Chapter 45: Drugs for Diabetes Mellitus

What are the drugs with Hypoglycemic effect?

1. Alcohol 2. Lithium 3. ACE inhibitors 4. Beta-adrenergic blockers

What Antidiabetic drug for type II DM are No hypoglycemia?

1. Alpha-Glucosida inhibitors: acarbose (Precose) 2. Incretin Enhancers (GLP-1, DPP-4 Agonist) 3. Thiazolidinediones: pioglitazone (Actos)

What Antidiabetic drug for Type II DM affects the liver?

1. Biguanide: Metformin (Glucophage) 2. Thiazolidinediones: pioglitazone (Actos)

What are the Common drugs that raise the level of blood glucose?

1. Corticosteroids 2. NSAIDs 3. Diuretics

Name all the hormones of Hyperglycemic hormones?

1. Epinephrine 2. Thyroid hormone 3. Growth hormone 4. Glucocorticoids

What is treatment of HHS?

1. Fluid replacement 2. Correction of electrolytes imbalances 3. Low dose insulin IV

Name the primary blood tests for diagnosing diabetics?

1. Hemoglobin A1C (HbA1C): HbA1C >6.5% 2. Fasting plasma glucose (FPG): >126 mg/dL 3. Oral glucose tolerance test (OGTT): loading dose of 75g glucose ingested; >200 mg/dL

Name the short term s/s of Type 1 Diabetes?

1. Hyperglycemia: fasting glucose >126 mg/dL 2. Polyuria: excessive urination 3. Polyphagia: increase hunger 4. Polydipsia: increase thirst 5. Glucosuria: high levels of glucose in urine 6. Weight loss 7. Fatigue 8. Warm/dry skin

What insulin is Clear solution?

1. Insulin aspart 2. Insulin lispro 3. Insulin glulisine 4. Insulin Regular

What insulin types are Rapid action?

1. Insulin aspart (Novolog) 2. Insulin lispro (Humalog) 3. Insulin glulisine (Alidra)

What insulin is Long solution?

1. Insulin detemir 2. Insulin glargine

What insulin type is Long acting?

1. Insulin detemir (Levemir) 2. Insulin glargine (Lantus)

6. A 63 year old patient 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 increase glucose release 2. He is converting to a type I diabetic 3. The oral antidiabetic drug is no longer working for him 4. Patients 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 increase glucose release

2. The patient 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 patient? 1. Make sure the patient's breakfast is available to eat before administering this insulin 2. Offer the patient a high-carbohydrate snack in 6hrs 3. Hold the insulin if the blood glucose level is greater than 100mg/dL 4. Administer the medication in two separate syringes

1. Make sure the patient's breakfast is available to eat before administering this insulin

What Antidiabetic drug for type II DM affects the Pancreas?

1. Meglitinides: nateglinide (Starix) 2. Sulfonylureas (1st and 2nd Gen)

What Antidiabetic drug for type II DM is S/E hypoglycemia?

1. Meglitinides: nateglinide (Starix) 2. Sulfonylureas (1st and 2nd Generation): chlorpropamide (Diabinese); 1st gen and glipizide (Gucotrol); 2nd gen

4. What patient education should the nurse provide to the patient with diabetes who is planning an exercise program? SATA 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

What is the treatment of DKA?

1. Normal saline with Regular insulin in IV 2. Kayexalate

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

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

5. A patient with type 2 diabetes has been nothing by mouth (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 medication 1. Hold all meds as per the NPO order 2. Give him the medication 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

1. A patient receives NPH and regular insulin every morning. The nurse is verifying that the patient 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 patient 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 hyperglycemia is greatest around the peak of insulin activity

4. The risk for hyperglycemia is greatest around the peak of insulin activity

25. Which of the following antihypertensives would reverse the hypoglycemic effect of antidiabetic pharmacotherapy? A. Hydrochlorothiazide (HydroDiuril) B. Timolol (Betimol, others) C. Nifedipine (Procardia) D. Enalapril (Vasotec)

A. Hydrochlorothiazide (HydroDiuril)

13. Which of the following stimulates the pancreas to secrete insulin? A. Hyperglycemia B. Hypoglycemia C. Glucagon D. Ketoacids

A. Hyperglycemia

27. MAO inhibitors used for treatment of what may potentiate hypoglycemic effects when used with what? A. Mood disorders, insulin B. Clinical depression, dextrothyroxine C. Cushing's syndrome, corticosteroids D. Attention deficit/hyperactivity disorder, epinephrine

A. Mood disorders, insulin

20. During oral hypoglycemia therapy, the nurse should assess for which symptoms related to abnormalities in liver function? A. Yellowed skin, pale stools, dark urine B. Pink skin, light brown stools, yellow urine C. Pale skin, red-tinged stools, amber urine D. Red skin, dark stools, clear urine

A. Yellowed skin, pale stools, dark urine

What Antidiabetic drug for Type II DM affects the Small Intestine?

Alpha-Glucosidase inhibitors: acarbose (Precose)

11. What is acarbose (Precose) classification?

Alpha-glucosidase inhibitor

What is Pramlintide (Symlin)?

