○Stimulate insulin release from the beta cells in the pancreas
○They improve binding to insulin receptors

98
Q

What would indicate the need to administer Sulfonylureas to a patient?

A

it is an adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes

99
Q

What would contraindicate the use of Sulfonylureas in patients?

A
  • Allergy
  • Severe medical event (insulin should be used instead)
  • Diabetic complications
  • Type 1 diabetes mellitus
  • Pregnancy and lactation (insulin should be used)
100
Q

What are some known adverse reactions that patients may experience when taking Sulfonylureas?

A

○Hypoglycemia
○GI distress
○Allergic skin reactions

101
Q

Are there any DDI’s to Sulfonylureas, and if so, what are they?

A

○Beta blockers - mask symptoms of hypoglycemia
○Alcohol - risk of altering glucose levels
○Herbal remedies - may effect blood glucose

102
Q

What is another name for Biguanides?

A

Metformin

103
Q

What are the actions of Metformin ?

A
  • Decreases hepatic production of glycogen & increases uptake of glucose
  • Keeps glucose levels more stable consistently even after meals - less drastic changes.
  • Improves insulin sensitivity of peripheral cells
104
Q

What would indicate the need to give a patient Metformin?

A

1st line treatment for type II diabetes
Can be used off label to treat PCOS

105
Q

What would contraindicate the use of Metformin in patients?

A

○Hypersensitivity
○Metabolic acidosis - Metformin may reduce the clearance of lactic acid in the body.
○Severe renal impairment - may reduce excretion of metformin

106
Q

What factors should prompt increased caution when administering Metformin to patients?

A

○Hepatic impairment
○Excessive alcohol intake
○NPO status
○iodine contrast
○Age 65 and older - decreased kidney functioning
○Hypoxic state

All cautions are linked to the increased risk of lactic acidosis.

107
Q

Metformin has a Black Box Warning, what is it?

A

risk of lactic acidosis which can be fatal.

108
Q

What are some known adverse reactions that patients may experience when taking Metformin ?

A

○Black box warning: lactic acidosis
○GI effects - can irritate GI tract and cause nausea and diarrhea.
○Dizziness, headache r/t brain sensitivity to blood sugar changes.
○Upper respiratory infection risk - side effect of long term use.
○Taste disturbance - metallic taste.

109
Q

Are there any DDI’s to Metformin , and if so what are they?

A

○Alcohol - may increase lactic acidosis
○Carbonic anhydrase inhibitors (sulfonamides) - may increase lactic acidosis
○Iodine containing contrast media - may lead to kidney failure

110
Q

What are some symptoms of lactic acidosis that patients taking metformin should be aware of?

A

Rapid breathing, fatigue, muscle pain and cramping, abdominal discomfort, nausea, dizziness, hypotension and altered mental status.

111
Q

What is the name of DPP-4 Inhibitor agent that we need to know?

A

Sitagliptin

112
Q

How does Sitagliptin work in the body?

A

Prolongs the action of incretin hormones
- Increase insulin secretion in response to food intake
- Inhibit glucagon secretion

Help prevent excessive glucose production by the liver.

113
Q

DPP- 4 inhibitors allow incretin hormones to act longer.
True/False

A

True

114
Q

Why would we give a patient Sitagliptin ?

A

As an adjunct agent to diet and exercise in type II diabetes

115
Q

What would contraindicate the use of Sitagliptin in a patient?

A

○Hypersensitivity
○Type I diabetes (would not do anything for these patients since their bodies does not produce insulin, so stimulating insulin production would not help) or DKA

116
Q

With what patient condition should we exhibit increased caution when administering Sitagliptin?

A

Renal impairment - drug may accumulate in blood stream and cause hypoglycemia

117
Q

What are some adverse reactions that a patient may experience when taking Sitagliptin?

A

Adverse reactions are rarely reported. hypersensitivity reaction has been reported on few occasions as well as pancreatitis and heart failure.

118
Q

Are there any DDI’s to Sitagliptin and if so, what are they?

A

Other medications that lower blood glucose

119
Q

What are the suffix(es), drug names and potential outliers that we need to know for Meglitinides ?

A

Repaglinide
Nateglinide

120
Q

How does Meglitinides work in the body?

A

Stimulates insulin release from the beta cells in the pancreas.

121
Q

What would indicate the use of Meglitinides in a patient?

