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218 Cards in this Set
- Front
- Back
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main types of Diabetes Millitus
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Type 1 & Type 2
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Type 1 Diabetes-IDDM
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Insulin dependent
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Type 2 Diabetes-NIDDM
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non-insulin dependent
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endogenous
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no insulin secreted from the pancreas: Type 1 Diabetic
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exogenous
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must have external source of insulin: Type 1 Diabetic
"no oral meds" |
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Cause of Type 1 Diabetes
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Autoimmune or Idiopathic
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Onset of Type 1-IDDM
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Rapid and Rapid progression
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Onset of Type 2-NIDDM
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Stealthy & sneaky onset-damage can occur before you know(retina, skin etc.)
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What is Type 2 -INDDM
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The pancreas still produces some insulin but in reduced amounts. and believed that there are fewer receptors for insulin or insulin resistance...occuring more in adolescents
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What is gestational diabetes?
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abnormal glucose tolerance during pregnancy..may reguire insulin...diet.
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Does gestational diabetes go away after birth of infant?
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NO..does not always go away with birth of infant
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Why are oral agents for Gestational diabetes(during Pregnancy) not given and only insulin can be given?
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orals are not safe for the baby.
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Insulin, what does it do?
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LOWERS BLOOD SUGAR
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What is Insulin?
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hormone normally produced in the Beta Cells of the pancreas. Is reguired for the entry of glucose into skeletal and heart muscle and fat.
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Insulin is made from what?
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Less commonly seen: Beef and Pork pancreas or from genetically altered E-Coli which produce a human type insulin(biosynthectic)
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Biosynthetic made insulin has fewer what?
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allergic reactions
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How is Insulin given and why?
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Injected-cannot take orally because if it is was it would be digestive and inactive because it is a protein.
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What are the 3 factors that determine when a patient is most likely to experience a hypo- or hyper- glycemic episode?
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onset, peak, and duration
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onset is?
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the time it takes for the insulin to BEGIN working
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peak Is?
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the time for insulin to have MAXIMUM effect.
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When taking Insulin, Blood sugar will be at its lowest point when?
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Peak
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Duration is?
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the length of time the insulin will remain active in the body
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Alpha cells in the pancreas cause what?
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the liver to turn glycogen into glucose -raising Blood Sugar
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hormone normally produced in the Beta cells of the pancreas?
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Insulin
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4 types of Insulin based on onset, peak and duration
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Rapid acting
short acting Intermediate Long acting |
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Rapid acting onset time?
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10-15 minutes
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Rapid acting peak time?
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1-2 hours
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Rapid acting duration time?
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3-4 hours
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Short acting onset time?
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30 minutes to 1 hour
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Short acting peak time?
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2-3 hours
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Short acting duration time?
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3 to 6 hours
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Intermediate onset time?
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2 to 4 hours
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Intermediate peak time?
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4 to 10 hours
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Intermediate duration time?
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10 to 16 hours
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peak level blood sugar is?
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blood sugar is the lowest
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insulin is needed for?
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entry of glucose into skeletal muscle and heart muscle and fat tissue
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onset, peak, and duration determine what in a patient?
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when the patient is having a hypo- or hyper- glycemic episode
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Rapid acting Insulin?
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lispro(Humalog)
gluisine(Aprida) aspart(Novolog) |
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Short regular acting Insulin?
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Humulin R
Novolin R |
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which insulin is the only one that can be injected both by IV and SQ?
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Short acting
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which insulins are clear?
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Rapid
short acting long acting -(but it cant be given IV-only short acting) |
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which Type of Insulin is cloudy and why?
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Intermediate-NPH
contains Protamine |
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what does Protamine in Intermediate insulin do?
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Protamine binds to insulin.
When insulin is injected, the Protamine slowly releases the Insulin giving it a longer period of action. |
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Long acting insulin
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Lantus(glargine)
Levemir(detemir) usually given @ night |
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which long acting insulin has no peak?
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Levemir(detemir)
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which long acting insulin has no peak and forms crystals in tissue for slow release
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Lantus(glargine)
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Long acting can only be given how?
