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NURS 1064 - Pharm > Chapter 49 > Flashcards

Chapter 49 Flashcards

1
Q

What are the 3 main classes of drugs which affect blood glucose levels?

A
  1. Insulins
  2. Non-insulin antidiabetics
  3. Glucose-elevating agents
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2
Q

What is the prototype drug for the insulin class of drugs which affect blood glucose levels?

A

Regular Insulin

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3
Q

What are three drugs are that closely related to regular insulin?

A
  1. Aspart
  2. Lispro
  3. Glulisine
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4
Q

What is the prototype drug which is a glucose-elevating agent?

A

Glucagon

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5
Q

How many people in the US does Diabetes Mellitus affect?

A
  1. 6 million people

- 7.8% of the population

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6
Q

How many people have type 1 diabetes? Type 2 diabetes?

A

Type 1 = 5-10%

Type 2 = 90-95%

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7
Q

What does diabetes increase your risk of?

A 
- cardiovascular disease
(HTN, heart disease, stroke)
- kidney failure
- blindness 
- nervous system disease
- extremity amputation
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8
Q

In 2007, what was the economic cost of diabetes?

A

$174 billion

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9
Q

What are the two major classes of oral antidiabetic drugs that are used to control type 2 diabetes?

A
  1. Sulfonylureas (anti-glycemics)

2. Non-sulfonylureas (anti-hyperglycemics)

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10
Q

What is the prototype sulfonylurea?

A

Glyburide

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11
Q

What is the prototype non-sulfonylurea?

A

Metformin

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12
Q

What are the three body systems that are involved in the regulation and use of glucose?

A
  1. Liver
  2. Pancreas
  3. Skeletal muscle tissue
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13
Q

What is the liver’s role in glucose regulation?

A

Liver synthesizes its own glucose supply (gluconeogenesis)

- stores and releases glucose that has been converted from dietary carbohydrates

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14
Q

What happens in the liver when blood glucose is low? When it is high?

A 
Low = releases its stored and synthesized glucose
High = stops producing and releasing glucose
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15
Q

What is the exocrine function of the pancreas?

A

Produce digestive enzymes

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16
Q

What is the endocrine function of the pancreas?

A

Synthesize and secrete peptide hormones

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17
Q

What are the three peptide hormones that the pancreas secretes from the islets of Langerhans?

A
  1. Insulin
  2. Glucagon
  3. Somatostatin
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18
Q

What types of cells are contained in the islets of Langerhans?

A
  1. Beta cells
  2. Alpha cells
  3. Delta cells
  4. F cells
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19
Q

What do Beta cells secrete?

A

Hypoglycemic hormone insulin

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20
Q

What do Alpha cells secrete?

A

Hyperglycemic hormone glucagon

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21
Q

What do Delta cells secrete?

A

Somatostatin - hormone that inhibits both glucagon and insulin secretion

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22
Q

What do F cells synthesize and secrete?

A

Pancreatic polypeptides used in digestion

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23
Q

What kind of tissue is the target for the action of insulin?

A

Muscle tissue

- contains the majority of insulin receptor sites

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24
Q

What provides a good indication of circulating insulin levels? Why?

A

C peptide

  • Proinsulin splits to form insulin and C peptide
  • they will be in equal concentrations
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25
Q

What is insulin secretion most commonly triggered by?

A

High blood glucose levels

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26
Q

What is the role of insulin?

A

Lowers blood glucose levels by stimulating peripheral glucose uptake (especially skeletal muscle and fat)
- promotes the uptake and storage of glucose in the liver (in the form of glucagon)

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27
Q

Which tissues do not need insulin so that glucose can enter their cells?

A
  • brain
  • nerves
  • intestine
  • liver
  • retina
  • erythrocytes
  • renal tubules
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28
Q

What factors can influence changes in blood glucose levels?

A
  • stress
  • secretion of insulin-antagonistic hormones (cortisol, E, growth hormone, glucagon, somatostatin)
  • rates of hepatic synthesis of glucose
  • presence of levels of insulin antibodies
  • number of cellular insulin receptors
  • use of glucose by peripheral cells or tissues
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29
Q

If glucagon is released, what happens in the liver?

