Pharmacology EXAM 4
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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.

True

what is polyuria?

  • increased peeing or peeing constantly (correct)
  • sugar in the urine
  • hunger
  • thirsty

    • what is polydipsia?

  • hunger
  • increased peeing
  • thirsty (correct)
  • sugar in the urine

    • what is polyphagia?

    <p>hunger</p> Signup and view all the answers

    what is glycosuria?

    <p>sugar in the urine</p> Signup and view all the answers

    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

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>macrovascular &amp; microvascular</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    What is the difference between A1C and fasting blood glucose

    <p>A1C shows a trend over a time frame while fasting only shows for right now</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Match

    <p>Short Acting/Regular insulin = Onset: 30-60mins, Peak: 2.5 Hrs, Duration: 6-10 Hrs Intermediate Acting/ NPH-CLOUDY insulin = Onset:1-2 Hrs Peak:4-8 Hrs., Duration: 10-18 Hrs. Rapid Acting insulin = Onset: 5-15mins, Peak:1-2 Hrs, Duration: 3-5 Hrs Long Acting insulin = Onset:1-2 Hrs, Peak: NONE, Duration: 24 Hrs.</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

    Match

    <p>Short Acting insulin = Regular insulin (Humulin R) for DKA patients and is the ONLY IV insulin-can be given IV OR SUBQ Intermediate Acting insulin = Insulin (Isophane) NPH and is CLOUDY Rapid Acting insulin = Afrezza (inhaled), and SUBQ (can be given SUBQ infusion pump) include :Insulin (Humalog) Insulin Aspart (Novolog), Insulin Glulisine (Apidra) Long Acting insulin = SUB Q and CLEAR Insulin Glargine (Lantus)(Basal Insulin), Insulin Detemir (Levemir), Insulin Degludec (Tresiba)</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

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

    <p>RIDE</p> Signup and view all the answers

    The following non insulin antidiabetic drug is a Sulfonylurea

    <p>All of the above</p> Signup and view all the answers

    match

    <p>Sulfonylureas = end in -RIDE Thiazolidinediones = end in -ZONE DDP-IV = end in -GLIPTIN GLP-1 = end in -TIDE</p> Signup and view all the answers

    match

    <p>Thiazolidinediones = work by decreasing insulin resistance. They increase glucose uptake and use in the skeletal muscle and inhibit glucose and triglyceride production in the liver. Alpha-Glucosidase inhibitors = They work by inhibiting the enzyme alpha-glucosidase in teh small intestine resulting in delayed glucose absorption. This ultimately controls the postprandial hyperglycemia (high blood sugar after eating) DPP-IV inhibitors = Work by mimicking naturally secreted incretin hormones (incretin hormones increases insulin synthesis and lower glucagon secretion) DPP-IV inhibitors delay the breakdown of of incretin hormones by inhibiting the DPP-IV enzyme and this reduces fasting and postprandial glucose concentrations Injectable GLP-1 = These drugs are incretin mimetics and they enchance glucose-dependent insulin secretion and suppress elevated glucagon secretion, slow gastric emptying and increase the first and second phase of insulin secretion</p> Signup and view all the answers

    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

    <p>True</p> Signup and view all the answers

    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?

    <p>injectable GLP-1</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    match the adverse effects to their medications

    <p>SGLT2 inhibitors = Necrotizing Fascitis of the perineum (Fournier's gangrene) Genital yeast infections, urinary tract infections, increased urination, hypotension, hypervolemia, hyperkalemia, possible ketoacidosis, never give to a patient with DKA , acute kidney injury Injectable GLP-1 = rare hemorrhagic or necrotizing pancreatitis, BLACK BOX WARNING risk for developing C-Cell tumors, Thyroid cancer. DPP-IV = upper respiratory tract infection, possible pancreatitis Thiazolidinediones = can cause or exacerbate heart failure, peripheral edema, weight gain (fluid retention+ increased adipose tissue) , decreased bone marrow density with increased risk for fractures</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    What is hypoglycemia?

