Pharm Exam 4 - Diabetic Meds

3 key things insulin does

• Decrease glucose

• Moves glucose out of blood into cells

• Promotes shift of K+ & Mg+ into cells

Define insulin sensitivity

How sensitive the body’s cells are in response to insulin

Define insulin resistance

Low insulin sensitivity; cells don’t use insulin effectively

2 key functions Amylin & Incretin (GLP-1) have in common

• Reduces speed of digestion

• Causes satiety

Metformin class

Biguanides

Metformin is the 1st line drug for…

Newly dx type-2-DM

Key contraindications of Metformin (2)

• Renal disease or dysfunction (Cr >1.5 male, 1.4 F; GFR <30 ml/min)

• Alcoholism

Key side effects of Metformin (4)

• N/D

• Flatulence

• Lactic acidosis

• Metallic taste

Symptoms of early lactic acidosis (4)

• Drowsiness

• Hyperventilation

• Malaise

• Muscle pain

Symptoms of lactic acidosis as it progresses (6)

• Abd pain

• Somnolence

• Malaise

• Myalgias

• Hypotension

• Bradyarrhythmia

Why should pts avoid alc when taking Metformin

Can lead to lactic acidosis & drop glucose too fast

Why is there a caution w/ radiologic contrast when taking Metformin?

Can cause ARF & lactic acidosis

When should metformin be stopped/started if radiologic procedure is needed?

48 hrs before & resume 48 hrs after

Glipizide class

Sulfonylureas

Contraindications of Glipizide (4)

• NPO

• Allergy to sulfonamide antibiotics (sulfa)

• Type-1-DM

Nursing implications of Glipizide (3)

• Give 30 mins before meal

• Avoid alc - can lead to hypoglycemia

• Ok to take w/ renal failure

Repaglinide class

Meglitinides (Glinide)

Repaglinide is useful for pts w/…

Erratic eating schedules

Contraindications for repaglinide (3)

• NPO

• Alc use

• Type-1-DM

Repaglinide adverse effect

Hypoglycemia!! - when do not eat after taking med

When taking repaglinide, what should the client do if they skip a meal or add a meal?

• Skip dose if skip meal

• Add dose if add a meal

Pioglitazone class

Thiazolidinedione (glitazone) 

Contraindication for giving pioglitazone  

Class III or IV HF

Caution pioglitazone for pts w/…

Liver or kidney disease

Side effects of pioglitazone (2)

• Weight gain

• Reduced bone mineral density & increased risk of fracture

Nursing implications for pioglitazone  (2)

• Slow onest & max activity may take months

• Weigh daily

Acarbose class

Alpha-glucosidase Inhibitor

Contraindications for acarbose (3)

• IBD

• Intestinal obstruction

• Malabsorption syndromes

Does acarbose cause hypoglycemia or weight gain?

NAUR

When should acarbose be taken?

W/ first bite of food

Sitagliptin class

Dipeptyl peptidase IV inhibitor (DPP-IV) 

Side effects of sitagliptin (2)

• URI

• Pancreatitis

Can sitagliptin  be given w/ insulin?

NOO

S/S to teach pt about pancreatitis when taking sitagliptin (3)  

• Monitor upper abd pain radiating to back

• Fever

• N/V

canagliflozin class

SGLT-2 Inhibitor (Sodium-glucose transporter-2) 

Canagliflozin contraindications (3)

• Type-I-DM

• Renal impairment

• Frequent ketones in urine or blood

Canagliflozin side effects (4)

• Yeast infections

• UTI

• Polyuria

• DKA

Canagliflozin nursing implications (2)

• Watch for DKA
  Teach will be glucose in urine

Pramlintide class

Amylin Mimetics  

Pramlintide contraindications (2)

• Allergy

• Gastroparesis or meds slowing GI motility

Pramlintide nursing implications (2)

• Give just before a meal that contains at least 30g of carbs

• Do not give med within 1 hr before or 2 hrs after taking

Exenatide class

Incretin Mimetics 

Exenatide side effects (2)

• Pancreatitis

• Weight loss of 5-10#

Exenatide nursing implications (3)

• Can’t be used w/ insulin

• Give within 1 hr of morning & evening meals

• Do not give after meals

Semaglutide class

Glucagon-like Peptide 1 (GLP-1) 

Adverse effects of Semaglutide (3)

• N

• Loss of appetite

• Pancreatitis

When taking Semaglutide, how much weight is typically lost & can it be kept off after stopping med?

• 15% lost

• Need to continue med to keep weight off

When taking Semaglutide, what does the nurse advise the pt to notify provider of?

• Symptoms of pancreatitis

• N, V, abd pain radiating to back

Lispro classification

Rapid acting

Onset of Lispro

15-30 mins

Peak of Lispro (glucose lowest)

30 min-3hrs

Duration of Lispro

3-5 hrs

Regular insulin classification

Short acting

Onset of reg insulin

30 min-1 hr

Peak of reg insulin (glucose lowest)

1-5 hrs

Duration of reg insulin

6-10 hrs

NPH classification

Intermediate acting

Onset of NPH

1-2 hrs

Peak of NPH (glucose lowest)

4-14 hrs

NPH duration

14-24 hrs

Glargine classification

Long acting

Can you mix Glargine?

NAURR

Glargine onset

1-4 hrs

Glargine peak (glucose lowest)

None

Glargine duration

24 hrs

How recently do you need a glucose check in order to safely give insulin? 

Prior to admin!! — Last 30 mins

When does the nurse expect that the glucose will be the LOWEST after giving insulin? 

Last 30 mins

What insulin type cannot be mixed AND has no peak? 

Glargine  

Dose for insulin

Dose written in units/ concentration is 100 units per 1 ml 

What syringe do we use for insulin?

Only use insulin syringe!!! (orange cap)

What insulin do we give IV in an emergency?

Only reg insulin can be given IV in emergency!!!

What insulin do we never shake?

• Never shake cloudy & premixed insulin (ROLL)

• Draw up clear before cloudy

15/15 rule: if suspect hypoglycemia, Check blood sugar and it’s less than 70, what should you give the client if they are conscious? 

15g simple carb

When should you give glucagon (IM injection) & what is the onset? 

Emergency (glucose <60), pt is semi-conscious, unconscious AND unable to ingest liquids and has NO IV ACCESS – onset 5-20 mins after injection 

When should you give Dextrose 50% (D50) & what is the onset? 

Emergency (glucose <60), pt is semi-conscious, unconscious AND unable to ingest liquids and has IV ACCESS – onset less than 1 min 

Once the blood sugar is ≥70, what do you give? 

Complex carb & protein – investigate cause! 

Complex carbs examples (3)

• Cereal w/ milk

• Peanut butter crackers

• Apple & cheese

15g simple carb example

½ cup fruit juice