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Pharmacology Exam 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

S/S of hypOglycemia?

A
  • Rapid onset and progression on symptoms
  • Headache
  • Difficulty problem solving
  • Disturbed or altered behavior
  • Coma
  • Seizures
  • Hunger
  • Anxiety
  • Tachycardia
  • Sweating
  • Cool and clammy skin
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2
Q

Early S/S of hypERglycemia?

A
  • Frequent urination
  • Increased thirst
  • Blurred vision
  • Fatigue
  • Headache
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3
Q

Late S/S of hypERglycemia?

A
  • Fruit-smelling breath
  • N & V
  • SOB
  • Weakness
  • Confusion
  • Coma
  • Abd. pain
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4
Q

When is hypoglycemia most likely to occur when receiving insulin?

A

@ peak (most amount of insulin in system at this time)

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5
Q

Is rapid acting insulin bolus insulin?

A

Yes

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6
Q

When inpatient when do you give rapid acting insulin?

A

Immediately before meals (if give to far ahead=hypoglycemia which is more dangerous)

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7
Q

When at home when do you give rapid acting insulin?

A

Inject and eat

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8
Q

What routes can rapid acting insulin be given?

A
  • Sub Q
  • IV
  • Cont. pump infusion
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9
Q

How does rapid acting insulin come?

A

Vial or pen

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10
Q

Can rapid acting insulin be mixed with NPH in the same syringe?

A

Yes

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11
Q

What are examples of rapid acting insulin?

A

-Insulin lispro, aspart, glulisine

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12
Q

Is there a form of concentrated rapid acting insulin?

A

Yes, concentrated lispro= U-200

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13
Q

What is the onset of rapid acting insulin?

A

5-15 minutes

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14
Q

When does rapid acting insulin peak?

A

1-2 hours

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15
Q

What is the duration of rapid acting insulin?

A

4-6 hours

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16
Q

Is short acting insulin similar to rapid acting insulin?

A

Yes

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17
Q

When is short acting insulin injected?

A

Before meal

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18
Q

Is short acting insulin older and less expensive?

A

Yes

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19
Q

Can you obtain short acting insulin “behind the counter”?

A

Yes

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20
Q

What is the onset time of short acting insulin?

A

30 min- 1 hour

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21
Q

When does short acting insulin peak?

A

2-5 hours

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22
Q

What is the duration of short acting insulin?

A

5 - 8 hours

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23
Q

What routes can short acting insulin be given?

A
  • Sub Q
  • IV: DKA or hyperkalemia
  • IV: insulin drip (100 units)
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24
Q

Can short acting insulin be mixed with NPH in the same syringe?

A

Yes

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25
Q

What are examples of short acting insulin?

A
  • Humulin R

- Novolin R

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26
Q

Does short acting insulin come in a concentrated form?

A

Yes, concentrated U-500

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27
Q

How concentrated is U-500 short acting insulin than typical concentrations of insulin?

A

-Five times more concentrated than U-100

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28
Q

1ml of U-500 contains how many units of insulin?

A

-500 units

-50 units of U-100 would require 0.5ml, while 50 units of U-500 would require 0.1ml

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29
Q

Is U-500 insulin clear?

A

Yes

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30
Q

Who is U-500 insulin for?

A

The Who require>200 units of insulin a day

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31
Q

What is the duration of U-500?

A

up to 24 hours

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32
Q

Can U-500 be mixed with NPH in same syringe or be given IV?

A

No

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33
Q

What is the onset of U-500 short acting insulin?

A

30-45 minutes

34
Q

What is the peak of U-500 short acting insulin?

A

varies 2-4 hours

35
Q

What does NPH stand for?

A

Neutral Protamine Hagedorn

36
Q

What is NPH insulin?

A

Intermediate acting insulin

37
Q

How is NPH given?

A

Injection

38
Q

How often is NPH given?

A

1-3 times per day

39
Q

Is there immediate control of postprandial hyperglycemia?

A

No

40
Q

Is NPH and older insulin, less expensive, and attainable from “behind the counter”?

A

Yes

41
Q

What routes can NPH be given?

A

ONLY SUB Q

42
Q

Is NPH cloudy?

A

Yes (roll between palms)

43
Q

Can NPH be mixed with rapid-acting or short-acting insulins?

A

Yes

44
Q

What is the onset time of NPH?

A

1-2 hours

45
Q

When does NPH peak?

A

4-6 hours

46
Q

What is the duration of NPH?

