1. Insulins

Question 1

rapid-acting insulins (4)

Answer 1

insulin aspart
insulin glulisine
insulin lispro
inhaled insulin

Question 2

insulin aspart (brand, available as…)(2)

Answer 2

NovoLOG: 100 units/mL

NovoLOG FlexPen: 100 units/mL

Question 3

insulin glulisine (brand, available as…)(2)

Answer 3

Apidra: 100 units/mL

Apidra SoloStar: 100 units/mL

Question 4

insulin lispro (brand, available as…)(2)

Answer 4

HumaLOG: 100 units/mL

HumuLOG KwikPen: 200 units/mL

Question 5

inhaled insulin (brand, available as…)(1)

Answer 5

Afrezza

4, 8, 12 unit cartridges

Question 6

HumaLOG KwikPen is used when a patient requires >__ units/day of rapid-acting insulin

Answer 6

20

Question 7

Administer rapid-acting insulin up to ___ minutes before or immediately _____ meals; lasts __-__ hrs (shorter than short-acting insulin)

Answer 7

15
after
3-5

Question 8

Afrezza cartridges should be at room temperature for ___ minutes before administration

Answer 8

10

Question 9

Afrezza should be inhaled [before/after] meals; lasts __-__ hrs

Answer 9

before

2-3

Question 10

Replace Afrezza inhaler every ___ days to maintain accurate drug delivery

Answer 10

15

Question 11

Afrezza BBW: CI in patients w/ chronic ____ disease such as ____ or ____. Before initiation, perform a detailed medical history, physical exam and _____ (____) to identify potential ____ disease in all patients.

Answer 11

lung
asthma or COPD
spirometry (FEV1)
lung

Question 12

Afrezza is not recommended in _____ or those who recently ____

Answer 12

smokers

quit

Question 13

Afrezza monitoring

Answer 13

pulmonary function tests (FEV1) at baseline, after 6 months, then annually

Question 14

short-acting or regular insulins (brand) (4)

Answer 14

HumuLIN R
NovoLIN R
ReliOn
Humulin R U-500 (available in a 20 mL vial)

Question 15

All short-acting insulin should be administered ___ minutes before meals; lasts __-__ hrs, and Humulin R U-500 lasts up to ___ hrs

Answer 15

30
6-10
24

Question 16

short-acting insulins [can/can’t] be used in IV solutions

Answer 16

can

Question 17

Humulin R U-500 is 5 times as concentrated and is recommended when the patient requires >____ units/day of short-acting insulin

Answer 17

200

Question 18

Humulin R U-500 [can/can’t] be mixed with other insulins

Answer 18

can’t

Question 19

Dosing formula for U-100 insulin syringe: divide prescribed dose/units of U-500 by __; that is equivalent to the unit markings on a U-100 insulin syringe

Answer 19

5

• the U-500 dose should always be expressed in actual units as well as the corresponding markings on the syringe the patient will be using
• a conversion chart should be used

Question 20

Dosing formula for volumetric (tuberculin or allergy) syringe: divide prescribed dose/units of U-500 by __; that is equivalent to the volume (mL) in a volumetric syringe

Answer 20

500

• the U-500 dose should always be expressed in actual units as well as the corresponding markings on the syringe the patient will be using
• a conversion chart should be used

Question 21

intermediate-acting (NPH) insulins (brand)(3)

Answer 21

HumuLIN N
NovoLIN N
ReliOn

Question 22

NPH is given ____ or ____ daily. It contains protamine, making it ____ in appearance.

Answer 22

once or twice

cloudy

Question 23

NPH onset is ~__-__ hrs; lasts up to ___ hrs.

Answer 23

1-2

24 (varies by patients)

Question 24

NPH [can/can’t] be mixed with rapid and short-acting insulins

Answer 24

can

Question 25

When mixing NPH, draw ____ before ____.

Answer 25

clear | cloudy

Question 26

long-acting (basal) insulins (3)

Answer 26

insulin detemir insulin glargine insulin degludec

Question 27

insulin detemir (brand, available as...)

