Metabolism Pharmacology Student PDF

METABOLI SM PHARMACO LOGY BARB HIGGINS MSN, RN PREGNANCY CATEGORY RISKS C= Animal reproduction A=Safest. Adequate and studies have shown an B=Animal reproduction...

METABOLI SM PHARMACO LOGY BARB HIGGINS MSN, RN PREGNANCY CATEGORY RISKS C= Animal reproduction A=Safest. Adequate and studies have shown an B=Animal reproduction well-controlled studies adverse effect on fetus studies have failed to have failed to and there are no well- demonstrate risk to fetus. demonstrate a risk to the controlled studies on No adequate well- fetus in the first trimester humans. Potential controlled studies in of pregnancy (and no risk benefits may warrant use pregnant women in later trimesters) during pregnancy despite potential risks. D=Positive evidence of human fetal risk based X=Should never use on adverse reaction data during pregnancy. Studies from human studies. in animals or humans Potential benefits may have shown fetal warrant use in pregnant damage. women.  INSULIN Rapid Acting (Lispro) Onset: 15 mins Peak: 40-50 mins Duration: 3-5 hrs. Short Acting (Regular) Onset: 0.5-1 hr. Peak: 2-3 hrs. Duration: 4-6 hrs.  Intermediate Acting (NPH) Onset: 2 hrs. Peak: 6-8 hrs. Duration: 12-16 hrs. INSULIN Long Acting (Levemir) Onset: 1.6 hrs. Peak: None Duration: Up to 42 hrs. INSULIN ROUTES SUBCUTANEOUS INHALED INSULIN PUMP (SQ) INSULIN REGIMENS Based on client’s weight, ranging from 0.4 to 1 unit/kg/day Divided into basal dose and mealtime doses Mealtime dose based on blood glucose levels Higher doses may be needed during puberty, pregnancy, or illness May use CHO counting INHALED INSULIN Used with Type 1 Requires pulmonary testing before starting the drug, at 6 months, and annually Still need a long-acting basal insulin for overnight and between meals INSULIN ADMINISTRATION Can be a calibrated syringe with attached needle and drawn up from a bottle of insulin May be insulin pen that has a cartridge, a dial to measure the dose, and a disposable needle Common syringe sizes are:  1 mL (measures doses up to 100 units)  0.5 mL (measures doses up to 50 units)  0.3 mL (measures doses up to 30 units) Standard insulin in U.S. is U-100 (100 units of insulin/mL U-500 can be used for clients that require large doses of insulin Inject into SQ tissue of abdomen, thighs, hips, buttocks, or upper arms Lipohypertrophy prevention INSULIN PUMP Small, computerized devise that continuously administers small doses of short-acting insulin CSII=continuous subcutaneous insulin infusion Change infusion set with needle every few days Many clients use to deliver basal and bolus SQ rapid-acting insulin injections to mimic normal beta cell insulin secretion Pump has a tiny sensor that reads glucose every 5 minutes to determine dose needed Approved for age 7 and older Complications=ketosis, DKA, Lipohypertrophy, and lipoatrophy  INSULIN PUMP This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY-NC  Sulfonylureas Glipizide, Glyburide Expected Pharmacological Action: insulin release from pancreas; can increase tissue sensitivity to insulin over time Control blood glucose levels in T2D in ORAL conjunction with diet and exercise ANTIDIAB Complications: hypoglycemia, weight gain Pregnancy category risk C ETICS Interactions with Glipizide=Alcohol (disulfiram- like reaction), NSAIDs, sulfonamide antibiotics, beta blockers can mask s/s of hypoglycemia and inhibit insulin release Best taken 30 mins. Before breakfast. Hold if NPO ORAL ANTIDIABETICS Meglitinides (glinides) Repaglinide, Nateglinide Expected Pharmacological Action: Insulin release from pancreas Control blood glucose levels in T2D with diet and exercise Complications: Hypoglycemia, weight gain Pregnancy category risk C Concurrent use of gemfibrozil increases risk for hypoglycemia (inhibits metabolism) Take within 30 mins of mealtime TID ORAL ANTIDIABETICS Biguanide Metformin Expected Pharmacological Action: Reduces the production of glucose within the liver through suppression of glycogenesis Increases glucose uptake and use in fat and skeletal muscles Decrease glucose absorption in the GI tract First choice for most with T2D to control blood glucose along with diet and exercise Off-label use= Polycystic ovary syndrome (PCOS) Complications: GI effects, Vit B12 and folic acid deficiencies, lactic acidosis Pregnancy category B Interactions=Alcohol, iodine-containing contrast medias  Thiazolidinediones Alpha-glucosidase ORAL inhibitors ANTIDIAB ETICS Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) Sodium-glucose co- transporter 2 (SGLT-2) inhibitors HYPERGLYCEMIC AGENT Glucagon Increases blood glucose levels by increasing the breakdown of glycogen into glucose Used for emergency management of hypoglycemic reactions Decrease in GI motility in clients undergoing radiological procedures of the stomach and intestines Complications=GI distress Pregnancy category risk B PO, IM, IV Effective when blood glucose >70  My ATI Learn: Skills Modules 3.0 Diabetes Mellitus Management ATI Video Case Studies RN SUGGEST 3.0: IONS Metabolism: Type 1 DM Metabolism: Type 1 DM Part 1 Metabolism: Type 1 DM Part 2 Teaching ND Learning/Pt Education: Disease Management QUESTION A homebound client with Type 2 diabetes mellitus calls the nurse to report nausea and flulike symptoms for 2 days. What advise should the nurse give the client? 1. “Be sure to check your blood glucose level in the mornings on a daily basis.” 2. “Take half of your regular dose of insulin and oral hypoglycemic agent.” 3. “Limit fluid intake and eat only when you are hungry.” 4. “Test your urine ketones if your blood glucose is higher than 240mg/dL.” ANSWER 4-to prevent DKA QUESTION A client newly diagnosed with diabetes mellitus (DM) has begun taking insulin. The client asks the nurse about alcohol consumption. What information should the nurse provide to the client? 1. “Moderate-to-high alcohol consumption without food can cause your blood glucose level to go down to low.” 2. “Moderate-to-high alcohol consumption without food can cause your blood glucose level to rise too high.” 3. “Consumption of alcohol has no effect on your blood glucose, as long as you don’t eat while drinking.” 4. “As long as you only drink beer and wine, and not hard liquor, there should be no effect from the alcohol. ANSWER 1-“Moderate-to-high alcohol consumption without food can cause your blood glucose level to go down to low.” QUESTION The nurse is instructing the newly diagnosed diabetic client how to mix regular insulin and NPH insulin. What should the nurse tell the client? 1. Shake the bottle of NPH before withdrawing the amount. 2. Withdraw the NPH first 3. Withdraw the regular first 4. Inject air into the bottle of regular first ANSWER 3-Withdraw the regular first QUESTION Metformin has been prescribed for a client newly diagnosed with type 2 diabetes mellitus. Which client statement about this medication validates to the nurse that the client understands the teaching? 1. Decreases sensitivity of peripheral tissue to insulin 2. Stimulates glucose production in the liver 3. Treats unstable type 2 diabetes mellitus 4. Decrease production of glucose by the liver ANSWER 4-Decrease production of glucose by the liver