NUR 2474 Pharmacology for Professional Nursing

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Final Exam Blueprint

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.

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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.

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*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).

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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.

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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.

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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

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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

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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

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