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Pharm 1 > drug therapy for diabetes mellitus > Flashcards

drug therapy for diabetes mellitus Flashcards

1
Q

describe glucose

A

-sugar in the blood
-body’s primary energy source (easy to break down)
-brain almost exclusively uses glucose for energy

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2
Q

what are the two major hormones that stabilize glucose levels

A

glucagon an insulin

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3
Q

what secretes glucagon and unsulin?

A

pancreas - islets of langerhans

has alpha and beta cells

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4
Q

describe alpha cells

A

-glucaogn secreting cells
-increase blood glucose levels

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5
Q

describe beta cells

A

-insulin secreting cells
-decrease blood glucose levels

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6
Q

describe glucagon

A

-glucagon is secreted with low blood glucose
-helps maintain glucose between meals
-works with insulin to maintain levels

glucagon stimulates the liver to convert some stored glycogen to glucose to be usd by the body

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7
Q

describe blood glucose levels after a meal and other levels of shit and what happens

A

-increased blood glucose
-pancreas increases insulin secretion and decreases glucagon secretion
-results in cellular uptake of glucose

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8
Q

describe blood glucose levels between meals and other levels of shit and what happens

A

-decreased blood glucose
-pancreas decreases insulin secretion and increases glucagon secretion
-results in release of stored glucose and breakdown of fat

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9
Q

after a meal, the pancreas recognizes rising glucose… then what happens

A

secretes insulin to lower blood glucose
-without insulin, glucose unable to enter cells

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10
Q

what does insulin do?

A

acts as transport to allow cells access to glucose
-glucose can enter cells
-cells store glucose as glycogen
-converts lipids to fat
-increase protein synthesis and stop glucogenesis

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11
Q

what are some hormones that increase blood glucose

A

-epinephrine
-thyroid hormone
-growth hormone
-glucocorticoids

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12
Q

what are some drugs that increase glucose

A

-phenytoin
-NSAIDS
-diuretics

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13
Q

what are some drugs that can decrease glucose

A

-alcohol
-lithium
-ACE inhibitors

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14
Q

describe 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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15
Q

what are the two classifications of diabetes mellitus

A

-type 1
-type 2

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16
Q

both classification of DM are characterized by…

A

hyperglycemia

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17
Q

classifications of DM differ in…

A

-onset, course
-pathology, treatment

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18
Q

describe type 1 diabetes mellitus

A

-common chronic disorder of childhood
-autoimmune disorder that destroys panceatic beta cells
-sudden onset between ages 4 and 20
-high incidence of complications
-difficult to control
-requires exogenous insulin administration

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19
Q

describe type 2 diabetes mellitus

A

-characterized by hyperglycemia and insulin resistance (insulin is present but unable to work)
-historically, onset after age 40 years (increasing prevalence among children and teens)
-gradual onset with less severe symptoms
-90% of people with diabtees have type 2

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20
Q

what aresome risk factors for development of diabetes melltius

A

-obesity
-sedentary lifestyle
-presence of metabolic syndrome
-ethnicities at high risk (african americans 13.3%, hispanics greater than 13.9%)

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21
Q

describe metabolic syndrome

A

-abdominal obesity, low HDL
-hypertriglyceridemia
-HTN and/or impaired fasting glucose

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22
Q

what are some clinical manifestations of DM

A

-hyperglycemia (fasting blood glucose levels greater then 126mg/dl)
-polyuria
-polyphagia (increased hunger)
-polydipsia (increased thirst)
-glucosuria (sugar in piss)
-weight loss
-fatigue

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23
Q

what are some chronic macrovascular complications of DM

A

-HTN
-MI
-stroke
-PVD

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24
Q

what are some microvascular chronic complications of DM

A

-nephropathy (damage to kidneys)
-retinopathy (damage to eyes)
-neuropathy (damage to nerves in periphery)

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25
Q

what are some other chronic complications of DM

A

-increased risk for infection
-decreased wound healing r/t poor blood flow
-diabetic foot ulcers

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26
Q

what is DKA

A

-life threatening, severe insulin deficiency, usually type 1
-fat broken down for energy, results in ketones
-ketones reproduce faster than needed, cause drop in pH (acidosis)

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27
Q

name some symptoms of DKA

A

-fruity odor to breath
-ketones in urine
-kussmaul’s respirations
-severe hyperglycemia (>240)
-polyuria, polydipsia
-N/V
-coma

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28
Q

describe the tx of DKA

A

-lots of IV fluids
-insulin

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29
Q

describe hyperocmolar hyperglycemic nonketotic coma (HHNC)

A

-life threatning, severe hyperglycemia, usually type 2
-excessive glucose and electrolytes
-severe dehydration

