Ch 26 Pharm

Front 1

____________ is a protein hormone secreted by beta cells in the pancreas.

Back 1

Insulin

Front 2

_________ a pancreatic hormone secreted with insulin delays gastric emptying increases satiety and suppresses glucagon secretion, thus complementing the effects of insulin on the blood sugar.

Back 2

Amylin

Front 3

Insulin is secreted into the portal circulation and transported to the ____________ where about half is used or degraded.

Back 3

Liver

Front 4

Liver muscle and _______ cells have many insulin receptors and are primary tissues for insulin action.

Back 4

Fat

Front 5

In the kidneys insulin is filtered by the _____________ and reabsorbed by the tubules which also degrade it.

Back 5

Glomeruli

Front 6

Oldest and largest group of oral agents

Back 6

Sulfonylureas

Front 7

Inhaled insulin approved and then removed form the market

Back 7

Exubera

Front 8

Increased the use of glucose by muscle and fat cells and decreases hepatic glucose production and decreases intestinal absorption of glucose.

Back 8

Metformin

Front 9

Used to replace endogenous insulin has the same effects as the pancreatic hormone

Back 9

Exogenous insulin

Front 10

Inhibits alpha glucosidase enzymes in the GI tract; Delays digestion of complex carbohydrates into simple sugars.

Back 10

Acarbose and miglitol

Front 11

How does the drug Metformin help the client with type 2 diabetes manage his or her disease?

Back 11

Type 2 is a heterogeneous disease and its etiology probably involves multiple factors such as a genetic predisposition and environmental factors. Obesity is a major cause. With obesity and chronic ingestion of excess calories along with a sedentary lifestyle more insulin is required. The increased need leads to prolonged stimulation and eventual "fatigue" of pancreatic bata cells. As a result the cells become less responsive to elevated blood glucose levels and less able to produce enough insulin to meet metabolic needs. Therefore, insulin secreted is inadequate or ineffective especially when insulin demand is increased by obesity, pregnancy, aging, or other factors.

Front 12

How do thiazolidinedoiones decrease insulin resistance?

Back 12

Most signs and symptoms stem from a lack of effective insulin and the subsequent metabolic abnormalities. Their incidence and severity depend on the amount to effective insulin and they may be precipitated by infection rapid growth pregnancy or other factors that increase demand for insulin. Most early symptoms result from disordered carbohydrate metabolism which causes excess glucose to accumulate in the blood (hyperglycemia). Hyperglycemia produces glucosuria when in turn produces polydipsia, polyuria, dehydration, and polyphagia.

Front 13

Laboratory testes indicate that Mrs. Ingles is dehydrated. What is the relationship between uncontrolled diabetes type 2 and dehydration?

Back 13

Pramlintide (Symlin) is a synthetic analog of amylin a peptide hormone secreted with insulin by the beta cells of the pancreas that is important in the regulation of glucose control during the post prandial period. Pramlintide is used as an adjunctive treatment with mealtime insulin for adult patient with type 1 or type 2 diabetes who have not achieved optimal glucose control with insulin therapy alone. Pramlintide slows gastric emptying helping to regulate the post prandial rise in blood glucose. The drug also suppresses post prandial glucagon secretion thus helping maintain better blood glucose control. Pramlintide increases the sense of satiety possibly reducing food intake and promoting weight loss. Pramlintide and insulin therapy may be combined with metformin or sulfonylureas for patients with type 2 diabetes.

Front 14

How does the drug extenatide help the patient to control his or her blood glucose?

Back 14

Extenatide acts as a natural helper hormone by stimulating the pancreas to secrete the right amount of insulin based on the food that was just eaten. This helps to reduce the problem of high blood glucose after meals. Extenatide also halts gluconeogenesis by the liver, keeping it from making too much glucose after a meal. Extenatide slows gastric emptying which serves to reduce the sudden rise of blood glucose after a meal and also quickly stimulates a feeling of satiety when eating. This fosters a sense of fullness which causes the patient to eat less and potentially lose weight. Extenatide may reduce the absorption of concurrently administered oral medications.

