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Pharmacology > Exam 4: Diabetes > Flashcards

Exam 4: Diabetes Flashcards

1
Q

What are the two rapid acting insulins?

A

1) lispro 2) aspart

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2
Q

What is the ONSET of lispro and aspart?

A

LESS than 30 min

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3
Q

What is the PEAK of lispro and aspart

A

30-90 min

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4
Q

What is duration of lispro and aspart?

A

3-5 hours

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5
Q

What is the short acting insulin?

A

regular

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6
Q

Regular insulin is the only insulin that comes in ____ form

A

IV

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7
Q

What is the ONSET of regualr insulin?

A

30 min

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8
Q

What is the PEAK of regular insulin?

A

2-5 hours

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9
Q

What is the duration of regular insulin?

A

4-12 hours

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10
Q

What is the intermediate acting insulin?

A

isophane NPH

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11
Q

isophane NPH is the only insulin that is _____ in appearance

A

cloudy

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12
Q

What is the ONSET of isophane NPH?

A

1-2 hours

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13
Q

What is the PEAK of isophane NPH?

A

4-12 hours

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14
Q

What is the duration of isophane NPH?

A

LESS than 24 hours

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15
Q

What are the two long acting insulins?

A

1) glargine 2) detemir

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16
Q

What is ONSET of glargine and detemir?

A

1 hour

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17
Q

What is the PEAK of glargin and detemir?

A

glargine has NO peak and detemir is 6-8 hours

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18
Q

What is the duration of glargin and detemir?

A

Duration is 24 hours

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19
Q

What is the combination insulin, HumULIN?

A

70 NPH and 30 regular

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20
Q

What is the combination insulin, isophane?

A

50 NPH and 50 regular

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21
Q

What is the combination insulin, HumALOG?

A

75 lispro protamine and 25 lispro

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22
Q

What are the two MOAs of insulin in order to lower BG?

A

1) promote cellular uptake of glucose 2) convert glucose into glycogen

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23
Q

What is the MOA of insulin in order to lower K?

A

promote cellular uptake of potassium

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24
Q

What is the indication for insulin for Type I and Type II?

A

ALL for Type I and only after Type II do not respond to oral agents to control BG

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25
Q

What are four other indications for insulin use?

A

1) acute stress (acute disease/surgery/trauma) 2) gestational 3) acute exacerbation of DM 4) hyperkalemia

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26
Q

What are the three types of admin form of insulin?

A

1) syringe and multi-dose vial 2) insulin pen 3) inlusin pump

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27
Q

Main route for insulin? And how should it be administered and why?

A

subQ. rotate site of injection to avoid lipodystrophy (atrophy, hypertrophy)

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28
Q

What level is needed to avoid hypoglycemia?

A

BG LESS than 70

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29
Q

When is rapid/short insulin administered?

A

AC (before meals) according to sliding scale and PRN for hyperglycemia (consult provider)

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30
Q

When is NPH given?

A

bid

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31
Q

When is detemir given?

A

once daily at HS (bedtime) OR bid

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32
Q

When is glargine given?

A

once daily at HS (bedtime)

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33
Q

Insulin becomes _________ after expiration?

A

ineffective

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34
Q

Open vials of insulin can be kept at room temp for up to ________?

A

29 days OR 3 months in a refrigerator

35
Q

Unopened vials of insulin can be kept in refrigerator until _________?

A

expiration date

36
Q

What should you NEVER do when storing insulin?

A

place in freezer

37
Q

What shoudl you avoid when storing insulin?

A

sunlight or heat

38
Q

How should premixed vials ALWAYS be stored?

A

in refrigerator

39
Q

What should a patient receiving insulin always wear?

A

medical alert bracelet

40
Q

When meal planning for the next 24 hours before admin of insulin: 1) avoid HYPOglycemia at the time of ______ and _____? 2) monitor for HYPERglycemia at the end of _________? 3) know what to do with insulin if expecting NPO in next 42 hr and __________ ?

A

1) onset and peak 2) duration of action 3) call the provider

41
Q

What are the two labs to check serum glucose?

A

point of care (capillaries blood sample - bedside) and serum BG by lab (venous sample)

42
Q

A SSI (Standing Order) for insulin used to manage BG at AC, can only be administerd if what two conditions are met?

A

patient is allowed to have a diet AND is willing to eat

43
Q

What type of insulin is a standing order used for?

A

short/rapid acting: lispro, aspart, regular

44
Q

ASA, glucocorticoids, diuretics, thyroid hormones, estrogen, epi - all do what to BG?

A

INCREASE BG

45
Q

oral antidepressants, oral AC - do what to BG?

A

DECREASE BG

46
Q

Oral Antidiabetic Agents MOA: _________ cell sensitivity to endogenous insulin

A

INCREASE

47
Q

Oral Antidiabetic Agents MOA: __________ insulin production

A

INCREASE

48
Q

Oral Antidiabetic Agents MOA: ___________ incretin (secreted from small intestine) to _________ insulin

A

INCREASE, INCREASE

49
Q

Oral Antidiabetic Agents MOA: ___________ breakdown of glycogen

A

DECREASE

50
Q

Oral Antidiabetic Agents MOA: ____________ breakdown of starches in GI

A

DECREASE

51
Q

What are the three oral antidiabetic agents in the group sulfonylureas?

