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56 Cards in this Set
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rapid acting insulin
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lispro (Humalog)
onset: less than 15 min peak 0.5-1 hour duration: 3-4 hour other: insulin aspart- (Novolog) insulin gluclisine (Apidra) |
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short acting
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regular insulin Humulin R
onset 0.5- 1 hour peak 2-3 hour duration- 3-4 hr regular insulin (Novolin R) |
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intermediate acting
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NPH insulin Humulin N
onset: 1-2 hours Peak: 4-12 hours duration: 18-24 hours insulin detemir (Levemir) |
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long acting
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Insulin glargine (Lantus)
onset: 1 hr peak: none duration: 24 hours |
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premixed insulins
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70% NPH and 30% Regular (Humulin 70/30)
75% insulin lispro protamine and 25% insulin lispro (Humalog 75/25) mixture of intermediate acting and rapid acting |
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insulin MOA
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decreases glucose levels
converts glucose into glycogen moves potassium into cells (along with glucose) |
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insulin uses
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glycemic control of DM (type 1, type 2, gestational) to prevent complications
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insulin adverse
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risk for hypoglycemia (too much insulin)- monitor for hypoglycemia
administer glucose- for conscious patients administer a snack of 15 g carbohydrate if client is not fully conscious- administer glucose parenterally lipohypertrophy- systematically rotate injection sites |
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insulin interactions
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sulfonylureas, meglitinides, beta blockers, alcohol have additive hypoglycemic effects with concurrent use
thiazide diuretics and glucocorticoids may raise blood glucose levels beta blockers may mask SNS response to hypoglycemia |
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insulin admin
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when mixing short-acting insulin with longer acting insulin, draw the short acting insulin up into the syringe first then the longer acting insulin.
Insulin suspensions: gently rotate vial between palms to disperse the particles throughout the vial do not administer short acting insulins if they appear cloudy or discolored insulin glargine and insulin detmir are clear- not admin IV and should not be mixed in a syringe with other insulin lispro, aspart, glulisine, and regular insuline SubQ injection, infusion, IV route administer NPH- subq ensure proper insulin storage |
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oral antidiabetics
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sulfonylureas
meglitinides biguanides thiazolidinediones (Glitazones) pioglitazone (Actos) alpha glucosidase inhibitors gliptins |
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sulfonylureas first gen
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tolburamide (Orinase)
other: chlorpropamide |
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sulfonylureas second gen
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glipizide (Glucotrol, Glucotrol XL)
other: glyburide (Diabeta), glimepiride (Amaryl) |
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sulfonylureas MOA
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insulin release from the pancreas
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meglitinides
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Proto: repaglinide (Prandin)
other: nateglinide (Starlix) |
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meglitinide MOA
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insulin release from the pancreas
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biguanide
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proto: metformin HCL (Glucophage)
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biguanide MOA
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reduces production of glucose within the liver though suppression of gluconeogenesis
increases muscles glucose uptake and use |
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thiazolidinediones (Glitazones)
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pioglitazones (Actos)
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thiazolidinediones MOA
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increases cellular response to insulin by decreasing insulin resistance
increased glucose uptake and decreased glucose production |
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alpha glucosidase inhibitors
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proto: acarbose (Precose)
other meds: miglitol (Glyset) |
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alpha glucosidase inhibitor MOA
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slows carbohydrate absorption and digestion
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gliptins
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sitagliptin (Januvia)
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gliptins MOA
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augments naturally occuring incretin hormones which promote release of insulin and decrease secretion of glucagon
lowers fasting and postprandial blood glucose levels |
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oral antidiabetics use
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control blood glucose levels in type 2 diabetes
metformin HCL is used to treat PCOS |
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glipizide and repaglinide adverse
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hypoglycemia
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metformin HCL adverse
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GI effects
Vitamin B and folic acid deficiency lactic acidosis (hyperventiliation, myalgia, sluggishness, somnolence)- can be treated with hemodialysis |
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pioglitazone adverse
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fluid retention
elevations in LDL cholesterol hepatotoxicity |
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acarbose adverse
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intestinal effects
