Pharmacology Exam 3 Anti-diabetics

Which is a rapid-acting insulin with an onset of action of less than 15 minutes?

A. insulin glargine (Lantus)
B. insulin aspart (NovoLog)
C. regular insulin (Humulin R)
D. insulin detemir (Levemir)

B. insulin aspart (NovoLog)

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?

A. insulin glargine (Lantus)
B. insulin glulisine (Apidra)
C. regular insulin (Humulin R)
D. NPH insulin

A. insulin glargine (Lantus)

Which insulin can be administered by continuous intravenous infusion?

A. insulin glargine (Lantus)
B. insulin aspart (NovoLog)
C. regular insulin (Humulin R)
D. insulin detemir (Levemir)

C. regular insulin (Humulin R)

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at what time?

A. 10:00 AM
B. 2:00 PM
C. 5:00 PM
D. 8:00 PM

C. 5:00 PM

Rationale: Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure?

A. acarbose (Precose)
B. metformin (Glucophage)
C. repaglinide (Prandin)
D. pioglitazone (Actos)

B. metformin (Glucophage)

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat?

A. acarbose (Precose)
B. metformin (Glucophage)
C. repaglinide (Prandin)
D. pioglitazone (Actos)

C. repaglinide (Prandin)

The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient?

A. “Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.”
B. “Mixing insulins will help increase insulin production.”
C. “Rotate sites at least once weekly.”
D. “Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption.”

A

The nurse would include which statement when teaching a patient about insulin glargine?

A. “You should inject this insulin just before meals because it is very fast acting.”
B. “The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day.”
C. “You can mix this insulin with NPH insulin to enhance its effects.”
D. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”

D

The nurse is providing education to a patient about the time to take glipizide (Glucotrol). For maximum benefit, the nurse will tell the patient to administer glipizide at which time?

A. In the morning
B. 30 minutes before a meal
C. 15 minutes postprandial
D. At bedtime

B. 30 minutes before a meal

The nurse will advise the patient to treat hypoglycemia with which drug?

A. propranolol (Inderal)
B. glucagon
C. acarbose (Precose)
D. bumetanide (Bumex)

B. glucagon

Side effects of Glucophage (metformin)
abdominal bloating, nausea, diarrhea, (GI upset) TAKE WITH MEALS

contraindications of Glucophage (metformin)
Renal disease and creatinine > than 1.5
CANNOT GIVE WITH IV CONTRAST!!

Glucophage (metformin)
– decreases glucose production by liver
– decreases intestinal absorption of glucose
– improves insulin receptors sensitivity

Sulfonylureas (Glipizide, glyburide, amaryl)
– binds to receptors of beta cells to stimulate release of insulin
– decreases secretion of glucagon

Side effects of Sulfonylureas
hypoglycemia, weight gain
MUST TAKE 30 MIN BEFORE MEAL (to warm up pancreas)

contraindications of Sulfonylureas
alcohol, use in elderly people, and allergy to sulfur

Glinides-Repaglinide (prandin)
Side effects, contraindications and action the same as Sulfonylureas only STRONGER.
Short duration of action

Thiazolidinedione-Pioglitazone (actos)
– decreases insulin resistance by increasing insulin receptors
– stimulates peripheral glucose uptake and storage
– inhibits glucose production in the liver

Side effects of actos
increased risk of heart failure, peripheral edema, weight gain, decreased bone density
TAKE WITH OR WITHOUT FOOD

contraindications of actos
heart failure, use caution with liver or kidney disease

Alpha-glucosidase inhibitor (precose)
– blocks enzyme that delays absorption of glucose
– reduces spike after meals

side effects of precose
abdominal pain, GI distress, flatulence, diarrhea, increased hepatic enzymes
MUST TAKE WITH 1ST BITE OF FOOD

contraindications of precose
Inflammatory Bowel Disease, intestinal obstruction, malabsorption syndrome

Which insulin can be given intravenously?
Regular acting insulin is the only type that can be administered through IV

If patient is on constant feeding tube, how often do you complete accuchecks?
q 4-6 hrs

Rapid Acting Insulin (Humalog, Novolog)
onset: 15 min
peak: 60-90 min
duration: 3-4 hrs

Short Acting Insulin (Humalin R)
onset: 30-60 min
peak: 2-4 hrs
duration: 5-8 hrs

Intermediate Acting Insulin (NPH)
onset: 2-4 hrs
peak: 4-8 hrs
duration: 10-16 hrs

Long Acting Insulin (Lantus)
onset: 1-2 hrs
peak: none (basal rate)
duration: 24+ hrs

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