Exam 2 Flashcards
rapid acting insulin (lispro)
onset: 15 mins
peak: 1 hour
duration: 2-4 hours
regular insulin (short acting)
onset: 30-60 mins
peak: 2-6 hours
duration: 3-8 hours
intermediate insulin (NPH)
onset: 2-4 hours
peak: 4-10 hours
duration: 10-20 hours
long acting insulin (glargine)
onset: 70 mins
peak: NONE
duration: 24 hours
regulating glucose depends on the
liver
-extracts glucose
-synthesizes it into glycogen (energy storage)
-glycogenolysis (breakdown glycogen)
pancreas
controls body’s fuel supply (glucose/insulin)
2 major functions:
-exocrine: pancreatic cells secrete directly into ducts NOT bloodstream
-endocrine: cells secrete INSULIN directly into blood stream
islet of langerhans
pancreatic islets are small islands of cells within the pancreas that make up the endocrine function
alpha cells
secrete glucagon in response to low blood sugar
-glucagon stimulates the liver to release stored glucose into the blood
beta cells
produce insulin, which lowers glucose levels by stimulating the movement of glucose into body tissues
hormones that RAISE blood glucose levels
-glucagon (islet of langerhans)
-epinephrine (adrenal medulla and other chromafin tissues)
-glucocorticoids (adrenal cortex)
-growth hormone (anterior pituitary)
insulin
-hormone secreted by the pancreas (beta cells)
-stimulates uptake, utilization, and storage of glucose
-stimulates the liver to store glucose (as glycogen)
polyphagia
increased hunger
-catabolism of fat and protein and cellular starvation
polydipsia
excessive thirst
-increased serum osmolality
polyuria
excessive urination
-osmotic diuresis, excreting water, loss of electrolyte
somogyi effect
overdose of insulin causes hypoglycemia and counter regulatory mechanisms cause hyperglycemia and ketosis
-bc poor diabetes management, must talk about ways to fix it
dawn phenomenon
hyperglycemia in the morning due to natural hormonal release
-don’t do anything
glipizide and glyburide are what class of meds
sulfonylureas
adipose tissue
provides insulation and mechanical support for the body
-secretes hormone-like molecules=adipokines
-contributes to immune cell function
adipocytes
fat-storing cells
-store calories as triglycerides
-can increase in number and HYPERTROPHY to increase fat mass
adipokines
secreted by adipose tissue (ENDOCRINE organ)
-cell-signaling proteins
-help regulate: appetite, food intake, energy expenditure, lipid storage, insulin secretion/sensitivity, etc
adiponectin
good adipokine
-inverse relationship with fat content in the body
-increased fat content=less adiponectin produced
what does adiponectin do
-increase energy expenditure
-enhance cell sensitivity to insulin
-anti-inflammatory effects
-protects against arteriosclerosis
leptin
good adipokine
-more fat, more leptin
-obese ppl become leptin resistant
-normally tells body that you’ve had enough to eat (satiety)
-works with adiponectin to increase insulin sensitivity, reduce triglyceride levels, and inhibit fat accumulation
glipizide class
sulfonylureas
glyburide class
sulfonylureas
sulfonylureas (glipizide and glyburide) MOA
binding and closing K-ATP channels in the pancreatic beta cells thereby stimulating secretion of insulin
-increase body’s sensitivity or response to insulin
-reduces the release of glucose from the liver
sulfonylureas (glipizide and glyburide) side effects
hypoglycemia (in pts with liver or kidney dysfunction)
sulfonylureas (glipizide and glyburide) nursing considerations
-do not take during pregnancy
-teach patients to avoid or limit ETOH, NSAIDS, Tagamet, sulfa-based abx taking these makes it more likely to experience side effect of hypoglycemia
metformin class
biguanides
biguanides (metformin) MOA
-lowers blood glucose by decreasing production of glucose in the liver
-enhances glucose uptake and utilization by muscle
-does not promote insulin release from the pancreas
-does not cause hypoglycemia
biguanides (metformin) side effects
-abdominal bloating, N/V/D, risk for acidosis in patients with elevated creatinine, do not use in patients with elevated ALT levels
biguanides (metformin) nursing considerations
-monitor serum glucose levels, give 30 minutes before meals
-must be held for 48 hours post IV contrast usage
linagliptin class
DPP4 inhibitor
sazagliptin class
DPP4 inhibitor
sitagliptin class
DPP4 inhibitor
DPP4 inhibitors (-gliptin) MOA
inhibits DPP4, an enzyme that inactivates the incretin hormone
DPP4 inhibitors (-gliptin) side effects
GI problems, N/V, stomach pain, flu-like symptoms, skin reactions, increased risk of pancreatitis
dulaglutide class
GLP-1 receptor agonist
exenatide class
GLP-1 receptor agonist
semaglutide class
GLP-1 receptor agonist
GLP-1 receptor agonist (-tide) MOA
-enhances glucose dependent insulin secretion
-stimulates glucose-dependent release of insulin, inhibits postprandial release of glucagon, and suppresses appetite
-slowed gastric emptying
GLP-1 receptor agonist (-tide) side effects
-N/V/D, injection site reactions, headache, upper respiratory infections, weight loss
GLP-1 receptor agonist (-tide) nursing considerations
-do not use for pts with history of pancreatitis
-black box warning: risk of thyroid c-cell tumors
-not recommended for people with ESRD or severe renal disease
-subq
dapagliflozin class
SLG-2 inhibitors
