Pharmacology Exam #3

Treatment of hypoglycemia

"Rule of 15" • If pt is conscious: give 15 g carbohydrate: 4 ounces of OJ, 2 ounces of grape juice, 8 ounces of milk, or glucose tablets • If pt is not fully conscious: give D50W intravenously or glucagon IM or SQ • Recheck blood glucose in 15 min, • Once blood glucose is ≥ 70 mg/dL, have pt eat a larger snack or meal

Rapid-acting insulin

- "meal-time insulin" because it should be given with meals - generic/trade name: lispro insulin (Humalog) - onset: 15-30 min. - peak: 30 min.-3 hrs - duration: 3-5 hrs

Short-acting insulin

- "sliding scale insulin" - generic/trade name: regular insulin (Humulin R) - onset: 30 min.-1 hr - peak: 1-5 hrs - duration: 6-10 hrs

Non-Insulin Injectable Antidiabetics:

- Amylin mimetics "-tides": pramlintide (Symlin) - Incretin mimetics "-tides": exenatide (Byetta), liraglutide (Victoza), dulaglutide (Trulicity)

Oral anti diabetics

- Biguanides: metformin (Glucophage) - Sulfonylureas "-ides": chlorpropamide (Diabinese), glipizide (Glucotrol), glimepiride (Amaryl) - Meglitinides "-glinides": repaglinide (Prandin), nateglinide (Starlix) - Thiazolidinediones "-glitazones", "TZDs": pioglitazone (Actos), rosiglitazone (Avandia) - Alpha-glucosidase inhibitors: acarbose (Precose), miglitol (Glyset) - Dipeptidyl peptidase-4 (DPP-4) inhibitors "-gliptins": sitagliptin (Januvia) - Sodium-glucose co-transporter 2 (SGLT-2) inhibitors: canagliflozin (Invokana), dapagliflozin (Farxiga)

Pre-mixed insulin

- Contains 2 different types of insulin - Eliminates the need for manual mixing of insulin - Novalin is 70% NPH and 30% regular: mixture of intermediate and short-acting insulins - Humalog is 75% insulin lispro protamine and 25% insulin lispro

Signs & Symptoms of Hypoglycemia if gradual onset

- HA - tremors - weakness - lethargy - disorientation

Beta2 Adrenergic Agonists

- aka "The Bronchodilators" - Medications: albuterol (Proventil), formoterol (Foradil), levalbuterol (Xopenex), salmeterol (Serevent), terbutaline - Purpose/Action: activate the beta2 receptors in the bronchial smooth muscle, causing bronchodilation

Long-acting insulin

- generic/trade name: Insulin glargine (Lantus) - onset: 1-4 hrs - peak: NO PEAK - duration: 24 hrs

Intermediate-acting insulin

- generic/trade name: NPH insulin (Humulin N) - onset: 1-2 hrs - peak: 4-14 hrs - duration: 14-24 hrs

Hyperglycemic Agents

- glucagon - D50W (50% dextrose solution in water)

Intermediate-acting insulin names and administration

- names: NPH (Humulin N or Novolin N) (The only cloudy insulin) - Can be mixed with rapid or short-acting insulin in the same syringe - Draw up the clear insulin first: "clear to cloudy" - Cannot be given intravenously

Ultra-long insulin names and administration

- names: U-300 insulin glargine (Troujeo), insulin degludec (Tresiba) - 300 units/mL instead of 100 units/mL like other types - More concentrated = less amount given in mL - Longer duration: up to 36 hours

Long-acting insulin names and administration

- names: detemir (Levimir) or glargine (Lantus) - Cannot be mixed in the same syringe as other insulins - Cannot be given intravenously - Must be administered at the same time each day, since the duration is 24 hrs. - Usually given at hs, but can be given at other times of the day

Medications that can cause hypoglycemia when taken with insulin

- sulfonylureas - meglitinides - beta blockers "-olols" - alcohol

Signs & Symptoms of Hypoglycemia if abrupt onset

- tachycardia - palpitations - diaphoresis - shakiness

Medications that can cause hyperglycemia when taken with insulin

- thiazide diuretics - glucocorticoids (prednisone, dexamethasone)

Normal fasting glucose level

74-106

A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include? A. "Rinse your mouth after each use of this medication." B. "Limit fluid intake while taking this medication." C. "Increase your intake of vitamin B12 while taking this medication." D. "You can take the medication as needed."