A

As an adjunct to diet and exercise in type II diabetes

122
Q

What would contraindicate the use of Meglitinides in patients?

A

○Hypersensitivity
○Type I DM (due to bodies cannot produce insulin) or Diabetic ketoacidosis because in DKA the pancreas cannot produce sufficient insulin which will make Meglitinides ineffective.

123
Q

What are some known adverse reactions that patients who are taking Meglitinides may have?

A

○Upper respiratory infections (URI) - long term use
○Headache (HA) - blood glucose fluctuation
○Arthralgias (joint pain ) - glucose changes
○Nausea, diarrhea, hypoglycemia

124
Q

Are there any DDI’s to Meglitinides , and if so, what are they?

A

Numerous - too many, check drug guide

125
Q

What SGLT-2 Inhibitors agent do we need to know for the exam?

A

Canagliflozin

126
Q

What is the action of Canagliflozin?

A

Blocks co-transporter system so glucose is not reabsorbed but is lost in
the urine.

127
Q

What would indicate the need to administer Canagliflozin to a patient?

A

Adjunct to diet and exercise in type II DM

Research being done on use in type I DM (more research needs to be done)

128
Q

What would contraindicate use of Canagliflozin ?

A

○Type I DM or DKA (may worsen blood sugar control and increase DKA)
○Severe renal impairment - less effective
○Pregnancy (2nd or 3rd trimester) - Cat X, can affect fetal kidney development and function

129
Q

What are some known adverse reactions that patients taking Canagliflozin may experience?

A

○Dehydration, hypotension - due to fluid loss due to increase glucose in urine
○UTIs, genital fungal infections
○DKA - can increase the amount of ketones
○Lower limb amputations

130
Q

Are there any DDIs to Canagliflozin , and if so, what are they?

A

Numerous: Rifampin can decrease the effectiveness of the SGL 2

131
Q

What is the Thiazolidinediones agent that we need to know for the exam?

A

Pioglitazone

132
Q

What is the action of Pioglitazone?

A

○Decrease insulin resistance in peripheral cells and liver
○Increase responsiveness to insulin
Only work if there is insulin to work on

133
Q

What would indicate the need to give a patient Pioglitazone?

A

The need for an adjunct to diet and exercise in type II DM

134
Q

What would contraindicate use of Pioglitazone?

A

Moderate to severe heart failure - can cause fluid retention which will worsen heart failure symptoms

135
Q

What patient condition should prompt for increased caution when administering Pioglitazone?

A

Liver impairment - drug metabolized in the liver which may increase liver damage

136
Q

What are some known adverse reactions that patients taking Pioglitazone may experience?

A

○Upper respiratory infection - due to their effect on the immune system & fluid retention
○Headaches, muscle pain - due to glucose changes
○Increased total cholesterol - affects how the liver processes fat and cholesterol
○Rapid weight gain and edema - due to fluid retention and fat storage in cells.

137
Q

Are there any DDI’s to Pioglitazone, and if so, what are they?

A

○Numerous
○Antidiabetic Medications - increased risk of hypoglycemia

138
Q

What two GLP-1 Agonists agents do we need to know for the exam?

A

Semaglutide
Exenatide

139
Q

What are the actions of Semaglutide and Exenatide?

A

○Increase insulin release
○Decrease glucagon release
○Slow GI emptying - reduces hunger

140
Q

What would indicate the need to administer Semaglutide or Exenatide to a patient?

A

○Adjunct to diet and exercise in type II DM
○Reduce risk of major CV events in type II DM because they can improve lipid profiles and reduce inflammation that further lowers the risk of heart related complications.

141
Q

What would contraindicate the use of Semaglutide and Exenatide?

A

○Type I DM or DKA - because medication will not be effective
○Pregnancy and lactation - animal studies showed harm to the babies.

142
Q

What adverse reactions may patients taking Semaglutide or Exenatide experience?

A

○GI effects
○Pancreatitis - if patient reports epigastric pain, medication should not be given

143
Q

What are some symptoms of Pacreatitis?

A

Rapid heartbeat, swollen abdomen, tenderness to palpation, nausea, vomiting and fever.

144
Q

Are there any DDI’s to Semaglutide and Exenatide, and if so, what are they?

A

○Other antidiabetic medications
○Oral medications: effects may be slowed due to the slowing of the GI emptying

145
Q

How are GLP-1 Agonists given?

