Chapter 32 - Antidiabetic Drugs Flashcards
When are oral antidiabetic drugs given?
usually given 30 minutes before meals
What is hypoglycemia?
low blood glucose level <50mg/dL
What is the most rapid acting insulin?
Human-based insulins
- Insulin lispro (Humalog, similar to endogenous insulin)
- Insulin aspart (NovoLog)
- Insulin glulisine (Apidra, newest) *if cloudy, do not use. Must be clear. Onset: 5-15 minutes Duration: 3-5 hours may be given SC or by SC cont. infusion *No IV *Pt must eat meal after injection
Since biguanides do not increase insulin secretion from the pancreas, what does that mean?
does not cause hypoglycemia and weight gain *results in decreased insulin resistance
How to treat gestational diabetes?
Insulin must be given to prevent birth defects; usually subsides after delivery
What is a Biguanide and and example?
Oral antidiabetic drug
metformin (Glucophage)*
What is there potential for with sulfonylureas?
Potential for cross allergy in pts allergic to sulfonamide antibiotics*
What is FPG? What does >126 mg/dL but <110 mg/dL mean? How do you find those numbers?
Fasting plasma glucose levels; may indicate “prediabetes”
Glucose tolerance test (oral glucose challenge)
*screening recommended every 3 years when 45 years or older
What are mild hypoglycemic cases treated with?
diet.
more protein, less carbs prevents rebound postprandial hypoglycemia
What is the treatment for DM?
Type 1: insulin therapy
Type 2: lifestyle changes, oral drug therapy, insulin when the previous no longer provides glycemic control
Example of Glinides (2)
- repaglinide (Prandin)
- nateglinide (Starlix)
What hormone(s) does the pancreas secrete?
Insulin and glucagon both assist in glucose regulation
Important when monitoring for therapeutic response:
Measure hemoglocin A1c to monitor long-term compliance with diet and drug therapy
Example of alpha-glucosidase inhibitors (2)
- acarbose (Precose)
- miglitol (Glyset)
What are other treatments for type 2 diabetes?
Lifestyle modifications: diet, exercise, smoking cessation, weight loss
How long should a pt rotate sites for insulin administration?
Rotate sites for about 1 week before rotating to a new location
0.5-1 inch away from previous site
How common is Diabetes Mellitus Type 1 vs Type 2?
Type 1: <10% of all diabetes
Type 2: 90% of all cases (most common)
Are insulin orders/prepared dosages second-checked with another nurse?
YES. Yellow. Know this. Do not ever forget that this needs to be second checked. Unforgivable.
In regards to fat metabolism, what does insulin do?
stimulates lipogenesis (production and accumulation of fat)
inhibits lipolysis (breakdown/destruction of fat)
What 2 things does inadequate insulin elevate?
Inadequate insulin elevates:
- blood glucose levels (hyperglycemia)
- triglyceride levels
What 2 things must be assessed before giving glucose-level-altering drugs?
- pt’s ability to consume food
- nausea/vomiting
hypoglycemia may occur if antidiabetics are given and pt does not eat
Which drug primarily affects GI tract: abdominal bloating, nausea, cramping, diarrhea, and feeling of fullness?
Biguanide: Metformin
What is macrovascular/microvascular?
Both are major long-term complications of DM (1 and 2)
Macrovascular is atherosclerotic plaque in coronary, cerebral, and peripheral arteries; think MACRO as BIG
Microvascular is capillary damage: retinopathy, neuropathy, nephropathy; think MICRO ias small. capillary.
What is diabetes mellitus primarily, and how many types are there?
Disorder of carbohydrate metabolism that leads to hyperglycemia
2 Types
What 4 things are important to obtain/document prior to giving glucose-level-altering drugs?
- thorough history
- vital signs
- blood glucose level, A1C level
- potential complications/drug interactions
PBTV
People’s Blood Takes Vacation
What complications occur from Type 1 Diabetes Mellitus?
Diabetic ketoacidosis (DKA)
Hyperosmolar nonketotic syndrome
Which 2 sulfonylureas need to be taken when?
- glyBuride taken with breakfast THINK: glyB needs breakfast
- glipizide taken 30 minutes prior to breakfast THINK: “ZIP” it down before breakfast
SKIPPED ONES
Glinides, slide 29 Thiazolidinediones (glitazones), slide 30 Alpha-glucosidase inhibitors (must be taken with meals), slide 32 Sulfonylureas, slide 36 (put in the yellow stuff and left out the white) Insulin, slide 42
How many types of antidiabetic drugs are there, and what are they?
