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PHARM EXAM 3 > Diabetes > Flashcards

Diabetes Flashcards

(56 cards)

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1
Q

What are the key points to know about glucose?

A

It’s easy to breakdown
-body’s primary energy source, brain almost exclusively uses
Low glucose leads to: confusion and drowsiness

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2
Q

What are the 2 major hormones used to stabilize glucose levels

A

Glucagon and insulin
-secreted by pancreas’s: islets of langerhans
-alpha and beta cells

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3
Q

What do alpha cells do?

A

Stimulates liver to turn glycogen in glucose
-glucagon secreting cells
-increase blood glucose levels

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4
Q

What do beta cells do?

A

Brings down glucose levels by body using it
-insulin secreting

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5
Q

When is glucagon secreted?

A

Low blood glucose
-maintains between meals

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6
Q

When is insulin secreted?

A

After a meal, caused by rising glucose
-allows transport of glucose into cells, allows glucose to convert to glycogen, convert lipids to fat, increases protein synthesis and stops glucogenesis

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7
Q

What hormones increase blood glucose

A

-epinephrine (SNS)
-thyroid hormone (metabolism)
-growth hormone (Muscle)
-glucocorticoids (promote glucose in liver)

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8
Q

What drugs increase/decrease glucose

A

I: phenytoin, beta blockers, NSAIDS, diuretics
D: alcohol, lithium, ace inhibitors

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9
Q

What is diabetes mellitus

A

Metabolic disorder, causing deficient insulin secretion or sensitivity, causing hyperglycemia
-Type 1 and 2

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10
Q

What are key points of type 1?

A

Childhood (4-20 years normally)
-autoimmune=beta cells are destroyed
-lots of complications/hard to control
-insulin dependent

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11
Q

What are the key points of type 2?

A

Caused by chronic high sugar and decreased excitability (insulin resistance)
-over 40, getting younger (obesity concern)
-gradual onset
-90% have type 2

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12
Q

What are the risk factors for type 2 diabetes?

A

Obesity, sedentary lifestyle,
metabolic syndrome (abdominal obesity, low HDL, hypertriglyceridema, hypertension, impaired fasting glucose)
African Americans and Hispanics

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13
Q

List the symptoms of DM

A

Hyperglycemia (more than 126 fasting)
Polyuria
Polyphagia (hungry)
Polydipsia (thirsty)
Glocosuria
Weight loss
Fatigue

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14
Q

What are macrovascular complications of DM?

A

In big vessels!
-HTN, MI, stroke, PVD

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15
Q

What are macrovascular complications of DM?

A

Little vessels!
-nephropathy (first cause of kidney failure)
-retinopathy (blindness)
-neuropathy (nerve damage)

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16
Q

What is ketoacidosis, the treatment and symptoms?

A

Severe insulin deficiency, fat is used for energy, ketones will reproduce faster, dropping pH

T: IV fluids to flush out glucose and acid, then insulin is given

S: fruity breath, ketones, kussmauls respirations, hyperglycemia (240), polyuria, polydipsia, nausea, vomiting, coma

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17
Q

What is hyperosmolar hyperglycemic nonketotic coma, treatment and symptoms?

A

Severe hyperglycemia and excessive electrolytes, with dehydration (type 2),

T: fluids, insulin, treat electrolyte imbalances

S: high glucose (600), polyuria, dehydration, drowsiness, confusion, coma

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18
Q

when should glucose levels be checked?

A

Before meals and bed time, if they are NPO or tube fed, every 6 hours

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19
Q

What should fasting glucose be

A

More than 126

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20
Q

What should blood sugar be before meals for a diabetic?

A

70-130

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21
Q

What is an A1C and what should it be?

A

Average blood sugar over 3 months
-normal is less than 7%

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22
Q

True or false. Diabetes mellitus is a chronic systemic tic disease characterized by only by metabolic abnormalities

A

False

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23
Q

True or false. Insulin is a hormone secrete by the beta cells in the pancreas.

24
Q

What are the symptoms of hyperglycemia?

Study These Flashcards
A

Three Ps (drinking, eating and urinating)
Fatigue
Weakness
Dry skin
hot and dry=sugar high

