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46 Cards in this Set

  • Front
  • Back

Rapid-acting Insulins

lispro (Humalog)


aspart (Novolog)


glulisine (Apidra)

Short-acting Insulins

Regular (Humulin R)


Regular (Novolin R)

Intermediate-acting Insulins

NPH (Humulin N)


detemir (Levemir)

Long-acting Insulins

glargine (Lantus)

Rapid-acting Insulin time/action profile

onset: 15-30 minutes


peak: 0.5-2.5 hours


duration: 3-6 hours

Short-acting Insulin time/action profile

onset: 0.5-1 hour


peak: 1-5 hours


duration: 6-10 hours


Intermediate-acting Insulin time/action profile

onset: 1-2 hours


peak: 6-14 hours


duration: 16-24 hours

Long-acting Insulin time/action profile

onset: 70 minutes


peak: none


duration: 24 hours


Premixed Insulins: Humulin 70/30


Humalog 75/25

70% NPH (inter.) and 30% regular (short-acting)


75% lispro protamine (int.) and 25% lispro (rapid)

Insulin action

1. increases cellular uptake of glucose ---> decrease serum glucose


2. converts glucose --> glycogen


3. moves K+ into cells as well

Hypoglycemia: Abrupt Onset

SNS Clinical Manifestations:



tachycardia, palpitations, diaphoresis, shakiness

Hypoglycemia: Gradual Onset

PNS Clinical Manifestations:



headache, tremor, weakness

Insulin Interactions

Sulfonylureas, meglitinides, BB's, ETOH --> hypoglycemia < 50 mg/dl

Insulin Interactions

thiazide diuretics, glucocorticoids --> increase serum glucose

Insulin Interactions

BB's mask s/s of hypoglycemia --> teach client not to rely on s/s, but rather to carefully monitor BG, maintain regular eating schedule, and take extra glucose during insulin peak action times

Mixing Insulin: Four Steps

" Draw up Clear Before Cloudy"



1. Inject air into Cloudy NPH


2. Inject air into Clear Regular


3. Turn Regular bottle upside-down and draw up (Fill) Regular dose


4. Draw up Cloudy NPH



Oral Antidiabetics: Sulfonylureas

MOA: increases pancreatic insulin secretion

Oral Antidiabetics: Meglithinides

MOA: increases pancreatic insulin secretion

Oral Antidiabetics: Biguanides

MOA: reduces hepatic gluconeogenesis, increase glucose uptake by muscle cells



Oral Antidiabetics: Thiazolidinediones (Glitazones)

MOA: decreases cellular insulin resistance, increases glucose uptale, and decreases glucose production

Oral Antidiabetics: Alpha Glucosidase Inhibitor

MOA: slows carbohydrate absorption and digestion

Oral Antidiabetics: Gliptins

MOA: insulin release and glucagon decrease (glucagon stimlulates BG increase)



Specifically, lowers fasting/ postprandial BG

Sulfonylureas

chlorpropamide (Diabinese)


tolbutamide (Orinase)


glipizide (Glucotrol)


glyburide (Diabeta)


glimepiride (Amaryl)

Meglitinides

repaglinide (Prandin)


nateglinide (Starlix)

Biguanides

metformin HCL (Glucophage)

Thiazolidinediones (Glitazones)

pioglitazone (Actos)

Alpha Glucosidase Inhibitor

acarbose (Precose)


miglitol (Glyset)

Gliptins

sitagliptin (Januvia)

AR/INT: metformin HCL



GI

AR: GI: A-N-V --> 3-4kg weight loss


INT: monitor s/s


AR/INT: metformin HCL



Vit. B/ folic acid deficiency

AR: Vit. B, folic acid deficiency r/t decreased absorption


INT: provide supplements as prescribed

AR/INT: metformin HCL



Lactic acidosis: HIGH ALERT!

HIGH ALERT!!! This AR has a 50% mortality rate



AR: Lactic acidosis AEB hyperventilation, myalgia, sluggishness, somnolence


INT: hold med, inform HCP immediately (severe lactic acidosis is treated w/ hemodialysis)


AR/INT: pioglitazone



Fluid retention

AR: Fluid retention


INT: monitor for edema, weight gain, s/s of HF

AR/INT: pioglitazone



Increased LDL

AR: Increased LDL


INT: monitor LDL levels

AR/INT: pioglitazone



Hapatotoxicity

AR: hepatotoxicity


INT: monitor ALT/ AST, jaundice, and dark urine

AR/INT: acarbose



Intestinal effects

AR: intestinal effects AEB abd. distention, crampin, hyperactive BS, diarrhea, excessive gas


INT: monitor effects on client

AR/INT: acarbose



Anemia

AR: anemia r/t decreased Fe absorption


INT: monitor H/H, Fe

AR/INT: acarbose



Hepatotoxicity

AR: hepatotoxicity r/t long term therapy


INT: monitor ALT/AST, advise client that normal liver function will resume with cessation of acarbose


CI: Pregnancy Risk Category C



glipidize, repaglinide, pioglitazone


CI: Pregnancy Risk Category B (generally avoided in preg/lact, but HCP may prescribe)

metformin, acarbose, sitagliptin

Oral antidiabetics precautions: renal failure, hepatic dysfunction, HF



CI: DKA

Rationale: drug may accumulate --> hypoglycemic effect

CI: metformin HCL

severe infection, shock, any hypoxic condition (ex. COPD)


CI: acarbose

GI disorders (inflammatory disease,ulceration, obstructions)


CI: pioglitazone

severe HF, hx of bladder cancer, active hepatic disease



use w/ caution in mild HF, elderly

Interactions: glipizide

ETOH --> disulfiram reaction (severe N-V, flushing and palpatations)



Sulfonamide abx, NSAIDS, ranitidine (Zantac), cimetidine (Tagamet) --> additive hypoglycemic effect



BBs --> mask SNS s/s of hypoglycemia (tachycardia, tremors, palpitations, diaphoresis)

Interactions: repaglinde and pioglitazone

gemfibrozi (Lopid) --> hypoglycemia

Interactions: metformin HCL

ETOH --> lactic acidosis (potentially fatal)



iodine-containing contrast media --> GI effects, hypoglycemia