Answer 27

Levemir: 100 units/mL | Levemir FlexTouch: 100 units/mL

Question 28

insulin glargine (brand, available as...)

Answer 28

Lantus: 100 units/mL Lantus SoloStar: 100 units/mL Toujeo SoloStar: 300 units/mL

Question 29

insulin degludec (brand, available as...)

Answer 29

Tresiba: 100 units/mL & 200 units/mL pen

Question 30

long-acting insulins are given ____ or ____ daily

Answer 30

once (at bedtime) | twice

Question 31

long-acting insulins [can/can't] be mixed with other insulins

Answer 31

can't

Question 32

_____ has an acidic pH and may sting upon injecting

Answer 32

glargine

Question 33

All insulin SEs

Answer 33

hypoglycemia, hypokalemia, weight gain, lipodystrophy, injection site reactions

Question 34

How does insulin cause hypokalemia?

Answer 34

insulin shifts K+ from the extracellular to intracellular space

Question 35

Use insulin with caution in renal [and/or] hepatic impairment

Answer 35

and

Question 36

Insulin pen devices should never be used for more than one person [even/except] when the needle is changed due to ___ __ ______.

Answer 36

even | risk of infection

Question 37

insulin monitoring

Answer 37

BG, A1C, weight

Question 38

pre-mixed insulins 70/30 (3)

Answer 38

NPH/regular degludec/aspart aspart protamine susp./aspart sol'n

Question 39

pre-mixed insulin 75/25 and 50/50

Answer 39

lispro protamine susp./lispro sol'n

Question 40

70 NPH/30 regular (brand)(3)

Answer 40

Humulin 70/30 Novolin 70/30 ReliOn

Question 41

70 degludec/30 aspart (brand)

Answer 41

Ryzodeg

Question 42

70 aspart protamine susp./30 aspart sol'n

Answer 42

NovoLog Mix 70/30

Question 43

75 lispro protamine susp./25 lispro sol'n | 50 lispro protamine susp./50 lispro sol'n

Answer 43

Humalog Mix 75/25 | Humalog Mix 50/50

Question 44

insulin DDI: meds that also cause hypoglycemia (identify high, moderate, low risk meds)

Answer 44

High risk: insulin, pramlintide Moderate risk: sulfonylureas, meglitinides Low risk: DPP-4 inh., GLP-1 RA, alpha-glucosidase inhibitors Management: use caution and/or reduce insulin dose

Question 45

Insulin dosing for T1DM: insulin ___, including ____-_____ and _____ insulins, are preferred to reduce ______ risk and mimic the physiologic pattern of endogenous insulin. It should be started at a total daily dose (TDD) of ___ units/kg/day based on _____ body weight.

Answer 45

``` analogs rapid-acting basal 0.6 actual ```

Question 46

Insulin dosing for T1DM: if using a rapid-acting (bolus) and long-acting (basal) insulin, aka ____-_____ strategy, ___% of the TDD is used as the basal dose and ___% for the bolus dose; the bolus is then further divided among the __ meals.

Answer 46

basal-bolus (preferred) 50% 50% 3

Question 47

Insulin dosing for T1DM: if using intermediate-acting NPH and regular insulins, aka ___/__ strategy, ____ of the TDD is used as the NPH dose and ___ as the regular insulin dose; these are generally dosed _____ daily, ___ minutes prior to breakfast and dinner.

Answer 47

``` NPH/R 2/3 1/3 twice 30 ```

Question 48

Insulin dosing for T2DM: _____ insulin is often initiated when patient fails to reach glycemic goals on multiple oral agents and is usually started at __-__ units/kg/day using ____ body weight or ___ units/day.

Answer 48

basal 0.1-0.2 actual 10

Question 49

Insulin dosing for T2DM: starting dose is titrated by 10-15% or __-__ units once or twice weekly to reach the fasting blood glucose goal. Would consider 1 to 3 rapid-acting mealtime insulins if ____ glucose levels are normal but ___ remains above goal and would titrate to achieve post-prandial targets.

Answer 49

2-4 fasting A1c