1
Q
What is the role of the pancreas?
A
The pancreas produces insulin, which allows glucose to enter cells for energy or storage. Without insulin, glucose builds up in the blood (hyperglycemia), leading to complications.
2
Q
What is Type 1 Diabetes (T1D)?
A
An autoimmune disorder where the body destroys the beta cells in the pancreas that make insulin. It results in little to no insulin production, causing glucose to remain in the blood.
3
Q
What are the classic symptoms of Type 1 Diabetes?
A
Classic symptoms include polyuria (excess urination), polydipsia (thirst), polyphagia (hunger), weight loss, and dehydration.
4
Q
What is the treatment for Type 1 Diabetes?
A
Requires lifelong insulin therapy (injections or pump).
5
Q
What percentage of diabetes cases does Type 1 Diabetes account for?
A
Accounts for less than 10% of cases.
6
Q
What is Type 2 Diabetes (T2D)?
A
Type 2 Diabetes accounts for 90–95% of all diabetes cases and is caused by insulin resistance and insulin deficiency.
7
Q
What are the associated complications of Type 2 Diabetes?
A
Complications include dyslipidemia (abnormal levels of fats in blood), hypertension, kidney damage, nerve damage, and poor wound healing.
8
Q
What lifestyle factors are linked to Type 2 Diabetes?
A
Closely linked with obesity, metabolic syndrome, and cardiovascular disease.
9
Q
What is the treatment for Type 2 Diabetes?
A
Treatment includes lifestyle changes (diet, exercise, weight management), oral drugs, and sometimes insulin.
10
Q
What targets are set for managing Type 2 Diabetes according to Diabetes Canada 2018?
A
Blood pressure < 130/80 mmHg and LDL cholesterol < 2.0 mmol/L (or ≥50% reduction from baseline).
11
Q
What is Gestational Diabetes (GDM)?
A
Develops during pregnancy due to hormone-induced insulin resistance, increasing risks for both mother and baby.
12
Q
What are the risks associated with Gestational Diabetes?
A
Increases risks for larger birth weight and higher risk of type 2 diabetes later in life.
13
Q
Does Gestational Diabetes resolve after delivery?
A
Usually resolves after delivery but requires monitoring and sometimes insulin or diet control.
14
Q
What is the goal of antidiabetic medications?
A
To maintain blood glucose (BG) within a normal range (normoglycemia) and prevent both hyperglycemia (too high) and hypoglycemia (too low).
15
Q
What does A1C measure?
A
A1C measures average blood glucose over 2–3 months based on RBC lifespan.
16
Q
What is the A1C goal for most adults with diabetes?
A
The goal is ≤ 7%.
17
Q
What is the contribution of the past 30 days to A1C results?
A
Approximately 50% of the A1C result comes from the past 30 days.
18
Q
What A1C level is diagnostic of diabetes?
A
A1C ≥ 6.5% is diagnostic of diabetes.
19
Q
What is the more lenient A1C target for frail older adults?
A
A more lenient target of 7–8.5% may be used.
20
Q
What are the fasting/pre-meal blood glucose targets according to Diabetes Canada?
A
The target is 4–7 mmol/L.
21
Q
What are the 2-hour postprandial blood glucose targets?
A
The target is 5–10 mmol/L.
22
Q
How is hypoglycemia defined?
A
Hypoglycemia is defined as ≤ 4 mmol/L.
23
Q
Why do fasting glucose and post-meal glucose targets matter?
A
Fasting glucose reflects baseline control, while post-meal glucose shows how well the body handles sugar intake and treatment effectiveness.
24
Q
What is the treatment approach for Type 1 Diabetes?
A
Type 1 Diabetes requires insulin therapy to reach glycemic targets.
25
What is the treatment approach for Type 2 Diabetes?
Type 2 Diabetes treatment progresses from lifestyle changes to oral drugs, and then to injectables/insulin if needed.
26
What is the aim of all antidiabetic drugs?
All antidiabetic drugs aim to keep the patient in a safe glycemic range (euglycemia).
27
What is the role of insulin in the body?
Insulin is the 'key' that opens the door for glucose to move from the blood into body cells.
28
What happens in Type 1 diabetes?
The pancreas makes little to no insulin, resulting in no 'key' for glucose, so it stays in the blood.
29
What happens in Type 2 diabetes?
Insulin may be present, but cells resist it, meaning the 'lock' is faulty.
30
What does insulin do in the body?
