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NURS 306 > Chapter 32: Antidiabetic Drugs > Flashcards

Chapter 32: Antidiabetic Drugs Flashcards

1
Q

Type 1 Diabetes patients require _______ insulin because ____________.

A

exogenous

they have absolute lack of insulin

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2
Q

Exogenous Insulin

A

(outside pancreas)

  • effects are the same as endogenous insulin
  • required for DM type 1
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3
Q

Exogenous insulin is prescribed for DM type 2 pts who

A

cannot control blood glucose by medications

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4
Q

Regular insulin is used for

A

acute management of hyperglycemia (i.e DKA, HNKS)

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5
Q

Benefits of Insulin

A
  • cost-effective

- decreased allergic reaction (human insulin)

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6
Q

Preparation for Insulin Vary based on

A
  • onset of action
  • time of peak effect
  • duration
  • expressed in units rather than mL
  • 100 USP units/mL
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7
Q

1mL = ? units

A

100 units

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8
Q

4 Types of Insulin

A
  1. Rapid Acting
  2. Short Acting
  3. Intermediate-Acting
  4. Long-Acting
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9
Q

Rapid Acting Insulin

A
  1. Insulin Lispro (Humalog)
  2. Insulin Aspart
  3. Insulin Glulisine
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10
Q

Short Acting Insulin

A

Regular insulin (Humulin R, Novolin R)

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11
Q

Rapid Acting Insulin: route, onset, peak, elimination and duration

A 
Route: SQ
Onset: 15 minutes
Peak: 2.5 hours
Elimination: N/A
Duration: 6-10 hours
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12
Q

Short Acting Insulin is used for

A

DKA, or coma associated w/ uncontrollable type 1 diabetes

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13
Q

Short Acting Insulin: route, onset, peak, elimination and duration

A 
Route: SQ (can be given IV bolus, IV infusion, IM)
Onset: 30-60 minutes
Peak: 2.5 hours
Elimination: N/A
Duration: 6-10 hours
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14
Q

Intermediate-Acting Insulin includes

A
  • Insulin NPH (insulin isophane suspension)
  • Humulin N
  • Novolin N
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15
Q

Intermediate-Acting Insulin

A
  • appears cloudy or opaque

- often combined with regular insulin

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16
Q

Intermediate-Acting Insulin: route, onset, peak, elimination and duration

A 
Route: SQ
Onset: 1-2 hours
Peak: 4-8 hours
Elimination: N/A
Duration: 10-18 hours
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17
Q

Long-Acting Insulin

A
  • DO NOT MIX WITH OTHER INSULIN

- Given once daily, very seldom twice daily depending on pt’s glycemic response

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18
Q

Long-Acting Insulin includes

A

-Insulin Glargine
-Insulin Detemir
Aka basal insulin

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19
Q

Insulin Glargine

A

Long-acting insulin

  • provides constant level of insulin in body
  • enhances safety
  • once daily
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20
Q

Insulin Detemir

A

Long-acting insulin

  • dose-dependent
  • lower doses require twice a day dosing/higher doses given once a day
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21
Q

Long-Acting Insulin: route, onset, peak, elimination and duration

A 
Route: SQ
Onset: 1-2 hours
Peak: None
Elimination: N/A
Duration: 24 hours
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22
Q

Fixed Combinations

A

Onset: 1-2 hours
Contains one intermediate and rapid acting/short acting
Used to increase effects of insulin (synergy)

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23
Q

Fixed Combinations include

A 
Humulin 70/30
Humulin 50/50
Novolin 70/30
Humalog Mix 75/25
Humalog 50/50
NovoLog 70/30
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24
Q

Slide-scale Insulin

A
  • giving short-acting or regular insulin dosage that is dependent on the patient’s blood glucose level
  • ordered in an amount that increases as the blood glucose increases
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25
Q

Sliding-scale insulin is typically used in

A

hospitalized diabetic patients (w/ infections, surgery, NPO, etc) or those on total parenteral nutrition (TPN) or enteral tube feedings.

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26
Q

Disadvantage of Slide-acting insulin

A

delays insulin administration until hyperglycemia occurs

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27
Q

Basal-Bolus Insulin

A
  • Preferred to sliding-scale

- Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus.

