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Pharmacology > Agents to control Blood glucose levels > Flashcards

Agents to control Blood glucose levels Flashcards

Chapter 38

1
Q

What does the endocrine gland do ?

A

-Insulin produced by beta cells in response to high blood glucose levels
-Glucagon in alpha cells in response to low blood glucose levels
-Insulin and glucagon maintain glucose levels

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2
Q

**Diabetes mellitus
What happens when you eat a meal ?

A

-Insulin is secreted from beta cells
-Moves glucose from blood to muscle, liver, fat cells

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3
Q

**Diabetes mellitus
What does insulin do in the body ?

A

-Transport/metabolizes glucose for energy
-Stimulates storage in liver/muscle (Glycogen)
-Enhances storage of dietary fat
-Signals liver to halt release of glucose
-Inhibits breakdown of stored glucose
-Speeds up transport of amino acids (from dietary protein) into cells

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4
Q

Diabetes-System fails due to:

A

-Destruction of beta cells lead to lack of insulin productions ( Type l)
-Insulin resistance/ impaired insulin secretion (Type ll)

Results in complex disturbances in usual metabolism of:
-Carbohydrates
-Protein
-Fats

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5
Q

**Diabetes Mellitus
What can failure of insulin system do to the body?

A

-Retinopathy-closing of tiny vessels in the eye
-Cardiac- Atherosclerosis
-Renal dysfunction- Related to changes in basement membrane of glomerulus
-Neuropathies-motor and sensory changes as nerves are deprived of oxygen

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6
Q

What does insulin medication do?

A

-Insulin corrects blood sugars quickly
-Oral agents take a long time to reach optimal effect
-Oral agents do not clear as quickly from the system
-Oral agents have more side effect

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7
Q

What are four major classes of insulin?

A

-Rapid acting- Insulin lispro (Humalog)
-Short acting- *Regular
-Intermediate acting- *NPH( Humulin N)
-Long acting- *Glargine(Lantus)

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8
Q

What is fixed combination insulin?

A

-Usually intermediate acting rapid of short
-Numerical designation indicates percentage of each of two component
-Example: Humulin 70/30 and Novolin 70/30

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9
Q

What is the onset peak and duration of Lispro insulin?

A

Onset: 15-30 min
Peak 30-90 mins
Duration <5 hours

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10
Q

What is the onset peak and duration of Regular insulin?

A

Onset: 30-60 mins
Peak: 2-3 hours
Durations: 4-6 hours

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11
Q

What is the onset peak and duration of NPH insulin?

A

Onset: 1-1.5 hrs of insulin
Peak: 4-12 hours
Duration: Up to 24. hours

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12
Q

What is the onset peak and duration of Glargine insulin?

A

Onset: 3-6 hours
Peak: Non
Duration: 24 hours

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13
Q

What Basal insulin(Background insulin)

A

-Slow continuous delivery of insulin: keeps blood glucose level stable between meals and during sleep
-intermediate or long acting insulin –> NPH, glargine, premixed 70/30

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14
Q

What is Nutritional insulin?

A

-Dose of insulin that is taken before meals or snacks to cover the expected rise in blood glucose from the food
-Rapid acting (lispro) given when tray is serve or immediately after

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15
Q

What is sliding scale insulin( Supplemental insulin/correctional insulin)

A

-Given in combination with nutritional insulin
-Dose of insulin given to correct elevated blood glucose level (based on blood sugar reading)
-Lispro(rapid acting)
-Regular insulin- TPN, TF
-rapid or short acting insulin

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16
Q

Describe insulin?

A

-Only treats hyperglycemia
-Does not meet basal requirements
-Large swings in glucose control

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17
Q

Describe insulin pump?

A

-Deliver rapid or short acting insulin over 24 hours
-Insulin doses can be basal, nutritional, or correctional

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18
Q

Describe insulin pen

A

-Pre-filled with insulin, deliver insulin SQ
-Use different pen for each insulin, discard after use
-Single patient use! Do not share!

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19
Q

What are adverse effects of insulin?

A

Hypoglycemia

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20
Q

What are contraindications for insulin?

A

-No contraindications except hypoglycemia

21
Q

What cautions to have when taking insulin?

A

-Pregnancy and lactation

22
Q

What are drug interactions of insulin?

A

-Steroids, diuretics, niacin, thyroid hormones
—> antagonize insulin =elevated blood sugar
-ETOH, salicylates blocker, oral Anti-diabetic agents—>Potentiate insulin and lead to lower blood sugar levels
-Becareful with beta blockers because it suppresses the sns which blocks the signs and symptoms of hypoglycemia

23
Q

**Special populations
Describe insulin given to different groups

A

Children
* Insulin ─ small doses used in infants
* Adolescents ─ constant changing insulin needs
* Metformin ─ only oral agent approved now
Pregnancy
* Gestational diabetes (9.2%), diet or med controlled
* Insulin drug of choice when pregnant
Older adults
* Co-morbidities, meds, physical limitations

24
Q

What are insulin nursing considerations?

A
  • Assess baseline status, VS, labs, self care ability, schedule of meds taken
    at home
  • Monitor for acute events that would change med requirements
  • Appropriate site, syringe, needle
  • Date vials
  • Pre-drawn syringes good for 1 week
  • Give mixed insulin within 15 minutes
  • Glargine (Lantus) can NOT be mixed
  • Assess response
  • Teach, teach, teach
  • Nutritional consult
  • VNA referral
  • Follow-up, when to call PCP/NP
25
Q

How do oral diabetic medications work?

