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PHARM EXAM 3 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the key points to know about glucose?

A

It’s easy to breakdown
-body’s primary energy source, brain almost exclusively uses
Low glucose leads to: confusion and drowsiness

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2
Q

What are the 2 major hormones used to stabilize glucose levels

A

Glucagon and insulin
-secreted by pancreas’s: islets of langerhans
-alpha and beta cells

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3
Q

What do alpha cells do?

A

Stimulates liver to turn glycogen in glucose
-glucagon secreting cells
-increase blood glucose levels

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4
Q

What do beta cells do?

A

Brings down glucose levels by body using it
-insulin secreting

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5
Q

When is glucagon secreted?

A

Low blood glucose
-maintains between meals

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6
Q

When is insulin secreted?

A

After a meal, caused by rising glucose
-allows transport of glucose into cells, allows glucose to convert to glycogen, convert lipids to fat, increases protein synthesis and stops glucogenesis

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7
Q

What hormones increase blood glucose

A

-epinephrine (SNS)
-thyroid hormone (metabolism)
-growth hormone (Muscle)
-glucocorticoids (promote glucose in liver)

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8
Q

What drugs increase/decrease glucose

A

I: phenytoin, beta blockers, NSAIDS, diuretics
D: alcohol, lithium, ace inhibitors

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9
Q

What is diabetes mellitus

A

Metabolic disorder, causing deficient insulin secretion or sensitivity, causing hyperglycemia
-Type 1 and 2

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10
Q

What are key points of type 1?

A

Childhood (4-20 years normally)
-autoimmune=beta cells are destroyed
-lots of complications/hard to control
-insulin dependent

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11
Q

What are the key points of type 2?

A

Caused by chronic high sugar and decreased excitability (insulin resistance)
-over 40, getting younger (obesity concern)
-gradual onset
-90% have type 2

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12
Q

What are the risk factors for type 2 diabetes?

A

Obesity, sedentary lifestyle,
metabolic syndrome (abdominal obesity, low HDL, hypertriglyceridema, hypertension, impaired fasting glucose)
African Americans and Hispanics

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13
Q

List the symptoms of DM

A

Hyperglycemia (more than 126 fasting)
Polyuria
Polyphagia (hungry)
Polydipsia (thirsty)
Glocosuria
Weight loss
Fatigue

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14
Q

What are macrovascular complications of DM?

A

In big vessels!
-HTN, MI, stroke, PVD

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15
Q

What are macrovascular complications of DM?

A

Little vessels!
-nephropathy (first cause of kidney failure)
-retinopathy (blindness)
-neuropathy (nerve damage)

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16
Q

What is ketoacidosis, the treatment and symptoms?

A

Severe insulin deficiency, fat is used for energy, ketones will reproduce faster, dropping pH

T: IV fluids to flush out glucose and acid, then insulin is given

S: fruity breath, ketones, kussmauls respirations, hyperglycemia (240), polyuria, polydipsia, nausea, vomiting, coma

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17
Q

What is hyperosmolar hyperglycemic nonketotic coma, treatment and symptoms?

A

Severe hyperglycemia and excessive electrolytes, with dehydration (type 2),

T: fluids, insulin, treat electrolyte imbalances

S: high glucose (600), polyuria, dehydration, drowsiness, confusion, coma

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18
Q

when should glucose levels be checked?

A

Before meals and bed time, if they are NPO or tube fed, every 6 hours

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19
Q

What should fasting glucose be

A

More than 126

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20
Q

What should blood sugar be before meals for a diabetic?

A

70-130

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21
Q

What is an A1C and what should it be?

A

Average blood sugar over 3 months
-normal is less than 7%

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22
Q

True or false. Diabetes mellitus is a chronic systemic tic disease characterized by only by metabolic abnormalities

A

False

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23
Q

True or false. Insulin is a hormone secrete by the beta cells in the pancreas.

A

True

24
Q

What are the symptoms of hyperglycemia?

A

Three Ps (drinking, eating and urinating)
Fatigue
Weakness
Dry skin
hot and dry=sugar high

25
Q

What are the symptoms of hypoglycemia?

A

Sweating
Tremors
Tachycardia
Hunger
Confusion
Drowsiness
Seizures
Cold and clammy=need some candy

26
Q

How is insulin given

A

NOT orally, subQ or IV
-100 units per ml

27
Q

What are examples of rapid acting insulin?

A

Lispro, aspart and glulisine
O: 15-30 min
P: 30 min - 2.5 hrs
D: 3-6 hrs

28
Q

What is the example of short acting insulin?

A

Regular
O: 30-60 min
P= 1-5 hrs
D=6-10 hrs

29
Q

What is the example of intermediate acting insulin?

A

NPH and isophane
O= 1-2 hrs
P= 4-12 hrs
D=16 hrs

30
Q

What are the examples of long acting insulin?

A

Glargine and detemir
O=3-4 hrs
P= continuous
D= 24 hrs

31
Q

What is the example of ultra long acting insulin?

