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Pharmacology Exam #3 > Blood Glucose Agents > Flashcards

Blood Glucose Agents Flashcards

1
Q

How does Insulin regulate blood glucose?

A
  • It is a hormone produced by the BETA cells in the pancreas
  • Released into circulation when blood glucose levels rise
  • Stimulates glycogen synthesis, conversion of lipids into fat stored as adipose tissue, and synthesis of proteins from amino acids
  • Released after meals causing blood glucose levels to fall
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2
Q

How does glucagon regulate blood glucose?

A
  • Released from the ALPHA cells of the Pancreas
  • Released when blood glucose levels fall
  • Causes immediate mobilization of glycogen stored in the liver
  • Raises blood glucose levels
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3
Q

Other processes that regulate blood glucose

A
  • Adipocytes secrete adiponectin, increases insulin sensitivity, decreases release of glucose from the liver, protects blood vessels from inflammation
  • Endocannabinoid receptors keep the body in a state of energy gain to prepare for stressful situations
  • Sympathetic nervous system decreases insulin release, increases release of stored glucose, and increases fat breakdown
  • Corticosteroids decrease insulin sensitivity, increase glucose release, and decrease protein building
  • Growth hormone decreases insulin sensitivity, increases FFAs, increases protein building
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4
Q

Clinical Signs of Diabetes Mellitus

A
  • Hyperglycemia: Fasting blood glucose > 126mg/dL
  • Glycosuria: sugar in the urine (may appear frothy)
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5
Q

Disorders associated with Diabetes Mellitus

A
  • Atherosclerosis: MIs and CVAs related to the build up of plaques in the vessel lining
  • Retinopathy: loss of vision as tiny vessels in the eye are narrowed and closed
  • Neuropathies: Oxygen is cut off to feet and legs, progressive changes to nerves, motor and sensory changes
  • Nephropathy: Renal dysfunction related to changes in the basement membrane of the glomerulus
  • Infections: Increase in frequency and severity r/t decreased blood flow and altered neutrophil function
  • Foot ulcers: Decreased wound healing r/t vascular insufficiency, unnoticed wounds r/t neuropathy and decreased perception of pain
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6
Q

Metabolic changes when insufficient insulin is released

A
  • Hyperglycemia: inc. blood sugar
  • Glycosuria: sugar in the urine
  • Polyuria: increased urine
  • Polyphagia: increased hunger
  • Polydipsia: increased thirst
  • Lipolysis: Fat breakdown
  • Ketosis: ketones cannot be removed efficiently and build up
  • Acidosis: Liver cannot remove all waste products
  • Protein in urine
  • Elevated BUN
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7
Q

What is Type 1 DM?

A
  • Rapid onset
  • Usually diagnosed in younger years
  • Caused by autoimmune destruction of BETA cells in the pancreas
  • Pts need INSULIN replacement
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8
Q

What is Type 2 DM?

A
  • Usually occurs in mature adults
  • Has a slow and progressive onset
  • Decreased insulin sensitivity in peripheral cells (insulin resistance)
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9
Q

Hypoglycemia
Signs and Symptoms

A

Blood glucose < 70mg/dL
* Shakiness
* Dizziness
* Sweating
* Hunger
* Tachycardia
* Inability to concentrate
* Confusion
* Irritability or moodiness

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10
Q

Signs of DANGEROUS complications of
Hyperglycemia

A
  • Fruity breath (ketones are being excreted through the lungs)
  • Dehydration
  • Fast, deep breaths (Kussmaul’s respirations)
  • Loss of orientation, coma
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11
Q

Lifespan Considerations for Antidiabetic Agents
In Children

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 teams d/t noncompliance and changing hormones
  • Team approach - family, patient, teachers, coaches, etc.
  • Metformin is the only oral DM drug approved
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12
Q

Lifespan Considerations for Antidiabetic Agents
In Adults

A
  • Two nurse check for insulin
  • Emphasize diet and exercise
  • Caution about OTC, herbal, and alternative therapies
  • Insulin is best choice in pregnancy and lactation
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13
Q

Lifespan Considerations for Antidiabetic Agents
In Older Adults

A
  • Two nurse checks for insulin
  • 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
  • Emphasize diet, exercise, skin, and foot care
  • More likely to experience end organ damage (i.e. kidneys)
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14
Q

