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ANTIDIABETIC
| Question | Answer |
|---|---|
| INJECTION SITES | Abdomen, Arms, Legs, buttocks |
| 3 P's | polyuria-increased urine, polydipsia -increased thirst and polyphagia-increased appetite |
| NORMAL BG RANGE | 70-100 |
| HIGH RANGE-HYPERGLYCEMIA | ANYTHING OVER 140 |
| HYPOGLYCEMIA | 60 AND BELOW |
| NPH/REGULAR | Humulin 70/30 and Novolin 7/30 premixed combo |
| LISPRO/HUMALOG | CLEAR 5min before meals |
| ASPART/NOVOLOG | CLOUDY adminster as scheduled |
| GLULISINE/APIDRA | CLOUDY |
| NPH/HUMULIN | CLOUDY |
| DETERMIR/LEVEMIR | LONG ACTING AND NO PEAK |
| LANTUS | LONG-ACTING NO PEAK |
| ADMINSTRATION | SC ONLY except regular can be given IV |
| WHAT INSULIN SHOULD YOU NOT MIX WITH OTHERS | LANTUS AND LEVEMIR not compatible with reg insulin |
| NORMAL A1C | 5.7 and below |
| PRE-Diabetic A1C | 5.7-6.4 |
| DIABETIC | 6.5 and above |
| Why Should You Use Caution with Diabetics Using Beta Blockers | can mask symptoms of Hypoglycemia |
| TYPE 1 | born with, insulin dependent IDDM, autoimmune destruction of pancreatic beta cells that results in insulin deffiency |
| TYPE 2 | later onset, body does not use insulin properly and pancreas cannot produce enough insulin |
| What are the things that trigger Type 2 | obesity, family history, age and inactive life style |
| SULFONYLUREAS | stimulates the release of insulin from pancreatic islets and increases sensitivity of insulin receptors on cells |
| FIRST GENERATION SULFONYLUREAS | not used commonly orinase tolinase and diabinese |
| SIDE EFFECTS FOR 1S GEN SULFONYLUREAS | extreme flushing, NV, tachycardia, headache |
| 2ND GEN SULFONYLUREAS | most commonly uses, glucotrol and glucotrol XL |
| 2nd GEN SULFONYLUREAS ADVANTAGES | increased risk of hypoglycemia(with anticoagulants), few drug interactions, smaller doses needed, longer duration |
| DRUG ADMIN of SULFONYLUREAS | ORALLY once given /eat |
| CONTRAINDICATIONS for SULFONYLUREAS | pregnancy, allergy to SULFA or Urea Drugs, advanced CKD; patients using ACE INHIBITORS conditions that predispose to hypoglycemia |
| SIDE EFFECTS FOR SULFONYLUREAS | GI upset, dizziness and HA, skin rash, hypoglycemia, weight gain avoid alcohol and risk of increase of hypoglycemia |
| WHAT TO MONITOR WHEN TAKING SULFONYLUREAS | CBC, A1C, BG AND LFT FUNCTIONS/medication compliance |
| NON SULFONYLUREAS USES | used for TYPE 2 not controlled by diet and excersise |
| COMMON NON SULFONYLUREAS | Prandin (most used,avoid grape juice ) /Meglitinide and Metformin-Biguanide |
| WHAT TO MONITOR WHEN TAKING NON-SULFONYLUREAS | CBD, BG, A1C, LFTS, COMPLIANCE |
| CONTRAINDICATIONS FOR NON SULFONYLUREAS | kidney disease, patients with lactic acidosis-which is life threating emergency |
| SIGNS OF LACTIC ADIDOSIS | abnormal muscle pain, fatigue and dyspenia |
| SIDE EFFECTS OF NON SULFONYLUREAS | NV, HYPOGLYCEMIA, LACTIC ACIDOSIS, DIAHREA |
| GLUCOSE ELEVATING AGENTS-GLUCAGON | DEXTROSE, SUGAR, ADM WITH PT IN LEFT LATERAL |
| WHAT IS GLUCAGON USED FOR | HYPOGLYCEMIA EMERGENCY |
| GLUCAGON SIDE EFFECTS | REBOUND HYPERGLYCEMIA 23-420 CAN BE EXPECTED |
| RULE OF 15 | 15 G OF RAPID ACTING CARBS, WAIT 15 AND RECHECK BG, REPEAT IF STILL LOW-WHEN STABLE CAN GIVE COMPLEX CARB SNACKS |
| STEPS FOR MIXING INSULIN-CLEAR TO CLOUDY RULE | inject air into cloudy first, then into clear, then pull back CLEAR 1ST AND THEN CLOUDY BEHIND IT-remove bubbles |
| METFORMIN | hard on kidneys-hold if using contrast; SE-NV and bloating; take with meals to avoid GI upset |
| LEVEMIR/DETEMIR/LANTUS | DO NOT PEAK-decreased thirst, monitor for Renal and Hypoglycemia |
| MEGLITINIDES CAN CAUSE | Hypoglycemia, allergic skin reaction, liver problems, abdominal pain and Nausea, constipation and diarrhea |
| HYPOGLYCEMIA | shakiness, tremors, dizziness, sweating, hunger, irritability, anxiety or nervous, HA and Cold clammy skin SEVER confusion and loss of consiousness |
| HYPERGLYCEMIA | elevated BG, Glucose in urine, frequent urination, increased thirst, untreated can lead to DKA |
| DKA | life threatening, body cannot use glucose due to lack of insulin and fat broken down for energy-ketones accumulate in blood BG 350 and above- untreated hyperglycima |
| DKA SYMPTOMS | fruity smelling breath, NV, very dry mouth, shortness of breath |
| GLP-1 | Receptor Agonist, incretin enhancers |
| GLP-1 EXAMPLES | semaglutide, mounjaro, Ozempic, liraglutide/Victoza Saxenda, Exenatide |
