- rapid acting: insulin lispro - short acting: human regular - intermediate acting insulin: NPH - long acting insulin: glargine

Diabetes Drugs Flashcards by Brooke Smithson

primary goal of diabetic pharmacology

prevent hyperglycemia and dec chance of long term complications
- maintain tight glycemic control and blood lipid levels

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types of insulin

rapid acting: insulin lispro
short acting: human regular
intermediate acting insulin: NPH
long acting insulin: glargine

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insulin administration

subq injection
- sites: back of arms, stomach, thighs
- ordered in units

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lispro

rapid acting
- starts working in 15 mins
- peaks in 1 hr
- works for 2-4 hrs
-administer w food
- must be in conjunction w either an intermediate or long acting

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insulin regular

short acting
- onset 30-60 mins
- peak 2-6 hr
- duration 3-8 hrs
- give before meals to control hyperglycemia
- often given for tube feeding
- used in insulin infusions

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NPH

intermediate acting insulin, neutral protamine hagedron –> protamine helps slow down absorption so that is lasts longer
- onset: 2-4 hrs
- peak: 4-10 hrs
- duration: 10-20 hrs

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NPH info

cloudy insulin so agitate before using
- typically injected 2x/day
- can be administered w rapid and short acting
- clear before cloudy

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glargine

long acting insulin
- once a day
- onset: 70 mins
- duration: all day
- helps control blood sugar all day so do not mix w other insulins
- often given at night

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blood sugar monitoring

need to know blood sugar before administering any type of insulin

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insulin pumps

computerized devices with basal infusion of regular insulin
- mostly used for type 1 diabetics
- bolus can be calculated when necessary
- surgically implanted
- still require a FSBG

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insulin regimens

most common is the sliding scale
- given based on blood glucose level
- can include basal dose of long acting
- important to educate

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insulin complications

hypoglycemia
allergic reactions are rare
lipodystrophies,lipoatrophy

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hypoglycemia causes

insulin overdose, dec cal intake, V/D, excessive alc, unaccustomed exercise, childbirth

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hypoglycemia s/s

tachycardia, sweating, nervousness, headache, drowsy, fatigue, dec LOC

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hypoglycemia treatment

oral carbs, parenteral glucagon, IV dextrose

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lipodystrophies, lipoatrophy

depressions of skin at injection sites
- feels hard and changes color
- fat cells harden and no longer absorbs insulin

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somogyi effect

overdose of insulin that causes hypoglycemia and counter regulatory mechanisms cause hyperglycemia and ketosis
- usually results from poor management

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dawn phenomenon

hyperglycemia in the morning due to natural hormonal release

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teaching points of glucose

monitor glucose level as directed
carry a good source of carbs in case hypo
rotate insulin sites
insulin vials are good for 30 days at room temp

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glipizide, glyburide class

sulfonylure

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glipizide, glyburide suffix

-ide

glipizide, glyburide moa

binding and closing K-ATP channels in the pancreatic beta cells which stimulates the secretion of insulin
- inc body’s sensitivity or response
- reduces release of glucose

glipizide, glyburide side effects

hypoglycemia

glipizide, glyburide nursing considerations

dont take if pregnant
Etoh, nsaids, tagamet, sulfa based ATB potentiates side effects

metformin class

biguanides

metformin moa

lowers glucose by dec production of glucose in liver - enhances glucose uptake by muscles - does not promote insulin from pancreas - does not cause hypoglycemia

metformin side effect

abdominal bloating, N/V/D, risk for acidosis in pt w elevated creatinine

metformin nursing implications

- no if elevated ALT levels - monitor serum glucose levels - give 30 mins before meals - must be held for 48 hrs post iv contrast usage - do not use w pt for heart failure, kidney disease, liver disease, excessive alc

metformin therapeutic usage

glycemic control, prevent t2d, pcos

linagliptin, sazagliptin, sitagliptin class

DPP4 inhibitor

linagliptin, sazagliptin, sitagliptin moa

inhibits dipeptidyl peptidase 4, the enzyme that inactivates incretin hormone - inc insulin by inc activity of incretins - reduce glucagon release - dec hepatic glucose production - slow down digestion and appetite

linagliptin, sazagliptin, sitagliptin side effects

- GI problems, flu like symptoms, skin rxns, inc risk of pancreatitis - not a high incidence of hypoglycemia

linagliptin, sazagliptin, sitagliptin indicated use

in combination w diet and lifestyle modifications - can be mono therapy or w other medications

dulaglutide, exenatide, semaglutide class

GLP-1 receptors agonists

dulagluide, exenatide, semaglutide suffix

- tide

dulagluide, exenatide, semaglutide moa

enhance glucose dependent insulin secretion - stimulates glucose dependent release of insulin - inhibits prostaglandin release of glucagon - suppress appetite - slowed gastric emptying

dulagluide, exenatide, semaglutide side effects

N/V/D, injection site rxn, headaches, upper respiratory infection, wt loss

dulagluide, exenatide, semaglutide nursing indications

- do not use if have pancreatitis - black box warning: risk of thyroid c cell tumor - not recommended for ppl w ESRD - given through SQ - usually given as adjunct therapy w metformin or other meds - plasma levels peak in 2 hrs, half life 2.5 - gila monster saliva

dapagliflozin class

sodium glucose cotransport ER 2 inhibitor - SLG2

dapagliflozin suffix

-flozin

dapagliflozin moa

prevent the kidneys from reabsorbing glucose back into the blood by blocking sodium-glucose transport proteins - allows kidneys to lower glucose levels by excreting it

dapagliflozin side effects

- inc risk of UTI - genital mycotic infection - hypotension - dizziness - fatigue

dapagliflozin nursing considerations

- PO - dont give to pt w ESRD or severe kidney disease - not FDA approved for t1d - can be given in conjunction w other meds - inc in use for other conditions like heart fail

glucagon

hypoglycemia antidote

glucagon moa

activates hepatic glucagon receptors, stimulates glycogenolysis and release of glucose

glucagon nursing considerations

- PO (awake pts) , SQ/IV/IM (low LOC pts) - short duration so may need multiple doses - check FSBG 15 mins after

result of steriods

inc blood sugar

being sick w diabetes

- sickness inc stress, which can inc glucose, so need to check more frequently - pts more prone to DKA, HHNS - stomach virus means dec food so need to watch bs closely and continue to take oral meds

diabetes diet

for both t1 and 2, need healthy variety of food - plate method and carb counting

exercise for diabetes pts

can help lower glucose levels, always be watchful tho bc can risk hypoglycemia if too hard of a change