NURS 5334 EXAM 3 QUESTIONS & ANSWERS, ALL 100% CORRECT.

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NURS 5334 EXAM 3 QUESTIONS & ANSWERS, ALL 100% CORRECT.What drugs are used to treat gestational diabetes? o Metformin and Insulin  What A1C value indicates diabetes mellitus? Pre-DM? o 6.5% or g... reater is considered diabetes o 5.7-6.4% pre-diabetes  What fasting and random values indicate DM? o Fasting plasma glucose—126 or greater is diabetes o Random (casual) plasma glucose—anything greater than 200 is diabetes  What are complications of insulin therapy? o Hypoglycemia o Can develop lipohypertrophy  Accumulation of subcutaneous fat that occurs when it is injected too frequently at the same site o Allergic reactions  Characterized by red and intensely itchy welts, breathing becomes difficult  If severe allergy develops:  Desensitization procedure (small doses to larger doses) o 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? o Hypoglycemic agents  Can intensify the hypoglycemia included by insulin  Examples: sulfonylureas, glinides, alcohol o Use with caution with hyperglycemic agents  Examples: thiazide and glucocorticoids and sympathomimetics  What effect do beta blockers have on insulin? o delay awareness of and response to hypoglycemia by masking the signs that are associated with stimulation of sympathetic nervous system o Impair glycogenolysis o Prevent the bodies counter-regulatory response  What are other therapeutic uses besides DM? o Hyperkalemia o Aids in diagnosis of GH deficiency o Diabetic ketoacidosis  Insulin dosage must be coordinated with what? o Carbohydrate intake  What is B/P goal in diabetic? o To be controlled, within normal 120/80  What medication can be given to decrease risk of diabetic nephropathy? o ACE inhibitor or ARB 1  What role does exercise play in treatment of both type 1 and type 2 DM? o Exercise increases cellular responsiveness to insulin and increases glucose tolerance o 150 minute per week of moderate intensity exercise is recommended  What are the 4 steps in the 4-step approach? o Step 1—diagnosis  Lifestyle changes plus metformin o 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 o Step 3  Three drug combination  Metformin  Plus 2 other drugs from step 2 o Decided based on a drug and patient specific considerations o 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? o Before meals—70-130 o Bedtime—100-140  What is the A1C goal? When is goal below 7 not appropriate? o 7% or below o 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] o Intermediate duration  Neutral protamine Hagedorn (NPH) insulin  Insulin detemir [Levemir] o Long duration  Insulin glargine  When are short duration insulins used? 2 o Administered in association with meals to control the post-prandial rise in blood glucose between meals and at night  When are intermediate insulins needed? o Administer 2-3 times daily to provide glycemic control between meals and during the night  How long is duration of glargine? Levemir? Degludec? o Glargine—up to 24 hours o Levemir  Low dose (0.2 units/kg)—12 hours  High doses (0.4 units/kg)—20-24 hours o Degludec—up to 42 hours  What are routes of administration? Which can be inhaled? o SQ injection o IV infusion o Inhalation—Afrezza, mealtime insulin  What is typical dosing for type 1? Type 2? o Total doses may range from 0.1 unit/kg body weight to more than 2.5 units/kg o Type 1  Initial doses typically range from 0.5-0.6 units/kg per day o 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? o Twice daily dosing o Intensive basal/bolus strategy o Continued subcutaneous insulin [Show More]

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