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SQ
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Mixing Intermediate insulin w/another Rapid or Short, what happens and why?
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swirling it in the palms -rolling gently to mix, mixture becomes cloudy-becasue it contains Protamine.
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Insulin is best kept how?
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In the frigerator, but Pt. can open and keep room temp for 1 month..put a date on it when opened!
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Prior to given Insulin you should know Patients last what?
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Glucose reading...if not done recently..must get one before giving!!!!!
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If a Pt. is NPO...for surgery, X-rays..etc. you should what with the Insulin?
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Hold until Patient EATS, unless otherwise ordered..notify Doctor
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On Blood Sugar reading of below 70 is ?
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Hypoglycemic
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Side effects of Insulin?
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Hypoglycemia-occurs when insulin reaches its peak action.
Low blood sugar requires immediate treatment with some source of SUGAR |
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S/S of Hypoglycemia
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HA, nausea, weakness, hunger, lethargy, uncordinated movemnet, vision changes, nervous/jittery, confused, sweating, combative
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why do early symptoms occur with hypoglycemia?
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stimulation by the Sympathetic Nervous System causes release of glycogen from the liver.
occurs when Patient has had more insulin than glucose |
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In a Diabetic hypoglycemia can occur because?
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too much insulin taken
burned glucose too rapidly(exercising) took injection but didn't eat! |
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Hyperglycemia is treated how?
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Giving Insulin to lower blood sugar
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Lipodystrophy is caused by what?
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failure to rotate injection sites.
cosmetic problem absorption rate of insulin is altered-prolonged and erractic ROTATE SITES |
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lipohypertrophy
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excess of fat
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lipoatrophy
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destruction of fat
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sliding scale insulin
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amount given varies according to the patients finger stick blood sugar reading and according to the scale prescribred by physician
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which insulin is always used on a sliding scale?
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SHORT ACTING:
ex: Regular(NovR or Hum R) |
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Oral diabetic medication
Biguanide oral hypoglycemic |
Glucophage(metformin)
Glucophage XR(metformin) Riomet(liguid metformin) |
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What do Biguanide oral hypoglycemic meds do?
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reduce formation of glucose in the liver & reduce absorption of glucose in the intestine. GIVE WITH MEALS
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Biguanide oral hypoglycemic meds are given to what type of insulin patient?
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Patient with type 2
These med's are not the same as oral insulin |
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side effects of Bigunides?(metformin)
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rare s/e: lactic acidosis
expected s/e: N/V, anorexia, abdominal cramps and flatulence-usually resolves in time. GI Tract |
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Sulfonylureas--second generation, what are they?...first generation-Diabinase or Orinase are seldom used anymore
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2nd generation:
"Gly", "Gli" Glucotrol(glipizide) Diabeta(glyburide) Micronase(glyburide) Amaryl(glimepiride) |
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Sulfonylureas do what?
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Stimulate release of insulin from pancreas
increase receptor response. |
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Sulfonylureas can cause?
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hypoglycemia as insulin does.
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If a patient is allergice to sulfonamides(sulfa drugs) which oral diabetic med might he be allergic to?
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Sulfonylureas:
glipizide-glucotrol glyburide-diabeta, micronase glimepride-amary |
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Ingesting alcohol with Sulfonylureas will cause what?
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Antabuse type reaction(violently vomitting)
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Antihyperglycemic or
Alpha-glucosiDASE inhibitors |
Precose(acarbose)
Glyset(miglitol) |
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Alpha-glucoidase inhibitors-antihyperglycemics do what?
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enzyme inhibitor
inhibits enzyme that digest sugars, slowing absorption of glucose If Hypoglycemic give-Glucose tab |
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antihyperglycemic-alpha-glucosidase inhibitors
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will not cause hypoglycemia by itself, but can enhance the effects of Sulfonylureas and insulin
GIVE WITH MEALS |
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reason to give sugar tab instead of sugar when taking alpha-glucosidase inhibitors-antihyperglycemics and Patient becomes hypoglycemic?
