NSG 170 Test 3 Flashcards
Lewis 53, McCuistion 50 (169 cards)
1
Q
What are the 2 groups of antidiabetic agents?
A
Insulin and oral hypoglycemic drugs
(McCuistion 50)
2
Q
How many types of DM are there and what are they
A
4
T1DM
T2DM
Secondary DM
Gestational DM
(McCuistion 50)
3
Q
What % of DM is T1DM?
A
10-12
(McCuistion 50)
4
Q
What % of DM is T2DM
A
85-90
(McCuistion 50)
5
Q
Which is more effective at raising serum insulin level? Oral glucose load or IV?
A
Oral
(McCuistion 50)
6
Q
Where is glucose converted to glycogen?
A
Liver
(McCuistion 50)
7
Q
HgA1C reflects averages of glucose over what time period?
A
3 months
(McCuistion 50)
8
Q
Insulin is metabolized where?
A
Liver
(McCuistion 50)
9
Q
Which insulin can be given IV?
A
Only regular
(McCuistion 50)
10
Q
When giving insulin should you roll or shake the vial?
A
Roll. Don’t shake.
(McCuistion 50)
11
Q
Lipoatrophy is more common in men or women? (pick 1)
A
Women
(McCuistion 50)
12
Q
Lipohypetrophy is more common in men or women? (pick 1)
A
Men
(McCuistion 50)
13
Q
Injections of insulin should be spread out how far apart?
A
1.5”
(McCuistion 50)
14
Q
Is rapid acting insulin clear or cloudy?
A
Clear
(McCuistion 50)
15
Q
Lispro, aspart, glulisine, and inhalation insulins are how fast acting?
A
Rapid
(McCuistion 50)
16
Q
Regular insulin is how fast acting?
A
Short acting
(McCuistion 50)
17
Q
NPH is how fast acting?
A
Intermediate
(McCuistion 50)
18
Q
Glargine, determir, and degludec are how fast acting?
A
Long
(McCuistion 50)
19
Q
Is short acting insulin clear or cloudy?
A
Clear
(McCuistion 50)
20
Q
Is intermediate acting insulin clear or cloudy?
A
Cloudy
(McCuistion 50)
21
Q
How much time before meals should rapid acting insulin be administered?
A
10-15 minutes
(McCuistion 50)
22
Q
How much time before meals should short acting insulin be administered?
A
30-60 minutes
(McCuistion 50)
23
Q
Regular insulin can be given via what route(s)?
A
IV or SQ
(McCuistion 50)
24
Q
Unopened insulin should be stored how?
A
Refrigerated
(McCuistion 50)
25
Once opened and left at room temperature, how long is insulin good for?
1 month
(McCuistion 50)
26
Once opened and left in refrigerator , how long is insulin good for?
3 months
(McCuistion 50)
27
Prefill syringes of insulin should be placed in the fridge and used within how long?
1-2 weeks
(McCuistion 50)
28
How long does glucagon take to raise glucose levels?
Within 10 minutes
(McCuistion 50)
29
Which insulin(s) are given once per day, usually?
Intermediate and Long
(McCuistion 50)
30
Thiazide diuretics increase or decrease serum glucose?
Increase
(McCuistion 50)
31
Glucocorticoids (cortisone preparations) increase or decrease serum glucose?
Increase
(McCuistion 50)
32
Thyroid agents increase or decrease serum glucose?
Increase
(McCuistion 50)
33
Estrogen increases or decrease serum glucose?
Increase
(McCuistion 50)
34
Tricyclic antidepressants increase or decrease serum glucose?
Decrease
(McCuistion 50)
35
Monoamine oxidase inhibitors (MAOIs) increase or decrease serum glucose?
Decrease
(McCuistion 50)
36
Aspirin products increase or decrease serum glucose?
Decrease
(McCuistion 50)
37
Oral anticoagulants increase or decrease serum glucose?
