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Nursing > Diabetes & Antihyperglycemics > Flashcards

Diabetes & Antihyperglycemics Flashcards

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1
Q

Why is insulin injected or inhaled?

A

It is destroyed in the GI tract

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2
Q

How is insulin classified?

A

Peak and duration

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3
Q

What type of DM is insulin ALWAYS required for?

A

Type I

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4
Q

Intensive insulin Tx regimens include:

A
  • Multiple daily injections

- Continuous subcutaneous insulin injection (CCIJ) - insulin pump

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5
Q

FPG levels must be higher than ____ to indicate a diagnosis of diabetes?

A

> 126 mg/dL

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6
Q

Plasma glucose levels higher than _____ suggests diabetes. Patients must also display S/S of _____, _____, and rapid weight loss.

A

200 mg/dL, polyuria, polydipsia

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7
Q

What is an indication of HgbA1C value of 5.5%

A

Normal range

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8
Q

“Prediabetes” is defined by impaired fasting plasma glucose between ____ - _____ mg/dL or impaired glucose tolerance (2-hour OGTT result of _____ - _____ mg/dL).

A

100, 125, 140, 199

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9
Q

Individuals who do not have diabetes, 2-hour glucose levels will be below _____ mg/dL

A

140

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10
Q

Individuals who do have diabetes, 2-hour glucose levels will be below _____ mg/dL

A

200

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11
Q

What type of medication can help protect against diabetic nephropathy

A

ACE inhibitors or ARB

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12
Q

For patients with DM, target values for blood glucose are ______ before meals and _____ at bedtime.

A

90 - 130 mg/dL, 100 - 140 mg/dL

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13
Q

The metabolic actions of insulin are primarily _____.

A

anabolic

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14
Q

Insulin deficiency promotes hyperglycemia by three mechanisms:

A

(1) increased glycogenolysis, (2) increased gluconeogenesis, and (3) reduced glucose utilization

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15
Q

Sulfonylureas MOA

A

Promotes insulin release from pancreas by blocking K+ channels on beta cells (opens Ca+ channels) –> stimulates insulin release

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16
Q

Sulfonylureas Therapeutic uses

A

DM2 and MODY

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17
Q

Sulfonylureas should be used in conjunction with…

A

lifestyle changes (diet & exercise)

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18
Q

Sulfonylureas side effects

A

Hypoglycemia
If BG is high Sulfonylureas will be therapeutic
Weight gain
CV toxicity

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19
Q

Sulfonylureas drug interactions

A

Avoid alcohol –> flushing, palpations, possible hypoglycemia

Avoid pregnancy

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20
Q

Sulfonylureas drug names

A

Glipzide (Glucotrol)
Glyburide (Diabeta Micronase)
Glimepiride (Amaryl)
Chlorporpamide

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21
Q

Secretagogues includes

A

Sulfonylureas & Meglitinides

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22
Q

Sulfonylureas onset is:

A

Rapid response

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23
Q

Meglitinides drug names

A

Repagunide (Prandin)

Natelinide (Starlix)

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24
Q

Meglitinides onset is:

A

short-acting (oral form)

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25
Q

Meglitinides side effects:

A

Hypoglycemia

Weight gain

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26
Q

Meglitinides MOA

A

Promotes insulin release from pancreas by blocking K+ channels on beta cells (opens Ca+ channels) –> stimulates insulin release

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27
Q

Meglitinides Therapeutic uses

A

Type 2 DM & MODY

Significantly reduced postprandial blood glucose

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28
Q

When do you administer Meglitinides

A

Given 15-30 minutes before each meal

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29
Q

Biguanides drug names

A

Metformin (Glucophage)

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30
Q

Biguanides MOA

A

Inhibits glucose production in liver
Slightly reduces glucose absorption in gut (intestines)
Sensitizes insulin receptors in target tissue

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31
Q

Biguanides Therapeutic uses

A

Glycemic control

Prevention of Type 2 DM (can delay development in high risk individuals (benefits: young, overweight)

-Control for GDM

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32
Q

Metformin is well known for being…

A

the drug choice for initial therapy in most patients with Type 2 DM

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33
Q

Biguanides Pharmacokinetics

A

Slowly absorbed from the small intestine

NOT metabolized (excreted unchanged by the kidneys)

