NUR 2474– Pharm Final Exam Review
Insulin: DM 1, DM 2, Gestational Diabetes
HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH
PRIORITY FOR TREATMENT
What types of insulin are ordered before meals and at bedtime? Lispro and Regular are not
ordered before bedtime; Lispro and Regular are usually given before meals; Lantus is given
before bedtime; In the elderly especially, lantus is sometimes split into a morning and
evening dose.
Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at
bedtime; NPH is often given only in the morning.
What type of insulin is sometimes given at bedtime, has the longest duration of all the
insulins, CANNOT BE MIXED WITH OTHER INSULINS, and for elderly patients is often
split into two doses (one in the morning and one at bedtime)? Insulin Glargine (Lantus)
is usually given once a day at bedtime. Elderly individuals often have their dose split in
two and are administered one dose in the morning and one dose at night; In addition,
sometimes insulin lispro is given in a sliding scale with a snack in the evening. It doesn’t
last throughout the night-that’s what we want to avoid.
*Insulin aspart protamine in combo with insulin aspart would NOT be given in
the evening, as it lasts too long.
*NPH would peak at exactly the WRONG TIME. Do not give that one at bedtime.
Why is a nurse concerned for a beta-blocker/insulin combination? Beta Blockers
can mask some of the symptoms of hypoglycemia
What do you assess for? What symptoms could be concealed by taking a beta
blocker while on insulin?
• Symptoms of hypoglycemia:
• Feeling shaky.
• Being nervous or anxious.
• Sweating, chills and clamminess.
• Irritability or impatience.
• Confusion.
• Fast heartbeat.
• Feeling lightheaded or dizzy.
• Hunger.
You will need to know the following chart:
Onset: When the medicine starts to work (when the blood sugar is going to start to go
down). Peak: Usually when the medicine is at its highest level, and you get the highest
effect (in this case it equates to the times when you see the lowest blood sugars).
,Duration: How long the medication is going to last in effectiveness (how long is it going
to affect blood sugars).
MOST ORAL ANTI-DIABETICS (ORAL HYPOGLYCEMICS): Type 2 Diabetes, Most
do not work for type 1 diabetes, Don’t risk it with babies we use regular insulin for
gestational diabetes. Glipizide (Glucotrol):
• How does it work? is in a class of medications called
sulfonylureas. Glipizide lowers blood sugar by causing the pancreas to
produce insulin (a natural substance that is needed to break down sugar in
the body) and helping the body use insulin efficiently.
• What diagnosis is it effective for (be specific)? Type 2, less than 5
years, no end organ damage, young enough
• What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic,
• What are the side/adverse effects? Hypoglycemia, diarrhea.constipation,
nausea, vomiting, upset stomach, loss of appetite. Headache, weight gain,
• What are contraindications?
• low blood sugar.
• pituitary hormone deficiency.
• a condition where the adrenal glands produce less
hormones called Addison's disease.
• glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• hepatic porphyria.
• a type of blood disorder where the red blood cells burst called hemolytic
anemia.
• alcoholism.
•
• Are there drug-drug interactions?
• Do not take if allergic to sulfa
• Are there drug-alcohol interactions? Do not take with alcohol
• Are there drug-food interactions? Take with breakfast
• Please note that this person will still need to be checking
their BS at least once a day
Metformin
• How does it work? works by reducing the amount of sugar your
liver releases into your blood. It also makes your body respond better to insulin.
• What diagnosis is it effective for (be specific)? Type 2, less than 5
years, no end organ damage, young enough
• What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic
• What are the side/adverse effects? Can be harsh on end organs,
esp. kidneys, . It's best to take metformin with a meal to reduce the side effects. IF
, SOMEONE IS GOING TO HAVE CONTRAST FOR A CT: THE METFORMIN IS STOPPED
PRIOR TO HAVING THE CONTRAST. If they are taking metformin, and they come into an
ER and a CT with contrast is ordered, do not blindly send the patient to
CT, LET THE PROVIDER KNOW AND THEY WILL ORDER IT WITHOUT
CONTRAST. Since it is so hard on the kidneys, drink plenty of water.
