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N306 E3 Diabetes

N306 Diabetes Medications II

QuestionAnswer
Identify the 1 indication for sulfonylureas. Type 2 DM
Identify the side fx for sulfonylureas (9). diarrhea or constipation; dizziness, gas, anorexia, HA, n/v, HYPOGLYCEMIA, photosensitivity (increased sunburn)
For sulfonylureas, use with caution in patients with _________. (3) Cardiac, liver, or blood diseases
Off all the classes, hypoglycemia is most commonly produced in _______. sulfonylureas
Identify the 3 sulfonylureas drugs discussed in lecture. glyburide (DiaBeta); glimepiride (Amaryl); glipizide extended release (Glucotrol XL)
_______ generation sulfonylureas have longer duration and fewer side effects than ________ generation. Second generation have longer duration and fewer side fx than generations.
Which oral hypoglycemic must be 30 minutes before meals? glipizide extended release (Glucotrol XL)
Identify mechanism of action(s) for sulfonylureas. (3) -Stimulate insulin production & enhance release of insulin from B cells in pancreas -Decrease liver glycogenolysis, gluconeogenesis - Increase cellular sensitivity to insulin
glycogenolysis the splitting up of glycogen in the liver
gluconeogenesis formation of glucose, especially by the liver, from noncarbohydrate sources, such as amino acids
Identify the 2 alpha-glucosidase inhibitors drugs discussed in lecture. acarbose (Precose) miglitol (Glycet)
Identify the mechanism of action for alpha-glucosidase inhibitors. Decrease absorption of carbohydrates (CHO) from the intestines
Identify the indication for alpha-glucosidase inhibitors. Type 2 DM
Identify the side fx for alpha-glucosidase inhibitors. (4) abdominal discomfort, abdominal pain, diarrhea, flatulence
Why are abdominal side fx common in alpha-glucosidase inhibitors? Because the mechanism of action occurs in the gut
Identify the first sign of hypoglycemia. Headache, and then cold, clammy skin, irritability
Identify a late sign of hypoglycemia. Confusion
Identify the 1 biguanide drug discussed in lecture. metformin (Glucophage) [Tip: Metformin is big.]
Identify the mechanism of action for biguanides. (3) -Decreases glucose absorption in the intestine -Decrease glucose production in liver -Improves insulin sensitivity in tissues (does not affect beta cells or release of insulin; does not cause immediate hypoglycemia compared to sulfonylureas.)
______ does not cause immediate hypoglycemia compared to sulfonylureas. Biguanides
Biguanides are perfect for patients with _____ and _______. Type 2 DM and metabolic X syndrome
_______, which is used prior to some scans, does not work well with metformin. It causes _________. IV radiographic contrast; causes patient to have lactic acidosis which may affect kidneys
Identify the side fx of biguanides. (6) Anorexia, abdominal gas, abdominal pain, diarrhea, HA, N/V
For biguanides, you must monitor ________ b/c ________. Serum creatinine levels, metformin is associated with renal impairment
What period of time is metformin contraindicated for patients receiving IV radiographic contrast? 2 days prior and 2 days after receiving IV radiographic contrast
Elevated serum creatinine levels in patients taking metformin indicates ________. possible renal impairment
Identify the treatment for metformin overdose or development of lactic acidosis. Correct acidosis, remove excess metformin
When should you immediately discontinue use of metformin? If signs of acidosis are present
Identify symptoms of lactic acidosis. (3) -Feeling tired or weak -Muscle pain -Trouble breathing