2 types:
- insulins
- oral hypoglycemic drugs
both aim to produce normal blood glucose states
Which drugs cause and do not cause weight gain?
Cause:
- thiazolidinediones
- glinides
Do not cause:
- biguanides
- alpha-glucosidase inhibitors
5 Types of Oral Drugs?
1. Biguanides*
2. Sulfonylureas*
- Glinides
- Thiazolidinediones
- Alpha-glucosidase inhibitors
BSGTA
Big Sisters Grow That Ass
Biguanides (Metformin):
First line drug, most common used for Type 2 Decreases: glucose production, intestinal glucose absorption, hepatic triglyceride/cholesterol production
Improves: insulin receptor sensitivity -> increased uptake of glucose by tissues Does not increase insulin secretion from pancreas
Can sulfonylureas be used with metformin and thiazolidinediones?
Yes. Yes indeed they can.
SMT
Safe Mets, Totally.
What antagonizes hypoglycemic effects of insulin, and what does that result in?
Corticosteroids antagonize hypoglycemia effects of insulin resulting in elevated glucose levels
Type 1 Diabetes Mellitus cause?
Lack of insulin production or production of defective insulin
When is rapid-acting insulin usually administered?
Within 15 minutes of the pt beginning a meal
Should insulin always be accompanied with a meal?
Yes.
If hypoglycemia occurs.. oh no! What do you do?!
Pt CONSCIOUS: oral form of glucose such as tablets/gel, corn syrup, honey, fruit juice, soft drink (non-diet), small snack like crackers/half a sandwich
Pt UNCONSCIOUS: give D50W or glucagon, IV Monitor blood glucose levels
Adverse effects of Thiazolidinediones: (4)
TMEMH
- moderate weight gain
- edema
- mild anemia
- hepatic toxicity, monitor ALT levels
Those Men Exclude Mini Hats
Thiazolidinediones Moderateweightgain Edema Mildanemia Hepatictoxicity
What does insulin primarily do?
Lowers blood glucose levels
What to do if a pt is NPO for a test/procedure?
Consult physician to clarify orders for antidiabetic drug therapy
Adverse effects of Glinides: (7)
GHHDWJUF
- h/a
- hypoglycemia effects (I think this is different from normal hypoglycemia)
- dizziness
- weight gain
- joint pain
- upper respiratory infection
- flulike symptoms
GHHDWJUF
Girls Hold Hairy Dogs With Just Umbrella Fingers
What is metabolic syndrome? What are two other names for it?
Comorbidities collectively referred to as “metabolic syndrome:”
- obesity
- coronary heart disease
- dyslipidemia
- hypertension
- microalbuminemia (protein in the urine)
- increased risk for thrombotic (blood clotting) events
Two other names:
- insulin-resistance syndrom
- syndrome x
What is a sulfonylureas? 5 examples.
Oral antidiabetic drug
- First generation:
- chlorpropamide (Diabinese)
- tolazamide (Tolinase) - Second generation:
- glimepiride (Amaryl)
- glipizide (Glucotrol)*
- glyburide (DiaBeta Micronase)*
Which pt’s receive (because they need) exogenous insulin?
Type 1 Diabetes Mellitus
Pt Education includes (6):
KDDMPC
- Knowledge of disease/type
- Disease management
- Dietary Control
- Medications
- Psychological adjustments
- Care of skin, prevention of wounds/infections, managing co-morbidities
KDDMPC Know Diabetes Doesn’t Mean People Care horribly acronym, but now I can’t forget it and you probably can’t either. We’re in this together. BTW, it’s 3:08am, and it took me 4 days to get through this but I just finished. Yay.
Who is the target for Oral Antidiabetic Drugs? What must they also do? When is it given?
Type 2 diabetic pts
drugs may not be effective without lifestyle changes
given 30 minutes prior meal
Inadequate insulin, what happens to kidneys, and what does that lead to?
Kidneys cannot reabsorb excess glucose
Leads to:
- increased solute concentration
- excess water in urine (polyuria, dehydration, and polydipsia)
Adverse effects of Alpha-glucosidase inhibitors, and what it does not cause
- flatulence
- diarrhea
- abdominal pain
Does not cause hypoglycemia, hyperinsulinemia, or weight gain
What does insulin restore for a diabetic pt?
Ability to:
- metabolize carbs, fats, and proteins
- store glucose in the liver
- convert glycogen to fat stores
Insulin facilitates phosphorylation of glucose to glucose-6-phosphate to glycogen for storage in the _______
liver. But really memorize this whole slide.
