Diabetes Pharmacology Flashcards by Daisy Perez

Goals of medication management

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

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General client education for diabetes pharmacology

Action of med, how to take it, hypoglycemia

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

Exercise, healthy and balanced diet

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Prolonged blood glucose levels can lead to complications such as

Heart disease, stroke, nephropathy, retinopathy

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What kind of medication is metformin (Glucophage)?

Oral biguanide

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Metformin is commonly given for type ___ diabetes

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First-line drug for type II diabetes

Metformin

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Metformin MOA

Decreases hepatic glucose production

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Metformin adverse effects

GI problems (nausea, diarrhea), lactic acidosis

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S/S of lactic acidosis

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

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Metformin contraindications

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

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

1 week

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Metformin nursing actions

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

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Examples of oral sulfonylureas

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

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Sulfonylureas MOA

Stimulate pancrease to make insulin

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Sulfonylureas adverse effects

Hypoglycemia, weight gain

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Sulfonylureas contraindications

age, sulfa allergy, renal failure

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Why is age a contraindication for sulfonylureas?

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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Sulfonylureas nursing actions

Monitor hypoglycemia and educate on how to treat hypoglycemia

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When should sulfonylureas be taken?

30 min before first meal

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Discontinue sulfonylureas if starting __________

Insulin

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Example of Thiazolidinedione (TZD)

Pioglitazone (Actos)

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

Thiazolidinediones (TZD)

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Pioglitazone (Actos) adverse effects

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

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Pioglitazone (Actos) contraindications

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

Pioglitazone (Actos) black box warning

Can cause or exacerbate HF

Pioglitazone (Actos) nursing actions

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

Examples of alpha-glucosidase inhibitors

Acarbose (Precose) and miglitol (Glyset)

Adverse effects of alpha glucosidase inhibitors

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

Alpha glucosidase inhibitor contraindications

Inflammatory bowel disease, malabsorption syndromes, intestinal obstruction, sulfonylureas

Alpha glucosidase inhibitors nursing actions

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

Alpha glucosidase inhibitors should be taken with

First bite of food

Example of Dipeptidyl Peptidase IV inhibitor

Sitagliptin (Januvia)

Sitagliptin (Januvia) MOA

Decreases hepatic glucose production and increases insulin production of medications

Sitagliptin (Januvia) adverse effects

Upper respiratory infections, headache, hypoglycemia, diarrhea, pancreatitis

Sitagliptin (Januvia) contraindications

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

Sitagliptin (Januvia) nursing actions

Monitor for pancreatitis and hypoglycemia

How often should Sitagliptin (Januvia) be taken?

Once a day

Examples of sodium glucose cotransporter inhibitors (SGLT2)

Canaglifozin (Invokana) and dapaglifozin (Farxiga)

SGLT2 MOA

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

SGLT2 adverse effects

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

SGLT2 contraindications

DKA, moderate/severe kidney disease

SLGT2 nursing actions

Monitor for infections and hypoglycemia

When should SLGT2 be taken?

Once a day before breakfast

SGLT2 patient education

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

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

Exenatide (Byetta, Bydureon) and semaglutide (Ozempic)

GLP-1 agonists MOA

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

GLP-1 agonists adverse effects

Nausea, weight loss, vomiting, diarrhea, pancreatitis

GLP-1 agonists contraindications

Kidney failure, hx of pancreatitis

GLP-1 agonists black box warning

Risk of developing thyroid C-cell tumors

Most GLP-1 agonists are administered as

Subq injections

GLP-1 agonists patient education

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

Insulin MOA

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

Insulin patient education

Action and timing of insulin, injection technique, hypoglycemia

Insulin contraindications

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

Glucocorticoids can _________ blood glucose levels

Increase

Beta blockers can mask the S/S of _________

Hypoglycemia (fast heart rate, shakiness)

Insulin administration education

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

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

HIGH; syringes; pens

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

Pumps

Short acting insulin

Regular (Humulin R, Novolin R)

Only insulin given IV

Regular (short-acting)

Short acting insulin onset

30-60 min

Short acting insulin peak

2-5 hours

Short acting insulin duration

6-10 hours

When should short acting insulin be given?

30 minutes before meals (lowers postprandial BG)

Examples of rapid acting insulin

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

Rapid acting insulin onset

15 min

Rapid acting insulin peak

1-2 hours

Rapid acting insulin duration

3-5 hours

Rapid acting insulin characteristics

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

Rapid acting insulin is given

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

Intermediate acting insulin

NPH (“cloudy”)

NPH onset

1-2 hours

NPH peak

4-8 hours

NPH duration

10-18 hours

How often is NPH insulin given?

Once or twice daily

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

True

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

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

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

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

Examples of long acting insulin

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

Long acting insulin onset

1-2 hours

Long acting insulin peak

None

Long acting insulin duration

12-36 hours

Characteristics of long acting insulin

Basal insulin, given once a day

Interpret Humulin 70/30 (fixed combination insulin)

70% intermediate acting, 30% short acting

Fixed combination insulin is given

Once or twice a day

Example of inhaled insulin

Afrezza

Afrezza onset

10-20 min

Afrezza duration

3 hours

How is Afrezza taken?

With each meal with a special inhaler

Afrezza contraindications

Smoking, lung disease (COPD, asthma)

Afrezza nursing actions

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

General nursing actions for insulin

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

Sliding scale or correction scale dose is initially _____ based

Weight

Characteristics of sliding scale

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

Correction scale

Base dose of 5 units plus sliding scale or carb ratio

Carbohydrate ratio

15 grams carbs = 1 unit of insulin

Multiple daily injections (MDI)

Long acting plus mealtime insulin