CNUR 300 Study Guide with 100% Complete Solutions
The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just
after the injection, the dietary department calls to inform the patient care unit that breakfast
trays will be 45 minutes late. What will the nurse do next?
A.Give the patient food, such as cereal and skim milk, and juice.
Rationale: Lispro insulin's onset of action is 15 minutes. It is essential that a patient with DM
eat a meal after injection. Otherwise, profound hypoglycemia may result.
A woman who has type 2 DM is now pregnant. She wants to know whether to take her oral
antidiabetic medication. What instructions will she receive?
A.She will be switched to insulin therapy while she is pregnant.
Rationale: Oral antidiabetic medications are generally not recommended for pregnant patients
because of a lack of firm safety data. Insulin therapy is the currently recommended drug
therapy for pregnant women.
basal-bolus insulin dosing
preferred method of treatment for hospitalized pts with DM
- basal insulin is long acting
- bolus insulin - meal bolus covers food, hold bolus if NPO
drug classes for diabetes
biguanides
thiazolidinediones
alpha-glucosidase inhibitors
sulfonylureas
meglitinides
SGLT2 inhibitors
incretin mimetics
biguanides
,metformin (glucophage)
- site of action: liver
- MOA: decrease insulin resistance, intestinal absorption of glucose, and hepatic
glucose production
- benefits: does not promote weight gain, low risk hypoglycemia, potential cancer risk reduction
- start low go slow
side effects/contraindications of biguanides
GI - nausea, bloating, diarrhea or loss of appetite
Metalic taste, hypoglycemia, reduction in B12
lactic acidosis
contraindicated in pts with kindey disease, liver failure, alcoholism, pts undergoing tests or
procedures requiring fasting or iodine dye
thiozolidinediones
- site of action: fat, muscle, liver
- MOA: decrease insulin resistance thereby muscle cells more sensitive to insulin, increase
glucose uptake and use in skeletal muscle, inhibit glucose and triglyceride production in
the liver
side effects/contraindications of thiozolidinediones
side effects - water retention, swelling of the feet and ankles, especially in the elderly,
weight gain, muscle weakness, fatigue, hepatic toxicity
contraindicated: liver disease, cardiomegaly, CHF, pregnancy, significant edema
sulfonylureas
glipizide
- site of action: pancreas
- MOA: stimulate secretion of more insulni from the beta cells, improve sensitivity to insulin
in the tissues
, - decrease in the use of this class because tey may increase beta cell destruction
side effects/contrainications sulfonylureas
side effects - hypoglycemia, bloating, nausea, heartburn, and sun sensitivity
contraindicated - sulfa allergy, type 1 diabetes, advances liver or kidney disease
use with caution in elderly - may cause hypoglycemia
meglitinides
- site of action: pancreas
- MOA: stimulates secretion of more insulin from the beta cells, improve sensitivity to insulin
in tissues, much like sulfonylureas but are shorter in action
- must be taken 30 minutes before meals
side effects/contraindications meglitinides
The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just
after the injection, the dietary department calls to inform the patient care unit that breakfast
trays will be 45 minutes late. What will the nurse do next?
A.Give the patient food, such as cereal and skim milk, and juice.
Rationale: Lispro insulin's onset of action is 15 minutes. It is essential that a patient with DM
eat a meal after injection. Otherwise, profound hypoglycemia may result.
A woman who has type 2 DM is now pregnant. She wants to know whether to take her oral
antidiabetic medication. What instructions will she receive?
A.She will be switched to insulin therapy while she is pregnant.
Rationale: Oral antidiabetic medications are generally not recommended for pregnant patients
because of a lack of firm safety data. Insulin therapy is the currently recommended drug
therapy for pregnant women.
basal-bolus insulin dosing
preferred method of treatment for hospitalized pts with DM
- basal insulin is long acting
- bolus insulin - meal bolus covers food, hold bolus if NPO
drug classes for diabetes
biguanides
thiazolidinediones
alpha-glucosidase inhibitors
sulfonylureas
meglitinides
SGLT2 inhibitors
incretin mimetics
biguanides
,metformin (glucophage)
- site of action: liver
- MOA: decrease insulin resistance, intestinal absorption of glucose, and hepatic
glucose production
- benefits: does not promote weight gain, low risk hypoglycemia, potential cancer risk reduction
- start low go slow
side effects/contraindications of biguanides
GI - nausea, bloating, diarrhea or loss of appetite
Metalic taste, hypoglycemia, reduction in B12
lactic acidosis
contraindicated in pts with kindey disease, liver failure, alcoholism, pts undergoing tests or
procedures requiring fasting or iodine dye
thiozolidinediones
- site of action: fat, muscle, liver
- MOA: decrease insulin resistance thereby muscle cells more sensitive to insulin, increase
glucose uptake and use in skeletal muscle, inhibit glucose and triglyceride production in
the liver
side effects/contraindications of thiozolidinediones
side effects - water retention, swelling of the feet and ankles, especially in the elderly,
weight gain, muscle weakness, fatigue, hepatic toxicity
contraindicated: liver disease, cardiomegaly, CHF, pregnancy, significant edema
sulfonylureas
glipizide
- site of action: pancreas
- MOA: stimulate secretion of more insulni from the beta cells, improve sensitivity to insulin
in the tissues
, - decrease in the use of this class because tey may increase beta cell destruction
side effects/contrainications sulfonylureas
side effects - hypoglycemia, bloating, nausea, heartburn, and sun sensitivity
contraindicated - sulfa allergy, type 1 diabetes, advances liver or kidney disease
use with caution in elderly - may cause hypoglycemia
meglitinides
- site of action: pancreas
- MOA: stimulates secretion of more insulin from the beta cells, improve sensitivity to insulin
in tissues, much like sulfonylureas but are shorter in action
- must be taken 30 minutes before meals
side effects/contraindications meglitinides
