NUR2474 Pharmacology for Professional Nursing – Examination Blue Print – Final Exam_ LATEST,100% CORRECT
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NUR2474 Pharmacology for Professional Nursing – Examination Blue Print – Final Exam_ LATEST
Insulin: DM 1, DM 2, Gestational Diabetes
HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH PRIORITY FOR TREATMENT
1. What types of insulin are ordered before meals and at bedtime? Lispro and Regula...
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NUR2474 Pharmacology for Professional Nursing –
Examination Blue Print – Final Exam_ LATEST
Insulin: DM 1, DM 2, Gestational Diabetes
HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH PRIORITY FOR TREATMENT
1. 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.
2. 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):
o 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.
o What diagnosis is it effective for (be specific)? Type 2, less than 5 years,
no end organ damage, young enough
o What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic,
o What are the side/adverse effects? Hypoglycemia, diarrhea.constipation,
nausea, vomiting, upset stomach, loss of appetite. Headache, weight gain,
o What are contraindications?
o low blood sugar.
o pituitary hormone deficiency.
o a condition where the adrenal glands produce less hormones called Addison's
disease.
o glucose-6-phosphate dehydrogenase (G6PD) deficiency.
o hepatic porphyria.
o a type of blood disorder where the red blood cells burst called hemolytic anemia.
o alcoholism.
o
,o Are there drug-drug interactions?
o Do not take if allergic to sulfa
o Are there drug-alcohol interactions? Do not take with alcohol
o Are there drug-food interactions? Take with breakfast
o Please note that this person will still need to be checking their BS at least
once a day
, Metformin
o 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.
o What diagnosis is it effective for (be specific)? Type 2, less than 5 years,
no end organ damage, young enough
o What classification(s) does it fit into? Oral hypoglycemic, Anti-diabetic
o 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.
o 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:
o 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
o What classification(s) does it fit into? alpha-glucosidase inhibitors, which
also includes miglitol (Glyset); anti-diabetic, oral hypoglycemic agent
o What are the side/adverse effects? Diarrhea
o What are contraindications? hypersensitivity, diabetic ketoacidosis, liver
cirrhosis, inflammatory bowel disease, or colonic ulceration
o Are there drug-drug interactions? Avoid taking a digestive enzyme such as
pancreatin, amylase, or lipase at the same time you take acarbose.
o Are there drug-alcohol interactions? Do not mix, it may cause sudden
hypoglycemia
o Are there drug-food interactions? No
grapefruit juice D50W Emergency Med Given IV
o How does it work? What diagnosis is it effective for (be specific)? Direct Sugar for
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