exam 3 prototype drugs

insulin action

promote use of glucose by body cells

insulin use

reduce blood glucose, control diabetes mellitus

insulin interactions

o Increase glucose with thiazides, glucocorticoids, estrogen, thyroid drug o Decrease glucose with aspirin, oral anticoagulants o Gastrointestinal secretions destroy insulin structure - therefore, no oral insulin.

lispro

rapid acting insulin

regular insulin

short acting insulin

NPH

intermediate acting insulin

glargine

long acting insulin

rapid acting insulin

• Insulin lispro • Insulin aspart • Insulin glulisin • Oral inhalation insulin

rapid acting insulin: onset, peak, duration

• Subcutaneous: Onset 15-30 minutes • Peak: 30-90 minutes • Duration: 3-5 hours

rapid acting insulin: important notes

• MUST GIVE 10-15 minutes BEFORE AMEAL • CLEAR LIQUID • RAPID = RIGHT NOW! • HYPOGLYCEMIA IS HIGH RISK - ESPECIALLY IF MEAL IS DELAYED!

short acting regular insulin: onset, peak, duration

• Subcutaneous: Onset: 30 min • Peak: 1.5-3.5 h • Duration: 4-12 h

short acting regular insulin: important notes

• GIVE 30 MINUTES before a MEAL • HYPOGLYCEMIA IS HIGH RISK - ESPECIALLY IF MEAL IS DELAYED • Clear liquid • Hospital setting: Sliding scale and DKA mgmt • STANDARD OF CARE: • The only insulin that may be given intravenously (IV)

intermediate-acting insulin

Insulin isophane NEUTRAL PROTAMINE HAGEDORN (NPH)

intermediate acting insulin: onset, peak, duration

• Subcutaneous: Onset 1.5 hours • Peak: 4-12 hours • Duration: 14-24 hours

intermediate acting insulin: important notes

• Contains PROTAMINE - prolongs the action of insulin • CLOUDY Liquid • Can be mixed with RAPID or REGULAR insulin - ONLY! • Gently roll vial - Do Not Shake

long-acting insulin types

o BASAL INSULIN o Glargine o Detemir

long acting insulin: onset, peak, duration

o Subcutaneous: Onset: 1-1.5 hours o Peak: NONE o Duration: 24 hours

long acting insulin: important notes

o Usually administered at bedtime o DO NOT MIX with other insulins o NOT for meal coverage

Glipizide

Oral Antidiabetic Drug: Second-generation sulfonylurea

Glipizide MOA

o Directly stimulates beta cells in the pancreas to secrete insulin o Indirectly alters sensitivity of peripheral insulin receptors, allowing increased insulin binding

Glipizide side effects

o Drowsiness, dizziness, headache, confusion

Glipizide adverse effects

o Hypoglycemia (INSULIN-LIKE REACTION) o Hyponatremia o Angioedema o Life-threatening- Agranulocytosis

Glipizide notes

o Administer at a mealtime. o Use avoided in the elderly.

Metformin

Oral Antidiabetic Drug

Metformin MOA

o Recommended as a first-line treatment. o Decreases glucose production in the liver by reducing gluconeogenesis o Improves tissue sensitivity to insulin. o Increases glucose transport to skeletal muscles and fatty tissues o Reduces glucose absorption from intestines o Improves tissue sensitivity to insulin

Metformin side effects

o Dizziness, headache, weakness, chills, metallic taste, nausea, diarrhea.

Metformin adverse effects

o Palpitations, chest pain oMegaloblastic Anemia (B12 deficiency by impairing absorption) o Life-threatening - lactic acidosis and acute renal failure

Metformin important notes

o Hold med if patient is having IV contrast:

• 48 hours before and after administration due to risk of: Lactic acidosis & Acute renal failure o Monitor renal function

• Usually stopped if moderate/severe kidney disease/GFR < 45

oral antidiabetics nursing actions

o Administer oral antidiabetics with food to minimize gastric upset. o Monitor blood glucose levels & report changes. o Teach patient to recognize symptoms of hypoglycemia (with insulin and sulfonylureas especially) oTeach patient to recognize symptoms of hyperglycemia. o Teach patient necessity of adherence to diet and drug regimen. o Avoid alcohol = hypoglycemic rxn

Hydrochlorothiazide (HCTZ)

thiazide diuretic

Hydrochlorothiazide (HCTZ) MOA

• Act on distal convoluted renal tubule to promote sodium, chloride, and water excretion • Causes vasodilation • Promote sodium, chloride, water excretion

Hydrochlorothiazide (HCTZ) uses

• To increase urine output and to treat hypertension and peripheral edema due to HF, nephrotic syndrome, and ascites • Hypertension • Peripheral edema

Thiazide Diuretics side/adverse effects

• Orthostatic hypotension, • Fluid/electrolyte Imbalances: ESPECIALLY IN THE ELDERLY • HYPERurecemia: Will exacerbate Gout • Photosensitivity • Life-threatening: Hypokalemia, renal failure, acute closed angle glaucoma, & Stevens-Johnson syndrome

Hydrochlorothiazide (HCTZ) Contraindications

o Renal failure o GFR < 30 o Age related concerns - hyponatremia (low Na+) and hyperglycemia

Hydrochlorothiazide (HCTZ) drug interactions

o Antihypertensives, antidiabetic (hyperglycemia)

o Causes electrolyte imbalances, interactions

Furosemide

loop diuretic

Furosemide MOA

• Act on ascending loop of Henle • Excrete sodium, water, K+, Ca+, Mg+ • More Potent and dose dependent • LaSIX - 6 hours half life (maybe)

Furosemide side/adverse effects

• Common side effects/adverse effects • Electrolyte imbalances: NOTABLY POTASSIUM • Orthostatic hypotension • Dizziness, headache, weakness • Muscle cramps

Spironolactone

potassium sparing diuretic

Spironolactone MOA

• Block action of aldosterone • Promote sodium (Na+)/water excretion & potassium (K+) retention

Spironolactone uses

edema, hormonal acne in women, and HTN/heart failure

Spironolactone side/adverse effects

• Hyperkalemia (potassium-sparing) • Dizziness • Headache • Weakness • GI distress • Photosensitivity