A

Degludec

32
Q

What is the action of insulin and the only contraindication

A

Increase glucose uptake and decreases glucose production

-hypoglycemia

33
Q

When should insulin be given normally?

A

Before meals, lining up with the onset

34
Q

What are some drug interactions and Nurisng implications of insulin?

A

-beta blockers, MAOI, salicylates, alcohol, herbals

N: mealtime dosing, rotate injections, monitor for hypoglycemia in sleep, high risk med

35
Q

What are the differences between programmed and sliding scale insulin?

A

P= regulates between meals, set amount ordered, watch nutrition status, normally regardless of blood sugar (as long above 70)
S: dosing based on blood sugar, notify if NPO

36
Q

What is some patient teaching related to insulin?

A

Diet/weight control/exercise
Know signs of hypoglycemia
Teach family about sighs
Follow up with dr.
Take blood sugar
Sick days
Proper injection sights

37
Q

True or false. Insulin plays a major role primarily in the metabolism of carbohydrates.

A

False

38
Q

What is an example of a sulfonylurea and its MOA?

A

Glyburide -oral
-stimulate pancreas to release insulin
(Must have functioning beta cells)

39
Q

Should pregnant people take oral diabetic medication?

A

No

40
Q

What are some adverse effects, contraindications and interactions of sulfonylureas?

A

A: hypoglycemia
C: sulfa allergy, renal failure, liver failure
D: beta blockers, alcohol

41
Q

What is an example of an alpha glucosidase inhibitor and its MOA?

A

Acarbose
-delays ingestion of complex carbs
-given with sulfonylurea
Indication: decrease in postpradial glucose

42
Q

What are some adverse effects, contraindications, interactions and nursing implications of alpha glucosidase inhibitors?

A

A: hypoglycemia, GI upset
C: hepatic, and bowel conditions
D: can decrease digoxin levels
N: take at beginning of meal

43
Q

What is an example of a biguanide, its MOA and indication for use?

A

Metformin (most common oral)
-decrease hepatic glucose production, and increase glucose use
I: insulin resistance and PCOS

44
Q

What are some adverse effects, contraindications and nursing considerations for biguanides?

A

A: lactic acidosis, GI upset
C: older adults (BB), renal failure, contrast (48hrs)
N: take with meals, increased effects with furosemide, digoxin, vancomycin

45
Q

What is an example of a thiazolidinedione, its MOA and indication?

A

Rosiglitaxone
-stimulates insulin receptors, used in common with insulin, sulfonyurea, and biguanides
I: insulin resistance

46
Q

What are some adverse effects, contraindications, and nursing considerations of Thiazolidinediones?

A

A: hepatic toxicity, HF, weight gain
C: liver disease, CV disease (BB)
N: take with meals, monitor liver, monitor HF, gemfibrozil can increase effects, may take 12 weeks to reach peak effect

47
Q

What is an example of a meglitinide, its MOA and indication?

A

Repaglinide
stimulates pancreatic insulin
Used with TZDs or biguanide
I: elevated glucose

48
Q

What are the adverse effects, contraindications, and nursing implications of meglitinides?

A

A: hypoglycemia (less than sulf) and GI upset
C: renal and liver disease, type 1 diabetes
N: take before all meals, gemfibrozil and itraconazole can increase effects

49
Q

What is an example of a DPP-4, its MOA, and indication?

A

Sitagliptin
-balance release of insulin and limit glucagon release, also delayed gastric emptying
-taken with TZD or biguanide
I: elevated glucose

50
Q

What are some adverse effects, contraindications and nursing implications of DPP-4?

A

A: upper respiratory tract infections, HF
C: type 1, insulin use, renal failure
N: once a day, with or without meal, weight loss

51
Q

What is an example of an amylin analog, its MOA, and indication?

A

Pramlintide
-suppresses glucagon secretion, used with insulin, sulfa, and biguanides
I: rise in postprandial blood glucose

52
Q

What are some adverse effects and nursing implications of amylin analogs

A

A: hypoglycemia (BB with insulin)
N: monitor sugar closely, avoid anticholinergics, weight loss, SQ injection before meals

53
Q

What is an example of an incretin mimetic, its MOA and indication?

A

Exenatide
-stimulates pancreas to make RIGHT amount of insulin based on food intake
-can be used as combo
I: postprandial glucose elevation

54
Q

What are some adverse effects, contraindications, and nursing considerations of incretin mimetics

A

A: hypoglycemia, GI distress, pancreatitis
C: liver disease, BB for thyroid cancer
N: SQ injection with 1 hr of breakfast and dinner, refrigerated, Dulaglutide=1 time a week, weight loss

55
Q

What is an example of a SGLT2 and its MOA

A

Canaglifozin
-blocks reabsorption of glucose in the kidney
-used as combo

56
Q

What are adverse effects, contraindications and Nurisng considerations of SGLT2?

A

A: dehydration, hypotension, electrolyte imbalance, bone loss, increase risk of amputation
C: renal failure
N: take with first meal, use in caution with meds that decrease BP, risk for dehydration of syncope

PHARM EXAM 3 (6 decks)

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