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Pharm DM

Pharmacology for DM

(pancreas, Endocrine function) What do the islets of Langerhands secrete directly into the blood? glucagon and insulin
What maintains homeostasis of blood glucose? -glucose in the bld stimulates islets of Langerhans in the pancreas to secrete insulin -insulin affects carbohydrate, lipid, and protein metabolism -w/out insulin, glucose can't enter the cells to be used for fuel
When is glucagon secreted? when levels of glucose in the bld are low
What does glucagon do? helps maintain adequate levels of glucose in the blood between meals and moves glucose from the liver to the blood
What is insulin replaced with? same low-level amounts normally found in the body
How is glucagon replaced? 1 mg IV, Subcu, or IM reverses hypoglycemic symptoms within 20 mins
What brings blood sugar up very quickly? D50- 50% dextrose
What are some causes of diabetes mellitus? genetic factors, environmental factors, more sedentary lifestyle, obesity, increased longevity, deficiency in secretion or action of insulin
What can diabetes mellitus result in? hyperglycemia
What is the goal of insulin therapy? to maintain bld glucose levels within strict, normal levels
What are the 5 types of insulin available in order of fastest to slowest onset/duration? Rapid, short, intermediate, premixed, long acting
What is most insulin obtained through today? recombinant technology
What is the route of admin for insulin? subcu or IV
What would happen if insulin were admin into a muscle? it increases absorption and has a faster onset
What are some nursing considerations for insulin? Assess for signs of hypoglycemia, especially during peak times of insulin effect, have food available before administering insulin, only regular insulin can be given IV
What are two examples of rapid acting insulin? lispro (Humalog) and aspart (Novalog)
What is the onset, peak, and duration times for rapid acting insulin? onset: 5-15 min, peak: 1-2 hr, duration: 3-4 hr (given subcu or via insulin pump)
What is the onset, peak, and duration times for short acting insulin? onset: 30 min -1 hr, peak: 1-3 hr, duration: 6-8 hr (given subcu, IV, or via insulin pump)
What are some examples of short acting insulin? Humulin R and Novolin R (R for regular)
When mixing insulins, which do you draw up first? Clear or cloudy? clear before cloudy (Regular insulin is clear, NPH insulin is cloudy)
What are some examples of intermediate acting insulin? NPH, Humulin N, Novolin N (always has an N in the name for NPH)
What is the onset, peak and duration times for intermediate acting insulin? Onset: 1-4 hrs, Peak: 8-12 hrs, Duration: 18-24 hrs. (ALWAYS given subcu, give 30 mins before breakfast, sometimes give a second smaller dose at bedtime)
What are some examples of premixed insulin preparations? Humulin 70/30, and Novolin 70/30 (70% NPH and 30% regular. Subcu only, never give IV)
What is the onset, peak, and duration of pre-mixed insulin? Onset: 4-8 hrs, Peak: 16-18 hrs, Duration: >36 hrs
What type of insulin is glargine (Lantus)? long- acting
When is glargine (Lantus) given, and what is the duration and peak? given daily at bedtime at the same time each day. Duration: >24hr. No peak time. Cannot be mixed with other types of insulin. Administered subcu
What type of insulin is Protamine zinc (PZI)? (Ultralente, Humulin U)long-acting
What is the onset, peak, and duration time for Protamine zinc (PZI)? Onset: 4-8 hrs, Peak: 14-24 hrs, Duration: 36 hrs
When administering any type of insulin, what should you consider about the syringe? Always match the units on the syringe to the units on the insulin vial. Ex: U100 or U150 (rarely used)
What are some adverse effects of insulin? hypoglycemia, allergic reaction at injection site (urticaria), Lipodystrophy-injecting cold insulin can cause this (remodeling of subcu fat from injections in same area several times a day)
What is education to give your patient r/t insulin? goals in insulin therapy, reasons for obtaining baseline data, rotate injection sites, insulin peaks, Do not inject into swollen areas of the skin, wear med-alert bracelet
How should insulin be stored? refrigerate BEFORE opening, Keep at room temperature AFTER opening. (this reduces lipodystrophy). Date when the vial was opened and discard 30 days after opening.
How would you instruct caregivers r/t insulin? Teach the procedure to test bld sugar before meals and before giving insulin, the procedure for preparing and administering insulin. And, teach about rotating injection sites.
