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6) Ch 52 Antidiabetics
pharmacology fscj 2011
56
Nursing
Undergraduate 3
12/11/2011

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Term
is a chronic disease of deficient glucose metabolism
Definition
diabetes mellitus (DM)
Term
what is secreted from the beta cells of the islets of Langerhans in the pancreas in response to an increase in glucose
Definition
insulin
Term
what disease is characterized by insufficient to no insulin secretion from the pancreas.. OR insufficient insulin cell receptors.. OR insulin resistance by the body?
Definition
diabetes mellitus (DM)
Term
signs and symptoms of diabetes mellitus (DM)
Definition
called the 3 “polys” polyuria, polydypsia, polyphagia
Term
How many types of Diabetes Malletus are there, and which is the most common?
Definition
4 types, type2 is the most common.
Term
the most common cause of Type 2 DM
Definition
Insulin resistance
Term
what is the most common reason for insulin resistance?
Definition
Crap diet filled with high sugar foods and drinks over a life span
Term
The normal range for serum glucose is
Definition
70-110 mg /dL
Term
what body chemical do they use to measure the average of a patient’s glucose over a three month period –
Definition
Hemoglobin A1c (HbA1c)
the hemoglobin not only carries O2, it interacts with glucose
Term
what syrum hemoglobin levels indicate a diagnosis of DM
Definition
HbA1c >=6.5 %
Term
A fasting serum blood glucose of ______ also indicates DM
Definition
A fasting serum blood glucose >200 also indicates DM
Term
Why is normal insulin not given orally?
Definition
It is a protein hormone and would be inactivated by GI enzymes.
Term
What does an insulin's "ONSET" level tell you?
Definition
ONSET tells you “when to feed ‘em”. For example, with the rapid acting insulin Humalog (Lispro) you need that tray right in front of them and the patient needs to say they are going to eat now (ie no N/V). Why? It has an onset of 5 MINUTES. If you give it and the pt doesn’t eat there’s trouble ahead!
Term
what does insulin's "PEAK" level tell you?
Definition
you “when to watch ‘em” And what are you watching for? The s/s of hypoglycemia.
Term
when using a "combination insulin". Which number is for the intermediate insulin? Which would be for the rapid insulin?
Definition
first numeral is the amount of intermediate-acting insulin and the second numeral is the amount of rapid or short-acting insulin.
Term
Lantus is different from other insulin meds because...
Definition
it has no real "PEAK" and therefore is unlikely to cause HYPOglycemia
Term
why cant you mix lantus with other insulin meds?
Definition
It is highly acidic and would destroy the other insulin.
Term
lipodystrophy
Definition
a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue. A lipodystrophy can be a lump or small dent in the skin that forms when a person keeps performing injections in the same spot.
Term
negative affect of injecting medications/insulins into an area affected by lipodystrophy?
Definition
the rejection of the injected medication, the slowing down of the absorption of the medication, or trauma that can cause bleeding that, in turn, will reject the medication.
Term
negative affect of injecting medications/insulins into an area affected by lipodystrophy?
Definition
the rejection of the injected medication, the slowing down of the absorption of the medication, or trauma that can cause bleeding that, in turn, will reject the medication.
Term
which type of DM is from not being able to produce enough (or any) insulin?
Definition
DM Type 1
Term
physiological factors that can increase the need for insulin
Definition
Illness, stress (trauma, surgery, emotional stress)
Term
which medications can raise glucose, and thus should be double careful when giving to a diabetic patient?
Definition
steroids, thiazide diuretics
Term
Hypoglycemia signs and symptoms?
Definition
WET AND CRAZY” – sweating, confused, slurred speech, uncoordination, nervous, agitated
Term
treatment for hypoglycemia?
Definition
? GLUCOSE. 15gm – wait 15 minutes and recheck. That 15gm of glucose needs to be something FAST ACTING like 4 oz of juice or regular soda (candy works but not as fast).At the 15 min recheck - if the glucose is now at a safe level – anything from 75-100 - we next give a long acting glucose combined with protein and fat: crackers and peanut butter, milk and crackers, milk and half a turkey sandwich.
Term
antihypoglycemia medication?
Definition
glucagon
Term
Hyperglycemia signs and symptoms?
Definition
“DRY AND CRANKY” – dry mucous membranes, poor skin turgor, extreme thirst, (polydypsia) fruity breath, tachycardia, polyuria, deep rapid breathing (Kussmaul respirations), fatigue
Term
Hyperglycemia treatments
Definition
In the hospital insulin(maybe even a regular insulin IV drip), IV hydration. Treatment at home? Contact HCP, take scheduled insulin, increase H20.
Term
diabetic ketoacidosis (hyperglycemic reaction) S&S?
Definition
Extreme thirst

Polyuria

Fruity breath odor

Kussmaul breathing (deep, rapid, labored, distressed, dyspnea)

