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Pharm 2 > Class 11 Deck 1 > Flashcards

Class 11 Deck 1 Flashcards

1
Q

What are the rapid acting insulins?

A
  • Lispro (humalog)
  • Aspart (Novolog)
  • Glulisine (apidra)
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2
Q

What are the Short acting insulins?

A

-Regular (Humulin R / Novolin R)

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3
Q

What are the Intermediate acting insulins?

A

-NPH (Humulin N / Novolin N)

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4
Q

What are the long acting insulins?

A

-Glargine (Lantus)

Detemer (Levimir)

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5
Q

Alpha stimulation does what to insulin secretion?

A

-Decrease secretion

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6
Q

Beta / Parasympathetic stimulation does what to insulin secretion?

A

-Increase secretion

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7
Q

Insulin response to glucose is_______ for oral ingestion than for I.V. infusion.

A

Greater

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8
Q

What is the onset, peak, DOA, and critical hypoglycemia time for Lispro (humalog)

A
  • 15 minutes
  • 30-90 minutes
  • 3-5 hours
  • 1/2 to 1 & 1/2 hours
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9
Q

How does Lispro compare to regular insulin in pump administration?

A
  • Better glyccemic control

- Less hypoglycemia

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10
Q

Which insulin is clear, has a neutral PH and contains a small amount of zinc?

A

-Regular (Humulin R, Novolin R)

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11
Q

Regular insulin does what when SQ injected?

A

-It forms hexamers, that must dissociate into monomers before it can be absorbed

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12
Q

What is the onset, peak and DOA of regular insulin?

A
  • Onset = 30-60 min
  • Peak = 2-4 hours
  • Duration 5-8 hours
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13
Q

How is regular insulin dosed perioperatively?

A
  • 1-5 units IV

- 0.5-2 units /hr infusion (50 in 50)

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14
Q

Describe intermediate insulin.

A
  • Humulin N and Novolin N
  • Turbid solution w/ neutral PH
  • Contain protamine which delays absorption
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15
Q

Can Humulin N or Novolin N be given IV?

A

No, SQ only

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16
Q

What is the onset, peak and duration of intermediate insulins?

A
  • Onset = 1-3 hrs
  • Peak = 8 hours
  • Duration = 12-16 hours
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17
Q

What insulin is used as a basal insulin replacement?

A

-Long acting (Lantus, levemir)

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18
Q

Can long acting insulins be given IV, mixed with other insulins?

A

No and No

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19
Q

What is the PH of Long acting?

A

Acidic

20
Q

What is the onset, peak and duration of long acting?

A
  • Onset = 1hr
  • no peak
  • 20-26 hours
21
Q

When is long acting administered and what might is cause?

A
  • H.S

- nocturnal hypoglycemia

22
Q

What drug is a useful baseline for diabetics, and what drugs are they usually used with?

A
  • Long acting

- Short acting or orals

23
Q

How are the all the insulins types dosed?

A
  • Rapid/short = AC and HS
  • Intermediate = BID
  • Long = Daily
24
Q

What is the most serious side effect of insulin? and what is it related to?

A
  • Hypoglycemia

- Compensatory effects of increased epinepherine

25
Q

What are the symptoms of hypoglycemia?

A
  • Diaphoresis
  • Tachy
  • HTN
  • Mental confusion → Seizures → Coma
26
Q

What may mask the the correct diagnosis of hypoglycemia?

A

-Rebound hyperglycemia from SNS activity in response to hypoglycemia

27
Q

What are the allergic reactions associated with insulin?

A

-Redness at site if injection

28
Q

Chronic ______ administration may lead to the development of antibodies to protamine

A

NPH

29
Q

What is lipodystrophy? and how do you avoid it?

A
  • Atrophy of fat at injection site

- rotating injection sites

30
Q

Define insulin resistance.

A

-Patients requiring more than 100 units per day

acute can be caused by trauma, surgery, infection

31
Q

How are hypoglycemic effects of insulin countered?

A
  • ACTH or Glucocorticoids
  • Estrogen
  • Glucagon
32
Q

How does epinepherine effect insulin?

A
  • Inhibits insulin secretion

- Stimulates glyconeogensis

33
Q

What is the normal Hgb A1c? What is the ADA reccomendation?

A
  • 4-6%

- 7-8.5%

34
Q

What insulins can be given IV?

A

-Regular or Short acting

35
Q

How should multiple SQ insulin be given?

A
  • 70% of total dose as intermediate or long acting at bedtime
  • Additional doses of rapid before meals/snacks
36
Q

What are the goals of insulin therapy?

A
  • Maintain BG levels as close to normal as possibe

- Delay long term complications of DM

37
Q

What are the risks of periop hyperglycemia?

A
  • Microangiopathy
  • Impaired leukocyte
  • Cerebral edema
  • Impaired wound healing
  • Post op sepsis
38
Q

What is desired more periop, High or low BG? and whay?

A

-High, because GA can mask hypoglycemia signs

39
Q

What is the optimal BG levels intraop?

A
  • 80-180

- <80

40
Q

How to dose patients preop with SQ insulin ( needing non-tight control)

A

-1/4 to 1/2 the AM dose of intermediate or long the morning of surgery (or decrease long acting PM)

41
Q

What is Dr. Shulkosky’s insulin control dose?

A
  • 1 unit regular for every 50-60 mg/dl of glucose
42
Q

What is the goal for larger/longer procedures? and why?

A
  • BG 80-120

- Improve healing, prevents infection, improves outcomes after CNS ischemia

43
Q

how to treat hypoglycemia?

A

-15-25ml of D50 and stop infusion

44
Q

Larger/longer procedures may require insulin drip, how much and when do you start?

A
  • 0.05units/kg/hr (0.5-1unit/hr)

- Start at BG of 150

45
Q

How to treat patients w/ insulin pumps?

A
  • Maintain basal rate
  • Turn off preprandial boluses
  • Measure q1 hour
  • Know typical bolus to decrease 50mg/dl

Pharm 2 (23 decks)

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