Decrease
(McCuistion 50)
38
response to an excessive dose of insulin. Hypoglycemic condition usually occurs 2-4am
Somogyi
(McCuistion 50)
39
Hyperglycemia on awakening. Awakens with headache and night sweats, nightmares
Dawn phenomenon
(McCuistion 50)
40
What is the management for Somogyi?
Reducing bedtime insulin. Check 2a-4a glucose levels.
(McCuistion 50)
41
What is the management for dawn phenomenon
Increase bedtime insulin
(McCuistion 50)
42
Insulin pumps should not be removed or disconnected for more than how long?
1-2 hours
(McCuistion 50)
42
How are sulfonylureas classified?
1st or 2nd Generation.
(McCuistion 50)
43
Tolbutamide
Short acting 1st generation sulfonylurea
(McCuistion 50)
44
Tolazamide
Intermediate acting 1st generation sulfonylurea
(McCuistion 50)
45
Chlorporpamide
Long acting 1st generation sulfonylurea
(McCuistion 50)
46
Glimepiride
2nd generation sulfonylurea
(McCuistion 50)
47
Glipizide
2nd generation sulfonylurea. Most common drug for T2DM
(McCuistion 50)
48
Aspirin, oral anticoagulants, MAOIs, sulfonamides, and cimetidine increase or decrease the action of sulfonylureas?
Increase
(McCuistion 50)
49
Thiazide diuretics, phenothiazines, phenytoin, and corticosteroids increase or decrease action of sulonylureas?
Decrease
(McCuistion 50)
50
What is the effect of alcohol when taking sulfonylureas?
increases half-life, and disulfiram-like reaction can result
(McCuistion 50)
51
Metformin
Biguanide
(McCuistion 50)
52
Does metformin produce hypoglycemia or hyperglycemia?
No
(McCuistion 50)
53
How long should metformin be withheld before/after IV contrast?
48 hours
(McCuistion 50)
54
What drug decreases hepatic production of glucose from stored glycogen, diminishing increase in BGL after meal and blunts degree of postprandial hyperglycemia.
Metformin
(McCuistion 50)
55
What drug(s) inhibits digestive enzyme (alpha glucosidase) in small intestine responsible for release of glucose from complex carbohydrates in diet.
Acarbose and miglitol
(McCuistion 50)
56
Acarbose
Alpha-Glucosidase Inhibitors
(McCuistion 50)
57
Miglitol
Alpha-Glucosidase Inhibitors
(McCuistion 50)
58
Pioglitazone
Thiazolidinediones
(McCuistion 50)
59
Rosiglitazone
Thiazolidinediones
(McCuistion 50)
60
Thiazolidinediones are contraindicated for what patients?
Contraindicated in class III and IV heart failure
(McCuistion 50)
61
Repaglinide
Meglitinides
(McCuistion 50)
62
Nateglinide
Meglitinides
(McCuistion 50)
63
Sitagliptin phosphate
Incretin modifier or dipeptidyl peptidase 4 (DPP-4) inhibitors
(McCuistion 50)
64
Saxagliptin
Incretin modifier or dipeptidyl peptidase 4 (DPP-4) inhibitors
(McCuistion 50)
65
Pramlintide
Incretin modifier or dipeptidyl peptidase 4 (DPP-4) inhibitors
(McCuistion 50)
66
Pramlintide is administered how?
SQ in abdomen and thigh before meal. Never in arm.
(McCuistion 50)
67
Exenatide
Incretin Mimetics aka “glucagon-like peptide 1 (GLP-1) agonists”
(McCuistion 50)
68
Liraglutide
Incretin Mimetics aka “glucagon-like peptide 1 (GLP-1) agonists”
(McCuistion 50)
69
Pramlintide acetate
amylin analogue
(McCuistion 50)
70
Glucagon and Diazoxide are drugs for what
Hyperglycemic drugs
(McCuistion 50)
71
Glucagon hormone is secreted by
alpha cells of the islets of Langerhans in the pancreas
(McCuistion 50)
72
Insulin hormon is secreted by
beta cells of the islets of Langerhans in the pancreas
(McCuistion 50)
73
What is alpha glucosidase?