    <p>Abnormally low blood glucose level (below 70mg/dL)</p> Signup and view all the answers

    match

    <p>Early signs of Hypoglycemia = Confusion, irritability, tremor, sweating Late signs of hypoglycemia = Hypothermia, seizures, coma and death will occur if not treated Hypoglycemia = abnormally low blood glucose level of 70mg/dL Always promote = lifestyle cahnges but with exercise recommend a snack or protein before workout to prevent hypoglycemia, When we workout we burn carbs, sugar etc. you don't want the patient to tank</p> Signup and view all the answers

    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

    <p>True</p> Signup and view all the answers

    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

    <p>All of the above</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Match

    <p>During Administration = monitor vitals, including blood glucose level for therapeutic effect After Administration = Reassess patients vital signs to check for improvement You should be concerned if: = The level of consciousness does not change or if high/low blood glucose level does NOT change with medical interventions, when the patient is stressed, has an illness or infection, trauma or is pregnant or lactating Patient education should include = lifestyle modifications, exercise, healthy diet with low sugar and low carbs</p> Signup and view all the answers

    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

    <p>True</p> Signup and view all the answers

    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

    <p>True</p> Signup and view all the answers

    ACID Related diseases include:

    <p>Both A and B</p> Signup and view all the answers

    Match

    <p>Peptic Ulcer Disease = gastric ulcer that involves digestion of the GI mucosa by the enzyme pepsin H. Pylori = bacterium that is found in the GI tract in 90% of the patients with duodenal ulcers and 70% of patients with gastric ulcers First Line Therapy = includes a 10-14 day course of a proton pump inhibitor and the antibiotics clarithromycin and either amoxicillin or metronidazole OR a combination of a proton pump inhibitor, bismuth subsalicylate and the antibiotics tetracycline and metronidazole Types of acid controlling drugs are: = antacids, h2 antagonists, PPIs</p> Signup and view all the answers

    MATCH

    <p>Antacids = Neutralize/ Buffer Acid H2 histamine 2 receptor antagonists = Suppress/Reduce Acid Proton Pump Inhibitors = Block the Acid Aluminum Carbonate = Basaljel</p> Signup and view all the answers

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

    <p>Aluminum &amp; Calcium = Constipation Magnesium = Diarrhea Calcium = kidney stones, rebound hyperacidity Calcium Carbonate = Produces gas and belching; often combined with simethicone</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

    TUMS is an example of calcium carbonate

    <p>True</p> Signup and view all the answers

    Match the antacid terms

    <p>Hydroxide salt = AlternaGel Combination products (aluminum and magnesium) = Gaviscon, Maalox, Mylanta, Di-Gel Antacids-Calcium Salts = Carbonate is the most common form Side Effects include = May cause constipation , kidney stones</p> Signup and view all the answers

    antacid contraindications are

    <p>Not recommended to patients with renal disease- may accumulate to toxic levels</p> Signup and view all the answers

    Antacids help to neutralize/buffer the acid secretions

    <p>True</p> Signup and view all the answers

    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"

    <p>True</p> Signup and view all the answers

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

    <p>tidine</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

    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"

    <p>True</p> Signup and view all the answers

    Proton Pump Inhibitors BLOCK ACID and end in ______________

    <p>Prazole</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

    match the acid controlling drugs

    <p>Sucralfate = is a mucosal protectant. it prtects and coats but can cause abortion. Misoprostol = protects and coats -educate women not to take this medication if within child bearing years, May cause abdominal cramps and diarrhea. Misc acid controlling drugs nursing implications = Antacids may cause premature dissolving of enteric coated medications, resulting in stomach upset. most medications should be administered 1-2 hrs after an antacid. TAKE ANTACID MEDICATIONS 1 HOUR BEFORE OR 2 HOURS AFTER MEALS Antiflatulents is = Simethicone- and is used to reduce the discomforts of gastric or intestinal gas (flatulence)</p> Signup and view all the answers

    MATCH

    <p>CCS DRUGS = Cell Cycle Specific Drugs (kill in a specific cycle of cell synthesis) CSNS DRUGS = Cell Cycle Non Specific Drugs (Kill all of the cells) Chemotherapy = refers to the pharmacologic treatment of cancer Tamoxifen = estrogen blocker that causes menopausal side effects in women.</p> Signup and view all the answers

    match the chemotherapy specific definitions

    <p>Primary Lesion = The original site of growth Metastasis = refers to the spreading of a cancer from its original site of growth ( primary lesion) to a new and remote part of the body Neoplasm = new tissue, any new and abnormal growth, specifically growth that is uncontrolled and progressive; a synonym for tumor. A malignant neoplasm or tumor is synonymous with cancer Tumor = a new growth of tissues characterized by a progressive and uncontrolled proliferation of cells. Tumors can be solid (ie brain tumor) or circulating (leukemia or lymphoma) and benign (noncancerous) or malignant (cancerous). circulating tumors are more precisely called hematologic tumors or hematologic malignancies. A tumor is also called a neoplasm</p> Signup and view all the answers

    match the chemotherapy-specific definitions

    <p>dose limiting adverse effects = adverse effects that prevent an antineoplastic drug from being given in higher dosages, often restricting the effectiveness of the drug. GI tract and bone marrow = are the primary locations affected by dose limiting adverse effects alopecia = hair loss Methotrexate is = also used to treat RA and psoriasis</p> Signup and view all the answers

    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.