Insulin
Mechanism of Action

A
  • Hormone that promotes the storage of the body’s fuels
  • Facilitates the transport of various metabolites across cell membranes
  • Stimulates the synthesis of glycogen from glucose
  • Reacts with specific receptor sites on the cell membranes
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15
Q

Insulin
Indications

A
  • Type 1 DM
  • Type 2 DM in patients whose diabetes cannot be controlled by diet or other agents
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16
Q

Insulin
Contraindications

A

Absolute:
* Hypoglycemia

Caution:
* Pregnancy and lactation (monitor closely)

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17
Q

Insulin
Adverse Effects

A
  • Hypoglycemia and ketoacidosis
  • Local injection site reactions
  • Decreased blood potassium levels
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18
Q

Insulin
Drug Interactions

A

Will need increased insulin doses
* Beta Blockers
* Thiazide Diuretics
* Glucocorticosteroids
* Glucose altering medications (salicylates, alcohol, oral antidiabetic agents, beta blockers)

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19
Q

Regular Insulin
Onset, peak time, duration

A

Onset: 30-60 min
Peak: 2-4 hours
Duration: 6-12 hours

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20
Q

NPH Insulin
Onset, peak time, duration

A

Onset: 1-1.5 hours
Peak: 4-12 hours
Duration: 24 hours

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21
Q

Inhaled Insulin
Onset, peak time, duration

A

Onset: 12-15 minutes
Peak: 60 minutes
Duration: 2.5-3 hours

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22
Q

Lispro Insulin
Onset, peak time, duration

A

Onset: < 15 min
Peak: 30-90 min
Duration: 2-5 hours

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23
Q

Aspart Insulin
Onset, peak time, duration

A

Onset: 10-20 min
Peak: 1-3 hours
Duration: 3-5 hours

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24
Q

Glargine Insulin
Onset, peak time, duration

A

Onset: 60-70 min
Peak: NONE
Duration: 24 hours

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25
Q

Glulisine Insulin
Onset, peak time, duration

A

Onset: 2-5 min
Peak: 30-90 min
Duration: 2 hours

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26
Q

Detemir Insulin
Onset, peak time, duration

A

Onset: 1-2 hours
Peak: 3-6 hours
Duration: 5.7-23.3 hours

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27
Q

Insulin
Assessment

A

History:
* Check for hypoglycemia, pregnancy, lactation
* Assess nutritional intake and activity level
* Assess history of blood sugar regulation

Physical:
* Skin lesions
* Orientation and reflexes
* Pulse and BP
* Respiratory status

Labs:
* Blood glucose within the hour
* Monitor High A1C
* Urinalysis
* BMP

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28
Q

Insulin
Nursing Diagnoses/ Conclusions

A
  • Glucose and electrolyte imbalance risk (r/t use of insulin and underlying disease)
  • Malnutrition risk (r/t changes in glucose transport)
  • Altered sensory perception (r/t glucose levels)
  • Infection risk (r/t injections and disease processes)
  • Injury risk (r/t potential hypoglycemia, hyperglycemia, and injection technique)
  • Coping impairment (r/t diagnosis and need for injection therapy)
  • Knowledge deficit
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29
Q

Insulin
Implementation/ Patient Teaching

A
  • Educate on foot care, drug-drug interactions, nerve sensitivities
  • Ensure patient is following dietary and exercise regimen and using good hygiene practices
  • Gently rotate the vial, never shake
  • Select a site free of bruising and scarring; rotate site each time
  • Give maintenance doses by subq injection or inhaled routes only
  • Monitor pt for signs and symptoms of hypoglycemia, especially during peak times
  • Always verify name of insulin being given
  • During stress - insulin may need to be increased
  • Do not mix insulins in the same injection
  • Store in a cool place away from sunlight
  • Make sure patient eats when taking insulin
  • Protect pt from infection
  • Instruct pts receiving betablockers to monitor glucose levels closely
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30
Q

Sulfonylureas
Drug Names

A

Tolbutamide: first generation - inc. risk of CV disease
Glipizide - 2nd generation
Glyburide 2nd generation
2nd generation has fewer drug interactions and longer duration

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31
Q

Sulfonylureas
Mechanism of Action

A
  • Stimulate insulin release from the beta cells in the pancreas
  • Improve binding to insulin receptors
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32
Q

Sulfonylureas
Indications

A
  • Adjunct to diet and exercise for Type 2 DM
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33
Q