Rapid, thready pulse

Dry mucous membranes, poor skin turgor

Blood sugar level 250 mg/dL
Term
Hypoglycemic reaction (insulin shock) S&S
Definition
Headache, lightheadedness

Nervousness, apprehension

Tremor

Excess perspiration; cold, clammy skin

Tachycardia

Slurred speech

Memory lapse, confusion, seizures

Blood sugar level <60 mg/dL
Term
With an inadequate amount of insulin, sugar cannot be metabolized, and fat catabolism occurs. The use of fatty acids (ketones) for energy causes ....
Definition
ketoacidosis (diabetic acidosis or diabetic coma).
Term
When more insulin is administered than needed for glucose metabolism, a hypoglycemic reaction, called what, occurs?
Definition
insulin shock
Term
first oral antidiabetic drugs
Definition
Sulfonylureas
Term
what are chemically similar to sulfonamides (so watch out for allergies to these and Sulfa), but have no antibacterial properties.
Definition
Sulfonylureas
Term
2nd gen Sulfonylureas (2 drugs)
Definition
are glipizide (Glucotrol) and glyburide (Diabeta).
Term
how do sulfonylureas work in the body?
Definition
they stimulate beta cells to secrete insulin and increase insulin receptor sensitivity.
Term
The nonsulfonylurea classes are what?
Definition
biguanides, alpha-glucosidase inhibitors, thiazolidinediones (the “glitazones”) and meglitinides (the “glitanides”).
Term
what is the most common antidiabetic PO drug class?
Definition
Biguanides (glucophage)
Term
Thiazolidinediones drug examples?
Definition
pioglitazone (Actos), rosiglitazone (Avandia)
Term
Thiazolidinediones method of action in the body?
Definition
enhance insulin receptor sensitivity  decreased insulin resistance
Term
Biguanides method of action in the body?
Definition
increases binding of insulin to cell receptors, increases cell sensitivity to insulin, decreases hepatic production of glucose, reduces absorption of glucose from small intestine
Term
Meglitinides drug examples?
Definition
repaglinide (Prandin), neteglinide (Starlix)
Term
Meglitinides method of action in the body?
Definition
: stimulate release if insulin from beta cells of pancreas; release insulin in quick bursts
Term
Incretin mimetic, exebatude (Byetta), method of action on the body?
Definition
enhances insulin secretion from pancreatic beta cells; blocks excess hepatic production of glucose
• Delays gastric emptying reduces appetite
Term
• exebatude (Byetta)is used for which disease?
Definition
Type2 Diabetes Mellitus.
Term
what medication is taken orally and NOT used for Acute HYPOglycemic reaction?
Definition
Diazoxide (Proglycem)
Term
what medication is • Used to treat chronic hypoglycemia due to hyperinsulinism, usually caused by islet cell cancer or pancreatic hyperplasia
Definition
Diazoxide (Proglycem)
Term
what medication IS used to treat ACUTE HYPOglycemic reaction?
Definition
Glucagon
Term
1. A client is diagnosed with type 2 diabetes mellitus. The nurse is aware that which statement is true?

a. Client is most likely a teenager.

b. Client is most likely a child younger than 10 years.

c. Heredity is a major causative factor.

d. Viral infections contribute most to disease development.
Definition
C
Term
2. Antidiabetic drugs are designed to control signs and symptoms of diabetes mellitus. The nurse primarily expects a decrease in which?

a. Blood glucose

b. Fat metabolism

c. Glycogen storage

d. Protein mobilization
Definition
A
Term
3. 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. Humulin N

b. lispro (Humalog)

c. glargine (Lantus)

d. Humulin R
Definition
B
Term
4. A client is receiving a daily dose of Humulin N insulin at 7:30 AM. The nurse expects the peak effect of this drug to occur at which time?

a. 8:15 AM

b. 10:30 AM

c. 5:00 PM

d. 11:00 PM
Definition
C
Term
5. When the client is prescribed glipizide (Glucotrol), the nurse knows that which side effects/adverse effects may be expected? (Select all that apply.)

a. Tachypnea

b. Tachycardia

c. Increased alertness

d. Increased weight gain

e. Visual disturbances

f. Hunger
Definition
B, E, F
Term
6. A nurse who is teaching a client how to recognize symptoms of hypoglycemia should include which symptoms in the teaching? (Select all that apply.)

a. Headache

b. Nervousness

c. Bradycardia

d. Sweating

e. Thirst

f. Sweet breath odor
Definition
A, B, D
Term
7. A client is newly diagnosed with Type 1 diabetes mellitus and requires daily insulin injections. Which instruction should the nurse include in the teaching of insulin administration?

a. Teach the family members to administer glucagon by injection if the client has a hyperglycemic reaction.

b. Instruct the client about the necessity for compliance with prescribed insulin therapy.

c. Teach the client that hypoglycemic reactions are more likely to occur at the onset of action time.

d. Instruct the client in the care of insulin container and syringe handling.
Definition
B
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