NURS 5334 EXAM 3 LATEST -

NURS 5334 EXAM 3 LATEST -

QUESTIONS AND CORRECT DETAILED ANSWERS (100%

VERIFIED ANSWERS) ||ALREADY GRADED A+

• What drugs are used to treat gestational diabetes?

• Metformin and Insulin

• What A1C value indicates diabetes mellitus? Pre-DM?

• 6.5% or greater is considered diabetes
• 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 • Drug interactions?

• Hypoglycemic agents

▪ Can intensify the hypoglycemia included by insulin

▪ Examples: sulfonylureas, glinides, alcohol

• Use with caution with hyperglycemic agents

▪ 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

• Impair glycogenolysis
• Prevent the bodies counter-regulatory response

• What are other therapeutic uses besides DM?

• Hyperkalemia
• Aids in diagnosis of GH deficiency
• Diabetic ketoacidosis

• Insulin dosage must be coordinated with what?

• Carbohydrate intake

• What is B/P goal in diabetic?

• To be controlled, within normal 120/80

• What medication can be given to decrease risk of diabetic nephropathy?

• ACE inhibitor or ARB 1 / 4

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• 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
• 150 minute per week of moderate intensity exercise is recommended

• What are the 4 steps in the 4-step approach?

• Step 1—diagnosis

▪ Lifestyle changes plus metformin

• Step 2

▪ 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

• Step 3

▪ Three drug combination • Metformin • Plus 2 other drugs from step 2

• Decided based on a drug and patient specific considerations
• Step 4

▪ 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?

• Before meals—70-130
• Bedtime—100-140

• What is the A1C goal? When is goal below 7 not appropriate?

• 7% or below
• 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?

o Short duration: Rapid acting

▪ Insulin lispro [Humalog] ▪ Insulin aspart [NovoLog] ▪ Insulin glulisine [Apidra]

o Short duration: Slower acting

▪ Regular insulin [Humulin R, Novolin R]

• Intermediate duration

▪ Neutral protamine Hagedorn (NPH) insulin ▪ Insulin detemir [Levemir]

• Long duration

▪ Insulin glargine • When are short duration insulins used?

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• 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
• Levemir

▪ Low dose (0.2 units/kg)—12 hours ▪ High doses (0.4 units/kg)—20-24 hours

• Degludec—up to 42 hours

• What are routes of administration? Which can be inhaled?

• SQ injection
• IV infusion
• Inhalation—Afrezza, mealtime insulin

• What is typical dosing for type 1? Type 2?

• Total doses may range from 0.1 unit/kg body weight to more than 2.5 units/kg
• Type 1

▪ Initial doses typically range from 0.5-0.6 units/kg per day

• Type 2

▪ 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?

• Twice daily dosing
• Intensive basal/bolus strategy
• Continued subcutaneous insulin

• How does metformin work?

• Inhibits glucose production in the liver
• Reduces glucose absorption in the gut
• Sensitizes insulin receptors in target tissues (fat and skeletal muscle) thus increase

glucose uptake and response to whatever insulin is available • What are side effects? BB warning?

• GI effects—diarrhea
• Lactic acidosis

• How does alcohol effect?

• Inhibits the breakdown of lactic acid

• What are the therapeutic uses other than DM?

• Gestational diabetes
• PCOS

• Sulfonylureas

• First generation

▪ Chlorpropamide [Diabinese] ▪ Tolazamide [Tolinase]

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