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Drug therapy for diabetes Flashcards

(107 cards)

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1
Q

Glucose

A

Sugar in the blood
Body’s primary energy source
Brain almost exclusively uses glucose for energy

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2
Q

2 major hormones stabilize glucose levels

A

Glucagon and Insulin

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3
Q

Alpha Cells

A

Glucagon secreting cells
Increase blood glucose levels
Stimulates the liver to turn glycogen into glucose so that the body can use it

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4
Q

Beta Cells

A

Insulin secreting cells
Insulin allows your body to use glucose. Cannot use glucose until the insulin arrives
Allows cells to start using the glucose in the blood
Decrease blood glucose levels

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5
Q

islets of langerhans

A

Location in the Pancreas where Alpha and Beta cells are located

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6
Q

Glucagon

A

secreted when the body has low blood glucose.
Helps to maintain glucose levels between meals
Kicks in when you haven’t had any meals
Tells the liver to release some of the store glycogen

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7
Q

Insulin

A

secreted after a meal, pancreas recognizes rising glucose
Secretes insulin to lower the blood glucose
Without insulin, glucose unable to enter cells
Acts as a transport to allow cells to access glucose

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8
Q

Glycogenesis

A

liver stores glycogen for the future

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9
Q

Hormones that can increase blood glucose

A

Epinephrine
Thyroid hormone
Growth Hormone (decreases how much muscle is using glucose)
Glucocorticoids

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10
Q

Drugs that Increase blood glucose

A

Phenytoin
Beta blockers
NSAIDS
Diuretics

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11
Q

Drugs that can decrease blood glucose

A

Alcohol
Lithium
ACE inhibitors

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12
Q

Diabetes Mellitus

A

Chronic metabolic disorder in which there is deficient insulin secretion or decreased sensitivity of insulin receptors resulting in hyperglycemia

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13
Q

Classification of DM

A

Type 1 and Type 2

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14
Q

Type 1 Diabetes

A

more chronic condition in childhood

Autoimmune disorder that destroys pancreatic beta cells

Difficult to control and there are a lot of complications

Sudden onset from ages between 4-20

High incidence of complications

Requires exogenous insulin administration***

Insulin dependent diabetes

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15
Q

Type 2 Diabetes

A

Characterized by high blood sugar

Caused by insulin resistance

Insulin is present, but the insulin is not working well

Historically, the onset is 40+ years old

90% of people with DM have type 2

This is not an autoimmune disorder

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16
Q

Insulin Resistance

A

Insulin receptors are not responding to insulin because there has been an influx of insulin for so long that the body is no longer excited about it

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17
Q

Risks for Type 2 Diabetes

A

Obesity

Sedentary lifestyle

Presence of metabolic syndrome

Abdominal obesity

Low HDL

Hypertriglyceridemia

Hypertension and/or impared fasting glucose

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18
Q

Ethnicities at risk for type two diabetes

A

African Americans: 13.3%
Hispanics greater than 13.9%

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19
Q

DM Clinical Manifestations

A

Polyuria
Hyperglycemia (fasting glucose greater than 126)
Polyphagia: frequent hunger
Polydipsia: frequent thirst
Glucosuria: so high that your kidneys start eliminating sugar
Weight loss
Fatigue

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20
Q

DM Chronic Complications from Untreated Diabetes

A

Nephropathy: damage to kidneys

Retinopathy: damage to eyes

Neuropathy: damage to nerves in the peripheral nervous system. Can lead to complete loss of feeling in certain limbs

Increased number and severity of infection

Poor wound healing

Diabetic foot ulcers

Poor sensation from nerve damage

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21
Q

DKA: diabetic Ketoacidosis

A

Life threatening, severe insulin deficiency, usually type 1
Fat broken down for energy, results in ketones
Fruity breath
Ketones in the urine
Drop in PH
Polyuria
Polydipsia
Coma
N+V

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22
Q

DKA: diabetic ketoacidosis Glucose level

A

Hyperglycemia (240+)

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23
Q

diabetic ketoacidosis treatment

A

lots of IV fluid and insulin

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24
Q

HHNC: Hyperosmolar Hyperglycemic Nonketotic Coma

A

Life threatening severe hyperglycemia, usually seen in type two diabetes
Excessive glucose and electrolytes
Severe dehydration
Typically because they do not know they are diabetic

