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Pharm NUR140 > Chapter 38 > Flashcards

Chapter 38 Flashcards

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1
Q 
What percentage of the population has diabetes mellitus?
A. 3%
B. 7%
C. 14%
D. 21%
A

B. 7%

Diabetes mellitus is a common chronic disease that affects 20.8 million people in the United States, or 7% of the population

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2
Q

People with diabetes are at increased risk for:

A 
cardiovascular disease,
kidney failure,
blindness,
nervous system disease,
extremity amputations,
dental disease,
complications of pregnancy.
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3
Q

Patho Type 1 Diabetes

A

An autoimmune disorder characterized by the destruction of the insulin-secreting beta cells in the pancreas, leading to absolute insulin deficiency.

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4
Q

Patho Type 2 Diabetes

A

The result of insulin resistance by the tissues and usually a decrease in insulin production.

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5
Q

Patho Gestational Diabetes Mellitus (GDM)

A

Occurs when a woman’s pancreatic function is not sufficient to overcome the insulin resistance created by the anti-insulin hormones secreted by the placenta.

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6
Q

Insulin does what?

A

It facilitates the passage of glucose into cells for energy.

It suppresses excess production of sugar in the liver and muscles as well as the breakdown of fat for energy

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7
Q

Regular Insulin

Pharmacotherapeutics

A

All types of diabetes mellitus

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8
Q

Regular Insulin

Pharmacokinetics

A

Administered: SC or IV

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9
Q

Regular Insulin

Pharmacodynamics

A

Injected insulin mimics the effect of endogenous insulin

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10
Q

Regular Insulin

Contraindications and precautions

A

Hypoglycemia

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11
Q

Regular Insulin

Adverse effects

A

Hypoglycemia,

Lipoatrophy

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12
Q

Regular Insulin

Drug interactions

A 
Alcohol,
Beta blockers,
Dobutamine,
Niacin,
MAOIs,
Thiazide Diuretics,
Tetracycline
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13
Q

Regular Insulin

Maximizing Therapeutic Effects

A

Store opened vials of regular insulin at room temperature,

Administer regular insulin with an insulin syringe into an appropriate subcutaneous site.

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14
Q

Regular Insulin

Minimizing Adverse Effects

A

Injection-site rotation also helps prevent lipodystrophy.

Assess blood glucose level prior to administration.

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15
Q

Regular Insulin

Patient and Family Education

A

Discuss how to administer insulin properly,
Discuss storage of insulin,
Discuss side effects of therapy

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16
Q

Regular Insulin

Ongoing Assessment and Evaluation

A

Evaluate ability to administer insulin.

Monitor fasting blood glucose and hemoglobin A1C levels.

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17
Q 
What SC site provides the most rapid absorption of insulin therapy?
A. Arm
B. Abdomen
C. Buttocks
D. Thigh
A

B. Abdomen

The most rapid absorption occurs when administration is into the abdominal SC layer. As much as 50% faster than other routes.

The next most rapid is into the arm, followed by the thigh, and finally the buttocks.

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18
Q

What are the types of IV or SC insulin?

A 
Rapid-Acting,
Short-Acting,
Intermediate-Acting,
Long-Acting,
Pre-Mixed
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19
Q

IV & SC Insulin Client Education

A

Perform self blood-glucose testing to monitor therapeutic benefit

Carry emergency carbohydrate to treat hypoglycemia

Never inject cold insulin

Rotate SC injection sites

Do not massage injection sites

In mixing insulins, draw up regular(R) first

When administering IV, monitor BG levels hourly or per MD’s orders

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20
Q

Oral Hypoglycemic Drugs:

Sulfonylureas

A 
First Generation:
        Chlorpropamide
Second Generation:
        Glyburide (DiaBeta)
        Glimepiride (Amaryl)
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21
Q

Oral Hypoglycemic Drugs:

Biguanide

A

Metformin (Glucophage)

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22
Q

Oral Hypoglycemic Drugs:

Alpha Glucosidase Inhibitors

A

Acarbose (Precose)

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23
Q

Oral Hypoglycemic Drugs:

Meglitinides

A

Repaglinide (Prandin)

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24
Q

Oral Hypoglycemic Drugs:

Thiazolidinediones

A

Pioglitazone (Actos)

Rosiglitazone (Avandia)