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use glucose tablets instead of sugar because sugar is absorbed slow-need faster acting
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Megalitinide oral hypoglycemics
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Prandin(repaglinide)
Starlix(nateglinide) Is a non- sulfonylurea:good choice for people who allergic to sulfonamides can cause hypoglycemia GI Tract s/e |
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Megalitinide oral hypoglycemics do what?
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lower blood sugar by stimulating the release of insulin from the Beta Cells of the Pancreas
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Thiazolidinedione oral hypoglycemic TZD's
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Black Box warning-on TZD's especially AVANDIA, due to increase risk of cardiovascular events.
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Thiazolidinedione oral hypoglycemic TZD's do what?
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work by increasing the sensitivity of muscle and fat tissue to insulin, allowing more glucose to enter the cells for metabolism
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Thiazolidinedione oral hypoglycemic TZD's may be used with what other meds?
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alone or with insulin, sulfonylureas(gli-gly) or glucophage((biguanide oral hypoglycemic)metformin
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Thiazolidinedione oral hypoglycemic TZD's
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Actos(pioglitazone)
Avandia(rosiglitazone) "glitazone" ending |
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What Anti-hypoglycemic agent-raises blood sugar
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Glucagon
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What is Glucagon?
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a hormone naturally secreted by the Alpha cells of the pancreas that causes the liver to turn glycogen into glucose and aids in the conversion of amino acids to glucose(gluconeogenesis)-means new sugar
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What is Glucagon used for?
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used to treat hypoglycemia in unconsious patients or those unable to ingest sugar(CHO)
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How is Glucagon given?
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SQ, IM, IV
response usually seen in 5-to 20 minutes |
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Metaglip
Sulfonylureas+biguanide |
glipizide+metformin)
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Avandament
TZD's+biguanide |
rosiglitazone+metformin
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Glucovance
Sulfonylurea+biguanide |
glyburide+metformin
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Prandimet
Meglitinide+biguanide |
repaglinide+metformin
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Avandaryl
TZD+sulfonylurea |
rosiglitzone+glimepiride
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Duetact
Actos+Amaryl |
TZD+sulfonylurea
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Janumet
Januvia+Glucaphage |
sitagliptin+metformin
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New Daibetic drug?
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Symlin(pramlintide)
Byetta(exenatide) Januvia(DPP-IV) |
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Symlin(pramlintide)-what is it?
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new class of injectable
anti-hypoglycemic med for Type 2 or Type 1. Is a synthetic analog of human AMYLIN-(amylin is similar to insulin)is absent or deficient in patients with diabetes |
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Amylin the ingrediant in Symlin does what?
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AMYLIN-amylin is similar to insulin, is absent or deficient in patients with diabetes..it is a naturally occuring neuroendocrine hormone synthesized by pancreatic beta cells that help control glucose after meals.
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Symlin(pramlintide) what does it do?
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reduces post meal blood sugar peaks
reduces glucose fluctuations through out the day enhances satiety(sensation of fullness) lowers meal time insulin reguirements weight loss |
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How is Symlin(pramlintideis) taken?
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just prior to meals, 3 times a day...it is given injection form and used for type 2 & 1
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Symlin(pramlintideis) is in what classification?
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amylinomimetic
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Byettta(exenatide) is in what classification
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incretin mimetic
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Byettta(exenatide) origins is from what?
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the Gila monsters saliva
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Byettta(exenatide) origin was discovered why?
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they found that the gila monster-(tiny lizard) could go a long time without eating-found the substance in his saliva slowed stomach emptying-thus making the lizard feel full longer
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Byettta(exenatide) does what?
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it mimics the bodys natural physiology for self regulating blood sugar and it slows the release of glucose from the liver, slows stomach emptying thereby regulating the delivery of nutrients to the intestine for absorption, and works centrally in the brain to regulate hunger-weight loss.
It is additional therapy for type 2 who are taking metformin and a sulfonylurea, but who have not achieved adequate sugar control |
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Byettta(exenatide) is just like Slymlin(pramlintide) in that what?
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both injected
main effects are nausea- (w/Byetta due to stomach emptying) additional therapy weight loss is seen |
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Byettta(exenatide) origins?
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the substance found in the gila monster is similar to the gut hormone found in humans known as GLP-1
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GLP-1 does what?