A. "Rinse your mouth after each use of this medication."

A nurse is admitting a client for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority? A. Administering a supplemental dose of hydrocortisone B. Instructing the client about coughing and deep breathing C. Collecting additional information about the client's history of Addison's disease D. Inserting an indwelling urinary catheter

A. Administering a supplemental dose of hydrocortisone

A nurse is caring for a client who is taking propylthiouracil. Which of the following findings should the nurse monitor for as adverse effect of this medication? A. Bradycardia B. Insomnia C. Heat intolerance D. Weight loss

A. Bradycardia

A nurse is planning care for a client who has brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client? A. Dexamethasone B. Methylphenidate C. Hydroxyzine D. Amitriptyline

A. Dexamethasone

A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhinitis. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication? (Select all that apply.) A. Dry mouth B. Nonproductive cough C. Skin rash D. Drowsiness E. Urinary hesitation

A. Dry mouth D. Drowsiness E. Urinary hesitation

A nurse is caring for a client who has cancer and is taking morphine and carbamazepine for pain. Which of the following effects should the nurse monitor for when giving the medications together? (Select all that apply.) A. Need for reduced dosage of the opioid B. Reduced adverse effects of the opioid C. Increased analgesic effects D. Enhanced CNS stimulation E. Increased opioid tolerance

A. Need for reduced dosage of the opioid B. Reduced adverse effects of the opioid C. Increased analgesic effects

A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? A. Somnolence B. Constipation C. Fluid retention D. Weight gain

A. Somnolence

A nurse is preparing to administer an opioid agonist to a client who has acute pain. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A. Urinary retention B. Tachypnea C. Hypertension D. Irritating cough

A. Urinary retention

A nurse is teaching a client who has a prescription for long-term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication? A. Weight gain B. Nervousness C. Bradycardia D. Constipation

A. Weight gain

A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcysteine. Which of the following information should the nurse include in the instructions? A. "Expect this medication to suppress your child's cough." B. "Expect this medication to smell like rotten eggs." C. "Expect this medication to cause euphoria." D. "Expect this medication to turn your child's urine orange."

B. "Expect this medication to smell like rotten eggs."

A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication? A. "I'll take this medication after I eat." B. "I'll take this medicine 30 minutes before I eat." C. "I'll take this medicine just before I go to bed." D. "I'll take this medication at least 1 hour before I eat."

B. "I'll take this medicine 30 minutes before I eat."

A nurse is teaching a client about the use of fluticasone to treat perennial rhinitis. Which of the following statements by the client indicates an understanding of the teaching? A. "I should use the spray every 4 hours while I am awake." B. "It can take as long as 3 weeks before the medication takes a maximum effect." C. "This medication can also be used to treat motion sickness." D. "I can use this medication when my nasal passages are blocked."

B. "It can take as long as 3 weeks before the medication takes a maximum effect."

A nurse is providing instructions to a client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include? A. "You can take this medication to abort an acute asthma attack." B. "Tremors are an adverse effect of this medication." C. "Prolonged use of this medication can cause hyperglycemia." D. "This medication can slow skeletal growth rate."

B. "Tremors are an adverse effect of this medication."

A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching? A. Take the albuterol at the same time each day. B. Administer the albuterol inhaler prior to using the beclomethasone inhaler. C. Use beclomethasone if experiencing an acute episode. D. Avoid shaking the beclomethasone before use.

B. Administer the albuterol inhaler prior to using the beclomethasone inhaler.

A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering pamidronate? A. Inspect the skin for redness and irritation when changing the intradermal patch. B. Assess the IV site for thrombophlebitis frequently during administration. C. Instruct the client to sit upright or stand for 30 min following oral administration. D. Watch for manifestations of anaphylaxis for 20 min after 1M administration.

B. Assess the IV site for thrombophlebitis frequently during administration.

A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. The nurse should identify that which of the following medications can cause an adverse effect when administered concurrently with fentanyl? A. Ampicillin B. Diazepam C. Furosemide D. Prednisone

B. Diazepam

A nurse is planning care for a client who has cancer and is taking a glucocorticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Monitor for urinary retention. B. Monitor blood glucose. C. Monitor blood potassium level. D. Monitor for gastric bleeding. E. Monitor for respiratory depression.