What assessment data would you gater r/t DM? obtain complete health hx, assess VS and glucose, appetite, knowledge, and injection sites
What are some potential nursing diagnoses for DM? Risk for injury (hypoglycemia), Knowledge deficit, Risk for imbalanced nutrition, Risk for infection
What are the patient goals and expected outcomes r/t DM? The patient will: immediately report s/s of hypoglycemia, demonstrate ability to self administer insulin, modify lifestyle to maintain tight control
What would be involved in implementing r/t DM? increase frequency of monitoring during illness, Monitor: wt, VS, K level, Glucose; and give simple sugar for hypoglycemia
What is the pharmacotherapy of oral antidiabetic therapy? oral hypoglycemic drugs are prescribed when diet and exercise have failed to bring bld glucose levels within normal limits
What is the classification of oral hypoglycemic meds based on? chemical structure and mechanism of action
Oral hypoglycemics All oral hypoglycemics lower bld glucose levels when taken on a regular basis. They are not used during pregnancy. Avoid alcohol consumption when taking them.
What are some examples of oral meds that stimulate insulin release? glipizide (Glucotrol), glyburide (DiaBeta), Exenatide (Byetta)-injection, repaglinide (Prandin)-inc risk of infection
When are oral meds that stimulate insulin release given? given before breakfast and evening meal
What are some examples of oral meds that delay digestion of CHO? acarbose (Precose)-GI side effects, miglitol (Glyset)
What are some examples of oral meds that decrease insulin resistance? glucophage (Metformin), rosiglitazone (Avandia)- most commone SE: fld retention, wt gain, HA
What class of drug is metformin (Glucophage)? biguanide antihyperglycemic
How do biguanide antihyperglycemic drugs work? decrease insulin resistance (rarely cause hypoglycemia)
What GI side effects might be seen with patient taking biguanide antihyperglycemics? N, D, flatulence, heartburn (take with food to decrease side effects)
What should you assess for someone taking biguanide antihyperglycemics? assess liver and renal function
When would you hold a biguanide antihyperglycemic med? hold prior to exam with contrast (hold before and after for about 24 hours, could overload the kidneys)
What is an example of a combination oral hypoglycemic med? glyburide/ metformin (Glucovance)
What are some nursing considerations for oral antidiabetic therapy? assess all body systems, psychosocial and lifestyle hx, assess knowledge of disease and tx, keep pre-prandial BS <110 mg/dl, monitor I&O and review labs, illness affects dosage, proper timing of dosages w/regard to meals, symptoms HHNKC
What would you educate the patient on r/t oral antidiabetic therapy? always carry a simple source of sugar, med-alert bracelet, avoid alcohol, take med w/food, importance of diet and exercise, swallow tabs whole (do not crush), time med w/regard to breakfast
What are actions and uses for glipizide (Glucotrol, Glucotrol XL)? type 2 diabetes who do not achieve glucose control with diat alone, used for short-term therapy for those who norm. can control glucose lvls by diet
What are adverse effects and interactions for glipizide (Glucotrol, Glucotrol XL)? N, heartburn, dizziness, HA, drowsiness. Hypoglycemia (tremors, palpitations, sweating), cholestatic jaundice, bld dyscrasias. Combined w/alcohol can cause a disulfiram reaction (hangover symptoms)
What are admin alerts for glipizide (Glucotrol, Glucotrol XL)? do not crush or chew. Give once a day 30 mins before breakfast.
Assessment data r/t oral antidiabetic therapy? prior to admin: complete health hx including allergies, drug hx, and ossible drug interactions. Assess bld glucose lvl, assess knowledge of drug
Potential nx diagnoses r/t oral antidiabetic therapy? Risk for injury, r/t adverse effects of drug therapy, Deficient knowledge (drug therapy), Deficient knowledge (glucose testing)
Patient goals and expected outcomes r/t oral antidiabetic therapy? Report: irritability, dizziness, diaphoreses, hunger, behavior chnges, chnges in LOC. Demonstrate: understand lifestyle mods necessary, understand drug's action, accurately self-monitor bld glucose, maintain bld glucose w/in nrml range
Implementation r/t oral antidiabetic therapy? inc freq of gluc mon. if exper fever, N, V, or D. Monitor gluc freq beginning of therapy, elderly, taking beta blckr. Ck urine for ketones if glucose over 300 mg/dL. Monitor wt, skin for rashes/itching, act lvl.
Evaluation of outcome criteria r/t oral antidiabetic therapy? confirm pt goals and expected outcomes have been achieved (if they've achieved goals planned in goals/expected outcome stage)
Created by: pepcpatty