251 Pharmacology Study Cards - Antidiabetic Flashcards
(110 cards)
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.
2
Q
What is diabetic ketoacidosis?
A
A severe metabolic complication of uncontrolled diabetes that, if untreated, may lead to serious hyperglycemic emergencies.
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.
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.
5
Q
What stimulates the conversion of glycogen to glucose in the liver?
A
Glucagon
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.
7
Q
What are the two main hormones produced by the pancreas?
A
Insulin and glucagon
8
Q
Generally, what range is normal for optimal plasma glucose levels?
A
4 - 6 mmol/L
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
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.
11
Q
What is the main result of diabetes?
A
hyperglycemia
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.
13
Q
What is glycogenolysis?
A
The breakdown of glycogen into glucose.
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.
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.
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.
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.
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.
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.
20
Q
What are ketones?
A
Organic chemical compounds produced through the oxidation of secondary alcohols (e.g., fat molecules), including dietary carbohydrates.
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.
22
Q
What is polydipsia?
A
Excessive intake of water; one of the common symptoms of uncontrolled diabetes.
23
Q
What is polyphagia?
A
Excessive hunger; one of the common symptoms of uncontrolled diabetes.
24
Q
What is polyuria?
A
Increased frequency or volume of urinary output; one of the common symptoms of uncontrolled diabetes.
25
What is Type I diabetes?
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.
26
What is Type 2 diabetes?
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.
27
What is the most common type of diabetes?
Type 2
28
What are comorbidities of Type 2 diabetes?
Obesity
Coronary heart disease
Dyslipidemia
Hypertension
Microalbuminemia (protein in the urine)
Increased risk for thrombotic (blood clotting) events
(collectively known as metabolic syndrome)
29
What is gestational diabetes?
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.
30
What are macrovascular complications of both types of diabetes?
(atherosclerotic plaque)
Coronary arteries
Cerebral arteries
Peripheral vessels
31
What are microvascular complications of both types of diabetes?
Microvascular (capillary damage)
Retinopathy
Neuropathy
Nephropathy
32
What are the four major classes of insulin?
- rapid-acting
- short acting
- intermediate acting
- long acting/ultra long acting
33
How often is screening for diabetes recommended?
Screening recommended every 3 years for all patients 40 years of age and older.
34
What are the features of pre-diabetes?
- 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)
35
Are exclusively non-pharmacological interventions an option for Type 1 diabetes?
No, insulin is always required.
36
List 5 non-pharmacological interventions for Type 2 diabetes.
* Weight loss
* Improved dietary habits
* Smoking cessation
* Reduced alcohol consumption
* Regular physical exercise
37
What is the glycemic goal of treatment?
* 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
38
What is the order of treatment for Type 2 diabetes?
* Lifestyle changes
* Oral drug therapy
* Insulin when the above two can no longer provide glycemic control
39
What are the main categories of antidiabetic drugs?
* 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.
40
What antidiabetic drug functions as a replacement for an endogenous hormone?
insulin
41
What does insulin restore a diabetic patient's ability to do?
* Metabolize carbohydrates, fats, and proteins
* Store glucose in the liver
* Convert glycogen to fat stores
42
List the four major classes of insulin and the identified example of each (red bolded).
* Rapid Acting (**insulin lispro**)
* Short Acting (**regular insulin**)
* Intermediate Acting (**insulin NPH**)
* Long Acting (**insulin detemir and glargine**)
43
How is human insulin created?
* Derived using recombinant deoxyribonucleic acid (DNA) technologies
* Recombinant insulin produced by bacteria and yeast
44
What is the onset of action for rapid acting insulin (lispro - Humalog)(aspart - Novorapid)?
It has the most rapid onset of action at 10 - 15 minutes.
45
What is the peak for rapid acting insulin (lispro - Humalog)(aspart - NovoRapid)?
1 - 2 hours
46
What is the duration for rapid acting insulin (lispro - Humalog)(aspart - NovoRapid)?
3 - 5 hours
47
What is important for a diabetic patient to do while or immediately after a rapid acting insulin injection?
Eat a meal.
48
By what route can rapid acting insulin be given?
May be given subcutaneously or via continuous subcutaneous infusion pump (but not intravenously)
49
What are two examples of rapid acting insulin?
* Insulin lispro (Humulin)
* Insulin aspart (NovoRapid)
50
What are two examples of short-acting insulin?
* Regular insulin (Humulin R)
* Novolin ge Toronto
51
What are the routes of administration for short-acting insulin?
* intravenous (IV) bolus
* IV infusion
* intramuscular
* subcutaneous
52
What is the onset of action for short acting insulin given via the subcutaneous route?
30 minutes
53
What is the peak for short acting insulin given via the subcutaneous route?
2 to 3 hours
54
What is the duration for short acting insulin given via the subcutaneous route?
6.5 hours
55
What is an example of an intermediate-acting insulin?
Insulin isophane suspension (also called NPH)
56
What are the pharmacological characteristics of insulin isophane suspension (also called NPH)?
* Cloudy appearance
* Often combined with regular insulin
* Onset: 1 to 3 hours
* Peak: 5 to 8 hours
* Duration: up to 18 hours
57
What are two examples of long-acting insulin?
* Insulin glargine (Lantus)
* Insulin detemir
58
What are the pharmacological properties of long acting insulin glargine (Lantus)?
* 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
What are the notable features of the long-acting insulin detemir?
* Duration of action is dose dependent.
* Lower doses require twice-daily dosing.
* Higher doses may be given once daily.
