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Final

NURS 310 Study Guide - Final Guide: Pharmacokinetics, Myopathy, Pramlintide

13 pages27 viewsFall 2017

Department
Nursing
Course Code
NURS 310
Professor
C
Study Guide
Final

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Chapter 28: Pharmacotherapy of Diabetes Mellitus
What are the pancreas function?
Glucose homeostasis and digestive enzymes
The most important disorder associated with pancreas
is
Diabetes mellitus
What causes diabetes?
1. Genetic factors
2. Environmental factors
Both of which impair the cellular use of glucose.
What type of gland is the pancreas, explain their
functions?
Endocrine:
- Islets of langerhans: secrets glucose and
insulin
- Alpha cells: secrete insulin
- Beta cells: secrete glucagon
Exocrine: secretion of several enzymes in the
duodenum, assisting in chemical digestion of nutrients
What does it release?
Insulin for elevated blood glucose levels
Glucagon for lowered blood glucose levels
What is an example of a negative feedback?
High insulin levels and falling blood glucose levels
provide negative feedback to the pancreas to stop
secreting insulin
What is insulins role in a cellular level?
It causes glucose to enter cells and be used as energy.
This causes the serum and blood glucose levels to fall.
What is a term for the effect insulin has on the blood
and serum levels?
Hypoglycemic effect
What is an exception of the hypoglycemic effect of
glucose on serum and blood?
The brain. It does not require insulin for glucose
transport
What is the effect that glucagon has from a cellular
level?
Hyperglycemic effect
Causes blood glucose to rise
Hyperglycemic hormones?
Hyperglycemic drugs?
Epinephrine, thyroid hormones, corticosteroids, growth
hormones
Phenytoin, nonsteroidal anti-inflammatory drugs,
diuretics
Hypoglycemic drugs?
Alcohol, lithium, ACE inhibitors and beta adrenergic
blockers
Diabetes is a disorder of which macronutrient?
Carbohydrate, it is important to understand way it
obtains, metabolizes, and stores glucose
What is the normal range for serum glucose during
fasting? Not fasting?
4-7mmol/L
5-8mmol/L
Where is two thirds of glucose stored?
Liver and muscle cells as glycogen
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What is glycogenolysis
Breakdown of glycogen into glucose
What are the physiological actions of insulin?
1. Promotes entry glucose into cells
2. Provides storage of glucose as glycogen
3. Inhibits breakdown of fat and glycogen
4. Increases protein synthesis and inhibits
gluconeogenesis
What is gluconeogenesis?
Production of new glucose from noncarbohydrate
molecules
What is diabetes mellitus?
It is a metabolic disease in which insulin sensitivity is
decreased OR decreased insulin secretion which
ultimately causes hyperglycemia.
Diabetes Mellitus includes
Type1, Type2, gestational diabetes and ohter types
What is the difference between Type1 and Type2?
Type1: lack of insulin secretion
Type2: lack of sensitivty for insulin on cell receptors
Both have serious chronic conditions affecting
cardiovascular and nervous system
Waht are the characterisitcs of Type1:
Accounts for 5-10% of all cases with diabetes
Most common diseases of childhood
Cause: Autoimmune destruction of pancreatic beta
cells causing lack of insulin secretion
Symptoms of Type1 of sustained hyperglycemia
Polyuria: excessive urination
Polyphagia: increased hunger
Polydipsia: increased thirst
Glucosuria: high levels of glucose in urine
Weight loss
Fatigue
Irritability
Blurred vision
What can happen of DM(type1) is untreated?
1. Damage to arteries: heart disease, stroke, kidney
disease, blindness.
2. Nerve degeneration: produces symptoms ranging
from tingling fingers or toes; complete loss of sensation
of a limb.
3. Glucose is unable to enter cells: lipids used as
energy, keto acids are produced as a by product. Keto
acids causes fruity odor. High levels of keto acids
lower pH causing diabetic ketoacidosis.
What is DKA? What causes it?
Diabetic Ketoacidosis
DKA caused by the lack of glucose being able to enter
cells for energy and therefore lipids are used. When
lipids are used the by product of lipid formation is
ketoic acid. High levels of ketoic acid lower the pH
causing DKA.
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Type 2 diabetes mellitus characteristics
Begins middle age
90 - 95% of diabetes are type 2
Adults and children who develop type 2 DM are
overweight and sedentary
Aboriginals are high risk for type 2
What does it mean to have insulin resistance?
When the receptors have become insensitive to the
hormone.
Proper diet and exercise can
Increase the sensitivity of insulin receptors
80% of people that have type 2 DM are
obese
What lab test is done for glucose control? What
does it tell you? What is a desirable level?
Glycosylated hemoglobin (A1C): estimates overall
glucose control a 3 month period.
A1C indicate percentage of hemoglobin to which
glucose has become bound (glycosylation).
A1C levels are found in people with elevated blood
glucose.
As exposure to glucose increases percentage of A1C
increases.
Less than 7% of A1C is desirable to prevent
complications
Type 1 diabetes is treated by
Exercise, dietary restrictions and insulin injections
Administering insulin when glucose is not available
can cause
Hypoglycemia and coma
There are several types of insulin available differing in
source, onset and duration of action
Subcutaneous injection
Insulin Pumps
Dry powder inhalers
What is the best type of insulin?
Human insulin is more effective, fewer allergies and
lower incidence of resistance
What are individualized for each pt. With insulin?
Doses and Routes
What is a fundamental principle about insulin therapy?
Right amount of insulin must be available to cells when
glucose is present
What is a Somogyi phenomenon?
1. Rapid decrease in blood glucose during night.
2. Stimulates release of hormones that elevate blood
glucose: epinephrine, cortisol, glucagon
3. Elevated glucose level in the morning
Nursing Consideration for Insulin Therapy
1. Monitor + education
2. Be familiar with onset, peak and duration of action
3. Assess client's level of understanding for insulin
reaction, hypoglycemia and DKA
4. NPH or regular insulin
- NPH: 30 mins before first meal
- Regular:
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