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Pharm > Ch. 52 - Antidiabetics > Flashcards

Ch. 52 - Antidiabetics Flashcards

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1
Q

Insulin:

A

Secreted by:

-beta cells of the islets of Langerhans in pancreas

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2
Q

Normal Glucose Ranges (1):

A
  1. ) Blood glucose
    • 60-100 mg/dL
  2. ) Serum (plasma) glucose
    - 70-110 mg/dL

3.) > 180mg/dL  glycosuria (glucose spills into urine)

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3
Q

Normal Glucose Ranges (2):

A

HbA1C:
-Average glucose level up to 3 mos(months)

-Goal = keep HbA1C Below 7%

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4
Q

Insulin Therapy (1):

A
  1. ) Dosage = measured in units
  2. ) Insulin syringes  (orange cap)
  3. ) U-100 = 100 units of insulin per milliliter
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5
Q

Insulin Therapy (2):

A
  1. ) U-500 = 500 units / mL
  2. ) Need prescription (but not for U-100)
  3. ) Need doses > 200 units insulin daily
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6
Q

Insulin Therapy (3):

A
  1. ) 10 mL vials
  2. ) Store in refrigerator
  3. ) Avoid extreme temps
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7
Q

Routes of Administration (1):

A
  1. ) SC
  2. ) Insulin pen = SC
    - More accurate, more expensive
    - Less painful
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8
Q

Routes of Administration (2):

A

3.) IV (REGULAR type only)

  1. ) Insulin pump (REGULAR type only)
    - Implantable
    - Portable
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9
Q

Insulin Pump:

A
  1. ) More effective than multiple injections
  2. ) Constant amt of insulin
  3. ) More expensive
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10
Q

4 Types of Insulin:

A

1.) Rapid acting
2.) Short acting
3.) Intermediate acting
4.) Long acting
(Combination)

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11
Q

Rapid Acting (1):

A

1.) lispro (Humalog)

2.) insulin aspart (NovoLog)
Ex: ^^^

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12
Q

Rapid Acting (2):

A
  1. ) Onset of Action
    - 5-15 min
  2. ) Peak Action:
    - Humalog: 30-90 min
    - NovoLog: 1-3 hrs
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13
Q

Rapid Acting (3):

A
  1. ) Duration:
    - Humalog: 2-5 hrs
    - NovoLog: 3-5 hrs
  2. ) Appearance = clear
  3. ) Administer:
    • 5 min before meals
      • *Ex: Make sure breakfast trays are infront of p/t first before giving insulin
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14
Q

Short Acting = Regular (1):

A

Insulin Regularrrr =

 - Humulin R
 - Novolin R
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15
Q

Short Acting = Regular (Humulin R) - 2:

A
  1. ) Onset: 30 min
  2. ) Peak: 2.5 – 5 hrs
  3. ) Duration  6 – 8 hrs
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16
Q

Short Acting = Regular (Humulin R)- 3:

A
  1. ) Appearance  clear
  2. ) Administer: ~30 min b4 meal
  3. ) ***ONLY type of insulin that can be given IV!!
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17
Q

Intermediate Acting (1):

A

insulin **NPH (N):

-**Humulin N, Novolin N

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18
Q

Intermediate Acting (2) - NPH (Humulin N):

A
  1. ) Onset: 1 – 2 hrs
  2. ) Peak: 6 – 12 hrs
  3. ) Duration  18 – 24 hrs
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19
Q

Intermediate Acting (3): - NPH (Humulin N)

A
  1. ) Appearance: Cloudy

5. ) Administer: 1 hr before breakfast

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20
Q

Long Acting (1):

A
  • glargine (Lantus)

- Vial  (purposely different) – tall, narrow vial

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21
Q

Long Acting - glargine (Lantus) (1):

A
  1. ) Onset: about 1 hr

2. ) Duration: 24 hr coverage WITHOUT a peak

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22
Q

Long Acting - glargine (Lantus) (2):

A
  1. ) Appearance: clear
  2. ) Administer: given at HS (bedtime)
  3. ) DO NOT MIX with any other insulins
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23
Q

Combination Products:

A

Reg & (intermediate acting):

 - 70% NPH & 30% Reg
 - 50% NPH & 50% Reg

 -B.i.d before meals
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24
Q

Adverse Effects of Insulin:

A

Hypoglycemia!

