MS - Diabetes Medications Flashcards
What are the onset, peak time and durations of rapid-acting, short-acting, intermediate acting, and long-acting insulin, and major insulin examples of each type?
Rapid-acting: Onset: 10-30 minutes Peak time: 30 min-3 hours Duration: 3-5 hours Major examples: lispro (Humalog), aspart (NovoLog), glulisine (Apidra)
Short acting: Onset: 30 min-1 hour Peak time: 2-5 hours Duration: 5-8 hours Major examples: Regular (Humulin R, Novolin R)
Intermediate acting: Onset: 1.5-4 hours Peak: 4-12 hours Duration: 12-18 hours Major examples: NPH (Humulin N, Novolin N)
Long acting: Onset: 0.8-4 hours Peak: no pronounced peak Duration: 24+ hours Major examples: glargine (Lantus), detemir (Levemir)
Which type of insulin can’t be mixed with any other insulin?
Long-acting cannot be mixed with any others (also can’t be diluted)
The client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement?
a. Provide a high-fat diet 24 hours prior to test.
b. Hold the biguanide medication for 48 hours prior to the test.
c. Obtained an informed consent form for the test.
d. Administer pancreatic enzymes prior to the test.
b. Hold the biguanide medication for 48 hours prior to the test.
Biguanide medication must be held for a test with contrast medium because it increases the risk of acidosis, which leads to renal problems.
When should Lispro insulin (Humalog) be administered?
a. Only once a day
b. 1 hour before meals
c. 30 to 45 minutes before meals
d. At mealtime or within 15 minutes of meals
d. At mealtime or within 15 minutes of meals
Which information will the nurse include when teaching a 50-year-old client who has type 2 diabetes about glyburide (Micronase, DiaBeta, Glynase)?
a. Glyburide decreases glucagon secretion from the pancreas.
b. Glyburide stimulates insulin production and release from the pancreas.
c. Glyburide should be taken even if the morning blood glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media
b. Glyburide stimulates insulin production and release from the pancreas.
The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking the glyburide, because hypoglycemia can occur with this class of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glucagon secretion is not affected by glyburide.
The client with type I diabetes mellitus is taught to take NPH (Humulin N) at 5 pm. each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?
a. 11 a.m., shortly before lunch.
b. 1 p.m., shortly after lunch.
c. 6 p.m. shortly after dinner.
d. 1 a.m., while sleeping.
d. 1 a.m., while sleeping.
Biguanides
Example: metformin (Glucophage)
- Reduces glucose production by the liver.
- Also enhances insulin sensitivity at tissue level and improves glucose transport into cells.
- Most common
- Hold before (1-2 days) and up to 48 hours after procedures with contrast - could pose a risk of acute kidney injury
Sulfonylureas
Examples: glipizide (Glucotrol), glimepiride (Amaryl), glyburide (Micronase)
- Increases insulin production by pancreas
- Hypoglycemia major side effect. Can cause weight gain.
Meglinitides
Examples: repaglinide (Prandin), nateglinide (Starlix)
- Increases release of insulin from pancreatic islets
- When taken before meal (30 min) - mimics normal response to eating
- Rapidly absorbed and eliminated, less likely to cause hypoglycemia
- Should not be taken if a meal is skipped
- Can cause weight gain
Alpha-glucosidase inhibitors
Examples: acarbose (Precose)
- “Starch blockers”
- Delay absorption of glucose in intestine –> decreased postprandial blood glucose
- Increases glucose uptake in muscles, decreases endogenous glucose production
- Taken with first bite of each MAIN meal
- Measured 2 hours after meal
Thiazolidinediones
Examples: pioglitazone (Actos), rosiglitazone (Avandia)
- “Insulin sensitizers” - increases insulin sensitivity but does not increase insulin production
- Big risk of adverse effects - MI, stroke, heart failure, also worsen heart failure, increased risk bladder cancer (Actos)
- Weight gain
Dipeptidyl peptidase-4 (DPP-4) inhibitors)
Example: sitagliptin (Januvia)
- Allows incretin hormones to fully function (which increase insulin synthesis/release from pancreas, and decrease hepatic glucose production - both things that would be desired).
- DPP-4 inhibitors allow this by blocking DPP-4 enzyme, which inhibit incretin hormones
- Results in insulin increase, decrease in glucagon secretion, and decrease in hepatic glucose production
- Lower potential for hypoglycemia
- No weight gain side effect, unlike other meds with similar effects
A nurse administers 15 units of glargine (Lantus) at bedtime because it peaks after:
a. 4 hours
b. 12 hours
c. It does not peak
d. 8 hours
c. It does not peak
Rationale: Long-acting
A hospitalized patient has been prescribed aspart (Novolog) to replace his Metformin before surgery. The nurse should administer his medication:
a. 30 minutes before meals
b. Twice a day
c. Before bedtime
d. 15 minutes before meals
d. 15 minutes before meals
Rationale: Rapid-acting
A patient with type 2 diabetes has been prescribed glipizide (Glucotrol), a sulfonylurea. Which common side effect should the nurse include in the discharge instructions?
a. Weight gain
b. Liver failure
c. Jaundice
d. Ecchymosis
a. Weight gain
Rationale: Weight gain due to increased insulin release
