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RD Polytechnic BScN 2nd Year Semester 1 > 251 Pharmacology Study Cards - Antidiabetic > Flashcards

251 Pharmacology Study Cards - Antidiabetic Flashcards

1
Q

Define diabetes.

A

A complex disorder of carbohydrate, fat, and protein metabolism resulting from the lack of insulin secretion by the β-cells of the pancreas or from defects of the insulin receptors; sometimes referred to as diabetes mellitus. There are two major types of diabetes: type 1 and type 2.

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2
Q

What is diabetic ketoacidosis?

A

A severe metabolic complication of uncontrolled diabetes that, if untreated, may lead to serious hyperglycemic emergencies.

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3
Q

What is gestational diabetes?

A

Diabetes that develops during pregnancy; it may resolve after pregnancy but may also be a precursor of type 2 diabetes in later life.

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4
Q

What is glucagon?

A

A hormone produced by the α-cells in the islets of Langerhans; glucagon stimulates the conversion of glycogen to glucose in the liver.

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5
Q

What stimulates the conversion of glycogen to glucose in the liver?

A

Glucagon

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6
Q

What is glucose?

A

One of the simple sugars that serves as a major source of energy. It is found in foods (e.g., fruits, refined sweets) and also is the final breakdown product of complex carbohydrate metabolism in the body; it is commonly referred to as dextrose.

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7
Q

What are the two main hormones produced by the pancreas?

A

Insulin and glucagon

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8
Q

Generally, what range is normal for optimal plasma glucose levels?

A

4 - 6 mmol/L

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9
Q

What are signs and symptoms of diabetes?

A

Elevated fasting blood glucose (higher than 7 mmol/L) or a hemoglobin A1c (HbA1c) level greater than or equal to 6.5%
Polyuria
Polydipsia
Polyphagia
Glycosuria
Weight loss
Fatigue
Blurred vision

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10
Q

What is diabetes primarily a disorder of?

A

Carbohydrate metabolism that involves either a deficiency of insulin, a resistance of tissue to insulin, or both.

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11
Q

What is the main result of diabetes?

A

hyperglycemia

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12
Q

True or false. A patient with Type 2 diabetes can have normal or elevated levels of insulin yet still have high plasma glucose levels.

A

True. This is because it is the receptors on the target tissues that are reduced or impaired.

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13
Q

What is glycogenolysis?

A

The breakdown of glycogen into glucose.

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14
Q

What is Hgb A1c?

A

Hemoglobin molecules to which glucose molecules are bound; also referred to as glycosylated hemoglobin and is most commonly referred to as A1C. Blood levels of HbA1c are used to monitor and diagnose diabetes.

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15
Q

What constitutes hyperglycemia?

A

A fasting plasma glucose level of 7 mmol/L or higher or a nonfasting plasma glucose level of 11.1 mmol/L or higher.

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16
Q

What is a hyperosmolar hyperglycemic state (HHS)?

A

A metabolic complication that occurs in patients with type 2 diabetes, characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis.

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17
Q

What is hypoglycemia?

A

A plasma glucose level of less than 4 mmol/L with autonomic or neuroglycopenic symptoms that respond to administration of a carbohydrate or the use of glucagon.

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18
Q

What is an impaired fasting glucose level?

A

A fasting glucose level of at least 6.1 mmol/L but lower than 6.9 mmol/L; it defines a prediabetic state often referred to as prediabetes.

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19
Q

What is insulin?

A

A naturally occurring hormone secreted by the β-cells in the islets of Langerhans in the pancreas in response to increased levels of glucose in the blood.

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20
Q

What are ketones?

A

Organic chemical compounds produced through the oxidation of secondary alcohols (e.g., fat molecules), including dietary carbohydrates.

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21
Q

What is metabolic syndrome?

A

A cluster of risk factors including abdominal obesity, hypertension, dyslipidemia, and elevated plasma glucose that places individuals at significant risk of developing type 2 diabetes and cardiovascular disease.

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22
Q

What is polydipsia?

A

Excessive intake of water; one of the common symptoms of uncontrolled diabetes.

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23
Q

What is polyphagia?

A

Excessive hunger; one of the common symptoms of uncontrolled diabetes.

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24
Q

What is polyuria?

A

Increased frequency or volume of urinary output; one of the common symptoms of uncontrolled diabetes.