Front 15

Identify one supplement that may increase blood glucose levels and describe the supplements mechanism of action.

Back 15

Certain supplements may increase blood glucose levels. Bee pollen may cause hyperglycemia and decrease the effects fo antidiabetic medication; it should not be used by people with diabetes. Ginkgo biloba extract is thought to increase blood sugar in patients with diabetes by increasing hepatic metabolism of insulin and oral hypoglycemic drugs, thereby making the drugs less effective. It is not recommend for use. Glucosamine, as indicated by animal studies, may cause impaired beta cell function and insulin secretion similar to that observed in humans with type 2 diabetes. Long term effects in humans are unknown but the product is considered potentially harmful to people with diabetes or prediabetes. Adverse effects on blood sugar and drug interactions with antidiabetic medications have not been reported. However, blood sugar should be monitored carefully. With chondroitin, with is often taken with glucosamine for osteoarthritis there is not information about effects on blood sugar, used by diabetics.

Front 16

Mr. Franks age 43 weights 246 pounds and is 5' 10" tall. His occupation is sedentary an he works 50 to 60hrs/wk. His fasting glucose test results are 132 and 140 on two separate occasions. What non medicdation methods would you include in your education plan to assist Mr. Franks to reduce his blood glucose? (select all that apply)

a. Oral Hyperglycemics

b. routine exercise

c. Oral hypoglycemics

d. Diet approved by physician

Back 16

b, d

Rationale: Individuals with impaired glucose tolerance can significantly reduce the risk of developing type 2 diabetes through intervention with diet and exercise.

Front 17

The parameters for a diagnosis of diabetes are a fasting plasma glucose test (FPG) greater than or equal to what level on two separate occasions?

a. 130mg/dL

b. 118mg/dL

c. 120mg/dL

d. 126mg/dL

Back 17

d

Rationale: A FPG result 126mg/dL on two separate occasions is diagnostic of diabetes; values of 100 to 125mg/dL are termed impaired glucose and values < 100mg/dL are considered normal.

Front 18

You are part of a group of physicians and nurses who are establishing parameters for an outpatient clinic geared to diabetes testing and treatment. Which of the following is the fastest and most cost effective test to determine a diagnosis for diabetes?

a. Fasting plasma glucose test

b. Preprandial and post parandial blood glucose test

c. Urine dip test

d. Capillary random blood glucose

Back 18

a

Rationale: Fasting plasma glucose test (FPG) is the simplest and least expensive screening test.

Front 19

Mrs. Dromedy visits the physicians office after routine labs are drawn you note that her A1C is 9. Which of the following does that indicate?

a. Normal lab result

b. Abnormal Lab result

c. Borderline high lab result

d. Diagnosis of hypoglycemia

Back 19

b.

Rationale: The American Diabetes association (ADA) suggests a target of A1C of &lt;7 percent. A1C should be measured every 3 to 6 months.

Front 20

Mrs. Smith is a newly diagnosed diabetic. She is a stay at home mother and responsible for meal preparation in the home. Which of the following are you responsible for? (select all that apply)

a. Establishing goals and treatment modalities needed to maintain homeostasis.

b. Mobilizing and coordination healthcare providers.

c. Teaching and supporting patients and caregivers

d. Monitoring the patients health status and progress in disease management.

Back 20

b, c, d

Rationale: Aspects of home care nursing role include mobilizing and coordinating health care providers and community resources; teaching and supporting patients and caregivers; monitoring the patients health status and progress in disease management; assisting the patient to obtain diabetic supplies for monitoring and medication administration and preventing or solving problems.

Front 21

Mrs. Batel is admitted into your critical care unit with a diagnosis of myocardial infarct and subsequent bypass grafts. She is diabetic type 1 for 10yrs. You under stand that strict control of her hyperglycemia is critical to prevent which of the following outcomes? (select all that apply)

a. Postoperative infections

b. increased mortality

c. Decreased absorption of antibiotics.

d. Hypertensive crisis

Back 21

a, b

Rationale: Hyperglycemia my complicate the progress of the critically ill patient resulting in increased complications such as postoperative infections poor recovery and increased mortality. Tight glycemic control is a key factor in preventing complications and improving mortality in diabetic patients in the intensive care unit.

