64 Questions
What is the role of Biguanides like Metformin?
Decrease production of glucose by the liver
Which of the following is a common adverse effect of Thiazolidiones (glitazones)?
Peripheral edema
What is a potential serious adverse effect of Injectable GLP-1 medications?
Risk of thyroid C-cell tumors
When should GLT2 inhibitors like Canagliflozin be avoided?
In patients with DKA
Which type of patients are Injectable GLP-1 medications indicated for?
Patients who have not achieved blood glucose control with other medications
What is a common adverse effect of Alpha-glucosidase inhibitors?
Flatulence
Which category of non-insulin antidiabetic drugs decreases insulin resistance?
Thiazolidiones
What should patients be informed about when taking GLT2 inhibitors like Jardiance?
Possibility of genital yeast infections
What is the appropriate time to administer IV D50W or SUBQ Glucagon?
If the patient is unconscious and unable to eat or drink
What should a nurse do before administering medication?
Consult another nurse for a second dosage check
When should Metformin be discontinued according to the text?
Before undergoing studies with contrast dye
What is advised in patient education regarding food intake?
Refrain from carbs to avoid increasing blood sugar levels
What should a nurse do if a patient is NPO (nothing by mouth) for a test or procedure?
Consult the primary care provider to clarify orders for antidiabetic drug therapy
When is it recommended to administer alpha-glucosidase inhibitors according to the text?
With each main meal's first bite
What should a nurse check before giving oral antibiotic drugs?
Blood glucose levels
Why is it important to ensure correct storage of insulin vials?
To prevent contamination and maintain potency
Which type of diabetes is characterized by insulin deficiency and insulin resistance?
Type 2 diabetes
What is the primary treatment for patients with Type 1 diabetes?
Insulin therapy
Which type of insulin has the most rapid onset of action?
Insulin Aspart (Novolog)
What is the duration of action of long-acting Insulin Detemir (Levemir)?
24 hours
Which condition is characterized by capillary damage and kidney damage?
Nephropathy
What is the peak time for Rapid-acting Insulin Lispro (Humalog)?
12 to 15 minutes
What is the primary side effect of Rapid-acting Insulin Afrezza?
Cough
What is the main reason for not taking metformin 2 days before and 2 days after an MRI?
To prevent toxic accumulation of electrolytes
Which adverse effect is commonly associated with antacids containing aluminum salts?
Kidney stones
What is the main indication for using magnesium salts as antacids?
Heartburn and indigestion
Which drug is commonly used to relieve gas-related symptoms?
Simethicone
What is a potential adverse effect of H2 blockers like Cimetidine and Famotidine?
Confusion
What is the main patient education point regarding proton pump inhibitors (PPIs)?
Once diagnosed with peptic ulcers, treatment most likely involves H.pylori
'Misoprostol' may cause which specific effect if taken by a pregnant woman?
Sporadic abortion
'Sucralfate' is often used for which type of ulcers?
Stress ulcers
What is the purpose of Tamoxifen?
To prevent the growth of cancer cells by blocking estrogen production
What are some common side effects of chemotherapy mentioned in the text?
Alopecia, nausea, vomiting, and fatigue
What is the main role of a nurse during chemotherapy according to the text?
To monitor for adverse effects and ensure patient comfort
What is the definition of 'myelosuppression' as per the text?
Decreased bone marrow activity leading to decreased white blood cells
What does 'extravasation' refer to in the context of chemotherapy?
Leakage of chemo medication under the skin causing tissue necrosis at IV sites
What is the significance of 'nadir' in the context of cancer treatment?
The lowest point after treatment where patients are most vulnerable
What is the purpose of 'targeted drug therapy' mentioned in the text?
To treat one specific type of cancer in the body
'Dose limiting adverse effects' mostly affect which parts of the body according to the text?
Gastrointestinal tract and bone marrow
Type 1 diabetes mellitus is caused by the lack of insulin production or the production of defective insulin.
True
Type 2 diabetes is less common compared to Type 1 diabetes.
