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Pharmacology Test #4 > Medications Affecting Blood Glucose > Flashcards

Medications Affecting Blood Glucose Flashcards

1
Q

What drugs can cause hypoglycemia?

A

ACE inhibitors, alcohol, lithium, beta-adrenergic blockers ( blocking beta-1 masks symptoms and blocking beta-2 causes hypoglycemia)

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2
Q

What drugs can cause hyperglycemia?

A

epinephrine (alpha and beta adrenergic agonist) (through its beta-2 stimulation it causes hyperglycemia), thyroid hormones, growth hormone, corticosteroids (prednisone, solu-medrol, especially if a stressed diabetic with an infection), loop and thiazide diuretics, phenytoin

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3
Q

What is the onset, peak, and duration of Lispro (Humalog), and aspart (Novolog), rapid acting insulins?

A

onset: 15-30 minutes
peak: 0.5-2.5 hours
duration: 3-6 hours

USUALLY GIVEN BEFORE MEALS, MAKE SURE YOU SEE THE FOOD TRAY ON THE UNIT BEFORE ADMINISTERING

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4
Q

What is the onset, peak, and duration of regular insulin (Humulin R); and regular insulin (Novolin R), short-acting insulins?

A

onset: 0.5-1 hour
peak: 1-5 hours
duration: 6-10 hours

CAN BE GIVEN BEFORE BREAKFAST FOR GLUCOSE CONTROL

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5
Q

What is the onset, peak, and duration of NPH (Humulin N); and detemir (Levemir), intermediate-acting insulins?

A

onset: 1-2 hours

Peak: 6-14 hours

duration: 16-24 hours

USUALLY GIVEN IN MORNING FOR LUNCH, POSTPRANDIAL LUNCH AND INTO DINNER

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6
Q

What is the onset, peak, and duration of glargine (Lantus), long-acting insulin?

A

onset: 70 minutes
peak: NONE
duration: 24 hours

USUALLY GIVEN AT NIGHT for steady blood glucose control

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7
Q

What is Humulin 70/30 composed of?

A

70% NPH and 30% regular insulin

USUALLY GIVEN IN MORNING TO COVER BREAKFAST, LUNCH, AND DINNER

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8
Q

What is Humalog 75/25 composed of?

A

75% insulin lispro protamine (intermediate-acting) and 25% insulin lispro (rapid-acting)

USUALLY GIVEN IN MORNING TO COVER BREAKFAST, LUNCH, AND DINNER

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9
Q

Is the pre-mixed insulin injection a better way than assessing blood glucose and getting the exact dose needed?

A

NO NO NO

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10
Q

If the nurse needed to manually mix insulin, what is the proper procedure, do you draw up cloudy or clear first?

A

draw up clear first!

  • roll insulin vials between hands
  • pull air into syringe and inject air into NPH (cloudy) vial
  • inject air into regular vial
  • draw up regular
  • draw up NPH (cloudy)
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11
Q

What is the therapeutic outcome of insulin?

A

promotes cellular uptake of glucose

moves potassium into cells with glucose (can be an emergent treatment of hyperkalemia) usually given with glucose to maintain bg

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12
Q

What can insulin be a treatment for other than hyperglycemia?

A

hyperkalemia (promotes influx of potassium into cells)

USUALLY GIVEN WITH GLUCOSE TO MAINTAIN BG LEVELS

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13
Q

What type of diabetes is insulin typically used to treat?

A

Type 1 glycemic control

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14
Q

Why would insulin be used in a patient with type 2 diabetes?

A

If diet/oral medications arent effective

NPO for surgery

Experiencing stress (can increase BG)

Tx for DKA and HHNS

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15
Q

What is the big adverse effect that can happen with insulin? What is a sign of this?

A

hypoglycemia - acute onset = (sympathetic response) - tachycardia, palpitations, diaphoresis, shakiness… gradual onset = (parasympathetic response) - weakness, HA, tremors, largely unknown why this gradual response occurs

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16
Q

If the patient has suspected hypoglycemia and is conscious what are the two things the nurse should do?

A

Check the blood glucose with a glucometer AND if hypoglycemic administer glucose - 15g carbohydrate (4oz juice, 8oz milk, or 1-2 glucose tablets)

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17
Q

If the patient is hypoglycemic and is unconscious, what is the best way to administer glucose?

A

IV glucose

IM or SQ glucagon

NOTHING ORAL!!!

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18
Q

Should diabetics wear a medical alert bracelet?

A

YES YES YES

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19
Q

What is an adverse effect from insulin injections themselves? What is a good way to prevent this?

A

lipohypertrophy - scar tissue and fat deposits form a lump under the skin of injection site

part injections at least an inch away from previous injections

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20
Q

Are there drugs that can make hypoglycemia worse or counteract the effects of insulin causing hyperglycemia?

A

YES YES YES

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21
Q

When are some times when insulin dosing may need to be adjusted?

A

ill

stressed

growth spurts

increased food intake

2nd and 3rd trimester of pregnancy

22
Q

Do you shake the insulin vials?

A

NO NO NO, you gently rotate vials to avoid damaging the insulin.