anemia hepatotoxicity |
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oral antidiabetics contraindications
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renal failure, hepatic dysfunction, heart failure
contraindicated in the treatment of diabetic ketoacidosis metformin is contraindicated for clients who have severe infections, shock, hypoxic condition acarbose is contraindicated in GI disorders pioglitizone is contraindicated in HF, bladder cancer, active hepatic disease |
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glipizide interactions
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alcohol- result in dislfiram-like reaction (intense nausea, vomiting, flushing, palpitations)
alcohol, NSAIDS, sulfonamides, ranitidine (Zantac) and cimetidine (Tagament)- additive hypoglycemic effect beta blockers- mask SNS response to hypoglycemia |
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repaglinide and pioglitazone interactions
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concurrent use of gemfibrozil (Lopid)- hypoglycemia
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metformin interactions
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alcohol- lactic acidosis
iodine-containing contrast media- kidney failure |
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acarbose interactions
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sulfonylureas or insulin- hypoglycemia
metformin- additive GI effects and risk for hypoglycemia |
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oral antidiabetics admin
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glipizide- 30 min prior to a meal
repaglinide - eat within 30 min of admin 3 times a day metformin- take immediate release tabs twice a day with breakfast and dinner- take sustained tabs once a day with dinner pioglitazone- once a day, with or without food acarbose- take with first bite of food, three times per day sitagliptin- once a day with or without food |
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amylin mimetics
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pramlintide (Symlin)
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amylin mimetics MOA
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mimis the actions of naturally occuring peptide homone amylin, resulting in reduction of postprandial glucose levels
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amylin mimetics USE
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supplemental glucose control for clients with type 1 and type 2 diabetes
used in conjunction with insulin or an oral antidiabetic medication, usually metformin or a sulfonylurea |
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amylin mimetics adverse
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nausea
reaction at injection site |
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amylin mimetics contraindications
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kidney failure
thyroid disease, osteoporosis, alcoholism |
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amylin mimetics interactions
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insulin increases risk for hypoglycemia
concurrent use of pramlintide with meds that slow gastric emptying time, such as opioids, or meds that delay food absorption such as acarbose |
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amylin mimetics admin
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administer prior to meals using thigh or abdomen
keep onopened vials in the refrigerator and do not freeze |
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incretin mimetics
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exenatide (Byetta)
other: liraglutide (Victoza) |
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incretin mimetics MOA
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mimics effects of naturally occuring glucagon like peptide 1 and thereby promotes release of insulin, decreases secretion of glucagon, and slows gastric emptying
Fasting and postprandial blood glucose levels are lowered |
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incretin mimetics use
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supplemental glucose control for clients who have type 2 diabetes
may be used in conjunction with an oral antidiabetic, usually metformin or a sulfonylurea |
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incretin mimetics adverse
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GI effects
pancreatitis |
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incretin mimetics contraindications
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kidney failure, UC, Crohn's
older adults and clients with renal or thyroid disease |
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incretin mimetics interactions
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oral contraceptives, antibiotics, acetaminophen absorption is delayed
concurrent use of sulfonylurea increases risk of hypoglycemia |
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incretin mimetics admin
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give injection within 60 min before the morning and evening meal
NEVER administer after a meal |
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incretin mimetics effectiveness
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preprandial glucose levels- 90-130 mg/dl
HbA1c less than 7% |
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hyperglycemic agent
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proto: glucagon (GlucaGen)
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hyperglycemic agent MOA
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increases blood glucose levels by increasing breakdown of glycogen into glucose
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hyperglycemic agent use
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emergency management of hypoglycemic reactions, such as insulin overdose in clients who are unable to take oral glucose
decrease in gastric motility in clients undergoing radilogical procedures of the stomach and intestines |
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hyperglycemic adverse
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GI distress
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hyperglycemic contraindications
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glucagon is ineffective for hyoglycemia resulting from inadequate glycogen stores (starvation)
caution to those with cardiovascular disease |
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hyperglycemic effectiveness
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blood glucose level greater than 50mg/dl
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