Identify the 2 thiazolidinediones (TZDs) discussed in lecture. rosiglitazone (Avandia); pioglitazone (Actos)
Identify the mechanism of action for thiazolidinediones. (2) -Decrease insulin resistance in periphery & liver (results in increased glucose processing) -Inhibits hepatic gluconeogenesis
Which drug is most often used in combination with thiazolidinediones? metformin (Glucophage)
What must you monitor for patients on thiazolidinediones? Liver function tests for toxicity
Does hypoglycemia occur with thiazolidinediones? No
Identify the side fx of thiazolidinediones. Edema, HA, myalgia, upper respiratory infection
Because thiazolidinediones promote fluid retention, they are contraindicated in _________. (2) Serious heart failure or pulmonary edema
Optimal lowering of blood glucose with thiazolidinediones takes _______ months of therapy. 3-4
Identify the 2 dipeptidyl peptidase IV (DDP-4) inhibitors discussed in lecture. sitagliptin (Januvia); saxagliptin (onglyza)
Identify the mechanism of action for dipeptidyl peptidase IV (DDP-4) inhibitors. Inhibits DPP-4 (thereby reducing incretin breakdown)(known to degrade GLP-1) which causes insulin secretion and suppresses glucagon secretion
Identify the normal function of DDP-4 enzyme. Break down incretins
incretins hormones secreted by intestine following a meal, when blood glucose is elevated
Identify the normal function of incretins. (2) Signal pancreas to increase insulin secretion and the liver to stop producing glucagon
Identify the route and frequency for a dose for dipeptidyl peptidase IV (DDP-4) inhibitors. Oral route, once daily
TRUE/FALSE: Diabetic patients are not able to secrete incretins in adequate amounts, thus disrupting an important glucose control mechanism. TRUE
Identify the 2 incretin mimetics discussed in lecture. exenatide (Byetta); liraglutide (Victoza)
Identify the mechanism of action for incretin mimetics. Mimics the action of incretin, thus increasing insulin secretion, supressing glucagon secretion, delaying gastric emptying (promotes satiety)
Identify the indication for incretin mimetics. Type 2 DM
Identify the indication for dipeptidyl peptidase IV (DDP-4) inhibitors. Type 2 DM
Identify the side fx for incretin mimetics. (2) N/V, diarrhea
Identify the route and frequency of dose for incretin mimetics. Subcutaneous injection, 2x daily
Do incretin mimetics cause hypoglycemia? No
Identify the 2 meglitinides discussed in lecture. nateglinide (Starlix); repaglinide (Prandin)
Identify the mechanism of action for meglitinides. Stimulates pancreas to release insulin
Identify the indication for meglitinides. Type 2 DM
Identify the side fx for meglitinides. (4) Hypoglycemia, palpitations, GI discomfort, flu-like symptoms (nateglinide)
Why aren't meglitinides good for patients with Type 1 DM? They do not have functioning beta cells in pancreas to stimulate
Meglitinides are similar to the hypoglycemic drug class of ________. sulfonylureas
Identify the 1 amylin analogs discussed in lecture. pramlintide acetate (Symlin)
Identify the mechanism of action for amylin analogs. (3) Delay gastric emptying, decrease postprandial (after meal) glucagon release, regulate appetite
Identify the indication for amylin analogs. Type 1 DM; Type 2 DM
amylin small peptide released by beta cell f pancreas at the same time insulin is released
Identify the normal function of amylin. Act synergistically with insulin in glycemic control
Do amylin analogs cause hypoglycemia? Yes, it is an adverse effect.