• What are contraindications? Kidney disease, heart attack; stroke;
diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms
and requires emergency medical treatment); a coma; or heart or liver disease
Acarbose:
• How does it work? What diagnosis is it effective for (be specific)?
by slowing the action of certain chemicals that break down food to release
glucose (sugar) into your blood. Slowing food digestion helps keep blood
glucose from rising very high after meals
• What classification(s) does it fit into? alpha-glucosidase inhibitors,
which also includes miglitol (Glyset); anti-diabetic, oral hypoglycemic agent
• What are the side/adverse effects? Diarrhea
• What are contraindications? hypersensitivity, diabetic
ketoacidosis, liver cirrhosis, inflammatory bowel disease, or colonic ulceration
• Are there drug-drug interactions? Avoid taking a digestive enzyme
such as pancreatin, amylase, or lipase at the same time you take acarbose.
• Are there drug-alcohol interactions? Do not mix, it may cause sudden
hypoglycemia
• Are there drug-food interactions? No grapefruit juice
• How does it work? What diagnosis is it effective for (be specific)?
Direct Sugar for Body
• What classification(s) does it fit into? Hyperglycemic agent
• What are the side/adverse effects? Hyperglycemia
• How does it work? What diagnosis is it effective for (be specific)?
Glucagon's role in the body is to prevent blood glucose levels dropping too
low. To do this, it acts on the liver in several ways: It stimulates the conversion
of stored glycogen (stored in the liver) to glucose, which can be released into
the bloodstream. This process is called glycogenolysis.
• What classification(s) does it fit into? Hyperglycemic agents
• What are the side/adverse effects? Hyperglycemia
• How does it work? What diagnosis is it effective for (be
specific)? Hypothyroid. Works as hormone replacement.
• What classification(s) does it fit into? Thyroid hormone replacement
therapy
• What are the side/adverse effects? Insomnia, tremors, increased
heart rate (might be overtreatment, so contact provider)
• What are contraindications?
Insulin: DM 1, DM 2, Gestational Diabetes
HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH
PRIORITY FOR TREATMENT
What types of insulin are ordered before meals and at bedtime? Lispro and Regular are not
ordered before bedtime; Lispro and Regular are usually given before meals; Lantus is given
before bedtime; In the elderly especially, lantus is sometimes split into a morning and
evening dose.
Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at
bedtime; NPH is often given only in the morning.
What type of insulin is sometimes given at bedtime, has the longest duration of all the
insulins, CANNOT BE MIXED WITH OTHER INSULINS, and for elderly patients is often
split into two doses (one in the morning and one at bedtime)? Insulin Glargine (Lantus)
is usually given once a day at bedtime. Elderly individuals often have their dose split in
two and are administered one dose in the morning and one dose at night; In addition,
sometimes insulin lispro is given in a sliding scale with a snack in the evening. It doesn’t
last throughout the night-that’s what we want to avoid.
*Insulin aspart protamine in combo with insulin aspart would NOT be given in
the evening, as it lasts too long.
*NPH would peak at exactly the WRONG TIME. Do not give that one at bedtime.
Why is a nurse concerned for a beta-blocker/insulin combination? Beta Blockers
can mask some of the symptoms of hypoglycemia
What do you assess for? What symptoms could be concealed by taking a beta
blocker while on insulin?
• Symptoms of hypoglycemia:
• Feeling shaky.
• Being nervous or anxious.
• Sweating, chills and clamminess.
• Irritability or impatience.
• Confusion.
• Fast heartbeat.
• Feeling lightheaded or dizzy.
• Hunger.
You will need to know the following chart:
Onset: When the medicine starts to work (when the blood sugar is going to start to go
down). Peak: Usually when the medicine is at its highest level, and you get the highest
effect (in this case it equates to the times when you see the lowest blood sugars).
,Duration: How long the medication is going to last in effectiveness (how long is it going
to affect blood sugars).