Moves glucose into muscle, fat, and liver cells for energy, stimulates carbohydrate metabolism, converts excess glucose into glycogen and fat stores, and supports protein metabolism.
31
What happens without insulin?
Blood sugar rises (hyperglycemia), cells can't get glucose, leading to breakdown of fat and muscle for energy, resulting in weight loss, weakness, and ketones in urine.
32
What are the symptoms of diabetes without insulin?
Excessive thirst, hunger, urination, and weight loss.
33
What are the main criteria for grouping insulin formulations?
Insulins are grouped by how fast they work (onset), when they work strongest (peak), and how long they last (duration).
34
What are rapid-acting insulins?
Examples: Insulin Lispro (Humalog), Insulin Aspart (Novo Rapid).
## Footnote
Onset: ~10–20 minutes, Peak: 1–2 hours, Duration: 3–5 hours. Use: Taken right before meals.
35
What are short-acting insulins?
Examples: Humulin R, Novolin Toronto.
## Footnote
Onset: 30 minutes, Peak: 2–4 hours, Duration: 6–8 hours. Use: Covers meals, needs to be given 30 min before eating.
36
What are intermediate-acting insulins?
Examples: Humulin N, Novolin NPH.
## Footnote
Onset: 1–2 hours, Peak: 6–12 hours, Duration: 12–18 hours. Use: Provides background (basal) insulin.
37
What are long-acting insulins?
Examples: Lantus, Levemir.
## Footnote
Onset: 1–2 hours, Peak: Minimal or 'peakless', Duration: Up to 24 hours (Lantus), ~20 hours (Levemir). Use: Provides constant basal coverage.
38
How should rapid and short-acting insulins be thought of?
They are considered 'bolus' doses for meals or to fix high sugar.
39
How should intermediate and long-acting insulins be thought of?
They are considered 'basal' doses that keep sugar steady between meals and overnight.
40
What is the general use of Short-Acting Insulin?
Covers blood sugar around mealtimes (prandial insulin) and can also be used as correction insulin to bring down high blood sugar.
41
What are the pharmacokinetics of Short-Acting Insulin?
Onset: ~30 minutes, Peak: 2–3 hours, Duration: ~6–8 hours.
42
What are the routes of administration for Short-Acting Insulin?
Subcutaneous (most common) and Intravenous (IV) for emergencies.
43
What is the significance of the IV route for Short-Acting Insulin?
It provides immediate action, making it lifesaving in critical cases such as DKA or diabetic coma.
44
How does Short-Acting Insulin compare to Rapid-Acting Insulins?
Slower than rapid-acting but longer lasting; must be injected 30 minutes before meals.
45
What are the nursing considerations for Short-Acting Insulin?
Check blood glucose before administration, teach patients to eat after injection, monitor closely during peak action, and rotate injection sites.
46
What are the key features of Intermediate-Acting Insulin?
Cloudy in appearance, Onset: 1–3 hours, Peak: 5–8 hours, Duration: up to 18 hours.
47
What is the clinical use of Intermediate-Acting Insulin?
Works as basal insulin to keep blood glucose stable between meals and overnight, often combined with short-acting insulin.
48
What are the nursing considerations for Intermediate-Acting Insulin?
Frequent monitoring due to unpredictable peak, teach patients to recognize hypoglycemia, and rotate injection sites.
49
How does the appearance of Short-Acting Insulin differ from Intermediate-Acting Insulin?
Short-acting insulin is clear, while Intermediate-acting (NPH) is cloudy.
50
What are examples of Long-Acting Insulin?
Insulin glargine (Lantus®) and Insulin detemir (Levemir®).
51
What are the key features of Long-Acting Insulin?
Both are clear, colourless solutions, must be given alone, and provide basal insulin to keep blood sugar stable between meals and overnight.
52
What is the onset time for Long-Acting Insulin?
Approximately 90 minutes.
53
What is the peak characteristic of Long-Acting Insulin?
There is no pronounced peak, providing steady, flat insulin levels.
54
What is the duration of Insulin glargine (Lantus)?
16–24 hours, usually administered once daily, but some patients may require twice daily.
55
What is the duration of Insulin detemir (Levemir)?
Duration depends on dose: lower doses may need twice daily, higher doses are often once daily.
56
What is the clinical use of Long-Acting Insulin?
Mimics the pancreas’s baseline insulin secretion, reduces fasting blood glucose levels, and provides stable coverage overnight.