Digestive enzyme in small intestine responsible for release of glucose from complex carbohydrates in diet
(McCuistion 50)
74
What is the HgA1c for a non diabetic?
<5%
(McCuistion 50)
75
What is the HgA1c for a prediabetic?
5.7-6.4%
(McCuistion 50)
76
What promotes the uptake of glucose, amino acids, and fatty acids and converts them to substances that are stored in body cells?
Insulin
(McCuistion 50)
77
During which trimester(s) does progesterone, cortisol, and human placental lactogen increase?
Second and third
(McCuistion 50)
78
What is the effect of progesterone, cortisol, and human placental lactogen on insulin?
Inhibits insulin usage. Contributing factor for gestational DM
(McCuistion 50)
79
What drugs can cause secondary DM?`
Glucocorticoids (cortisone, prednisone), thiazide diuretics (hydrochlorothiazide), and epinephrine
(Lewis 53)
80
T1DM has what type of onset?
Abrupt
(Lewis 53)
81
T2DM has what type of onset?
Gradual
(Lewis 53)
82
Which DM has islet cell abnormalities?
T1DM, at first.
(Lewis 53)
83
glucagon, epinephrine, growth hormone [GH], cortisol are what what kind of hormones?
Counterregulatory
(Lewis 53)
84
What kind of insulin?:
lispro (Humalog)
aspart (NovoLog)
glulisine (Apidra)
Rapid
(Lewis 53)
85
What kind of insulin?:
Regular
(Humulin R, Novolin R)
Short
(Lewis 53)
86
What kind of insulin?:
NPH (Humulin N, Novolin N)
Intermediate
(Lewis 53)
87
What kind of insulin?:
degludec (Tresiba)
detemir (Levemir)
glargine (Basaglar, Lantus, Toujeo)
insulin glargine (Basaglar)
Long
(Lewis 53)
88
What kind of insulin?:
Afrezza
Inhaled
(Lewis 53)
89
The protein in insulin which makes it cloudy is called what?
Protamine
(Lewis 53)
90
Which insulin most closely mimics natural insulin secretion in response to a meal?
Short
(Lewis 53)
91
Predisposition to which DM is related to human leukocyte antigens (HLAs)
T 1 DM
(Lewis 53)
92
Newly diagnosed patients with which DM may have a remission, or “honeymoon period,” for 3 to 12 months
T 1 DM
(Lewis 53)
93
What 5 measures define Metabolic Syndrome?
Increased glucose levels
abdominal obesity
high BP
high triglyceride levels
decreased high-density lipoprotein (HDL) levels
(Lewis 53)
94
What causes polydipsia and poluria symptoms in DM?
osmotic effect of excess glucose in the bloodstream
(Lewis 53)
95
What causes polyphagia symptoms in DM?
cell malnourishment when insulin deficiency prevents cells from using glucose for energy
(Lewis 53)
96
What are the risk factors for T2DM?
family history of type 2 DM
being overweight or obese
being older
(Lewis 53)
97
What population is most at risk for T2DM?
Native Americans and Alaska Natives have the highest prevalence of DM (23.5%)
(Lewis 53)
98
Which DM is characterized by a combination of inadequate insulin secretion and insulin resistance.
T 2 DM
(Lewis 53)
99
Impaired glucose tolerance if
2-hour oral glucose tolerance test (OGTT) values are 140-199
(Lewis 53)
100
Impaired fasting if glucose if
100-125
(Lewis 53)
101
What disease(s) could cause DM?
Cushing syndrome, hyperthyroidism, pancreatitis, cystic fibrosis, hemochromatosis, & parenteral nutrition
(Lewis 53)
102
What meds could cause DM?