23
Q

If the short-acting insulin looks cloudy should it still be administered?

A

NO NO NO (should be clear, means its bad)

24
Q

What insulins can Lantus be mixed with?

A

NONE

it is acidic and cannot be mixed

25
Q

Should insulin be injected in the same area? Which area allows for fastest absorption and which area allows for slowest absorption?

A

YES YES YES

but sites in the area should be rotated

Abdomen - fastest

Thigh - slowest

26
Q

What are some key points for storage of insulin?

A

Unopened vials can be stored in the fridge until the expiration date

opened vials can be stored at room temperature for one month

premixed vials may be stored for up to 3 months in the fridge

syringes that are premixed may be kept for 1-2 weeks in the fridge, keep in vertical position with needles pointing up, gently rotate syringe to mix medication.

27
Q

What is the therapeutic action of sulfonylureas and meglitinides?

A

They both increase insulin secretion from the pancreas.

28
Q

What are the two adverse effects of sulfonylureas and meglitinides?

A

hypoglycemia

disulfiram reaction with alcohol

29
Q

When should sulfonylureas and meglitinides be administered?

A

30 minutes before meals for onset to occur during meal.

30
Q

What is the therapeutic action of biguanides?

A

reduces production of glucose in the liver and increase muscle uptake of glucose

31
Q

What are the 3 adverse effects of biguanides? and some nursing considerations/teaching points for them?

A

GI - anorexia, n/v, weight loss - monitor and may need to discontinue

Vitamin B12 and folic acid deficiency - provide supplements, encourage patient to take vitamins

Lactic acidosis - BIG ONE - hyperventilation, sluggishness, somnolence, myalgia (muscle pain) – avoid in patients in shock, severe infection, and hypoxic condition because these cause lactic acidosis as well

32
Q

What should the patients avoid while taking biguanides ?

A

alcohol - it can increase the lactic acidosis

33
Q

When should biguanides be taken?

A

With meals (helps with GI effects)

34
Q

What is the therapeutic action of thiazolidinediones (Gliazones)?

A

increase cellular response to insulin by decreasing resistance

increase cellular uptake of glucose and decrease the production of glucose

35
Q

What are the 3 adverse effects of gliazones? What are some patient teaching/nursing considerations for them?

A

fluid retention - monitor for edema, weight gain, signs of heart failure

elevation in LDL - monitor cholesterol

hepatotoxicity - baseline and periodic liver function tests, teach patient signs of liver dysfunction

36
Q

What are the two types of patients who shouldnt receive gliazones?

A

Patients in severe heart failure and patients in liver failure

37
Q

Can gliazones be taken with or without food?

A

YES YES YES

38
Q

What is the therapeutic action of alpha glucosidase inhibitors?

A

slows carbohydrate absorption and digestion

39
Q

What are the 3 adverse effects of Alpha glucosidase inhibitors? What are some nursing considerations/patient teaching points for them?

A

GI effects - abdominal distention, cramping, hyperactive bowel sounds, diarrhea, gas - monitor and report, may discontinue, TAKE WITH MEALS

anemia - due to decreased iron absorption - monitor H&H, may discontinue

hepatotoxicity with long-term use - check baseline and periodic liver function

40
Q

What types of patients would we want to avoid giving alpha glucosidase inhibitors to?

A

inflammatory GI disorders, ulcerations, obstructions

41
Q

What is the therapeutic action of amylin mimetics?

A

mimics the action of peptide hormone to reduce postprandial glucose levels

MAY BE USED IN CONJUNCTION WITH OTHER ORAL ANTIDIABETIC AGENTS

42
Q

When and how would you administer amylin mimetics? What should the nurse watch out for?

A

administer SQ prior to meals using the thigh or abdomen, this slows the absorption allowing for its postprandial effect

monitor injection site for reactions

43
Q

What is the therapeutic action of incretin mimetics?

A

mimics the effects of naturally occurring glucagon promoting the increase of insulin

MAY BE USED IN CONJUNCTION WITH OTHER ORAL ANTIDIABETICS

44
Q

When and how would you administer incretin mimetics?

A

administer 60 minutes before meal SQ (so effect occurs during meals)

45
Q

Do we mix amylin or incretin mimetics with insulin?

A

NO NO NO

some incretin mimetics come pre-mixed, but we never mix ourselves

46
Q

What is an adverse effect of incretin mimetics?

A

pancreatitis - severe abdominal pain - MONITOR AND REPORT SIGNS

47
Q

What is the therapeutic action of glucagon (GlucaGen)?

A

increases the breakdown of glycogen to glucose to increase blood sugar levels

48
Q

What is glucagon used for?

A

emergent treatment of hypoglycemic state, usually when patient is unconscious.

49
Q

How would glucagon be administered when unconscious?

A

SQ, IM, or IV

50
Q

As soon as the patient is conscious what would you immediately give them?

A

FOOD!!

51
Q

What is the big thing to teach patients about management of hypoglycemia?

A

always have a source of glucose with you!!

52
Q

What does glucagon do to help radiological procedures?

A

decreases gastric motility for better imaging.

Pharmacology Test #4 (8 decks)

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