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28
Q

Long-acting insulin (Glargine) is not recommended for

A

NPO due to high risk for hypoglycemia

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29
Q

Bolus Insulin (Lispro or Aspart) is

A

rapid acting.

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30
Q

Blood glucose levels are monitored

A

frequently

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31
Q

Administration of Insulin: Routes

A

Can be given SQ or IV

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32
Q

What type of insulin is given IV?

A

regular insulin is administered intravenously (ONLY during emergency situations)

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33
Q

Potential Problems With Insulin

A
  1. hypoglycemia (headache is the first sign)
  2. lipodystrophy
  3. somogyi effect
  4. dawn phenomenon
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34
Q

S&S of Hypoglycemia

A
  • HEADACHE and tachycardia
  • confusion , sweating and drowsiness
  • convulsions, shakiness, palpitations
  • light headedness, coma, death
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35
Q

Lipodystrophy

A
  • slight pitting of skin d/t selective loss of body fat that affects absorption
  • rotate sites to avoid
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36
Q

Somogyi effect

A
  • secondary to rebound hypoglycemia
  • patient wakes up with hyperglycemia due to hypoglycemia
  • has such low level of blood sugar that body tries to compensate and turns into hyperglycemia
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37
Q

Dawn Phenomenon

A
  • patient wakes up and has an early rise of blood glucose levels (between 5-8 am)
  • D/T reduced tissue sensitivity to insulin
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38
Q

Insulin Pumps

A
  • used for multiple day SQ injections
  • are consistent, convenient, and control delivery
  • change every 2-3 days
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39
Q

Sites to inject insulin

A
  1. subcutaneous fat on back of the arm
  2. vastus lateralis
  3. abdomen
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40
Q

Mechanism of Action: Insulin

A
  • replaces insulin in pancreas that isn’t made or is made defectively.
  • doesn’t reverse defects in insulin receptor sensitivity.
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41
Q

What do insulin pumps do?

A
  • provides small continuous doses of short acting insulin

- pt. can give bolus of additional dose before meals

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42
Q

Indications for Insulin

A

Treats type 1 or type 2, but is individualized to each patient. Must be in conjunction with lifestyle modifications.

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43
Q

Insulin Contraindications

A
  • known drug allergy
  • never administer to an already hypoglycemic patient.
  • blood glucose must always be tested prior to administration
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44
Q

Adverse Effects of Insulin

A
  • Hypoglycemia
  • Damage, shock and possible death
  • Weight gain
  • Lipodystrophy at site of injections
  • Allergic Reactions (rare)
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45
Q

Insulin Interactions

A

check exam 3 study guide from mentor

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46
Q

Oral Antidiabetic Drugs include

A 
Biguanides
Sulfonylureas
Glinides
Thiazolidinediones (Glitazones)
alpha-Glucosidase inhibitors
Dipeptidyl peptidase-IV (DPP-IV) inhibitors
Amylin agonists
Incretin mimetics
SGLT2 inhibitors
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47
Q

Goal of LDL

A

100 mg/dL

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48
Q

ADA new-onset type 2 diabetes may be treated with both

A

lifestyle interventions and oral biguanide drug metformin (if no contraindications)

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49
Q

Biguanide includes

A

Metformin (only drug)

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50
Q

Biguanide

A
  • first line drug
  • good for type 2 and overweight
  • doesn’t stimulate pancreas
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51
Q

Mechanism of Action: Biguanide

A
  • Decreases glucose production by the liver
  • Decreases intestinal absorption of glucose
  • Improves insulin receptor sensitivity
  • Increase peripheral glucose uptake and use
  • Decreased hepatic production of triglycerides and cholesterol
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52
Q

Indications of Biguanide

A

newly diagnosed type 2 who are overweight/obese

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53
Q

Contraindications of Biguanide

A
  • renal disease or renal dysfunction

- alcoholism, metabolic acidosis, hepatic disease, heart failure

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54
Q

Why is renal disease or dysfunction a contraindication for biguanide?

A

metformin is excreted from kidneys so accumulation occurs and increases risk of lactic acidosis.
Need to check creatinine levels!