A

Glucagon stimulates glycogenolysis and gluconegogenesis

- resulting in a release of glucose into the blood

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30
Q

What are the three types of diabetes mellitus?

A
  1. Type 1
  2. Type 2
  3. Gestational
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31
Q

What is diabetes insipidus?

A

Metabolic disorder

  • high amounts of dilute urine are formed because of deficient production of ADH or inability of the kidney tubules to concentrate urine
  • does not affect blood glucose levels
  • is NOT treated with insulin or oral antidiabetics
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32
Q

What is the defining characteristic of Type 1 diabetes?

A

Autoimmune disorder

  • destruction of insulin-secreting beta cells in the pancreas
  • leading to absolute insulin deficiency
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33
Q

What happens if the body’s reserve of insulin is depleted?

A

Results in HYPERglycemia

- circulating glucose CANNOT enter the cells

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34
Q

How does ketoacidosis occur?

A

Body is in a hyperglycemic state

  • high circulating blood glucose
  • glucose cannot enter cells
  • body thinks there is NOT ENOUGH glucose so it starts to break down lipids and proteins for energy
  • This causes an increase in ketoacids
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35
Q

What is the final result of Type 1 diabetes?

A

Destruction of pancreatic beta cells

  • may occur over period of months to years
  • state of absolute insulin deficiency
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36
Q

What is required for all cases of Type 1 diabetes?

A

Insulin therapy

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37
Q

When is the onset of Type 1 diabetes?

A

Childhood or puberty

- however it CAN develop at any age

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38
Q

What is Type 2 diabetes characterized by?

A

Insulin RESISTANCE by the tissues

- usually a decrease in insulin production

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39
Q

What is Type 2 diabetes closely linked with?

A
  • obesity
  • sedentary lifestyle
  • lack of physical exercise
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40
Q

What happens to insulin levels in Type 2 diabetes?

A

Normal or increased

  • may be increased because the pancreas tries to overcome the resistance by producing more insulin
  • b/c the peripheral tissue is resistant to insulin, insulin does not enter the cells but stays in the bloodstream
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41
Q

When is Type 2 diabetes most prevalent?

A

Later years in life

- but we are seeing it younger and younger (as children get fatter and fatter)

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42
Q

What is considered the primary defect in Type 2 diabetes?

A

Insulin resistance

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43
Q

What is the metabolic syndrome?

A

An insulin-resistance syndrome

- a precursor to the development of type 2 diabetes

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44
Q

What is the age of onset of Type 1 diabetes? Type 2?

A

Type 1 = usually before 20 yrs

Type 2 = usually after 40 yrs

45
Q

What is the incidence of Type 1 diabetes? Type 2?

A

Type 1 = 5 - 10%

Type 2 = 90 - 95%

46
Q

What is the body weight of a person with Type 1 diabetes? Type 2 diabetes?

A

Type 1 = Thin or underweight

Type 2 = Overweight or obese

47
Q

What are the clinical s/s of Type 1 diabetes?

A 
Hyperglycemia
Polyphagia
Polydipsia
Polyuria
Weight loss
48
Q

What are the clinical s/s of Type 2 diabetes?

A 
Hyperglycemia
Fatigue
Weakness
Mild 3 P's
Fungal infections
Blurred vision
49
Q

Typically when is ketoacidosis seen? (Type 1 or Type 2)

A

Type 1

50
Q

What are the three ways that we can manage Type 1 diabetes (3) ?

A
  1. Insulin injections
  2. Dietary controls
  3. Exercise regimen
51
Q

What are the ways that we can manage Type 2 diabetes (5) ?

A
  1. Weight reduction
  2. Dietary controls
  3. Exercise regimen
  4. Oral drug therapy
  5. Insulin
52
Q

Metabolic syndrome is a combination of which conditions?

A
  1. Insulin resistance
  2. Compensatory hyperinsulinemia (to maintain glucose homeostasis)
  3. Obesity
53
Q

If a patient is undiagnosed with Type 2 diabetes, what are they are increased risk for?

A
  • coronary artery disease
  • stroke
  • peripheral vascular disease
54
Q

How does Gestational diabetes mellitus occur?