57
What is a risk associated with Long-Acting Insulin?
Less risk of hypoglycemia compared to NPH, but patients may experience night-time hypoglycemia if the dose is too high or they miss a bedtime snack.
58
What are nursing considerations for Long-Acting Insulin?
Dosing is individualized, always check fasting glucose, educate patients on timing and dosing, and cannot be mixed with other insulins.
59
What is the nurse's role in administering insulin?
The nurse is responsible for safely administering insulin, which is a high-alert medication.
60
What should be assessed and documented before giving insulin?
History, vital signs, blood glucose level, HbA1c, and potential complications & drug interactions.
61
What history should be assessed before administering insulin?
Allergies and comorbidities such as kidney or liver disease.
62
What vital signs should be monitored before giving insulin?
Signs of hypoglycemia, including tachycardia, sweating, and tremors.
63
Why is it important to check blood glucose levels before administering insulin?
To ensure the current glucose level is appropriate before giving insulin.
64
What does HbA1c measure?
Long-term control of blood glucose, which helps guide the overall treatment plan.
65
What are potential complications and drug interactions with insulin?
Corticosteroids can increase glucose levels, while alcohol can decrease glucose levels.
66
Why is insulin considered a high-alert medication?
A wrong dose can cause severe hypoglycemia, seizures, coma, or death.
67
What are the '10 Rights' of medication administration?
Right patient, right drug, right dose, right time, right route, right documentation, right reason, right response, right education, right to refuse.
68
What should be done with insulin orders?
Double-check insulin orders by verifying type, dose, and timing with another registered nurse per policy.
69
What type of syringes should be used for insulin?
Only insulin syringes or insulin pens calibrated in units, never mL.
70
How is insulin identified on syringes?
By the orange cap on syringes, which is important for unit dosing.
71
What should be ensured before giving rapid or short-acting insulin?
Ensure the patient has eaten to prevent hypoglycemia.
72
Why is it important to rotate injection sites for insulin?
To avoid lipodystrophy.
73
What is the key takeaway regarding insulin administration?
Strict monitoring, correct equipment, and double-checking with another nurse are essential responsibilities before administration.
74
What is hypoglycemia?
Hypoglycemia is defined as blood glucose levels less than 4 mmol/L.
75
What are the causes of hypoglycemia?
Causes include too much insulin or medication, not eating enough, or exercising more than usual.
76
Why does hypoglycemia matter?
The brain needs glucose as its main energy source. If levels drop too low, the brain and body can’t function properly.
77
What are early warning signs of hypoglycemia?
Early warning signs include trembling, palpitations, sweating, anxiety, hunger, nausea, and tingling sensation.
78
What are neuroglycopenic symptoms of hypoglycemia?
Neuroglycopenic symptoms include trouble concentrating, confusion, drowsiness, weakness, dizziness, headache, vision changes, and slurred speech.
## Footnote
These symptoms may mimic alcohol intoxication.
79
What are the complications of untreated hypoglycemia?
Untreated hypoglycemia can progress to seizures, loss of consciousness, coma, and permanent brain damage or death.
80
What is the key takeaway about hypoglycemia?
Hypoglycemia develops quickly and is life-threatening. Always check for early signs and treat right away with fast-acting glucose (e.g., juice, glucose tablets).
81
What is severe hypoglycemia?
Severe hypoglycemia is a condition where the patient may be conscious but requires immediate treatment to raise their blood sugar.
82
What is the initial treatment for a conscious patient with severe hypoglycemia?
Give them 20 grams of glucose in a form they can swallow, such as gel, liquid, or tablets.
83
What should you do if the patient cannot swallow?
If the patient becomes unconscious and can't swallow, use other methods like glucagon injection or IV dextrose.
84
What are the options for administering glucagon?
You can give 1 milligram of glucagon by intramuscular or subcutaneous injection, or 3 milligrams as a nasal spray.
85
What can be administered if the patient has an IV line?
You can give 50% dextrose in water (D-50-W) by IV push.
86
What are the main medications to raise blood glucose in severe hypoglycemia?
The main medications are oral glucose (if they can swallow), glucagon, or IV dextrose.
87
How are insulin doses determined for children?
Insulin doses are based on weight (kids need smaller, precise doses).
88
What is the target A1C level for children?
Target A1C ≤ 7.5% to keep sugars in control.
89
Why is preventing hypoglycemia important in children?
Preventing hypoglycemia is very important because low blood sugar in children can harm brain development and cognitive function.