    <p>True</p> Signup and view all the answers

    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)

    <p>True</p> Signup and view all the answers

    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

    <p>True</p> Signup and view all the answers

    match

    <p>emetic potential = the likelihood that a given drug will produce vomiting is know as its emetic potential myelosuppression = also called bone marrow suppression, bone marrow depression IS the suppression of bone marrow function, which can result to dangerously reduced numbers of red blood cells, white blood cells and platelets. Nadir = the lowest point in any fluctuating value overtime. for example; the lowest white blood cell count measured after the count has been depressed by chemotherapy Extravasation = The leakage of any intravenously or intraarterially administered medication into the tissue space surrounding the vein or artery; can cause serious tissue injury.</p> Signup and view all the answers

    match

    <p>targeted drug therapy = uses drugs that recognize a specific molecule involved in the growth of cancer cells., while mostly sparing healthy cells. Chelation = Chemical binding, or inactivation of another drug, produces insoluble complexes, the result leads to reduced drug absorption H&amp;H = Hemoglobin &amp; Hematocrit- will show if you're anemic WBC = White blood cell count to check for low platelets and potential bleeding</p> Signup and view all the answers

    <p>AST/ALT = to check the liver GFR, BUN, CREATININE = to check the kidneys A1C = check trends in blood glucose Fasting glucose- = to check blood sugar right now.</p> Signup and view all the answers

    match

    <p>Dose limiting = the highest dose a medication can be given Nephrotoxicity = kidney toxicity Peripheral Neuropathy = pins and needles, burning ototoxicity = hearing loss</p> Signup and view all the answers

    match

    <p>infiltration = when the IV gets disloged with regular drugs and causes like a bubble and it will be uncomfortable but eventually it will go back to normal and the patient will be okay heart failure = the patient would present with having edema, shortness of breath, fatigued, dyspnea bone marrow suppression = the patient would present looking frail, tired, easy bruising, you need to walk with these patients as they are weak INR LABS = for WARFARIN and for HEPARIN aPTT</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus Type 2

    • Signs and symptoms: polyuria (increased urination), polydipsia (thirst), polyphagia (hunger), glycosuria (sugar in urine), unexplained weight loss, fatigue, and blurred vision.

    Polyuria, Polydipsia, Polyphagia, and Glycosuria

    • Polyuria: increased urination
    • Polydipsia: excessive thirst
    • Polyphagia: excessive hunger
    • Glycosuria: sugar in urine

    Type 1 and Type 2 Diabetes Mellitus

    • Type 1 DM: genetic, less than 10% of all DM cases, no insulin production
    • Type 2 DM: 90% of all DM cases, due to poor diet and lifestyle

    Complications of Diabetes Mellitus

    • Macrovascular complications: atherosclerotic plaque (build-up in arteries)
    • Microvascular complications: capillary damage

    Non-pharmacologic Treatment for Type 2 DM

    • Weight loss
    • Improved dietary habits
    • Smoking cessation
    • Reduced alcohol consumption
    • Regular physical exercise

    HbA1C and Fasting Blood Glucose Goals

    • HbA1C goal: less than 7%
    • Fasting blood glucose goal: 80-130mg/Dl

    Medications for Type 2 DM

    • Afrezza: inhaled, rapid-acting medication (peak: 12-15 minutes)
    • Insulin syringes: orange, marked with "units" at the bottom near the plunger
    • Biguanides (Metformin): first-line drug, decreases glucose production/intestinal absorption
    • Sulfonylureas: non-insulin antidiabetic drugs (end in "-ide" or "-amine")
    • Alpha-Glucosidase inhibitors (Acarbose, Miglitol): delay glucose absorption, control postprandial hyperglycemia

    Adverse Effects and Contraindications

    • Metformin: GI abdominal bleeding, cramping, feeling of fullness, LACTIC ACIDOSIS (rare, lethal)
    • Contraindications for Metformin: renal or hepatic disease
    • Sulfonylureas: contraindicated in sulfa allergy
    • Alpha-Glucosidase inhibitors: contraindicated in certain bowel disorders (flatulence, diarrhea, abdominal pain)

    GLP-1 Injectables

    • Patient education: may experience weight loss (5-10 lbs), inject properly
    • Adverse effects: rare hemorragic/necrotizing pancreatitis
    • Black box warning: risk of developing thyroid C-Cell tumors, thyroid cancer

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