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Pharm NUR140 > Chapter 38 > Flashcards

Chapter 38 Flashcards

1
Q 
What percentage of the population has diabetes mellitus?
A. 3%
B. 7%
C. 14%
D. 21%
A

B. 7%

Diabetes mellitus is a common chronic disease that affects 20.8 million people in the United States, or 7% of the population

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2
Q

People with diabetes are at increased risk for:

A 
cardiovascular disease,
kidney failure,
blindness,
nervous system disease,
extremity amputations,
dental disease,
complications of pregnancy.
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3
Q

Patho Type 1 Diabetes

A

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

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4
Q

Patho Type 2 Diabetes

A

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

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5
Q

Patho Gestational Diabetes Mellitus (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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6
Q

Insulin does what?

A

It facilitates the passage of glucose into cells for energy.

It suppresses excess production of sugar in the liver and muscles as well as the breakdown of fat for energy

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7
Q

Regular Insulin

Pharmacotherapeutics

A

All types of diabetes mellitus

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8
Q

Regular Insulin

Pharmacokinetics

A

Administered: SC or IV

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9
Q

Regular Insulin

Pharmacodynamics

A

Injected insulin mimics the effect of endogenous insulin

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10
Q

Regular Insulin

Contraindications and precautions

A

Hypoglycemia

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11
Q

Regular Insulin

Adverse effects

A

Hypoglycemia,

Lipoatrophy

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12
Q

Regular Insulin

Drug interactions

A 
Alcohol,
Beta blockers,
Dobutamine,
Niacin,
MAOIs,
Thiazide Diuretics,
Tetracycline
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13
Q

Regular Insulin

Maximizing Therapeutic Effects

A

Store opened vials of regular insulin at room temperature,

Administer regular insulin with an insulin syringe into an appropriate subcutaneous site.

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14
Q

Regular Insulin

Minimizing Adverse Effects

A

Injection-site rotation also helps prevent lipodystrophy.

Assess blood glucose level prior to administration.

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15
Q

Regular Insulin

Patient and Family Education

A

Discuss how to administer insulin properly,
Discuss storage of insulin,
Discuss side effects of therapy

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16
Q

Regular Insulin

Ongoing Assessment and Evaluation

A

Evaluate ability to administer insulin.

Monitor fasting blood glucose and hemoglobin A1C levels.

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17
Q 
What SC site provides the most rapid absorption of insulin therapy?
A. Arm
B. Abdomen
C. Buttocks
D. Thigh
A

B. Abdomen

The most rapid absorption occurs when administration is into the abdominal SC layer. As much as 50% faster than other routes.

The next most rapid is into the arm, followed by the thigh, and finally the buttocks.

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18
Q

What are the types of IV or SC insulin?

A 
Rapid-Acting,
Short-Acting,
Intermediate-Acting,
Long-Acting,
Pre-Mixed
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19
Q

IV & SC Insulin Client Education

A

Perform self blood-glucose testing to monitor therapeutic benefit

Carry emergency carbohydrate to treat hypoglycemia

Never inject cold insulin

Rotate SC injection sites

Do not massage injection sites

In mixing insulins, draw up regular(R) first

When administering IV, monitor BG levels hourly or per MD’s orders

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20
Q

Oral Hypoglycemic Drugs:

Sulfonylureas

A 
First Generation:
        Chlorpropamide
Second Generation:
        Glyburide (DiaBeta)
        Glimepiride (Amaryl)
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21
Q

Oral Hypoglycemic Drugs:

Biguanide

A

Metformin (Glucophage)

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22
Q

Oral Hypoglycemic Drugs:

Alpha Glucosidase Inhibitors

A

Acarbose (Precose)

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23
Q

Oral Hypoglycemic Drugs:

Meglitinides

A

Repaglinide (Prandin)

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24
Q

Oral Hypoglycemic Drugs:

Thiazolidinediones

A

Pioglitazone (Actos)

Rosiglitazone (Avandia)

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25
Q

Oral Antidiabetic Drug Prototype

A

glyburide (DiaBeta)

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26
Q

Glyburide

Pharmacotherapeutics

A

Adjunctive treatment to lower blood glucose levels in diabetes mellitus type 2.

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27
Q

Glyburide

Pharmacokinetics

A 
Administered: oral.
Metabolism: liver.
Excreted: urine and feces.
Onset: 2 hours.
Protein bound
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28
Q

Glyburide

Pharmacodynamics

A

Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells.