Corticosteroids (prednisone), thiazides, phenytoin (Dilantin), and atypical antipsychotics (cloazapine)
(Lewis 53)
103
Fructosamine can measure glycemia over what period of time?
1-3 weeks
(Lewis 53)
104
Glimepiride (Amaryl), glipizide (Glucotrol, Glucotrol XL), and glyburide (DiaBeta, Glynase)
Sulfonylureas
(Lewis 53)
105
nateglinide
repaglinide
Meglitinides
(Lewis 53)
106
acarbose
miglitol (Glyset)
α-Glucosidase Inhibitors
(Lewis 53)
107
pioglitazone (Actos)
rosiglitazone (Avandia)
Thiazolidinediones
(Lewis 53)
108
alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia).
Dipeptidyl Peptidase-4 Inhibitors
(Lewis 53)
109
canagliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance).
Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors
(Lewis 53)
110
Bromocriptine (Cycloset)
Dopamine Receptor Agonist
(Lewis 53)
111
Semaglutide (Rybelsus)
Liraglutide (Victoza)
Exenatide (Byetta)
Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
Glucagon-Like Peptide-1 Receptor Agonists
(Lewis 53)
112
Pramlintide (Symlin)
Amylin Analogs
(Lewis 53)
113
Loop diuretics can worsen hypoglycemia/hyperglycemia by inducing potassium loss. (pick one)
Hyperglycemia
(Lewis 53)
114
ADA recommends ≥2 servings of fish per week to provide what?
polyunsaturated
(Lewis 53)
115
What is the alcohol limit set by the ADA in DM?
1 for women
2 for men
(Lewis 53)
116
MyPlate recommends ____ of the plate filled with nonstarchy vegetables
half
(Lewis 53)
117
MyPlate recommends ____ of the plate filled with a starch.
one-fourth
(Lewis 53)
118
MyPlate recommends ____ of the plate
filled with a protein.
one-fourth
(Lewis 53)
119
How many minutes per week of moderate intensity aerobic activity should DM get?
150mins/wk
(Lewis 53)
120
How many times per week should a DM do resistance training?
2-3/wk
(Lewis 53)
121
Glucose-lowering effects of exercise can last up to __ hours
48
(Lewis 53)
122
_______ is a life-threatening syndrome that can occur in patients with DM who are able to make enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.
Hyperosmolar hyperglycemia syndrome
(Lewis 53)
123
What Caused by a profound deficiency of insulin. It is characterized by hyperglycemia, ketosis, acidosis, and dehydration. It is most likely to occur in people with type 1 DM.
DKA
(Lewis 53)
124
________ is a manifestation of insulin resistance. It can appear as a velvety light brown to black skin thickening, mainly on flexures, axillae, and the neck.
Acanthosis nigricans
(Lewis 53)
125
Average temperature range:
36° to 38°C (96.8° to 100.4°F)
(Potter 29)
126
Average oral/tympanic:
37°C (98.6°F)
(Potter 29)
127
Average rectal:
37.5°C (99.5°F)
(Potter 29)
128
Axillary:
36.5°C (97.7°F)
(Potter 29)
129
In the older adult population the average core temperature ranges from _____ as a result of changes in temperature regulation.
35° to 36.1°C (95° to 97°F)
(Potter 29)
130
When is the lowest body temperature usually?
6:00am
(Potter 29)
131
When is the highest body temperature?
4:00pm
(Potter 29)
132
What controls body temperature the same way a thermostat works in the home?
The hypothalamus, located between the
cerebral hemispheres,
(Potter 29)
133
_______ controls heat loss
anterior hypothalamus
(Potter 29)
134
_______ controls heat production
posterior hypothalamus
(Potter 29)
135
When large amounts of thyroid hormones are secreted, the BMR can increase how much?