A

-Stimulate pancreas to release insulin
-Decrease insulin resistance
-Alter glucose absorption in GI tract
-Control release of glucose from liver

26
Q

Describe sulfonylureas

A

(Oral medication )
-Stimulate insulin release
-Excreted in urine and bile, safer for renal compromise
-Longer duration of action
-Less likely to react with other meds

27
Q

What is Glyburide (Diabeta, Micronase)

A

A sulfonylureas, a type of insulin
(Oral medication )

28
Q

What do sulfonylureas do?

A

-Stimulate functioning beta cells in the pancreatic islet to release insulin
-Excreted in urine and bile, safer for renal compromise
-Longer duration of action
-Less likely to react with other med

29
Q

Describe Glyburide (Diabeta, Micronase)

A

*Sulfonylureas

Used for type ll diabetes
-Adjunct to diet and excerise, can be used with insulin

30
Q

What are adverse affects of Glyburide (Diabeta, Micronase)

A

*Sulfonylureas

-Hypoglycemia
-Gi effects which lead to N/V, heartburn, anorexia, sometimes when patients may not eat after taking

31
Q

What are contras/ cautions with Glyburide (Diabeta, Micronase)?

A

*Sulfonylureas

-Allergies, need for tight control of glucose,
-Type l diabetes,they don’t have any beta cells and it will not benefit them
-Not used for pregnancy

32
Q

What are drug to drug interactions when taking Glyburide (Diabeta, Micronase)?

A

*Sulfonylureas

-Caution with beta blockers because they can mask hypoglycemic effect
-Meds that acidifies urine- because that decreases excretion
-Cross allergy with sulfa drugs

33
Q

What is Biguanides also called?

A

Metformin(Gucophage)

34
Q

What is the therapeutic action of metformin(Glucophage)?

A

Biguanides
-Primarily decreases glucose production in liver, increases uptake of glucose
-Decreases intestinal absorption of glucose
-Improves insulin sensitivity of peripheral cells
-Does not stimulate insulin secretion may allow for less or unchanged insulin secretion

35
Q

What group of people use Metformin(Glucophage)?

A

Biguanides
-Initial drug for type ll
-Used in children> 10 years with type ll diabetes
-Good for obesity related diabetes
-Monotherepy or in combination

36
Q

What are adverse affects of Metformine (Glucophage)?

A

Biguanides
-Gi complications usually happens earlier (D/N/V, distention, constipation, abd. discomfort)
-Asses for lactic acidosis (Malaise, myalgia’s, respiratory hyperventilation, somnolence, severe abd pain

37
Q

What are contradictions with Metformin (Glucophage)?

A

Biguanides
-Renal disease, acute cardiac events,sepsis due to increased side effects including lactic acidosis
-DKA
-Caution with people with hepatic impairment

38
Q

What are drug to drug interactions with Metformin (Glucophage)?

A

Biguanides
-containing dyes, can lead to acute kidney failure
stop metformin day of exam and 48 hrs after

39
Q

What medication would be considered Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)?

A

**semaglutide (Ozempic, Rybelsus)

40
Q

What is therapeutic actions of semaglutide (Ozempic, Rybelsus)?

A

**Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)

-Increase insulin release
-Decrease glucagon release
-Slow GI emptying to allow more absorptions of nutrients

41
Q

What are indications of semaglutide (Ozempic, Rybelsus)?

A

**Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)

-Adjunct to diet and exercise in type 2
– Some agents used to reduce risk of major CV events in patients with type 2
and CV disease

42
Q

**Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)

What are pharmacokinetics semaglutide (Ozempic, Rybelsus)?

A

-Mostly given subcutaneous injection

43
Q

What are adverse effects of semaglutide (Ozempic, Rybelsus)?

A

**Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)

-Pancreatitis ( watch if pt says they feel epigastric pain)
-GI N/V, decreased appetite, C/D

44
Q

What are in contras of semaglutide (Ozempic, Rybelsus)?

A

**Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)

-Boxed warning with risk of thyroid cancer
-Not for type l diabetes or dka
-Pregnancy/ lactation

45
Q

What are drug to drug interactions of semaglutide (Ozempic, Rybelsus)?

A

**Glucagonlike Polypeptide Receptor
Agonists (GLP-1 Agonists)

-Oral medications effects may be delayed due to slowed emptying of gastric emptying
-Other anti-diabetic medication

46
Q

What would you give in a hypoglycemic event for conscious vs unconscious patients?

A

Conscious pt: Glucose tablet or gel which will be absorbed quickly

Unconscious pt: D50% given IVP, and glucagon subcutaneous, may induce vomiting so turn pt to the side

47
Q

Who is at risk for hypoglycemia ?

A
  • Hepatic Disease
  • Renal Failure
  • Endocrine Deficiency
  • Beta Cell tumors(insulinoma)
  • Gastric disorders which
    interfere with absorption
  • Critically ill with: cardiac,
    sepsis or severe trauma
  • History of severe
    hypoglycemia
  • Type 1 diabetes
  • Severe malnutrition
48
Q

What are signs and symptoms of hypoglycemia ?

A
  • Sweating
  • Nervousness
  • Hunger
  • Mental confusion
  • Argumentative
  • Tremors
  • Diaphoresis
  • Loss of consciousness
    leading to seizures, coma and
    death
  • “COLD AND CLAMMY…
    NEED SOME CANDY
49
Q

What are signs and symptoms of hyperglycemia?

A
  • Unusual thirst (polydipsia)
  • Frequent urination (polyuria)
  • Excessive hunger (polyphagia)
  • Fatigue and weakness
  • Blurred vision
  • Abdominal pains
  • Nausea and vomiting
  • Rapid weight loss
  • Skin infections
  • Changed mental status
  • Warm, dry, flushed skin
  • “HOT AND DRY…SUGAR HIGH”

Pharmacology (39 decks)

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