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NUR7560 Advanced Pharmacology Exam 2 Study Guide
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- Nursing (NUR7560)
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- University Of St. Augustine
NUR7560 Advanced Pharmacology Exam 2 Study Guide on Endocrine and Diabetes Topic
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Pharmacology Exam 2 Study GuideUnits 4 – 5 (Endocrine and Infectious Disease)
Endocrine
Understand the conversion of NPH insulin to insulin glargine.
Reduce dose by 20% when converting from NPH given BID to Lantus Daily
So, if patient is on total of 100u NPH, then they will get 80 units of Lantus daily.
Know the mechanism of action, side-eff ect profile, and contraindications for all classes of diabetic
medications.
MOA Side Effects Contraindication
Sulfonylureas Stimulates the pancreas to release Hypoglycemia Pregnancy/BF
“-ide” more insulin Weight Gain DKA
They block ATP-dependent K+ Hypersensitivity
channels in the islet cells
opening of Ca2+ channels. in
Ca2+ facilitates fusion of storage
vesicles containing insulin to cell
membrane releasing insulin to
circulation
Biguanides ↓ amount of glucose released from the Lactic acidosis GFR < 30
liver GI SE Pregnancy/BF
↓ hepatic glucose production (↓ Chronic/binge ETOH
heptaogluconeogenesis) ↓ interstitial
absorption of glucose & slight
improvement in insulin sensitivity (↑
peripheral glucose uptake &
utilization)
Predominant effect on excessive
hepatic glucose production
which can impact the fasting blood
glucose levels but w/o causing
hypoglycemia (in non-ETCH/fasting
person).
Thiazolidinediones Makes the body more sensitive to ↑ risk of CHF Dyslipidemia
“-one” insulin Bone fx (wrist fx) CHF/CVD
Potent agonist to PPARγ receptors Wt. gain CAD or ASCVD
that make the liver & muscle cells Osteoporosis/Fracture
more sensitive to insulin. Up
regulates GLUT- 4 receptors
DPP-4 inhibitors Work like metformin, but less NV; Cold like symptom
“liptin” effective Photosensitive
Pancreatitis
Risk of CHF
SGLT-2 inhibitors Glucose altered into the renal Frequent UTIs Renal impairment or CKD
“-flozin” tubule is usually reabsorbed by the DKA Risk of DKA (euglycemic)
influx cell membrane transporter Hypotension
(SGLT2) located w/in the luminal Ketoacidosis
membrane of the proximal renal Candida vulvognitis
tubule. This transporter uses
sodium down a concentration
gradient to move glucose into the
renal tubular cell against a
concentration gradient for
reabsorption back into the body.
About 90% of glucose is reabsorbed
in the kidney by this route
,Alpha Glucosidase inhibit alpha-glucosidase enzyme in N/V
inhibitor the small intestine, which is needed GI S/E
to quickly break down ingested
complex carbohydrates into
glucose for absorption.
Basically: slows down
carbohydrate
digestion/absorption in the
intestines but does NOT block it
GLP-1 receptor They are analogs of the hormone Hypoglycemia Patien w/ thyroid c-cell
agonist incretion (glucagon-like peptide Increased weight loss tumors including medullary
“-tide” 1) GLP-1 that ↑ glucose Increased nausea and GI SE thyroid carcinoma (MTC) &
multiple endocrine syndrome
sensitive insulin secretion, ↑B- Needs renal dosing
type 2 (MEN2)
cell growth and replication,
slows gastric emptying & may ↓
food intake
Basic Insulin kinetics – timing of dosing, peak or no peak, glucose monitoring in relation to insulin
therapy, and metabolism
Drug Name Onset Peak Duration Meal Timing
Rapid Acting Afrezza (Human 12 – 15 mins 53 min 2 – 3 hrs Beginning of meal
(inhaled) Insulin Powder) (shortest)
Rapid Acting Apudura (Glulisine) 5 – 15 mins 30 – 90 mins 3 - 4 hrs 5 – 15 mins before
(injected) Novolog (aspart) 5 – 15 mins 1 – 2 hrs 4 – 6 hrs meals (and 20 mins
Humalog (Lispro) 5 – 15 mins after start of meal with
(10 – 20) gluisine only)
W/ 1st bite of food
Short Acting Regular 6 – 10 hrs 30 mins before meals
It does not closely If patient has impaired
mimic the renal f(x) the insulin will act
physiologic longer. Advise patient to
response compared have snacks in case they
to other insulin become hypoglycemic
Interm Acting NPH 1 – 2hrs 4 – 8 hrs 10 – 20 hrs Within 15 mins before
It can be mixed Peak effect meals when mixed with
with regular insulin may cause rapid acting insulin; 30
hypoglycemia if mins before meals when
they don’t mixed with regular
coordinate with
meals
Long acting (basal Lantus; Toujeo 1 – 2 hrs Non significant ~ 24 hrs --
insulin) (Insulin Glargine)
Levemir (Insulin 3 – 4 hrs 6 – 8hrs 6 – 23 hrs Avoid cold injections
Detemir (dose w/ (dose Evening meal or bedtime;
chronic use) dependent) or 12 hrs after morning
dose if given BID
Tresiba (insulin 1 hrs 9 hrs ~ 25 hrs --
degludec)
, Recognizing, evaluating, and managing hypoglycemia in diabetic patients
SxS:(B-blockers may hide hypoglycemic s/s)
Confusion/delirium
HA, Lightheadedness
Anxiousness
Palpitations
Seizures, shakiness
Sweating (hypoglycemic symptom seen w/ B-blockers)
Work up:
CBC: Complete blood count
CMP: Comprehensive metabolic panel
UA: Urinalysis
C-Peptide (if indicated)
Plasma Insulin Levels (if indicated)
ECG: Electrocardiogram
Treatment
Pts who can tolerate food:
20g glucose: gradual rise in blood glucose over 15-20 mins; repeated if necessary
Sublingual sucrose: can increase glucose levels ~44md/dL w/in 10 min
o Must be able to protect the airway
Pts who cannot swallow: 25g (50mL of 50% dextrose [D50] IV/IO)
If dextrose/IV/IO not available
1mg glucagon IM x1
Dose-dependent risk of nausea
Which oral medication class is likely to cause hypoglycemia?
Sulfonylureas: Chlorpropamide, tolazamide, tolbutamide
What are potential side eff ects SGLT2 inhibitors and GLP-1 agonists?
SGLT2 inhibitors GLP-1 agonists
Common Side Eff ects Common Side Eff ects:
o Genital Infections: Increased risk of genital fungal o Gastrointestinal Issues: Nausea, vomiting, diarrhea, and
infections, especially in women. constipation are common, especially at the start of
o Urinary Tract Infections (UTIs): Higher incidence of therapy.
UTIs due to increased glucose in the urine. o Injection Site Reactions: Redness, itching, or discomfort
o Polyuria: Increased urination due to the osmotic at the injection site.
diuresis effect. o Headache: Mild to moderate headaches may occur.
o Dehydration: Potential for volume depletion and o Dizziness: Some patients may experience dizziness.
dehydration.
o Hypotension: Can cause low blood pressure, Serious Side Eff ects:
especially in patients on diuretics. o Pancreatitis: Cases of acute pancreatitis have been
o Dyslipidemia: May cause slight increases in LDL reported; symptoms include severe abdominal pain that
cholesterol. may radiate to the back.
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