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25
Q

What is Type I diabetes?

A

Diabetes caused by an autoimmune disease resulting in β-cell destruction and that makes the individual prone to hyperglycemia and ketoacidosis; most commonly develops in children and adolescents.

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26
Q

What is Type 2 diabetes?

A

A type of diabetes that is most common in adults and is becoming increasingly common in children and adolescents; characterized by hyperglycemia that occurs as a result of predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance.

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27
Q

What is the most common type of diabetes?

A

Type 2

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28
Q

What are comorbidities of Type 2 diabetes?

A

Obesity
Coronary heart disease
Dyslipidemia
Hypertension
Microalbuminemia (protein in the urine)
Increased risk for thrombotic (blood clotting) events
(collectively known as metabolic syndrome)

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29
Q

What is gestational diabetes?

A

Hyperglycemia that develops during pregnancy
Insulin must be given to prevent birth defects.
Usually subsides after delivery
30% of patients may develop type 2 diabetes within 10 to 15 years.

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30
Q

What are macrovascular complications of both types of diabetes?

A

(atherosclerotic plaque)
Coronary arteries
Cerebral arteries
Peripheral vessels

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31
Q

What are microvascular complications of both types of diabetes?

A

Microvascular (capillary damage)
Retinopathy
Neuropathy
Nephropathy

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32
Q

What are the four major classes of insulin?

A
  • rapid-acting
  • short acting
  • intermediate acting
  • long acting/ultra long acting
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33
Q

How often is screening for diabetes recommended?

A

Screening recommended every 3 years for all patients 40 years of age and older.

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34
Q

What are the features of pre-diabetes?

A
  • HbA1c of 6.0 to 6.4%
  • Fasting plasma glucose levels higher than or equal to 6.1 mmol/L but less than 6.9 mmol/L
  • Impaired glucose tolerance test (oral glucose challenge)
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35
Q

Are exclusively non-pharmacological interventions an option for Type 1 diabetes?

A

No, insulin is always required.

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36
Q

List 5 non-pharmacological interventions for Type 2 diabetes.

A
  • Weight loss
  • Improved dietary habits
  • Smoking cessation
  • Reduced alcohol consumption
  • Regular physical exercise
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37
Q

What is the glycemic goal of treatment?

A
  • HbA1c of less than 7%˜
  • Fasting blood glucose goal for diabetic patients: 4 to 7 mmol/L˜
  • 2-hour postprandial target of 5 to 10 mmol/L
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38
Q

What is the order of treatment for Type 2 diabetes?

A
  • Lifestyle changes
  • Oral drug therapy
  • Insulin when the above two can no longer provide glycemic control
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39
Q

What are the main categories of antidiabetic drugs?

A
  • Insulins˜
  • Oral hypoglycemic drugs˜
  • A combination of oral antihypoglycemic and insulin controls glucose levels.˜
  • Some new injectable hypoglycemic drugs may be used in addition to insulin or antidiabetic drugs.
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40
Q

What antidiabetic drug functions as a replacement for an endogenous hormone?

A

insulin

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41
Q

What does insulin restore a diabetic patient’s ability to do?

A
  • Metabolize carbohydrates, fats, and proteins
  • Store glucose in the liver
  • Convert glycogen to fat stores
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42
Q

List the four major classes of insulin and the identified example of each (red bolded).

A
  • Rapid Acting (insulin lispro)˜
  • Short Acting (regular insulin)˜
  • Intermediate Acting (insulin NPH)˜
  • Long Acting (insulin detemir and glargine)
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43
Q

How is human insulin created?

A
  • Derived using recombinant deoxyribonucleic acid (DNA) technologies
  • Recombinant insulin produced by bacteria and yeast
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44
Q

What is the onset of action for rapid acting insulin (lispro - Humalog)(aspart - Novorapid)?

A

It has the most rapid onset of action at 10 - 15 minutes.

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45
Q

What is the peak for rapid acting insulin (lispro - Humalog)(aspart - NovoRapid)?

A

1 - 2 hours

46
Q

What is the duration for rapid acting insulin (lispro - Humalog)(aspart - NovoRapid)?

A

3 - 5 hours

47
Q

What is important for a diabetic patient to do while or immediately after a rapid acting insulin injection?