55
Q

Lactic acidosis S&S

A 
hyperventilation
cold/clammy skin
muscle pain
abdominal pain
dizziness
irregular heart beat
56
Q

Adverse effects of Biguanide

A
  • GI related: abdominal bleeding, nausea, cramping, feeling of fullness, and diarrhea
  • Weight loss
  • Less common metallic taste, hypoglycemia, reduction in vit B12
57
Q

Interactions of Biguanide

A
  • hypoglycemic drugs, diuretics and steroids additive effects additive hypoglycemia
  • cimetidine inhibits metabolism -> increased effects
  • contrast media -> decreased excretion lactic acidosis (discontinue metformin 48 hours before giving contrast due to possible kidney failure)
58
Q

Nursing Management for patients taking biguanide

A
  • assess blood glucose levels, medication hx, allergies
  • sliding scale
  • doesn’t matter when given pertaining to meals
59
Q

Sulfonylureas include

A

“ide”
Glyburide
Glimepiride
Glipizide

60
Q

Characteristics of Sulfonylureas

A

second-generation (has longer duration and fewer side effects)

61
Q

Mechanism of Action: Sulfonylureas

A
  • stimulates insulin secretion from beta cells of pancreas -> increased insulin levels
  • beta cell function must be present
  • decreases liver glycogenolysis and gluconeogenesis
  • increase cellular sensitivity to insulin
62
Q

Indications for Sulfonylureas

A
  • second-step drug of type 2 whose A1C levels remain elevated after metformin
  • can be used in conjunction with metformin and thiazolidinediones
  • must have working pancreas
63
Q

Contraindications of Sulfonylureas

A
  • hypoglycemia; and conditions predisposing you to hypoglycemia like reduced caloric intake (NPO)
  • ethanol use
  • advanced age
  • beta blockers
64
Q

Adverse Effects of Sulfonylureas

A
  • hypoglycemia: degree depends on dose, diet and eating habits
  • weight gain: because of stimulation of insulin
  • Photosensitivity, skin rash, nausea, epigastric fullness, heartburn
65
Q

Interactions of Sulfonylureas

A
  • alcohol, herbal (ginger, garlic, ginseng) enhances effects of hypoglycemia
  • carbamazepine, phenobarbital, phenytoin, rifampin increased metabolism -> decreased effects
66
Q

Nursing management for pts taking sulfonylureas

A

give 30 minutes before meals

67
Q

Glinides include

A

“glinide”
Nateglinide
Repaglinide

68
Q

Characteristics of Glinides

A

quick onset, short duration of action

69
Q

Mechanism of Action: Glinides

A

similar to sulfonylureas
stimulates pancreas to release insulin
have shorter duration of action

70
Q

Indications for Glinides

A
  • Type 2 diabetes

- can be used with metformin and thiazolidinediones

71
Q

Contraindication of Glinides

A
  • hypoglycemia; NPO
  • ethanol use
  • advanced age
72
Q

Adverse Effects of Glinides

A
  • Hypoglycemia (food not eaten after dose)

- Photosensitivity, weight gain

73
Q

Interactions of Glinides

A

sulfonylureas -> antagonistic effects (double dosing)

74
Q

Nursing Management for patients taking Glinides

A
  • given 30 minutes before meals
  • sunscreen
  • orange juice ready for patient
  • patient education
  • check blood glucose levels
  • if pt. does not eat, can skip dose
75
Q

A-glucosidase inhibitors include

A

Acarbose, Miglitol

76
Q

Mechanism of Action for A-glucosidase inhibitors

A
  • decreased absorption of carbohydrates in small intestines -> delayed absorption of glucose.
  • must be taken with first-bite of meal
77
Q

Indications of A-glucosidase inhibitors

A

Type 2

78
Q

Contraindications for A-glucosidase inhibitors

A
  • inflammatory bowel disease
  • malabsorption syndromes
  • intestinal obstruction
79
Q

Adverse effects for A-glucosidase inhibitors

A
  • flatulence, diarrhea, abdominal pain

- high doses -> elevated levels of hepatic enzymes

80
Q

Interactions of A-glucosidase inhibitors

A

-bioavailability of digoxin, ranitidine, and propranolol may be reduced (digoxin and beta blockers