Identify the route and frequency of dose for amylin analogs. Subcutaneously prior to each meal, with U-100 syringe
Can pramlintide be mixed with insulin? No
Can pramlintide be injected in the same site as insulin? No
Identify the 3 combination drug treatments. glyburide + metformin (Glucovance); Avandia + metformin (Avandamet); Januvia + metformin (Janumet) [Tip: JAG + metformin]
Identify the 4 drugs affecting blood glucose levels. Beta-blockers Thiazides Loop diuretics Corticosteroids
How do beta blockers affect blood glucose levels? (2) -Interact with insulin and other hypoglycemic agents -Can mask s/s of hypoglycemia
How often should a newly diagnosed diabetes patient check his glucose? 3x daily, before meals
How often should a diabetes patient check his glucose? At least once a day, but could change depending on how stable glucose is
Why shouldn't alcohol be taken with hypoglycemic drugs? Hypoglycemia and lactic acidosis are more common
Identify the effect of corticosteroids on blood glucose levels. Increases blood glucose
Identify the labs/tests needed when assessing pt receiving oral hypoglycemic therapy. (8) CBC, electrolytes, glucose, A1C level, lipid profile, osmolality, hepatic and renal function
_______ insulin is used for acute management of hyperglycemia. Regular insulin
Insulin is required for a pt with Type ___ DM. It is prescribed to a Type ___ DM pt who cannot control their blood glucose. Type 1 DM; Type 2 DM
Identify the pregnancy category for insulin. Category A
How is insulin available? Subcutaneous (maintenance) and IV (emergency)
Identify the 3 rapid-acting insulins. aspart (Novolog), lispro (Humalog), glulisine (Apidra)
Identify the 1 short-acting insulins. regular (Novolin R, Humulin R)
Identify the 1 intermediate-acting insulins. isophane susp (NPH, Humulin N)
Identify the 2 long-acting insulins. detemir (Levemir), glargine (Lantus)
Identify the onset, peak, and duration of insulin aspart (Novolog). Onset: 10-20 mins; Peak: 1-3 hr; Dura: 3-5 hr
Identify the onset, peak, and duration of insulin lispro (Humalog). Onset: 5-15 mins; Peak: 1-1.5 hr; Dura: 3-4 hr
Identify the onset, peak, and duration of insulin glulisine (Apidra). Onset: 15-30 mins; Peak: 1 hr; Dura: 3-4 hr
Identify the onset, peak, and duration of insulin regular (Humulin R, Novolin R.) Onset: 30-60 mins; Peak: 1-5 hr; Dura: 6-10 hr
Identify the onset, peak, and duration of insulin isophane susp (NPH, Humulin N). Onset: 1-2 hr; Peak: 6-14 hr; Dura: 16-24 hr
Identify the onset, peak, and duration of insulin detemir (Levemir). Onset: Gradual; Peak: 6-8 hr; Dura: to 24 hr
Identify the onset, peak, and duration of insulin glargine (Lantus). Onset: 1.1 hr; Peak: No peak; Dura: to 24 hr
Which insulin has no peak? Insulin glargine (Lantus)
Which insulin has a gradual onset? insulin detemir (Levemir)
Identify the indication(s) for insulin. Type 1 DM; DKA, gestational DM; Type 2 DM
Which insulin is prescribed to pts with gestational diabetes? Intermediate or long-acting
Why is insulin a high-risk drug that requires a double check with a fellow RN? If pt has too much insulin, blood glucose will drop too low, and pt could go into coma, eventually die
Why is it important to rotate insulin injection sites? Lipodystrophy may form and will affect absorption
lipodystrophy medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue
Administration of insulin when there is no glucose available in the blood could cause _______. When could this happen? Serious hypoglycemia or coma; pt injects insulin but skips meal
Why is human insulin prevalent over other types? More effective, fewer allergies, lower incidence of resistance
Why is it important to know the peak action of any insulin? It is when risk for hypoglycemic adverse effects are greatest
Why can't insulin be given orally? GI tract destroys insulin
Hypoglycemic s/s are ________. (7) Tachycardia, confusion, sweating, drowsiness, convulsions, coma, death
Identify the quickest way to reverse serious hypoglycemia. IV glucose in dextrose solution
Identify the quickest way to reverse serious hypoglycemia, for patients who cannot take IV glucose. Glucagon given IV, IM, SC reverses symptoms in less than 20 mins
Somogyi effect the occurrence of "reactive" hyperglycemia following hypoglycemia
dawn phenomenon hyperglycemia secondary to hypoglycemia that occurs while we are asleep
Identify the 7 oral hypoglycemic agents discussed in lecture. Sulfonylureas, thiazolidinediones, alpha-glucosidase inhibotors, biguanides, meglitinides, incretin mimetics, DDP-4 inhibitors [Tip: STAB MID]
Created by: nikkirosety