Lilly Pharm Ch 33 Antidiabetic Drugs Flashcards
(15 cards)
Which is a true statement about Humulin-N insulin?
a. it is a long acting insulin
b. it is a rapid-acting insulin.
c. it is an intermediate-acting insulin.
d. it is given based on blood glucose levels measured before meals.
c. it is an intermediate-acting insulin
Types of Insulin & How to Remember Them
- Rapid-Acting Insulin
• Examples: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
• Onset: 10–15 minutes
• Peak: 30–90 minutes
• Duration: 3–5 hours
• Key Use: Taken right before meals to manage blood sugar spikes.
Memory Tip:
“Rapid = right before meals.”
Just think: You eat → it works fast.
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- Short-Acting Insulin
• Example: Regular insulin (Humulin R, Novolin R)
• Onset: 30–60 minutes
• Peak: 2–3 hours
• Duration: 5–8 hours
• Key Use: Given 30 minutes before meals. Can be used IV in emergencies.
Memory Tip:
“Short = scheduled 30 mins before meals.”
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- Intermediate-Acting Insulin
• Example: NPH (Humulin N, Novolin N)
• Onset: 1–3 hours
• Peak: 4–12 hours
• Duration: 12–24 hours
• Key Use: Often used twice a day. Covers insulin needs between meals and overnight.
Memory Tip:
“NPH = Not Particularly Hasty” (still a little dry humor, sue me)
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- Long-Acting Insulin
• Examples: Glargine (Lantus), Detemir (Levemir), Degludec (Tresiba)
• Onset: 1–2 hours
• Peak: None (steady release)
• Duration: 24 hours or more
• Key Use: Basal insulin—keeps blood sugar stable throughout the day and night.
Memory Tip:
“Long = Lasts all day. No peak. Once daily dosing.
What early signs of hypoglycemia should the nurse tell the patient about?
a. Urticaria and rash
b. nausea and diarrhea
c. irritability and confusion
d. fruity, acetone odour to the breath
c. Irritability and confusion
• a. Urticaria and rash
That’s an allergic reaction, not a glucose crisis. Wrong party.
• b. Nausea and diarrhea
That’s a stomach bug or bad takeout, not hypoglycemia.
• d. Fruity, acetone breath
That’s a sign of hyperglycemia—specifically diabetic ketoacidosis (DKA). Not the same problem, not even close.
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TL;DR:
Low blood sugar = moody, confused, sweaty mess.
Tell your patients: if they feel like yelling at someone while forgetting their own name, grab a juice box immediately
A patient has just been prescribed insulin. What should the nurse tell this patient to do to take insulin correctly?
a. Use the injection site that is the most accessible.
b. During times of illness, increase insulin dosage by 25%.
c. When mixing insulins, draw the cloudy insulin first.
d. When mixing insulins, draw the clear insulin (such as regular insulin) up into the syringe first.
d. When mixing insulins, draw the clear insulin up into the syringe first.
If mixing, the regular (clear) insulin should always be drawn into the syringe first.
When mixing insulins, you always draw up the clear (regular) insulin before the cloudy (NPH) insulin to prevent contamination.
Why?
• Regular (clear) insulin is short-acting and does not contain any additives.
• NPH (cloudy) insulin contains a protein that delays absorption.
• If you draw up the cloudy insulin first, the needle might introduce some of its protein particles into the regular insulin vial, which could alter its effectiveness.
The Order (Mnemonic: “Clear before Cloudy”)
1. Inject air into the cloudy (NPH) vial first, without drawing insulin.
2. Inject air into the clear (regular) vial and immediately withdraw the needed dose of clear insulin.
3. Withdraw the needed dose of cloudy insulin.
This prevents contaminating the regular insulin vial with the protein from NPH insulin.
Would you like a visual breakdown or a simpler way to remember this?
Which is a true statement regarding acarbose, a glucose-elevating drug?
a. It is also naturally synthesized by the pancreas.
b. It is used for the treatment of hypotensive emergencies.
c. It is only available as an alpha-glucosidase inhibitor.
d. It stimulates insulin release from the pancreas.
c. It is only available as an alpha-glucosidase inhibitor.
Why is this important to know?
Because acarbose works in a very different way than most other diabetes meds:
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Quick facts about acarbose:
• Class: Alpha-glucosidase inhibitor
• Mechanism: Slows the breakdown of complex carbohydrates in the small intestine, delaying glucose absorption into the bloodstream.
• Effect: Reduces postprandial (after-meal) blood sugar spikes.
• Does NOT stimulate insulin secretion.
• Does NOT treat low blood sugar or hypotension.
• Common side effect: GI upset (gas, bloating, diarrhea), because undigested carbs ferment in the gut.