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25
Oral Antidiabetic Drug Prototype
glyburide (DiaBeta)
26
Glyburide | Pharmacotherapeutics
Adjunctive treatment to lower blood glucose levels in diabetes mellitus type 2.
27
Glyburide | Pharmacokinetics
``` Administered: oral. Metabolism: liver. Excreted: urine and feces. Onset: 2 hours. Protein bound ```
28
Glyburide | Pharmacodynamics
Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells.
29
Glyburide | Contraindications and Precautions
Hypersensitivity
30
Glyburide | Adverse Effects
``` Hypoglycemia, Anorexia, Nausea & Vomiting, Heartburn, Metallic taste in the mouth ```
31
Glyburide | Drug Interactions
Possible
32
Glyburide | Health Status
Assess overall health before starting therapy
33
Glyburide | Life Span and Gender
Pregnancy category B
34
Glyburide | Lifestyle, Diet, and Habits
Assess willingness to follow diet
35
Glyburide | Environment
Assess environment where drug will be given
36
Glyburide | Maximizing Therapeutic Effects
Administer before breakfast or the first main meal of the day
37
Glyburide | Minimizing Adverse Effects
Monitor the patient's blood glucose levels periodically throughout therapy to detect hypoglycemia. Monitor patients with renal and hepatic impairment for signs of adverse effects
38
Glyburide | Patient and Family Education
Teach about diabetes management Teach patients and families the signs and symptoms of hypoglycemia
39
Glyburide | Ongoing Assessment and Evaluation
Interview the patient and family and observe for therapeutic and adverse responses to glyburide and adherence to prescribed treatments
40
The mechanism of action of GLYBURIDE is the decreased production of insulin by the liver, which results in decreased blood glucose levels. A. True B. False
B. False The mechanism of action of glyburide is stimulation of the beta cells in the pancreas. Hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells.
41
Non-sulfonylureas Classes
Biguanides, Thiazolidinediones, Alpha-Glucosidase Inhibitors
42
Non-sulfonylureas Prototype Drug
metformin (Fortamet, Glucophage)
43
Metformin | Pharmacotherapetuics
Adjunct to therapy to lower blood glucose in type 2
44
Metformin | Pharmacokinetics
Administered: oral Metabolism: liver Excreted: kidneys
45
Metformin | Pharmacodynamics
Decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake
46
Metformin | Contraindications and precautions
Hepatic disease
47
Metformin | Adverse Effects
``` Anorexia, Nausea & Vomiting, Weight loss, Abdominal discomfort, Dyspepsia, Flatulence, Diarrhea, Metallic taste sensation ```
48
Metformin | Drug Interactions
May react with contrast media used for radiographic procedures
49
Metformin | Health Status
Assess medical history and current medial status
50
Metformin | Life span and gender
Pregnancy category B
51
Metformin | Lifestyle, diet, and habits
Assess diet, exercise, and alcohol intake
52
Metformin | Environment
Assess environment where drug will be given
53
Metformin | Culture and inherited traits
Drug has been studied in several ethnic groups
54
Metformin | Maximizing Therapeutic Effects
Administer twice a day with morning and evening meal. Adherence with recommended diet and daily exercise help in control of type 2 diabetes
55
Metformin | Minimizing Adverse Effects
Taking the drug at mealtimes and using gradual dosage increments minimize these effects
56
Metformin | Patient and Family Education
Teach patients to take with meals, morning and evening Emphasize that patients should not use alcohol while taking metformin
57
Metformin | Ongoing Assessment and Evaluation
Monitor blood glucose levels: Fasting Glucose Hemoglobin A1C
58
Glucagon | Pharmacotherapeutics
Hypoglycemia (first line of defense)
59
Glucagon | Pharmacokinetics
T1/2: 3 to 10 minutes
60
Glucagon | Pharmacodynamics
Increases blood glucose levels by stimulating glycogenolysis in the peripheral tissues
61
Glucagon | Contraindications and Precautions
Hypersensitivity
62
Glucagon | Adverse Effects
Hypotension, Respiratory distress, Nausea & Vomiting
63
Glucagon | Health Status
Assess blood glucose level and LOC
64
Glucagon | Life span and gender
Pregnancy category B
65
Glucagon | Lifestyle, diet and habits
Review adherence to treatment plan
66
Glucagon | Environment
Assess environment where drug will be given
67
Glucagon | Maximizing Therapeutic Effects
Use reconstituted glucagon immediately A dose of 0.5 to 1.0 mg is usually effective
68
Glucagon | Minimizing Adverse Effects
Administer supplemental carbohydrates ASAP once consciousness has been achieved
69
Glucagon | Patient and Family Education
Emphasize to patients and family members measures to prevent hypoglycemic reactions from insulin. Instruct family members in the proper technique for emergency administration of glucagon.
70
Glucagon | Ongoing Assessment and Evaluation
Blood glucose levels should be monitored before, during, and after glucagon administration.

Pharm NUR140 (5 decks)

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