A

Eat a meal.

48
Q

By what route can rapid acting insulin be given?

A

May be given subcutaneously or via continuous subcutaneous infusion pump (but not intravenously)

49
Q

What are two examples of rapid acting insulin?

A
  • Insulin lispro (Humulin)
  • Insulin aspart (NovoRapid)
50
Q

What are two examples of short-acting insulin?

A
  • Regular insulin (Humulin R)
  • Novolin ge Toronto
51
Q

What are the routes of administration for short-acting insulin?

A
  • intravenous (IV) bolus
  • IV infusion
  • intramuscular
  • subcutaneous
52
Q

What is the onset of action for short acting insulin given via the subcutaneous route?

A

30 minutes

53
Q

What is the peak for short acting insulin given via the subcutaneous route?

A

2 to 3 hours

54
Q

What is the duration for short acting insulin given via the subcutaneous route?

A

6.5 hours

55
Q

What is an example of an intermediate-acting insulin?

A

˜Insulin isophane suspension (also called NPH)

56
Q

What are the pharmacological characteristics of insulin isophane suspension (also called NPH)?

A
  • Cloudy appearance
  • Often combined with regular insulin
  • Onset: 1 to 3 hours
  • Peak: 5 to 8 hours
  • Duration: up to 18 hours
57
Q

What are two examples of long-acting insulin?

A
  • Insulin glargine (Lantus)
  • Insulin detemir
58
Q

What are the pharmacological properties of long acting insulin glargine (Lantus)?

A
  • Clear, colourless solution
  • Constant level of insulin in the body
  • Usually dosed once daily
  • Can be dosed every 12 hours
  • Referred to as basal insulin
  • Onset: 90 minutes
  • Peak: none
  • Duration: 24 hours
59
Q

What are the notable features of the long-acting insulin detemir?

A
  • Duration of action is dose dependent.
  • Lower doses require twice-daily dosing.
  • Higher doses may be given once daily.
60
Q

List two fixed combination insulins.

A
  • Humulin 30/70
  • Novolin 30/70, 40/60, 50/50
61
Q

What do fixed combination insulins contain?

A

˜Each contains two different insulins, fixed combinations:

  • One intermediate-acting type
  • Either one rapid-acting type (Humalog, NovoLog) or one short-acting type (Humulin)
62
Q

What are the adverse effects of insulin?

A
  • Hypoglycemia
  • Tachycardia, palpitations
  • Headache, lethargy, tremors
  • Blurred vision, dry mouth, hunger
63
Q

What drug interactions can result in reduced effects and elevated blood glucose?

A

•Β blockers, corticosteriods, epinephrine, furosemide, thyroid hormones

64
Q

What drug interactions can result in increased effects and lowered blood glucose?

A

•Alcohol, anabolic steroids, sulfa drugs, ACE inhibitors, MAOI’s, propanolol and salicylates

65
Q

What kind of protocol might hospitalized patients be placed on?

A
  • Sliding scale protocol
  • Not preferred though
66
Q

Name three areas that glucose gets stored in the body when there are adequate amounts in the blood.

A
  • Stored as glycogen in the liver
  • Stored to a lesser extent in skeletal muscle tissue
  • Also in adipose tissue as triglyceride body fat
67
Q

What is the most common precipitator of diabetic ketoacidosis or hyperosmolar nonketonic syndrome?

A

Some type of physical or emotional stress

68
Q

What are major outcomes of hypoglycemia?

A

Brain damagr, shock, and possibly death. It is the most immediate and serious adverse effect of insulin.

69
Q

True or false: The combination of lispro product Humalog® Mix25/75™ insulin lispro protamine (an intermediate-acting insulin) and 25% insulin lispro (a rapid-acting insulin) is currently approved for use in children younger than 18 years of age.

A

False, it is not.

70
Q

What two special populations need added attention with insulin therapy?

A

Pediatric patients and pregnant women

71
Q

Describe the difference between regular insulin and the newer rapid-acting drugs.

A

The rapid-acting insulins are considered human insulin analogues; this means that they are insulin molecules with synthetic alterations to their chemical structures that alter their onset or duration of action. They have a faster onset of action and a shorter time to peak plasma level, but they also have a shorter duration of action than does regular insulin.

72
Q

What is currently the safest therapy for pregnant women?

