Diabetes Drugs

Question 1

Medication example for rapid-acting insulin

Answer 1

Insulin lispro (Humalog)
Insulin Aspart (Novolog)

Question 2

Medication example for short-acting insulin

Answer 2

Regular insulin (Humulin R)

Question 3

Medication example for intermediate-acting insulin

Answer 3

NPH

Question 4

Medication example for long-acting insulin

Answer 4

Insulin Glargine (Lantus)

Question 5

Medication example for ultra-long duration

Answer 5

Insulin Glargine (Toujeo)

Question 6

Medication example for combination insulin

Answer 6

Humulin 50/50

Question 7

Medication example for Biguanides

Answer 7

Metformin (Glugophage)

Question 8

Medication example for Sulfonylureas

Answer 8

Glyburide (Diabeta)

Question 9

Medication example for Meglitinides

Answer 9

Repaglinide (GlucoNorm)

Question 10

Medication example for Thiazolidinediones

Answer 10

Rosiglitazone (Avandia)

Question 11

Medication example for Alpha-Glucosidase Inhibitors

Answer 11

Acarbose (Glucobay)

Question 12

Medication example for Sodium-Glucose Co Transporter 2 Inhibitors

Answer 12

Canagliflozin (Invokana)

Question 13

Medication example for Dipeptidyl peptidase 4 inhibitors

Answer 13

Sitagliptin (Januvia)

Question 14

Medication example for Incretin Mimetics

Answer 14

Liraglutide (Victoza)

Question 15

Nursing considerations of insulin during stress and infection

Answer 15

Increase insulin

Question 16

Nursing considerations of insulin during skipping meals and exercise

Answer 16

Decrease insulin

Question 17

When to administer short-duration, rapid-acting insulin?

Answer 17

For example, Insulin lispro (Humalog) or Insulin Aspart (Novolog) should be administered within 15 minutes before or just after meals

Question 18

When to administer short-duration, short-acting insulin?

Answer 18

For example, regular insulin (Humulin R) should be administered 30 minutes before meals

Question 19

Which is the only insulin that can be mixed? (Hint: only cloudy insulin)

Answer 19

Neutral Protamine Hagedorn insulin suspension (NPH)

Question 20

When to administer NPH?

Answer 20

Twice daily at the same times each day (am + pm)

Question 21

What does NPH stand for?

Answer 21

Neutral Protamine Hagedorn insulin suspension (NPH)

Question 22

When to administer combination insulin?

Answer 22

For example, Humulin 50/50 should be given twice daily

Question 23

Another name for sliding scale

Answer 23

Also called corrective or supplemental

Question 24

Key takeaways: biguanides

Answer 24

An example is metformin.
MOA is decreasing liver production and intestinal absorption of glucose. Also increases insulin sensitivity
DO NOT give it to patients with renal impairment because it’s not metabolized and excreted by the kidneys; it can accumulate and become toxic when there’s renal impairment.
HOLD metformin before and after CT dye because it can be very hard on the kidneys (48 hours before and again after)

Question 25

Why are biguanides favourable?

Answer 25

Does not stimulate insulin release from the pancreas - therefore less risk for hypoglycemia.
Does not cause weight gain

Question 26

Key takeaways: sulfonylureas

Answer 26

MOA is triggering the release of insulin from pancreatic beta cells. It requires insulin synthesis in the pancreas, therefore ineffective in Type 1 Diabetes.

Question 27

Adverse effects and notable interactions with sulfonylureas

Answer 27

Risk for hypoglycemia → cause reduction in blood glucose regardless of the blood sugar level dangerous.
Weight gain.
NSAIDs and alcohol can worsen hypoglycemia
Beta Blockers block the early SNS warning signs of hypoglycemia and insulin secretion simultaneously.

Question 28

Key takeaways: meglitinides

Answer 28

MOA stimulates pancreatic insulin release → more short-acting than glyburide (sulfonylurea).
Require the insulin synthesis in the pancreas, therefore ineffective in Type 1 Diabetes
Adverse effect: hypoglycemia → patients must eat within 30 minutes of taking this drug

Question 29

Key takeaways: Insulin Sensitizers thiazolidinediones (glitazones)

Answer 29

Flagged for high-risk to heart failure so not used in Canada

Question 30

Key takeaways: alpha-glucosidase inhibitors

Answer 30

This drug inhibits alpha-glucosidase (enzyme) which breaks down carbohydrates. Hypoglycemia may develop when used in combination with insulin or sulfonylureas.

Question 31

Key takeaways: Didpeptidyl peptidase-4 (DPP-4) inhibitors (Gliptins)

Answer 31

DPP-4 is an enzyme that inactivates incretin hormones (a hormone that encourages insulin secretion). It enhances the actions of incretin hormones like insulin secretion; suppresses glucagon secretion; reduces liver production of glucose; and delays gastric emptying.

Question 32

Key takeaways: Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors

Answer 32

Inhibits SGLT-2 in the kidney → reduces the reabsorption of glucose. By blocking the reabsorption of glucose, glucose will be lost in the urine in addition to sodium. Risk of increased urination, UTI, and yeast infections.

Question 33

Key takeaways: Incretin Mimetics Glucagon-like Peptide-1 (GLP-1) Receptor Agonists

Answer 33

It activates receptors for GLP-1. GLP-1 is a hormone produced in the intestines. It is released from cells in the GI tract after a meal, promoting insulin release and inhibiting glucagon release. This one induces weight loss. It is also injectable