Diabetes & Pain

Question 1

Short-acting Insulin

Answer 1

Onset: 30-60 min.
Peak: 2-3 hours
Duration: 5-7 hours

Question 2

Intermediate- acting Insulin

Answer 2

Onset: 1-1.5 hours
Peak: 8-12 hours
Duration: 12-24 hours

Question 3

Long- acting Insulin

Answer 3

levemir/Determir
glargine/Lantus

Onset: 1 hour
NO PEAK
Duration:24 hours

Question 4

Glipizide (Glucotrol)

Answer 4

• sulfonylurea
• avoid giving to those who are allergic to sulfa
• increases pancreatic secretion of insulin
• take 30 min before breakfast and dinner, do not skip meals
• can cause hypoglycemia

Question 5

Acarbose (Precose)

Answer 5

• Acts in GI to delay digestion of carbs into glucose
• slows glucose absorption
• GI symptoms- gas, bloating, diarrhea
• take with first bite of food

Question 6

Sitagliptin (Januvia)

Answer 6

Increases incretin (increases insulin, stops glucagon, slows gastric emptying)

Question 7

Pramlintide (Symlin)

Answer 7

• slows gastric emptying
• decreases glucagon
• given SQ

Question 8

Metaformin (Glucophage)

Answer 8

• first line, all type 2 diabetics
• sensitizes body to insulin
• decreases glucose production
• decreases glucose absorption in GI
• Hard on kidneys, must be off drug days before getting contrast dye

Question 9

Humulin R

Novolin R

Answer 9

• short-acting insulin, regular insulin
• only insulin that can be administered IV!!
• hypoglycemic drug of choice for patients with diabetes in acute or emergency situations or DKA.

Question 10

NPH
Humulin N
Novolin N

Answer 10

• Intermediate-acting insulin
• common for long term administration
• cloudy appearance when correctly mixed
• ONLY SQ
• hypoglycemia reactions occur during mid to late afternoon
• NOT recommended for acute situations
• 7-26 units may be given twice daily initially

Question 11

Nalbuphine (Nubain)

Answer 11

Synthetic analgesic used for moderate to severe pain, Not a controlled drug. Most common adverse effect is sedation. Not recommended in children

Question 12

Butorphanol (Stadol)

Answer 12

Synthetic, schedule IV agonist similar to morphine in analgesic effects and ability to cause respiratory depression

Adverse effects: drowsiness, nausea, vomiting. Not recommended in children under 18

May be topical to nasal mucosa by a metered spray

Question 13

Narcan (Naloxone)

Answer 13

Action: Competes with opioids for receptor sites in the brain and prevents binding with receptors or displaces opioids already occupying receptor sites

Question 14

Pre-emptive analgesia

Answer 14

Used to lessen postsurgical pain. Simultaneous medications may be used from different drug classes to block pain from multiple pathways. Commonly given before the start of surgery and continue through the maintenance phase

Question 15

Hyperglycemia

Answer 15

often associated with intra-abdominal obesity, high levels of plasma triglycerides and low levels of HDL’s, Increased blood pressure, and Increased fasting plasma glucose

Question 16

fasting plasma glucose

Answer 16

below 100 is considered normal

Question 17

Acute complications of diabetes

Answer 17

diabetic ketoacidosis (T1), Hyperglycemic Hyperosmolar State (T2), hypoglycemia

Question 18

Hyperglycemic Hyperosmolar State

Answer 18

Increased serum osmolarity has the effect of pulling water out of body cells including brain cells.

Symptoms include Weakness, dehydration, polyuria, neurologic signs and symptoms, excessive thirst, hemiparesis, Babinski reflex, aphasia, muscle fasciculation, hyperthermia, hemianopia, hallucinations, seizures, and coma.

May be confused with stroke in older adults