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30
Q

what the symptoms of HHNC

A

-extremely high glucose (>600)
-polyuria
-dehydration
-drowsiness
-confusion
-coma

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31
Q

describe the treatment of HHNC

A

-lots of IV fluid
-give insulin
-may need to treat electrolyte imbalances

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32
Q

when are blood sugars generally checked

A

-check AC and HS ig eating
-Q6 if NPO or tube feeding/TPN

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33
Q

what value is abnormal fasting glucose

A

> 126

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34
Q

diabetic AC blood sugar goal is…

A

70-130

varies per agency and pt

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35
Q

what is hemoglobin A1C

A

-average blood sugar over 3 months
-normal less the 7%

greater than 7% indicates diabetes

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36
Q

true or false?

diabetes mellitus is a chronic, systemic disease characterized only by metabolic acidosis

A

false

DM is a chronic, systemic disease characterized by metabolic and vascular abnormalities

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37
Q

true or false?

insulin is a hormone secreted by beta cells in the pancreas

A

true

insulin is a ho**rmone secreted by beta cells in the pancreas that allows rapid entry of glucose into the cells

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38
Q

what are the symptoms of hyperglycemia

A

-three Ps (polyuria, polyphagia, polydipsia)
-fatigue
-weakness
-dry skin

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39
Q

what are the symptoms of hypoglycemia

A

-sweating
-tremors
-tachycardia
-hunger
-confusion
-drowsiness
-seizures

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40
Q

what is the goal of drug therapy for diabetes

A

control glucose levels and prevent complications

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41
Q

what does the treatment for DM depend on?

A

type of DM

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42
Q

what drug therapy is used for type 1 DM

A

insulins

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43
Q

what drug therapy is used for type 2 DM

A

-sulfonylureas
-alpha glucosidase
-biguanide
-thiazolidines
-meglitinides
-DDP 4 inhibitors
-amylin analogs
-incretin mimetics
-SGLT2 inhibitors

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44
Q

describe insulin

A

-human insulines only in the US
-synthetic product is identical to endogenous insulin
-synthesized in laboratories by altering the type or sequence of amino acids

different types differ in onset and duration of action

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45
Q

describe administration of insulin

A

-canno be given orally
-most given sub Q
-regular can also be given IV (this is the only type that can be)
-U100 concentration in US (100units/ml)
-measured with orange tipped syringe or pen

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46
Q

name some different type of insulin and describe em a little

A

-rapid acting (rapid onset, shorter duration than reg)
-short acting (regular) (short onset, short duration of action)
-intermediate acting (slower absorption, prolonged action)
-long acting (provide basal insulin over 24hr period similar to normal)
-**ultra long acting **(provide basal insulin over 42hr period)

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47
Q

insulin chart

rapid acting
generic name

A

-aspart
-lispro
-glulisine

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48
Q

insulin chart

rapid acting
onset

A

15-30min

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49
Q

insulin chart

rapid acting
peak

A

30min-2.5hr

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50
Q

insulin chart

rapid acting
duration

A

3-6hrs

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51
Q

insulin chart

short acting
generic name

A

regular

52
Q

insulin chart

short acting
onset

A

30-60min

53
Q

insulin chart

short acting
peak

A

1-5hrs

54
Q

insulin chart

short acting
duration

A

6-10hrs

55
Q

insulin chart

intermediate acting
generic name

A

-NPH
-isophane

56
Q

insulin chart

intermediate acting
onset

A

1-2hrs

57
Q

insulin chart

intermediate acting
peak

A

4-12hrs

58
Q

insulin chart

intermediate acting
duration

A

16hrs

59
Q

insulin chart

long acting
generic name

A

-detemir
-glargine

60
Q

insulin chart

long acting
onset

A

3-4hrs

61
Q

insulin chart

long acting
peak

A

continuous

62
Q

insulin chart

long acting
duration

A

24hrs

63
Q

describe the action of insulin

A

-increase glucose uptake by cells
-decreases glucose production by liver

64
Q

describe the use of insulin

A

-lower blood glucose
-regular may be given IM or IV in an emergency
-can be used in children and older adults

65
Q

name a contraindication of insulin

A

hypoglycemia

66
Q

describe timing with meals for insulin

A

plan for onset to start with meal
-lispro = 15-30mins before
-regular = 30-60mins before

snack at peak bc its the most likely time to see hypoglycemia

67
Q

what are some adverse effects of insulin

A

-hypoglycemia
-local reactions (rotate site)

68
Q

what are some drug-drug interactions with insulin

A

any drug that affects glucose levels
-beta blockers, MAOIs, salicylates, alcohol, herbal preparations