False
Insulin resistance can lead to reduced number of insulin receptors in many tissues.
True
Rapid-acting insulin Afrezza is administered intravenously (IV).
False
Long-acting insulin Glargine, like Lantus, has a peak time of 1 to 2 hours.
False
Metformin is primarily used for Type 1 diabetics.
False
Insulin-sensitizing drugs increase insulin resistance.
False
GLP-1 medications can cause weight loss.
True
Genital yeast infections are a possible adverse effect of GLT2 inhibitors.
True
Hyperglycemia is characterized by low blood glucose levels.
False
Oral forms of concentrated glucose are recommended for patients who need a quick increase in blood sugar levels.
True
Glucagon is administered intravenously (IV) or subcutaneously (SUBQ) to patients who are conscious and able to eat or drink.
False
Before administering medication, it is important for nurses to check the patient's history, vital signs, and potential complications only.
False
Insulin syringes calibrated in milligrams should be used to measure and give insulin injections.
False
Alpha-glucosidase inhibitors are given with each main meal to help reduce gastrointestinal effects.
True
Antacids are commonly used for long-term management of peptic ulcers.
False
Aluminum salts in antacids are contraindicated in patients with severe renal failure.
True
Magnesium hydroxide is a common antacid used for heartburn and stomach upset.
True
H2 blockers are associated with side effects like manboobs and thrombocytopenia.
True
Sucralfate is primarily used for the treatment of acid reflux disease.
False
Long-term self-medication can conceal symptoms of serious underlying diseases like cancer or ulcers.
True
Tamoxifen works by promoting estrogen production in the body.
False
Alopecia, nausea, vomiting, and fatigue are common side effects of chemotherapy.
True
Myelosuppression is a condition where bone marrow activity decreases, leading to fewer white blood cells, red blood cells, and platelets.
True
Extravasation is a term used to describe the leakage of chemo medications under the skin from an infiltrated IV line.
True
Study Notes
Diabetes Mellitus
- Type 1 diabetes mellitus:
- Lack of insulin production or production of defective insulin
- Affected patients need exogenous (human-produced) insulin
- Fewer than 10% of all DM cases are type 1
- Type 2 diabetes:
- Insulin deficiency and insulin resistance
- Most common type: 90% of all cases
- Many tissues are resistant to insulin:
- Reduced number of insulin receptors
- Insulin receptors less responsive
- Major long-term complications of both types of diabetes:
- Macrovascular (atherosclerotic plaque):
- Coronary arteries
- Cerebral arteries
- Peripheral vessels
- Microvascular (capillary damage):
- Retinopathy (bleeding inside the eye, blurred vision)
- Neuropathy (hands and feet, numbness, and tingling sensations)
- Nephropathy (kidney damage)
- Macrovascular (atherosclerotic plaque):
Nonpharmacologic Treatment Interventions for Type 1 and Type 2
- Type 1:
- Always require insulin therapy
- Type 2:
- Weight loss
- Improved dietary habits
- Smoking cessation
- Reduced alcohol consumption
- Regular physical exercise
- Glycemic goal of treatment:
- Understand the difference between fasting blood glucose and HBA1c
- HbA1c of less than 7%
- A1c goals are higher in those with multiple comorbidities or living in an institution, such as a nursing home
Insulins
- Rapid-acting:
- Most rapid onset of action (5-15 minutes)
- Peak: 1-2 hours
- Duration: 3-5 hours
- Patient must eat a meal after injection
- Examples:
- Insulin LISPRO (Humalog)
- Insulin ASPART (Novolog)
- Insulin GLULISINE (Apidra)
- Short-acting:
- Onset: 30-60 minutes
- Peak: 2-5 hours