A

glimepiride, glipizide, and glyburide

52
Q

What is main side effect of glimepiride, glipizide, and glyburide?

A

HYPOglycemia

53
Q

Why should alcohol be avoided with glimepiride, glipizide, and glyburide?

A

they cause disulfiram-like reaction

54
Q

What are the contraindications for glimepiride, glipizide, and glyburide?

A

SURGERY & SEVERE INFECTION, renal failure, liver failiure, pregnancy, lactation

55
Q

What is the oral antidiabetic agent drug in the group Biguanides?

A

metformin

56
Q

What is one key thing to remember to avoid RF when taking metformin?

A

stop taking 48 hours prior and after IV contrast!!

57
Q

GI upset, diarrhea, nausea, and anorexia are all side effects of metformin - to negate, how should metformin be administered?

A

BID with meals to decrease the side effect of diarrhea

58
Q

What dificiencies are you going to have with metformin?

A

Vit B12 and folic acid (B9) - provide supplements PRN

59
Q

Three contraindications of metformin?

A

1) severe infection 2) acute disorders 3) chronic alcohol abuse disorder

60
Q

What is the Alpha-glucosidase Inhibitor?

A

acarbose

61
Q

What is the Alpha-glucosidase Inhibitor, acarbose, MOA?

A

blocks pancreatic amylase (prevents sucrose break down)

62
Q

Since acarbose blocks pancreatic amylase (prevents sucrose break down) - when should it be administered?

A

Take with teh FIRST BITE of a meal TID

63
Q

What is a key safety education point for those taking acarbose when managing HYPOglycemia?

A

manage with dextrose paste - NOT table sugar

64
Q

What side effect does acarbose cause in regards to iron? What should the nurse monitor?

A

it causes poor iron absoprtion = anemia. the nurse should monitor H&H

65
Q

Acarbose causes GI sypmtoms, but what is important to note about this side effect?

A

they diminish over time

66
Q

What are the two main contraindications for the use of acarbose?

A

1) inflammatory bowel disease 2) bowel ulceration/obstruction

67
Q

For oral antidiabetic agents - what is the contraindication in terms of a patient that it will be ineffective in?

A

Type I DM

68
Q

What pregnancy category are oral antidiabetic agents in?

A

C - risk to animal fetus

69
Q

When taking oral antidiabetic agents - what requires 24 hour planning?

A

next 24 hour meal planning

70
Q

What two impairments should you caution for when using oral antidiabetic agents?

A

hepatic and renal impairments

71
Q

What side effect do oral antidiabetic agents cause on the heart and oxygen demand?

A

INCREASE cardiac function and O2 demand

72
Q

What patient education should be given to a patient taking oral antidiabetic agents?

A

keep a log of BG with factors affecting (diet, infection, medication, acitivty)

73
Q

For nursing considerations, why should a DM patient avoid alcohol: 1) high carb content causes _________ 2) liver failure causes __________ 3) low PO intake causes _________ , therefore _________ 4) interactions with oral agents causing __________ reactions

A

1) HYPERglycemia 2) HYPOglycemic effect 3) malnutrition, HYPOgylcemia 4) disulfiram-like reactions

74
Q

What are the two main goals for BG in diabetic patients?

A

Keep fasting BG below 150 (normal people would be less than 100) AND prevent HYPOglycemia (emergency!!)

75
Q

The main HYPOglycemia causes are: 1) too much _____ or ______ 2) too little _______, _______, ________ 3) physical activity without proper __________

A

1) insulin, oral agent 2) food, vomiting, diarrhea 3) carb loading

76
Q

Definition of HYPOglycemia?

A

BG LESS than 70 mg/dL

77
Q

What are the EARLY s/s of hypoglycemia?

A

anxiety, diaphoresis, cold/clammy skin, shakiness, palpitations (tachycardia)

78
Q

What are the LATE s/s of hypoglycemia?

A

AMS, slurred speech, poor cordination, drowsiness, difficutly arousing from sleep, seizure/coma, death within minutes

79
Q

What it critical to know about beta-blockers usage in DM patients?

A

it can mask hypoglycemia s/s of tachycardia - so reducing HR making it difficult for the patient to report palpitation

80
Q

If patient is FULLY awake and can SAFELY swallow, what are the hypoglycemia treatments used?

A

Give apple juice and check BG 15 min later, if BELOW 75 - retreat. Follow with some protein (PB sandwich)

81
Q

If patient is LETHARGIC/DROWSY (need verbal/tactile stimulation) - what should you NOT do for hpyoglycemia treatment?

A

NOT take anything my mouth

82
Q

If patient is LETHARGIC/DROWSY (need verbal/tactile stimulation) - what injection should give, why, what route, and what is onset?

A

1 mg glucagon IM - to stimulate the liver to release glucose. onset: 10 min

83
Q

If patient is LETHARGIC/DROWSY (need verbal/tactile stimulation) - what is the most immediate acting hypoglyemic treatment? route? onset?

A

25-50 ml of 50% dextrose in water (D50) - patent IV site. onset: 1 min

Pharmacology (7 decks)

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