WEEK 3+4 PHARMA Flashcards

1
Q

Insulin is always required for type 2 diabetes. True or false?

A

False, Always required for type 1 diabetes

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2
Q

What is done for people with type 1 diabetes when body does not produce endogenous insulin?

A

replacement therapy

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3
Q

goal of insulin therapy

A

prevent long term complications of diabetes by keeping BG levels within targeet ranges

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4
Q

Are insulin requirements the same throughout for everybody?

A

No, it varies in response to fluctations of BG that occur with daily activities - excersise, sleeping, eating

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5
Q

Insulin: indication, moa, desired effects and adverse effects

A

Indication: required for those with type 1 diabetes and for those whose BG is uncontrolled in type 2 diabetes
Mechanism of action: replacement for endogenous insulin - literally works like endogenous insulin
Desired effects - restores ability to metabolize carbohydrates, fats and proteins, glucose uptake by cells
Adverse effects: Hypoglycemia (taking too much insulin, not timing insulin right with food intake, skipping a meal)

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6
Q

TCSD - Totally Care Seeing you Die

Signs of hypoglycemia

A

T- Tachycardia
C - confusion
S - sweating
D - drowsiness
If severe - convulsions, coma, death

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7
Q

How is hypoglycemia treated

A

glucagon, D50W or glucose source

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8
Q

Are insulin dosages/routes the same for everyone? if so, what does it depend on?

A

No, doses and route are higly individualized for each client
depends on - how many doses daily, type of insulin (long vs short)

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9
Q

Common route for insulin

A

subcutaneous

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10
Q

why is insulin given subcu and not orally or any other way?

A

if intramuscular - uptake is super fast and can be inconsistent
if oral - goes through digestive enzymes and may not produce action

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11
Q

what is an insulin pump?

A
  • to deliver small doses of insulin at predetermined intervals, with large boluses programmed manually at mealtimes
  • pump delivers insulin through small pliable catheter that is anchored in SC tissue of abdomen
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12
Q

Types of insulin

A

Rapid - Lispro
Short acting (regular) - Humulin-R
Intermdiate acting - Humulin - N
Long acting - glargine

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13
Q

Diabetes checklist

A
  1. USE - basal-bolus injection therapy or continuous subcutaneous insulin injection
  2. TAILOR - insulin regimen to treat individual treatment goals lifestyle, diet, age, general health, motivation, hypoglycemia motivation, self management
  3. COUNSEL- about the risk, prevention and treatment of insulin-induced hypoglycemia
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14
Q

Difference between basal - bolus injection therapy and continuous subcutaneous insulin infusion

A
  • Basal-bolus injection therapy - bolus insulin at mealtime+basal insulin once or twice a day
  • continuous subcu insulin infusion - insulin pump therapy with a continuous subcutaneous infusion of insulin via a catheter
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15
Q

Rapid:Lispro

A
  • bolus injection
  • prandial - 15 minutes before or after a meal
  • onset of action - 10-15 minutes
  • peak - 30-60 minutes
  • duration of action - 5 hours or less
  • used in combination with intermediate or long acting insulin - basal
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16
Q

short acting - Humulin R

A

-AKA regular
- bolus injection
- given 30 minutes before meal with one or more meals
- hypoglycemic reactions can occur if regular insulin is not supported by suffiecient food or is given to hypoglycmeic patients
- onset - 30-60 minutes
- peak effect- 2-3 hours
- duration of action - 5-7 hours

17
Q

Intermediate - Humulin N

A
  • basal insulin
  • often started once daily at bedtime
  • can be given once or twice a day , not specific to meals
  • onset - 1-3 hours
  • peak effect - 5-8 hours
  • duration of action - longer acting source of insulin - upto 18 hours
18
Q

Long acting - Glargine

A
  • basal insulin
  • once daily at bedtime
  • no specific peak (provides consistent BG levels)
  • onset - 90 minutes
  • duration - upto 24 hours
19
Q

Role of nurse: insulin therapy

A
  • familiar with onset, peak, duration
  • convey info to client
  • explain hypoglycemia and DKA and what actions to take
  • not all insulin are compatible and may not be mixed together in a single syringe
  • provide education bout insulin, potential adverse effects, technique for self administering insulin, diet and lifestyle
  • monitor - BG levels, increase frequency of testing if client has fever, vomiting, diarrhea, weight on regular basis, serum K levels, urine for ketones if BG above 14mmol/L, signs of long term complication
  • rotate injection sites and monitor for signs of irritation/infection
  • have client report adverse effects related to insulin therapy
20
Q

When is hypoglycemia most likely to occur?

A
  • when insulin reaches its peak effect
  • during excersise - depletion of glycogen stores needd to compensate for you working out
  • acute illness
21
Q

why is insulin used in caution for pregnant clients or those with severe stress/infection

A
  • increased insulin requirements and must be monitored more carefully
22
Q

Client education - insulin therapy

A
  • closely monitor BG before each meal and before insulin adminsitration
  • always carry source of simple sugar in case of hypoglycemic reactions
23
Q

what do you do If BG less than 4 mmol/L

A

take a fast acting carbohydrate (15g glucose tablets, 3tsp sugar or 1/2 cup orange juice)
- repeat in 15 minutes if blood glucose is still less than 4mmol/L
- is there is more than 1 hour until next meal, eat a snack of starch and protein

24
Q

remember hypoglycemia - too much insulin is given

Signs of hypoglycemia

A
  • nervousness
  • confusion
  • excessive sweating
  • rapid pulse
  • tremors
  • signs of overdose
25
Q

remember hyperglycemia (too much glucose - insulin is not right)

Signs of hyperglycemia

A
  • increased thirst or urine output
  • decreased appetite
  • excessive fatigue
26
Q

what to do when youre not sure about whether they are hypo/hyperglycmeic?

A

treat for hypoglycemia - hypoglycemia progresses rapidly and hyperglycemia progresses slowly

27
Q

why do we need to rotate insulin sites?

A

to prevent lipodystrophy - person lose fat from parts of body and gains it in organs

28
Q

do I keep insulin vials in the fridge?

A

No, store at room temp but refrigerate to keep it stable when not needed

29
Q

Pharmacotherapy in type 2 diabetes

A
  1. choose intial therapy based on glycemia
  2. start with metformin
  3. individualize your therapy choice based on characterists of the person with diabetes and the agent
  4. reach target within 3-6 months of diagnosis
30
Q

if glycemic targerts are not achieved in 3 months, what do you do (type 2)

A

antihyperglycmeic therapy should be added to reduce the risk of microvascular complications

31
Q

why is metformin chosen over other agents

A

due to its low risk of hypoglycemia and weight gain

32
Q

Choice of therapy? (type 2)

A

A1C<1.5% over target - initate healthy behavior intervention and start metformin if not at target in 3 months or start metformin with healthy behavior interventions
A1C> 1.5% over target - start metformin with healthy behavior interventions or consider second concurrent agent

33
Q

How is type 2 diabetes controlled?

A
  • some clients can achieve target BG levels with nutrition guidance and physical activity alone
  • but most also need oral antihyperglycemic drugs
  • insulin only prescribes when BG not controllable by other means
34
Q

So when is insulin used for type 2 diabetes?

A
  • symptomatic hyperglycemia and/or metabolic decompensation
  • polyuria
  • polydipsia
  • weight loss
  • volume depletio
  • start insulin with/without metformin
35
Q

Three core mechaninsms contributing to type 2 diabetes?

A
  • decreased insulin stimulated glucose uptake - insulin resistance
  • impaired insulin secretion - beta cell dysfunction
  • excessive glucagon secretion and increased hepatic glucose production