Pharm Exam #3 (DIABETES)

Disease states you are more at risk for with DM?

-MI -DVT -PE -STROKE -AAA RETINOPATHY

adverse effects of SGLT2?

-UTI -gential mycotic infections -pancreatitis -acute renal failure *** contraindicated with renal function that is impaired**

first generation sulfonylurea drugs

-chlorpropamide (diabinese) -tolazamide (tolinase) -tolbutamide (orinase)

before giving any drugs that alter glucose levels, obtain and document:

-history -vitals -blood glucose level, A1C -potential complications and drug interactions

adverse effects of DPP-4?

-no hypoglycemia -URI, ha, abd pain

adverse effects of GLP-1?

-no hypoglycemia -n/v/d

common TZD drugs

-pioglitazone (actos) -rosiqlitazone

A 63 year old client with type 2 diabetes is admitted to the nursing unit with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he requires sliding-scale insulin. What is the most likely reason for the elevated glucose levels. 1)It is temporary condition related to the stress response with increased glucose release. 2)He is converting to a type 1 diabetic. 3)The oral anitdiabetic drug is no longer working for him. 4)Clients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control.

1)It is temporary condition related to the stress response with increased glucose release.

The client is scheduled to receive 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. Which nursing intervention is most appropriate for this client? 1)Make sure the client's breakfast is available to eat before administering this insulin 2)Offer the client a high-carbohydrate snack in 6 hours 3)Hold the insulin if the blood glucose level is greater that 100mg/dL 4)Administer the medications in two separate syringes.

1)Make sure the client's breakfast is available to eat before administering this insulin

What client education should the nurse provide to the client with diabetes who is planning an exercise program? (Select all that apply) 1)Monitor blood glucose levels before and after exercise. 2)Eat a complex carbohydrate prior to strenuous exercise. 3)Exercise may increase insulin needs. 4)Withhold insulin prior to engaging in strenuous exercise. 5)Take extra insulin prior to exercise

1)Monitor blood glucose levels before and after exercise. 2)Eat a complex carbohydrate prior to strenuous exercise.

symptoms of diabetes: screening fasting plasma glucose higher than or equal to--

126 mg/dL

symptoms of diabetes: screening casual blood glucose level greater than or equal to...

200 mg/dL

The nurse is initiating discharge teaching with the newly diagnosed client with diabetes. Which of the following statements indicates that the client needs additional he teaching? 1)"If I am experiencing hypoglycemia, I should drink 1/2 cup of apple juice." 2)"My insulin needs may increase when I have an injection." 3)"I must draw the NPH insulin first if I am mixing it with regular insulin." 4)"If my blood glucose levels are less that 60 mg/dL, I should notify my health care provider."

3)"I must draw the NPH insulin first if I am mixing it with regular insulin."

A client with type 2 diabetes has been NPO since midnight for surgery in the morning. He has been on a combination of oral type 2 antidiabetic drugs. What would be the best action for the nurse to take concerning the administration of his medications? 1)Hold all medications as per the NPO order. 2)Give him the medications with a sip of water. 3)Give him half the original dose. 4)Contact the health care provider for further orders.

4)Contact the health care provider for further orders.

A client receives NPH and regular insulin every morning. The nurse is verifying that the client understands that there are two different peak times to be aware of for this insulin regimen. Why is this an important concept for the nurse to stress? 1)The client needs to plan the next insulin injection around the peak times. 2)Additional insulin may be needed at peak times to avoid hyperglycemia. 3)It is best to plan exercise or other activities around peak insulin activity. 4)the risk for hypoglycemia is greatest around the peak of insulin activity

4)the risk for hypoglycemia is greatest around the peak of insulin activity

metabolic disorder in which there is deficient insulin or decreased sensitivity to insulin -results in hyperglycemia

diabetes

______ and _____ is the leading cause for renal failure

diabetes and high BP

end in gliptin

DPP-4 inhibitors

prevent the breakdown of incretins allowing them to work as above -taken once a day/orally -end in "gliptin" *keep watch on kidney function -does not cause hypoglycemia -adverse effects: URI, headache, abd pain

DPP-4 inhibitors -linagliptin (tradjenta) -saxagliptin (onglyza) -sitagliptin (januvia)

most common adverse effects of Biguanides (metformin)

GI related, N/V, abd discomfort, metallic taste, diarrhea, anorexia, feeling of fullness -BLACK BOX WARNING: LACTIC ACIDOSIS

end in tide

GLP-1 agonists

mimic effects of incretins end in -tide -increase secretion of insulin -slow absorption of glucose -reduce action of glucagon -slow gastric emptying and increase feeling of satiety -given subQ - sometimes twice a day -high incidence of N/V, diarrhea -does not cause hypoglycemia

GLP-1 agonists -exenatide (byetta) SC Bid -liraglutide (victoza) SC qd -dulaglutide (trulicity) SC once a week

a dose of long acting insulin has been ordered for bedtime for a diabetic patient. The nurse expects to give which type of insulin?