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25
HHNC: Hyperosmolar Hyperglycemic Nonketotic Coma
Polyuria: peeing so much Dehydration Drowsiness Confusion Coma
26
Diabetic Ketoacidosis Symptoms
Fruity breath Ketones in the urine Drop in PH Polyuria Polydipsia Coma N+V
27
Glucose level of HHNC
greater than 600
28
Abnormal fasting blood sugar
greater than 126
29
When to check blood sugar
before meals and before bedtime (AC and HS)
30
Diabetic AC blood sugar normal levels
70-130
31
Hemoglobin A1C
Measures average blood glucose over 3 month period
32
Hemoglobin A1C % that indicates diabetic
Over 7% means that the person is diabetic
33
s/sx of Hyperglycemia
Three ps Fatigue Weakness Dry Skin
34
s/sx of hypotension
Sweating Tremors Tachycardia Hunger Confusion Drowsiness Seizures
35
Goal of Diabetic Drug Therapy
Control glucose levels and manage complications
36
tx for type 1 diabetes
insulin and insulin only
37
Insulin route
SubCue Can be given IV
38
Rapid Acting Insulin Types
Lispro and Aspart
39
Rapid Acting Insulin OPD
O: 15-30 Min P: 30-2.5h D: 3-6H
40
Short Acting Type
Regular (only one that is able to be given IV)
41
Short Acting Insulin OPD
O: 30-60min P: 1-5h D: 6-10h
42
Intermediate Acting insulin Type
NPH
43
Intermediate Acting Insulin OPD
O: 1-2h P: 4-12h D: 16h
44
Long Acting Insulin Types
Glargine, Detemir
45
Long Acting Insulin OPD
O: 3-4h P: continuous D: 24h
46
Ultra Long Acting insulin Type
Degludec
47
Onset of insulin
when the insulin hits the bloodstream
48
Peak of Insulin
when the insulin is at its strongest blood sugar lowering level
49
Duration of insulin
how long you are gonna have the benefits from the insulin
50
Contraindication for insulin
low blood sugar
51
Nursing Consideration for insulin
Plan onset to start when the meal is being eaten. I.e give lispro 20-30 minutes before you eat breakfast I.e regular insulin should be taken 30-60 minutes before a meal
52
We might need a snack when the blood sugar is lowest. When would this be
The Peak
53
Drug to Drug Interaction with insulin
Beta blocker Aspirin NSAIDS
54
Nursing Implications for insulin
Rotate injection site Know onset and peak Abdomen is the best injection site Monitor for s/sx of hypoglycemia while they are sleeping
55
Insulin pumps Function
provide basal dose of insulin (continuous underlying dose)
56
Programmed insulin:
Set amount of insulin given to cover for the meal. Given with the meals. Regardless of blood sugar. The patient needs to be eating to receive programmed insulin
57
Sliding Scale Insulin
Based on current blood sugar level Example: 61-150=0 units 151-200=3 units 201-250=5 unites
58
Patient Teaching with insulin
Weight control and exercise can reduce the glucose running in your bloodstream Diet is important with new diabetic Know signs and symptoms of hyper/hypo glycemia Teach family what to do Keep follow up appointments Test blood glucose as ordered What to do if you are sick Proper SQ injection technique
59
Sulfonylureas Example
Glyburide
60
Sulfonylureas action
Stimulates pancreas to release insulin Bind to K+ channels on pancreatic beta cells Increase number of insulin receptors
61
Sulfonylurea Indications for use
elevated blood sugars *Must have some functioning beta cells
62
Sulfonylurea Route
Oral
63
Sulfonylurea Contraindications
Sulfa allergy Renal failure Liver failure
64
Drug-Drug interactions with Sulfonylurea
Beta Blockers Alcohol
65
Alpha-Glucosidase inhibitor Example
Acarbose
66
Alpha-Glucosidase inhibitor action
Delays digestion of complex carbohydrates Decreases the increase in blood sugar after meals Give it at the beginning of the meal because it works in the GI tract
67
Alpha-Glucosidase inhibitor Adverse Effect
Hypoglycemia GI upset Gas Diarrhea Cramping
68
Alpha-Glucosidase inhibitor Indication for Use
decrease postprandial glucose
69
Alpha-Glucosidase inhibitor Contraindications
Liver disease Bowel problem
70
Alpha-Glucosidase inhibitor drug-to-drug interaction
Can DECREASE digoxin levels
71
Biguanides Example
Metformin
72
Biguanides Action
Decreases hepatic glucose production Increases use of glucose by muscle and fat cells, decreases intestinal absorption of glucose Overall decrease in blood glucose level
73
Biguanide Indications for use
Insulin resistance Common first choice for type 2 diabetes Used to treat PCOS (Poly cystic ovarian syndrome)