B. Monitor blood glucose. C. Monitor blood potassium level. D. Monitor for gastric bleeding.

A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? A. Sedation B. Nasal congestion C. Productive cough D. Constipation

B. Nasal congestion

A nurse is teaching a client who has Grave's disease and a new prescription for propranolol. Which of the following client statements indicates effective teaching? A. "Propranolol helps increase blood flow to my thyroid gland." B. "Propranolol is used to prevent excess glucose in my blood." C. "Propranolol will decrease my tremors and fast heart beat." D. "Propranolol promotes a decrease of thyroid hormone in my body."

C. "Propranolol will decrease my tremors and fast heart beat."

A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's family member asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make? A. "The medication will increase respirations." B. "The medication will prevent dependence on the morphine." C. "The medication will relieve constipation." D. "The medication works with the morphine to increase pain relief."

C. "The medication will relieve constipation."

A nurse is teaching clients about the use of insulin to treat type I diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration? A. Insulin glargine B. NPH insulin C. Regular insulin D. Insulin lispro

C. Regular insulin

A nurse is teaching a client who has a new prescription for dextromethorphan to suppress a cough. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication? A. Diarrhea B. Anxiety C. Sedation D. Palpitations

C. Sedation

A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? A. Monitor for seizures and confusion with repeated doses. B. Protect the client's skin from the severe diarrhea that occurs with morphine. C. Withhold this medication if respiratory rate is less than 12/min. D. Give morphine intermittent via IV bolus over 30 seconds or less.

C. Withhold this medication if respiratory rate is less than 12/min.

A nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A. "Take oral medications 30 min before injection." B. "Use upper arms as preferred injection sites." C. "Mix pramlintide with the breakfast dose of insulin." D. "Inject pramlintide just before a meal." E. "Discard open vials after 28 days."

D. "Inject pramlintide just before a meal." E. "Discard open vials after 28 days."

A nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. The nurse should identify which of the following information as true regarding butorphanol? A. Butorphanol has a greater risk for abuse than morphine. B. Butorphanol causes a higher incidence of respiratory depression than morphine. C. Butorphanol cannot be reversed with an opioid antagonist. D. Butorphanol can cause abstinence syndrome in opioid-dependent clients.

D. Butorphanol can cause abstinence syndrome in opioid-dependent clients.

A nurse is caring for a client who is taking for somatropin to stimulate growth. The nurse should plan to monitor the client's urine for which of the following? A. Bilirubin B. Protein C. Potassium D. Calcium

D. Calcium

A nurse is reviewing the medical record of a client who takes desmopressin for diabetes insipidus. Which of the following findings is an adverse effect of desmopressin? A. Hypovolemia B. Hypercalcemia C. Agitation D. Headache

D. Headache

A nurse is caring for a client who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor? A. WBC B. Amylase C. Platelet count D. Liver function tests

D. Liver function tests

A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A. Decreased appetite B. Explosive diarrhea C. Decreased pulse rate D. Orthostatic hypotension

D. Orthostatic hypotension

A nurse is caring for an older adult client who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? A. The client will start at a high dosage, and the amount will be tapered as needed. B. The client will remain on the initial dosage during the course of treatment. C. The client's dosage will be adjusted daily based on blood levels. D. The client will start on a low dosage, which can be gradually increased.

D. The client will start on a low dosage, which can be gradually increased.

Inhaled insulin administration

Dry powder inhaler with 4-, 8-, or 12-unit cartridges

Hypokalemia

K+ is less than 3.5 mEq/L • Administration of insulin moves potassium out of the bloodstream and into the cells causing lower K+ levels • Major concern: cardiac dysrhythmias or abnormal heart rates

Nursing Administration of Insulin

Use insulin-specific syringes that correspond to the insulin concentration • U-100 insulin, use U-100 syringe

A client is receiving a daily dose of NPH insulin at 0730. The nurse expects the peak effect of this drug to occur at which time? a.) 1330 b.) there is no peak for this insulin c.) 1030 d.) 0815

a.) 1330

A patient who is taking a thyroid replacement medication begins to experience cold intolerance, depression, constipation, and dry skin. What is the concern? a.) Inadequate doses of the medication b.) Possible overdose of the medication c.) Worsening of the underlying disease d.) Drug interactions with another medication

a.) Inadequate doses of the medication Rationale: A return of the symptoms of hypothyroidism indicates that the patient is receiving inadequate doses of the medication.

