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Drugs Acting on Endocrine - Insulin
Insulin & Drugs to Treat DM 1 & 2
9
Pharmacology
Undergraduate 1
02/15/2016

Additional Pharmacology Flashcards

 


 

Cards

Term

Biguanides 

Definition

Drug:  metformin (Glucophage) 

 



Action: Decreases hepatic glucose production and decreases intestinal absorption of glucose 

 

 



Use: 1st line treatment for DM Type 2 

 


 


Adverse: GI bloating / Nausea / Diarrhea 

 


 

Contraindications:renal disease 



Nursing Implications: 

  • Take w/ meals to decrease tomach upset 
  • discontinue 48 hours before diagnostic tests 
  • Monitor blood glucose
  • Need for diet/exercise

 


*Does not cause hypoglycemia 

Term

Sulfonylureas

Definition

Drug:  

  • glipizide (Glucotrol) - 2nd generation
  • glyburide (Diabeta)  

 



Action: increases insulin secretion from pancreas 

 

 



Use:  Type 2 DM

 


 


Adverse: hypoglycemia 

 


 

Contraindications: renal disease 


 



Nursing Implications: 

  • monitor blood glucose
  • take before meals
  • teach signs/symptoms of hypoglycemia
  • teach diet/exercise
Term

Meglitinides 

Definition

Drug:  repaglinide (Prandin) 



Action: Facilitates pancrease to produce more insulin after a meal 

 

 



Use:  DM Type 2 

 


 

Adverse: hypoglycemia / weight gain / GI disturbances 


 

Contraindications: CANNOT BE TAKEN WITH SULFONYLUREAS

 



Nursing implications: 

  • Give a dose with each meal; if meal is skipped, do not give
  • Give 15-30 minutes before meal
  • Monitor blood glucose
Term

Alpha Glucosidase Inhibitors 

Definition

Drug:  

  •  miglitol (Glycet)
  • acarbose (Precose) 

 



Action: Inhibit enzymes in GI tract, delaying digestion of complex carbohydrates

 

 



Use:  diabetes mellitus 

 


 

Adverse: GI upset / bloating 


 

Nursing Implications: 

  • must take these with meal 
Term

Incretin Mimetics 

Definition

Drug:  exenatide (Byetta) - subQ 


 

Action: hormones are released by GI tract in response to food; slows gastric emptying, increasing the feeling of satiety 

 


Use: type 2 DM 

 

 


Adverse: GI upset 

Term

DPP-4 Inhibitors 

Definition

Drug:  sitagliptin (Januvia) - PO



Action: stimulates insulin release in response to a meal 

 



Use: Type 2 DM 

 


 

Adverse:  Respiratory tract infection 

 


 

Contraindications: renal disease 



*Not a first line treatment; only has small area of use nowadays 

Term

Other Agents 

Definition

rosiglitazone (Avandia) 

 


Action: increases effectiveness of circulating insulin

 

Use:  Limited use for diabetes 

 

Adverse: fluid retention / edema / worsening of heart failure / heart attack 

 


pramlintide (Symlin) - subQ 

 

 

Action: slows gastric emptying 

 

Use:  diabetes 

 

Adverse: hypoglycemia 

 

Nursing Implications: 

  • can be used with insulin, sulfonylureas, or metformin 
Term

Insulin 

Definition

Insulin - given IV, SQ, Nasal Spray

U-100 or U-500 


Types: 

  • Insulin Lispro (Humalog) - rapid acting (within 15 min) 
  • Regular insulin (Humulin) - short, subQ, IV 
    • only insulin that can be given IV 
  • Insulin isophane (NPH) - intermediate; slower acting
    • stays in body much longer (patient must eat consistently) 
    • not used in hospital b/c of risk of hypoglycemia
  • Insulin glargine or detemir (Lantus, Levimer) - long acting, mimics basal insulin 
    • Does NOT cause hypoglycemia 
    • treats glucose made by liver 
    • this is never mixed with other insulines in syringes
  • Insulin human (Afreeza) - inhaled
    • usually used along with Lantus or Levimer
    • used in caution in people with lung problems 

[image]
Peak: most effective time when drug is in the body
insulin will counteract carbohydrates eaten to lower blood glucose levels 
  • Time when insulin is working the hardest/most effective
  • Controls when a patient must eat to prevent hypoglycemia 
Duration: how long insulin stays in the body
 


Action: synthesized pancreatic hormone 

 



Use:  Type 1 DM / some Type 2 Diabetics 


 

Adverse: hypoglycemia 

 


Nursing Interventions: 

  • Monitor blood glucose
  • Hemoglobin A1c - measures 90 day blood glucose avg
  • Emergency situations: glucose less than 70, nurse treats with orange juice (simple sugar)
  • Teach Patients:
    • how to monitor glucose levels
    • to correlate intake of carbs with peak timing of insulin
    • to keep 15g of carbs/simple sugar on hand (candy bar)
    • to recognize hypoglycemic symptoms (anxiety, sweaty, hunger)
    • to recognize hyperglycemic signs (thirst, headache, fatigue, frequent urination)
    • to have a "sick day" plan (insulin needs change when a person is ill) 
      • drink plenty of water while ill
      • infection raises glucose levels so med is necessary

 

Term

Other: Insulin Types

Definition

Mixed combinations: 

  • Humulin 70/30 (NPH 70%, Regular 30%)
  • Humalog 75/25 (NPH 75%, Rapid 25%)
  • Numerous combinations 
*each mixture contains short or rapid acting insuling along with NPH 
*come with self-injection pen , easier for older patients 


Weight Based: 
Patient monitored before meals & at bedtime
Short or Rapid acting Insulin is administered based on weight 
4x/day 

Sliding Scale: 
Insulin based only on blood glucose levels
4x/day

Carbohydrate counting: 

Only the foods that contain carbohydrates will increase blood glucose so they are the only foods that are counted when determining the amount of insulin they require 



Insulin Pumps:
Some patients use these to have continual infusion of basal insulin
Patient also monitors blood glucose throughout day and can administer addtl bolus insulin throughout the day (keeps tight control on glucose level)
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