Pharm exam 4 anti diabetes

Brand name zofran: generic name ?

Ondasterone

Brand name lantus: generic name ?

Glargine-

Brand name : emend generic name ?

Aprepitant,

Brand name :prilosec generic name ?

Omeprazole

Brand name :humalog generic name ?

Insulin Lispro

Brand name :phenergan generic name ?

Promethazine

Brand name : marinol generic name ?

Dronabinol -

Brand name : carafate generic name ?

Sucralfate -

Drug class zofran

5ht3 receptor blockers

Drug class lantus

Long acting insulin

Drug class emend

NK1 receptor anatgonist

Drug class prilosec

PPI

Drug class humalog

Rapid-acting insulin

Drug class phenergan

Phenothiazine

Drug class marinol

Cannabinoid

Drug class carafate

GI protectant

What are the two fundamental physiological problems that cause Diabetes Mellitus?

Insulin resistance—insulin receptors are unresponsive or deficient in numbers

Inefficient insulin secretion from beta cells

Why does glycosuria lead to the symptom of polyuria in diabetic patients?

When blood glucose increases to 180, glucose spills into urine, causing osmotic diuresis

What is the physiological cause of polydipsia in uncontrolled diabetes?

Dehydration from polyuria makes blood becomes more concentrated.

Why do patients with untreated diabetes experience polyphagia?

Cells are starving for energy because glucose cannot enter them without effective insulin action.

How does the pathophysiology of Type 1 Diabetes differ from Type 2 regarding insulin production?

Type 1 involves autoimmune destruction of beta cells that produce insulin, while Type 2 involves relative deficiency or resistance

Which type of Diabetes Mellitus is primarily caused by an autoimmune destruction of pancreatic beta cells?

Type 1

Is insulin produced in type 2 diabtetes

Yes, some beta cell fucntion

Why are oral antidiabetic medications ineffective for patients with Type 1 Diabetes?

These patients lack the functioning beta cells required for oral secretagogues to work.

What is the primary cause of 'Secondary Diabetes'?

External factors such as medications (e.g., steroids) or specific medical conditions that damage the pancreas

Most common type of diabteste

Type 2 - 90-95% of cases

Causes of secondary diabetes

Medication, glucocorticoid, thiazide diuretic, epinephrine. Resolves after discontinuing the agent

Causes of gestational diabetets

Hormonal changes in 2nd and 3rd trimesters, which causes insulin resistance

Sometimes removal after pregnancy increases risk of type 2 diabetes later.

Normal fasting blood glucose

70--99

Prediabetes fasting BG

100-125 mg/dl

Diabetes diagnosis: fasting BG

Greater than 126 mg/dl on two occasions

Normal hba1c

Less than 5.7%

Pre diabtest hba1c

5.7-6.4%

Diabtets hba1c

Greater than or equal 6.5 %

Goal for managed diabetts hba1c

Less than 7%

Which typer of glucose raises bg faster

Oral gluocose

Why is HbA1c a more useful measurement than a single blood glucose reading?

It measures average blood glucose levels over the past 2 to 3 months.

What is the peak time for Rapid-Acting insulins like Lispro (Humalog) or aspart?

40 min

What is the peak time for Rapid-Acting insulins. Gluslisiosne/inhaled

55 min

Ex of rapid acting insulin

Lispro (humolog)

Aspart (novolog)

Onset of rapid acting insulin

15 min

Duration rapid acting insulin

1-3 hr

Appreance rapid acting insulin

Clear

Example of short acting insulin

Regular (humulin R)

Onset of short acting insulin

30 min

Peak of short acting insulin

1.5- 3.5 hr

Duartion short acting insulin

4-12 hr

Apprance short acting insulin

Clear

Intermediate acting insulin example

NPH (humulin N)

Intermediate insulin onset

1-2 hr

Intermediate insulin peak

4-12 hr

Intermediate insulin. Duration

14-24 hr

Intermediate insulin apperance

Cloudy

Long actiong insluin example

Glargine (lanatus)

Detemir (levermir)

Long actiong insluin onset

1-1.5 hr

Long actiong insluin peak

None

Long actiong insluin duration

24 hr

Long actiong insluin apperance

Clear

Why must Regular insulin be drawn into a syringe before NPH when mixing them? Clear before cloudy

To prevent the protein in NPH from contaminating the vial of clear Regular insulin.

What is the clinical significance of Long-Acting insulin having no peak?

What is the clinical significance of Long-Acting insulin having no peak?

Which insulin is only able to be given iv

Regular insulin

Why is regular insulin only one that is able to be given IV?

because of its rapid onset, short duration of action, and formulation as a clear, soluble solution.