A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? a.) Somnolence b.) Constipation c.) Fluid retention d.) Weight gain

a.) Somnolence

The nurse is reviewing the history of a patient who will be taking the amylin mimetic drug pramlintide. Which condition is a contraindication to the use of this drug? a.) gastroparesis b.) coronary artery disease c.) hypothyroidism d.) hypertension

a.) gastroparesis

Lipohypertrophy

abnormal collection of adipose tissue from repeated insulin injections - teach patients to rotate injection sites one inch away from previous site

When is the patient at greatest risk for hypoglycemia after receiving insulin?

at it's peak

A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication? a.) "I'll take this medication after I eat." b.) "I'll take this medicine 30 minutes before I eat." c.) "I'll take this medicine just before I go to bed." d.) "I'll take this medication at least 1 hour before I eat."

b.) "I'll take this medicine 30 minutes before I eat."

A patient taking glipizide asks the nurse, "How does my diabetic pill work, anyway?" Which information will the nurse provide to the patient regarding the mechanism of action of glipizide? a.) "It decreases the amount of glucose made by the liver." b.) "It increases insulin production." c.) "It decreases the amount of glucose the body takes in from food." d.) "It helps the body use insulin."

b.) "It increases insulin production."

A woman who has hypothyroidism will have to stop her thyroid replacement therapy now that she is pregnant. a.) True b.) False

b.) False Rationale: Fetal growth may be retarded if maternal hypothyroidism is untreated during pregnancy.

When will the nurse administer the drug acarbose? a.) 30 minutes before a meal b.) With the first bite of a meal c.) 1 hour after eating d.) The first thing in the morning

b.) With the first bite of a meal

Hypoglycemia

blood glucose levels below 70mg/dL

A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements made by the client indicates understanding of the administration of this medication? a.) "I'll take this medicine as soon as I wake up in the morning." b.) "I'll take this medicine just before I go to bed." c.) "I'll take this medicine 30 minutes before I eat." d.) "I'll take this medicine with the first bite of my meals."

c.) "I'll take this medicine 30 minutes before I eat."

Which of the following statements about biosynthetic long-acting insulins glargine and detemir are correct? (Select all that apply.) a.) They have a very high risk of hypoglycemic reactions because of large fluctuations in insulin levels. b.) They provide a 48-hour basal source of insulin for the body. c.) Neither insulin glargine or detemir should be mixed with other insulins. d.) Their onset of action is 1-2 hours. e.) They are cloudy in appearance.

c.) Neither insulin glargine or detemir should be mixed with other insulins. d.) Their onset of action is 1-2 hours.

A nurse is teaching clients about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration? a.) Insulin glargine b.) NPH insulin c.) Regular insulin d.) Insulin lispro

c.) Regular insulin

A patient has been taking levothyroxine for 6 months. After this month's laboratory work, the physician tells the nurse that the patient is "euthyroid." What does that term mean? a.) The patient is experiencing hyperthyroidism. b.) The patient is experiencing hypothyroidism. c.) The patient's thyroid hormone levels are within normal limits. d.) The patient's thyroid hormone levels are still fluctuating.

c.) The patient's thyroid hormone levels are within normal limits. Rationale: The term euthyroid means that normal thyroid hormone levels have been achieved.

The nurse monitoring a patient for a therapeutic response to oral antidiabetic drugs will look for a.) fewer episodes of diabetic ketoacidosis (DKA). b.) glucose levels of 150 mg/dL. c.) hemoblobin A1C levels of less than 7%. d.) weight loss of 5 pounds.

c.) hemoblobin A1C levels of less than 7%.