100% above normal
(Potter 29)
136
The absence of thyroid hormones reduces the BMR by ___ , causing a decrease in heat production.
half
(Potter 29)
137
Shivering sometimes increases heat production by how much?
4 to 5 times greater than normal.
(Potter 29)
138
Nonshivering thermogenesis occurs primarily in neonates because?
they cannot shiver
(Potter 29)
139
What are the four methods of heat loss?
Radiation
Conduction
Convection
Evaporation
(Potter 29)
140
____ is the transfer of heat from the surface of one object to the surface of another without direct contact between the two.
Radiation
(Potter 29)
141
As much as ___ %of the surface area of the human body radiates heat to the environment.
85%
(Potter 29)
142
_____ is the transfer of heat from one object to another with direct contact.
Conduction
(Potter 29)
143
______ is the transfer of heat away by air movement.
Convection
(Potter 29)
144
______ is the transfer of heat energy when a liquid is changed to a gas.
Evaporation
(Potter 29)
145
Approximately ____ to _____ mL a day evaporates from the skin and lungs, resulting in water and heat loss.
600 to 900
(Potter 29)
146
Physical exercise over ___ % of the heat produced is lost by sweat evaporation.
80%
(Potter 29)
147
each hour of exercise in hot conditions up to _____ of body fluid can be lost in sweat
2 L
(Potter 29)
148
A newborn loses up to ___ % of body heat through the head and therefore needs to wear a cap to prevent heat loss
30%
(Potter 29)
149
Febrile seizures are unusual in children over ____ old.
5 years
(Potter 29)
150
________ is a rare disorder characterized by hyperthermia with skeletal muscle rigidity.
Malignant hyperthermia (MH)
(Lewis 19)
151
_______, especially when given with volatile inhalation agents, is the primary trigger of MH.
Succinylcholine (Anectine)
(Lewis 19)
152
Fundamental defect is of malignant hyperthermia is:
hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium.
(Lewis 19)
153
Definitive treatment of MH is prompt administration of:
dantrolene (Dantrium, Ryanodex).
(Lewis 19)
154
Perioperative hypothermia is a core body temperature less than
96.8°F (36°C)
(Lewis 20)
155
Shivering can increase resting energy expenditure and O2 consumption up to ___%, causing hypoxemia and myocardial ischemia (angina).
500
(Lewis 20)
156
If the patient is hypothermic, take the temperature every ___ minutes until normothermic.
15
(Lewis 20)
157
________ measures include the use of warmed cotton blankets, socks, reflective blankets, and limited skin exposure.
Passive warming
(Lewis 20)
158
________ measures involve the application of external warming devices, including forced air warmers, heated water mattresses, radiant warmers, heated and humidified O2, and warmed IV fluids.
Active warming
(Lewis 20)
159
______ are severe cramps in large muscle groups fatigued by heavy work.
Heat cramps
(Lewis 21)
160
______ has symptoms of fatigue, nausea and vomiting, and extreme thirst. Hypotension, tachycardia, elevated body temperature, dilated pupils, mild confusion, ashen color, and profuse sweating.
Heat exhaustion
(Lewis 21)
161
______ is the most severe form of heat stress.
Heatstroke
(Lewis 21)
162
_____ is true tissue freezing that results in the formation of ice crystals in the tissues and cells. Peripheral vasoconstriction is the first response to cold stress.
Frostbite
(Lewis 21)
163
_______ involves the skin and subcutaneous tissue, usually the ears, nose, fingers, and toes.
Superficial frostbite
(Lewis 21)
164
____ frostbite involves muscle, bone, and tendon.
Deep
(Lewis 21)
165
What is the temperature range for mild hypothermia?
93-95
(Lewis 21)
166
What is the temperature range for moderate hypothermia?
86-93
(Lewis 21)
167
What is the temperature range for severe hypothermia?
<86
(Lewis 21)
168
______ , a further drop in core temperature. This occurs when cold peripheral blood returns to the central circulation.
Afterdrop
