Diabetes Pharm

Question 1

Goal of diabetes pharm and targeted range for blood sugar

Answer 1

Prevent hyperglycemia and long-term complications by maintaining tight glycemic control of 80-140 and A1C below 6.5%

Question 2

Lispro (Humalog)/Novolog aspart—when given, peak, onset, duration

Answer 2

Rapid acting insulin given with long-acting or intermediate insulin and during or after meals; Onset—15m, Peak—1h, Duration—2-4h

Question 3

Side effects of insulin

Answer 3

Hypoglycemia, lipodystrophy, lipoatrophy, somogyi effect

Question 4

Human regular insulin

Answer 4

Short acting insulin; usually given before meals, often tube feed; O30-60, P2-6h, D3-8h

Question 5

Neutral protamin hagedron (NPH)

Answer 5

Intermediate acting insulin; protamine slows absorption so it lasts thru the day; often given with rapid or short; must agitate before giving; O2-4h, P4-10h, D10-20h

Question 6

Glargine (lantus)

Answer 6

Long-acting insulin; don’t mix with other insulin; usually given at night and can correct with rapid insulinl; O70min, all day

Question 7

ACHS

Answer 7

Before each meal and at bedtime

Question 8

Insulin pump

Answer 8

Mostly used for type 1; computerized to give a basal infusion of regular insulin based on calories/carb intake; surgically implanted; might still require a finger stick

Question 9

Sliding scale

Answer 9

Regular insulin given thru days with meals according to sugar levels

Question 10

What can cause hypoglycemia

Answer 10

Childbirth, insulin overdose, Dec caloric intake, diarrhea, excess alcohol, unaccustomed exercise

Question 11

Hypoglycemia tx

Answer 11

Oral CHO intake, parenteral glucagon, IV dextrose

Question 12

Lipodystrophies/lipoatropy

Answer 12

Depression of skin at injection sites (feels hard, changes color)

Question 13

Somogyi effect

Answer 13

Overdose of insulin causes hypoglycemia and counter-regulatory mechanism cause hyperglycemia and ketosis

Question 14

Dawn phenomenon

Answer 14

Hyperglycemia in morning from natural hormone release (usually cortisol) that often resolves itself

Question 15

Teaching points for diabetes

Answer 15

Vials given for 30 days at room temp, monitor sugar according to dr, rotate sites, carry carbs like popcorn, nuts, cheese, fruit in case

Question 16

Glipizide and glyburide class and MOA

Answer 16

2nd generation diabetes; SULFONYLUREAS that bind and close K-ATP channels in pancreatic beta cells which stimulates secretion of insulin (makes beta cells work harder); decreases liver release of glucose and inc body response to insulin

Question 17

Glipizide and glyburide SE and nursing considerations

Answer 17

Hypoglycemia (esp for kidney/liver dysfunction); Be cautious using alcohol, not for pregnant, not for preexisting liver/kidney probs, be careful or don’t take with NSAIDS, sulfa-based ATB potentiates, and Tagamet

Question 18

Metformin class and MOA

Answer 18

Biguanides; Lowers glucose by decreasing production of glucose in liver; enhances glucose uptake and use by muscles; does NOT promote insulin release from pancreas

Question 19

Metformin SE and NC

Answer 19

Does NOT cause hypoglycemia; GI bloat, diarrhea, N/V, risk for ACIDOSIS in pt w/ elevated creatinine; not good when creatinine levels are elevated, elevated ALT levels, kidney probs, liver prob, excessive drinking, or heart failure; HOLD 48 hours post contrast use; monitor serum glucose levels and give 30 min before bed

Question 20

linagliptin, sazagliptin, sitagliptin class and MOA

Answer 20

DPP4 inhibitors; inhibits dipeptidyl peptidase 4, which is an enzyme that normally inactivates the incretin hormone, causing increased insulin release thru enhanced incretin activity, dec glucagon release, dec hepatic glucose production, dec digestion and appetite

Question 21

linagliptin, sazagliptin, sitagliptin SE and NC

Answer 21

low incidence of hypoglycemia, GI, flu-like, skin rx, inc risk pancreatitis; Watch pancreas, don’t use with other meds that increase risk of pancreatitis

Question 22

dulaglutide, exenatide, semaglutide class and MOA

Answer 22

GLP1 agonist; enhances GLPq which causes glucose-dependent release of insulin, inhibits postprandiol release of glucagon and suppresses appetite, slows gastric emptying

Question 23

GLP1 SE and NC

Answer 23

Headache, weight loss, upper resp infection, N/V/D; Usually given with metformin or another med; don’t give if history of pancreatitis; black box—don’t give with severe renal disease or history of thyroid cell tumors

Question 24

Dapagliflozin class and MOA

Answer 24

Sodium glucose cotransporter 2 (SGLT2) inhibitor; prevents kidneys from reabsorbing glucose back into the blood by blocking sodium glucose transport proteins which normally absorbs glucose, allowing kidneys to lower glucose and remove excess glucose in urine

Question 25

Dapagliflozin SE and NC

Answer 25

UTI, gentian mycotic infection, hypotension, faint, dizzy, fatigue; increasingly used with other conditions like heart failure; Don’t give with ESRD (renal disease) or severe kidney disease; not FDA approved for type 1; often given with other meds

Question 26

Glucagon class and MOA

Answer 26

Hypoglycemia antidote; Activates hepatic glucagon receptors, stimulates glycogen lysis and releases glucose

Question 27

Glucagon nursing considerations

Answer 27

Short duration or action, multiple dose may be needed (half-life 25-35 minutes); check finger stick 15 minutes post-admin

Question 28

Steroid effect on blood sugar

Answer 28

Increase blood sugar; may need to alter insulin schedule

Question 29

What happens when the body is sick with diabetes?

Answer 29

Body is more stressed—check blood sugar more often, patient prone to DKA, HHNS; may not eat normal with stomach virus

Question 30

Exercise and blood sugar

Answer 30

Exercise can help Dec blood glucose levels; need to check often for hypoglycemia

Question 31

How long does it take metformin to work?

Answer 31

2-3 days to onset; 2-4 weeks for peak