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Pharm > Ch. 52 - Antidiabetics > Flashcards

Ch. 52 - Antidiabetics Flashcards

1
Q

Insulin:

A

Secreted by:

-beta cells of the islets of Langerhans in pancreas

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2
Q

Normal Glucose Ranges (1):

A
  1. ) Blood glucose
    • 60-100 mg/dL
  2. ) Serum (plasma) glucose
    - 70-110 mg/dL

3.) > 180mg/dL  glycosuria (glucose spills into urine)

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3
Q

Normal Glucose Ranges (2):

A

HbA1C:
-Average glucose level up to 3 mos(months)

-Goal = keep HbA1C Below 7%

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4
Q

Insulin Therapy (1):

A
  1. ) Dosage = measured in units
  2. ) Insulin syringes  (orange cap)
  3. ) U-100 = 100 units of insulin per milliliter
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5
Q

Insulin Therapy (2):

A
  1. ) U-500 = 500 units / mL
  2. ) Need prescription (but not for U-100)
  3. ) Need doses > 200 units insulin daily
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6
Q

Insulin Therapy (3):

A
  1. ) 10 mL vials
  2. ) Store in refrigerator
  3. ) Avoid extreme temps
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7
Q

Routes of Administration (1):

A
  1. ) SC
  2. ) Insulin pen = SC
    - More accurate, more expensive
    - Less painful
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8
Q

Routes of Administration (2):

A

3.) IV (REGULAR type only)

  1. ) Insulin pump (REGULAR type only)
    - Implantable
    - Portable
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9
Q

Insulin Pump:

A
  1. ) More effective than multiple injections
  2. ) Constant amt of insulin
  3. ) More expensive
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10
Q

4 Types of Insulin:

A

1.) Rapid acting
2.) Short acting
3.) Intermediate acting
4.) Long acting
(Combination)

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11
Q

Rapid Acting (1):

A

1.) lispro (Humalog)

2.) insulin aspart (NovoLog)
Ex: ^^^

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12
Q

Rapid Acting (2):

A
  1. ) Onset of Action
    - 5-15 min
  2. ) Peak Action:
    - Humalog: 30-90 min
    - NovoLog: 1-3 hrs
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13
Q

Rapid Acting (3):

A
  1. ) Duration:
    - Humalog: 2-5 hrs
    - NovoLog: 3-5 hrs
  2. ) Appearance = clear
  3. ) Administer:
    • 5 min before meals
      • *Ex: Make sure breakfast trays are infront of p/t first before giving insulin
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14
Q

Short Acting = Regular (1):

A

Insulin Regularrrr =

 - Humulin R
 - Novolin R
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15
Q

Short Acting = Regular (Humulin R) - 2:

A
  1. ) Onset: 30 min
  2. ) Peak: 2.5 – 5 hrs
  3. ) Duration  6 – 8 hrs
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16
Q

Short Acting = Regular (Humulin R)- 3:

A
  1. ) Appearance  clear
  2. ) Administer: ~30 min b4 meal
  3. ) ***ONLY type of insulin that can be given IV!!
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17
Q

Intermediate Acting (1):

A

insulin **NPH (N):

-**Humulin N, Novolin N

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18
Q

Intermediate Acting (2) - NPH (Humulin N):

A
  1. ) Onset: 1 – 2 hrs
  2. ) Peak: 6 – 12 hrs
  3. ) Duration  18 – 24 hrs
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19
Q

Intermediate Acting (3): - NPH (Humulin N)

A
  1. ) Appearance: Cloudy

5. ) Administer: 1 hr before breakfast

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20
Q

Long Acting (1):

A
  • glargine (Lantus)

- Vial  (purposely different) – tall, narrow vial

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21
Q

Long Acting - glargine (Lantus) (1):

A
  1. ) Onset: about 1 hr

2. ) Duration: 24 hr coverage WITHOUT a peak

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22
Q

Long Acting - glargine (Lantus) (2):

A
  1. ) Appearance: clear
  2. ) Administer: given at HS (bedtime)
  3. ) DO NOT MIX with any other insulins
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23
Q

Combination Products:

A

Reg & (intermediate acting):

 - 70% NPH & 30% Reg
 - 50% NPH & 50% Reg

 -B.i.d before meals
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24
Q

Adverse Effects of Insulin:

A

Hypoglycemia!