A nurse is caring for a client who has a prescription for metformin. The nurse should monitor the client for which of the following adverse effects? a.) hyperlipidemia b.) respiratory alkalosis c.) lactic acidosis d.) hypoglycemia

c.) lactic acidosis

A client is to receive insulin before breakfast, and the time of breakfast tray delivery is variable. The nurse knows that which insulin should not be administered until the breakfast tray has arrived and the client is ready to eat? a.) glargine b.) regular c.) lispro d.) NPH

c.) lispro

Beta blockers affect on insulin

can mask the sympathetic nervous system response to hypoglycemia - patient may not have tachycardia or tremors with a low blood sugar - teach patient to monitor blood glucose levels closely

A nurse is caring for a client who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor? a.) WBC b.) Amylase c.) Platelet count d.) Liver function tests

d.) Liver function tests

A patient on an antithyroid medication is joining his friends for dinner. The best menu choice for this patient would be: a.) a seafood platter. b.) a sushi bar. c.) a tofu burger. d.) pasta with marinara sauce

d.) pasta with marinara sauce Rationale: He should avoid foods high in iodine, such as soy, tofu, and seafood.

Type 1 DM

do not produce insulin, must have insulin to survive diagnosed around age 12

Insulin

is the key for glucose to get into cells

•Dosed once a day in mcg •Will require higher doses in pregnancy •Monitor for palpitations •Contraindicated if recent MI •Takes 6-8 weeks to see full therapeutic effect •Best to take in the morning to avoid insomnia •Used to treat hypothyroidism (Synthroid, Levothroid, Levoxyl)

levothyroxine

Type 2 DM

may be controlled with oral, injectable, and/or insulin (insulin resistance)

Rapid-acting insulin names and administration

names: lispro (Humalog), aspart (Novolog), glulisine (Apidra) administeration: subq or IV

Short-acting insulin names and administration

names: regular (Humulin R, Novolin R) administration: Can be given IV or SQ

Insulin actions

promote cellular uptake of glucose, converts glucose into glycogen, promotes storage of glucose in liver and muscles, moves K+ into cells

•Oral medication •Pregnancy Category D •methimazole is the only alternative drug in this class •Requires 2 weeks of therapy before symptoms improve •Avoid foods high in iodine •Used to treat hyperthyroidism •(PTU)

propylthiouracil

What insulin types mimic what the body should do naturally? (These types are also the only ones that are able to be administered via IV.)

rapid-acting and short-acting

Biguanides: metformin (Glucophage)

• 1st choice of medication for most Type 2 diabetics • Action: reduce production of glucose in the liver, increase glucose uptake, decrease glucose absorption in the GI tract, decreases insulin resistance • Also used to treat polycystic ovary syndrome (PCOS) • Adverse effects: • GI distress (n/v, diarrhea) • Lactic acidosis: (may be fatal); S/S include muscle pain, sleepiness (somnolence), malaise, hyperventilation • Interactions: use with iodinated radiologic contrast media can result in: acute renal failure and lactic acidosis • DC metformin 24-48 hours prior to test and for 48 hours after. Check BUN/Cr prior to restarting. • Used alone, does not cause hypoglycemia • May result in modest weight loss

Sulfonylureas "-ides": chlorpropamide (Diabinese), glipizide (Glucotrol), glimepiride (Amaryl)

• 1st generation: chlorpropamide (Diabinese) • 2nd generation: glipizide (Glucotrol), glimepiride (Amaryl) • Action: insulin release from the pancreas • Adverse effects: hypoglycemia, weight gain, alcohol intake with glipizide can cause intense n/v, palpitations, and flushing (disulfiram -like reaction) • Give 30 minutes before breakfast, hold if unable to eat • Contraindications: pregnancy & lactation

Thiazolidinediones "-glitazones", "TZDs": pioglitazone (Actos), rosiglitazone (Avandia)

• Action: decrease insulin resistance, increase glucose uptake and decrease glucose production • Adverse effects: fluid retention (assess for edema, CHF, weight gain); liver toxicity • Nursing interventions: monitor weight and liver enzymes (ALT, AST) • Given once a day, with or without food

Amylin mimetics "-tides": pramlintide (Symlin)

• Action: decreases gastric emptying time and reduces postprandial (post-meal) glucose levels. Mimics a naturally occurring peptide hormone amylin. • Used in Type 1 or 2 diabetics who have ineffective control with insulin therapy • Adverse effects: nausea, reaction at injection sites, risk for hypoglycemia when used with insulin • Administered SQ prior to meals • May delay absorption of oral medications: give 1 hr before or 2 hrs after pramlintide

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors: canagliflozin (Invokana), dapagliflozin (Farxiga)

