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54 Cards in this Set

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What are antidiabetics used for?
blood sugar control
Insulin is used in the management of Type ____ diabetes mellitus.
1
It may also be used in Type 2 diabetes mellitus when diet and/or oral medications fail to adequately control blood sugar.
okay
Name 3 types of insulin preparation?
rapid-acting
intermediate-acting
long-acting
Name sources of insulin preparation? (5)
beef
beef/pork
pork
semisynthetic
human recombinant DNA
What does the choice of insulin preparation and source depend on? (3)
degree of control desired
daily blood sugar
fluctuations
history of previous reactions
Oral agents are used primarily in Type ____ diabetes mellitus.
2
When are oral agents used?
when diet therapy alone fails to control blood sugar or symptoms or when patients are not amenable to using insulin.
Some oral agents may be used with _____
insulin
Insulin is produced by the ______.
pancreas
What does insulin do?
it lowers blood glucose by increasing transport of glucose into cells and promotes the conversion of glucose to glycogen

it promotes the conversion of amino acids to proteins in muscle

stimulates triglyceride formation

inhibits the release of free fatty acids
How do metformin
nateglinide
rapaglinide
sulfonylureas
lower blood sugar?
by stimulating endogenous insulin secretion by beta
cells of the pancreas and by increasing sensitivity to insulin at intracellular receptor sites; intact pancreatic function is required
Miglitol delays digestion of ingested carbohydrates, thus _____ blood sugar, especially after meals.
lowering
Miglitol may be combined with _______.
sulfonylureas
Which two thiazolidinediones increase insulin sensitivity?
pioglitizone
rosiglitazone
Insulin is contraindicated in
hypoglycemia
Oral hypoglycemic agents are contraindicated in?
hypersensitivity
(cross-sensitivity with
other sulfonylureas and
sulfonamides may exist)
hypoglycemia
Type 1 diabetes
Do not use oral hypoglycemic agents if?
pregnant or lactating
What 3 things may alter INSULIN and/or ORAL HYPOGLYCEMIC AGENT requirements?
infection
stress
diet changes
Oral hypoglycemic agents should be used cautiously in ______ patients. Dosage reduction may be necessary.
geriatric
Using oral hypoglycemic agents and sulfonylureas with caution in patients with a history of ______ disease.
cardiovascular
Metformin may cause ____ _____.
lactic acidosis
Insulin has additive ______ effects with oral hypoglycemic agents.
hypoglycemic
With oral hypoglycemic agents, ingestion of alcohol may result in _______-like reaction with some agents.
disulfiram
What 5 things may DECREASE the effectiveness of oral hypoglycemic agents?
alcohol
corticosteroids
rifampin
glucagon
thiazide diuretics
What 8 things may INCREASE the effectiveness of oral hypoglycemic agents?
anabolic steroids
chloramphenicol
clofibrate
MAO inhibitors
most NSAIDS
salicylates
sulfonamides
warfarin
Anabolic steroids

chloramphenicol
clofibrate
MAO inhibitors
most NSAIDS
salicylates
sulfonamides
warfarin
All of these may have an increased or decreased hypoglycemic effect?
increase
____ _____ may produce hypoglycemia and mask signs and symptoms.
Beta blockers
Observe patient for signs and symptoms of _______ reactions.
hypoglycemic
Which alpha-glucosidase inhibitor and which thiazolidinediones do not cause hypoglycemia when taken alone but may increase the hypoglycemic effect of other hypoglycemic agents?
miglitol
pioglitazone
Patients who have been well controlled on ______ but develop illness or laboratory abnormalities should be assessed for ketoacidosis or lactic acidosis.
Hint: a biguinide

Assess serum electrolytes, ketones, glucose, and if indicated, blood pH, lactate, pyruvate, and metformin levels.

