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54/64 Unit 2 > Diabetes Pharmacology > Flashcards

Diabetes Pharmacology Flashcards

1
Q

Goals of medication management

A

Decrease BG, decrease risk of complications, increase quality of life, better health outcomes

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2
Q

General client education for diabetes pharmacology

A

Action of med, how to take it, hypoglycemia

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3
Q

Besides pharmacotherapy, what are other ways to manage blood glucose levels?

A

Exercise, healthy and balanced diet

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4
Q

Prolonged blood glucose levels can lead to complications such as

A

Heart disease, stroke, nephropathy, retinopathy

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5
Q

What kind of medication is metformin (Glucophage)?

A

Oral biguanide

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6
Q

Metformin is commonly given for type ___ diabetes

A

2

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7
Q

First-line drug for type II diabetes

A

Metformin

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8
Q

Metformin MOA

A

Decreases hepatic glucose production

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9
Q

Metformin adverse effects

A

GI problems (nausea, diarrhea), lactic acidosis

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10
Q

S/S of lactic acidosis

A

Hyperventilation, cold/clammy skin, muscle pain, abdominal pain, dizziness, irregular heartbeat

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11
Q

Metformin contraindications

A

Renal disease/dysfunction (creatinine <30 mL/min), contrast media procedures

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12
Q

Metformin should be discontinued at least _____ before any procedures with contrast media

A

1 week

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13
Q

Metformin nursing actions

A

Monitor severity of adverse effects, discontinue if necessary, take as directed 1-2x day WITH meals

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14
Q

Examples of oral sulfonylureas

A

Glipizide (Glucotrol), Glyburide (Diabeta), Glimepiride (Amaryl)

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15
Q

Sulfonylureas MOA

A

Stimulate pancrease to make insulin

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16
Q

Sulfonylureas adverse effects

A

Hypoglycemia, weight gain

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17
Q

Sulfonylureas contraindications

A

age, sulfa allergy, renal failure

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18
Q

Why is age a contraindication for sulfonylureas?

A

Older adults have a decreased metabolism; since these meds stimulate production of insulin, older adults would metabolize it slower increasing the risk for hypoglycemia

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19
Q

Sulfonylureas nursing actions

A

Monitor hypoglycemia and educate on how to treat hypoglycemia

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20
Q

When should sulfonylureas be taken?

A

30 min before first meal

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21
Q

Discontinue sulfonylureas if starting __________

A

Insulin

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22
Q

Example of Thiazolidinedione (TZD)

A

Pioglitazone (Actos)

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23
Q

Only class of drug that targets insulin resistance in type II diabetes

A

Thiazolidinediones (TZD)

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24
Q

Pioglitazone (Actos) adverse effects

A

Peripheral edema/fluid retention, weight gain, reduced bone density

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25
Q

Pioglitazone (Actos) contraindications

A

Hear failure, liver or kidney disease (use with caution)

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26
Q

Pioglitazone (Actos) black box warning

A

Can cause or exacerbate HF

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27
Q

Pioglitazone (Actos) nursing actions

A

Monitor for edema, weight gain, and indications of HF; perform baseline liver function tests

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28
Q

Examples of alpha-glucosidase inhibitors

A

Acarbose (Precose) and miglitol (Glyset)

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29
Q

Adverse effects of alpha glucosidase inhibitors

A

Flatulence*, diarrhea, abdominal pain, may elevate hepatic enzymes

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30
Q

Alpha glucosidase inhibitor contraindications

A

Inflammatory bowel disease, malabsorption syndromes, intestinal obstruction, sulfonylureas

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31
Q

Alpha glucosidase inhibitors nursing actions

A

Monitor adverse effects, liver function, and hypoglycemia; discontinue if necessary

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32
Q

Alpha glucosidase inhibitors should be taken with

A

First bite of food

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33
Q

Example of Dipeptidyl Peptidase IV inhibitor

A

Sitagliptin (Januvia)

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34
Q

Sitagliptin (Januvia) MOA

A

Decreases hepatic glucose production and increases insulin production of medications

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35
Q

Sitagliptin (Januvia) adverse effects

A

Upper respiratory infections, headache, hypoglycemia, diarrhea, pancreatitis

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36
Q

Sitagliptin (Januvia) contraindications

A

Drug allergy, use of insulin or sulfonylureas (increases risk for hypoglycemia)

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37
Q

Sitagliptin (Januvia) nursing actions

A

Monitor for pancreatitis and hypoglycemia

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38
Q

How often should Sitagliptin (Januvia) be taken?

A

Once a day

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39
Q

Examples of sodium glucose cotransporter inhibitors (SGLT2)

A

Canaglifozin (Invokana) and dapaglifozin (Farxiga)

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40
Q

SGLT2 MOA

A

Blocks receptors in kidneyes to prevent uptake of glucose and increases glucose excretion through diuresis

41
Q

SGLT2 adverse effects

A

Genital yeast infections, UTIs, increased urination, necrotizing fasciitis of perineum, and pancreatitis

42
Q

SGLT2 contraindications

A

DKA, moderate/severe kidney disease

43
Q

SLGT2 nursing actions

A

Monitor for infections and hypoglycemia

44
Q

When should SLGT2 be taken?