60
List two fixed combination insulins.
* Humulin 30/70
* Novolin 30/70, 40/60, 50/50
61
What do fixed combination insulins contain?
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
What are the adverse effects of insulin?
* Hypoglycemia
* Tachycardia, palpitations
* Headache, lethargy, tremors
* Blurred vision, dry mouth, hunger
63
What drug interactions can result in reduced effects and elevated blood glucose?
•Β blockers, corticosteriods, epinephrine, furosemide, thyroid hormones
64
What drug interactions can result in increased effects and lowered blood glucose?
•Alcohol, anabolic steroids, sulfa drugs, ACE inhibitors, MAOI’s, propanolol and salicylates
65
What kind of protocol might hospitalized patients be placed on?
* Sliding scale protocol
* Not preferred though
66
Name three areas that glucose gets stored in the body when there are adequate amounts in the blood.
* Stored as glycogen in the liver
* Stored to a lesser extent in skeletal muscle tissue
* Also in adipose tissue as triglyceride body fat
67
What is the most common precipitator of diabetic ketoacidosis or hyperosmolar nonketonic syndrome?
Some type of physical or emotional stress
68
What are major outcomes of hypoglycemia?
Brain damagr, shock, and possibly death. It is the most immediate and serious adverse effect of insulin.
69
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.
False, it is not.
70
What two special populations need added attention with insulin therapy?
Pediatric patients and pregnant women
71
Describe the difference between regular insulin and the newer rapid-acting drugs.
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
What is currently the safest therapy for pregnant women?
insulin
73
When is combination therapy recommended for Type 2 diabetics?
Combination therapy is recommended if A1C exceeds 9%
Two drugs from two different classes
74
What steps are involved in the effective treatment of Type 2 diabetes?
* 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
What are the recommendations for treatment for new onset of Type 2 diabetes?
* 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
What drug belongs to the biguanide group of drugs?
metformin
77
What is the mode of action for metformin (biguanide)?
* 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
True or False. Metformin may be used in combination with **sulfonylureas, thiazolidinediones** or **incretin mimetics** when monotherapy & lifestyle measure are not successful
True
79
What are the adverse effects of metformin?
* 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
Name one sulfonylureas.
Gliclazide
81
What is the mode of action of sulfonylureas?
* 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
What are the adverse effects of sulfonylureas?
* hypoglycemia
* weight gain
* skin rash
* nausea
* epigastric fullness
* heartburn
83
What interactions exist for sulfonylureas - gliclazide?
* 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
What contraindications are there for sulfonyureas - Gliclazide?
* Severe liver and kidney disease
* Active hypoglycemia
* Not used in pregnancy
85
How does the oral antidiabetic medication T***hiazolidinediones (Glitazones) work?***
Insulin sensitizing drugs; enhance receptor sensitivity; slow onset up to months (pioglitazone - Actos®)
86
How does the oral antidiabetic medication ***Glinides work?***
Similar to sufonlyureas, increase insulin secretion in pancreas, much shorter duration of action (repaglinide – GlucoNorm®)
87
How does the oral antidiabetic medication ***Dipeptyl petidase 4 (DPP-4) Inhibitors***
## Footnote
***work?***
Slow down incretin hormone breakdown; increase insulin secretion and lower glucagon secretion (sitagliptin - Januvia®)
88
What are symptoms of hypoglycemia?
**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
What is one form of glucose elevating subsance?
Glucagon
90
What options can be used in the event of hypoglycemia?
* 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
What should you do before giving drugs that alter glucose levels?
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
In what circumstances might overall concerns for any patient with diabetes increase?
* Is under stress
* Is pregnant or lactating
* Has an infection
* Has an illness or trauma
93
True or false: Oral hypoglycemics may cause photosensitivity
True
94
What non-pharmacological interventions are important to emphasize?
Weight & dietary management, exercise, foot care, eye care
95
What are key topics for patient education relative to diabetes mellitus?
* Disease process
* Diet and exercise recommendations
* Self-administration of insulin or oral drugs
* Potential complications
96
What important factors do you need to keep in mind for insulin administration?
* 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
What are important nursing considerations for oral antidiabetic medications?
* 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
What would be evidence of a therapeutic response to antidiabetic medication?
* 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
Which antidiabetic medication is considered a first-line drug for type 2 diabetes, especially for patients with a BMI over 25?
metformin (biguanide)
100
Who are glinides most useful for?
People with type 2 diabetes with high postprandial glucose levels and who have low circulating insulin.
101
True or false: Glitazones increase the risk of heart failure.
True. They are not recommended for patients with with symptoms of heart failure.
102
What are incretins?
Hormones released by the GI tract in response to food.
103
How do incretin mimetics works?
Enhance glucose-dependent insulin secretion, suppress elevated glucagon secretion, and slow gastric emptying.
104
Which long acting insulin can be given once a day?
glargine (Lantus)
105
The nurse will instruct the patient to treat hypoglycemia with which drug?
liquid glucose or glucagon
106
What patient teaching is included for patients on oral hypoglycemic agents?
exercise, hygiene, foot care, dietary plans, weight control, avoid smoking and alcohol, don't skip meals or doses of meds
107
Which drug might put a patient on insulin at risk for unrecognized hypoglycemia?
Nonselective beta blockers
108
What is the only insulin that can be administered IV?
Regular insulin (short-acting insulin)
109
What are signs and symptoms of hypoglycemia?
* 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
Which rapid acting insulin starts working less than 15 minutes after administration?
insulin lispro