A

When a woman’s pancreatic function is not sufficient to overcome the insulin resistance created by the anti-insulin hormones secreted by the placenta

55
Q

What are some examples of anti-insulin hormones that are secreted by the placenta?

A
  • Estrogen
  • Prolactin
  • Cortisol
  • Progesterone
56
Q

What can happen if gestational diabetes goes undiagnosed?

A
  • Preeclampsia
  • Fetal macrosomia (large infants)
  • birth trauma
  • perinatal mortality
57
Q

What are some endogenous sources which may produce diabetes?

A
  • genetic defects in beta cell function, insulin action or diseases of the pancreas (cystic fibrosis)
58
Q

What are some exogenous sources which may produce diabetes?

A
  • surgical removal of pancreas, ingestion of certain drugs/chemicals (glucocorticoid steroids)
59
Q

What are the 4 criteria that are used to diagnose diabetes?

A
  1. Plasma glucose = 126 mg/dL after fasting for 8 hours
  2. Plasma glucose = 200 mg/dL during an oral glucose tolerance test
  3. A1C level of > 6.5%
  4. Symptoms of diabetes and hyperglycemia or hyperglycemic crisis at any time of the day (regardless of last meal)
60
Q

What is an oral glucose tolerance test?

A

75 g of glucose is dissolved in water is ingested

61
Q

How does the A1C test measure the average blood glucose level from the last 2-3 months?

A

Hemoglobin molecules react with glucose –> glycosylated hemoglobin
- it will last the lifespan of the RBC to determine the patient’s blood glucose level over time

62
Q

What are the classic signs of hyperglycemia?

A
  • excessive urination
  • excessive thirst
  • fatigue
  • dry or itchy skin
  • poor wound healing
  • vision changes
63
Q

At what value is a blood glucose level considered hyperglycemic?

A

> 126 mg/dL

64
Q

What is the dawn phenomenon?

A

Blood glucose levels are at their highest between 5am and 6am
- release of growth hormone overnight is believed to produce this increase in blood glucose

65
Q

How do we treat dawn phenomenon?

A

Providing larger doses of intermediate-acting insulin at bedtime

66
Q

What is the Somogyi effect?

A

Produces early morning hyperglycemia

  • precipitating factor is actually a HYPOglycemic event sometime after midnight
  • body compensates by releasing glucose from the liver
  • when the body overcompensates –> REBOUND HYPERGLYCEMIA occurs
67
Q

How do we treat the Somogyi effect?

A
  • lowering the insulin dose
  • increasing dietary intake at bedtime
  • or both
68
Q

What are the chronic complications of diabetes usually classified as?

A
  1. Microvascular
  2. Macrovascular
    - according to the type of blood vessel damaged
69
Q

What are some of the macrovascular complications?

A
  • atherosclerotic vascular disease
  • myocardial infarction
  • cerebrovascular accident
70
Q

What are some of the microvascular complications?

A
  • cataracts, glaucoma, and blindness from retinopathy
  • lower extremity infections and gangrene
  • foot ulcers
  • Charcot joints
  • renal failure
  • sexual dysfunction
71
Q

What can severe hypoglycemia result in?

A
  • coma

- altered consciousness

72
Q

What is Basal insulin?

A

The continuous secretion that maintains glucose homeostasis

body’s baseline level of insulin

73
Q

What is Prandial insulin?

A

Insulin secretion stimulated in response to meals

74
Q

What is the non-physiologic regimen of diabetic therapy?

A

Does not mimic normal beta-cell secretion

- ideal for those newly diagnosed (those who still produce some endogenous insulin)

75
Q

What is the physiologic regimen of diabetic therapy?

A

Used in complete beta-cell failure when glucose control cannot be achieved with the non-physiologic regimen

76
Q

What is correctional (or supplemental) insulin used for?

A

Patients with diabetes who are hospitalized (or ill), may require doses of insulin to correct any elevations in blood glucose

77
Q

What are the 4 kinds (types) of insulin?

A
  • rapid
  • short (regular)
  • intermediate
  • long-acting
78
Q

What is the prototype insulin?

A

Short-acting insulin

79
Q

What are the trades names for Regular insulin?