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is broken down in the body by an enzyme called DDP-IV
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Byettta(exenatide) is different then Slymlin(prsmlintide) in that what?
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Symlin is given 3 times a day before meals
Byetta is given twice a day before meals Symlin is for Type 2 & type 1 diabetes Byetta is only for Type 2 |
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Byettta(exenatide) pens should be stored in 36 to 45 degrees but what changed
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when opened patients can store at room temperature
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DDP_IV Inhibitors
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GLP-1 in the body is broken down by an enzyme called DPP-IV, logically you can either make a synthetic GLP-1 that is not broken down by the enzyme(for example Byetta) or you could try to stop the enzyme that breaks down the GLP-1 your body already makes
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DDP_IV Inhibitors do what?
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they inhibit this enzyme from breaking down GLP-1-this allows GLP-1 already in blood to circulate longer
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DDP_IV Inhibitors-new class -first drug approved in this class
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Januvia-
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hypothyroidism is ?
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inadequate thyroid hormone production-
causes weight gain everything slows down Treatment: give thyroid hormones |
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hyperthyroidism is ?
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overproduction of thyroid hormone-
weight loss bulging eyes everything works faster treatment:surgery, radiactive iodine(I-131) AND ANTI-THYROID MEDICATION TO SUPPRESS THYROID FUNCTION |
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What do thyroid replacement hormones do?
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replace deficient T3 and T4 hormones to return to euthyroid state(well being)
used for HYPOthyroidism |
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What are the names of the thyroid replacement drugs?
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Synthroid or Levoxyl (Levothyroxine)-synthetic
Proloid Thyroid-real thing Cytomel |
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When taking replacement hormones the intial dose will not be the what?
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the maintenance dose
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Antithyroid medications are the exact opposite of what meds?
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thyroid replacement meds for hypothyroidism
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Antithyroid meds are used for?
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hyperthyroidism
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What meds are used for hyperthyroidism?
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Iodine-131(radioactive)
PTU-(propylthiouracil) Tapazole |
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How does Iodine-131 radioactive work on hyperthyroidism?
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it is absorbed into the thyroid gland in high concentrations.
other than the Gonads-other organs of the body use very little iodine. Radiation has a half life and continues to affect the gland for a long time! |
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How is Iodine-131 given and what are the potential S/E
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added to water and swallowed
has no color or taste HANDLE WITH CARE report spills for proper clean up The main side effect is the eventual development of hypothyroidism requiring replacement hormones. |
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How long does Iodine131-radiaction take to work?
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takes 3-6 months to fully access the affects
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Anti-thyroid meds:
PTU(propylthiouracil) and Tapazole do what? |
block the synthesis of T3 and T4
They do not destroy what is already produced in excess. |
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When using Anti-thyroid meds:
PTU(propylthiouracil) and Tapazole how long does it take and why? |
it takes several days to 3 weeks before improvement is noted because they do not destroy what is already produced in excess ( T3 and T4).
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How are Anti-thyroid meds:
PTU(propylthiouracil) and Tapazole used? |
can be used long term or for short term course before sugery.
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Why would Anti-thyroid meds:
PTU(propylthiouracil) and Tapazole be used short term? |
before surgery: to get the gland more stabilized
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What are Corticosteroids?
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hormones normally secreted by the adrenal cortex of the adrenal gland
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Where is the adrenal cortex located?
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In the adrenal gland
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What hormones are secreted by the adrenal cortex?
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corticosteroids
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What are the 2 types of corticosteroids?
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Mineral corticoids
Glucocorticoids |
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What do Mineral corticoids do?
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maintain fluid and electrolyte balance
treats adrenal gland insufficiency |
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What do Glucocorticoids do?
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to regulate carbohydrate, protein, and fat metabolism.
Has a potent ANTIINFLAMMATORY, ANTIALLERGIC proerties. |
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What potent properties are in Glucocorticoids?
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antiinflammatory and antiallergic
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What are some conditions Glucocorticoids are used for?
