NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
1. Glycemic Goals in As with type 1 diabetes, preventing long-term complications requires a com-
Type 2 Diabetes prehensive treatment plan. Lifestyle measures (diet and physical activity) and
drug therapy are the foundation of glycemic control. Physical activity provides
the additional benefit of promoting glucose uptake by muscle, even when in-
sulin levels are low. In addition to glycemic control, the plan should address
other factors that can increase morbidity and mortality. Accordingly, all patients
should be screened and treated for hypertension, nephropathy, retinopathy, and
neuropathy. In addition, dyslipidemias (high LDL cholesterol, low high-density
lipoprotein [HDL] cholesterol, and high triglycerides) should be corrected
2. Diabetic monitor glucose levels
Nephropathy treatment intervention for diabetes
Prevention
3. 1st generation vs Second-generation drugs being more commonly used due to their increased
2nd generation potency and shorter duration of action.
Sulfonylurea
4. DDP4I: Adverse Upper Respiratory Infections - The most common side effect of DDP-4 inhibitors.
Effects Pancreatitis-Rarely, manifested by abdominal pain and vomiting.
Hypersensitivity- cause various reactions, including anaphylaxis, angioedema, or
Stevens-Johnson syndrome.
5. DDP4I: MOA Inhibiting the dipeptidyl peptidase-4 enzyme, which results in the prolonged
activity of incretin hormones. Incretins help increase insulin release in response to
meals and decrease hepatic glucose production without directly releasing insulin.
6. GLP-1 receptor Exenatide is an incretin mimetic that acts by activating GLP-1 receptors like
agonists: MOA endogenous incretin hormones, leading to slowed gastric emptying and insulin
release, inhibited postprandial glucagon release, and suppressed appetite. These
actions collectively improve glucose control and can induce weight loss.
7.
, NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
GLP-1 receptor Basic Metabolic Panel (BMP)
agonists: Moni- Regular monitoring of kidney function and blood glucose levels is recommended
toring to adjust dosing accordingly.
Hemoglobin A1c
Monitoring hemoglobin A1c will provide information on the effectiveness of the
treatment regimen.
8. Glycemic Control Fasting and premeal: The American Diabetes Association (ADA) recommends
Targets a target of 80-130 mg/dL. The American College of Endocrinologists and the
International Diabetes Federation recommend a target of <110 mg/dL and 100
mg/dL, respectively.
Postmeal: The ADA recommends a target of <180 mg/dL, measured 1-2 hours
after the start of a meal. The American College of Endocrinologists and the
International Diabetes Federation recommend a target of <140 mg/dL.
HbA1c: The general target for glycemic control is an HbA1c d7%.
9. Incretin Mimetics Category: Glucagon-like Peptide-1 (GLP-1) Receptor Agonists, Incretin Mimetic
(Non-insulin Injectable)
Primary Function: GLP-1 receptor agonists, also known as incretin mimetics, repli-
cate the effects of the incretin hormone GLP-1, released from the gastrointestinal
tract cells after a meal to help control blood glucose levels. They can be used alone
or in combination with other medications for diabetes.
Unique Features: GLP-1 receptor agonists are non-insulin injectable medications
injected subcutaneously. They have also recently been studied and prescribed for
weight management in clients without diabetes due to their ability to decrease
food consumption, appetite, and hinger, while increasing sensations of fullness
and satiety.
10. Incretin Mimetics Metformin and glyburide have been used during pregnancy. However, insulin
in Pregnancy is preferred as it does not cross the placenta or enter breast milk in significant
amounts.
, NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
Previously classified as a Pregnancy Risk Category C agent: Providers should weigh
the risks and benefits.
11. Meglitinides vs main difference between the glinides and the sulfonylureas is their pharmacoki-
sulfonylureas netic profile—the glinides are shorter acting and are taken with each meal. Only
two glinides are available: repaglinide and nateglinide.
Sulfonylureas act primarily by stimulating the release of insulin from pancreatic
islets. If the pancreas is incapable of insulin synthesis, sulfonylureas will be
ineffective—which is why they do not work in patients with type 1 diabetes. With
prolonged use, sulfonylureas may increase target cell sensitivity to insulin.
12. Biguanides Met- First, it inhibits glucose production in the liver. Second, it reduces (slightly) glucose
formin: MOA absorption in the gut. And third, it sensitizes insulin receptors in target tissues
(fat and skeletal muscle) and thereby increases glucose uptake in response to
whatever insulin may be available. In contrast to the sulfonylureas (see later),
metformin does not stimulate insulin release from the pancreas. As a result,
metformin does not actively drive blood glucose levels down and hence poses
little if any added risk for hypoglycemia when used alone.
13. Metformin: Preg- In women taking an oral drug for type 2 diabetes, current practice is to discontinue
nancy the oral drug and switch to insulin. The only exception is the oral agent metformin,
which is often satisfactory for managing type 2 diabetes in pregnancy. Women
who discontinue oral medications can resume oral therapy after delivery.
