NURS 5334 Antimicrobial Exam – 2025 Exam 2 (Verified)
What drugs are used to treat gestational diabetes? - Metformin abd Insulin
What A1C value indicates diabetes mellitus? Pre-DM? - 6.5% or greater is considered diabetes o 5.7-
6.4%pre-diabetes
What fasting and random values indicate DM? - Fasting plasma glucose—126 or greater is diabetes.
Random (casual) plasma glucose—anything greater than 200 is diabetes
What are complications of insulin therapy? - Hypoglycemia
Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when it is injected too
frequently at the same site. Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses). 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
insulin drug interactions - o Hypoglycemicagents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides, alcohol o Usewithcautionwithhyperglycemicagents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin? - delay awareness of and response to hypoglycemia by
masking the signs that are associated with stimulation of sympathetic nervous system
o Impairglycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM? - Hyperkalemia o Aids in diagnosis of GH deficiency o
Diabeticketoacidosis
Insulin dosage must be coordinated with what? - 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? - ACE inhibitor or ARB
What role does exercise play in treatment of both type 1 and type 2 DM? - 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? - Step1—diagnosis
Lifestyle changes plus metformin o Step2
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 Step3
Three drug combination
Metformin
Plus 2 other drugs from step 2
o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
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? -
Beforemeals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate? - 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? - Shortduration:Rapidacting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine [Apidra] o Shortduration:Sloweracting
Regular insulin [Humulin R, Novolin R] o Intermediateduration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir] o Longduration
Insulin glargine
When are short duration insulins used? - Administered in association with meals to control the post-
prandial rise in blood glucose between meals and at night
When are intermediate insulins needed? - Administer 2-3 times daily to provide glycemic control
between meals and during the
night
How long is duration of glargine? Levemir? Degludec? - 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? - SQ injection IV infusion. Inhalation—
Afrezza, meal time insulin
Typical insulin dosing for type 1? Type 2? - Total doses may range from 0.1 unit/kg body weight to
more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
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 livero Reduces glucose absorption
in the guto Sensitizes insulin receptors in target tissues (fat and skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
Metformin What are side effects? BB warning? - o GI effects—diarrhea
o Lactic acidosis
How does alcohol effect? - 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]
Tolbutamine [Orinase]
o Second Generation:
Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
MOA?
~~~~~~~~~~~~
Main side effect? - Promote insulin release
~~~~~~~~
Hypoglycemia
Weight gain
How does cimetidine effect? Beta blocker? - Cimetidine—intensifies the response
What drugs are used to treat gestational diabetes? - Metformin abd Insulin
What A1C value indicates diabetes mellitus? Pre-DM? - 6.5% or greater is considered diabetes o 5.7-
6.4%pre-diabetes
What fasting and random values indicate DM? - Fasting plasma glucose—126 or greater is diabetes.
Random (casual) plasma glucose—anything greater than 200 is diabetes
What are complications of insulin therapy? - Hypoglycemia
Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when it is injected too
frequently at the same site. Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses). 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
insulin drug interactions - o Hypoglycemicagents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides, alcohol o Usewithcautionwithhyperglycemicagents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin? - delay awareness of and response to hypoglycemia by
masking the signs that are associated with stimulation of sympathetic nervous system
o Impairglycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM? - Hyperkalemia o Aids in diagnosis of GH deficiency o
Diabeticketoacidosis
Insulin dosage must be coordinated with what? - 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? - ACE inhibitor or ARB
What role does exercise play in treatment of both type 1 and type 2 DM? - 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? - Step1—diagnosis
Lifestyle changes plus metformin o Step2
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 Step3
Three drug combination
Metformin
Plus 2 other drugs from step 2
o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
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? -
Beforemeals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate? - 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? - Shortduration:Rapidacting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine [Apidra] o Shortduration:Sloweracting
Regular insulin [Humulin R, Novolin R] o Intermediateduration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir] o Longduration
Insulin glargine
When are short duration insulins used? - Administered in association with meals to control the post-
prandial rise in blood glucose between meals and at night
When are intermediate insulins needed? - Administer 2-3 times daily to provide glycemic control
between meals and during the
night
How long is duration of glargine? Levemir? Degludec? - 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? - SQ injection IV infusion. Inhalation—
Afrezza, meal time insulin
Typical insulin dosing for type 1? Type 2? - Total doses may range from 0.1 unit/kg body weight to
more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
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 livero Reduces glucose absorption
in the guto Sensitizes insulin receptors in target tissues (fat and skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
Metformin What are side effects? BB warning? - o GI effects—diarrhea
o Lactic acidosis
How does alcohol effect? - 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]
Tolbutamine [Orinase]
o Second Generation:
Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
MOA?
~~~~~~~~~~~~
Main side effect? - Promote insulin release
~~~~~~~~
Hypoglycemia
Weight gain
How does cimetidine effect? Beta blocker? - Cimetidine—intensifies the response