If a patient in DKA requires IV insulin, which specific type should the nurse prepare?

Regular insulin.

What complication should a nurse assess for if a patient has been injecting insulin into the same abdominal spot for years?

Lipodystrophy which is loss of fat at the injection site and can alter absorption—lumpy, erratic absorption

Once an insulin vial is opened, how long is it typically stable at room temperature?

28 days

Unopened insulin are stored

Refirgerator at 36-46 F

A patient's insulin looks cloudy but supposed to be clear regular insulin. What do you do?

Do not use it, discard the vial or pen immediately, and use a fresh supply

What are the early, adrenergic signs of hypoglycemia?

Shakiness, diaphoresis (sweating), tachycardia, and nervousness.

What are the late, neuroglycopenic signs of hypoglycemia?

Confusion, irritability, slurred speech, and seizures.

According to the 'Rule of 15', what should a conscious patient with hypoglycemia receive?

15 g of simple carbohydrates

How long should a nurse wait to re-check blood glucose after implementing the Rule of 15?

15 min

According to 15-15-15 rule, what do u give an unconscious patient

Glucagon

According to 15-15-15 rule what do u do if there's no response to glucagon injection?

Call 911 if no response within 15 min

Why is a patient on a beta-blocker at high risk during a hypoglycemic episode?

Masks hypoglycemia symptoms—there is no tachycardia warning.

WHAT CAUSES DAWN PHENOMENON?

Normal hormone surge like (growth hormone and cortisol)

Usually at 4-8 am

Treatment of dawn phenomenon

Increase bedtime insulin dose

3am glucose of dawn phenomenon

Normal or slightly elevated

Morning glucose of dawn phenomenon

High

Cause of somogyi effect

Rebound from nocturnal hypoglycemia

3 am glucose of somogyi effectr

LOW hypolgycemia is occuring

Morning glucose of somogyi effectr

High

Treatment of the Somogyi effect

Decrease the bedtime insulin dose.

Bedtime snacks can help nocturnal hypoglycemia.

How do you definitely differentiate dawn phenomenon and the Somogyi effect?

A specific action and finding for each

Somogyi - decrease bedtime insulin

Dawn—increase bedtime insulin for both high morning BG

Check BG at 3 am.

Why are ketones produced during Diabetic Ketoacidosis (DKA)?

When there is hyperglycemia and inadequate insulin, fat is broke down (catabolism) and ketones are produced

The body breaks down fats for energy because glucose cannot enter the cells due to lack of insulin.

What is the physiological purpose of Kussmaul breathing in a patient with DKA and what is it?

Deep rapid breathing

To blow off CO2 and compensate for metabolic acidosis.

Why does fruity/acetone breath happen

Because glucose isn't used for energy due to lack of insulin, fat is burned rapidly, which produces high level of ketone (acetone), which is expelled through the lungs.

Acetone has a fruity/nail polish smell

Blood glucose threshold DKA

Greater than 250

What are the three essential components of DKA treatment?

IV fluids (hydration), IV Regular insulin, and Potassium replacement.

Why is iv fluid used as treatment for DKA

Reverse severe dehydration.

Why is iv regular insulin used as treatment for DKA

Has rapid onset, especially when given iv

Why is potassium replacement used as treatment for DKA

Prevents severe hypokalemia and dangerous cardiac arrhythmias.

4 criteria patient must meet to be considered for oral diabetic agents instead of insulin

Onset of diabetes at age 40 or up

Diagnosis of diabetes for less than 5 years

Normal weight or overweight

Fasting glucose 2 mg/dL

Less than 40 unit of insulin are required a day.

Normal renal and hepatic function

Why might a well-controlled type 2 diabetic patient on oral medication need to temporarily switch to insulin during hospitalization?

This can cause glycemic instability and need more rapid and precise control that oral may not be able to

Mechanism of action of first-generation sulfonylureas

Stimulate pancreatic beta cells to secrete more insulin

Mechanism of action of second-generation sulfonylureas

Increase tissue response to insulin and decrease hepatic glucose production.

2nd gen example of sulfonylureas

Glimepiride, glipizide,glyburide

Can sulfonylureas be using for type 1 diabetes?

No it requires functioning beta cell

Most dangeorus side effect of sulfonylureas

Hypoglycemia

Hyponatremia-blurred vision

sulfonylureas effect on weight

Weight gain

Why does concurrent use of beta-blockers make sulfonylurea therapy dangerous?

Increases hypoglycemia risk and masks its signs, which can be dangerous because it's undetected.