69
Q

what are some nursing implications r/t insulin

A

-be aware of mealtimes
-rotate injection site (abdomen best)
-monitor for hypoglycemia during sleep
-insulin pumps (provide basal dose, usually reg or rapid, may be allowed in hospital)
-high risk med (know policy, programmed vs SSI, know hypoglycemia protocol)

70
Q

describe programmed insulin orders

A

-given to regulate levels between meals
-set amount ordered
-watch nutrition status

71
Q

describe sliding scale insulin orders

A

-dose based on blood sugar levels
-notify MD if NPO

72
Q

describe patient teaching for insulin

A

-diet, weight control, and exercise
-know s/sx hyper/hypoglycemia
-teach family what to do
-keep follow up appts
-test blood glucose as ordered
-what to do if you are sick
-proper SQ injection technique

73
Q

true or false?

insulin plays a major role primarily in the metabolism of carbs

A

false

insulin plays a major role in metabolism of carbs, fat, and protein where the nutrients are broken down to simpler molecules (glucose, lipids, and amino acids)

74
Q

give and example of sulfonylureas

A

glyburide

75
Q

what do sulfonylureas do

A

stimulates pancreas to release insulin
-bind K+ channels on pancreatic beta cells
-increase number of insulin receptors

76
Q

what are some indications of use of sulfonylureas

A

elevated serum glusoce levels

must have some functioning beta cells (not for type 1)

77
Q

what are some adverse effects of sulfonylureas

A

hypoglycemia

78
Q

what are some contraindications of sulfonylureas

A

-sulfa allergy
-renal failure
-liver failure

79
Q

what are some drug-drug interactions with sulfonylureas

A

-beta blockers
-alcohol

80
Q

give an example of alpha-glucosidase inhibitors

A

acarbose

81
Q

what do alpha-glucosidase inhibitors do

A

delays digestion of complex carbs
-decreases the increase in BS after meals
-given in combo with sulfonylureas

82
Q

whats an indication of use for alpha-glucosidase inhibitors

A

decrease in postprandial glucose

83
Q

what are some adverse effects of alpha-glucosidase inhibitors

A

-hypoglycemia
-GI upset

84
Q

what are some contraindications of alpha-glucosidase inhibitors

A

-hepatic disease
-bowel conditions (IBS)

85
Q

name a drug-drug interaction for alpha-glucosidase inhibitors

A

can decrease digoxin levels

86
Q

name a nursing implication for alpha-glucosidase inhibitors

A

take at beginning of meal

87
Q

give and example of biguanides

A

metformin

88
Q

what do biguanides do

A

-decreases hepatic glucose production
-increases use of glucose by muscle and fat cells
-decreases intestinal absorption of glucose

89
Q

what are some indications for use of biguanides

A

-insulin resistance
-commonly first choice for type 2 DM
-used to treat PCOS

90
Q

what are some adverse effects of biguanides

A

-lactic acidosis
-GI upset

91
Q

what are some contraindications of biguanides

A

-older adults (black box warning to avoid over 80 y.o.)
-renal failure
-hold metformin 48hrs before and after contrast media (CT dye, heart cath) testing to avoid renal failure

92
Q

what are some nursing implications for biguanides

A

-take with meals
-increased effects if taken with furosemide, digoxin, vancomyocin
-monitor renal function

93
Q

give an example of thiazolinediones (TZDs)

A

rosiglitaxone

94
Q

what do thiazolinediones (TZDs) do

A

-stimulates insulin receptors on muscle, fat, and liver cells
-used in combo with insulin, sulfonylureas, or biguanides
-indications for use: insulin resistance

95
Q

what are some adverse effects of thiazolinediones (TZDs)

A

-hepatotoxicity
-congestive heart failure
-weight gain

96
Q

what are some contraindications of thiazolinediones (TZDs)

A

-liver disease
-CV disease (black box warning of risk of CHF and MI)

97
Q

what are some nursing implications of thiazolinediones (TZDs)

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 peak effects

98
Q

give an example of meglitinides

A

repaglinide

99
Q

what do meglitinides do

A

-stimulates pancreatic stimulation of insulin (needs working beta cells)
-used in combo with TZDs or biguinides
-indications for use: elevated serum glucose

100
Q

what are some adverse effects of meglitinides

A

-hypoglycemia less so than sulfonyureas
-GI upset

101
Q

what are some contraindications of meglitinides

A

-renal disease
-liver disease
-type 1 DM

102
Q

what are some nursing implications for meglitinides

A

-take just before meals (if meal is skipped, skip dose. if meal is added, add dose)
-gemfibrozil and itraconazole increase effects