90
What is the treatment of choice for pregnant women with diabetes?
Insulin is the treatment of choice (oral diabetes meds are not safe).
91
Why is tight blood sugar control essential for pregnant women?
Tight blood sugar control is essential to protect both mom and baby.
92
What complications can poor blood sugar control during pregnancy cause?
Poor control can cause congenital anomalies (birth defects), stillbirth, and high birth weight (macrosomia) which increases risk of complications during delivery.
93
How are A1C targets different for older adults compared to younger adults?
A1C targets may be set a little higher than younger adults because the risk of hypoglycemia is more dangerous (falls, confusion, heart problems).
94
What is the main goal for older adults regarding insulin use?
Main goal: prevent hypoglycemia while keeping sugars reasonably controlled.
95
What is the key takeaway regarding insulin use in special populations?
Insulin use must be tailored to the patient’s age, condition, and life stage.
96
What does Basal insulin mean?
Basal insulin refers to background coverage that provides a steady, constant level of insulin all day and night.
97
What is the role of long-acting insulin?
Long-acting insulin (like insulin glargine / Lantus) keeps blood sugar stable between meals and overnight.
98
What does Bolus insulin mean?
Bolus insulin refers to mealtime coverage that is given just before meals to cover the rise in glucose from carbohydrates.
99
What are examples of rapid-acting insulins?
Examples include lispro (Humalog) and aspart (NovoRapid).
100
How does Bolus insulin function?
It spikes like the pancreas normally does after food and is also used for correction doses if blood sugar is too high.
101
Why is Basal–Bolus therapy better than Sliding Scale?
It mimics the natural pancreas with steady background insulin and bursts at meals, preventing big swings in blood sugar.
102
What is a key benefit of Basal–Bolus therapy?
It improves control, making it safer and more effective at reducing complications.
103
What analogy is used to describe insulin therapy?
Insulin is likened to air conditioning in a house: Basal is the thermostat on low all day, while Bolus is turning on extra cool air when cooking.
104
What is the key takeaway about Basal–Bolus therapy?
Basal–bolus therapy is the gold standard because it mimics how a healthy pancreas works: constant background insulin plus mealtime bursts.
105
What are oral/injectable antidiabetic medications used for?
They are used in type 2 diabetes to lower blood sugar (glucose) levels and keep them within a safe range to prevent complications.
106
Can oral/injectable antidiabetic medications be used alone?
Yes, they can be used alone or in combination with other drugs, insulin, and lifestyle changes.
107
What are the key lifestyle changes recommended for type 2 diabetes management?
Balanced meals, portion control, reduced sugar, healthier carbs, exercise, smoking cessation, and weight loss.
108
How does exercise benefit those with type 2 diabetes?
Exercise improves insulin sensitivity and lowers blood sugar.
109
Why is smoking cessation important in diabetes management?
It reduces cardiovascular risk.
110
What impact does weight loss have on blood sugar control?
Even small reductions in weight improve blood sugar control.
111
What other treatments are important for diabetes management?
Managing hypertension (high blood pressure) and high cholesterol, as they are common in diabetes and increase cardiovascular risk.
112
What does the HbA1c test measure?
It reflects the average blood sugar over the past 90–120 days (3–4 months).
113
Why is the HbA1c test important?
Glucose attaches to red blood cells, which live about 120 days, allowing for an average measurement.
114
What is the goal HbA1c level for most patients?
The goal is ≤ 7%, though it may vary slightly depending on age and health.
115
What is the big picture in type 2 diabetes care?
Lifestyle changes are the foundation, with medications added when lifestyle alone isn’t enough. HbA1c is the main test to monitor treatment effectiveness.
116
What is Metformin (Glucophage®)?
Metformin is a biguanide medication used primarily as a first-line treatment for Type 2 diabetes.
117
What is the mechanism of action of Metformin?
Metformin lowers blood glucose by increasing insulin sensitivity, decreasing hepatic glucose production, and decreasing intestinal glucose absorption.
118
How does Metformin increase insulin sensitivity?
It helps muscle, liver, and fat tissues respond better to insulin, allowing glucose to enter cells more easily.
119
What does Metformin do to hepatic glucose production?
It decreases the liver’s tendency to release extra glucose into the blood.
120
How does Metformin affect intestinal glucose absorption?
It decreases the amount of glucose absorbed from food in the gut.
121
When is Metformin indicated for use?