A

insulin

73
Q

When is combination therapy recommended for Type 2 diabetics?

A

˜Combination therapy is recommended if A1C exceeds 9%

Two drugs from two different classes

74
Q

What steps are involved in the effective treatment of Type 2 diabetes?

A
  • Lifestyle changes
  • Careful monitoring of blood glucose levels
  • Therapy with one or more drugs
  • Treatment of associated comorbid conditions such as high cholesterol and high blood pressure
75
Q

What are the recommendations for treatment for new onset of Type 2 diabetes?

A
  • Lifestyle interventions
  • Oral biguanide drug metformin
  • If lifestyle modifications and the maximum tolerated metformin dose do not achieve the recommended A1c goals after 3 to 6 months, additional treatment should be given with dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagonlike peptide 1 (GLP-1) receptor agonists (liraglutide, exenatide, abliglutide) or insulin.
76
Q

What drug belongs to the biguanide group of drugs?

A

metformin

77
Q

What is the mode of action for metformin (biguanide)?

A
  • Does not increase insulin secretion from pancreas and therefore does not cause hypoglycemia˜
  • Reduces glucose production/gluconeogenesis
  • Reduced triglycerides & cholesterol˜
  • Decreases intestinal absorption of glucose˜
  • Improves glucose uptake by skeletal muscle, adipose, liver
78
Q

True or False. ˜Metformin may be used in combination with sulfonylureas, thiazolidinediones or incretin mimetics when monotherapy & lifestyle measure are not successful

A

True

79
Q

What are the adverse effects of metformin?

A
  • Abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea
  • Metallic taste, hypoglycemia, and a reduction in vitamin B12 levels after long-term use
  • Lactic acidosis is an extremely rare complication.
  • Concentrations increased when given with furosemide and nifedipine, cimetidine and digoxin˜
  • IMPORTANT: Discontinue metformin the day of the test and 48hrs after undergoing radiological study that requires radioactive iodine based dye
    • This may leads to acute kidney injury and lactic acidosis
80
Q

Name one sulfonylureas.

A

Gliclazide

81
Q

What is the mode of action of sulfonylureas?

A
  • Stimulate insulin secretion from β cells (NEED FUNCTIONING CELLS)˜
  • Enhance action of insulin in muscle, liver, adipose tissue˜
  • Prevent liver from breaking down insulin as fast˜
  • Typically 2nd generation
    • Gliclazide *Study
82
Q

What are the adverse effects of sulfonylureas?

A
  • hypoglycemia
  • weight gain
  • skin rash
  • nausea
  • epigastric fullness
  • heartburn
83
Q

What interactions exist for sulfonylureas - gliclazide?

A
  • Increased effect of hypoglycemia
    • Alcohol*, anabolic steroids, β blockers, chloramphenicol, MAOI’s, oral anticoagulants, sulfonamides, garlic, ginseng
  • Decreased effect
    • Adrenergics, corticosteroids, thiazides, thyroid drugs

*Alcohol may cause a reaction similar to Antabuse (induced vomiting and hypertension)

84
Q

What contraindications are there for sulfonyureas - Gliclazide?

A
  • Severe liver and kidney disease
  • Active hypoglycemia
  • Not used in pregnancy
85
Q

How does the oral antidiabetic medication Thiazolidinediones (Glitazones) work?

A

Insulin sensitizing drugs; enhance receptor sensitivity; slow onset up to months (pioglitazone - Actos®)

86
Q

How does the oral antidiabetic medication Glinides work?

A

Similar to sufonlyureas, increase insulin secretion in pancreas, much shorter duration of action (repaglinide – GlucoNorm®)

87
Q

How does the oral antidiabetic medication Dipeptyl petidase 4 (DPP-4) Inhibitors

work?

A

Slow down incretin hormone breakdown; increase insulin secretion and lower glucagon secretion (sitagliptin - Januvia®)

88
Q

What are symptoms of hypoglycemia?

A

˜Adrenergic

  • Anxiety, tremors, sensation of hunger, palpitations, sweating˜

Central nervous system

  • Difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness and headache˜

Later signs

  • Hypothermia, seizures
  • Coma and death will occur if not treated
89
Q

What is one form of glucose elevating subsance?

A

Glucagon

90
Q

What options can be used in the event of hypoglycemia?