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29
Q

Glyburide

Contraindications and Precautions

A

Hypersensitivity

30
Q

Glyburide

Adverse Effects

A 
Hypoglycemia,
Anorexia,
Nausea & Vomiting,
Heartburn,
Metallic taste in the mouth
31
Q

Glyburide

Drug Interactions

A

Possible

32
Q

Glyburide

Health Status

A

Assess overall health before starting therapy

33
Q

Glyburide

Life Span and Gender

A

Pregnancy category B

34
Q

Glyburide

Lifestyle, Diet, and Habits

A

Assess willingness to follow diet

35
Q

Glyburide

Environment

A

Assess environment where drug will be given

36
Q

Glyburide

Maximizing Therapeutic Effects

A

Administer before breakfast or the first main meal of the day

37
Q

Glyburide

Minimizing Adverse Effects

A

Monitor the patient’s blood glucose levels periodically throughout therapy to detect hypoglycemia.

Monitor patients with renal and hepatic impairment for signs of adverse effects

38
Q

Glyburide

Patient and Family Education

A

Teach about diabetes management

Teach patients and families the signs and symptoms of hypoglycemia

39
Q

Glyburide

Ongoing Assessment and Evaluation

A

Interview the patient and family and observe for therapeutic and adverse responses to glyburide and adherence to prescribed treatments

40
Q

The mechanism of action of GLYBURIDE is the decreased production of insulin by the liver, which results in decreased blood glucose levels.

A. True
B. False

A

B. False

The mechanism of action of glyburide is stimulation of the beta cells in the pancreas. Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells.

41
Q

Non-sulfonylureas Classes

A

Biguanides,
Thiazolidinediones,
Alpha-Glucosidase Inhibitors

42
Q

Non-sulfonylureas Prototype Drug

A

metformin (Fortamet, Glucophage)

43
Q

Metformin

Pharmacotherapetuics

A

Adjunct to therapy to lower blood glucose in type 2

44
Q

Metformin

Pharmacokinetics

A

Administered: oral
Metabolism: liver
Excreted: kidneys

45
Q

Metformin

Pharmacodynamics

A

Decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake

46
Q

Metformin

Contraindications and precautions

A

Hepatic disease

47
Q

Metformin

Adverse Effects

A 
Anorexia,
Nausea & Vomiting,
Weight loss,
Abdominal discomfort,
Dyspepsia,
Flatulence,
Diarrhea,
Metallic taste sensation
48
Q

Metformin

Drug Interactions

A

May react with contrast media used for radiographic procedures

49
Q

Metformin

Health Status

A

Assess medical history and current medial status

50
Q

Metformin

Life span and gender

A

Pregnancy category B

51
Q

Metformin

Lifestyle, diet, and habits

A

Assess diet, exercise, and alcohol intake

52
Q

Metformin

Environment

A

Assess environment where drug will be given

53
Q

Metformin

Culture and inherited traits

A

Drug has been studied in several ethnic groups

54
Q

Metformin

Maximizing Therapeutic Effects

A

Administer twice a day with morning and evening meal.

Adherence with recommended diet and daily exercise help in control of type 2 diabetes

55
Q

Metformin

Minimizing Adverse Effects

A

Taking the drug at mealtimes and using gradual dosage increments minimize these effects

56
Q

Metformin

Patient and Family Education

A

Teach patients to take with meals, morning and evening

Emphasize that patients should not use alcohol while taking metformin

57
Q

Metformin

Ongoing Assessment and Evaluation

A

Monitor blood glucose levels:
Fasting Glucose
Hemoglobin A1C

58
Q

Glucagon

Pharmacotherapeutics

A

Hypoglycemia (first line of defense)

59
Q

Glucagon

Pharmacokinetics

A

T1/2: 3 to 10 minutes

60
Q

Glucagon

Pharmacodynamics

A

Increases blood glucose levels by stimulating glycogenolysis in the peripheral tissues

61
Q

Glucagon

Contraindications and Precautions

A

Hypersensitivity

62
Q

Glucagon

Adverse Effects

A

Hypotension,
Respiratory distress,
Nausea & Vomiting

63
Q

Glucagon

Health Status

A

Assess blood glucose level and LOC

64
Q

Glucagon

Life span and gender

A

Pregnancy category B

65
Q

Glucagon

Lifestyle, diet and habits

A

Review adherence to treatment plan

66
Q

Glucagon

Environment

A

Assess environment where drug will be given

67
Q

Glucagon

Maximizing Therapeutic Effects

A

Use reconstituted glucagon immediately

A dose of 0.5 to 1.0 mg is usually effective

68
Q

Glucagon

Minimizing Adverse Effects

A

Administer supplemental carbohydrates ASAP once consciousness has been achieved

69
Q

Glucagon

Patient and Family Education

A

Emphasize to patients and family members measures to prevent hypoglycemic reactions from insulin.

Instruct family members in the proper technique for emergency administration of glucagon.

70
Q

Glucagon

Ongoing Assessment and Evaluation

A

Blood glucose levels should be monitored before, during, and after glucagon administration.

Pharm NUR140 (5 decks)

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