103
Q

give an example of dipeptidyl peptidase 4 inhibitors (DPP-4)

A

sitagliptin

104
Q

what do dipeptidyl peptidase 4 inhibitors (DPP-4) do

A

-balance the release of insulin and linit the release of additional glucose from liver, inhibition of glucagon secretion, delayed gastric emptying, and induction of satiety (need working beta cells)
-may take in combo with TZD or biguanide
-indications for use: elevated serum glucose

105
Q

what are some adverse effects of dipeptidyl peptidase 4 inhibitors (DPP-4)

A

-upper resp infections
-heart failure

106
Q

what are some contraindications of dipeptidyl peptidase 4 inhibitors (DPP-4)

A

-type 1 DM
-insulin use
-renal failure

107
Q

what are some nursing implications for dipeptidyl peptidase 4 inhibitors (DPP-4)

A

one daily - with or without meals

108
Q

give an example of amylin analogs

A

pramlintide

109
Q

what do amylin analogs do

A

-suppresses postprandial glucagon secretion, increases sense of satiety
-used in addition to insulin, sulfonyureas, or biguanides
-indications for use: reagulate the postprandial rise in blood glucose

110
Q

what are some adverse effects of amylin analogs

A

hypoglycemia
black box warning for severe hypoglycemia if mixed with insulins

111
Q

what are some nursing implications for amylin analogs

A

-monitor blood sugars very closely
-avoid giving with anticholinergics
-may promote weight loss
-SQ injection

112
Q

give an example of incretin mimetics and describe them a little

A

exenatide

-stimulates panreas to secrete the right amount of insulin based on the food that was just eaten
-can be used in combo with oral meds
-indications for use: postprandial glucose elevations

113
Q

what are some adverse effects of incretin mimetics

A

-hypoglycemia
-GI distress and nausea
-pancreatitis

114
Q

what are some contraindications of incretin mimetics

A

-liver disease
-black box warning for risk of thyroid cancer

115
Q

what are some nursing implications for incretin mimetics

A

-SQ injection within one hour of breakfast and dinner
-must be refigerated
-some extended release versions available, only need 1 weekly injection
-may promote weight loss

116
Q

give an example of sodium glucose contransporter 2 inhibitors (SGLT2)

A

canagliflozin

117
Q

what do sodium glucose contransporter 2 inhibitors (SGLT2) do

A

-blocks reabsorption of glucose in the kidney, promotes excretion of glucose in urine
-used in combo with other ant-diabetics
-indication for use: improved glucose control

118
Q

what are some adverse effects of sodium glucose contransporter 2 inhibitors (SGLT2)

A

-dehydration
-hypotension
-electrolye imbalance
-bone loss
-increased risk of leg/foot amputations

119
Q

what are some contraindications of sodium glucose contransporter 2 inhibitors (SGLT2)

A

renal failure

120
Q

what are some nursing implications for sodium glucose contransporter 2 inhibitors (SGLT2)

A

-take with first meal of the day
-use caution in combo with meds that decrease BP
-risk for dehydration or syncope

121
Q

name some things to include in general patient education regarding antidiabetics

A

-consistent diet and exercise = best control
-maintain normal weight
-unopened bottle of insulin stored in fridge
-kow s/sx hyper/hypo glycemia and what to do
-teach friend/family how to treat hypoglycemia
-maintain BS to prevent complications
-complete follow up appts
-dont start new med/herbs without telling MD
-alert MD if BS is greater than 250

122
Q

describe hyperglycemia management

A

seek MD if:
-BS more than 250
-ketones in urine
-fever above 101
-vomiting/diarrhea
-miss multidose of a med

123
Q

describe hypoglycemia management

A

-rapidly absorbed sugar (takes 10-20 minutes to work)
-if the patient is alert you can give 4oz of juice, 1 tube glucose gel, or 2-3 glucose tabs)
if the patient is unable to swallow dextrose 5-% half ampule, glucagon IM, SQ

avoid taking so much sugar that you cuase hyperglycemia

124
Q

describe managing sick days as a diabetic

A

-illness can cause stress response and increase BS
-continue to take anti-diabetic meds
-test for ketones in urine
-check glucose at least 4x daily
-if unable to eat, continue liquids -> 15g carbs every 1-2 hrs, drink 2-3 quarts of fluids

15g carbs = 8oz of gatorade

125
Q

a pt with type 2 DM is scheduled for a heart cath in one week. the nurse instructs the pt to stop taking which med 2 days before the procedure?

A

metformin

biguanides like metformin can cause kidney failure if given 48 hours before or after receiving contrast dye

Pharm 1 (29 decks)

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