74
Biguanide Adverse Effects
Lactic acidosis GI upset Does not have anything to do with hypoglycemia*
75
Biguanide Contraindications
Avoid using in older adults (80+) BLACK BOX Avoid using with patients with renal failure HOLD METFORMIN 48H BEFORE AND AFTER ANYTHING WITH A CONTRAST MEDIA
76
Nursing implications for metformin
Take with meals Increased effects when taken with: Digoxin Furosemide Vancomycin Monitor Renal function
77
Thiazolidines Examples
Rosiglitazone
78
Thiazolidines (TZDs) Action
Stimulates insulin receptors on muscle, fat, and liver cells Helps body use the insulin better Used in combination with insulin, sulfonylureas, or biguanides
79
Thiazolidines (TZDs) Indication for use
Insulin Resistance
80
Thiazolidines (TZDs) Adverse Effects
Hepatotoxicity Congestive Heart Failure Weight Gain Liver disease (Black Box) CV disease (Black Box)
81
Thiazolidines Nursing Implications
Take with meals Monitor Liver function studies Monitor patients for signs of heart failure Gemfibrozil may increase effects May take 12 weeks to reach maximum effect
82
Meglitinides example
Repaglinide
83
Meglitinides Action
Stimulates pancreatic stimulation of insulin (need working beta cells) Used in combination with TZDs or Biguanides
84
Meglitinides Adverse Effects
Hypoglycemia GI upset
85
Meglitinides Contraindications
Renal and liver disease Type 1 diabetes
86
Meglitinides Nursing considerations
Give this medication just before meals. If we skip the meal we need to skip the dose
87
Dipeptidyl Peptidase 4 inhibitors (DPP4) Example
Sitagliptin
88
Dipeptidyl Peptidase 4 inhibitors (DPP4) Action
Balance the release of insulin and limit the release of additional glucose from the liver, inhibition of glucagon secretion, delayed gastric emptying, induction of satiety NEED WORKING BETA CELLS May take in combo with TZD and Biguanides
89
Dipeptidyl Peptidase 4 inhibitors (DPP4) Adverse Effects:
Respiratory tract infection Heart Failure
90
Dipeptidyl Peptidase 4 inhibitors (DPP4) Contraindication
Using insulin Renal failure Type 1 diabetes
91
Amylin Analogs Example
Pramlintide
92
Amylin Analogs Action
Suppresses postprandial glucagon secretion and increases sense of satiety Used in addition to insulin, sulfonylureas, and biguanides Injection
93
Amylin Analogs Adverse effects
Risk of hypoglycemia BLACK BOX WARNING
94
Amylin Analogs Nursing Implications
Monitor blood sugar closely Avoid giving this with other anticholinergics because if will slow down GI May promote weight loss SQ injection before meals
95
Incretin Mimetic Example
Exenatide
96
Incretin Mimetic Action
Stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten Sensitive to when you are eating Gut is more sensitive to your food coming in
97
Incretin Mimetic Indications for use
postprandial glucose elevation
98
Incretin Mimetic Adverse Effects
Hypoglycemia Gi distress Pancreatitis
99
Incretin Mimetic Contraindications
Liver disease Black box warning: risk for thyroid cancer
100
Incretin Mimetic Nursing implications
SQ injection within 1 hour of breakfast and dinner Must be refrigerated Some Extended Release versions available only need 1 weekly injection May promote weight loss
101
Sodium Glucose Cotransporter 2 Inhibitor Example
Canagliflozen *New
102
Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Action
Blocks reabsorption of glucose in the kidney, promotes excretion of glucose in the urine Used in combination with other antidiabetics
103
Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Adverse Effects
Dehydration* Hypotension* Electrolyte imbalance Bone loss Increased risk for limb amputation
104
Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Contraindication
Renal failure
105
Sodium Glucose Cotransporter 2 Inhibitor (SGLT2) Nursing implication
Take with the first meal of the day Caustius giving this with other meds that might decrease blood pressure Care for risk of dehydration or syncope
106
Education for Hyperglycemia:
Call doctor if blood sugar is higher than 250 Call doctor if ketones in urine Fever above 101 Vomiting or Diarrhea Miss multidoses of meds
107
Education Hypoglycemia
Alert: Glucose gel Orange juice or soda 2-3 glucose tabs Unable to swallow: Dextrose 50% half ampule Glucagon SQ

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