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NURS 5334 Pharmacology Exam 3 Study Guide
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NURS 5334 Pharmacology Exam 3 Study Guide
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NURS 5334 ADVANCED PHARMACOLOGY EXAM 3 STUDY GUIDE 1 NURS 5334 Pharmacology Exam 3 Study Guide • 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 inclu ded 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 2 • 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 insuli ns used? 3 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]The benefits of buying summaries with Stuvia:
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