Insulin facilitates phosphorylation of glucose to glucose-6-phosphate to glycogen for storage in the liver.
What does Biguanide: Metformin primarily affect, and what does it not cause?
- ab bloating
- nausea
- cramping
- diarrhea
- feeling of fullness
does not cause hypoglycemia
Example of Thiazolidinediones (2), nickname, and how often given
- pioglitazone (Actos)
- rosiglitazone (Avandia) AKA glitazones
Given once daily or in two divided doses*
2 “New” antidiabetic drugs
- Amylin mimetics: pramlintide (Symlin)
- Incretin mimetics: exenatude (Byetta) and sitagliptin (Januvia)
* cannot be given with insulin*
Adverse effects of Sulfonylureas: (5ish)
- hypoglycemia
- hematologic effects
- nausea
- epigastric fullness
- heartburn
- many others
2 examples of combined insulin products, 2 rules for them, Onset/Duration
Examples:
NPH 70, regular 30: Humulin 70/30 or Novolin 70/30 or Novolog 70/30
NPH 50 regular 50: Humulin 50/50
Rules:
- DO NOT MIX WITH OTHER INSULINS
- Injected subQ
Onset: 1-2 hrs
Duration: 24 hours
What is Intermediate-acting insulin?
Isophane insulin suspension, NPH Cloudy
Onset: 1-2 hours
Duration: 10-18 hours
Often combined with Regular insulin to reduce # of insulin injections per day
Does insulin stimulate or inhibit protein synthesis?
Insulin stimulates protein synthesis
4 things to check when insulin is ordered?
- correct route
- correct type of insulin
- timing of the dose
- correct dosage
What is a short acting insulin?
Regular insulin (Humulin R)
Onset: 30-60 minutes
Duration: 6-10 hours P
eak: 2.5 hours
Must be clear, usually subQ
only insulin that can be given IV bolus, IV infusion, or IM
What is Long-acting insulin?
glargine (Lantus), detemir (Levemir)
normally clear/colorness referred to “basal insulin”
injected subQ; forms microprecipitates -> slowly absorbed over 24 hrs
NO PEAK dosage: once daily, or once/12 hrs
What two glands is the pancreas, and what do they each secrete?
Exocrine: secretes digestive enzymes through pancreatic duct Endocrine: secretes hormones directly into bloodstream (no duct)
Does insulin promote or demote intracellular shift of K and Mg? Does that increase or decrease blood concentrations of these electrolytes?
Insulin promotes intracellular shift of K and Mg which decreases blood concentrations of K and Mg
When may allergy cross-sensitivity occur with sulfonylureas?
Allergic cross-sensitivity may occur with loop diuretics and sulfonamide antibiotics
When mixing two insulins in one syringe, which goes first?
Always withdraw the CLEAR REGULAR or RAPID-ACTING insulin first
Indications of oral antidiabetic drugs:
used alone or in combo with other drugs/diet/lifestyle changes to lower blood glucose levels in pts with Type 2 diabetes
Insulin stimulates ________ metabolism in _______, _______, and adipose tissue by facilitating ___________ of ________ into the cells
Insulin stimulates carbohydrate metabolism in skeletal, cardiac, and adipose tissue by facilitating transport of glucose into the cells
What 3 things can Biguanide: Metformin cause?
- metallic taste
- reduced B12 levels
- Lactic acidoses (rare and lethal)
Inadequate insulin also causes these 3 things:
- Ketonemia
- Polyphagia
- Weight loss and lethargy *
Ketonemia is high concentrations of ketones in blood
*polyphagia/hyperphagia is excessive hunger and/or abnormally large intake of solids by mouth
What hyperglycemia develops during pregnancy, and what can happen to those pts?
Gestational diabetes
30% of pts may develop Type 2 DM within 10-15 years
Type 2 Diabetes Mellitus cause?
insulin deficiency and insulin resistance many tissues are resistant to insulin
reduced # of insulin receptors and/or receptors are less responsive
3 Glucose elevating drugs:
- oral forms of concentrated glucose (buccal tab, semisolid gel)
- 50% dextrose in water (D50W)
- glucagon
Name at least 5, or all if you’re an overachiever, s/s of Diabetes Mellitus
- elevated fasting blood glucose (>126 mg/dL)
- polyuria
- polydipsia
- polyphagia
- glycosuria
- unexplained weight loss
- fatigue
- hyperglycemia
Symptoms of early vs. late hypoglycemia
early: confusion, irritability, tremor, sweating
late: hypothermia, seizures, coma/death will occur if not treated
