CH 45: Drugs for DM

Question 1

function of the pancreas

Answer 1

secrete glucagon and insulin

Question 2

cluster of cells responsible for endocrine function of the pancreas

Answer 2

islets of Langerhans

Question 3

physiologic action of insulin

Answer 3

-promotes entry of glucose into cells
-provides storage of glucose, as glycogen in skeletal muscle and the liver
-inhibits breakdown of fat and glycogen
-increases protein synthesis and inhibits gluconeogenesis

Question 4

hyperglycemic medications:

Answer 4

 NSAIDs
 Corticosteroids
 Diuretics

Question 5

hyperglycemic hormones:

Answer 5

epi
thyroid
GH
glucocorticoids

Question 6

hypoglycemic drugs:

Answer 6

alcohol
ACE inhibitors
beta blockers
lithium

Question 7

why can insulin not be given PO

Answer 7

GI tract destroys insulin

Question 8

reasons for morning hyperglycemia in patients:

Answer 8

-waning insulin
-dawn phenomenon (4-8 am)
-somogyi phenomenon

Question 9

antihyperglycemic drug used with insulin for DM

Answer 9

Pramlintide (Symlin)

Question 10

labs for regular insulin

Answer 10

liver
urinalysis
thyroid
K
Ca
Mg

Question 11

antidiabetic drugs: biguanide (metformin) adverse effects

Answer 11

flatulence
D/N
anorexia
abd pain
bitter and metallic taste
lactic acidosis

Question 12

antidiabetic drugs: incretin mimetics (GLP-1 agonists) adverse effects

Answer 12

N/V/D
nervousness
injection site reactions
antibody formation
pancreatitis
CKD
thyroid tumors

Question 13

antidiabetic drugs: Incretin enhancers (DPP-4 inhibitors) adverse effects

Answer 13

flulike symptoms
URI
back pain
hypoglycemia
hepatic impairment
anaphylaxis
pancreatitis

Question 14

antidiabetic drugs: Meglitinides adverse effects

Question 15

antidiabetic drugs: sulfonylureas adverse effects

Answer 15

N
heartburn
dizziness
HA
drowsiness
hypoglycemia
cholestatic jaundice
blood dyscasias

Question 16

antidiabetic drugs: thiazolidinediones adverse effects

Answer 16

URI
myalgia
HA
edema
weight gain
hypoglycemia
cholestatic jaundice
blood dyscrasias

Question 17

antidiabetic drugs: other possible adverse effects

Answer 17

confusion
agitation
hallucinations
female genital infections
UTI
nasopharyngitis
hypotension
CKD
hyperkalemia
hypoglycemia

Question 18

Metformin (Biguanide) therapuetic effects

Answer 18

treatment of type 2 DM

Question 19

Metformin (Biguanide) adverse effects

Answer 19

N/V/D
abd discomfort
metallic taste
anorexia
HA
dizziness
agitation
fatigue

Question 20

Metformin (Biguanide) labs

Answer 20

false positive urinary ketones

Question 21

Metformin (Biguanide) onset, peak, duration

Answer 21

onset = less than 1 hr
peak = 1-3 hr
duration = 12 -24 hr

Question 22

MOA for thiazolidinediones

Answer 22

reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis

Question 23

MOA of meglitinides

Answer 23

act by stimulating the release of insulin form pancreatic islet cells

Question 24

MOA of incretion mimetics

Answer 24

activate receptor GLP-1 causing lower blood glucose by increasing secretion of insulin slowing absorption of glucose and reducing glucagon

Question 25

MOA of incretion enhancers

Answer 25

allow naturla incretion levels to rise and produce greater response by lowering blood glucose

Question 26

administration and compatibility of insulin lispro

Answer 26

subq - 5-10 min before meals
can give with NPH - draw lispro first

Question 27

administration and compatibility of regular insulin

Answer 27

subq - 30-60 m before meals - IV
can mix with NPH, sterile water or normal saline

Question 28

administration and compatibility of NPH

Answer 28

subq - 30 min before first meal
can mix with aspart, lispro, regular

Question 29

admin of insulin glargine

Answer 29

subq - once daily

Question 30

insulin therapy goal is a1c below

Answer 30

6.5%

Question 31

glucose between meals

Answer 31

Pancreas secretes glucagon = the opposite effect of insulin = glucose rises

Question 32

body’s reaction to hyperglycemia

Answer 32

pancreas secretes insulin
cells take up glucose for energy and storage
homeostasis restored

Question 33

body’s reaction to hypoglycemia

Answer 33

pancreas secretes glucagon
liver breaks down glycogen, returning glucose to blood
homeostasis restored

Question 34

body’s reaction to hypoglycemia

Answer 34

pancreas secretes glucagon
liver breaks down glycogen, returning glucose to blood
homeostasis restored

Question 35

S/S of hypoglycemia

Answer 35

pale
cool
moist skin
confusion
lightheaded
weak
anxious

Question 36

biguanide (metformin) safety and monitoring

Answer 36

GI distress, metallic taste, diarrhea, anorexia
Kidney function
d/c 2 days prior and 2 days after IV contrast
lactic acidosis
vitamins B12, folic acid levels
Report drowsiness, malaise, general body aches

Question 37

GLP 1 Agonists safety and monitoring

Answer 37

Gi symptoms
Pancreatitis
Renal insufficiency
hypoglycemia

Question 38

DPP 4 Inhibitors (Onglyza) safety and monitoring

Answer 38

Pancreatitis
hypersensitivity

Question 39

Meglintinidines (prandin) safety

Answer 39

hypoglycemia
weight gain
take with first bite of meal

Question 40

sulfonylureas (glyburide) safety and monitoring

Answer 40

Weight gain
Liver dysfunction
Hypoglycemia
Avoid alcohol

Question 41

thiazolidinediones (actos) safety and monitoring

Answer 41

May require 3 to 4 months to work
Liver function
Hypoglycemia
Fractures in women
Unintended pregancy Black box for heart failure
hypoglycemia