Anti-diabetic, gastrointestinal, deficiency anemia, hematopoietic agents

Question 1

Manifestations of Diabetes Mellitus

Answer 1

poydipsia, polyphagia, polyuria (more common in type 1) type 2 may be more asymptomatic initially

Question 2

Complications of diabetes mellitus

Answer 2

vascular injuries found in the eye, kidney, brain, heart, extremities, and neuropathy

Question 3

Diagnostics for diabetes mellitus

Answer 3

HA1C q3 months for pt with diabetes, FPG (fasting plasma glucose)

Question 4

Rapid acting insulin

Answer 4

Novolog, Humalog, Apidra

Question 5

Short acting (regular) insulin

Answer 5

Novolin R, Humulin R

Question 6

Intermediate acting (NPH)

Answer 6

Novolin N, Humulin N

Question 7

Long acting insulin

Answer 7

Lantus, Levemir

Question 8

Metformin (Glucophage) class and indications

Answer 8

Biguanide class oral antidiabetic (first line)
lowers glucose but does not stimulate insulin release indicated for Type 2 and gestational DM

Question 9

Adverse effects of Metformin (Glucophage)

Answer 9

N/D, decreased appetite, toxicity related lactic acidosis, decreased B12 and folic acid absorption

Question 10

Nursing considerations Metformin (Glucophage)

Answer 10

LA signs, monitor renal, stop for contrast CT and for admission, B12 and folic acid supplement, potential for weight loss

Question 11

Metformin (Glucophage) MOA

Answer 11

Sensitizes insulin receptors in target tissues, inhibits gastric glucose reabsorption, inhibits hepatic gluconeogenesis

Question 12

Glipizide (Glucotrol) class and indication

Answer 12

Sulfonylurea class, Type 2 DM

Question 13

Glipizide (Glucotrol) MOA

Answer 13

stimulates pancreatic insulin release by binding with and blocking ATP-sensitive potassium channels in the cell membrane to cause depolarization

Question 14

Adverse effects Glipizide (Glucotrol)

Answer 14

hypoglycemia (more likely with kidney and or liver dysfunction), rare SJS/TENS and CV toxicity

Question 15

Nursing considerations Glipizide (Glucotrol)

Answer 15

monitor for hypoglycemia, contraindicated for pregnant or breastfeeding, avoid alcohol, beta blockers can diminish benefits of sulfonylurea (glipizide)

Question 16

Pioglitazone (Actos) class and indication

Answer 16

Thiazolidinediones class, Type 2 DM

Question 17

MOA Pioglitazone (Actos)

Answer 17

activates PPAR gamma to turn on insulin-responsive genes that are responsible for carp and lipid metabolism

Question 18

Adverse effects Pioglitazone (Actos)

Answer 18

HF 2/2 fluid retention, ovulation in premenopausal women, increased risk of fractures in women, bladder cancer

Question 19

Nursing considerations Pioglitazone (Actos)

Answer 19

monitor and educate ab HF s/s, assess GU history, interactions with CYP2C* inhibitors (atorvastatin, ketoconazole, rifampin, cimetidine)

Question 20

Acarbose (Precose) class and Indications

Answer 20

Alpha-glucosidase inhibitor, Type 2 DM

Question 21

Acarbose (Precose) MOA

Answer 21

delays absorption of dietary carbohydrates to reduce postprandial hyperglycemia by inhibiting glucosidase that is needed for complex carb catabolism

Question 22

Acarbose (Precose) adverse effects

Answer 22

GI, liver dysfunction, anemia b/c of decreased absorption of Fe (iron)

Question 23

Acarbose (Precose) nursing considerations

Answer 23

hypoglycemia if used with insulin or sulfonylurea, monitor LFT and s/s liver dysfunction

Question 24

Canagliflozin (Invokana) class and indication

Answer 24

Sodium-glucose Co-transporter 2 (SGLT-2) inhibitor, Type 2 DM

Question 25

Canagliflozin (Invokana) MOA

Answer 25

Inhibits SGLT-2 to block receptor reabsorption of filtered glucose, leading to glucosuria

Question 26

Sitagliptin (Januvia) class and indications

Answer 26

Dipeptidyl peptidase-4 (DPP-4) inhibitor, Type 2 DM (usually adjunct with metformin)

Question 27

Sitagliptin (Januvia) MOA

Answer 27

enhances actions of incretin hormones to stimulate glucose-dependent release of insulin and suppress postprandial release of glucagon by inhibiting DPP-4

Question 28

Semaglutide (Ozempic/Wegovy) class and indication

Answer 28

Glucagon-like peptide-1 (GLP-1) class SQ injectiable, Type 2 DM (can be used w/ozempic with CV benefits or chronic weight management as Wegovy)

Question 29

MOA Semaglutide (Ozempic/Wegovy)

Answer 29

activates GLP-1 receptors to cause same effects as endogenous incretins (slow gastric emptying, stimulate release of insulin, inhibit postprandial glucagon release, suppress appetite)

Question 30

Adverse effects Semaglutide (Ozempic/Wegovy)

Answer 30

N/V/D, increased risk of pancreatitis and renal impairment/AKI, hypersensitivity reaction, possible MTC (medullary thyroid carcinoma)

Question 31

Tirzepatide (Monjaro) class and indication

Answer 31

Glucose-dependent insulinotropic (GIP) & glucagon-like peptide-1 (GLP-1) class SQ injection, Type 2 DM

Question 32

Tirzepatide (Monjaro) MOA

Answer 32

GLP-1 agonist effects, acts as agonist at GIP receptors to produce similar effects

Question 33

Tirzepatide (Monjaro) adverse effects

Answer 33

GI (N/V/D), constipation, abdominal pain, increase risk pancreatitis, renal impairment/AKI, hypersensitivity, possible MTC (medullary thyroid carcinoma)

Question 34

Glargine (Lantus) indication, class

Answer 34

Long acting once or twice daily insulin Stimulates glucose, amino acids, nucleotides, and K Basal glycemic control in Type 1 & 2 DM SQ NEVER IV

Question 35

Adverse effects Glargine (Lantus)

Answer 35

hypoglycemia, hypokalemia, lipohypertrophy

Question 36

Nursing considerations Glargine (Lantus)

Answer 36

baseline labs and monitor glucose, rotate injection site, Clear medication (throw out and don't use if cloudy), **usually admin HS but can be twice

Question 37

Glulisine (Apidra) indication and MOA

Answer 37

Rapid acting insulin that stimulates uptake of glucose, amino acids, nucleotides, and K+ Postprandial glycemic control in Type 1 & 2 DM

Question 38

Glulisine (Apidra) adverse effects

Answer 38

hypoglycemia, hypokalemia, lipohypertrophy

Question 39

Nursing considerations Glulisine (Apidra)

Answer 39

baseline labs and monitor glucose, rotate injections, clear medication (cloudy throw out), **administered AC (before meals) and PC (after meals)

Question 40

Regular (Humulin R/Novolin R) indication and action

Answer 40

Short acting insulin stimulates uptake of glucose, amino acids, nucleotides, and K+ Postprandial glycemic control via SQ injection or basal glycemic control via SQ infusion in type 1 & 2 DM

Question 41

Regular (Humulin R/Novolin R) adverse effects

Answer 41

hypoglycemia, hypokalemia, lipohypertrophy

Question 42

Regular (Humulin R/Novolin R) nursing considerations

Answer 42

baseline labs and monitor glucose, rotate injection site, clear medication (throw out if cloudy), **administer 20-30 minutes AC (before meals)