Glargine (Lantus)

_____ is a test that allows healthcare providers to see how diabetics have managed their blood glucose level over the last 2-3 months

HbA1c

insulin: -most rapid onset of action -shorter duration -give with food -watch for signs of hypoglycemia

Rapid acting -aspart (novolog) -lispro (Humalog) -glulisine (apidra)

end in fozin

SGLTz

-"glitazone" *watch liver function, heart function *watch for hepatoxicity *contraindicated in pts with serious HF or pulmonary edema *watch fluid retention *watch weight gain

TZD

decrease insulin resistance -insulin sensitizing drugs -increase glucose uptake and use in skeletal muscles

TZD

end in glitazone

TZD

-lack of insulin production OR production of defective insulin -affected patients need exogenous insulin -complications: DKA & Hyperosmolar nonketotic syndrome -oral anti diabetic drugs are not effective

Type 1

-most common type of DM -caused by insulin deficiency and insulin resistance -many tissues are resistant to insulin (reduced # insulin receptors, insulin receptors are less responsive) -these people respond to oral hypoglycemics

Type 2

decrease hepatic production of glucose -increase uptake of glucose by tissues -does not cause hypoglycemia -lowers LDL and TG -promotes weight loss *watch renal function -can also treat POS *must discontinue 2 days priod and 2 days after IV contrast

biguanides

common alpha-glucosidase inhibitors

acarbose (precose) miglitol (glyset)

-works in small intestine to prevent the breakdown of carbs ****Taken with the first bite of meal****teach pt -taken with every meal (3x a day)

alpha-glucosidase inhibitors

_____ are given with the first bite of each main meal

alpha-glucosidase inhibitors

when drawing up two types of insulin in one syringe...

always withdraw the regular or rapid acting insulin first

____ may mask many of the symptoms of hypoglycemia

beta blockers

early symtpoms of hypoglycemia

confusion, irritability, tremor, sweating

signs of hypoglycemia

cool clammy confusion weakness irritability restlessness

when insulin is ordered, ensure:

correct route correct type of insulin timing of the dose correct dosage

alpha-glucosidase inhibitors adverse effects

flatulence diarrhea abdominal pain does not cause hypoglycemia or weight gain

if hypoglycemia occurs:

give glucagon or have pt eat glucose tablets (or corn syrup, honey, fruit juice, or nondiet soft drink) or have them eat a small snack (half sandwich or some crackers) -monitor blood glucose levels

second generation sulfonylurea drugs

glimepride (amaryl) glipizide (glucotrol) glyburide (diabeta, micronase)

adverse effects of meglintidnides

headache hypoglycemia effects dizziness weight gain joint pain upper resp infection/flu like symptoms

what can correct the acidosis and more excess metformin

hemodialysis

most common adverse effect of meglitinides

hypoglycemia

most common adverse effect of sulfonylureas

hypoglycemia

when administering insulin, the nurse must keep in mind that the most immediate and serious adverse effect of insulin therapy is?

hypoglycemia

adverse effects of sulgonylureas are......

hypoglycemia weight gain hypersensitivity reactions GI distress hepatotoxicity *****cation in elderly and avoid alcohol

later symptoms of hypoglycemia

hypothermia, seizures, coma, and death if not treated

A patient taking rosiglitazone (Avandia) tells the nurse, "There's my insulin pill!" The nurse describes the mechanism of action of Avandia by explaining that this drug is not insulin but it works by:

inhibiting hepatic glucose production

insulin? -glargine (lantus) -detemir (levemir)

long acting

atherosclerotic plague

macrovascular

act by stimulating the release of insulin from pancreatic islet cells -end in -linide -short duration from 2 to 4 hrs -take with meals, multiple times of day (3x a day)

meglintidnides

end in glinide

meglitinides

____ is taken with meals to reduce GI effects

metformin

common biguanide drug

metformin (glucophage)

protein in the urine

microalbuminemia

capillary damage

microvascular

adverse effects of TZD

moderate weight gain edema headache hepatic toxicity -hypoglycemia does not occur BLACK BOX WARNING OF HF AND INCREASED RISK FOR MYOCARDIAL ISCHEMIA

signs of hyperglycemia

polyuria polydipsea polyphagia hot dry

insulin? -aspart (Novolog) -lispro (Humalog) -glulisine (Apidra)

rapid acting

A patient is to be placed on an insulin drip to control his high blood glucose levels. The nurse knows that what type of insulin is the only type that can be given IV?

regular (short acting)

common meglitine drug

repaglinide (prandin) nateglinide (starlix)

insulin? -humulin R -Novolin R

short acting

insulin: -regular insulin -onset of 30 to 60 -only insulin that can be given IV -monitor blood sugar very closely

short acting humulin R novolin R

risk factors: DM

smoking HTN CAD

end in ride, zide, mide

sulfonylureas

this drug stimulates the pancreas to produce more insulin -can be dosed once or twice a day -first thing in the morning 30 mins before eating -second generation has fewer drug-drug interactions -result: lower blood glucose levels

sulfonylureas

keep in mind that overall concerns for any diabetic patient increases when the patient is....

under stress had an infection illness or trauma

while monitoring a patient who is receiving insulin therapy, the nurse observes for signs of hypoglycemia, such as?

weakness, sweating, and confusion

when giving oral acarbose (Precose), the nurse should administer it at what time?

with the first bite of the meal