DM medications Flashcards by Yaz Bassi

What is the problem with diabetics taking beta blockers?

beta blockers mask the S&S of hypoglycemia

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three scenarios in which the nurse should decide to take a patients blood sugar?

If patient not feeling well.
If patient back from an exam and didn’t get breakfast
If patient sweating or confused

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Three types of rapid acting insulin?

Lispro (Humalog),
Aspart (Novorapid),
Glulisine (Apidra)

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Onset, peak and duration of rapid acting insulin such as ,
Lispro (Humalog),
Aspart (Novorapid),
Glulisine (Apidra)

Onset: < 15 mins
Peak: 0.5-1 hour
Duration: 3-4 hours

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When is the best time to administer rapid acting insulin?

0-15 mins before a meal.

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What is it best to be doing during the peak of rapid acting insulins?

eating (:

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When is the best time to administer short acting insulin such as,
-Regular (Humulin R or Novolin R)

30 min before meal *

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What is the only insulin that can be given parenterally (IV)

regular insulin (Humulin R or Novolin R)

(short acting)

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NPH onset, peak and duration

intermediate acting insulin

onset: 1-2hours
peak: 4-12 hours
duration: 18-24 hours

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Semilente onset, duration and peak

Intermediate acting insulin

onset: 0.5-1.5 hours
peak: 4-7 hours
duration: 12-16 hours

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Regular (Humulin R or Novolin R) insulin onset, peak, duration

Short acting

onset: 0.5-1 hr
peak: 2-3 hours
duration: 8 hours

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Lantus (Glargine) onset, peak and duration

long acting

onset: 1 hours
Peak: no peak
Duration 10-24 hours

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Levermir (Detimir)
onset:
Peak:
Duration:

long acting

onset: 3-4 hours
Peak: 3-9 hours
Duration: 24 hours

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Ultralente/Novolin L
Onset:
Duration:
Peak:

ultra-long acting

Onset: 4-8 hours
Duration: 16-18 hours
Peak: 36 hours

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Lente
Onset:
Peak:
Duration:

long acting

Onset: 1-2.5 hours
Peak: 8-12 hours
Duration: 18-24 hours

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What insulin is used in the management of gestational diabetes

human regular insulin
(Humulin R, Novolin R)

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Insulin therapy side effects (3),
Insulin therapy adverse reactions (3),

SE’s
1. Irritation at injection site
2. Lipodystrophy
3. Weight gain
ADR’s
1. Hypoglycemia
2. Rebound hyperglycemia
3. Hypokalemia

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The nurse should consider a patients medicine history and that certain a).. could alter the affects of insulin

herbs and dietary supplements,

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Prior to administering insulin, what should the nurse consider/ensure in regards to the patient and their BS

The nurse should ensure that the patient has consumed, or is capable of consuming, adequate food to prevent a hypoglycemic reaction

The nurse should educate the patient on how a).. b).. and c).. affect their serum glucose

a) insulin therapy
b) diet
c) exercise

When should the nurse withhold administering insulin

when blood glucose levels are less than 4 mmol or if the patient exhibits signs of hypoglycemia

In order to prevent lipodystrophy, the nurse should do what

Rotate injection sites weekly

What would be important for the nurse to check periodically to ensure the patients blood glucose is being monitored properly?

A1C hemoglobin

What organs can face long term diabetic complications?

Eyes
Heart
Kidneys
Feet

What insulin must be drawed into a syringe FIRST

CLEAR insulin

The nurse must be fimilar with what when administering insulin

Be familiar with onset, peak, and duration of action of prescribed insulin, important aspects of each specific insulin, signs and symptoms of hypoglycemia and hyperglycemia

All insulin types are compatible with one another **True or False**

**False** example Lantus must not be mixed in a single syringe

# **Sulfonylureas** What is the family last name and what does the medication primarly do?

↑ stimulates insulin release from pancreas ↑ sensitivity to insulin receptors ↓ Chance of prolonged hypoglycemia | **"IDE"**

Biguanides

- decrease glucose production by liver. - increase insulin sensitivity at tissues - Improve glucose transport into cells | – only drug is metformin

Meglitinides – “family name”

- glinide increase insulin release

Thiazilidinediones (TZDs) – “family name ”

-glitazone Decrease production & release of glucose from the liver Increase insulin sensitivity in fat and muscle tissue Hard on liver

Alpha-Glucosidase Inhibitors

Interferes with carb breakdown and absorption. | acts on GI, very little systemic affect Acarbose

DPP4 Inhibitors (oral) – “family name”

-gliptin increase insulin secretion from β-cell in the pancreas decrease glucagon release from α-cell in the pancreas

SGLT-2 Inhibitors – family name

- gliflozin increase insulin secretion from β-cell in the pancreas decrease glucagon release from α-cell in the pancreas

GLP-1RA Agonists (injectable) – “family ending”

-glutide (ozempic) decrease breakdown of insulin keeping it circulating longer decrease rate of digestion (decrease appetite) – wt loss

Second generation sulfonylureas have a)..

fewer drug-drug interactions.

what populations are Sulfonylureas contraindicated in?

women who are pregnant or breast-feeding, or persons with renal or liver disease or people with sensitive to sulfa drugs or thiazide diuretic

When caring for a patient on antihyperglycemic agents, what 4 things should the nurse consider

1. Monitor **BG** (hypoglycemia & hyperglycemia) 2. Check for **S&S** of illness or infection 3. Watch** liver** function 4. Assess for **adherence to therapy**, and the ability for self-care

# 14 things Contraindications/precautions of biguanides (metformin)

1. Impaired renal function 2. Heart failure, liver failure, 3. hx of lactic acidosis 4. Concurrent serious infection (ie septicemia) 5. Any condition that predisposes patient to hypoxemia 6. Anemia, 7. diarrhea, vomiting, 8. dehydration, 9. fever, 10. gastroparesis, GI obstruction 11. Hyperthyroidism, 12. pituitary insufficiency, 13. trauma 14. Pregnancy and lactation

10% of people using sulfonylureas experience

decreased effectiveness after prolonged use

Most side effects with sulfonylureas are

minor and GI-related

what are contraindications for taking sulfonylureas

1. Sensitivity to sulfa drugs or thiazide diuretics 2. Renal or hepatic disease 3. If used during pregnancy, discontinue at least 1 month before delivery

# 11 things Drug interactions with sulfonylureas?

1. Alcohol 2. Oral anticoagulants, 3. MAOIs, 4. probenecid, 5. sulfonamides 6. Chloramphenicol, 7. salicylates, 8. clofibrate 9. Rifampin 10. Thiazides/sulfonamide based drugs 11. Ginseng, garlic, black cohosh, juniper berries, fenugreek, coriander, dandelion root

In order to prevent lactic acid build up, what should the nurse know about buganides (metformin)?

Needs to be held 48 hours prior and 48 hours after a patient needs contrast dye to prevent lactic acid build up.

How long does buganides (metformin), take to reach its therapeutic effect

6-12 weeks

In T2D, what is typically the first line of defense medication

buganides (metformin)