NURS 5334 EXAM 3 STUDY GUIDE & EXAM REVIEW~ QUESTIONS & ANSWERS
Exam 3 Study Questions
What drugs are used to treat gestational diabetes?
o Metformin and Insulin
What A1C value indicates diabetes mellitus? Pre-DM?
o 6.5% or greater is considered diabetes
o 5.7-6.4% pre-diabetes
W...
Exam 3 Study Questions
What drugs are used to treat gestational diabetes?
o Metformin and Insulin
What A1C value indicates diabetes mellitus? Pre-DM?
o 6.5% or greater is considered diabetes
o 5.7-6.4% pre-diabetes
What fasting and random values indicate DM?
o Fasting plasma glucose—126 or greater is diabetes
o Random (casual) plasma glucose—anything greater than 200 is diabetes
What are complications of insulin therapy?
o Hypoglycemia
o Can develop lipohypertrophy
Accumulation of subcutaneous fat that occurs when it is injected too frequently
at the same site
o Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses)
o Hypokalemia
Promotes the uptake of potassium cells and insulin activates a membrane-bound
enzyme with sodium potassium and ATPase that pumps potassium into the cells
and sodium out
Drug interactions?
o Hypoglycemic agents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides, alcohol
o Use with caution with hyperglycemic agents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin?
o delay awareness of and response to hypoglycemia by masking the signs that are
associated with stimulation of sympathetic nervous system
o Impair glycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM?
o Hyperkalemia
o Aids in diagnosis of GH deficiency
o Diabetic ketoacidosis
Insulin dosage must be coordinated with what?
o Carbohydrate intake
What is B/P goal in diabetic?
o To be controlled, within normal 120/80
What medication can be given to decrease risk of diabetic nephropathy?
o ACE inhibitor or ARB
1
, What role does exercise play in treatment of both type 1 and type 2 DM?
o Exercise increases cellular responsiveness to insulin and increases glucose tolerance
o 150 minute per week of moderate intensity exercise is recommended
What are the 4 steps in the 4-step approach?
o Step 1—diagnosis
Lifestyle changes plus metformin
o Step 2
Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a DPP4
inhibitor, a sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like
peptide 1, or a GLP-1 receptor agonist or basal insulin
Second drug choice made considering efficacy, the hypoglycemia risk of the
patient, the patient tolerability, and weight-related considerations (some help
weight loss, some cause weight gain), cost
o Step 3
Three drug combination
Metformin
Plus 2 other drugs from step 2
o Decided based on a drug and patient specific considerations
o Step 4
If 3 drug combination that includes basal insulin fails after 3-6 months, more
complex insulin regimen
Usually in combination with one or more non-insulin medications
When a patient is on insulin therapy what are the blood glucose goals before meals? At
bedtime?
o Before meals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate?
o 7% or below
o Those with severe hypoglycemia risk, limited life expectancy, advanced microvascular or
macrovascular complications—not below 7
What are the short acting insulins? Intermediate? Long acting?
o Short duration: Rapid acting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine [Apidra]
o Short duration: Slower acting
Regular insulin [Humulin R, Novolin R]
o Intermediate duration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir]
o Long duration
Insulin glargine
When are short duration insulins used?
2
, o Administered in association with meals to control the post-prandial rise in blood glucose
between meals and at night
When are intermediate insulins needed?
o Administer 2-3 times daily to provide glycemic control between meals and during the
night
How long is duration of glargine? Levemir? Degludec?
o Glargine—up to 24 hours
o Levemir
Low dose (0.2 units/kg)—12 hours
High doses (0.4 units/kg)—20-24 hours
o Degludec—up to 42 hours
What are routes of administration? Which can be inhaled?
o SQ injection
o IV infusion
o Inhalation—Afrezza, mealtime insulin
What is typical dosing for type 1? Type 2?
o Total doses may range from 0.1 unit/kg body weight to more than 2.5 units/kg
o Type 1
Initial doses typically range from 0.5-0.6 units/kg per day
o Type 2
Initial doses range from 0.2-0.6 units/kg per day
Dosage increased or decreased according to carb intake, activity
What are the 3 dosing schedules?
o Twice daily dosing
o Intensive basal/bolus strategy
o Continued subcutaneous insulin
How does metformin work?
o Inhibits glucose production in the liver
o Reduces glucose absorption in the gut
o Sensitizes insulin receptors in target tissues (fat and skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
What are side effects? BB warning?
o GI effects—diarrhea
o Lactic acidosis
How does alcohol effect?
o Inhibits the breakdown of lactic acid
What are the therapeutic uses other than DM?
o Gestational diabetes
o PCOS
Sulfonylureas
o First generation
Chlorpropamide [Diabinese]
Tolazamide [Tolinase]
3
, Tolbutamine [Orinase]
o Second Generation:
Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
o MOA?
Promote insulin release
o Main side effect?
Hypoglycemia
Weight gain
o How does cimetidine effect? Beta blocker?
Cimetidine—intensifies the response
Beta blockers—diminish the benefits by suppressing the insulin release
Meglitinides (Repaglinide and Nateglinide)
o MOA—stimulate pancreatic insulin release
o Drug/Drug interaction—gemfibrozil
Thiazolidinediones (glitazones)
o Reduce glucose levels primarily by decreasing insulin resistance
o Only indication is type 2 diabetes, mainly as an add-on to metformin
o Rosiglitazone [Avandia]: Restricted use
o Pioglitazone [Actos]
o Can they be used in patient with CHF?
No
Alpha-glucosidase inhibitors (Acarbose or Precose; Miglitol (glyset))
o What races are these more effective in?
Latinos and African Americans
DPP-4 inhibitors (gliptins)
o MOA—promote glycemic control by enhancing the actions of the incretin hormones and
they stimulate glucose dependent release of insulin
Suppress your post-prandial release of glucagon
o What is the % of A1C reduction?
0.5%
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (Canagliflozin, Dapagliflozin)
How does colesevelam work in treatment of DM? Bromocriptine?
o Colesevelam—bile acid sequestrant used to lower cholesterol and helps lower blood
glucose
Many with diabetes also have high cholesterol so 2 birds-1 stone
o Bromocriptine—adjunct to diet and exercise (0.5% reduction)
Injectables
o Amylin memetics?
Pramlintide
Side effects—hypoglycemia when used with insulin
Drug/Drug—insulin
4
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller APLUS100. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.49. You're not tied to anything after your purchase.
