Chapter 66 diabetes Flashcards
why is it important to closely monitor a patient that is diabetic and on beta blocker**
because beta blockers can mask the S&S of hypoglycemic drugs
what is the only method of administration for Glulisine (Apidra) **
given by subcutaneous injection only
what type of insulin is often used in insulin infusion pumps**
Insulin lispro (Humalog)
what are the different types of rapid insulin **
-lispro
-aspart
-glulisine
What is the onset peak and duration of lispro **
Onset: 5-15 min
Peak: 30 min-1h
Duration: 3-4 h
What is the onset peak and duration of aspart**
Onset: 15 min
Peak: 1-3 h
Duration: 3-5 h
What is the onset peak and duration of glulisine **
Onset: 15-30 min
Peak: 1 h
Duration: 3-4 h
what is the short acting type of insulin **
Regular insulin
when is the best time to take rapid acting insulin **
best to take it while eating since it has such a short onset
what is the onset peak and duration of regular insulin**
onset: 30-60 min
peak: 2-4 h
duration: 5-7 h
when is the best administration time for regular insulin **
30 min before a meal
what is the intermediate type of insulin **
Isophane
what is the only insulin that is administered IV **
regular insulin
what are some adverse effects of insulin therapy**
-irritation at injection site
-lipodystrophy
-weight gain
What are some SERIOUS adverse effects of insulin therapy**
-hypoglycemia
-rebound hyperglycemia
-hypokalemia
what is the minimum level that a patients blood glucose has to be to administer insulin**
Do not administer when blood glucose levels are less than 4 mmol
how often do you have to rotate injection sites to avoid lipodystrophy **
rotate injection sites weekly
what parts of the body are most likely to be affected by diabetes**
-Eyes
-Heart
-Kidney
-feet
how long can in use vials of insulin be left at room temperature?
they can be left up to 4 weeks
does rapid acting insulin have different absorption rates at different sites?
no the absorption rate does not vary from site to site
if you were drawing a clear insulin and a cloudy insulin into a syringe which would you draw in first?**
draw the clear insulin into the syringe first to prevent cloudy insulin from entering the clear insulin bottle
who would sulfonylureas be contraindicated for?**
-women who are pregnant or breastfeeding
-persons with renal or liver disease
how do sulfonylureas help control type 2 diabetes**
-stimulate insulin release from the pancreas
-increase sensitivity to insulin receptors
what is the suffix that is commonly used for sulfonylureas **
Commonly will end in “-ide”
what is a common side effect of sulfonylureas **
minor GI side effects
what is the prototype drug for sulfonylureas
glyburide
what are the contraindications for sulfonylureas **
-Sensitivity to sulfa drugs
-sensitivity to thiazide diuretics
-renal disease
-hepatic disease
-if used during pregnancy discontinue at least 1 month before delivery
what are some serious adverse effects that sulfonylureas can cause
hepatotoxicity
blood problems
how do biguanides help control type 2 diabetes**
-decrease glucose production by the liver
-increase insulin sensitivity at tissues
-increases glucose transportation into cells
-decreases intestinal absorption of glucose* (important because this causes the GI side effects)
How long does a patient have to take biguanides for until they reach their full therapeutic effect **
6-12 weeks for them to reach their therapeutic effect
what is the prototype drug for biguanides
the prototype and only drug in this classification is metformin
what are the contraindications of biguanides*
-kidney problems
-liver problems
-heart failure
-hypoxemia (since metformin increases anaerobic cellular respiration and if they have hypoxemia can lead to a buildup of lactic acid)
-pregnancy and lactation
- hyperthyroidism
do biguanides cause weight gain**
no they do not
how long before and after a procedure with contrast dye do biguanides need to be held **
need to be held for 48 hours before and 48 hours after a procedure with contrast dyes
how do meglitinides help control type 2 diabetes**
increase insulin production from the pancreas
can meglitinides cause hypoglycemia **
yes they can since they stimulate more insulin to be produced
what is the suffix that is commonly used for meglitines **
“-glinide”
what are some contraindications of meglitinides
-hepatic impairment (since it is mostly metabolized through the liver)
-pregnancy or lactation
-elderly patients
how do Alpha Glucosidase Inhibitors help control type 2 diabetes**
block and enzyme in the small intestine that slows the absorption of carbs
What is the suffix that is used for alpha glucosidase inhibitors*
there is no suffix for this class of medication
how do Thiazolidinediones TZD help control type 2 diabetes**
-greatly increase insulin sensitivity at target cells
-decrease gluconeogenesis
what is the suffix that is used for TZD’s**
usually “-glitazone”
what organ are TZD’s very hard on **
very hard on the liver
what are the two classes of incretin enhancers
-Activating GLP-1 receptors
-Inhibiting dipeptidyl peptidase 4 (DDP-4)
what are the effects of incretin on the body?
-increase amount of insulin produced
-decrease amount of glucagon
-delays gastric emptying (slows glucose absorption)
-Increases feelings of satiety
how does GLP-1 and DDP-4 inhibitors help to treat type 2 diabetes
-GLP-1 are just a replacement so they add more incretins into the system
-DDP-4’s prevents the breakdown of incretins so they remain in the body for longer
what is the suffix used for DDP4 inhibitors?
“-gliptin”
what is the suffix used for GLP-1 agonists?
“-glutide”