81
Q

Nursing Management for patients taking A-glucosidase inhibitors

A
  • monitor liver and liver function tests

- med must be taken with first-bite of meal

82
Q

Thiazolidinediones include

A

“glitazone”
Rosiglitazone
Pioglitazone

83
Q

Mechanisms of Action: Thiazolidinediones

A
  • decreases insulin resistance
  • increases glucose uptake and use in skeletal muscles (makes skeletal muscles sensitive to insulin)
  • inhibits glucose production in liver
  • often used in combination with metformin
84
Q

Indications for Thiazolidinediones

A

type 2

85
Q

Contraindications for Thiazolidinediones

A
  • new york heart association class III and IV heart failure

- caution with liver/kidney disease

86
Q

Adverse Effects for Thiazolidinediones

A
  • increase risk for heart failure

- peripheral edema (lower extremities), weight gain, fluid overload

87
Q

Interactions of Thiazolidinediones

A
  • antifungals
  • grapefruit juice
  • polypharmacy
  • pioglitazone is partly metabolized by cytochrome P-450 enzyme (CYP3A4); pioglitazone concentrations may increase if concurrently taken with a CYP3A4 inhibitor (ketoconazole or erythromycin)
88
Q

Nursing Management for patients taking Thiazolidinediones

A

-INO, monitor for weight gain, monitor for cardiac function

89
Q

Dipeptidyl Peptidase IV (DDP-4) Inhibitors include

A

“gliptin”
Sitagliptin
Sazagliptin
Linagliptin

90
Q

Mechanism of Action: Dipeptidyl Peptidase IV (DDP-4) inhibitors

A
  • inhibits DPP-4 causing insulin secretion and suppression of glucagon secretion.
  • lowers blood glucose
91
Q

Indications for Dipeptidyl Peptidase IV (DDP-4) inhibitors

A

type 2

92
Q

Contraindications for Dipeptidyl Peptidase IV (DDP-4) inhibitors

A

known drug allergy

93
Q

Adverse Effects of Dipeptidyl Peptidase IV (DDP-4) inhibitors

A
  • upper respiratory infection, headache, diarrhea
  • hypoglycemia
  • cases of pancreatitis have been reported.
94
Q

Interactions of Dipeptidyl Peptidase IV (DDP-4) inhibitors

A
  • increase digoxin levels

- sulfonylureas and glinides -> increase risk of hypoglycemia

95
Q

SGLT2 Inhibitors include

A

Invokana

96
Q

Mechanism of Action: SGLT2 Inhibitors

A
  • inhibits SGLT2
  • blocks absorption of glucose in kidneys, increase glucose excretion -> lowers blood glucose levels
  • works like diuretics
97
Q

Indications of SGLT2 Inhibitors (Canagliflozin)

A
  • type 2

- must have working kidneys, patient will have “sugary urine”

98
Q

Contraindications of SGLT2 Inhibitors (Canagliflozin)

A

kidney failure/disease

99
Q

Adverse Effects of SGLT2 Inhibitors (Canagliflozin)

A

yeast infection, UTI (due to sugary urine), dehydration and hypoglycemia

100
Q

Interactions of SGLT2 Inhibitors (Canagliflozin)

A

alcohol, sulfonylureas, diuretics

101
Q

Amylin Agonist

A
  • amylin is a natural hormone secreted by beta cells along w/ insulin in response to food.
  • injectable
102
Q

Amylin Agonist includes

A

Pramlintide acetate

103
Q

Mechanism of Action: Amylin Agonist

A
  • slows gastric emptying
  • suppresses glucagon secretion and hepatic glucose production
  • increases satiety (feeling full)
104
Q

Indications for Amylin Agonist

A

type 1 or type 2

105
Q

Contraindications for Amylin Agonist

A
  • gastroparesis

- taking drugs that alter GI motility

106
Q

Adverse effects of Amylin Agonist

A

-GI related: nausea, vomiting, anorexia, headache

107
Q

Interactions of Amylin Agonist

A
  • if given: preprandial rapid or short acting insulin, insulin needs to be reduced 50%
  • if given: oral drugs, it can delay oral absorption taken at same time.
  • given at least one hour before other medications
108
Q

