Summary Pharmacology Exam 2 Study guide with complete solution

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RASMUSSEN COLLEGE
PHARMACOLOGY
CONCEPT REVIEW #2

Diabetes
 Type 1
o Insulin-dependent DM
 Type 2
o Non-insulin-dependent DM
 Normal Blood glucose 70-100
 Major symptoms
o Polyuria
 Peeing a lot
o Polydipsia
 Drink a lot
o Polyphagia
 Eating a lot
 Managing hypoglycemia
o Diazoxide
 Used for patients with Chronic hypoglycemia caused by hyperinsulinism
 Not indicated for hypoglycemic reaction
o Dextrose
 Given IV
 Insulin-induced hypoglycemia
o Glucagon
 When it should be administered
 Sub Q – when pt has lost consciousness
 Feed them – if pt is still awake
o Orange juice
 Routes
 Sub Q
 Assessments pre and post administration
 Check blood sugar
 What they eat
 Frequency of blood glucose checks
 Before you give it and after your give it – monitor
o Assessing it and actions
 Insulin
o Action: Promote use of glucose by body cells, store glucose as glycogen in
muscles
o Use: Reduce blood glucose, control diabetes mellitus Type 1
o Interactions
 Increase glucose with thiazides, glucocorticoids, estrogen, thyroid drugs
 Decrease glucose with TCAs, MAOIs, aspirin, oral anticoagulants
o Side Effects
 Low Blood Sugar, Rash, Weight Gain – when first starting to use it, Scarring
at injection site if sites are not rotated well
 Hypoglycemia, insulin shock
 Too much insulin
 Nervousness, tremors
 Lack of coordination
 Cold, clammy skin
 Headache, confusion
 Somogyi effect

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 Occurs in predawn hours
 Rapid decrease in blood glucose during night stimulates hormonal
release to increase blood glucose
 Lipodystrophy
 Lipoatrophy – divots
 Lipohypertrophy – little fat bumps
 Dawn phenomenon
 Hyperglycemia upon awakening
 Symptoms
o Headache, night sweats, nightmares
 Diabetic ketoacidosis
 Hyperglycemia

o Patient teaching
 Teach patients to recognize and immediately report symptoms of
hypoglycemic (insulin) reaction—such as headache, nervousness,
sweating, tremors, rapid pulse—and those of hyperglycemic reaction
(diabetic acidosis): thirst, increased urine output, and a sweet, fruity
breath odor.
 Advise patients that hypoglycemic reactions are more likely to
occur during peak action time. Most diabetic patients know whether
they are having a hypoglycemic reaction, but some have a higher
tolerance to low blood glucose and can have a severe reaction without
realizing it.
 Explain that orange juice, sugar-containing drinks, and hard candy
may be used when a hypoglycemic reaction begins.
 Teach family members to administer glucagon by injection if a
patient has a hypoglycemic reaction and cannot drink sugar-
containing fluid.
 Inform patients that certain herbs may interact with insulin and oral
antidiabetic drugs. A hypoglycemic or hyperglycemic effect might occur
(Complementary and Alternative Therapies 47.1).
 Teach patients about the necessity of compliance with prescribed
insulin therapy and diet. HbA1c provides the most accurate picture of
optimal diabetic control.
 Advise patients to carry a MedicAlert card, tag, or bracelet that indicates
the health problem and the insulin dosage.
 Self-Administration
o Instruct patients on how to check blood glucose with
a glucometer (OneTouch AccuSure, GlucoSure, Accu-Chek).
o Teach patients about the care of insulin containers
and syringes.
 Inform patients taking NPH insulin with regular
insulin that regular insulin is drawn up before
NPH insulin.
 Diet
o Advise patients taking insulin to eat the prescribed
diet on a consistent schedule. Diet information may be
obtained from the ADA or from a nutritionist.
o Onset, peak and duration of regular, Novolog/Humalog, NPH, Lantus, Levimer
 Rapid-acting insulin (clear)
 Insulin lispro, insulin aspart, insulin glulisine, oral inhalation insulin
o Onset of action: 5-30 min
o Peak 30 min: – 1.5 hrs
o Duration: 3-5 hrs

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 Short-acting insulin (clear)
 Regular
o Onset of action: 0.5-1 hr
o Peak: 2-5 hrs
o Duration: 4-12 hrs
 Intermediate-acting (cloudy)
 Insulin isophane NPH
o Onset of action: 1-2 hrs
o Peak: 4-12 hrs
o Duration: 14-24 hrs
 Long-acting
 Insulin glargine
o Onset of action: 1-2 hrs
o Duration: 6-8 hrs
o Administered at bedtime - 24 hrs
o Mixing insulins and observations for hypoglycemia
 Composed of short- and intermediate-acting
 Rapid- (FIRST) and intermediate-acting
o Pre-mix
 NPH 70/regular 30
 NPH 50/regular 50
 Storage of insulin
 Keep in refrigerator until opened.
 Avoid storing insulin in direct sunlight or at high temperatures.
 Never shake insulin – always roll
o Interpreting sliding scales
 Adjusted doses dependent on individual blood glucose
 Monitor blood glucose.
 Before meals and at bedtime
 Involves rapid or short-acting insulin
 EX: If below 60, notify MD
 If 60 – 124, no coverage
If 125 – 150, give two units
If 151 – 200, give four units
If 201 – 250, give six units
If 251 – 300, give eight units
If over 300 notify the physician
 Oral antidiabetic agents
o Used to treat Type 2 Diabetes
o Not used in pregnancy (woman must take insulin)
o Not used in type 1 diabetes
o How they work
 Stimulate pancreatic beta cells to secrete more insulin
 Increase tissue response to insulin
 Decrease in glucose production
o Special concerns (1st dose hypoglycemia, etc.)
 Criteria to go on oral antidiabetic
 Onset of diabetes mellitus at age 40 years or older
 Diagnosis of diabetes for less than five years
 Normal weight or overweight
 Fasting blood glucose 200 mg/dL or less
 Less than 40 units of insulin required per day
 Normal renal and hepatic function
o Patient teaching


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