It is used as a first-line drug for Type 2 diabetes and can also be used for prediabetes.
122
What is a key requirement for Metformin to be effective?
The pancreas must still be functioning; it is not effective for Type 1 diabetes.
123
Does Metformin cause hypoglycemia?
No, Metformin does not cause hypoglycemia on its own because it does not increase insulin secretion.
124
What effect does Metformin have on weight?
Metformin helps with weight control and often causes mild weight loss or is weight-neutral.
125
What are common side effects of Metformin?
Common side effects include gastrointestinal upset such as nausea, diarrhea, and cramping.
126
What serious but rare risk is associated with Metformin?
Lactic acidosis, which is more likely in patients with kidney or liver impairment or alcohol abuse.
127
Why is Metformin often continued long-term?
It improves both blood sugar control and cardiovascular outcomes.
128
What is the summary of Metformin's role in diabetes treatment?
Metformin is the go-to first drug for Type 2 diabetes, enhancing insulin effectiveness, reducing liver glucose output, and lowering food glucose absorption.
129
What are the contraindications for using metformin?
1. Kidney disease or poor kidney function: drug is cleared by kidneys; buildup increases risk of lactic acidosis.
2. Alcoholism: alcohol raises the risk of lactic acidosis.
3. Metabolic acidosis: already too much acid in blood.
4. Liver disease/failure: liver is key in glucose metabolism; dysfunction increases risk of acidosis.
5. Contrast dye procedures: can damage kidneys, so metformin is usually stopped before/after the procedure.
130
What are the most common adverse effects of metformin?
GI upset: bloating, nausea, cramping, diarrhea, feeling of fullness (usually improves if taken with meals).
## Footnote
Most common side effect.
131
What are DPP-4 inhibitors commonly known as?
DPP-4 inhibitors are commonly known as 'gliptins'.
132
What are some examples of DPP-4 inhibitors?
Examples include sitagliptin (Januvia®), saxagliptin (Onglyza®), and linagliptin (Trajenta®).
133
How are DPP-4 inhibitors often used in treatment?
DPP-4 inhibitors are often combined with metformin.
134
What is the mechanism of action of DPP-4 inhibitors?
DPP-4 inhibitors block the enzyme DPP-4, allowing incretins to last longer, which improves blood sugar control after meals.
135
What do incretin hormones do?
Incretin hormones help increase insulin secretion and decrease glucagon release.
136
What are the therapeutic effects of DPP-4 inhibitors?
They lower fasting blood sugar and post-meal blood sugar, helping to smooth out blood glucose swings after eating.
137
What are common adverse effects of DPP-4 inhibitors?
Common adverse effects include upper respiratory tract infections, headache, and diarrhea.
138
What serious condition can DPP-4 inhibitors rarely cause?
They can rarely cause pancreatitis, which is inflammation of the pancreas.
139
What are the contraindications for DPP-4 inhibitors?
Contraindications include allergy to the drug and caution in patients with liver or kidney problems.
140
Do DPP-4 inhibitors cause hypoglycemia when used alone?
DPP-4 inhibitors don’t directly cause hypoglycemia when used alone, but the risk increases when combined with other glucose-lowering drugs.
141
When are DPP-4 inhibitors especially useful?
They are especially useful for controlling blood sugar after meals.
142
What are SGLT2 Inhibitors?
SGLT2 Inhibitors are medications that end with '-gliflozins'.
## Footnote
Examples include Canagliflozin (Invokana®) and Dapagliflozin (Forxiga®).
143
What is the mechanism of action of SGLT2 Inhibitors?
They block the reabsorption of glucose in the kidneys, leading to glucose excretion in urine and lowering blood sugar levels without depending on the pancreas.
## Footnote
This also causes osmotic diuresis, lowering blood pressure.
144
What are the benefits of SGLT2 Inhibitors?
They provide better blood sugar control, promote weight loss, lower blood pressure, help in heart failure, and may increase HDL cholesterol.
## Footnote
They may also raise LDL cholesterol.
145
What are the indications for SGLT2 Inhibitors?
They are indicated for Type 2 diabetes management and heart failure management.
146
What are the contraindications for SGLT2 Inhibitors?
Contraindications include allergy, Type 1 diabetes, history of DKA, and kidney disease.
147
What are the adverse effects of SGLT2 Inhibitors?
Adverse effects include genital yeast infections, UTIs, gastrointestinal upset, and hypotension.
