Pharmacology EXAM 4

Signs and symptoms of diabetes mellitus type 2 are: Polyuria (increased peeing) , Polydipsia (Thirsty) (if you are constantly peeing, you're going to feel constantly thirsty), Polyphagia (hunger), glycosuria (sugar in your urine), unexplained weight loss, Fatigue and blurred vision.

what is polyuria?

what is polydipsia?

what is polyphagia?

what is glycosuria?

in Type 1 DM, the patient doesn't make any insulin. it is genetic and less than 10% of all DM cases are type 1

Type 2 DM is 90% of all DM cases and is due to poor diet and lifestyle

which are the two major complications of both types of diabetes? ______________ & ______________ which are also known as atherosclerotic plaque & capillary damage.

Macrovasular (atherosclerotic plaque consists of plaque build up in which arteries?

Microvascular or capillary damage in DM can include which of the following?

Non-pharmacologic treatment for type 2 DM is weightloss , improved dietary habits smoking cessation, reduced alcohol consumption and regular physical exercise.

What is the difference between A1C and fasting blood glucose

The goal is to have an HbA1C of less than 7% after the patient has already been diagnosed.

the fasting blood glucose goal for a Diabetic patient is 80-130mg/Dl

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Afrezza is an inhaled-rapid-acting medication with a peak of 12-15 mins and must be given in conjunction with long-acting insulins or oral diabetic agents. It is for Type 2 DM but has a BLACK BOX WARNING regarding the risk of acute bronchospasm.

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Insulin syringes are ALL orange and say "units" at the bottom near the plunger

bigunaides refer to metformin and is a type of medication that helps lower blood sugar for people with type 2 diabetes. it is a FIRST LINE drug and works by decreasing the production of GLUCOSE/intestinal absorption of glucose. ADVERSE EFFECTS include GI abdominal bleeding , cramping, feeling of fullness...Also can have a rare adverse effect called LACTIC ACIDOSIS (not dka) AND IT IS LETHAL IF IT OCCURS. contraindications include renal or hepatic disease- check BUN, GFR and creatinine.

Non-insulin antidiebtic drugs called Sulfonylureas that you shouldn't give to patients that have a sulfa allergy end in __________

The following non insulin antidiabetic drug is a Sulfonylurea

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Alpha-Glucosidase inhibitors inhibit the enzyme alpha-glucosidase in the small intestine resulting in delayed glucose absorption. Ultimately controlling the post prandial hyperglycemia.

Medications include: Acarbose (precose) and Miglitol (Glyset)

Contraindications include certain bowel disorders that are flatulence, diarrhea, and abdominal pain

which medication has a BLACK BOX WARNING for the risk of developing thyroid C-Cell Tumors, Thyroid cancer and has adverse effects of rare hemorragic or necrotizing pancreatitis?

The patient education for GLP-1 injectables is May experience weightloss 5-10 lbs, make sure where and how to administer injections

match the adverse effects to their medications

FOR ALL medications educate patients to make diet and lifestyle changes as well as monitor levels and watch for signs of hypoglycemia (diabetic medications)

What is hypoglycemia?

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Glucose-elevating drugs are drugs that are used in ACUTE hypoglycemic situations to RAISE blood sugar.

Oral forms include: Glucose buccal tabs and semisolid gel IV Form: is 50% dextrose in water (D50W) or dextrose50 SUBQ form is: Glucagon

The appropriate time to use glucose elevating drugs is with a conscious patient after you obtain a thorough medical history, vital signs, BGL, A1C, and review complications and drug interactions. The following is an available route and drug

BEFORE administering any DM medications at all.. NURSING IMPLICATIONS INCLUDE: -Obtain a thorough history -Vital Signs -Check blood glucose level, -Check HbA1C level -Check for potential complications and interactions -Assess the patient's ability to consume food -Assess for nausea and vomiting (Hypoglycemia may be a problem if the antidiabetic drugs are given and the patient does not eat.

If a patient is NPO for a test or procedure, consult the primary care provider to clarify orders for antidiabetic drug therapy

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DM nursing implications for insulin should include: -providing thorough patient education regarding self-administration of insulin injections, including the timing of doses, monitoring blood glucose levels, and injection site rotations

Nursing Implications on patient education for Oral Antidiabetic Drugs include:

-Assess for signs of hypoglycemia -If hypoglycemia occurs: **Administer oral form of glucose if the patient in CONSCIOUS -Give the patient glucose tablets or gel. corn syrup, honey, fruit juice or non-diet soft drink or have the patient eat a small snack, such as crackers or half a sandwich. -Deliver the IV D50W or SUBQ glucagon if the patient is unconscious. -Monitor blood glucose levels

ACID Related diseases include:

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Antacid's adverse effects are minimal but depend on the compound that is used. match the compounds with their adverse effects.

antacid patient education includes: Avoid taking this medication if you have electrolyte issues or dehydration. They have constipating effects, given to patients with renal failure and often given with magnesium.

TUMS is an example of calcium carbonate

Match the antacid terms

antacid contraindications are

Antacids help to neutralize/buffer the acid secretions

Histamine 2 (H2) receptor antagonists help suppress/reduce acid secretion in the stomach. These medications include: Cimetidine (Tagamet) (causes confusion / don't give to ELDERLY PATIENTS Nizatidine (Axid) Famotidine (Pepcid)

ALL end in "TIDINE"

H2 RECEPTOR ANTAGONISTS END IN _____________ and all SUPPRESS/REDUCE ACID SECRETIONS

H2 adverse effects: Gynecomastia /man boobs and confuses elderly patients. For testing purposes, if an elderly patient is confused, you know it's H2 causing it.

Proton pump inhibitors BLOCK ACID.

These medications include: -Lansoprazole (prevacid) -Omeprazole (prilosec) -Rabeprazole (AcipHex) -Pantoprazole (Protonix) -Esomeprazole (Nexium) -Dexlansoprazole (Dexilant)

These medications all end in "Prazole"

Proton Pump Inhibitors BLOCK ACID and end in ______________

PATIENT EDUCATION for Proton pump inhibitors include:

-If a patient is on warfarin, they will have an increased chance of bleeding -Sucralfate, may delay the absorption of proton pump inhibitors -Food may decrease the absorption of proton pump inhibitors

ADVERSE effects include POSSIBLE predisposition to GI tract infections: C DIFF, osteoporosis and risk of wrist, hip, spine fractures in long term users and pneumonia.

match the acid controlling drugs

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match the chemotherapy specific definitions

match the chemotherapy-specific definitions

CHEMOTHERAPY patient education - do not take if pregnant, prepubescent (a child who has not yet reached puberty) , or an older adult, some medication side effects can cause tye 1 diabetes.

during chemotherapy would present as such: -Alopecia -vomiting -liver,kidney, lung toxicities can occur -convulsions -extravasation (chemo going into the subq tissue when fluids are misplaced that causes cell death /tissue necrosis, you can lose an arm) -cachexia (a state of having great weightloss and muscle loss)

a job/ role of the RN with a patient who is on chemotherapy is to provide them comfort, support and safety. take everything into consideration

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