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Nursing > Drug therapy for diabetes > Flashcards

Drug therapy for diabetes Flashcards

1
Q

Glucose

A

Sugar in the blood
Body’s primary energy source
Brain almost exclusively uses glucose for energy

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2
Q

2 major hormones stabilize glucose levels

A

Glucagon and Insulin

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3
Q

Alpha Cells

A

Glucagon secreting cells
Increase blood glucose levels
Stimulates the liver to turn glycogen into glucose so that the body can use it

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4
Q

Beta Cells

A

Insulin secreting cells
Insulin allows your body to use glucose. Cannot use glucose until the insulin arrives
Allows cells to start using the glucose in the blood
Decrease blood glucose levels

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5
Q

islets of langerhans

A

Location in the Pancreas where Alpha and Beta cells are located

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6
Q

Glucagon

A

secreted when the body has low blood glucose.
Helps to maintain glucose levels between meals
Kicks in when you haven’t had any meals
Tells the liver to release some of the store glycogen

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7
Q

Insulin

A

secreted after a meal, pancreas recognizes rising glucose
Secretes insulin to lower the blood glucose
Without insulin, glucose unable to enter cells
Acts as a transport to allow cells to access glucose

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8
Q

Glycogenesis

A

liver stores glycogen for the future

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9
Q

Hormones that can increase blood glucose

A

Epinephrine
Thyroid hormone
Growth Hormone (decreases how much muscle is using glucose)
Glucocorticoids

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10
Q

Drugs that Increase blood glucose

A

Phenytoin
Beta blockers
NSAIDS
Diuretics

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11
Q

Drugs that can decrease blood glucose

A

Alcohol
Lithium
ACE inhibitors

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12
Q

Diabetes Mellitus

A

Chronic metabolic disorder in which there is deficient insulin secretion or decreased sensitivity of insulin receptors resulting in hyperglycemia

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13
Q

Classification of DM

A

Type 1 and Type 2

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14
Q

Type 1 Diabetes

A

more chronic condition in childhood

Autoimmune disorder that destroys pancreatic beta cells

Difficult to control and there are a lot of complications

Sudden onset from ages between 4-20

High incidence of complications

Requires exogenous insulin administration***

Insulin dependent diabetes

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15
Q

Type 2 Diabetes

A

Characterized by high blood sugar

Caused by insulin resistance

Insulin is present, but the insulin is not working well

Historically, the onset is 40+ years old

90% of people with DM have type 2

This is not an autoimmune disorder

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16
Q

Insulin Resistance

A

Insulin receptors are not responding to insulin because there has been an influx of insulin for so long that the body is no longer excited about it

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17
Q

Risks for Type 2 Diabetes

A

Obesity

Sedentary lifestyle

Presence of metabolic syndrome

Abdominal obesity

Low HDL

Hypertriglyceridemia

Hypertension and/or impared fasting glucose

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18
Q

Ethnicities at risk for type two diabetes

A

African Americans: 13.3%
Hispanics greater than 13.9%

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19
Q

DM Clinical Manifestations

A

Polyuria
Hyperglycemia (fasting glucose greater than 126)
Polyphagia: frequent hunger
Polydipsia: frequent thirst
Glucosuria: so high that your kidneys start eliminating sugar
Weight loss
Fatigue

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20
Q

DM Chronic Complications from Untreated Diabetes

A

Nephropathy: damage to kidneys

Retinopathy: damage to eyes

Neuropathy: damage to nerves in the peripheral nervous system. Can lead to complete loss of feeling in certain limbs

Increased number and severity of infection

Poor wound healing

Diabetic foot ulcers

Poor sensation from nerve damage

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21
Q

DKA: diabetic Ketoacidosis

A

Life threatening, severe insulin deficiency, usually type 1
Fat broken down for energy, results in ketones
Fruity breath
Ketones in the urine
Drop in PH
Polyuria
Polydipsia
Coma
N+V

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22
Q

DKA: diabetic ketoacidosis Glucose level

A

Hyperglycemia (240+)

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23
Q

diabetic ketoacidosis treatment

A

lots of IV fluid and insulin

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24
Q

HHNC: Hyperosmolar Hyperglycemic Nonketotic Coma

A

Life threatening severe hyperglycemia, usually seen in type two diabetes
Excessive glucose and electrolytes
Severe dehydration
Typically because they do not know they are diabetic

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25
Q

HHNC: Hyperosmolar Hyperglycemic Nonketotic Coma

A

Polyuria: peeing so much
Dehydration
Drowsiness
Confusion
Coma

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26
Q

Diabetic Ketoacidosis Symptoms

A

Fruity breath
Ketones in the urine
Drop in PH
Polyuria
Polydipsia
Coma
N+V

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27
Q

Glucose level of HHNC

A

greater than 600

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28
Q

Abnormal fasting blood sugar

A

greater than 126

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29
Q

When to check blood sugar

A

before meals and before bedtime (AC and HS)

