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pharm 140 > blood glucose levels 49 > Flashcards

blood glucose levels 49 Flashcards

1
Q

what percentage of the population has DM?

A

7%

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2
Q

which is more common, DM 1 or DM2?

A

DM2 (90-95%)

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3
Q

metabolic changes when insufficient insulin is released

A 
hyperglycemia
glycosuria
polydipsia
lipolysis
ketosis
acidosis
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4
Q

hyperglycemia results from what 3 main abnormalities?

A
  1. excessive glucose production in liver
  2. absent or impaired glucose production and secretion by the pancreas
  3. peripheral insulin resistance
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5
Q

type 1 diabetes

A

autoimmune disorder characterized by the destruction of insulin-secreting beta cells in the pancreas, leading to absolute insulin deficiency

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6
Q

type 2 diabetes

A

result of insulin resistance by the tissues and usually a decrease in insulin production

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7
Q

gestational diabetes (GDM)

A

occurs when a woman’s pancreatic function is not sufficient to overcome the insulin resistance created by the anti-insulin hormones secreted by the placenta

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8
Q

insulin functions

A
  • facilitates passage of glucose into cells for energy
  • suppresses excess production of sugar in the liver and muscles
  • inhibits breakdown of fat for energy
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9
Q

exogenous insulin

A

synthetic insulin

aspart, lispro, glulisine

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10
Q

insulin interactions

A 
alcohol
beta blockers
dobutamine
niacin
MAOIs
thiazide diuretics
tetracycline
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11
Q

insulin contraindications

A

hypoglycemia

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12
Q

insulin adverse effects

A

hypoglycemia

lipoatrophy

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13
Q

insulin nursing diagnoses

A
  1. deficient knowledge r/t insulin pharmacotherapeutics
  2. risk for non-adherence to self care r/t complexity and chronic nature of insulin regimen
  3. risk for hypoglycemia r/t incorrect insulin administration
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14
Q

insulin planning/interventions

A

max therapeutic effect: store opened vials at room temperature; administer with an insulin syringe into appropriate subq site

min adverse effects: rotate injection site to prevent lipodystrophy; assess blood glucose prior to administration

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15
Q

which subq site provides the most rapid absorption of insulin therapy?

A

abdomen; up to 50% faster

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16
Q

rapid acting insulins

A
  1. aspart (NovoLog)
  2. lispro (Humalog)
  3. glulisine (Apidra)
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17
Q

rapid acting insulin administration

A 
administer within 15 min of the start of the meal
begins working in 10-20 min
peak 30 min-3 hrs
duration 3-5 hrs
can be used in insulin pumps
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18
Q

short-acting insulin

A

regular (R) or novolin: acts in 30-60 min, lasts 5-8 hrs

velosulin (used in insulin pump): acts in 30-60 min, lasts 2-3 hrs

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19
Q

intermediate insulin

A

NPH (N): acts in 1-2 hrs, lasts 18-24 hrs

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20
Q

long-acting insulin

A 
insulin glargine (Basaglar, Lantus, Toujeo) - 20-24 hrs
insulin detemir (Levemir) - up to 24 hrs
insulin degludec (Tresiba) - lasts up to 42 hrs
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21
Q

pre-mixed insulin

A

humulin [70/30, 50/50]
humolog mix [75/25]
novolin [70/30]
novolog [70/30]

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22
Q

insulin pt education

A 
self glucose testing
carry emergency carbs
never inject cold insulin
do not massage injection site
draw up regular (R) first
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23
Q

oral hypoglycemic drugs

A 
sulfonylureas (gen1 and gen2)
biguanide
alpha glucosidase inhibitors
meglitinides
thiazolidnediones
24
Q

sulfonylureas

A 
prototype glubiride (DiaBeta)
adjunctive treatment to lower blood glucose levels in DM2
25
glyburide pharmacokinetics
given PO metabolized in liver excreted thru urine/feces protein bound
26
glyburide action
hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells
27
glyburide contraindications
hypersensitivity
28
glyburide adverse effects
``` hypoglycemia anorexia n/v heartburn metallic taste ```
29
glyburide considerations
pregnancy category B | pt willingness to follow diet
30
glyburide nursing diagnoses
ineffective health maintenance r/t drug induced n/v, abdominal pain and disulfiram reaction 2/2 alcohol ingestion imbalanced nutrition (more than body requirements) r/t weight gain 2/2 glyburide/sulfonylurea therapy ineffective protection r/t leukopenia 2/2 bone marrow depression associated with glyburide use
31
glyburide planning/interventions
max therapeutic effect: administer before breakfast or first meal of the day min adverse effect: monitor blood glucose levels to detect hypoglycemia; monitor pts with renal/heptaic impairment for s/s adverse effects
32
nonsulfonylureas
three classes: 1. biguanides 2. thiazolidinediones 3. alpha-glucosidase inhibitors prototype for all nonsulfonylureas is metformin
33
metformin action
decreases hepatic glucose production decreases intestinal absorption of glucose improves insulin sensitivity by increasing peripheral glucose uptake it is ADJUNCT to therapy to lower blood glucose in DM2 pts
34
metformin pharmacokinetics
given PO metabolized in liver excreted in urine
35
metformin contraindications
hepatic disease
36
metformin adverse effects
``` anorexia GI upset (n/v/d and flatulence) weight loss dyspepsia metallic taste ```
37
metformin interactions
may interact with contrast used in radiographic procedures alcohol
38
metformin + pregnancy
pregnancy category B
39
metformin diagnoses
risk for imbalanced nutrition (less than body requirements) r/t anorexia 2/2 adverse GI effects from metformin
40
metformin interventions
max therapeutic effect: administer 2x daily with morning and evening meal; adherence to diet/exercise help to control DM2 min adverse effect: take drug at mealtime and increase dose gradually to minimize these effects
41
glucagon
glucose-elevating agent (opposite effect of insulin) hyperglycemic polypeptide hormone produced by alpha cells in pancreatic islets of Langerhans first line of defense against hypoglycemia secreted in response to decreased serum blood sugar
42
glucagon pharmacokinetics
half life of 3-10 min
43
glucagon action
increases blood glucose levels by stimulating glycogenolysis in the peripheral tissues
44
glucagon contraindications
hypersensitivity
45
glucagon adverse effects
hypotension respiratory distress n/v
46
glucagon interactions
oral anticoagulant
47
glucagon + pregnancy
pregnancy category B
48
glucagon diagnoses
risk for injury r/t hypotension from adverse effects of glucagon
49
glucagon interventions
max therapeutic effect: use reconstituted glucagon immediately; typical dose is 0.5-1 mg min adverse effect: administer supplemental carbohydrates as soon as possible
50
rapid acting insulin indications
covers insulin needs for meals eaten at the same time as the injection; often used in combination with longer acting insulin
51
short acting insulin indications
covers insulin needs for meals eaten within 30-60 min of administration
52
intermediate-acting insulin indications
covers insulin needs for about half a day or overnight; often combined with rapid or short acting insulins
53
long-acting insulin indications
covers insulin needs for about one full day; often combined with rapid or short acting insulins
54
pre-mixed insulin indications
generally taken 2-3x daily before mealtimes contain specific amts of intermediate and short acting insulin in one bottle or pen
55
drugs that have additive effects when used with insulin
sulfonylureas beta blockers alcohol
56
drugs that counteract effects of insulin
thiazide diuretics | glucocorticoids

pharm 140 (18 decks)

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