Ch39 Diabetes

Question 1

When drawing short and long acting insulin what should u do

Answer 1

Draw the short acting first then the long acting, this prevents the possibility of injecting some of the ,one acting into the short acting.

Question 2

What 2 insulins are both clear in color and not administered via IV Aand should not be mixed in a syringe with any other insulin.

Answer 2

Insulin glaring and insulin detemir

Question 3

What route should NPH insulin be administered

Answer 3

SC

Question 4

How should lispro, aspart, glulisine and regular insulin be administered

Answer 4

SC
CONTINOUS SC
IV

Question 5

What should you educate clients about regarding SC insulin

Answer 5

Administer in one general area to have consistent rates of absorption
Absorption rates for SC tissue increase from thigh to upper arm to abdomen.

Question 6

Name rapid acting insulins

Answer 6

Lispro ( humalog)
Insulin aspart ( novolog)
Insulin glulisine ( apidra)
Rapid acting insulin has a onset of 15-30 min peaks in 30min -2.5 hr

Question 7

Name short acting insulins

Answer 7

Regular insulin ( humulin -R)(novolin R)
It has a onset of 30-1hr. And peaks in 1-5 hr

Question 8

Name intermediate acting insulins

Answer 8

Insulin detemir (levemir)

Question 9

What is the pharmalogical action of insulin

Answer 9

1. Promotes cellular uptake of glucose ( decreases glucose)
2. Converts glucose into glycogen
3. Moves potassium into cells along with glucose.

Question 10

What are adverse effects of insulin use

Answer 10

Risk for hypoglycemia

Lipohypertrophy/ inject injection sites and allow 1 inch between injection sites.

Question 11

What are medication interactions of insulin

Answer 11

1. Sulfonylureas, meglitinides,beta blockers, and alcohol can have a additive hypoglycemic effect
2. Concurrent use of thiazide diuretics and glucocorticoids may raise blood glucose levels and thereby counteract the effects of insulin

Question 12

How should short acting insulins always appear

Answer 12

Clear

DO NOT ADMINISTER CLOUDY OR DISCOLORED

Question 13

Oral anti diabetics

Answer 13

1. Sulfonylureas-chlorpropamide ( Diabinese)glipizide (glucotrol)tolzamide,
   glyburide ( DiaBeta), glimepiride ( amaryl)
2. Meglitinides-repaglinide ( Prandin), nateglinide ( Starlix)
   Both classes of drugs release insulin from the pancreas.

Question 14

What does the oral anti diabetic drug metformin do

Answer 14

It reduced the production of glucose within the liver thru supression of glucogenesis, it also increases muscles' glucose uptake and use
Metformin is in the drug class BIGUANIDES

Question 15

What are thiazolidinediones ( glitazones) do

Answer 15

They are an oral anti diabetic drug that increases cellular response to insulin by decreasing insulin resistance
It increases glucose uptake and decreased glucose production

Question 16

What is the prototype thiazolidinediones

Answer 16

Pioglitazone ( actos)

Question 17

What do alpha glucosidase inhibitors do

Answer 17

Slows carbohydrate absorption and digestion

Question 18

What is the prototype alpha glucosidase inhibitor

Answer 18

Acarbose (precose)

Miglitol ( glyset)

Question 19

What are glipitines

Answer 19

They are augments naturally occurring in retain hormones which promote release of insulin and decreases secretion of glucagon
It lowers fasting and postprandial blood glucose levels

Question 20

What is the prototype glipitines

Answer 20

Sitagliptin ( Januvia)

Question 21

What are the drug classes of oral anti diabetic drugs

Answer 21

Sulfonylureas
Meglitinides 
Biguanides 
Thiazolidinediones 
Alpha glucosidase 
Gliptins

Question 22

What is metformin also used for

Answer 22

It,is used to treat poly cystic ovary syndrome ( Pcos)

Question 23

What are adverse effects of glipizide and repaglinide

Answer 23

Hypoglycemia

Question 24

What are adverse effects of metformin

Answer 24

1. GI effects such as anorexia, nausea, vomiting; resulting in wt loss.
2. Vit b12 and folic acid deficiency caused by altered absorption.
3. “lactic acidosis ( hyperventilation, myalgia, sluggishness, somnolence, 40% mortality rate

Question 25

What are adverse effects of pioglitazone ( thiazolidinediones)

Answer 25

Fluid retention
Elevations in LDLS
Hepatoxicity

Question 26

What are adverse effects of acarbose ( alpha glucosidase inhibitors)

Answer 26

Intestinal effects  ( abdominal distention and cramping, hyperactive bowel sounds, diarrhea, excessive gas)
Anemia due to decrease of iron absorption
Hepatoxicity with long term use

Question 27

What are contraindications of insulin

Answer 27

Sulfonylureas, meglitinides, beta blockers, and alcohol have a additive hypoglycemic effect with concurrent use. Monitor for levels less than 50.
Thiazide diuretics and glucocorticoids may raise blood glucose levels counteracting the insulin
Beta blockers may mask SNS response to hypoglycemia such as tachycardia and tremors making it difficult to distinguish between hypoglycemia.