Anti hyperglycemic drug; synthetic analog of Amylin, a natural hormone released by the beta cells of the pancreas at the same time as insulin

21. If injection sites are not rotated regularly, the diabetic patient may suffer from which of the following? A. Petechiae B. Lipodystrophy C. Hematoma D. Pustules

B. Lipodystrophy

19. Persons with type I or type II diabetes who are not able to achieve glucose control by the use of insulin alone might be administered this insulin adjunct, resembling a natural hormone found in beta cells of the pancreas. A. Metformin (Glucophage) B. Pramlintide C. Novolog Mix D. Humalog Mix

B. Pramlintide

26. Why must the nurse instruct a patient receiving glipizide (Glucotrol XL) to avoid crushing or chewing the tablets? A. The patient may choke B. The effectiveness of the medication would be hindered C. It would cause blood glucose levels to rise too rapidly D. Irritation of the oral mucosa may occur

B. The effectiveness of the medication would be hindered

24. If a patient is prescribed regular insulin (Humulin R, Novolin R) and is also prescribed antihypertensive drugs, which of the following would likely mask symptoms of hypoglycemia reaction due to insulin therapy? A. Hydrochlorothiazide (HydroDiuril) B. Timolol (Betimol, others) C. Nifedipine (Procardia) D. Enalapril (Vasotec)

B. Timolol (Betimol, others)

10. What is metformin immediate-release (Glucophage, Riomet) classification?

Biguanide

What Antidiabetic drug for type II DM are Rarely hypoglycemia?

Biguanide: Metformin (Glucophage)

Which of the following oral hypoglycemia have a black box warning related to lactic acidosis?

Biguanides

14. While taking a health history, the nurse should recognize that which of the following is NOT a short-term sign of type I diabetes mellitus? A. Polyuria B. Polyphagia C. Acidosis D. Polydipsia

C. Acidosis

23. When considering glucose regulation in the body, which of the following components of homeostasis would be restored following insulin therapy? A. Sensor (senses glucose in the bloodstream) B. Control center (determines the set point for glucose levels in the bloodstream) C. Effector (responds to the increased levels of glucose in the bloodstream) D. Receptor (produces a response at the site of glucose action)

C. Effector (responds to the increased levels of glucose in the bloodstream)

22. Which of the following nursing diagnosis is NOT appropriate for the patient receiving insulin therapy? A. Risk for injury B. Risk for Imbalanced Nutrition C. Risk for Role Confusion D. Risk for infection

C. Risk for Role Confusion

15. When giving insulin, the nurse knows the most common route of administration is which of the following? A. Oral B. Intradermal C. Subcutaneous D. Intramuscular

C. Subcutaneous

Will your body be hypoglycemia or hyperglycemia at the Duration?

Hyperglycemia

What causes HHS and what is the level of glucose?

Hyperosmolar hyperglycemic state (HHS) is long term type II DM and caused by insufficient circulating insulin. Can be >600 mg/dL

Will your body be hypoglycemia or hyperglycemia at the Peak?

Hypoglycemia

Which of the following adverse effects does the RN recognize when too much insulin has been administered?

Hypoglycemia, tachycardia, convulsions

17. Which of the following adverse effects does the nurse recognize when too much insulin has been administered? A. Hypoglycemia B. Tachycardia C. Convulsion D. All of the above

D. All of the above

18. When giving oral hypoglycemia, the nurse expects which of the following actions to occur? A. The pancreas is stimulated to secrete more insulin B. Insulin receptors become more sensitive to target tissues C. The liver is inhibited from releasing glucose D. Both a and b

D. Both a and b

16. When planning follow-up care, the nurse should know that which of the following is a longer—acting form of insulin? A. Insulin lispro (Humalog) B. Insulin isophane (NPH, Humulin N, ReliOn N) C. Insulin glargine (Lantus) D. Insulin aspart (NovLog)

D. Insulin aspart (NovLog)

What is long term s/s of type I DM?

Diabetic ketoacidosis (DKA)

What Antidiabetic drug for Type II DM affects the Liver and Pancreas?

Incretin Enhancers (GLP-1, DDP-4 Agonists)

MAO inhibitors may potentiate hypoglycemic effects when used with which of the following drug?

Insulin

When planning a follow up care, the nurse should know which of the following rapid acting forms of insulin?

Insulin Lispro

What insulin type is Short acting?

Insulin Regular

When planning a follow up care, the nurse should know which of the following short acting forms of insulin?

Insulin Regular

What insulin is Cloudy solution?

Insulin isophane (NPH)

What insulin type is Interm acting?

Insulin isophane (NPH)

If injection sites aren't regularly rotated, the patient with diabetes may suffer from which of the following?

Lipodystrophy

9. What is nateglinide (Starlix) classification?

Meglitinide

What is the adverse effects of Pramlintide (Symlin)?

N/V, abdominal pain, headache, dizziness, fatigue, coughing, allergic reaction or arthralgia

What is the onset, peak, and duration of insulin Regular?

Onset: 30-60 mins Peak: 2-4 hrs Duration: 5-7 hrs

What is the BBW of pramlintide (Symlin)?

Severe hypoglycemia

What is the MOA of Pramlintide (Symlin)?

Slow gastric emptying time and increase satiety, thereby leading to reduced calorie intake (feel full), given SQ immediately prior to each meal

Oral hypoglycemic drug can work by all the various mechanisms of action EXCEPT which of the following?

Stimulate small intestinal enzymes responsible for breaking down complex carbohydrates into monosaccharides

When giving human regular insulin (Humulin R, Novolin R), the nurse knows the two routes of administration include which of the following?

Subcutaneous, IV

8. What is glyburide (DiaBeta, Micronase) classification?

Sulfonylurea

Which of the following oral hypoglycemic commonly cause hypoglycemia as an adverse side effect?

Sulfonylureas, Meglitinide

When giving oral hypoglycemics, the nurse expects which of the r following actions to occur?

The pancreas is stimulated to secrete more insulin AND insulin receptors become more sensitive to target tissues

12. What is pioglitazone classification?

Thiazolidinedione