- Duration: 6-10 hours
- Routes of administration:
- IV bolus
- IV infusion
- IM
- SUBQ
- Intermediate-acting:
- Insulin isophane suspension (also called NPH)
- Cloudy appearance
- Often combined with regular insulin
- Onset: 1-2 hours
- Peak: 4-8 hours
- Duration: 10-18 hours
- Long-acting:
- Insulin GLARGINE (LANTUS)
- Clear, colorless solution
- Constant level of insulin in the body
- Usually dosed once daily
- Can be dosed every 12 hours
- Referred to as basal insulin
- Examples:
- Toujeo: more concentrated U-300 form
- Insulin DETEMIR (Levemir): duration of action is dose-dependent
- Insulin GLARGINE (lantus or basaglar): biosimilar insulin U100
Non-Insulin Antidiabetic Drugs
- Biguanides:
- Metformin
- Used for Type 2 diabetics, PCOS, metabolic syndrome
- NOT USED FOR TYPE 1
- MOA:
- Decrease production of glucose by the liver
- Decrease intestinal absorption of glucose
- Increase uptake of glucose by tissues
- Adverse effects:
- Primarily affects GI tract: abdominal bloating, nausea, cramping, diarrhea, feeling of fullness
- May also cause metallic taste, reduced vitamin B-12 levels
- Contraindications:
- Renal or hepatic disease
- Thiazolidiones (glitazones):
- Rosiglitazone (Avandia)
- Pioglitazone (Actos)
- Indicaton: TYPE 2 DM
- MOA:
- Insulin-sensitizing drugs
- Increase glucose uptake and use in skeletal muscle
- Inhibit glucose and triglyceride production in the liver
- Adverse effects:
- Can cause or exacerbate heart failure
- Peripheral edema
- Weight gain (fluid retention and increased adipose tissue)
- Decreased bone marrow density with increased risk for fractures
- Alpha-glucosidase inhibitors:
- Acarbose
- Miglitol
- Adverse effects:
- Flatulence
- Diarrhea
- Abdominal pain
- Contraindications:
- Certain bowel disorders
- Dipeptidyl peptidase-IV (DPP-IV) inhibitors:
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
- Alogliptin (Nesina)
- Sitagliptin (Januvia)
- Adverse effects:
- Upper respiratory tract infections
- Headache
- Diarrhea
- Hypoglycemia can occur and is more common when used with a sulfonylurea
- GLP-1 receptor agonists:
- Exenatide (Byetta)
- Liraglutide (Victoza)
- Dulaglutide (Trulicity)
- Albiglutide (Tanzeum)
- Lixisenatide (Adlyxin)
- Semaglutide (Ozempic)
- MOA:
- Enhance glucose-dependent insulin secretion
- Suppress elevated glucagon secretion
- Slow gastric emptying
- Adverse effects:
- Nausea
- Vomiting
- Diarrhea
- Black box warning: risk of developing thyroid C-cell tumors
Hyperglycemia and Hypoglycemia
- Hyperglycemia:
- Elevated blood glucose levels
- Signs and symptoms:
- Polyuria
- Polydipsia
- Polyphagia
- Fatigue
- Blurred vision
- Hypoglycemia:
- Blood glucose levels < 70 mg/dL
- Signs and symptoms:
- Early symptoms:
- Confusion
- Irritability
- Tremor
- Sweating
- Late symptoms:
- Hypothermia
- Seizures
- Coma
- Death
- Early symptoms:
Glucose-Elevating Drugs
-
Oral forms:
- Buccal tablets
- Semisolid gel
-
Intravenous:
- 50% dextrose in water (D50W)
-
SUBQ:
- Glucagon
-
Appropriate time to use them:
- If patients' glucose has dropped below their baseline
- If signs and symptoms are evident and a glucose check has been completed and considered low for the patient's normal
- If the patient has not been able to eat or drink something to increase the glucose levels
- If the patient is unconscious, you would deliver the IV D50W or SUBQ Glucagon.### Type 1 vs Type 2 Diabetes Mellitus
-
Type 1 diabetes: Lack of insulin production or production of defective insulin, requires exogenous insulin, fewer than 10% of all DM cases
-
Type 2 diabetes: Insulin deficiency and insulin resistance, most common type (90% of all cases), characterized by insulin resistance and reduced insulin receptors