25
What are the symptoms of hypoglycemia?
Sweating Tremors Tachycardia Hunger Confusion Drowsiness Seizures Cold and clammy=need some candy
26
How is insulin given
NOT orally, subQ or IV -100 units per ml
27
What are examples of rapid acting insulin?
Lispro, aspart and glulisine O: 15-30 min P: 30 min - 2.5 hrs D: 3-6 hrs
28
What is the example of short acting insulin?
Regular O: 30-60 min P= 1-5 hrs D=6-10 hrs
29
What is the example of intermediate acting insulin?
NPH and isophane O= 1-2 hrs P= 4-12 hrs D=16 hrs
30
What are the examples of long acting insulin?
Glargine and detemir O=3-4 hrs P= continuous D= 24 hrs
31
What is the example of ultra long acting insulin?
Degludec
32
What is the action of insulin and the only contraindication
Increase glucose uptake and decreases glucose production -hypoglycemia
33
When should insulin be given normally?
Before meals, lining up with the onset
34
What are some drug interactions and Nurisng implications of insulin?
-beta blockers, MAOI, salicylates, alcohol, herbals N: mealtime dosing, rotate injections, monitor for hypoglycemia in sleep, high risk med
35
What are the differences between programmed and sliding scale insulin?
P= regulates between meals, set amount ordered, watch nutrition status, normally regardless of blood sugar (as long above 70) S: dosing based on blood sugar, notify if NPO
36
What is some patient teaching related to insulin?
Diet/weight control/exercise Know signs of hypoglycemia Teach family about sighs Follow up with dr. Take blood sugar Sick days Proper injection sights
37
True or false. Insulin plays a major role primarily in the metabolism of carbohydrates.
False
38
What is an example of a sulfonylurea and its MOA?
Glyburide -oral -stimulate pancreas to release insulin (Must have functioning beta cells)
39
Should pregnant people take oral diabetic medication?
No
40
What are some adverse effects, contraindications and interactions of sulfonylureas?
A: hypoglycemia C: sulfa allergy, renal failure, liver failure D: beta blockers, alcohol
41
What is an example of an alpha glucosidase inhibitor and its MOA?
Acarbose -delays ingestion of complex carbs -given with sulfonylurea Indication: decrease in postpradial glucose
42
What are some adverse effects, contraindications, interactions and nursing implications of alpha glucosidase inhibitors?
A: hypoglycemia, GI upset C: hepatic, and bowel conditions D: can decrease digoxin levels N: take at beginning of meal
43
What is an example of a biguanide, its MOA and indication for use?
Metformin (most common oral) -decrease hepatic glucose production, and increase glucose use I: insulin resistance and PCOS
44
What are some adverse effects, contraindications and nursing considerations for biguanides?
A: lactic acidosis, GI upset C: older adults (BB), renal failure, contrast (48hrs) N: take with meals, increased effects with furosemide, digoxin, vancomycin
45
What is an example of a thiazolidinedione, its MOA and indication?
Rosiglitaxone -stimulates insulin receptors, used in common with insulin, sulfonyurea, and biguanides I: insulin resistance
46
What are some adverse effects, contraindications, and nursing considerations of Thiazolidinediones?
A: hepatic toxicity, HF, weight gain C: liver disease, CV disease (BB) N: take with meals, monitor liver, monitor HF, gemfibrozil can increase effects, may take 12 weeks to reach peak effect
47
What is an example of a meglitinide, its MOA and indication?
Repaglinide stimulates pancreatic insulin Used with TZDs or biguanide I: elevated glucose
48
What are the adverse effects, contraindications, and nursing implications of meglitinides?
A: hypoglycemia (less than sulf) and GI upset C: renal and liver disease, type 1 diabetes N: take before all meals, gemfibrozil and itraconazole can increase effects
49
What is an example of a DPP-4, its MOA, and indication?
Sitagliptin -balance release of insulin and limit glucagon release, also delayed gastric emptying -taken with TZD or biguanide I: elevated glucose
50
What are some adverse effects, contraindications and nursing implications of DPP-4?
A: upper respiratory tract infections, HF C: type 1, insulin use, renal failure N: once a day, with or without meal, weight loss
51
What is an example of an amylin analog, its MOA, and indication?
Pramlintide -suppresses glucagon secretion, used with insulin, sulfa, and biguanides I: rise in postprandial blood glucose
52
What are some adverse effects and nursing implications of amylin analogs
A: hypoglycemia (BB with insulin) N: monitor sugar closely, avoid anticholinergics, weight loss, SQ injection before meals
53
What is an example of an incretin mimetic, its MOA and indication?
Exenatide -stimulates pancreas to make RIGHT amount of insulin based on food intake -can be used as combo I: postprandial glucose elevation
54
What are some adverse effects, contraindications, and nursing considerations of incretin mimetics
A: hypoglycemia, GI distress, pancreatitis C: liver disease, BB for thyroid cancer N: SQ injection with 1 hr of breakfast and dinner, refrigerated, Dulaglutide=1 time a week, weight loss
55
What is an example of a SGLT2 and its MOA
Canaglifozin -blocks reabsorption of glucose in the kidney -used as combo
56
What are adverse effects, contraindications and Nurisng considerations of SGLT2?
A: dehydration, hypotension, electrolyte imbalance, bone loss, increase risk of amputation C: renal failure N: take with first meal, use in caution with meds that decrease BP, risk for dehydration of syncope

PHARM EXAM 3 (6 decks)

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