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30
Q

Diabetic AC blood sugar normal levels

A

70-130

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31
Q

Hemoglobin A1C

A

Measures average blood glucose over 3 month period

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32
Q

Hemoglobin A1C % that indicates diabetic

A

Over 7% means that the person is diabetic

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33
Q

s/sx of Hyperglycemia

A

Three ps
Fatigue
Weakness
Dry Skin

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34
Q

s/sx of hypotension

A

Sweating
Tremors
Tachycardia
Hunger
Confusion
Drowsiness
Seizures

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35
Q

Goal of Diabetic Drug Therapy

A

Control glucose levels and manage complications

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36
Q

tx for type 1 diabetes

A

insulin and insulin only

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37
Q

Insulin route

A

SubCue
Can be given IV

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38
Q

Rapid Acting Insulin Types

A

Lispro and Aspart

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39
Q

Rapid Acting Insulin OPD

A

O: 15-30 Min
P: 30-2.5h
D: 3-6H

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40
Q

Short Acting Type

A

Regular (only one that is able to be given IV)

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41
Q

Short Acting Insulin OPD

A

O: 30-60min
P: 1-5h
D: 6-10h

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42
Q

Intermediate Acting insulin Type

A

NPH

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43
Q

Intermediate Acting Insulin OPD

A

O: 1-2h
P: 4-12h
D: 16h

44
Q

Long Acting Insulin Types

A

Glargine, Detemir

45
Q

Long Acting Insulin OPD

A

O: 3-4h
P: continuous
D: 24h

46
Q

Ultra Long Acting insulin Type

A

Degludec

47
Q

Onset of insulin

A

when the insulin hits the bloodstream

48
Q

Peak of Insulin

A

when the insulin is at its strongest blood sugar lowering level

49
Q

Duration of insulin

A

how long you are gonna have the benefits from the insulin

50
Q

Contraindication for insulin

A

low blood sugar

51
Q

Nursing Consideration for insulin

A

Plan onset to start when the meal is being eaten.
I.e give lispro 20-30 minutes before you eat breakfast
I.e regular insulin should be taken 30-60 minutes before a meal

52
Q

We might need a snack when the blood sugar is lowest. When would this be

A

The Peak

53
Q

Drug to Drug Interaction with insulin

A

Beta blocker
Aspirin
NSAIDS

54
Q

Nursing Implications for insulin

A

Rotate injection site
Know onset and peak
Abdomen is the best injection site
Monitor for s/sx of hypoglycemia while they are sleeping

55
Q

Insulin pumps Function

A

provide basal dose of insulin (continuous underlying dose)

56
Q

Programmed insulin:

A

Set amount of insulin given to cover for the meal. Given with the meals. Regardless of blood sugar. The patient needs to be eating to receive programmed insulin

57
Q

Sliding Scale Insulin

A

Based on current blood sugar level
Example:
61-150=0 units
151-200=3 units
201-250=5 unites

58
Q

Patient Teaching with insulin

A

Weight control and exercise can reduce the glucose running in your bloodstream
Diet is important with new diabetic
Know signs and symptoms of hyper/hypo glycemia
Teach family what to do
Keep follow up appointments
Test blood glucose as ordered
What to do if you are sick
Proper SQ injection technique

59
Q

Sulfonylureas Example

A

Glyburide

60
Q

Sulfonylureas action

A

Stimulates pancreas to release insulin
Bind to K+ channels on pancreatic beta cells
Increase number of insulin receptors

61
Q

Sulfonylurea Indications for use

A

elevated blood sugars
*Must have some functioning beta cells

62
Q

Sulfonylurea Route

A

Oral

63
Q

Sulfonylurea Contraindications

A

Sulfa allergy
Renal failure
Liver failure

64
Q

Drug-Drug interactions with Sulfonylurea

A

Beta Blockers
Alcohol

65
Q

Alpha-Glucosidase inhibitor Example

A

Acarbose

66
Q

Alpha-Glucosidase inhibitor action

A

Delays digestion of complex carbohydrates
Decreases the increase in blood sugar after meals
Give it at the beginning of the meal because it works in the GI tract

67
Q

Alpha-Glucosidase inhibitor Adverse Effect

A

Hypoglycemia
GI upset
Gas
Diarrhea
Cramping

68
Q

Alpha-Glucosidase inhibitor Indication for Use

A

decrease postprandial glucose

69
Q

Alpha-Glucosidase inhibitor Contraindications

A

Liver disease
Bowel problem

70
Q

Alpha-Glucosidase inhibitor drug-to-drug interaction

A

Can DECREASE digoxin levels

71
Q

Biguanides Example

A

Metformin

72
Q

Biguanides Action

A

Decreases hepatic glucose production
Increases use of glucose by muscle and fat cells, decreases intestinal absorption of glucose
Overall decrease in blood glucose level

73
Q

Biguanide Indications for use

A

Insulin resistance
Common first choice for type 2 diabetes
Used to treat PCOS (Poly cystic ovarian syndrome)