148
What is a key nursing tip regarding SGLT2 Inhibitors?
These medications work in the kidneys, not the pancreas, and do not usually cause hypoglycemia unless combined with insulin or secretagogues.
149
What is the first critical nursing responsibility for antidiabetic medications?
Always check blood glucose (BG) before giving any antidiabetic medication.
150
When should oral agents and insulin be administered?
They are best given with meals or just before meals to reduce the risk of hypoglycemia.
151
What should a nurse do if a patient is NPO and there are no clear orders about holding medications?
The nurse must contact the prescriber.
152
What is the risk of giving insulin or oral hypoglycemics without food?
It can cause dangerous hypoglycemia.
153
What is Metformin's role in diabetes treatment?
It is the first-line drug for type 2 diabetes.
154
How should Metformin be administered to reduce side effects?
Always give with meals to reduce gastrointestinal (GI) side effects like bloating, nausea, and diarrhea.
155
What should be done before imaging procedures requiring contrast dye?
Metformin must be discontinued to avoid the risk of contrast-induced nephropathy and lactic acidosis.
156
When can Metformin be resumed after imaging procedures?
It can be resumed only when kidney function is confirmed safe.
157
What is the summary of critical nursing responsibilities for antidiabetic medications?
Check BG → match meds to food intake → hold meds if NPO until clarified → be extra careful with metformin + contrast dye to avoid kidney and metabolic complications.
158
What is the first step in nursing assessment for antidiabetic therapy?
Review all current medications, including OTC and herbal supplements. Look for drug interactions that can affect blood sugar levels.
159
What should be included in the physical assessment for diabetic patients?
Vital signs, blood glucose levels, and HbA1c. Watch for signs of complications from diabetes such as neuropathy, infection, and poor healing.
160
What are the early warning signs of hypoglycemia?
Tremors, sweating, anxiety, and hunger.
161
What should you check before administering oral antidiabetic medications?
Always check if the patient is able to safely eat or swallow.
162
What gastrointestinal issues should be assessed in diabetic patients?
Assess for nausea, vomiting, and diarrhea, as these can affect the ability to take medications or eat.
163
What should be done if a patient is NPO before a test or procedure?
Consult the provider to clarify which medications should be held.
164
What special concerns should be noted for diabetic patients?
Patients are at higher risk of unstable blood sugar when under stress, have an infection or illness, or are pregnant or lactating.
165
What effect do stress hormones have on blood sugar levels?
Stress hormones like epinephrine and norepinephrine oppose insulin and raise blood sugar levels.
166
What should be checked before giving antidiabetic medications in practice?
Check blood glucose levels, confirm if the patient is eating, watch for hypoglycemia risk, and consider stress or illness factors that could alter insulin needs.
167
What is important for Nutrition & Weight Management in diabetes?
Maintain a balanced diet with adequate carbs, proteins, and fats. Stabilize weight to prevent extra stress on blood sugar control. Improve dietary habits by reducing processed sugars and choosing high-fiber foods.
168
What should patients understand about glucose control?
Learn what causes unstable glucose, such as missed meals, stress, infection, or improper medication. Recognize patterns and practice management strategies like adjusting meals, activity, and stress reduction.
169
What are key points regarding Medication & Monitoring?
Take prescribed medications consistently and on schedule. Perform regular blood glucose monitoring, such as before meals and at bedtime. Watch for early signs and symptoms of hyperglycemia and hypoglycemia.
170
What are the signs of Hyperglycemia?
Thirst, frequent urination, fatigue, blurred vision.
171
What are the signs of Hypoglycemia?
Sweating, tremors, confusion, dizziness, irritability.
172
Why do these goals matter for patients with diabetes?
They help the patient become more independent in self-care, reduce the risk of complications, and promote long-term health stability.
173
What should be monitored to assess therapeutic response in antidiabetic therapy?
Blood glucose levels should decrease with proper treatment. HbA1c (glycated hemoglobin) is measured every ~3 months (reflects average blood sugar over 90–120 days).
## Footnote
Goal: HbA1c < 7%. Goal fasting glucose: 4–7 mmol/L.
174
What complications should be monitored in antidiabetic therapy?
Watch for hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). Early detection prevents emergencies like seizures, coma, or diabetic ketoacidosis (DKA).
175
What patient knowledge should be assessed in antidiabetic therapy?
Does the patient know how to check blood glucose at home, how to take medications correctly, and when to report abnormal signs (e.g., dizziness, confusion, excessive thirst, frequent urination)?