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34
Q

Biguanides adverse effects

A

Accumulate to toxic levels w/renal failure)
Lactic acidosis (inhibits mitochondrial oxidation of lactic acid) –> medical emergency/ immediate attention
(esp. in those with elevated serum creatine, liver disease or conditions associated with hypoxemia or dehydration)

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35
Q

Biguanides side effects

A

Decreased appetite, nausea, diarrhea, decreases absorption of B12 and folic acid (deficiency)

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36
Q

Biguanides benefits

A
  • Does NOT produce hypoglycemia
  • Weight neutral
  • Improve lipid profiles
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37
Q

Biguanides drug interactions

A

Alcohol can inhibit breakdown of lactic acid

Discontinue prior to surgery and diagnostic testing using IV contrast material

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38
Q

Alpha-Glucosidase Inhibitors

A

Acarabose (Precose)

Miglitol (Glyset)

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39
Q

Alpha-Glucosidase Inhibitors MOA

A

Delays absorption of dietary carbs

Alpha-glucosidase: enzyme located in brush border of cells lining the intestine (when enzyme is inhibited, digestion of carbs is delayed –> reduction of BG after a meal)

40
Q

Alpha-Glucosidase Inhibitors Therapeutic uses

A

Type 2 DM
Lowers A1C levels (great glycemic control)
Mainly postprandial BG lowering

41
Q

Alpha-Glucosidase Inhibitors Pharmacokinetics

A
  • Only 2% of dose is absorbed as active drug –> systemic effects are minimal
  • In the gut, drug is converted to inactive products by bacteria and digestive enzymes
42
Q

Alpha-Glucosidase Inhibitors adverse effects

A

Hypoglycemia does not occur when used alone

Long-term, high dose therapy –> liver dysfunction (liver function tests every 3 months)

43
Q

Alpha-Glucosidase Inhibitors side effects

A

GI issues: flatulence, cramps, abdominal distention, diarrhea, rumbling bowel sounds

Can cause decreased absorption of iron (risk of anemia)

44
Q

Alpha-Glucosidase Inhibitors drug interactions

A

Table sugar is not effective in reversing low BG

Bad for those who have bowel disease, liver diseases and renal dysfunction

45
Q

Incretins

A

GLP-1 agonists

DPP-4 inhibitors

46
Q

GLP-1 agonists drug names

A
  1. Exenatide (Byetta)
  2. Liraglitide
  3. Albiglutide
  4. Dulaglutide
  5. Exenatide
47
Q

DPP-4 inhibitors drug names

A
  1. Sitagliptin (Januvia)
  2. Saxagliptin
  3. Alogliptin
  4. Linagliptin
48
Q

GLP-1 agonists therapeutic uses

A

Injectable adjunctive therapy to improve glycemic control in Type 2 DM (SQ injection)

49
Q

DPP-4 inhibitors therapeutic uses

A

Used solo or in conjunction with diet and exercise

50
Q

DPP-4 inhibitors pharmacokinetics

A

Undergoes rapid & nearly complete absorption in presence or absence of food

  • Peak: 1-4 hours after dose
  • Half-life: 12 hours
51
Q

GLP-1 agonists pharmacokinetics

A

Peak: 2.1 hours
Half-life: 2.4 hours
Excreted unchanged in urine

52
Q

GLP-1 agonists adverse effects

A

Can accumulate to toxic levels (pts with renal failure)

Risk of pancreatitis

53
Q

DPP-4 inhibitors adverse effects

A

Can accumulate to toxic levels (pts with renal failure)

Risk of pancreatitis

54
Q

GLP-1 agonists side effects

A

Hypoglycemia (dose related)
N and V, diarrhea, headache, weight loss (GI SE)
Weight loss

55
Q

DPP-4 inhibitors side effects

A

UTI, headache, nasal passage & throat inflammation, constipation, dizziness, pancreatitis

Myalgias (muscle pain) & arthralgias (joint pain)

56
Q

DPP-4 inhibitors benefits

A
  • Neutral hypoglycemia

- Neutral on weight

57
Q

GLP-1 agonists drug interactions

A

Only used in pregnant women if benefits outweigh risks

Delays gastric emptying (can slow down absorption of oral drugs)

