Pharmacology

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session 16

LESSON TITLE: ANTIDIABETIC DRUGS

Materials:
LEARNING OUTCOMES:
Notebook, Pharmacology book, Drug handbook,
At the end of the lesson, the nursing student can: pens & paper

1. Compare type 1 and type 2 diabetes mellitus;

2. Explain a hypoglycemic reaction and describe the
symptoms;
3. Differentiate among rapid acting, intermediate acting
and long acting insulins; and,
4. Identify the action of oral antidiabetic drugs and their
side effects.
References:
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company

LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (10 minutes)

EVERYBODY WRITES
You will write on the table provided the difference between Type 1 and Type 2 Diabetes Mellitus.
TYPE 1 DM TYPE 2 DM
Previous name Insulin dependent diabetes mellitus Non insulin dependent diabetes
(IDDM) mellitus (NIDDM)
Juvenile diabetes
Childhood diabetes
Cause Autoimmune disease Metabolic Condition
Immune system attacks the beta cells The pancreas no longer produces
in the pancreas. By destroying these enough insulin or the body is resistant
cells, the pancreas can no longer to it. The pancreas is still functioning
produce insulin just not as well as it could be.
Insulin Production

Prevention

Age of diagnosis

Risk factors

Treatment

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MAIN LESSON (45 minutes)

Antidiabetic drugs are a group of drug structurally unrelated to sulfonylureas and are
effective when used in combination with insulin or sulfonylureas. These drugs include
alpha-glucosidase inhibitors, biguanides, dipeptidyl peptidase-4 (DPP-4) inhibitors,
human amylin, incretin mimetics, meglitinides, and thiazolidinediones.

Therapeutic Action
 Alpha-glucosidase inhibitors acarbose and miglitol inhibit alpha-glucosidase, an
enzyme that breaks down glucose for absorption. Therefore, they delay the absorption
of glucose. They have only a mild effect on glucose levels and do not enhance insulin
secretion. They are associated with severe hepatic toxicity and GI distress.
 Biguanide metformin decrease the production and increases the uptake of
glucose. It is effective in lowering blood glucose and does not cause hypoglycemia as
the sulfonylureas do. It has been associated with development of lactic acidosis and
GI distress.
 Meglitinides nateglinide and repaglinide are newer agents that act like
sulfonylureas to increase insulin release.
 Synthetic human amylin pramlintide works to modulate gastric emptying after a
meal to cause a feeling of fullness or satiety. It also prevents the postmeal rise
in glucagon that usually elevates glucose levels. Human amylin is a hormone
produced by beta cells in the pancreas that is important in regulating postmeal glucose
levels. It should not be used when patient is unable to eat.
 Incretin mimetics exenatide and liraglutide mimic the effects of GLP-1: enhancement of glucose-
dependent insulin secretion by the beta cells in the pancreas, depression of elevated glucagon secretion, and
slowed gastric emptying to help moderate and lower blood glucose levels.
 DPP-4 inhibitors lina-, saxa-, and sitagliptin slow the breakdown of GLP-1 to prolong the effects of increased
insulin secretion, decreased glucagon secretion, and slowed GI emptying.
 Thiazolidinediones pioglitazone and rosiglitazone decrease insulin resistance.
Indications
 Biguanide metformin is approved for use in children 10 years of age and older. It is also being used in the
treatment of women with polycystic ovarian syndrome (PCOS).
 Meglitinides nateglinide and repaglinide are used to lower postprandial glucose levels because they are rapid-
acting and with a very short half-life. They are taken just before meals.
 Thiazolidinediones pioglitazone and rosiglitazone are used in combination with insulin, metformin, and
sulfonylureas in patients with insulin resistance.
 Bromocriptine, a dopamine agonist used to treat Parkinson’s disease was approved in 2009 as a CNS approach
to treat type 2 diabetes.
Contraindications and Cautions
 Allergy to sulfonylureas and other antidiabetic agents. Avoid hypersensitivity reactions
 Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
 Pregnancy and lactation. Potential adverse effect on the fetus or neonate.
Adverse Effects
 Common adverse effects include hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea,
heartburn, and allergic skin reaction.
 Pioglitazone is strongly linked with an increased risk of bladder cancer if it is used for over 1 year.
 Rosiglitazone is linked with increased risk of cardiovascular problems.
Interactions
 decreased excretion with drugs that acidify urine
Nursing Responsibilities
 Administer the drug as prescribed in the appropriate relationship to meals to ensure therapeutic effectiveness.
 Ensure that patient has dietary and exercise regimen and using good hygiene practices to improve the
effectiveness of the insulin and decrease adverse effects of the disease.
 Monitor nutritional status to provide nutritional consultation as needed.
 Monitor response carefully; blood glucose monitoring is the most effective way to evaluate dose. Obtain blood
glucose levels as ordered to monitor drug effectiveness.