A

more than 12 hours

47
Q

Does long acting insulin provide basal control?

A

Yes

48
Q

Does long acting insulin have a prolonged duration with no peak?

A

Yes

49
Q

Is long acting insulin for meal time correction?

A

No

50
Q

How often is long acting insulin given?

A

Once or twice a day

51
Q

What is the onset on long acting insulin?

A

1-2 hours

52
Q

When does long acting insulin peak?

A

varies 6-20 hours

53
Q

What routes can long acting insulin be given?

A

Only Sub Q

54
Q

Can long acting insulin be mixed with other insulins?

A

No

55
Q

What are examples of long acting insulin?

A

Insulin glargine, detemir, degludec

56
Q

When should concentrated insulin only be used?

A

For people receiving >200 units a day

57
Q

Why is concentrated insulin used?

A

To reduce excess amount of fluid volume going into Sub Q

58
Q

Is concentrated insulin anything greater than U-100?

A

Yes

59
Q

Describe basal insulin:

A
  • Long-acting
  • Once daily (some twice)
  • Current research supports use with meal time/sliding scale insulins (especially in hospitals)
  • Less fluctuations in blood sugar
60
Q

Describe bolus insulin:

A
  • With meals
  • Can be pre-set “fixed” dose
  • Carb counting can also be done
  • Sliding scale or “correctional” insulin can also be given (correction factor)
61
Q

What does GLP-1 Agonist stand for?

A

Glucagon-like peptide-1 receptor agonist

62
Q

What is the mechanism of action of GLP-1?

A
  • Incretin mimetics
  • Works on presence of food
  • Stimulate-glucose release
  • Decrease glucagon release
  • Decrease appetite, delay gastric emptying
63
Q

When do we give GLP-1?

A
  • Take with food ( to tell pancreas how much insulin to produce)
  • Slows post meal spike
64
Q

What are adverse effects of GLP-1?

A
  • GI side effects
  • Pancreatitis
  • Hypoglycemia when combined with sulfonylureas
  • Some are associated with thyroid carcinoma in rodent studies
65
Q

What are therapeutic effects of GLP-1

A
  • Improve glycemic control
  • Weight loss
  • No need to eat around the time of administration
66
Q

What patient teaching is needed with GLP-1?

A

-S/S of hypoglycemia

67
Q

What is the mechanism of action for Metformin?

A
  • Decrease liver glucose production
  • Increases tissue response to insulin
  • Does not stimulate insulin secretion
68
Q

Is Metformin associated with weight gain or hypoglycemia?

A

No

69
Q

When do we give Metformin?

A

With meals, 1-2 times a day

70
Q

What are adverse effects of Metformin?

A
  • GI upset (most common)
  • Black Box Warning
  • Drug interactions
71
Q

What is the black box warning for Metformin?

A
  • Increase risk of lactic acidosis in patients 80 years and older
  • Don’t use after heart attacks
72
Q

What are the drug interactions associated with Metformin?

A

-Hold for 48 hours prior to test/procedure with IV contrast/Iodine: Can lead to renal failure
-Cimetidine (antacid/antihistamine):
risk of increase lactic acidosis

73
Q

What are therapeutic effects of Metformin?

A
  • T2DM
  • Pre-diabetes
  • PCOS
  • Gestational Diabetes
  • Controlled blood sugars with no spikes
74
Q

What patient teaching is needed with Metformin?

A

Take with meals to help with GI upset and blood sugar spikes due to meals

75
Q

Glyburide is wha type of drug?

A

Sulfonylurea

76
Q

What is the mechanism of action for Glyburide?

A
  • Binds to beta cells in pancreas to stimulate release of insulin
  • Patient must still have functioning beta cells in the pancreas
  • Generally not used with insulin
77
Q

Does T1DM have functioning beta cells?

A

No, have no beta cells

78
Q

Does T2DM have functioning beta cells?

A

Yes but may be worn out

79
Q

When do we give Glyburide?

A

30 minutes before meal?

80
Q

What are adverse effects of Glyburide?

A
  • Hypoglycemia

- Weight gain

81
Q

What are therapeutic effects of Glyburide?

A

-Prevention of harmful effects from hyperglycemia?

82
Q

What patient teaching is needed with Glyburide?

A
  • S/S of hypoglycemia
  • take 30 minutes before meal
  • Ask about allergies to sulfonamide antibiotics (possible cross sensitivity)
  • Best results with proper diet and exercise

Pharmacology Exam 1 (4 decks)

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