Complications of Diabetes
- Macrovascular complications: Atherosclerotic plaque in coronary arteries, cerebral arteries, and peripheral vessels
- Microvascular complications: Retinopathy (bleeding inside the eye, blurred vision), neuropathy (numbness, tingling sensations in hands and feet), and nephropathy (kidney damage)
Nonpharmacologic Treatment Interventions for Type 1 and Type 2
- Type 1: Always requires insulin therapy
- Type 2: Weight loss, improved dietary habits, smoking cessation, reduced alcohol consumption, and regular physical exercise
- Glycemic goal of treatment: HbA1c < 7%, with individualized goals for those with comorbidities or living in institutions
Insulins
- Rapid-acting:
- Insulin LISPRO (Humalog)
- Insulin ASPART (Novolog)
- Insulin GLULISINE (Apidra)
- Insulin AFREZZA (inhaled, rapid-acting, with peak action in 12-15 minutes and short duration of 2-3 hours)
- Short-acting: Insulin (Humulin R)
- Intermediate-acting: Insulin isophane suspension (NPH)
- Long-acting: Insulin GLARGINE (LANTUS), Insulin DETEMIR (Levemir), and Insulin DEGLUDEC (Tresiba)
Patient Education
- Inform patients about blood glucose management, healthy eating, and regular exercise
- Teach patients to administer injectable insulin and monitor blood glucose levels
Non-Insulin Antidiabetic Drugs
- Biguanides: Metformin (used for Type 2, PCOS, and metabolic syndrome)
- Thiazolidiones (glitazones): Pioglitazone (Actos) and Rosiglitazone (Avandia)
- Alpha-glucosidase inhibitors: Acarbose (Precose) and Miglitol (Glyset)
- Dipeptidyl peptidase-IV (DPP-IV) inhibitors: Saxagliptin (Onglyza), Linagliptin (Trajenta), and Sitagliptin (Januvia)
- Injectable GLP-1: Exenatide (Byetta), Liraglutide (Victoza), and Albiglutide (Tanzeum)
- SGLT2 inhibitors: Canagliflozin (Invokana), Dapagliflozin (Farxiga), and Empagliflozin (Jardiance)
Hyperglycemia and Hypoglycemia
- Hyperglycemia: Elevated blood glucose levels, with signs and symptoms including confusion, irritability, and increased thirst and urination
- Hypoglycemia: Low blood glucose levels, with signs and symptoms including hunger, shakiness, and sweating, and late symptoms including seizures, coma, and death if not treated
Acid-Related Distress
- Antacids: Neutralize acid in the stomach, with types including aluminum salts (Basaljel), magnesium salts (Mylanta), and calcium salts (Tums)
- Histamine-2 (H2) blockers: Reduce acid secretion, with examples including Cimetidine (Tagamet), Ranitidine (Zantac), and Famotidine (Pepcid)
- Proton pump inhibitors (PPIs): Block acid production, with examples including Omeprazole (Prilosec), Lansoprazole (Prevacid), and Esomeprazole (Nexium)
- Miscellaneous acid-controlling drugs: Sucralfate (Carafate), Misoprostol (Cytotec), and Simethicone (Mylicon)
Cancer and Chemotherapy
- Chemotherapy: Pharmacologic treatment of cancer, with two types of antineoplastic drugs: cell-cycle nonspecific and cell-cycle specific
- Chemotherapy side effects: Alopecia, nausea, vomiting, fatigue, and stomatitis
- Patient education: Inform patients about potential side effects, monitor for complications, and ensure safe and isolated environment
- Targeted drug therapy: Medication used for one specific type of cancer
- Dose limiting adverse effects: Highest dose of medication that can be given without causing severe side effects
- Extravasation: IV sites that cause necrosis of the tissue, caused by a infiltrated chemo IV line
Explore the different forms of concentrated glucose and when to use them in the treatment of hypoglycemia. Understand the nursing implications for administering medications such as IV D50W and SUBQ Glucagon.
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