Front 22

Glucosuria, polydipsia, hunger, polyuria, dehydration, and polyphagia,

These signs of diabetes is?

Back 22

Hyperglycemia

Front 23

Hunger, shakiness, nervousness, dizziness, lethargy, sweating, cold, clammy skin, confusion

These signs of diabetes is?

Back 23

Hypoglycemia

Front 24

What is the function of Endogenous insulin?

Back 24

1. Central to carbohydrate, fat, and protein motabolism

2. Helps cells to use glucose for energy

3. Helps cells in the liver, muscle, and fat take glucose from the blood and store it as glycogen

Front 25

What is the function of Exogenous insulin?

Back 25

1. Only effective for drug treatment for type 1 diabetes

2. used in type 2 diabetics when cannot be controlled by diet, weight control, or oral agents, or in times of stress, illness, infections, surgery, ect.

3. All insulin in the US is human insulin

4. Cannot be given orally

Front 26

Regular insulins is _________ acting

Back 26

short

Front 27

Lispro (humalog), aspart (Novolog), glulisine (Apidra) are what kind of insulin?

Back 27

Insulin analogs

Front 28

Name some factors that influence Insulin requirements.

Back 28

Increased Need, Weight gain, Increased caloric intake, Pregnancy, Decreased activity, hyperthyroidism, Surgery, Drugs such as corticosteroids, epinephrine, thyroid drugs, thiazide diuretics.

Front 29

Mr. Gonazalez age 54 is diagnosed with chronic renal failure and hyperglycemia. He asks if he can be prescribed sulfonylurea because it works well for his friend. If he were to be given sulfonylurea this patients renal impairment may lead to which of the following effects?

a. Accumulation and hypoglycemia.

b. Accumulation and hyperglycemia

c. Decreased absorption of the sulfonylurea.

d. Hypersensitivity to sulfonylurea.

Back 29

a

Rationale: Sulfonylureas and their metabolites are lead to accumulation and hypoglycemia. They should be used cautiously with close monitoring of renal function, in patient with mild to moderate renal impairment and are contraindicated in severe renal impairment.

Front 30

Treatment with thiazide diuretics corticosteroids, and estrogens may cause which of the following conditions?

a. hypoglycemia

b. Pulmonary hypertension

c. congestive heart failure.

d. hyperglycemia

Back 30

d.

Rationale: Renal insufficiency may increase risk of adverse effects with anti diabetic drugs; and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.

Front 31

Type 2 diabetes is being increasingly identified in children. This trend is mainly attributed to which of the following?

a. Working partents

b. Economics

c. Obesity and inadequate exercise

d. Lack of after school programs due to budget constraints.

Back 31

c.

Rationale: Type 2 diabetes is being increasingly identified in children. This trend is attributed mainly to obesity and inadequate exercise, because most children with type 2 are seriously overweight and have poor eating habits.

Front 32

In young children hypoglycemia may be manifested by which of the following signs or symptoms? (select all that apply)

a. Changes in behavior

b. Poor appetite

c. Impaired metal functioning

d. Flat affect

Back 32

a, c

Rationale: In young children hypoglycemia may be manifested by changes in behavior including severe hunger irritability and lethargy. In addition, mental functioning may be impaired in all age groups even with mild hypoglycemia. Anytime hypoglycemia is suspected blood glucose should be tested.

Front 33

Recognition of hypoglycemia may be delayed in children because signs and symptoms are vague and the children may be unable to communicate them to parents or caregivers. Because of these difficulties most pediatric diabetologist recommend maintaining blood glucose levels in what range?

a. Between 90 and 100mg/dL

b. Between 100 and 200mg /dL

c. Between 120 and 150mg/dL

d. Between 110 and 150mg/dL

Back 33

b

Rationale: Recognition of hypoglycemia may be delayed because signs and symptoms are vague and the children may be unable to communicate to parents or caregivers. Because of these difficulties, most pediatric diabetologist recommend maintaining blood glucose levels between 100 and 200mg/dL to prevent hypoglycemia. In addition the bed time snack and blood glucose measurement should never be skipped.