If either form of acidosis is present, discontinue metformin immediately and treat acidosis.
metformin
What are two lab considerations that should be monitored periodically throughout therapy to evaluate effectiveness of treatment?
serum glucose
glycosylated hemoglobin
Three potential nursing diagnoses?
Nutrition, altered: more than
body requirements
Knowledge deficit: related
to medication regimen
Noncompliance
Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require ____ ____ insulin. Withhold oral hypoglycemic agents and reinstitute after resolution of acute episode.
sliding scale
Patients switching from daily insulin dose may require gradual conversion to ____ _____.
oral hypoglycemics
Insulin comes in different types and strengths and from different species. Check _____, _____ _____, _____, and _____ ____ with another licensed nurse.
type
species' source
dose
expiration date
Do not interchange insulins without physician's order. Use only insulin syringes to draw up dose. Use only ____ syringes to draw up insulin lispro dose.
U100
If hypoglycemia occurs, advise patient to take a glass of _____ ____ or 2-3 tsp of sugar, honey, or corn syrup dissolved in water (glucose, not _____ _____, if taking miglitol), and notify hcp.
1 orange juice
2 table sugar
Patient Teaching tips?
Follow diet, med, and
exercise program
Educate proper testing of
serum glucose and ketones
Notify hcp if nausea,
vomiting, or fever
develops
Notify hcp if unable to eat
usual diet
Notify hcp if blood sugar
levels are not
controlled
Carry sugar or glucose form
and ID describing
medication regimen
Insulin is recommended method
of controlling blood
sugar during pregnancy;
use contraceptives other
than ORAL contraceptives
and notify hcp promptly if
pregnancy planned or
suspected
Educate patient:
proper administration of
meds
type of insulin
equipment (syringe and
cartridge pens)
syringe disposal
don't change brands of
insulin or syringes
rotation of injection
sites
med compliance
What should patient know about sulfonylurea use?
Concurrent use with alcohol may cause a disulfiram-like reaction evidenced by:

abdominal cramps
nausea
flushing
headache
hypoglycemia
What are the symptoms for a disulfiram-like reaction?
abdominal cramps
nausea
flushing
headache
hypoglycemia
What should patient know about metformin?
explain to patient the risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, or severe or continuing diarrhea occurs of if medical tests or surgery is required
Effectiveness of therapy can be evidenced by?
control of blood glucose levels without appearance of hypoglycemic or hyperglycemic episodes
What is disulfiram?
Disulfiram (ie, tetraethylthiuram disulfide), which has the trade name of Antabuse, is a commonly used medication in the management of alcoholism because of its effectiveness in maintaining abstinence.
Agents that produce disulfiramlike reactions with ethanol include the following:
Industrial solvents ("degreasers' flush")

Mushrooms (eg, Coprinus atramentarius [inky cap], Clitocybe claviceps)

Antibiotics (eg, metronidazole, sulfonamides, cephalosporins, nitrofurantoin)

Oral HYPOGLYCEMIC agents

Pesticides (eg, carbamates, monosulfiram [Tetmosol])
Prehospital care for disulfiram-like reactions?
In acute disulfiram overdose, administer activated charcoal (AC), if available.
Induced emesis with ipecac syrup is NOT recommended.
Emesis may delay administration of AC, worsen nausea and vomiting associated with toxicity, and increase incidence of pulmonary aspiration caused by an unprotected airway if seizures and coma suddenly supersede.
Ipecac syrup contains ethanol and could precipitate DER (disulfiram-ethanol reaction)
Decontamination procedures are not likely to be beneficial once the reaction begins.
Perform gastric lavage in the hospital setting in cases of massive alcohol ingestion; maintain a patent and protected airway. Use of AC is not required for any of the disulfiram syndromes.
Emergency department care for disulfiram-ethanol reaction?
As with prehospital care, ED treatment is supportive.
No specific antidote is available for treatment of DER or acute disulfiram overdose.
In acute disulfiram overdose, use of multiple dose activated charcoal (MDAC) might be beneficial.
MDAC can increase rate of elimination of disulfiram and its metabolites that undergo enterohepatic recirculation.
In severe DER, hemodialysis may be indicated to enhance the elimination of ethanol and acetaldehyde.
Neither hemodialysis nor hemoperfusion have been beneficial for treatment of acute disulfiram overdose.
Name 6 groups of antidiabetics?
alpha-glucosidase inhibitors
biguanide
insulins
meglitinides
sulfonylureas
thiazolidinediones
Name 2 alpha-glucosidase inhibitors?
acarbose
Precose

miglitol Glyset
Name 1 biguanide?
metformin
Glucophage, Glucophage XR, {Novo-Metformin}
Name 10 insulins?
insulin aspart, rDNA origin
insulin lispro, rDNA origin
insulin lispro/protamine
insulin lispro mixture,
rDNA origin
regular insulin
NPH insulin (isophane insulin
suspension)
NPH/regular insulin mixtures
insulin zinc suspension
(lente insulin)
insulin zinc suspension,
extended (ultralente
insulin)
insulin glargine
concentrated regular insulin
Name 2 meglitinides?
nateglinide
repaglinide
Name 3 sulfonylureas?
glimepiride
glipizide
glyburide
Name 2 thiazolidinediones?
pioglitazone
rosiglitazone