A
  • Concentrated Glucose: Rapidly dissolving buccal tablets given and semisolid gels for oral use; better than regular sugar
  • Intravenous glucose solutions up to 50% D50W
  • Glucagon: a natural hormone given by injection
  • Diazoxide: useful for long-term illness such as pancreatic cancer (oral)
91
Q

What should you do before giving drugs that alter glucose levels?

A

˜Obtain and document:

  • A thorough history
  • Vital signs
  • Blood glucose levels, HbA1c level
  • Potential complications and drug interactions

Also,

  • Assess the patient’s ability to consume food.
  • Assess for nausea or vomiting.
  • Hypoglycemia may be a problem if antidiabetic drugs are given and the patient does not eat.
  • If a patient is to take nothing by mouth (NPO) for a test or procedure, consult the primary care provider to clarify orders for antidiabetic drug therapy.
92
Q

In what circumstances might overall concerns for any patient with diabetes increase?

A
  • Is under stress
  • Is pregnant or lactating
  • Has an infection
  • Has an illness or trauma
93
Q

True or false: Oral hypoglycemics may cause photosensitivity

A

True

94
Q

What non-pharmacological interventions are important to emphasize?

A

Weight & dietary management, exercise, foot care, eye care

95
Q

What are key topics for patient education relative to diabetes mellitus?

A
  • Disease process
  • Diet and exercise recommendations
  • Self-administration of insulin or oral drugs
  • Potential complications
96
Q

What important factors do you need to keep in mind for insulin administration?

A
  • Insulin order and prepared dosages are second-checked with another registered nurse (or per agency policy).
  • Check blood glucose level before giving insulin.
  • To mix suspensions, roll vials between hands instead of shaking them.
  • Ensure correct storage of insulin vials.
  • Only use insulin syringes, calibrated in units, to measure and give insulin.
  • Ensure correct timing of insulin dose with meals.
  • When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting (clear) insulin first.
97
Q

What are important nursing considerations for oral antidiabetic medications?

A
  • Always check blood glucose levels before administering.
  • Usually given 30 minutes before meals
  • α-Glucosidase inhibitors are given with the first bite of each main meal.
  • Metformin is taken with meals to reduce gastrointestinal effects.
  • Metformin will need to be discontinued if the patient is to undergo studies with contrast dye, because of possible renal effects; check with the prescriber.
98
Q

What would be evidence of a therapeutic response to antidiabetic medication?

A
  • Decrease in blood glucose levels to the level prescribed by physician
  • Measure HbA1c to monitor long-term compliance with diet and drug therapy.
  • No significant hypoglycemia and hyperglycemia.
99
Q

Which antidiabetic medication is considered a first-line drug for type 2 diabetes, especially for patients with a BMI over 25?

A

metformin (biguanide)

100
Q

Who are glinides most useful for?

A

People with type 2 diabetes with high postprandial glucose levels and who have low circulating insulin.

101
Q

True or false: Glitazones increase the risk of heart failure.

A

True. They are not recommended for patients with with symptoms of heart failure.

102
Q

What are incretins?

A

Hormones released by the GI tract in response to food.

103
Q

How do incretin mimetics works?

A

Enhance glucose-dependent insulin secretion, suppress elevated glucagon secretion, and slow gastric emptying.

104
Q

Which long acting insulin can be given once a day?

A

glargine (Lantus)

105
Q

The nurse will instruct the patient to treat hypoglycemia with which drug?

A

liquid glucose or glucagon

106
Q

What patient teaching is included for patients on oral hypoglycemic agents?

A

exercise, hygiene, foot care, dietary plans, weight control, avoid smoking and alcohol, don’t skip meals or doses of meds

107
Q

Which drug might put a patient on insulin at risk for unrecognized hypoglycemia?

A

Nonselective beta blockers

108
Q

What is the only insulin that can be administered IV?

A

Regular insulin (short-acting insulin)

109
Q

What are signs and symptoms of hypoglycemia?

A
  • Sweating, trembling, palpitations, anxiety, and a sensation of hunger
  • CNS manifestations include: difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness, and headache
110
Q

Which rapid acting insulin starts working less than 15 minutes after administration?

A

insulin lispro

RD Polytechnic BScN 2nd Year Semester 1 (9 decks)

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