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Karch’s Focus on Nursing Pharmacology, 9th Ed., Tucker | Registered Nurse (RN) School Study Aid

Chapter 38: Agents to Control Blood Glucose Levels
15 Picmonics to Learn | 30 mins
Blood Glucose Lab Value
70-100 mg/dL
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25 secs
Hemoglobin A1c Lab Value
4-6%
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1 min
Hyperglycemia
Mechanism
Insulin Resistance
Too Little Insulin/Medication
Infection/Illness
Corticosteroids
Assessment
Elevated Blood Glucose
Polyphagia
Polydipsia
Polyuria
Hypotension
Fatigue/Drowsiness
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1 min
Insulin
Rapid Acting
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)
Short Acting
Regular Insulin (Humulin R)
Intermediate Acting
Isophane NPH (Humulin N)
Long Acting
Detemir (Levemir)
Glargine (Lantus)
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2 mins
Mixing NPH and Regular Insulin for Injection
Verify Order
Roll NPH Insulin
Alcohol to Multiuse Vials
Inject Air into NPH Insulin (Cloudy)
Inject Air into Regular Insulin (Clear)
Withdraw Regular Insulin Units
Withdraw NPH Units
Verify with 2nd Nurse
Discard if Error
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3 mins
Pregnant Diabetic Patient Interventions
First Trimester
Increase Insulin then Decrease
Metformin
Nutrition
Exercise
Second Trimester
Increase Insulin
More Likely to Develop Hypoglycemia than Hyperglycemia
Third Trimester
Double or Quadruple Insulin
Early Delivery
Postpartum
Drastically Decrease Insulin
Monitor Neonate for Hypoglycemia
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3 mins
Diabetes Interventions
Early Diagnosis
Insulin
Oral Hypoglycemics
Glucose Monitoring
Routine Exercise
Diabetic Diet
Monitor for Complications
Insulin Therapy
Diabetic Ketoacidosis (DKA)
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2 mins
Pramlintide (Symlin)
Mechanism
Synthetic Amylin Analog
Indications
Diabetes Type 1 and 2
Supplement Mealtime Insulin
Side Effects
Nausea
Skin Reactions at Injection Site
Considerations
Hypoglycemia When Combined with Insulin
Delayed Absorption of Oral Drugs
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2 mins
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
Mechanisms
Alpha Glucosidase Inhibitors
Delays Absorption of Carbohydrates
Indications
Type 2 Diabetes
Side Effects
Flatulence
Diarrhea
Anemia
Cramps
Considerations
Monitor LFTs
Oral Glucose for Hypoglycemia
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2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
Mechanisms
2nd Generation Sulfonylureas
Blocks Potassium Channels in Beta Cells
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Considerations
More Potent
Beta Blockers Reduce Effects
Avoid Alcohol
Avoid Breastfeeding
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2 mins
Exenatide (Byetta)
Mechanism
Incretin Mimetic
GLP-1 Synthetic Analog
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Nausea and Vomiting
Diarrhea
Thyroid Cancer
Pancreatitis
Renal Failure
Considerations
(Give Exenatide) One Hour After Other Medications
Adjunct Therapy
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3 mins
Glucagon (GlucaGen)
Mechanism
Increases Glucose
Indications
Hypoglycemic Emergency
Side Effects
Nausea and Vomiting
Considerations
Reconstitute Powder
Consume Oral Carbohydrates
50% Dextrose IV (If No Effect)
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2 mins
Hypoglycemia Intervention
Interventions
Mild to Moderate Hypoglycemia
Simple Carbohydrate (Oral Dextrose, Fruit Juice, Candies)
Complex Carbohydrate (Whole Grains, Vegetables)
Severe Hypoglycemia or Unconscious
50% Dextrose
Glucagon
Considerations
Monitor Blood Glucose Q 10-15 Minutes
Give Small Meal After Intervention
Patient Education
Hypoglycemia Prevention
Encourage Self-Monitoring
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3 mins
Pancreas
Characteristics
Acinar Cells Release Digestive Enzymes
Ductal Epithelial Cells Release Bicarbonate
Islets of Langerhans
Beta Cells Release Insulin
Alpha Cells Release Glucagon
Delta Cells Release Somatostatin
Somatostatin Inhibits Alpha and Beta Cells
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3 mins
Beta Blocker Antidote
Antidote
Glucagon
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29 secs

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