Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
80 Cards in this Set
- Front
- Back
|
secretagogues |
substance that stimulates hormone secretions
|
|
|
What are some examples of secretagogues?
|
Sulfonylureas and Meglintinide Analogs
|
|
|
sulfonylureas
|
stimulate the pancreas to secrete more insulin
|
|
|
What is an example of 2nd generation sulfonylureas?
|
Glipizide (glucotrol)
|
|
|
When should Glipizide (Glucotrol) be administered?
|
30 minutes before meal
|
|
|
What are some considerations before administering Glipizide (Glucotrol)?
|
have to have a working pancreas, eliminated in the kidneys so those with kidney damage will have more trouble clearing the drug
|
|
|
meglitinide analogs
|
non-sulfonylurea insulin secretagogues, which increase insulin secretion, have a faster action and shorter duration
|
|
|
What are some examples of meglitinide analogs?
|
Repaglinide (Prandin) or Nateglinide (Starlix)
|
|
|
When should Prandin or Starlix be taken?
|
just prior to eating (RAPID onset)
|
|
|
What is the major side effects of meglitinide analogs?
|
hypoglycemia
|
|
|
When should you hold administration of a meglitinide analog?
|
if NPO or on fluid restrition
|
|
|
biguanides
|
decrease production of glucose by the liver and increase sensitivity of peripheral re,ceptor sites to insulin, decreasing postprandial hyperglycemia
|
|
|
What is an example of a biguanide?
|
Metformin (Glucophage)
|
|
|
What are the major side effects of biguanides?
|
GI, best taken with meals to avoid
lactic acidosis, ETOH makes more susceptible |
|
|
What consideration should be made before diagnostic studies while taking biguanides?
|
Metformin (glucophage) must be held 2 days prior to studies with dye or contrast
|
|
|
What are some signs and symptoms of lactic acidosis?
|
muscle weakness, abdominal pain, dyspnea, cold hands, persistent n/v, weight loss, bradycardia, arrythmias, enlarged liver
|
|
|
When is Metformin (glucophage) contraindicated?
|
in clients with renal impairment who have a creatinine level >1.4 mg/dL
|
|
|
Alpha-glucosidase inhibitors
|
delay the absorption of glucose in the intestinal system which results in lower postprandial blood glucose levels
|
|
|
What are some examples of alpha-glucosidase inhibitors?
|
Acarbose (Precose) and Miglitol (Glyset)
|
|
|
When should you administer alpha-glycosidase inhibitors?
|
immediately before eating only
|
|
|
What are some side effects of alpha-glucosidase inhibitors?
|
GI disturbances- flatulence, diarrhea, abdominal discomfort
|
|
|
What measures should you take to avoid side effects of alpha-glucosidase inhibitors?
|
avoid rich foods and gas producing foods
|
|
|
What conditions would be not recommended to administer alpha glucosidase inhibitors?
|
creatinine >2.0 mg/dL, drugs may accumulate in clients with kidney dysfunction
|
|
|
What must you do if hypoglycemia occurs after administering alpha-glucosidase inhibitors and why?
|
administer glucose tablets, sucrose absorption is blocked
|
|
|
Thiazolidinediones (TZDs)
|
enhance insulin action at the receptor sites
|
|
|
What are some examples of TZDs?
|
Pioglitizone (Actos) and Rosiglatozone (Avandia)
|
|
|
What lab tests need to be performed when taking TZDs?
|
liver function, both baseline and at frequent intervals
|
|
|
What drug interaction must you consider when administering TZDs?
|
they lower the effectiveness of BCPs
|
|
|
What major side effects can occur with TZDs?
|
fluid retention, weight gain, CHF
|
|
|
How long do TZDs work in the body?
|
12-24 hours
|
|
|
What should be considered before administering Pramlintide (Symlin)?
|
It has a black box warning
|
|
|
Dipeptidyl Peptidase-4 inhibitor (DPP-4)
|
increases active levels of incretins which stimulate pancreas to release more insulin and decrease glucose production
|
|
|
What are some examples of DPP-4 inhibitors?
|
Sitagliptin (Januvia) and Saxagliptin (Onglyza)
|
|
|
What should be considered before administering amylin analogs?
|
they have a black box warning
|
|
|
When should you administer DPP-4 inhibitors?
|
they may be taken with or without food
|
|
|
What is a major side effect of Sitagliptin (Januvia)?
|
increased incidence of pancreatitis
|
|
|
What is a major side effect of Saxagliptin (Onglyza)?
|
increased incidence of infection
|
|
|
What is the action of insulin?
|
stimulates glucose uptake in skeletal muscle and fat and inhibits hepatic production of insulin
|
|
|
What are conventional regimens of insulin therapy?