14. Metformin: Side GI Disturbances - can cause nausea, diarrhea, and decreased appetite.
Effects Altered Nutrient Absorption - can cause decreased absorption of vitamin B12 and
folic acid, potentially leading to pernicious anemia.
Metabolic Acidosis - has a black box warning of this severe side effect, with clients
with renal impairment particularly at risk.
15. Most common reactions are upper respiratory tract infection, headache, sinusitis,
and myalgia.
, NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
pioglitazone
(TZD): Adverse Associated with heart failure (HF) secondary to renal retention of fluid. If HF is
Effects diagnosed, pioglitazone should be discontinued or used in reduced dosage.
16. pioglitazone Thiazolidinediones activate the peroxisome proliferator-activated receptor gam-
(TZD): MOA ma (PPAR gamma) in the cell nucleus, which activates insulin-responsive genes
regulating carbohydrate and lipid metabolism. This activation increases cellular
insulin sensitivity, especially in skeletal muscle and adipose cells, and mildly
reduces liver glucose production.
17. Repaglinide hypoglycemia. In patients with liver dysfunction, metabolism of repaglinide may
(Meglitinide): pt be slowed, and hence the risk for hypoglycemia may be increased. Because of
education possible hypoglycemia, it is imperative that patients eat no later than 30 minutes
after taking the drug.
18. SGLT-2 in- Urinary Tract Infections - These infections are caused by increased glucose in the
hibitors: Adverse urine since certain bacteria thrive in those conditions.
Effects Genital Fungal Infections - These infections can be complicated to treat and stem
from increased glucose in the urine. Females are particularly affected.
Orthostatic Hypotension - This drop in blood pressure occurs with position change
and can also involve dizziness, especially in older adults and when used with
diuretics.
19. SGLT-2 in- Work by blocking the reabsorption of glucose in the kidneys. By targeting the
hibitors: MOA SGLT-2 transporter in the kidneys, responsible for approximately 90% of glu-
cose reabsorption, these inhibitors facilitate increased urinary glucose excretion,
thereby improving glycemic control and offering the added benefit of weight loss
due to caloric loss.
20. SGLT-2 in- Primary Function: SGLT-2 inhibitors lower blood glucose levels in adults with
hibitors: Thera- type 2 diabetes by promoting glucose excretion in the urine. They can also be
peutic Goal added to the treatment regimen of clients who are overweight or have a risk of
Study online at https://quizlet.com/_g4vumf
1. Glycemic Goals in As with type 1 diabetes, preventing long-term complications requires a com-
Type 2 Diabetes prehensive treatment plan. Lifestyle measures (diet and physical activity) and
drug therapy are the foundation of glycemic control. Physical activity provides
the additional benefit of promoting glucose uptake by muscle, even when in-
sulin levels are low. In addition to glycemic control, the plan should address
other factors that can increase morbidity and mortality. Accordingly, all patients
should be screened and treated for hypertension, nephropathy, retinopathy, and
neuropathy. In addition, dyslipidemias (high LDL cholesterol, low high-density
lipoprotein [HDL] cholesterol, and high triglycerides) should be corrected
2. Diabetic monitor glucose levels
Nephropathy treatment intervention for diabetes
Prevention
3. 1st generation vs Second-generation drugs being more commonly used due to their increased
2nd generation potency and shorter duration of action.
Sulfonylurea
4. DDP4I: Adverse Upper Respiratory Infections - The most common side effect of DDP-4 inhibitors.
Effects Pancreatitis-Rarely, manifested by abdominal pain and vomiting.
Hypersensitivity- cause various reactions, including anaphylaxis, angioedema, or
Stevens-Johnson syndrome.
5. DDP4I: MOA Inhibiting the dipeptidyl peptidase-4 enzyme, which results in the prolonged
activity of incretin hormones. Incretins help increase insulin release in response to
meals and decrease hepatic glucose production without directly releasing insulin.
6. GLP-1 receptor Exenatide is an incretin mimetic that acts by activating GLP-1 receptors like
agonists: MOA endogenous incretin hormones, leading to slowed gastric emptying and insulin
release, inhibited postprandial glucagon release, and suppressed appetite. These
actions collectively improve glucose control and can induce weight loss.
7.
, NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
GLP-1 receptor Basic Metabolic Panel (BMP)
agonists: Moni- Regular monitoring of kidney function and blood glucose levels is recommended
toring to adjust dosing accordingly.
Hemoglobin A1c
Monitoring hemoglobin A1c will provide information on the effectiveness of the
treatment regimen.
8. Glycemic Control Fasting and premeal: The American Diabetes Association (ADA) recommends
Targets a target of 80-130 mg/dL. The American College of Endocrinologists and the
International Diabetes Federation recommend a target of <110 mg/dL and 100
mg/dL, respectively.
Postmeal: The ADA recommends a target of <180 mg/dL, measured 1-2 hours
after the start of a meal. The American College of Endocrinologists and the
International Diabetes Federation recommend a target of <140 mg/dL.