Sulfonylureas
Contraindications

A

Absolute:
* Allergy
* Diabetic complications
* Type 1 DM
* Pregnancy and lactation

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34
Q

Sulfonylureas
Adverse Effects

A
  • Hypoglycemia
  • GI distress
  • Allergic skin reactions
35
Q

Sulfonylureas
Drug Interactions

A
  • Beta Blockers
  • Alcohol
  • Herbal remedies
36
Q

Biguanides
Drug Name

37
Q

Biguanides: Metformin
Mechanism of Action

A
  • Decreases production and increases uptake of glucose
  • Lowers both basal and postprandial glucose levels
  • Decreases hepatic glucose production
  • Improves insulin sensitivity of peripheral cells
38
Q

Biguanides: Metformin
Indication

A
  • 1st line treatment for Type 2 DM

Can be used off label for PCOS

39
Q

Biguanides: Metformin
Contraindications

A

All will increase risk of lactic acidosis
Absolute:
* Hypersensitivity
* Metabolic acidosis
* Severe renal impairment

Cautions:
* Hepatic impairment
* Excessive alcohol intake
* NPO status
* Radiologic contrast
* Age 65 and older
* Hypoxic state (HF, resp. distress)

40
Q

Biguanides: Metformin
Adverse Effects

A
  • Black Box warning: Lactic acidosis (rare)
  • GI effects
  • Dizziness, headache
  • Upper Respiratory Infections
  • Taste disturbances
41
Q

Biguanides: Metformin
Drug Interactions

A
  • Alcohol
  • Carbonic anhydrase
  • Iodine containing contrast media (can lead to kidney failure)
42
Q

DPP-4 Inhibitor
Drug Name

A

Sita”-gliptin”

43
Q

DPP-4 Inhibitor: Sitagliptin
Mechanism of Action

A
  • Slow inaction of incretin hormones: increase insulin release and decrease glucagon release
44
Q

DPP-4 Inhibitor: Sitagliptin
Indication

A
  • Adjunct to diet and exercise for Type 2 DM
45
Q

DPP-4 Inhibitor: Sitagliptin
Contraindications

A

Absolute:
* Allergy
* Type 1 DM or DKA

Caution:
* Renal impairment

46
Q

DPP-4 Inhibitor: Sitagliptin
Adverse Effects

A

Rarely reported

46
Q

Meglitinides
Indication

A
  • Adjunct to diet and exercise in Type 2 diabetes
46
Q

DPP-4 Inhibitor: Sitagliptin
Drug Interactions

A
  • Other medications that lower blood glucose
47
Q

Meglitinides
Mechanism of Action

A
  • Stimulates insulin release from the beta cells in the pancreas
48
Q

Meglitinides
Drug Names

A

“-glinide”
Repaglinide
Nateglinide

49
Q

Meglitinides
Contraindications

A

Absolute:
* Hypersensitivity
* Type 1 DM or DKA

50
Q

Meglitinides
Adverse Effects

A
  • Upper Respiratory Infections
  • Headache
  • Arthralgias
  • Nausea, diarrhea
  • Hypoglycemia
51
Q

Meglitinides
Drug Interactions

52
Q

SGLT-2 Inhibitors
Drug Name

A

“-gliflozin”

Canagliflozin

53
Q

SGLT-2 Inhibitors: Canagliflozin
Mechanism of Action

A
  • Blocks co-transporter system so glucose is not reabsorbed but is lost in the urine
54
Q

SGLT-2 Inhibitors: Canagliflozin
Indication

A
  • Adjunct to diet and exercise in Type 2 DM

(Research being done for Type 1 DM - not FDA approved)

55
Q

SGLT-2 Inhibitors: Canagliflozin
Contraindications

A

Absolute:
* Type 1 DM or DKA
* Severe renal impairment
* Pregnancy (2nd and 3rd trimester: can affect fetal kidney development)

56
Q

SGLT-2 Inhibitors: Canagliflozin
Adverse Effects

A
  • Dehydration and Hypotension
  • UTIs
  • Genital fungal infections
  • DKA
  • Lower Limb amputations (esp in patients with vascular disorder)
57
Q

SGLT-2 Inhibitors: Canagliflozin
Drug Interactions

A
  • Numerous: Rifampin
58
Q

Thiazolidinediones
Drug Name

A

“-glitazone”