176
What lifestyle and safety measures should be evaluated in patients with diabetes?
Do not skip meals to prevent hypoglycemia. Wear a medical alert bracelet to inform others in case of an emergency. Avoid alcohol and smoking as alcohol can trigger hypoglycemia, and smoking worsens cardiovascular risks. Teach what to do if hypoglycemia occurs (15 g rule, recheck in 15 min).
177
Why is evaluation important in antidiabetic therapy?
Evaluation ensures the treatment plan is working (measured by blood sugar & HbA1c), while also confirming the patient is knowledgeable enough to safely manage their diabetes outside the hospital.
178
What are glucocorticoids?
Glucocorticoids are powerful anti-inflammatory and immunosuppressive agents used in various medical conditions.
179
What are the routes of administration for glucocorticoids?
Glucocorticoids can be given topically, systemically, or inhaled depending on the condition.
180
What factors influence the choice of glucocorticoid administration route?
The choice of route depends on the site of action, disease severity, and need for systemic vs local effects.
181
What is the mechanism of action of glucocorticoids?
They exert indirect effects via enzyme modulation, modifying the activity of enzymes that regulate inflammation, immunity, and metabolism.
182
What are the anti-inflammatory effects of glucocorticoids?
They stabilize membranes of inflammatory cells, decrease capillary permeability, and reduce the migration of white blood cells in inflamed areas.
183
What metabolic effects do glucocorticoids have?
They promote protein breakdown, increase glycogen storage in the liver, redistribute fat, increase blood glucose, and promote bone demineralization.
184
What physiological roles do glucocorticoids play?
They increase energy supply during stress, prevent excessive immune reactions, and reduce inflammation.
185
What are some clinical uses of glucocorticoids?
They are used in autoimmune diseases, allergic conditions, transplant medicine, endocrine replacement therapy, and cancer treatment.
186
What are key nursing considerations when administering glucocorticoids?
Monitor blood glucose, signs of infection, osteoporosis risk, fluid retention, and taper off gradually.
187
Why are glucocorticoids used for relief of inflammatory symptoms?
They reduce redness, swelling, itching, and discomfort in conditions like eczema, asthma, and GI diseases.
188
How do glucocorticoids help in allergic reactions?
They calm widespread inflammation in severe allergic reactions or anaphylaxis.
189
What role do glucocorticoids play in replacement therapy?
They replace hormones in adrenocortical deficiency, such as Addison’s disease.
190
How do glucocorticoids assist in brain and neurological conditions?
They reduce fluid and swelling around the brain in cerebral edema and limit inflammation in spinal cord injuries.
191
What is the role of glucocorticoids in cancer and immune suppression?
They reduce immune activity in cancer patients and prevent organ rejection in transplant patients.
192
Why do glucocorticoids work effectively?
They block multiple steps in the inflammatory process, suppress overactive immune responses, stabilize blood vessels, and increase energy availability.
193
In simple terms, why are glucocorticoids used?
They are effective for controlling inflammation and overactive immune responses, providing symptom relief and preventing damage.
194
What are glucocorticoids?
Powerful drugs with strong anti-inflammatory and immunosuppressive benefits, but also many adverse effects, especially with long-term use.
195
What is an adverse effect of glucocorticoids on the immune system?
Suppression of immune response leading to increased susceptibility to infections.
196
How do glucocorticoids affect wound healing?
They can impair wound healing due to reduced inflammatory response.
197
What metabolic effects do glucocorticoids have?
They can cause diabetes/hyperglycemia, weight gain, and redistribution of fat.
198
What is a 'Cushingoid' appearance?
A characteristic appearance due to fat redistribution, including moon face, buffalo hump, and abdominal obesity.
199
What effect do glucocorticoids have on electrolyte and fluid balance?
They can cause sodium and water retention, leading to edema and hypertension.
200
What are the musculoskeletal effects of glucocorticoids?
They can cause osteoporosis, myopathy, and growth suppression in children.
201
What are the ophthalmic effects of glucocorticoids?
Long-term use can lead to cataracts and glaucoma.
202
What dermatologic effects can occur with glucocorticoid use?
Skin atrophy, easy bruising, striae, and hirsutism.
203
What neuropsychiatric effects can glucocorticoids cause?
Mood swings, irritability, and potential psychiatric effects like depression and psychosis.
204
What are some other adverse effects of glucocorticoids?