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Rheumatoid arthritis
Adrenal insufficiency severe psoriasis chronic eczema multiple myeloma Hodgkins disease' Luekemia MS myasthenia gravis Lupus COPD serum sickness sever hay fever asthma exfoliative dermatitis shock many others |
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Most reasons for use of glucocorticoids?
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Antiinflammatory affect!
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Corticosteroids:
Mineral Corticoids-how do they work? |
affect fluid and electrolyte balance by acting on the distal tubules of the kidney causing sodium and water retention and postassium and hydrogen excretion
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Mineral Corticoids uses?
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replacement for adrenal insufficiency:
ex:Addison's Disease |
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Mineral Corticoid:
Florinef has both properties of what? |
mineralcorticoid and glucocoticoid
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mineralcorticoid and glucocoticoid are both contained in what med?
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Florinef
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The major Glucocorticoid of the Adrenal Cortex is what?
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Cortisol
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Do glucocorticoids cure tissue inflammation?
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NO...they relieve symptoms of tissue inflammation
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What corticosteroid relieves symptoms of tissue inflammation?
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Glucocorticoids
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Endings for Corticosteroids:
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"sone", "lone"
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What Corticosteroids meds used a lot for sinuitis injections?
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Glucocorticoids:
Celestone(betamethasone) Decadron(deltasone) |
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What happens if you abruptly stop taking Corticosteroids?
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Adrenal Insufficiency
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How should someone get off of Corticosteroids and why?
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Therapy should be withdrawn gradually over a period of time, depending on how long a patient has been on the medication.
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What would be the affect of someone coming off Corticosteroids abruptly?
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Adrenal Atrophy-can lead to Adrenal Crisis
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What should a Person taking
Corticosteroids wear? |
a medic alert bracelet
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How should Corticosteroids be administered?
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with meals to minimize Gastric Irritation
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What should you monitor for in a patient on Corticosteroids?
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S/S of bleeding
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What can taking Corticosteroids cause?
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PUD
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Corticosteroids could cause what from sodium retention?
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fluid retention
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Patient should monitor BP and weighed daily on Corticosteroids why?
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-you retain fluids and it affects Blood Pressure and weight
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What symptoms are masked by Corticosteroids and should be monitored closely?
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symptoms of infection(antiinflammatory)
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Corticosteroids can cause?
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Mood Changes;
euphoria insomnia-most common depression |
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why should you monitor blood sugar checks when using Corticosteroids?
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can cause Hyperglycemia:
steroid induced diabetes |
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using Corticosteroids why should you examine skin daily?
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it can retard the healing process-it is suppressing the inflammatory response
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Long term therapy on Corticosteroids can cause?
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cataracts
increased risk of osteoporosis moon face buffalo hump thin and fragile skin |
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The Gonads?
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reproductive organs:
testes & ovaries |
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What does Estrogen do?
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responsible for the development of the sex organs and sexual characteristics
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Estrogen is used to treat?
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hot flashes from menpause
contraception HRT after oophorectomy osteoporosis prostatic cancer |
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Estrogen drugs?
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"estr"
Premarin Estrace Vivelle-patch Depogen(estradiol) IM q 3-4 weeks |
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Patients on Estrogen should report?
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HTN, thrombophelbitis(blood clot)
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What are Progestins?
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derivative of the hormone progesterone
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The thyroid gland is located where?
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in front of and on either side of the trachea
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The thyroid gland produces what?
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T3 and T4 for which it needs idodine...
it also secretes calcitonin |
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What does thyroid hormones do?
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regulates basal metabolic rate and affects every cell in the body
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Progestins are what?
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derivatives of progesterones
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Progestins are used to treat what?
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dysfunctional uterine bleeding
secondary: amenorrhea breakthrough uterine bleeding endometriosois or combination w/ estrogen contraception |
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Progestins med
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Provera
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Progestins S/E?
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weight gain
edema N/V/D tiredness oily scalp acne |
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Androgens is what?
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the natural dominant androgen by the male is testosterone
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Androgens
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Dancorine(danazol)
Andro 100 (testosterone) Depotestosterone (testosterone cypionate) IM q 2-4 weeks |
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Androgens are used to treat what?
|
eunuchism (testicles are cut off)
crytorchidism(when testicle doesnt come down) hypogonadism breast cancer in women |
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S/E of Androgens in women?