A
  • Novolin-R

- Humulin-R

80
Q

When is insulin indicated for Type 1 diabetics? Type 2?

A

Type 1 = for all patients
Type 2 = for patients that cannot control their hyperglycemia with diet and exercise, weight reduction, oral antidiabetic drugs

81
Q

What is regular insulin used to control?

A

To correct a current glucose elevation or an expected rise after eating
- not for use all day due to it’s short duration

82
Q

Why can regular insulin NOT be given orally?

A

It is destroyed by gastric acids

83
Q

Which SC injection site provides the most rapid absorption?

A

Abdominal SC layer

  • next is arm
  • then thigh
  • finally buttocks
84
Q

How long does insulin remain stable at room temperature for?

A

1 month

- for longer storage, place in refrigerator

85
Q

Where is insulin filtered and where is it reabsorbed?

A

Filtered in glomerulus

Reabsorbed in proximal renal tubule (98%)

86
Q

How does renal impairment affect diabetic patients?

A

It reduces the amount of insulin excreted, thus reducing the amount of insulin required
- renal function impairment occurs commonly in diabetic patients b/c of vascular insufficiency

87
Q

When is insulin contraindicated?

A

In times of hypoglycemia

88
Q

What are the earliest signs of hypoglycemia?

A
  • fatigue and malaise
  • trembling
  • irritability
  • headache
  • nausea
  • numbness
  • paresthesias
  • muscle weakness
89
Q

How can lipodystrophy be caused?

A

By repetitive SC injections into the same injection site

= disturbances in fat metabolism

90
Q

With insulin, why do we rotate WITHIN the site, and not simply change injection sites?

A

It would substantially change the absorption of insulin and the blood glucose levels of the patient

91
Q

If a patient has a low hematocrit, what will this do to the blood glucose reading?

A

Create a falsely HIGHER reading

92
Q

If a patient has a high hematocrit, what will this do to the blood glucose reading?

A

Create a falsely LOWER reading

93
Q

If a patient is experiencing shock or dehyration, what will this do to the blood glucose reading?

A

Create a falsely LOWER reading

94
Q

What can you give your patient if they are hypoglycemic?

A
  1. 4 oz juice or non-diet soda
  2. 4 oz water with 4 tsp of sugar
  3. 8 oz non fat milk
95
Q

When mixing types of insulin, which one do you draw up first?

A

Short-acting drawn into the syringe first

96
Q

What are the three rapid-acting insulins?

A
  1. Aspart (NovoLog)
  2. Lispro (Humalog)
  3. Glulisine (Apidra)
97
Q

What does protamine do when it is added to insulin?

A

Prolongs the action of the insulin

98
Q

What are the separate parts of NovoLog Mix 70/30?

A
  1. 70% Aspart protamine

2. 30% Aspart

99
Q

What does NPH stand for?

A

Neutral Protamine Hagedorn

100
Q

What does the “N” signify on insulin? Is it clear or cloudy?

A

Intermediate acting

- cloudy in appearance

101
Q

When is the onset, peak and duration of NPH?

A

Onset: 1 - 1.5 hours
Peak: 4 - 12 hours
Duration: up to 24 hours

102
Q

What is Detemir (Levemir)? (Rapid, short, intermediate or long acting)

A

Long acting insulin

- clear insulin

103
Q

What are the two main classes of oral anti-diabetic medications?

A
  1. Sulfonylureas

2. Non-sulfonylureas

104
Q

How are second generation different than first generation drugs?

A

Second generation contain fewer drug interactions

105
Q

What is Glyburide?

A

Potent second generation oral sulfonylurea

106
Q

How is Glyburide absorbed? Metabolized?

Excreted?

A

Absorbed: In the GI tract
Metabolized: Liver
Excreted: urine and feces

107
Q

Why is Glyburide ineffective on Type 1 diabetes?

A

Because there is no endogenous release of insulin

- cannot stimulate the beta cells to produce insulin

108
Q

Why should Glyburide be used cautiously in patients with know hepatic or renal disease?

A

May elevate drug blood levels

- increase the risk of hypoglycemic reactions

NURS 1064 - Pharm (9 decks)

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