Give drugs @ least 1 hr. before GLP-1

58
Q

SGLT2 drug names

A

Canaglifiozin (Invokana)

Dapaglifiozin (Farxiga)

59
Q

SGLT2 MOA

A

Blocks the reabsorption of glucose in the kidneys  bloodstream

  • Increase urinary glucose excretion
  • Lower BG levels
60
Q

SGLT2 therapeutic uses

A

improved glycemic control

61
Q

SGLT2 pharmacokinetics

A

Half-life: 12 hours (can be given once a day)

Peak: 1-2 hours

62
Q

SGLT2 adverse effects

A
  • Hypoglycemia
  • Female genital fungal infections
  • GU/vaginal yeast infection
  • UTI
  • Increased urination
  • Postural hypotension & dizziness (older adults)
63
Q

SGLT2 side effects

A

-Weight loss

64
Q

SGLT2 Benefits:

A
  • Reduction in systolic BP

- Weight loss

65
Q

SGLT2 drug interactions

A

Co-administration can decrease efficacy

66
Q

Rapid-Acting drug names

A

Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)

67
Q

Rapid-Acting onset

A

10-30 minutes

68
Q

Rapid-Acting peak

A

1/2 - 3 hours

69
Q

Rapid-Acting duration

A

3-6 hours

70
Q

Rapid-Acting characteristics

A

CLEAR: very rapid onset, start meal within 5-10 minutes. Safe to mix with NPH, but must be administered immediately
“Band-aid to situations”

71
Q

Short-Acting drug names

A

(Humulin-R)

Novolin-R

72
Q

Short-Acting onset

A

1/2 - 1 hour

73
Q

Short-Acting peak

A

1-5 hours

74
Q

Short-Acting duration

A

6-10 hours

75
Q

Short-Acting characteristics

A

CLEAR: the only insulin that may be given intravenously (IV). Used during surgery, in diabetic emergencies, during periods of stress, and for rapid action before meals. (Usually used in hospitals, not home use)

76
Q

Intermediate-Acting drug names

A

(Humulin-N)

Novolin-N

77
Q

Intermediate-Acting onset

A

1-2 hours

78
Q

Intermediate-Acting peak

A

6-14 hours

79
Q

Intermediate-Acting duration

A

16-24 hours

80
Q

Intermediate-Acting characteristics

A

CLOUDY: Addition of zinc and protamine to regular insulin alters onset, peak and duration of action. NOT to be given by intravenous (IV) route!

Can be mixed with rapid or short acting insulin

81
Q

Combination Therapy (Pre-mixed) drug names

A

NPH/Regular 70/30
NPH/Regular 50/50
Humalog Mix 75/25
Humalog Mix 50/50

82
Q

Combination Therapy (Pre-mixed) characteristics

A

Mixtures of insulin have the same effect as if they were injected in separate syringes. Both combinations are CLOUDY. Should NOT be used for intravenous (IV) infusion, as they both contain protamine and zinc.

83
Q

Combination Therapy (Pre-mixed) benefits

A

Theses combinations were developed to more closely stimulate the varying levels of endogenous insulin excretion. Secondarily, the pre-mixed insulins may increase the ease of self-administration

84
Q

Long-acting drug names

A

Glargine (Lantus)

Detemir (Levemir)

85
Q

Long-acting onset

A

1-2 hours

86
Q

Long-acting peak

A

none

87
Q

Long-acting duration

A

18 - 24+ hours

88
Q

Long-acting charecteristics

A

CLEAR: Not to be mixed with any other type of insulin. (Usually home use/discharge use)

89
Q

What is the only type of insulin that is appropriate for mixing with short-acting insulins?

A

NPH (Neutral Protamine Hagedorn)

Humulin N
Novolin N

90
Q

IV insulin is used to treat what?

A

Diabetic ketoacidosis

91
Q

Analgesics

A

NSAIDS
non-NSAIDS
Opioids

92
Q

Antiretrovirals MOA

A

nuclueotide analog reverse transcriptase inhibitor

93
Q

Give an example of an antiretroviral

A

Truvada

94
Q

Give an example of an

A

anticoagulants

95
Q

Give an example of an antibiotics

A

penicillin / amoxicillin

Nursing (18 decks)

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