Front 34

Avoiding hypoglycemia is a major goal in infants and young children because of potentially damaging effects on growth and development. An adequate supply of glucose is needed for which of the following types of development to occur?

a. Skeletal development

b. Organ development

c. Brain and spinal cord development

d. Spatial development

Back 34

c

Rationale: Avoiding hypoglycemia is a major goal in infants and young children because of potentially damaging effects on growth and development. For example, the brain and spinal cord do not develop normally without an adequate supply of glucose.

Front 35

James Elliot, age 2 months, is diagnosed with diabetes. His parents are having difficulty measuring 2units of insulin in the U100 syringe. What would you expect the physician to order?

a. U - 50 (50units/mL) insulin

b. U - 20 (20units/mL) insulin

c. U - 30 (30units/mL) insulin

d. U - 10 (10units/mL) insulin

Back 35

d

Rationale: Administration of insulin for infants and toddlers who weight less than 10 kg or require less than 5 units of insulin per day can be difficult because small doses are hard to measure in a U - 100 syringe. Use of diluted insulin allows more accurate administration. The most common dilution strength is U-10 ( 10 unites /mL), a diluent is available from insulin manufacturers for this purpose. Vials of diluted insulin should be clearly labeled and should be discarded after 1 month.

Front 36

Julie Hart age 4 yrs is diabetic with blood glucose level of 120mg/dL. Julie's mother brings her to the physicians office with symptoms of the flu and dehydration. Which of the following would you expect the physician to order?

a. Regular sodas, clear juices, regular gelatin desserts.

b. Diet sodas, clear juices, regular gelatin

c. IV ringers solution

d. IV saline 0.9%

Back 36

a

Rationale: During illness children are highly susceptible to dehydration, and an adequate fluid intake is very important. Many clinicians recommend sugar containing liquids (ex regular soda, clear juices, regular gelatin desserts) if blood glucose values are lower then 250mg/dL. If blood glucose is higher then fluids without sugar should be given.

Front 37

Richard Sykes, age 4yrs, is diagnosed with type 1 diabetes. You are responsible for his family education plan. In addition to insulin, which of the following is needed for effective management of Richards diabetes? (Select all that apply)

a. Consistent schedule of meals and snacks.

b. Limited exercise based on blood glucose monitoring

c. Blood glucose monitoring

d. Limited involvement in contact sports programs.

Back 37

a, c

Rationale: Insulin is the only drug indicated for use in type 1 diabetes; it is required as replacement therapy because affected children cannot produce insulin. Effective management requires a consistent schedule of injections and dose adjustments and exercise.

Front 38

_____________ therapy is a major component of an treatment for DKA.

Back 38

Insulin

Front 39

IV fluids are the first step in treating DKA, usually consist of which of the following solutions?

a. D5 1/2 NS

b. Lactated Ringers

c. D5

d. 0.9% sodium chloride

Back 39

d

Rationale: IV fluids are the first step in treating DKA, usually consist of 0.9% sodium chloride, an isotonic solution. Hypotonic solutions are usually avoided because they allow intracellular fluid shifts and may cause cerebral, pulmonary, and peripheral edema.

Front 40

Studies indicated that insulin is absorbed fastest from which area of injection?

a. Deltoid

b. Thigh

c. Abdomen

d. Hip

Back 40

c

Rationale: Studies indicate that insulin is absorbed fastest from the abdomen followed by deltoid thigh and hip.

Front 41

With regular insulin before meals it is very important that the medication be injected at the correct time so that the insulin will be available when blood sugar increases after the meal. How many minutes before a meal should regular insulin be injected?

a. 10 to 15

b. 30 to 45

c. 20 to 30

d. 15 to 20

Back 41

d

Rationale: With regular insulin before meals it is very important that the medication be injected 30 to 45 minutes before meals so that the insulin will be available when blood sugar increases after the meal.

Front 42

In acute situations, dosage of regular insulin needs frequent adjustments based on measurements of __________

Back 42

Blood Glucose