HbA1c: The general target for glycemic control is an HbA1c d7%.
9. Incretin Mimetics Category: Glucagon-like Peptide-1 (GLP-1) Receptor Agonists, Incretin Mimetic
(Non-insulin Injectable)
Primary Function: GLP-1 receptor agonists, also known as incretin mimetics, repli-
cate the effects of the incretin hormone GLP-1, released from the gastrointestinal
tract cells after a meal to help control blood glucose levels. They can be used alone
or in combination with other medications for diabetes.
Unique Features: GLP-1 receptor agonists are non-insulin injectable medications
injected subcutaneously. They have also recently been studied and prescribed for
weight management in clients without diabetes due to their ability to decrease
food consumption, appetite, and hinger, while increasing sensations of fullness
and satiety.
10. Incretin Mimetics Metformin and glyburide have been used during pregnancy. However, insulin
in Pregnancy is preferred as it does not cross the placenta or enter breast milk in significant
amounts.
, NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
Previously classified as a Pregnancy Risk Category C agent: Providers should weigh
the risks and benefits.
11. Meglitinides vs main difference between the glinides and the sulfonylureas is their pharmacoki-
sulfonylureas netic profile—the glinides are shorter acting and are taken with each meal. Only
two glinides are available: repaglinide and nateglinide.
Sulfonylureas act primarily by stimulating the release of insulin from pancreatic
islets. If the pancreas is incapable of insulin synthesis, sulfonylureas will be
ineffective—which is why they do not work in patients with type 1 diabetes. With
prolonged use, sulfonylureas may increase target cell sensitivity to insulin.
12. Biguanides Met- First, it inhibits glucose production in the liver. Second, it reduces (slightly) glucose
formin: MOA absorption in the gut. And third, it sensitizes insulin receptors in target tissues
(fat and skeletal muscle) and thereby increases glucose uptake in response to
whatever insulin may be available. In contrast to the sulfonylureas (see later),
metformin does not stimulate insulin release from the pancreas. As a result,
metformin does not actively drive blood glucose levels down and hence poses
little if any added risk for hypoglycemia when used alone.
13. Metformin: Preg- In women taking an oral drug for type 2 diabetes, current practice is to discontinue
nancy the oral drug and switch to insulin. The only exception is the oral agent metformin,
which is often satisfactory for managing type 2 diabetes in pregnancy. Women
who discontinue oral medications can resume oral therapy after delivery.
14. Metformin: Side GI Disturbances - can cause nausea, diarrhea, and decreased appetite.
Effects Altered Nutrient Absorption - can cause decreased absorption of vitamin B12 and
folic acid, potentially leading to pernicious anemia.
Metabolic Acidosis - has a black box warning of this severe side effect, with clients
with renal impairment particularly at risk.
15. Most common reactions are upper respiratory tract infection, headache, sinusitis,
and myalgia.
, NUR 565 exam 2
Study online at https://quizlet.com/_g4vumf
pioglitazone
(TZD): Adverse Associated with heart failure (HF) secondary to renal retention of fluid. If HF is
Effects diagnosed, pioglitazone should be discontinued or used in reduced dosage.
16. pioglitazone Thiazolidinediones activate the peroxisome proliferator-activated receptor gam-
(TZD): MOA ma (PPAR gamma) in the cell nucleus, which activates insulin-responsive genes
regulating carbohydrate and lipid metabolism. This activation increases cellular
insulin sensitivity, especially in skeletal muscle and adipose cells, and mildly
reduces liver glucose production.
17. Repaglinide hypoglycemia. In patients with liver dysfunction, metabolism of repaglinide may
(Meglitinide): pt be slowed, and hence the risk for hypoglycemia may be increased. Because of
education possible hypoglycemia, it is imperative that patients eat no later than 30 minutes
after taking the drug.
18. SGLT-2 in- Urinary Tract Infections - These infections are caused by increased glucose in the
hibitors: Adverse urine since certain bacteria thrive in those conditions.
Effects Genital Fungal Infections - These infections can be complicated to treat and stem
from increased glucose in the urine. Females are particularly affected.
Orthostatic Hypotension - This drop in blood pressure occurs with position change
and can also involve dizziness, especially in older adults and when used with
diuretics.
19. SGLT-2 in- Work by blocking the reabsorption of glucose in the kidneys. By targeting the
hibitors: MOA SGLT-2 transporter in the kidneys, responsible for approximately 90% of glu-
cose reabsorption, these inhibitors facilitate increased urinary glucose excretion,
thereby improving glycemic control and offering the added benefit of weight loss
due to caloric loss.
20. SGLT-2 in- Primary Function: SGLT-2 inhibitors lower blood glucose levels in adults with
hibitors: Thera- type 2 diabetes by promoting glucose excretion in the urine. They can also be
peutic Goal added to the treatment regimen of clients who are overweight or have a risk of