74
Q

Biguanide Adverse Effects

A

Lactic acidosis
GI upset
Does not have anything to do with hypoglycemia*

75
Q

Biguanide Contraindications

A

Avoid using in older adults (80+) BLACK BOX
Avoid using with patients with renal failure
HOLD METFORMIN 48H BEFORE AND AFTER ANYTHING WITH A CONTRAST MEDIA

76
Q

Nursing implications for metformin

A

Take with meals
Increased effects when taken with:
Digoxin
Furosemide
Vancomycin
Monitor Renal function

77
Q

Thiazolidines Examples

A

Rosiglitazone

78
Q

Thiazolidines (TZDs) Action

A

Stimulates insulin receptors on muscle, fat, and liver cells
Helps body use the insulin better
Used in combination with insulin, sulfonylureas, or biguanides

79
Q

Thiazolidines (TZDs) Indication for use

A

Insulin Resistance

80
Q

Thiazolidines (TZDs) Adverse Effects

A

Hepatotoxicity
Congestive Heart Failure
Weight Gain
Liver disease (Black Box)
CV disease (Black Box)

81
Q

Thiazolidines Nursing Implications

A

Take with meals
Monitor Liver function studies
Monitor patients for signs of heart failure
Gemfibrozil may increase effects
May take 12 weeks to reach maximum effect

82
Q

Meglitinides example

A

Repaglinide

83
Q

Meglitinides Action

A

Stimulates pancreatic stimulation of insulin (need working beta cells)
Used in combination with TZDs or Biguanides

84
Q

Meglitinides Adverse Effects

A

Hypoglycemia
GI upset

85
Q

Meglitinides Contraindications

A

Renal and liver disease
Type 1 diabetes

86
Q

Meglitinides Nursing considerations

A

Give this medication just before meals. If we skip the meal we need to skip the dose

87
Q

Dipeptidyl Peptidase 4 inhibitors (DPP4) Example

A

Sitagliptin

88
Q

Dipeptidyl Peptidase 4 inhibitors (DPP4) Action

A

Balance the release of insulin and limit the release of additional glucose from the liver, inhibition of glucagon secretion, delayed gastric emptying, induction of satiety
NEED WORKING BETA CELLS
May take in combo with TZD and Biguanides

89
Q

Dipeptidyl Peptidase 4 inhibitors (DPP4) Adverse Effects:

A

Respiratory tract infection
Heart Failure

90
Q

Dipeptidyl Peptidase 4 inhibitors (DPP4) Contraindication

A

Using insulin
Renal failure
Type 1 diabetes

91
Q

Amylin Analogs Example

A

Pramlintide

92
Q

Amylin Analogs Action

A

Suppresses postprandial glucagon secretion and increases sense of satiety
Used in addition to insulin, sulfonylureas, and biguanides
Injection

93
Q

Amylin Analogs Adverse effects

A

Risk of hypoglycemia
BLACK BOX WARNING

94
Q

Amylin Analogs Nursing Implications

A

Monitor blood sugar closely
Avoid giving this with other anticholinergics because if will slow down GI
May promote weight loss
SQ injection before meals

95
Q

Incretin Mimetic Example

A

Exenatide

96
Q

Incretin Mimetic Action

A

Stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten
Sensitive to when you are eating
Gut is more sensitive to your food coming in

97
Q

Incretin Mimetic Indications for use

A

postprandial glucose elevation

98
Q

Incretin Mimetic Adverse Effects

A

Hypoglycemia
Gi distress
Pancreatitis

99
Q

Incretin Mimetic Contraindications

A

Liver disease
Black box warning: risk for thyroid cancer

100
Q

Incretin Mimetic Nursing implications

A

SQ injection within 1 hour of breakfast and dinner
Must be refrigerated
Some Extended Release versions available only need 1 weekly injection
May promote weight loss

101
Q

Sodium Glucose Cotransporter 2 Inhibitor Example

A

Canagliflozen
*New

102
Q

Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Action

A

Blocks reabsorption of glucose in the kidney, promotes excretion of glucose in the urine
Used in combination with other antidiabetics

103
Q

Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Adverse Effects

A

Dehydration*
Hypotension*
Electrolyte imbalance
Bone loss
Increased risk for limb amputation

104
Q

Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Contraindication

A

Renal failure

105
Q

Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Nursing implication

A

Take with the first meal of the day
Caustius giving this with other meds that might decrease blood pressure
Care for risk of dehydration or syncope

106
Q

Education for Hyperglycemia:

A

Call doctor if blood sugar is higher than 250
Call doctor if ketones in urine
Fever above 101
Vomiting or Diarrhea
Miss multidoses of meds

107
Q

Education Hypoglycemia

A

Alert:
Glucose gel
Orange juice or soda
2-3 glucose tabs

Unable to swallow:
Dextrose 50% half ampule
Glucagon SQ

Nursing (17 decks)

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