Peripheral edema, GI irritation/ulcer risk, and rare cases of avascular necrosis.
205
What nursing considerations are important for glucocorticoid therapy?
Monitor blood glucose, electrolytes, BP, weight, and bone density; educate on calcium and vitamin D; taper gradually.
206
What is a key takeaway regarding glucocorticoids?
They are effective but dangerous in long-term use, affecting nearly every system.
207
What are glucocorticoids?
Powerful medications with wide-ranging therapeutic and adverse effects that influence nearly every body system.
208
What is the role of nurses in glucocorticoid therapy?
Nurses monitor, prevent, and teach patients about the risks associated with glucocorticoids.
209
What baseline assessments are important before initiating glucocorticoid therapy?
CBC & WBC count, electrolytes, weight, vital signs, blood glucose monitoring, and GI history.
210
Why is CBC & WBC count important?
Glucocorticoids suppress immunity and may mask infections, making infection detection harder.
211
What electrolyte imbalances can glucocorticoids cause?
Increased sodium/water retention leading to hypertension, edema, heart failure, and hypokalemia.
212
What vital sign is particularly important to monitor?
Blood pressure due to the risk of hypertension.
213
How do glucocorticoids affect blood glucose levels?
They raise glucose levels by stimulating gluconeogenesis and reducing insulin sensitivity.
214
What are some system-specific adverse effects of glucocorticoids?
Cardiovascular, CNS, endocrine/metabolic, gastrointestinal, musculoskeletal, ophthalmic, and dermatologic effects.
215
What cardiovascular effects can glucocorticoids have?
Edema, hypertension, heart failure, electrolyte imbalance, thromboembolism, and dysrhythmias.
216
What nursing actions are necessary for cardiovascular effects?
Monitor BP, daily weights, I&O, assess for edema, and monitor electrolytes and cardiac rhythm.
217
What CNS effects can glucocorticoids cause?
Mood changes, steroid psychosis, headaches, vertigo, and neuropathy.
218
What nursing actions are necessary for CNS effects?
Assess mental status, educate patients to report mood changes, and monitor for seizures.
219
What endocrine/metabolic effects can glucocorticoids cause?
Hyperglycemia, Cushing’s syndrome, and growth suppression in children.
220
What nursing actions are necessary for endocrine/metabolic effects?
Monitor glucose frequently and educate patients on diet and exercise.
221
What gastrointestinal effects can glucocorticoids cause?
Gastritis, ulcers, reflux, nausea, and abdominal discomfort.
222
What nursing actions are necessary for gastrointestinal effects?
Administer with food or milk, monitor for signs of bleeding.
223
What musculoskeletal effects can glucocorticoids cause?
Osteoporosis, fractures, myopathy, and muscle wasting.
224
What nursing actions are necessary for musculoskeletal effects?
Encourage weight-bearing exercise and assess for muscle weakness.
225
What ophthalmic effects can glucocorticoids cause?
Cataracts and glaucoma with long-term therapy.
226
What nursing actions are necessary for ophthalmic effects?
Encourage regular eye exams and report vision changes.
227
What dermatologic effects can glucocorticoids cause?
Skin thinning, bruising, delayed wound healing, and striae.
228
What nursing actions are necessary for dermatologic effects?
Educate patients to apply a thin layer of topical corticosteroid and inspect skin.
229
What are critical nursing responsibilities for glucocorticoid therapy?
Do not stop abruptly, monitor intake & output, electrolytes, blood glucose, and growth in children.
230
What should patients be educated about regarding glucocorticoids?
Take with food, never stop suddenly, monitor for swelling, weight gain, mood changes, and signs of infection.
231
What is a key point about glucocorticoids?
They are life-saving and highly effective but require vigilant monitoring due to systemic effects.
Pharm Lecture
flashcards
Decks in class (17)
# Cards
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Unit 1 (part 1)200
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Unit 2: Drugs Affecting The Autonomic NS278
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Unit 3: coagulation modifiers and anemia medications220
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Unit 3: coagulation modifiers and anemia medications163
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Unit 3: drugs for anemia75
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Lecture 4231
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Lecture 5: Drugs affecting the respiratory system245
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Lecture 6: Drugs Affecting GI131
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Lecture 7255
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Lecture 8184
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Lecture 9380
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Lecture 9 (Pt. 2)122
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Lecture 10225
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Lecture 10 pt. 2121
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Lecture 11168
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Lecture 11 (part 2)132
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Unit 12146