SLG-2 inhibitors (dapagliflozin) MOA
-prevents kidneys from reabsorbing glucose back into the blood
-kidneys lower BG, excess BG removed via urine
SLG-2 inhibitors (dapagliflozin) side effects
-increased UTI risk, genital mycotic infections
-hypotension, fainting, dizziness, fatigue
SLG-2 inhibitors (dapagliflozin) nursing considerations
-oral
-do not give to someone with ESRD or severe kidney disease
-only type 2
orlistat is
OTC
orlistat MOA
binds to gastric and pancreatic enzymes and BLOCKS these enzymes; reduces fat absorption by 30%
orlistat side effects
-black box: liver injury
-GI symptoms: oily spotting, flatulence, and fecal incontinence…reduce by reducing fat intake to less than 30%
-decreases vitamin concentrations…MUST TAKE multi-vitamin with this medication
orlistat nursing considerations
-MUST TAKE FOR 3 MONTHS TO START SEEING EFFECT
glucagon
hypoglycemia antidote
glucagon MOA
activates hepatic glucagon receptors, stimulates glycogenolysis and release of glucose
-check finger stick 15 minutes post
donepezil class
cholinesterase inhibitors
cholinesterase inhibitors (donepezil) MOA
-works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase
cholinesterase inhibitors (donepezil) side effects
-normally none to mild, resolve on their own
-GI upset, drowsy, dizzy, insomnia, muscle cramping
-bradycardia, reflex tachycardia, syncope
-PO at bedtime, best with food
cholinesterase inhibitors (donepezil) nursing considerations
-patients forgetful, must have some way to ensure patient is taking medications
memantine class
NMDA receptor antagonist
NMDA receptor antagonist (memantine) MOA
-blocks stimulation of NMDA receptors believed to be associated with AD
NMDA receptor antagonist (memantine) side effects
-uncommon
-confusion, hypotension, headache, dizziness, CONSTIPATION
tramadol class
centrally acting analgesic
centrally acting analgesic (tramadol) MOA
-binds weakly to mu opioid receptors
-inhibit reuptake of norepi and serotonin
side effects of centrally acting analgesic (tramadol)
-usually none
-drowsy, dizzy, headache, nausea, constipation, respiratory depression
-rare: seizures when combined with other CNS depressants
gabapentin class
anti-convulsants
pregablin class
anti-convulsants
anticonvulsants (gabapentin and pregablin) MOA
-unknown, but thought to spontaneously suppress neuronal firing-pain
-to complement effects of opioids
-used specifically for neuropathic pain
anticonvulsants (gabapentin and pregablin) side effects
-drowsy, dizzy, visual problems
-can only be partially reversed with Naloxone
-NEUROPATHIC PAIN
aspirin, ibuprofen, naproxen, ketolorac, celecoxib class
NSAIDS
NSAIDS MOA
-anti-prostaglandins
-decreased prostaglandins by blocking key enzyme cyclooxygenase (COX) (an enzyme crucial to production of prostaglandins)
-COX-1 & COX-2
NSAIDS side effects
NON-SELECTIVE COX:
-GI upset, stomach ulcers, GI bleeding, rash, edema, kidney failure, increase in BP, inhibits platelet aggregation, SOA in asthma patients
SELECTIVE COX-2 INHIBITORS:
-GI mucosa still protected, and platelet function not impacted
-no impact/effect on platelets
-SERIOUS CARDIOVASCULAR THROMBOTIC EVENTS
-cardiovascular and GI risk black box warnings
acetaminophen MOA
-unknown
-decreases prostaglandin synthesis in the CNS possibly
acetaminophen side effects
-with normal doses hardly any
-large amounts hepatic necrosis (acute), LIVER FAILURE with chronic-long term use, and mild nephropathy
-potentially lethal when overdosed
-hepatotoxicity-ceiling effect
-NO-ANTI-INFLAMMATORY properties
-look for jaundice, elevated LFTs, creatinine levels
-adult dose restriction: 4 g/24 hrs
morphine MOA
-mu agonist mimics the action of endogenous opioids at the mu receptors
morphine side effects
-respiratory depression
-CNS depression
-constipation
-drowsiness/fatigue
-confusion, dry mouth, itching -assess LOC, BP, pulse, RR
when to use hydromorphone
SEVERE PAIN
when to use fentanyl
-moderate to severe pain
-surgical induction
-chronic pain
-EXTREMELY POTENT
when to use merperidine
-moderate to severe pain
-weaker than morphine and shorter duration of action
-less respiratory depression
-LOTS of drug/drug interactions -CNS stimulations=seizures DO NOT USE WHEN MULTIPLE DOSES NEED TO BE GIVEN
when to use codeine
-mild-moderate pain, reduce coughing
-not for children under 18 related to life threatening breaking problems
oxycodone
-moderate to severe pain
-10x more potent than codeine
hydrocodone
-mild-moderate pain and cough relief
-cough suppressant
-6x more potent than codeine
methandone
-choice for detoxification treatment in opioid addiction
-longer half-life
naloxone
-opioid antagonist
-antidote to reverse effects of morphine
-abrupt reversal of opioid effects with RECURRENT PAIN, increased BP
phenytoin class
hydantoins
phenytoin uses
tonic-clonic and partial seizures
valproic acid
-absence, myoclonic, and tonic-clonic seizures
-highly protein bound
-contraindicated for liver disease and urea cycle disorders
-adverse effects: hepatotoxicity, pancreatitis
topiramate
adjunct therapy for partial and secondary generalized seizures, tonic-clonic
-side effects: general CNS depression, GI upset, watch for visual changes
-can interact with contraceptives
levetiracetam
indicated for adjunct therapy for partial seizures with and without generalization