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masculinization
voice changes facial hair clitoral enlargement |
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S/E of Androgens in men?
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over medication-priapism(erection longer than normal)
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What Androgen med is given IM q 2-4 weeks?
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Depotestosterone
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What Estrogen med is given IM q 3-4 weeks?
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Depogen
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Estrogen is responsible for what?
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the development of the sex organs and sexual characteristics
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Estrogen meds treat what?
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hot flahes in menopause
contraception HRT after oophorectomey osteoporisis prostatic cancer |
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Estrogen meds?
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"estr"
Premarin Estrace Vivelle-patch Depogen(estradiol) given IM q 3-4 weeks |
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What Estrogen med is Patch form?
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Vivelle
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S/E of Estrogen?
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the ones to be reported:
HTN, thrombophlebitis(blood clot) others that resolve over time: weight gain edema breat tenderness nausea |
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Main side effect of Estrogen to report?
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HTN, and Thrombophelbitis(blood clot)
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When do you give Short acting Insulin (Humulin R, Novolin R)?
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30 to 60 minutes before meal
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When do you give Rapid acting insulin ( Humalog, Novolog, Aprida)
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within 15 minutes of meal
(best if tray is in front of patient) |
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What brand of Rapid acting insulin is brand new?
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Apidra
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When using Intermediate insulin ( Humulin N, Novolin N) what causes it to slowly release having a longer period of action?
|
Protamine
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What is the brand new Long acting insulin?
|
Levemir(detemir)
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Is long acting insulins clear or cloudy?
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clear
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What is Intermediate acting insulins called?
|
NPH, Humulin N, Novolin N
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Long acting insulin is usually given when?
|
at night
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Which long acting insulin forms crystals in tissue for slow release?
|
Lantus(glargine)
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In combination of R insulins(short) and N insulins(Intermediate) dosages which one is drawn up first?
|
Regular-Short acting Humulin R, Novolin R
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Because Intermediate insulins, Humulin N and Novolin N percipitate out, they must be what?
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gentry and thouroughly mixed before withdrawal and injected immediately after preparation
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Insulin is administered how?
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SQ
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The sites that provide most rapid SQ absorption sites are?
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abdomen and upper arm
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insulin syringes are available in what sizes?
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100 unit, 50 unit, and 30 unit sizes
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Each calibration on a 30 unit and 50 unit syringe is measured in what?
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1 unit
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Calibrations on a 100 unit capacity syringemay measure what?
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1 or 2 unit increments, depending on their designs
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Insulin cannot be given how?
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orally
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Type 2 occurs more in who now?
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Adolescents
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Obese people are likely to be what?
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Type 2 diabetics
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Oral insulin agents are not used when?
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Pregnant-not safe for baby
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glucagon works the opposite of ______ and does what?
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Insulin-lowers blood sugar
glucagon raises the blood sugar |
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"log" endings in insulin ?
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Rapid acting
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"lin" ending in insulin?
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Short acting and Intermediate Insulin
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"R" behind humulin means what?
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Short acting(Regular) Insulin
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" N" behind humulin and Novolin means what?
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Intermediate Insulin
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lispro
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(Humulog) Rapid
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glulistine
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(Apidra) Rapid
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aspart
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Novolog-Rapid
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Short acting can be injected how?
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both IV and SQ
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Levemir(detemir) long acting has no what?
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Peak
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Which insulin is clear but cannot be given IV?
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Long acting
Lantus & Levemir |
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Insulin always used on sliding scale?
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Short acting(regular) R
Humulin R & Novolin R |
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Why is absorption rates altered in diabetics and what can they do fix it?
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Because of Lipodystrophy
they can rotate sites |
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What is the rare but fatal side effect with Biguanides oral hypoglycemic meds?
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Lactic Acidosis
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Oral diabetic meds that can cause Hypoglycemia?
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Meglitinide
Sulfonylureas Alph-glucosidase(-will not cause by itself but can enhace effect of insulin or sulfonylureas) TZD's wont cause unless using other Hypoglycemic agents |