A

Subq

146
Q

Prior to administering any Noninsulin Antidiabetic agents to a patient, what are some things that we need to assess?

A

○contraindications or cautions - allergy, pregnancy & lactation
○physical assessment - skin, neuropathy, retinopathy, fluid retention
○presence of any skin lesions
○nutritional intake
○activity level, including amount and degree of exercise
○Monitor blood glucose levels, urinalysis, renal/liver function

147
Q

Prior to administering any Noninsulin Antidiabetic agents to a patient, what are some nursing diagnoses that we should be prepared for?

A

○Hyperglycemia r/t diabetes mellitus disease process
○Hypoglycemia r/t dosing of antidiabetic agents
○Coping impairment r/t diagnosis and therapy
○Knowledge deficit

148
Q

When/After administering any Noninsulin Antidiabetic agents to a patient, what are some implementations that we should expect to do/ be prepared to do?

A

○Administer the drug as prescribed in an appropriate
relationship with meals
○Ensure that the patient is following diet and exercise
modifications
○Monitor nutritional status
○Monitor response carefully; blood glucose monitoring is
the most effective way
○Monitor patients during times of trauma, pregnancy, or
severe stress
○Provide thorough patient teaching

149
Q

What does glucose elevation agents do?

A

Raise the blood level of glucose when severe hypoglycemia occurs (<70 mg/dL)

150
Q

What Glucose elevating agent do we need to know for the exam?

A

Glucagon

151
Q

How does Glucagon work in the body once administered?

A

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

152
Q

What would indicate the need to administer Glucagon to a patient?

A

hypoglycemia

153
Q

What would contraindicate administration of Glucagon in a patient?

A

○Known allergy
○Pregnancy (benefit must outweigh risk)

154
Q

What patient conditions should prompt increased caution when administrating Glucagon?

A

○Lactation - can cause glucose changes in baby
○Hepatic dysfunction, renal dysfunction (can lead to accumulation), or cardiac disease (Can increase heart rate & BP)

155
Q

What known adverse reactions may a patient taking Glucagon experience?

A

○GI upset (common)
○Alteration in BP

156
Q

Are there any DDI’s to Glucagon, and if so, what are they?

A

Anticoagulants - can increase effectiveness

157
Q

Prior to administering Glucagon to a patient, what are some things that we should be assessing for?

A

○contraindications and caution - check blood sugar
○complete physical assessment
○Orientation and reflexes and baseline pulse, blood pressure,
adventitious sounds, and BS
○Glucose levels and appropriate lab values

158
Q

Prior to administering Glucagon to a patient, what are some nursing diagnoses that can be expected?

A

○Risk for unstable blood glucose related to ineffective dosing of the
drug
○Malnutrition risk more than body requirements related to
metabolic effects, and less than body requirements related to GI
upset
○Altered sensory perception (kinesthetic, visual, auditory, and
tactile) related to glucose levels

159
Q

When/After administering Glucagon to a patient, what are some implementations that we should be doing or be prepared to do?

A

○Monitor blood glucose levels
○Have insulin on standby during emergency use
○Monitor nutritional status
○Provide thorough patient teaching

160
Q

when is glucagon normally administered?

A

When diabetic patients are suffering from a diabetic agent overdose which has lead to hypoglycemia and are unconscious and cannot get glucose through oral method.

161
Q

Which insulin is fast acting? How quickly does it start working and when does it peak?

A

Lispro and Aspart 30-60 min and peaks at 2- 3 hrs

162
Q

When should Lispro be taken?

A

Before meals

163
Q

When would patients possibly require higher insulin doses?

A

Times of stess

164
Q

How long does Glargine work for?

A

24 hrs

165
Q

Is NPH fast acting, moderate or long acting?

A

Moderate

166
Q

Which type of diabetes is more likely to experience DKA, and why?

A

Type 1 - due to no insulin production

167
Q

To monitor for DKA, what labs should we be monitoring?

A

BUN & Kidney functions

168
Q

How is DKA treated?

A

With insulin drip

169
Q

For DKA, what insulin reading tells us the the DKA is severe or moderate?

A

Reding of 300-500 is moderate.
Reading over 500 is severe

170
Q

what are some S&S of DKA?

A

Fruity breath, Kussmauls breathing

Pharmacology Exam 3 (12 decks)

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