A

Once a day before breakfast

45
Q

SGLT2 patient education

A

Proper hygiene, S/S of UTI, hydration (d/t increased urination)

46
Q

Examples of glucagon-like peptide 1 (GLP-1) agonists

A

Exenatide (Byetta, Bydureon) and semaglutide (Ozempic)

47
Q

GLP-1 agonists MOA

A

Four in one: decreases hepatic glucose production, increases insulin production, slows down digestion, suppresses appetite

48
Q

GLP-1 agonists adverse effects

A

Nausea, weight loss, vomiting, diarrhea, pancreatitis

49
Q

GLP-1 agonists contraindications

A

Kidney failure, hx of pancreatitis

50
Q

GLP-1 agonists black box warning

A

Risk of developing thyroid C-cell tumors

51
Q

Most GLP-1 agonists are administered as

A

Subq injections

52
Q

GLP-1 agonists patient education

A

Rotate sites, take before meals (once a day or once a week)

53
Q

Insulin MOA

A

Decreases glucose levels, coverts glucose to glycogen and promotes energy storage, moves K+ into cells along with glucose

54
Q

Insulin patient education

A

Action and timing of insulin, injection technique, hypoglycemia

55
Q

Insulin contraindications

A

Careful with use with sulfonylureas, meglitinides, alcohol, glucocorticoids, and beta blockers

56
Q

Glucocorticoids can _________ blood glucose levels

A

Increase

57
Q

Beta blockers can mask the S/S of _________

A

Hypoglycemia (fast heart rate, shakiness)

58
Q

Insulin administration education

A

Administer in fatty areas (back of arms, abdomen, outer thigh), count to ten before withdrawing needle to prevent loss of units, rotate site (at least 1 inch from previous injection; if on abdomen, administer at least 2 in from belly button); if administering 50+ units split the dose into different syringes

59
Q

Insulin is a _____ alert medication! Only use insulin __________ or insulin _____

A

HIGH; syringes; pens

60
Q

Individuals who have insulin _____ typically have better blood sugar control over individuals who self-administer insulin injections

A

Pumps

61
Q

Short acting insulin

A

Regular (Humulin R, Novolin R)

62
Q

Only insulin given IV

A

Regular (short-acting)

63
Q

Short acting insulin onset

A

30-60 min

64
Q

Short acting insulin peak

A

2-5 hours

65
Q

Short acting insulin duration

A

6-10 hours

66
Q

When should short acting insulin be given?

A

30 minutes before meals (lowers postprandial BG)

67
Q

Examples of rapid acting insulin

A

Lispro (Humolog), Aspart (Novolog, Fiaspa), Lisine (Apidra)

68
Q

Rapid acting insulin onset

A

15 min

69
Q

Rapid acting insulin peak

A

1-2 hours

70
Q

Rapid acting insulin duration

A

3-5 hours

71
Q

Rapid acting insulin characteristics

A

Lowers postprandial BG, used in insulin pumps, bolus insulin, dose can be dependent on BG level and amount of carbs eaten

72
Q

Rapid acting insulin is given

A

Right before meal (“when your food is hot, take your shot!”)

73
Q

Intermediate acting insulin

A

NPH (“cloudy”)

74
Q

NPH onset

A

1-2 hours

75
Q

NPH peak

A

4-8 hours

76
Q

NPH duration

A

10-18 hours

77
Q

How often is NPH insulin given?

A

Once or twice daily

78
Q

T or F: NPH can be given in the same syringe as regular insulin

A

True

79
Q

When administering regular and NPH insulin, draw up _____ before _____

A

Clear (regular); cloudy (NPH) (you don’t want cloudy in the clear!)

80
Q

Explain the process of administering 5 units of regular insulin and 5 units of NPH

A

Pull 10 mL of air into syringe, inject 5 mL of air in cloudy (NPH), inject 5 mL of air in clear (regular), draw up 5 units of regular, draw up 5 units of NPH

81
Q

Examples of long acting insulin

A

Glargine (Lantus, Basaglar), Detemir (Levemir), Degludec (Trisiba)

82
Q

Long acting insulin onset

A

1-2 hours

83
Q

Long acting insulin peak

A

None

84
Q

Long acting insulin duration

A

12-36 hours

85
Q

Characteristics of long acting insulin

A

Basal insulin, given once a day

86
Q

Interpret Humulin 70/30 (fixed combination insulin)

A

70% intermediate acting, 30% short acting

87
Q

Fixed combination insulin is given

A

Once or twice a day

88
Q

Example of inhaled insulin

A

Afrezza

89
Q

Afrezza onset

A

10-20 min

90
Q

Afrezza duration

A

3 hours

91
Q

How is Afrezza taken?

A

With each meal with a special inhaler

92
Q

Afrezza contraindications

A

Smoking, lung disease (COPD, asthma)

93
Q

Afrezza nursing actions

A

Monitor lung function before starting and every 6 months, monitor BG and hypoglycemia

94
Q

General nursing actions for insulin

A

Monitor BG and for hypoglycemia, recommend rotating injection sites, adjust dose if needed per orders, sliding scale used in hospital

95
Q

Sliding scale or correction scale dose is initially _____ based

A

Weight

96
Q

Characteristics of sliding scale

A

Typically used in acute care setting, dependent of level of insulin resistance

97
Q

Correction scale

A

Base dose of 5 units plus sliding scale or carb ratio

98
Q

Carbohydrate ratio

A

15 grams carbs = 1 unit of insulin

99
Q

Multiple daily injections (MDI)

A

Long acting plus mealtime insulin

54/64 Unit 2 (8 decks)

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