| GLP-1 USES | TYPE 2, WT MANAGEMENT, |
| GLP-1 SIDE EFFECTS | CONSTIPATION, NV, ABDOMINAL PAIN, DECREASED APPETITE |
| ADVERSE EFFECTS OF GLP-1 | PANCREATITIS, GB DISEASES, SEVERE DEHYDRATIONS, DELAYED GASTRIC EMPTYING, POSSIBLE THYROD C-CELL TUMORS |
| GLP-1 CONTRAINDICATIONS | History of MTC, History of Pancreatitis, Pregnancy and Breastfeeding |
| GLP-1 LABS | BG, A1C, BUN, CR |
| GLP-1 PATIENT EDUCATION | Eat smaller slower meals, avoid high fat meals at initiation, injection sites, WT loss occurs gradually |
| INSULIN- ACTION/USE | Restores the ability of cells to use glucose for energy corrects hyperglycemia treats type 1 and 2 and DKA used to lower serum potassium in cases of hyper kalemia |
| INSULIN types | lispro, aspart, NPH |
| most insulin are | suspensions (cloudy) except regular and rapid acting clear |
| rotate sites because of | lipodystrophy |
| do not mix | glargine or detemir with other insulins |
| sulfonylureas action/use | adjunct to diet/exercise in type 2 diabetes to lower diabetes |
| in type 2 diabetes when insulin is started .. | sulfonylureas are stopped |
| NON SULFONYLUREAS action /use | biguanides lower blood glucose by decreasing hepatic glucose production alpha-glucosidease inhibitors delay carbohydrate absorption from the inestines |
| NON SULFONYLUREAS action /use | used for type 2 diabetees not controled by diet and excersise, espicially to reduce post meal glucose spikes |
| prandin causes | DKA |
| SUGAR IS | DEXTROSE AND GLUCOGEN |
| glucose elevating agents (glucagon ) ACTION | STIMulates glycogen breakdown in the liver promotes glusoce synthesis used in emergency txt og severe hypoglycemia |
| glucose elevating agents (glucagon ) administration conisderations | reconstitution per manufacture instructions routes : SC IM or IV push flush IV line with D5W NOT compatible with saline do not mix with other drugs in same line |
| Symlin (pramintide acetate | administer immediately with meals preff with first bite hyperglycimia can occor within 30 min |
| glipizide | well known fro causing hypoglycemia |
| Levemir detemir /lantis | do not peak,may decrease thirst monitor hypoglycima and renal function |
| prandlin (repaglinide) | do not consume grapfruit juic or grapefruit wile on this med |
| meglitinides (glinides )- can cause : | hyperglycima allergic skin reaction liver problems abdominal apin Nausea,diahrea, constipstion |
| DKA typically | rappid onset in diabetes type 1 |
| HHS (hyperosmolor hyperglycemic state- | eleevtaed 600 gradual onset more commone type 2 |
| GLP-1 | mimic natural hormone , GLP 1 glucagon like peptide 1 increase glucose depedent insulin secretion slow gastric emtyping - constipation- |
| GLP-1 PATIENT EDUCATION | report sever abdominal pain ,pancreatitis and persistant vomiting |
| GLP-1 Nursing considerations | start low dose and titrate slowly to reduce GI side effects monitor NV EDUCATE WT LOSS EXPECTED Increase risk of hypogycemia with insulin or sulfonylureas injectable weekly or daily |
| GLP-1 Drugs lower | appetitie, hastirc emptying, glucagon , and WT |
| ozempic and wegovy is | same drug, diffrent indecation and dose |
| mounjaro/zapound is | dual action incretin (GKP-1 + GIP) |
| OZEMPIC GENERIC NAME /MECHANISM | SEMAGLUTIDE/ GLP 1 RECEPTOR AGONIST |
| WEGOVY GENERIC NAME /MECHANISM | SEMAGLUTIDE/GLP 1 RECEPTOR AGONIST |
| MOUNJARO GENERIC NAME /MECHANISM | TIRZEPATIDE/GLP 1 RECEPTOR + GIP AGONIST |
| ZEPBOUND GENERIC NAME /MECHANISM | TIRZEPATIDE/GLP 1 RECEPTOR + GIP AGONIST |
| VICTOZA GENERIC NAME /MECHANISM | LIRAGLUTIDE/ GLP 1 RECEPTOR AGONIST |
| BYETTA GENERIC NAME /MECHANISM | EXENATIDE/ GLP 1 RECEPTOR AGONIST |
| OZEMPIC INDICATION/ DOSING | type 2 diabetes - weekly SQ |
| WEGOVY INDICATION/ DOSING | chronic wt managment -weekly SQ |
| MOUNJARO INDICATION/ DOSING | type 2 diabetes-weekly SQ |
| ZEPBOUND INDICATION/ DOSING | chronic wt managment weekly SQ |
| VICTOZA INDICATION/ DOSING | type 2 DAILY SQ |
| BYETTA INDICATION/ DOSING | type 2 TWINCE DAILY SQ |
| OZEMPIC KEY NOTES | IMPORVES GLYCEMIC CONTROL; WEIGTH LOSS COMMON |
| WEGOVY KEY NOTES | HIGHER DOSE OF SEMAGLUTIDE THAN OZEMPIC |
| MOUNJARO KEY NOTES | DUAL INCETIN - GREATER A1c & wt reduction |
| ZEPBOUND KEY NOTES | same drug as mounjaro, obesity indication |
| VICTOZA KEY NOTES | CV benift |
| BYETTA KEY NOTES | older agent |
Created by:
danpol1775