Nursing Management for patients taking Amylin Agonists

A
  • council on nutrition and intake

- take before any major meal

109
Q

Incretin Mimetics include

A

“tide”
Extenatide
Liraglutide
Pramlintide

110
Q

Pramlintide

A

synthetic form of amylin (same MOA as amylin)

111
Q

Characteristics of Incretin Mimetics

A

injectable

112
Q

Mechanism of Action: Incretin Mimetics

A
  • stimulates insulin secretion
  • reduces postprandial glucagon production
  • slow gastric emptying
  • increases satiety (fullness)
113
Q

Indications for Incretin Mimetics

A
  • type 2

- given 60 minutes before meal

114
Q

Contraindications of Incretin Mimetics

A

known allergy

115
Q

Adverse Effects of Incretin Mimetics

A
  • GI related: nausea, vomiting and diarrhea
  • Weight loss
  • Rare: hemorrhagic or necrotizing pancreatitis
116
Q

Interactions of Incretin Mimetics

A

delay absorption of other orally administered drugs by slowing gastric emptying

117
Q

Combination Treatments

A
  • Glyburide + Metformin
  • Avandia + Metformin
  • Januvia + Metformin
118
Q

Injectable Antidiabetic Drugs

A
  • amylin agonists

- incretin mimetics

119
Q

Drugs Affecting Blood Glucose Levels

A
  1. Beta Blockers
  2. Thiazide diuretics
  3. Loop Diuretics
  4. Corticosteroids
120
Q

How do beta blockers affect blood glucose levels?

A
  • interact with INSULIN and oral hypoglycemic agents

- can mask S&S of hypoglycemia

121
Q

How do corticosteroid affect blood glucose levels?

A

increase blood glucose levels

122
Q

Why is it important to monitor blood glucose?

A

self management

increases compliance and team work

123
Q

When should you monitor blood glucose levels?

A
  • 3-4 times a day until glucose levels are stabilized

- 1-2 times a day before meals when compliant and stabilized

124
Q

Nursing Implications: Nurses should obtain what information before administering antidiabetic drugs?

A

thorough hx, VS, blood glucose levels, A1C levels, potential complications, and drug interactions prior to administering.

125
Q

Nursing Implications: Assess

A
  • pt ability to consume food
  • for N/V
  • signs of hypoglycemia
126
Q

Nursing Implications: Monitor

A
  • blood glucose levels

- for therapeutic response (A1C to monitor long-term compliance)

127
Q

If patient who needs antidiabetic drugs is NPO, the nurse should

A

consult primary care provider to clarify orders

128
Q

Concerns for patient increase when the patient

A

is under stress, has an infection, has an illness/trauma or is pregnant/lactating

129
Q

Nursing Implications: Teaching

A
  • Educate patient on disease process, diet/exercise recommendations, self-administration of insulin/oral drugs, potential complications
  • Teach patient to limit alcohol consumption, report symptoms of anorexia or fatigue, and to notify physician if blood glucose rises above recommended level.
130
Q

What steps should the nurse do when preparing insulin?

A
  • Check for correct route, type, timing and dosage.
  • Always second-check insulin with another nurse.
  • Check blood glucose levels before giving.
  • Roll vials between hands (DO NOT SHAKE)
  • Ensure correct storage of vials
  • Only use insulin syringes
  • Ensure correct timing of meals
  • Withdraw regular, then withdraw modified.
131
Q

When preparing to give oral medications the nurse must do what?

A
  • check blood glucose levels before

- administered usually 30 minutes before meals

132
Q

The nurse would treat hypoglycemia with

A
  • glucagon
  • administer oral form if pt is conscious
  • give patient glucose tablets, corn syrup, honey, fruit juice, small snack
  • deliver D50W or glucagon IV if pt is unconscious.
133
Q

Biguanides DO NOT

A

DO NOT AFFECT BETA CELLS
DO NOT INCREASE INSULIN SECRETION FROM PANCREAS
DO NOT CAUSE IMMEDIATE HYPOGLYCEMIA

NURS 306 (26 decks)

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