|
a mix of insulins are used to control blood glucose with one or more injections per day
|
|
|
What is the downside of using conventional insulin regimens?
|
you cannot vary meal patterns or activity patterns
|
|
|
What are intensive regimens of insulin therapy?
|
a basal dose is maintained, with bolus doses administered during the day after testing (up to 8 times/day)
|
|
|
What is the benefit of intensive insulin regimens?
|
it is more flexible, allowing variances in meal and activity patterns
|
|
|
What are some complications of insulin therapy?
|
lipodystrophy, lipohypertrophy, and lipoatrophy
|
|
|
lipodystrophy
|
localized reaction at injection site
|
|
|
lipoatrophy
|
loss of SQ tissue secondary to immune reactions to the impurities in insulin
|
|
|
lipohypertrophy
|
development of fibrofatty masses at the injection site
|
|
|
What are some causes of morning hyperglycemia?
|
insulin waning, dawn phenomenon, Somogyi phenomenon
|
|
|
Insulin waning
|
progressive increase in glucose from bedtime until morning
|
|
|
What are some interventions to prevent insulin waning?
|
increase pre-dinner or bedtime dose of intermediate/long acting insulin or start evening dose if not part of the treatment plan
|
|
|
What is dawn phenomenon?
|
glucose remains WNL until 3am when the level begins rising, thought to be from nocturnal surges in growth hormone secretion
|
|
|
What are some interventions to prevent dawn phenomenon?
|
administer intermediate acting insulin at bedtime
|
|
|
What is Somogyi's phenomenon?
|
glucose levels drop too low at night, causing a counter-regulatory response to hyperglycemia resulting in hyperglycemia
|
|
|
What are some interventions to prevent Somogyi's phenomenon?
|
decreasing dose of evening insulin or increasing evening snack
|
|
|
What does brittle mean with diabetes?
|
patient having wide fluctuations in blood glucose
|
|
|
How do you differentiate the types of morning hyperglycemia?
|
you must take FSBG during the night
|
|
|
How long does insulin keep after opening?
|
30 days
|
|
|
How should you store insulin?
|
at room temperature
|
|
|
What are some things to consider before drawing insulin?
|
check for flocculation (frosting), roll in hands, do not inject cold
|
|
|
What needle size is used for insulin injections?
|
0.5 to 1" and 27 to 29 gauge
|
|
|
At what angle do you administer insulin?
|
45 to 90 degrees depending on thickness of SQ tissue (45 preferred)
|
|
|
What is the onset, peak, and duration for rapid acting insulin?
|
o: 15 min p: 40 minutes to 1 hour d: 3-5 hours
|
|
|
What is the onset, peak, and duration for short acting insulin?
|
o: 30 min to 1 hour p: 2-3 hours d: 4-6 hours
|
|
|
What is the only insulin to give IVP?
|
short acting
|
|
|
What is the onset, peak, and duration for intermediate acting insulin?
|
O: 2 to 4 hours P: 6 to 8 hours D: 12 to 16 hours
|
|
|
What is an example of intermediate acting insulin?
|
NPH (Humalin N, Novolin N)(cloudy)
|
|
|
What is the onset, peak, and duration for long acting insulin?
|
O: 2 hours P: continuous D: 24 hours
|
|
|
What should be assessed at the peak of insulin effectiveness?
|
hypoglycemia
|
|
|
What is an example of rapid acting insulin?
|
Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
|
|
|
What is an example of short acting insulin?
|
Regular (Humulin-R, Novolin-R)
|
|
|
What is an example of long acting insulin? |
Glargine (Lantus), Detemir (Levemir)
|
|
|
What are the names of rapid acting insulin? |
humalog, novalog, apidra |
|
|
what is the onset peak and duration of rapid acting? |
15 minutes, 1 hr (40-50 mins Novalog), 3-5 hr |
|
|
what are the names of Short-acting (regular) insulin? |
Humalin-R, Novalin R |
|
|
What is the onset, peak and duration of short acting (regular) insulin? |
30 mins - 1hr, 2-3 hours, 4-6 hours |
|
|
What are the names of intermediate insulin? |
NPH, Humalin-N, Novalin-N |
|
|
What is the onset peak and duration of intermediate insulin? |
2-4 hrs, 6-8 hrs, 12-16 hours |
|
|
What are the names of the long acting insulins? |
Glargine (lantus), detemir (levemir) |
|
|
What is the onset, peak and duration of long acting insulin? |
2 hours, continuous, 24 hours |
|
|
Which insulins are used in conventional regimens? |
Short acting (regular), and Intermediate |
|
|
Which insulins are used in Intensive regimens? |
Long acting, plus short or rapid acting |
