Lilley Chapter 33: Antidiabetic Drugs Flashcards
Which of the following is a rapid-acting insulin with an onset of action of less than 15 minutes?
A. Insulin detemir (Levemir®)
B. Insulin glargine (Lantus®)
C. Regular insulin (Humulin R®)
D. Insulin aspart (Humalog®)
D. Insulin aspart (Humalog®)
Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is short-acting.
Which long-acting insulin mimics natural, basal insulin, with no peak action and a duration of 24 hours?
A. Neutral protamine Hagedorn (NPH) insulin
B. Regular insulin (Humulin R)
C. Insulin glargine (Lantus)
D. Insulin glulisine (Apidra®)
C. Insulin glargine (Lantus)
Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.
Which insulin can be administered by continuous intravenous (IV) infusion?
A. Insulin aspart (Humalog)
B. Insulin detemir (Levemir)
C. Insulin glargine (Lantus)
D. Regular insulin (Humulin R)
D. Regular insulin (Humulin R)
Regular insulin is the only insulin used for IV therapy.
Assuming the patient eats breakfast at 0830 hours, lunch at noon, and dinner at 1800 hours, he or she is at highest risk of hypoglycemia after an 0800-hour dose of NPH insulin at what time?
A. 1700 hours
B. 1000 hours
C. 1400 hours
D. 2000 hours
A. 1700 hours
Breakfast eaten at 0830 hours would cover the onset of NPH insulin, and lunch will cover the 1400 hour time frame. However, if the patient does not eat a midafternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.
The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure?
A. metformin (Glucophage®)
B. repaglinide (GlucoNorm®)
C. pioglitazone (Actos®)
D. acarbose (Glucobay®)
A. metformin (Glucophage®)
The concurrent use of metformin with iodinated (iodine-containing) radiological contrast media has been associated with both acute renal failure and lactic acidosis. Therefore, metformin should be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiological study that requires such contrast media.
Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and to skip the dose if he or she does not eat?
A. repaglinide (GlucoNorm)
B. acarbose (Glucobay)
C. pioglitazone (Actos)
D. metformin (Glucophage)
A. repaglinide (GlucoNorm)
Repaglinide’s very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.
The patient has been prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) to be administered subcutaneously every morning. What should the nurse tell the patient about how the insulin is to be administered?
A. “Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.”
B. “Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption.”
C. “Inject the needle at a 30-degree angle.”
D. “Rotate sites at least once or twice a week.”
A. “Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.”
When insulins are mixed, withdraw the regular (clear) insulin first, then withdraw the NPH (cloudy) insulin.
The nurse is teaching a patient about insulin glargine (Lantus). Which of the following instructions she gives the patient is correct?
A. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”
B. “You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism.”
C. “It is often combined with regular insulin to decrease the number of insulin injections per day.”
D. “The duration of action for this insulin is 8 to 10 hours, so you will need to take it twice a day.”
A. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”
Insulin glargine is a long-acting insulin with a duration of action up to 24 hours. It should not be mixed with any other insulins. It is usually dosed once daily, but it may be dosed every 12 hours, depending on the patient’s glycemic response.
The nurse is providing education to a patient who has been prescribed gliclazide. The nurse explains that this medication is more effective when administered at which time?
A. At bedtime
B. In the morning
C. 30 minutes before a meal
D. 15 minutes postprandial
C. 30 minutes before a meal
Gliclazide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the gliclazide to correspond to the elevation in the blood glucose level induced by the meal.
The nurse will instruct the patient to treat hypoglycemia with which drug?
A. acarbose (Glucobay)
B. bumetanide
C. glucagon
D. propranolol
C. glucagon
Glucagon stimulates glycogenolysis, raising serum glucose levels.
When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug?
A. Insulin glulisine (Apidra)
B. NPH insulin
C. Insulin glargine (Lantus)
D. gliclazide (Diamicron®)
D. gliclazide (Diamicron®)
Oral medications are generally not recommended for patients who are pregnant because of a lack of firm safety data. For this reason, insulin therapy is currently recommended drug therapy for pregnant women with diabetes.
As part of a teaching plan, what should the nurse tell patients who are taking oral hypoglycemic drugs? (Select all that apply.)
A. It is okay to skip breakfast one to two times per week.
B. Report symptoms of anorexia and fatigue.
C. Dietary changes are not necessary.
D. Take the medication only as needed.
E. Avoid smoking and alcohol consumption.
B, E. Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. Skipping meals can cause low blood glucose levels and should be avoided. Type 2 diabetes mellitus is managed with lifestyle changes. All other options are correct.
Which of the following describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.)
A. Increase of hepatic glucose production
B. Inhibited breakdown of insulin by liver
C. Enhanced actions of insulin in various tissues
D. Stimulation of insulin secretion from beta cells
B, C, D. The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would increase serum glucose levels, the opposite effect as that of oral hypoglycemic drugs.
