N306 E3 Diabetes Word Scramble
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| Question | Answer |
| 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] |
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