Pioglitazone

59
Q

Thiazolidinediones: Pioglitazone
Mechanism of Action

A
  • Decrease insulin resistance in peripheral cells and liver
  • Increase responsiveness to insulin
60
Q

Thiazolidinediones: Pioglitazone
Indication

A
  • Adjunct to diet and exercise in Type 2 DM
61
Q

Thiazolidinediones: Pioglitazone
Contraindications

A

Absolute:
* Mild to moderate HF

Cautions:
* Liver impairment

62
Q

Thiazolidinediones: Pioglitazone
Adverse Effects

A
  • Upper Respiratory Infections
  • Headaches, muscle pain
  • Increased Total Cholesterol
  • Rapid weight gain and edema
63
Q

Thiazolidinediones: Pioglitazone
Drug Interactions

A

Numerous

Other Antidiabetic medications

64
Q

GLP-1 Agonists
Drug Names

A

“-glutide” and “-natide”

Semaglutide
Exanatide

65
Q

GLP-1 Agonists
Mechanism of Action

A
  • Increase insulin release
  • Decrease glucagon release
  • Slow down GI emptying
66
Q

GLP-1 Agonists
Indication

A
  • Adjunct to diet and exercise in Type 2 DM
  • Reduce risk of major CV events in Type 2 DM
67
Q

GLP-1 Agonists
Contraindications

A
  • Type 1 DM or DKA
  • Pregnancy or lactation
68
Q

GLP-1 Agonists
Adverse Effects

A
  • GI effects
  • Pancreatitis
69
Q

GLP-1 Agonists
Drug Interactions

A
  • Other antidiabetic medications
  • Oral medications: effects may be slowed
70
Q

Noninsulin Antidiabetic Agents
Assessment

A

History:
* Assess for contraindications and cautions
* Assess activity level and nutrition intake

Physical:
* Baseline complete physical assessment
* Look for any skin lesions

Labs:
* Blood glucose levels
* Urinalysis
* Renal and hepatic function tests

71
Q

Noninsulin Antidiabetic Agents
Nursing Diagnoses/ Conclusions

A
  • Hyperglycemia risk (r/t diabetes mellitus disease process)
  • Hypoglycemia risk (r/t dosing of antidiabetic agents)
  • Coping impairment (r/t diagnosis and therapy)
  • Knowledge deficit
72
Q

Noninsulin Antidiabetic Agents
Implementation/ Patient Teaching

A
  • Administer the drug as prescribed in relationship to meals (short acting insulin immediately before meals)
  • Ensure patient is following diet and exercise modifications
  • Monitor nutritional status
  • Monitor response carefully: Blood glucose
  • Monitor patients during times of trauma, pregnancy, or severe stress
73
Q

Glucose Elevating Agents
Drug Name

74
Q

Glucose Elevating Agent: Glucagon
Mechanism of Action

A
  • Increases the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose
75
Q

Glucose Elevating Agent: Glucagon
Indications

A
  • Hypoglycemia
76
Q

Glucose Elevating Agent: Glucagon
Contraindications

A

Absolute:
* Allergy
* Pregnancy

Caution:
* Lactation
* Hepatic dysfunction
* Renal dysfunction
* Cardiac disease

77
Q

Glucose Elevating Agent: Glucagon
Adverse Effects

A
  • GI Effects
  • Alteration of Blood Pressure
78
Q

Glucose Elevating Agent: Glucagon
Drug Interactions

A
  • Anticoagulants
79
Q

Glucose Elevating Agent: Glucagon
Assessment

A

History:
* Contraindications and cautions

Physical:
* Orientation and reflexes
* Baseline pulse and BP
* Lung sounds
* Bowel sounds

Labs:
* Glucose levels

80
Q

Glucose Elevating Agent: Glucagon
Nursing Diagnoses/ Conclusions

A
  • Risk for unstable blood glucose (r/t ineffective dosing of the drug)
  • Malnutrition risk: more than body requirements (r/t metabolic effects)
  • Malnutrition risk: less than body requirements (r/t GI effects)
  • Altered sensory perception (r/t glucose levels)
  • Knowledge Deficit
81
Q

Glucose Elevating Agent: Glucagon
Implementation

A
  • Monitor blood glucose levels closely
  • Have insulin on standby for emergency use
  • Monitor nutritional status

Pharmacology Exam #3 (14 decks)

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