MOST ORAL ANTI-DIABETICS (ORAL HYPOGLYCEMICS): Type 2 Diabetes, Most
do not work for type 1 diabetes, Don’t risk it with babies we use regular insulin for
gestational diabetes. Glipizide (Glucotrol):
• How does it work? is in a class of medications called
sulfonylureas. Glipizide lowers blood sugar by causing the pancreas to
produce insulin (a natural substance that is needed to break down sugar in
the body) and helping the body use insulin efficiently.
• What diagnosis is it effective for (be specific)? Type 2, less than 5
years, no end organ damage, young enough
• What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic,
• What are the side/adverse effects? Hypoglycemia, diarrhea.constipation,
nausea, vomiting, upset stomach, loss of appetite. Headache, weight gain,
• What are contraindications?
• low blood sugar.
• pituitary hormone deficiency.
• a condition where the adrenal glands produce less
hormones called Addison's disease.
• glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• hepatic porphyria.
• a type of blood disorder where the red blood cells burst called hemolytic
anemia.
• alcoholism.
•
• Are there drug-drug interactions?
• Do not take if allergic to sulfa
• Are there drug-alcohol interactions? Do not take with alcohol
• Are there drug-food interactions? Take with breakfast
• Please note that this person will still need to be checking
their BS at least once a day
Metformin
• How does it work? works by reducing the amount of sugar your
liver releases into your blood. It also makes your body respond better to insulin.
• What diagnosis is it effective for (be specific)? Type 2, less than 5
years, no end organ damage, young enough
• What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic
• What are the side/adverse effects? Can be harsh on end organs,
esp. kidneys, . It's best to take metformin with a meal to reduce the side effects. IF
, SOMEONE IS GOING TO HAVE CONTRAST FOR A CT: THE METFORMIN IS STOPPED
PRIOR TO HAVING THE CONTRAST. If they are taking metformin, and they come into an
ER and a CT with contrast is ordered, do not blindly send the patient to
CT, LET THE PROVIDER KNOW AND THEY WILL ORDER IT WITHOUT
CONTRAST. Since it is so hard on the kidneys, drink plenty of water.
• What are contraindications? Kidney disease, heart attack; stroke;
diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms
and requires emergency medical treatment); a coma; or heart or liver disease
Acarbose:
• How does it work? What diagnosis is it effective for (be specific)?
by slowing the action of certain chemicals that break down food to release
glucose (sugar) into your blood. Slowing food digestion helps keep blood
glucose from rising very high after meals
• What classification(s) does it fit into? alpha-glucosidase inhibitors,
which also includes miglitol (Glyset); anti-diabetic, oral hypoglycemic agent
• What are the side/adverse effects? Diarrhea
• What are contraindications? hypersensitivity, diabetic
ketoacidosis, liver cirrhosis, inflammatory bowel disease, or colonic ulceration
• Are there drug-drug interactions? Avoid taking a digestive enzyme
such as pancreatin, amylase, or lipase at the same time you take acarbose.
• Are there drug-alcohol interactions? Do not mix, it may cause sudden
hypoglycemia
• Are there drug-food interactions? No grapefruit juice
• How does it work? What diagnosis is it effective for (be specific)?
Direct Sugar for Body
• What classification(s) does it fit into? Hyperglycemic agent
• What are the side/adverse effects? Hyperglycemia
• How does it work? What diagnosis is it effective for (be specific)?
Glucagon's role in the body is to prevent blood glucose levels dropping too
low. To do this, it acts on the liver in several ways: It stimulates the conversion
of stored glycogen (stored in the liver) to glucose, which can be released into
the bloodstream. This process is called glycogenolysis.
• What classification(s) does it fit into? Hyperglycemic agents
• What are the side/adverse effects? Hyperglycemia
• How does it work? What diagnosis is it effective for (be
specific)? Hypothyroid. Works as hormone replacement.
• What classification(s) does it fit into? Thyroid hormone replacement
therapy
• What are the side/adverse effects? Insomnia, tremors, increased
heart rate (might be overtreatment, so contact provider)
• What are contraindications?