  1. ) Hypoglycemic (insulin) reaction
  2. ) May be d/t:
    • Omitting / irreg scheduled meals
    • Increase exercise
    • Administration errors
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25
Hypoglycemic (insulin) Reaction: S/S:
Sweating, confusion, tachycardia, HA(headache), hunger, weakness: = Coma, death Blood sugar level
26
Hypoglycemic (insulin) Reaction: Tx:
Glucose: - Oral - Parenteral (if unconscious) = Glucagon
27
Insulin Lipodystrophy:
Atrophy or hypertrophy of SC fat at injection sites ------------------------------------------------------ Prevent: *Rotate sites *Massage site after injection
28
Insulin Resistance:
Need for higher doses of insulin
29
Coverage Orders (Sliding Scale):
1. ) Additional insulin to ‘cover’ increased blood sugar levels 2. ) Based on blood glucose levels 3. ) Rapid or Short acting insulin used
30
Coverage Orders (Sliding Scale) -EXAMPLE
Blood Glucose Level ------ Regular Insulin order 0-180 mg/dL No coverage 181-240 mg/dL 2 units SC 241-300 mg/dL 4 units SC
31
Administration of Insulin (1):
1. ) Always use Insulin syringe! | 2. ) U-100 syringes = 100 units / mL
32
Administration of Insulin (2):
3. ) Lo-dose syringes - 30 unit syringes - 50 unit syringes 4.)For smaller doses of insulin
33
Injection Sites:
Client: - Thigh - Abdomen = (fastest absorption) * Both easier to self-inject
34
Rotate Sites!:
1. ) Injecting into an infrequently used site : - May cause hypoglycemia 2. ) Establish rotation pattern 3. ) Keep track, document site used
35
Measuring 2 Types of Insulin in Same Syringe (1):
1. ) Gently roll longer acting insulin vial {NEVER shake!} 2. ) Clean both stoppers on vials 3. ) Inject appropriate amt of air into longer acting insulin (do not withdraw insulin yet!)
36
Measuring 2 Types of Insulin in Same Syringe (2):
4.) Inject appropriate amt of air & WITHDRAW insulin from short acting (Regular) insulin THEN --> 5.) Withdraw longer acting (Intermediate) insulin
37
Measuring 2 Types of Insulin in Same Syringe (3):
6. ) After mixing Regular & Intermediate insulin:  7. ) Adm WITHIN 30 MIN 8. ) Intermediate insulin will alter functioning of Regular insulin
38
Hypoglycemic reaction (insulin shock) vs Diabetic Ketoacidosis (hyperglycemic reaction):
If unsure = Tx for insulin reaction | -Glucose (better if glucose is elevated than dropped)
39
Hypoglycemic Reaction (insulin shock) (1):
1. ) Able to swallow: | 2. ) Rapidly absorbed sugar = OJ, sugar containing drink, hard candy
40
Hypoglycemic Reaction (insulin shock) (2):
3.) Unable to swallow --> Glucagon injection
41
Glucagon:
- SQ, IM, IV | * Tx: insulin-induced hypoglycemia
42
Hypoglycemic Reaction (insulin shock) (3):
4. ) Should recover within 15 min --> | 5. ) No response --> contact physician--> emergency department
43
Hypoglycemic Reaction (insulin shock) (4):
6.) Fasting = do not give insulin!!
44
Teach Self-Care Skills!:
1. ) Insulin administration 2. ) Blood glucose monitoring 3. ) Foot care 4. ) Diet
45
Teach Self-Care Skills cont:
5. ) Exercise 6. ) Medic-alert ID 7. ) S/S hypo-hyperglycemia
46
Oral Antidiabetic Drugs (1):
1. ) Stimulate pancreatic beta cells to secrete insulin | 2. ) Need some pancreatic function
47
Oral Antidiabetic Drugs (2):
3.) Type 2 diabetes (NIDDM) = DO NOT respond to diet alone
48
Oral Antidiabetic Drugs (3):
4. ) Best respond:  - Dx after age 40 - Not overweight - Need
49
Sulfonylureas (1st & 2nd Generations):
Stimulate pancreatic beta cells to secrete insulin
50
Examples: 1st Generation >
1. ) tolbutamide (Orinase) - Short acting 2. ) tolazamide (Tolinase) - Intermediate acting 3. ) chlorpropamide (Diabenese) - Long acting
51
2nd Generation Sulfonylureas:
1. ) More potent 2. ) Greater hypoglycemia potency (why it’s stronger acting) 3. ) Longer duration 4. ) Fewer SE
52
Examples – 2nd Generation:
1. ) glimepiride (Amaryl) 2. ) glipizide (Glucotrol) 3. ) glyburide (DiaBeta, Micronase ) Admin: -1 or more times / day
53
Adverse Effects:
- Hypoglycemia - Hepatotoxicity/jaundice - GI distress - Hematological disorders
54
Hypersensitivity Reactions:
Ingesting Alcohol --> Flushing, nausea, palpations
55
Biguanides:
1. ) Decreases hepatic production of glucose from stored glycogen  2. ) Reduces the increase in serum glucose after a meal
56
Biguanides – Example:metformin (Glucophage):
Also increases insulin receptor sensitivity Admin: - 500 mg 1-3 times/day with meals - Increases dose gradually
57
metformin (Glucophage) (1):
S/S: 1. ) Does NOT produce hypoglycemia or hyperglycemia 2. ) GI effects 3. ) Bitter metallic taste
58
metformin (Glucophage) (2):
4. ) Avoid alcohol | 5. ) Observe for lactic acidosis
59
Nursing Interventions – Oral Antidiabetics:
-Adm with food to decrease GI upset -Monitor bl sugar levels: Blood glucose = 60-100 mg/dL Serum glucose = 70-110 mg/dL
60
Teach (1):
1. ) Recognize s/s: * Hypo- & hyperglycemia 2. ) May need insulin: * Stress, Surgery, Serious infection
61
Teach (2):
3. ) MedicAlert card, tag, bracelet | 4. ) Use of glucometer
62
Diabetes Mellitus (DM):
Deficiency in glucose metabolism - Caused by: * Lack of (or) * Inefficient use of * Insulin in the body
63
Two Types of DM:
Type 1: * Insulin-dependent (IDDM) * No pancreatic reserve of insulin * Need daily insulin therapy
64
Type 1 (IDDM):
- Wide variations in blood glucose levels | * MORE (1) prone to ketosis (accumulation of ketones in blood)
65
Type 2 (NIDDM) (2):
- Can be controlled by: * Wt loss & special diet * Diet & oral hypoglycemic agents *LESS (2) likely to develop ketosis

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