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Why this matters clinically:
1. Different mechanism
Unlike sulfonylureas (e.g., glyburide) or meglitinides, acarbose does not cause hypoglycemia on its own, making it a safer option in some patients.
2. You need to treat hypoglycemia differently
If a patient on acarbose becomes hypoglycemic (e.g., due to another drug or delayed meal), you must give them pure glucose (like glucose tablets), not table sugar or juice — because acarbose blocks the digestion of complex sugars.
A 75-year-old with type 2 diabetes mellitus has recently been placed on glyburide 10mg daily. When is the best time to take this medication?
a. At night
b. With breakfast
c. After the midday meal
d. Any time of day.
b. with breakfast
Glyburide should always be taken in the morning with breakfast to prevent hypoglycemia at night.
It increases insulin release regardless of whether you’ve eaten or not, which is kind of rude, metabolically speaking. So if you take it without food, your insulin spikes but your blood sugar doesn’t, and… surprise! Nighttime hypoglycemia. A very quiet, very dangerous kind of drama.
So:
• With breakfast = good. The drug kicks in as food hits the system.
• At night = nope. That’s just asking your pancreas to ambush your bloodstream.
• After lunch = better than nothing, but still off-sync.
• Any time of day = wild card
A patient who has type 2 diabetes is scheduled for a laparoscopy and has been NPO since midnight. The patient is concerned about having to hold the medication. What is the best action for the nurse to take regarding the administration of the patients oral antidiabetic drug?
a. Give the patient half the original dose.
b. Hold all medications as ordered.
c. Contact the physician for further orders.
d. Give the patient the medication with a sip of water.
c. Contact the physician for further orders.
A patient with type 2 diabetes self administers insulin injections as part of therapy. What should the nurse tell this patient to do if she has hypoglycemia?
a. Call the physician
b. Administer regular insulin
c. take an oral form of glucose
d. rest until the symptoms pass.
c. Take an oral form of glucose.
The nurse is teaching a patient about self injection of insulin. What should the nurse tell the patient to do regarding injection sites?
a. avoid the abdomen because absorption is irregular.
b. choose a different site at random for each injection.
c. give the injection in the same area each time to promote consistent absorption.
d. rotate sites within the same location for about 1 week before rotating to a new location.
d. rotate sites within the same location for about 1 week before rotating to a new location.
A patient has been prescribed a rapid acting insulin, such as insulin lispro. What important information should the nurse give this patient about taking this type of insulin?
a. It should be taken within 15 minutes of beginning a meal.
b. It should be take after the meal.
c. Dosing is once daily at the midday meal.
d It is taken only in the evenings with a snack before bedtime.
a. It should be taken within 15 minutes of beginning a meal.
Six months after starting treatment for type 2 diabetes, a patient has a follow-up examination. Which laboratory test will best reflect the patient’s adherence to the antidiabetic therapy over the past few months
a. Hemoglobin and hematocrit levels.
b. Hemoglobin A1c level.
c. Fingerstick fasting blood glucose
d. Serum insulin levels
b. Hemoglobin A1c level.
reflects the patients adherence to therapy for several months previously.
A patient with a history of COPD and type 2 diabetes has been treated for pneumonia for the past week. His pneumonia has resolved, but when the nurse monitors his blood glucose levels, his blood glucose is still elevated and he requires small amounts of sliding scale insulin coverage. What is the best explanation for this elevation?
a. the antibiotics may have caused an increase in blood glucose levels.
b. the corticosteroids may have caused an increase in glucose levels.
c. his type 2 diabetes has converted to type 1 diabetes.
d. the hypoxia from the COPD has caused an increased need for insulin.
b. the corticosteroids may have caused an increase in glucose levels.
Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blod glucose levels.
When should the nurse administer acarbose (glucobay), an alpha-glucosidase inhibitor?
a. 30 minutes before breakfast.
b. with the first bite of each meal.
c. 30 minutes after breakfast.
d. once daily, at bedtime.
b. with the first bite of each main meal.
A 48 year old male is diagnosed with metabolic syndrom and is started on biguanide metformin (glucophage). He asks the nurse why he needs this drug. The nurse’s best explanation of the purpose of the metformin is that it:
a. increases the pancreatic secretion of insulin.
b. decreases glucose production by the liver.
c. increases intestinal absorption of glucose.
d. decreases the pancreatic secretion of insulin.
b. decreases glucose production by the liver.
When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfra drugs. The patient has an order for sulfonylurea glicazide. What is the best action for the nure to take?
a. give the drug as ordered 30 minutes before breakfast.
b. Hold the drug, and check the order with the physician.
c. Give the drug and monitor for adverse effects.
d. Give a reduced dose of the drug with breakfast.
b. Hold the drug, and check the order with the physician.
Which types of insulin can be administered intravenously?
a. regular insulin
b. NPH insulin.
c. insulin glargine
d. insulin detemir
a. regular insulin