  1. ) Hypoglycemic (insulin) reaction
  2. ) May be d/t:
    • Omitting / irreg scheduled meals
    • Increase exercise
    • Administration errors
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25
Q

Hypoglycemic (insulin) Reaction: S/S:

A

Sweating, confusion, tachycardia, HA(headache), hunger, weakness:
= Coma, death

Blood sugar level

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26
Q

Hypoglycemic (insulin) Reaction: Tx:

A

Glucose:

  • Oral
  • Parenteral (if unconscious) = Glucagon
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27
Q

Insulin Lipodystrophy:

A

Prevent:
*Rotate sites
*Massage site after injection

28
Q

Insulin Resistance:

A

Need for higher doses of insulin

29
Q

Coverage Orders (Sliding Scale):

A
  1. ) Additional insulin to ‘cover’ increased blood sugar levels
  2. ) Based on blood glucose levels
  3. ) Rapid or Short acting insulin used
30
Q

Coverage Orders (Sliding Scale) -EXAMPLE

A

Blood Glucose Level —— Regular Insulin order
0-180 mg/dL No coverage
181-240 mg/dL 2 units SC
241-300 mg/dL 4 units SC

31
Q

Administration of Insulin (1):

A
  1. ) Always use Insulin syringe!

2. ) U-100 syringes = 100 units / mL

32
Q

Administration of Insulin (2):

A
  1. ) Lo-dose syringes
    • 30 unit syringes
    • 50 unit syringes

4.)For smaller doses of insulin

33
Q

Injection Sites:

A

Client:

  • Thigh
  • Abdomen = (fastest absorption)
    • Both easier to self-inject
34
Q

Rotate Sites!:

A
  1. ) Injecting into an infrequently used site :
    • May cause hypoglycemia
  2. ) Establish rotation pattern
  3. ) Keep track, document site used
35
Q

Measuring 2 Types of Insulin in Same Syringe (1):

A
  1. ) Gently roll longer acting insulin vial {NEVER shake!}
  2. ) Clean both stoppers on vials
  3. ) Inject appropriate amt of air into longer acting insulin (do not withdraw insulin yet!)
36
Q

Measuring 2 Types of Insulin in Same Syringe (2):

A

4.) Inject appropriate amt of air & WITHDRAW insulin from short acting (Regular) insulin

THEN –>

5.) Withdraw longer acting (Intermediate) insulin

37
Q

Measuring 2 Types of Insulin in Same Syringe (3):

A
  1. ) After mixing Regular & Intermediate insulin: 
  2. ) Adm WITHIN 30 MIN
  3. ) Intermediate insulin will alter functioning of Regular insulin
38
Q

Hypoglycemic reaction (insulin shock) vs Diabetic Ketoacidosis (hyperglycemic reaction):

A

If unsure = Tx for insulin reaction

-Glucose (better if glucose is elevated than dropped)

39
Q

Hypoglycemic Reaction (insulin shock) (1):

A
  1. ) Able to swallow:

2. ) Rapidly absorbed sugar = OJ, sugar containing drink, hard candy

40
Q

Hypoglycemic Reaction (insulin shock) (2):

A

3.) Unable to swallow –> Glucagon injection

41
Q

Glucagon:

A
  • SQ, IM, IV

* Tx: insulin-induced hypoglycemia

42
Q

Hypoglycemic Reaction (insulin shock) (3):

A
  1. ) Should recover within 15 min –>

5. ) No response –> contact physician–> emergency department

43
Q

Hypoglycemic Reaction (insulin shock) (4):

A

6.) Fasting = do not give insulin!!