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  Monitor patients during times of trauma, pregnancy, or severe stress, and arrange to switch to insulin coverage
as needed.
 Provide comfort measures to help patient cope with drug effects.
 Provide patient education about drug effects and warning signs to report to enhance patient knowledge and to
promote compliance.

Let them explain in not less than five sentences the diabetic management triangle.

The Triangle of Diabetes Care brings together evidence that they are all important, not only to help manage the everyday
ups and downs of diabetes, but also to reduce the risk of long-‐term complications and to improve overall health and
wellbeing.

CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice

1. Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best
response by the nurse? Select all that apply.
A. “Your alpha cells should be able to secrete insulin, but cannot.”
B. “The exocrine function of your pancreas is to secrete insulin.”
C. “Without insulin, you will develop ketoacidosis (DKA).”
D. “The endocrine function of your pancreas is to secrete insulin.”
E. “It means your pancreas cannot secrete insulin.”
E
ANSWER: ________
The best response for the nurse is option E.
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
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2. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro
(Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply.
A. The nurse could have given the insulin subcutaneously.
B. The nurse should have contacted the physician.
C. The nurse should have used regular insulin (Humulin R).
D. The nurse used the correct insulin.
BC
ANSWER: ________
Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as
RATIO:___________________________________________________________________________________________
it was not regular insulin. Contact the provider to clarify the order. regular insulin is the only insulin that can be
_________________________________________________________________________________________________
given intravenously (IV). The nurse cannot give the insulin subcutaneously when it is ordered to be given
_________________________________________________________________________________________________
intravenously (IV).

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3. Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse
reveal?
A. The client will be very thirsty.
B. The client will complain of nausea.
C. The client will need to urinate.
D. The client will have moist skin.
D
ANSWER: ________
Danger of hypoglycemia and sweating is one of the symptoms.
RATIO:___________________________________________________________________________________________
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4. A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as
being at highest risk for developing diabetes?
A. The 50-year-old client who does not get any physical exercise
B. The 56-year-old client who drinks three glasses of wine each evening
C. The 42-year-old client who is 50 pounds overweight
D. The 38-year-old client who smokes one pack of cigarettes per day
ANSWER: ________
B
RATIO:___________________________________________________________________________________________
Choice B is what the nurse should assess.
_________________________________________________________________________________________________
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5. Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess?
A. Potassium
B. AST (aspartate aminotransferase)
C. Serum amylase
D. Sodium
A
ANSWER: ________
Insulin causes potassium to move into the cell and may cause hypokalemia. There is no need to monitor the
RATIO:___________________________________________________________________________________________
sodium, serum amylase, and AST levels.
_________________________________________________________________________________________________
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6. Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education
with this drug? Select all that apply.
A. It stimulates the pancreas to produce more insulin.
B. It must be taken with meals.
C. It decreases sugar production in the liver.
D. It inhibits absorption of carbohydrates.
E. It reduces insulin resistance.
BCE
ANSWER: ________
BCE are applied.
RATIO:___________________________________________________________________________________________
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7. Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates the learning has
occurred when the client makes which statement?
A. “I should check my blood sugar immediately prior to the administration.”
B. “I should provide direct pressure over the site following the injection.”
C. “I should use the abdominal area only for insulin injections.”
D. “I should only use calibrated insulin syringe for the injections.”
D
ANSWER: ________
To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin injections should be
RATIO:___________________________________________________________________________________________
rotated to the arm and thigh, not just the abdominal area. There is no need to apply direct pressure over the
_________________________________________________________________________________________________
site following an insulin injection.
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8. Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a
glass of wine with dinner. What will the best plan of the nurse for client education include?
A. The alcohol could cause pancreatic disease.
B. The alcohol could cause serious liver disease.
C. The alcohol could predispose you to hypoglycemia.

