Exam 3 - Chapter 45 (Diabetic Meds)

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  1. lispro (Humalog) is what action of insulin?
  2. what is the onset, peak, and duration of lispro (Humalog)
    • onset 5-15 min
    • peak 0.5-1 hr
    • duration 3-4 hrs
  3. what is the action of regular insulin (Humulin R, Novolin R)?
  4. what are the onset, peak, and duration of regular insulin (Humulin R, Novolin R)
    • onset 30-60 min
    • peak 2-4 hrs
    • duration 5-7 hrs
  5. what is the action of NPH insulin?
  6. what is the onset, peak, and duration of NPH insulin?
    • onset 1-2 hrs
    • peak 4-12 hrs
    • duration 18-24 hrs
  7. what is the action of detemir (Levemir) insulin?
  8. what is the onset, peak, and duration of detemir (Levemir) insulin?
    • onset gradual: over 24 hrs
    • peak 6-8 hrs
    • duration to 24 hours
  9. what is the action of Lantus insulin?
  10. what is the onset, peak and duration of Lantus insulin?
    • onset gradual: begins at 1.1 hrs
    • peak - no peak
    • duration to 24 hrs
  11. what happens when a client takes insulin and exercises or skips a meal?
    • body uses glucose for energy
    • decreases blood sugar = hypoglycemia
  12. what are the s/s of hypoglycemia?
    • BS <70
    • fatigue
    • weakness
    • HA
    • tremors
    • sweating
    • confusion, dizziness, shakiness
    • tachycardia, palpitations
    • pale, cool skin
  13. what is the treatment for mild hypoglycemia?
    • glucose gel
    • 15 gm sugar
    • 8 oz skim milk
    • 1/2 C OJ
    • 608 life savers
    • 2-3 tsp sugar
  14. what is the 15-15-15 rule for hypoglycemia treatment?
    • give 15 gm sugar
    • wait 15 min
    • monitor BS
    • give 15 gm additional sugar
  15. what is the treatment of severe hypoglycemia BS <40?
    • IV 50% Dextrose & Water
    • if no IV then Glucagon 1mg IM (side lying-pt will vomit)
  16. what are the consequences of untreated hypoglycemia
    • confusion
    • seizures
    • coma
    • death
  17. name the drug classes for the pneumonic "Some Mothers Buy Toy Animals"
    • sulfonylureas
    • meglitinides
    • biguanides
    • thiazolindinediones
    • alpha-glucose inhibitors
  18. what is the action of sulfonylureas (chlorpropamide, glimepiride, glipizide)
    • stimulates insulin from pancreas beta cells
    • increase sensitivity of insulin receptors

    "IDE" rather have my pancreas secrete insulin
  19. what are the side effects of sulfonylureas?
    • weight gain
    • hypoglycemia
    • heart burn
    • dizziness
    • HA
    • drowsiness
    • tremors
    • diarrhea
    • constipation
    • N&V
    • photosensitivity
    • rash
  20. what are the black box warnings of sulfonylureas?
    • blood dyscrasias (aplastic anemia, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia)
    • jaundice
    • drug-induced hepatitis
  21. what is the action of meglitinides?
    stimulates mealtime insulin from pancreatic islet cells
  22. name some meglitinides
    • prandin (Repaglinide)
    • Nateglinide
  23. what are the adverse effects of meglitinides (prandin Repaglinide)?
  24. nursing implications for meglitinides (prandin Repaglinide)?
    • take same time each day
    • must eat before med taken
    • short duration of action 2-4 hrs
  25. what is the action of biguanides (glucophage Metformin)
    • prevents the liver from breaking down glycogen into glucose
    • increases the sensitivity to insulin
  26. what are the side effects of biguanides (glucophage Metformin)?
    • GI (N&V, diarrhea, anorexia)
    • flatulence
    • weakness
  27. what is the black box warning of biguanides (glucophage Metformin)?
    lactic acidosis
  28. what is the action of thiazolidinediones (pioglitazone Actos, rosiglitazone Avandia)
    • inhibits hepatic gluconeogenesis
    • lowers insulin resistance
  29. what are the side effects of thiazolidinediones (pioglitazone Actos, rosiglitazone Avandia)?
    • URI
    • HA
    • myalgia
    • anorexia
    • jaundice
    • dark urine
  30. what are the names of two thiazolidinediones?
    • pioglitazone (Actos)
    • rosiglitazone (Avandia)
  31. what is the action of alpha-glucosidase inhibitors (acarbose Precose, miglitol Glyset)?
    • interferes with enzymes in the intestines which break down complex CHO into monosaccharides
    • delays CHO digestion (binds with carbs)
  32. name two alpha-glucosidase inhibitors
    • acarbose (Precose)
    • miglitol Glyset
  33. what are the side effects of alpha-glucosidase inhibitors (acarbose Precose, miglitol Glyset)?
    • GI - cramping, diarrhea, flatulence
    • increase LFT's
  34. what is the action of pramlinitide (Symlin)?
    slows rate at which food (including glucose) is absorbed from the intestine
  35. what are the adverse effects of pramlinitide (Symlin)?
    • GI (N&V, anorexia, abd pain)
    • dizziness
    • fatigue
    • HA's
  36. what is the black box warning of pramlinitide (Symlin)?
    hypoglycemia - most all diabetic drugs!
  37. why is pramlinitide (Symlin) prescribed therapeutically?
    indicated for Type I and Type II, if unable to achieve BS control on insulin alone
  38. what should be done with insulin orders for pts started on Symlin?
    decrease dosing (by 50% to prevent hypoglycemia)
  39. what is the action of exenatide (Byetta)?
    enhance insulin secretion after release from the gut into systemic circulation (enhances incretins)
  40. what drug do we refer to as "bye bye appetite - bye bye fat?"
    exenatide (Byetta)
  41. what are the adverse effects of exenatide (Byetta)?
    • hypoglycemia (increased with other agents)
    • GI (N/V/D, anorexia)
    • pancreatitis
    • dizziness
    • HA
    • inj site reactions
    • antibody formation
  42. what is the action of sitagliptin phosphate (Januvia)?
    blocks DPP-4 which wants to inactivate incretins (GLP-1)
  43. what are the adverse effects of sitagliptin phosphate (Januvia)?
    • nasopharyngitis
    • URI
    • HA
    • hypoglycemia with metformin & sulfonylureas
    • GI (abd pain, diarrhea)
    • anaphylactoid
    • angioedema
    • Stevens-Johnson syndrome
  44. what is the concept of the Incretin glucose control mechanism?
    • to lower blood sugar, incretin either:
    • stimulates insulin release
    • inhibits glucagon release
  45. what is the reason for taking increatin enhancers (GLP-1 agonists or DPP-4 inhibitors)?
    • take a drug that either:
    • enhances incretin (GLP-1)
    • or inhibits incretin (DPP-4)
  46. what are the labs to monitor DM?
    • FBG
    • A1C
    • random capillary glucose
  47. Humalog KwikPen and U-100 insulin device pt teaching
    • inject 1-60 units at a time (may dial backward to correct)
    • must prime with 2 units to a stream of insulin
    • this ensures the correct amount of insulin each time
    • needle replaced after each injection
  48. why is the TDD (total daily dose) of basal-bolus insulin protocols adjusted?
    • adjust TDD up or down based on:
    • past response to insulin
    • presence of hyperglycemia inducing agents/stress
Card Set:
Exam 3 - Chapter 45 (Diabetic Meds)
2017-03-08 04:52:18
Chapter 45
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