44
Q

Teach Self-Care Skills!:

A
  1. ) Insulin administration
  2. ) Blood glucose monitoring
  3. ) Foot care
  4. ) Diet
45
Q

Teach Self-Care Skills cont:

A
  1. ) Exercise
  2. ) Medic-alert ID
  3. ) S/S hypo-hyperglycemia
46
Q

Oral Antidiabetic Drugs (1):

A
  1. ) Stimulate pancreatic beta cells to secrete insulin

2. ) Need some pancreatic function

47
Q

Oral Antidiabetic Drugs (2):

A

3.) Type 2 diabetes (NIDDM) = DO NOT respond to diet alone

48
Q

Oral Antidiabetic Drugs (3):

A
  1. ) Best respond: 
    - Dx after age 40
    - Not overweight
    - Need
49
Q

Sulfonylureas (1st & 2nd Generations):

A

Stimulate pancreatic beta cells to secrete insulin

50
Q

Examples: 1st Generation >

A
  1. ) tolbutamide (Orinase)
    • Short acting
  2. ) tolazamide (Tolinase)
    • Intermediate acting
  3. ) chlorpropamide (Diabenese)
    • Long acting
51
Q

2nd Generation Sulfonylureas:

A
  1. ) More potent
  2. ) Greater hypoglycemia potency (why it’s stronger acting)
  3. ) Longer duration
  4. ) Fewer SE
52
Q

Examples – 2nd Generation:

A
  1. ) glimepiride (Amaryl)
  2. ) glipizide (Glucotrol)
  3. ) glyburide (DiaBeta, Micronase )

Admin:
-1 or more times / day

53
Q

Adverse Effects:

A
  • Hypoglycemia
  • Hepatotoxicity/jaundice
  • GI distress
  • Hematological disorders
54
Q

Hypersensitivity Reactions:

A

Ingesting Alcohol –> Flushing, nausea, palpations

55
Q

Biguanides:

A
  1. ) Decreases hepatic production of glucose from stored glycogen 
  2. ) Reduces the increase in serum glucose after a meal
56
Q

Biguanides – Example:metformin (Glucophage):

A

Also increases insulin receptor sensitivity

Admin:

- 500 mg 1-3 times/day with meals
- Increases dose gradually
57
Q

metformin (Glucophage) (1):

A

S/S:

  1. ) Does NOT produce hypoglycemia or hyperglycemia
  2. ) GI effects
  3. ) Bitter metallic taste
58
Q

metformin (Glucophage) (2):

A
  1. ) Avoid alcohol

5. ) Observe for lactic acidosis

59
Q

Nursing Interventions – Oral Antidiabetics:

A

-Adm with food to decrease GI upset

-Monitor bl sugar levels:
Blood glucose = 60-100 mg/dL
Serum glucose = 70-110 mg/dL

60
Q

Teach (1):

A
  1. ) Recognize s/s:
    • Hypo- & hyperglycemia
  2. ) May need insulin:
    • Stress, Surgery, Serious infection
61
Q

Teach (2):

A
  1. ) MedicAlert card, tag, bracelet

4. ) Use of glucometer

62
Q

Diabetes Mellitus (DM):

A

Deficiency in glucose metabolism

  • Caused by:
    • Lack of (or)
    • Inefficient use of
    • Insulin in the body
63
Q

Two Types of DM:

A

Type 1:

* Insulin-dependent (IDDM)
* No pancreatic reserve of insulin
* Need daily insulin therapy
64
Q

Type 1 (IDDM):

A
  • Wide variations in blood glucose levels

* MORE (1) prone to ketosis (accumulation of ketones in blood)

65
Q

Type 2 (NIDDM) (2):

A
  • Can be controlled by:
    • Wt loss & special diet
    • Diet & oral hypoglycemic agents

*LESS (2) likely to develop ketosis

Pharm (18 decks)

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