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D. The alcohol could predispose you to hyperglycemia.
C
ANSWER: ________
Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. Alcohol can cause pancreatic
RATIO:___________________________________________________________________________________________
disease, but the client's pancreas is not producing any insulin currently. Alcohol can cause liver disease, but
_________________________________________________________________________________________________
the more immediate concern is hypoglycemia.
_________________________________________________________________________________________________

9. Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse
administer this medication?
A. When the client is eating
B. Thirty minutes before meals
C. fifteen minutes before meals
D. When the meal trays arrive on the floor
A
ANSWER: ________
The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is
RATIO:___________________________________________________________________________________________
eating to prevent hypoglycemia.
_________________________________________________________________________________________________
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10. Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client’s
additional insulin vials are not refrigerated. What is the best action by the nurse at this time?
A. Instruct the client to label each vial with the date when opened.
B. Tell the client there is no need to keep additional vials.
C. Have the client place the insulin vials in the refrigerator.
D. Have the client discard the vials.
ANSWER: ________
C
RATIO:___________________________________________________________________________________________
Vials not in use should be refrigerated to preserve drug potency. There is no need to discard the vials. The
_________________________________________________________________________________________________
client should always have additional vials of insulin available.
_________________________________________________________________________________________________

11. During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The physician writes orders
for the client with diabetes mellitus. Which order would the nurse validate with the physician?
A. Use Humalog insulin for sliding scale coverage.
B. Metformin (Glucophage) 1000 mg per day in divided doses.
C. Administer regular insulin 30 minutes prior to meals.
D. Lantus insulin 20U BID.
D
ANSWER: ________
Lantus insulin is usually prescribed once-a-day so an order for BID dosing should be validated with the
RATIO:___________________________________________________________________________________________
physician. Humalog insulin can be prescribed for sliding scale coverage.
_________________________________________________________________________________________________
_________________________________________________________________________________________________

12. An older woman with diabetes mellitus visits the clinic concerning her condition. Of which of the following symptoms
might an older woman with diabetes mellitus complain?
A. Anorexia
B. Pain intolerance
C. Weight loss
D. Perineal itching
D
ANSWER: ________
Older women may complain of perineal itching due to vaginal candidiasis. Symptoms of a diabetic condition in
RATIO:___________________________________________________________________________________________
the older person include the following: anorexia, incontinence, falls, pain intolerance, and cognitive or
_________________________________________________________________________________________________
behavioral changes.
_________________________________________________________________________________________________

13. Which of the following exerts its effect by inhibiting the enzyme that breaks down glucose for absorption?
A. Miglitol
B. Metformin
C. Pramlintide
D. Linagliptin
A
ANSWER: ________
Miglitol inhibit alpha-glucosidase, an enzyme that breaks down glucose for absorption
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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14. This antidiabetic agent works best in patients with insulin resistance.
A. Biguanides
B. Dipeptidyl peptidase-4 inhibitors
C. Thiazolidinediones
D. Meglitinides
D
ANSWER: ________
Meglitinides nateglinide and repaglinide are newer agents that act like sulfonylureas to increase insulin release.
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

15. Which antidiabetic agent works by modulating gastric emptying after a meal to cause a feeling of fullness?
A. Incretin mimetics
B. Meglitinides
C. Human amylin
D. Biguanides
C
ANSWER: ________
RATIO:___________________________________________________________________________________________
Synthetic human amylin pramlintide works to modulate gastric emptying after a meal to cause a feeling of
_________________________________________________________________________________________________
fullness or satiety.
_________________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
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2. ANSWER: ________
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3. ANSWER: ________
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8. ANSWER: ________
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9. ANSWER: ________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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11. ANSWER: ________
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12. ANSWER: ________
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14. ANSWER: ________
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15. ANSWER: ________
RATIO:___________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

DAILY DOZEN
Choose two questions from a generic list to respond to about the day’s lesson.
1. The thing that made the most sense to me today was…
2. One thing that I just don’t understand is…
3. When someone asks me what I did in math today, I can say…
4. One thing I would like more information about is…
5. I need more examples of…
6. I enjoyed…
7. The most important concept that we discussed today was…
8. Today’s class would have been even better if we had…
9. I was confused by…
10. The thing we did in class today that best fit my learning style was…
11. The one thing the teacher did today that worked well for me was…
12. The one thing the teacher did today that did not work well for me was…

1. __________________________________________________________________________________________

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2. __________________________________________________________________________________________

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For next session, review Hypertension and Hypertensive drugs.

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