Antidiabetics

Question 1

Caused by absolute lack of insulin secretion; Due to autoimmune destruction of pancreatic islet cells

Answer 1

Type I Diabetes

Question 2

Methods of insulin administration

Answer 2

Syringe
Insulin pumps
Insulin pen injectors
Insulin jet injectors

Question 3

How to mix insulin

Answer 3

Draw up the Clear (Fast acting)
Before the Cloudy (Long acting)

Question 4

Thickening of tissue around the injection site

Answer 4

Lipohypertrophy

Question 5

Deep, retracted scar on the skin the results from serious damage to SQ fatty tissue

Answer 5

Lipoatrophy

Question 6

Why is site rotation important?

Answer 6

Site rotation is important to avoid side effects of lipohypertrophy and lipoatrophy

Question 7

Only regular insulin can be given intravenously.

True or False

Answer 7

True

Question 8

Routes of insulin administration

Answer 8

Subq and IV

Question 9

Onset: 15 min
Peak: 1-2 hrs
Duration: 3-5 hrs
Admin: SQ, within 15 min of meals

Answer 9

Rapid-acting (clear)

Ex: Lispro, aspart, & glulisine

Question 10

Onset: 30-60 min
Peak: 2.5 hrs
Duration: 6-10 hrs
Admin: SQ, 30-60 in before meals, can be IV

Answer 10

Short-acting (clear)

Ex: Regular (Humulin R, Novolin R)

Question 11

Onset: 1-2 hrs
Peak: 4-8 hrs
Duration: 10-18 hrs
Admin: SQ, mix (cloudy)

Answer 11

Intermediate acting (cloudy)

Ex: Insulin isophane (NPH)

Question 12

Onset: Lantus 1-2 hrs, Levemir gradual
Peak: Lantus none, Levemir 6-8 hrs
Duration: Lantus 24 hours, Levemir up to 24 hrs
Admin: SQ, once or twice a day, same time each day

Answer 12

Long acting

Ex: glargine (Lantus) & detemir (Levemir)

Question 13

Can long acting insulin be mixed with other insulins?

Answer 13

No!

Question 14

Promote use of glucose by body cells, store glucose as glycogen in muscles

Reduce blood glucose

Answer 14

Insulins

Question 15

-Adjusted doses dependent on individual blood glucose
-Usually done before eating and at bedtime
-Usually uses rapid or short-acting insulin

Answer 15

Sliding-scale insulin coverage

Question 16

Adverse effects of insulin

Answer 16

Adverse effects – hypoglycemia (insulin shock)

Can result from:
Insulin overdose
Improper timing of insulin dose
Skipping a meal

Question 17

Insulin side effects

Answer 17

Hypoglycemia & hyperglycemia

Question 18

Headache, dizziness, confusion, slurred speech
Nervousness, anxiety, agitation
Tremors, incoordination, sweating, tachycardia, seizures

Answer 18

Sx of hypoglycemia

Question 19

Extreme thirst, dry mucous membranes
Poor skin turgor, polyuria, fruity breath
Fatigue, tachycardia, Kussmaul respirations

Answer 19

Sx of hyperglycemia

Question 20

Hyperglycemia upon awakening

Answer 20

Dawn phenomenon

Question 21

Rapid decrease in blood glucose during night stimulates hormonal release to increase blood glucose

Occurs in predawn hours

Answer 21

Somogyi effect

Question 22

Insulin resistant

Controlled through lifestyle changes

Answer 22

Type II Diabetes

Question 23

Drugs used to manage type 2 diabetes
-Two or more different types for best control
-May occasionally need insulin

Goals:
Normal blood glucose levels
Reduced blood fat levels
Normal body weight

Answer 23

Oral antidiabetic drugs

Question 24

Side effects & adverse effects for oral antidiabetic drugs

Answer 24

Side effects – NVD, rash

Adverse effects – severe hypoglycemia

Question 25

Drugs that directly stimulate beta cells in the pancreas to secrete more insulin Indirectly alters sensitivity of peripheral insulin receptors, allowing increased insulin binding Uses: control hyperglycemia in type 2 DM Take once or twice a day

Answer 25

2nd gen Sulfonylureas Ex: glipizide (Glucotrol)

Question 26

Side effects & adverse effects of glipizide (Glucotrol)

Answer 26

-Hypoglycemia (especially in individuals who drink alcohol while taking) -GI distress, weight gain -Drowsiness, dizziness, confusion -Blood dyscrasias (agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia, pancytopenia) hepatic failure

Question 27

Drugs that stimulate pancreatic beta cells to release insulin (action similar to sulfonylureas) Short-acting Take 15-30 minutes before each meal

Answer 27

Meglitinides Ex: nateglinide (Starlix) and repaglinide (Prandin)

Question 28

Meglitinides are contraindicated in pts w/

Answer 28

Liver dysfunction (decrease liver metabolism, more drug in the body, could cause hypoglycemia)

Question 29

Act on liver to reduce release of glucose from stored glycogen Increase cell sensitivity to insulin (does not cause hypoglycemia) Reduce absorption of glucose from intestinal tract

Answer 29

Biguanides Ex: Metformin (Glucophage)

Question 30

Iodinated contrast media can increase risk of renal failure and lactic acidosis when taking metformin (Glucophage). How long does the drug need to be held before and after testing w/ contrast?

Answer 30

48 hrs

Question 31

Drugs that block enzymes in small intestine responsible for release of glucose from complex carbohydrates in the diet Digestion of glucose is delayed. Carbohydrates must be in monosaccharide form to be absorbed. Most common side effects are GI related (diarrhea, bloating, flatulence)

Answer 31

Alpha-glucosidase Inhibitors Ex: acarbose (Precose)