• Action: excretes glucose through urine by preventing reabsorption in the kidney • For Type 1 diabetics, used in conjunction with insulin • Adverse effects: cystitis, candidiasis, polyuria; dizziness and risk for hypotension (espec. in older adults who are also on diuretics) • Take once a day before breakfast

glucagon

• Action: increases blood sugar by increasing the breakdown of glycogen into glucose • Used in the emergency management of hypoglycemic reactions if pt is unable to take oral glucose • Adverse effects: GI distress • Nursing interventions: • Turn patient on left side after administration to reduce risk of aspiration • Provide oral glucose (Rule of 15) as soon as patient is alert and able to swallow • Can be given SQ, IM, or IV (IV is preferred, works faster, within minutes)

Meglitinides "-glinides": repaglinide (Prandin), nateglinide (Starlix)

• Action: insulin release from the pancreas • Adverse effects: hypoglycemia, weight gain • Give 30 minutes before meals (TID) • Teach pt if they skip a meal, skip the dose to avoid hypoglycemia

Incretin mimetics "-tides": exenatide (Byetta), liraglutide (Victoza), dulaglutide (Trulicity)

• Action: promotes insulin release, decreases secretion of glucagon, slows gastric emptying, decreases fasting and post-prandial blood sugars, & decreases caloric intake. Mimics naturally occurring glucagon-like peptide-1 incretin hormone (GLP-1 agonist) • Used in conjunction with oral antidiabetics such as metformin or a sulfonylurea • Adverse effects: GI effects (n/v, diarrhea); pancreatitis • Administered SQ 60 min before am and pm meals • Take oral meds 1 hr before incretin mimetic to prevent delayed absorption Comes in pre-filled pen, keep refrigerated and discard after 28 days

Dipeptidyl peptidase-4 (DPP-4) inhibitors "-gliptins": sitagliptin (Januvia)

• Action: promotes release of insulin & decrease secretion of glucagon by enhancing a naturally occurring incretin hormone • Adverse effects: pancreatitis (rare); pretty well tolerated • Take once a day, with or without food

Alpha-glucosidase inhibitors: acarbose (Precose), miglitol (Glyset)

• Action: slows carb absorption & digestion • Adverse effects: GI effects (abdominal distention, cramping, gas, diarrhea), liver toxicity, anemia due to decreased iron absorption • Given TID with first bite of food

Asthma and COPD

• Both are airflow disorders and are treated with many of the same medications • Medication management addresses two issues that lead to bronchoconstriction: inflammation and hyper-responsiveness

D50W (50% dextrose solution in water)

• Can be given IV in an emergency hypoglycemic reaction, if patient is unconscious and unable to swallow • May also induce n/v: roll patient to: left side to reduce risk of aspiration

albuterol (Proventil) and levalbuterol (Xopenex)

• Inhaled via inhaler or nebulizer, short-acting, "rescue inhaler" • Prevent and treat bronchospasm (acute asthma attack) • Used 15-30 min prior to exercise to prevent exercise-induced asthma

formoterol (Foradil) and salmeterol (Serevent)

• Inhaled, long-acting; used q 12 hrs NOT prn • Used for: Used for long-term control of asthma • Often combined with glucocorticoid in same inhaler: fluticasone/salmeterol (Advair)

terbutaline

• Oral, long-acting control of asthma • Not widely used

Beta2 Adrenergic Agonists adverse reactions

• Tachycardia, angina, and tremors: caused from stimulation of the sympathetic nervous system • Reduced dosage and use of a spacer can decrease AEs

Why does hypoglycemia occur?

• Too much insulin • Not enough food, especially when insulin peaks • Vomiting and diarrhea • Alcohol intake • Strenuous exercise • Childbirth

Proper storage of insulin

• Unopened vials are stored in the refrigerator until expiration date • Insulins premixed in syringes can be kept for 1-2 weeks under refrigeration, store with needles pointed up • Opened vials can be kept for 30 days at room temp, avoid sunlight and heat

Nursing Care of the Diabetic Patient

• Wear medical alert bracelet with DM and medications taken • S/S of hypoglycemia: tachycardia, palpitations, lethargy, nausea • How to treat hypoglycemia • Carry source of glucose, especially if on insulin or other agent that can cause hypoglycemia or if history of hypoglycemic unawareness