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NAPLEX - OUR cards > Diabetez pt 2 (injectables) > Flashcards

Diabetez pt 2 (injectables) Flashcards

1
Q

How to GLP-1 agonists work?

A

Analogs of incretin hormone GLP-1 which increases glucose-dependent insulin secretion and decreases glucagon secretion

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2
Q

Exenatide brand, dose, renal dosing

A

Byetta
5 mcg SC BID for 1 month, then 10 mg SC BID

CrCL < 30 mL/min not recommended (underlined)

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3
Q

Exenatide extended release brand, dose, renal dosing

A

Bydureon
2 mg SC once ~~~weeeeekly~~~
CrCL < 30 mL/min not recommended (underlined)

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4
Q

Liraglutide brand, dose, renal dosing

A

Victoza
Start 0.6 mg SC daily x 1 week, then 1.2 mg SC daily
Can increase to 1.8 mg SC daily if needed
No renal dosing

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5
Q

Dulaglutide brand, dose, renal dosing

A

Trulicity
0.75 mg SC once weekly, can increase to 1.5 mg SC once weekly

~~weeeekly~~

No renal dosing

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6
Q

Lixisenatide brand, dose, renal dosing

A

Adlyxin

10 mcg SC daily x 14 days, then increase to 20 mcg aily

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7
Q

GLP-1 agonist boxed warnings, contraindications, warnings, side effects, counseling points

A

Boxed warnings: All except Byetta (exenatide) and Adlyxin (lixisenatide) risk of thyroid C-cell carcinomas, seen in rats, unknown if applied to humans

Contraindications: all except Byetta and Adlyxin - personal or family history of medullary thyroid carcinoma

Warnings: Pancreatitis, not recommended in patients with severe GI disease

side effects: nausea, wt loss (slowed gastric emptying)

Counseling: dose Byetta and Adlyxin within 60 minutes of meals, all others can be given without regard to meals

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8
Q

Which class of drugs can cause pancreatitis?

A

GLP-1 agonists

(Byetta, Bydureon, Trulicity, Victoza, Adlyxin

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9
Q

How are GLP-1 agonists administered?

A

SC

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10
Q

True or false: Give Byetta within 60 minutes after a meal?

A

False - within 60 mins before a meal

After can cause hypoglycemia

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11
Q

Bydureon vial counseling points

A

Single-dose vial/tray - once mixed, must inject immediately or else clumps will form

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12
Q

Once weekly GLP-1 agonists

A

Bydureon, Trulicity, Tanzeum

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13
Q

Symlin MOA, dosing, boxed warning, contraindications, warnings, side effects

A

Pramlintide is an analog of amylin which controls postprandial glucose by slowing gastric emptying, suppressing glucagon secretion following a meal, and increasing satiety

Type 1: 15 mcg/dose increase in 15 mcg increments every 3 days
Type 2: 60 mcg/dose, up to 120 mcg/dose after 3 days
Give prior to each major meal (> 30 g/carbs)

Boxed warning: severe hypoglycemia if used with insulin
Contraindications: gastroparesis
Warnings: hypoglycemia - reduce mealtime insulin by 50% when starting

Side effects: n/v, anorexia, headache, wt loss

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14
Q

Name the rapid acting insulins

A

Aspart (Novolog)
Glulisine (Apidra,)
Lispro (Humalog)
Afrezza (powder)

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15
Q

Warnings w rapid acting insulin

A

Hypoglycemia, hypokalemia (shifts K from intracellular space to the intracellular space)

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16
Q

Counseling, boxed warnings, contraindications w Afrezza

A

Rapid acting insulin inhalation powder
Replace inhaler every 15 days

Boxed warnings: Acute bronchospasm in asthma or COPD
Contraindications: Asthma, COPD

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17
Q

Name the short acting regular insulins

A

Humulin R
Novolin R
Comes as 100 units/mL or 500 units/mL

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18
Q

When is concentrated (500 units/mL) insulin recommended?

A

In patients where > 200 units/day of insulin is required

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19
Q

Counseling for U-500 uinsulin?

A

Must use a U-500 syringe to avoid dosing errors

Each marking represents 5 units - no dose conversion needed

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20
Q

True or false: Insulin is available without a prescription

A

Yes - Humulin R, Novolin R, Humulin N, Novolin N, Humulin 70/30, and Novolin 70/30 are available without a prescription

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21
Q

Name the intermediate acting insulins

A

NPH Insulin

Humulin N, Novolin N

22
Q

Counseling for Novolin N, Humulin N

A

Solution is cloudy when mixed
Can mix with rapid or short-acting insulins but draw up rapid or short acting first and then add NPH bc NPH is cloudy whereas rapid/short are not

23
Q

Name the long-acting insulins

A

Detemir (Levemir)
Glargine (Lantus, Basaglar, Toujeo)
Degludec (Tresiba)

24
Q

Insulin pumps should be limited to what kind of insulin?

A

Short acting or regular insulin

25
Q

How to initiate basal-bolus insulin (calculations)

A

Step 1: Calculate TDD (0.6 units/kg/day using ABW)
Step 2: Divide TDD into 50% basal, 50% bolus
Step 3: Divide bolus into 3 meals

0.6 units/kg/day x 70 kg = 42 units
= 21 units Lantus and 21 units Humalog
= 21 units lantus + 7 units humalog TIDAC

26
Q

What is the Rule of 500?

A

500 divided by the total daily dose of RAPID ACTING insulin = grams of carbs covered by 1 unit of rapid acting insulin

Rapid acting insulins: Aspart (novolog), glulisine (apidra), lispro (humalog)

27
Q

What is the rule of 450?

A

450 divided by the total daily dose of REGULAR insulin = grams of carbs covered by 1 unit of rapid acting insulin

Regular insulin: Humulin R, Novolin R

28
Q

What is the 1800 rule?

A

Used to determine amount of RAPID ACTING insulin needed to return their blood glucose to a normal range

1800/TDD = correction factor for 1 unit of rapid-acting insulin

Blood glucose now - target blood glucose divided by correction factor = correction dose

29
Q

What is the 1500 rule?

A

Used to determine amount of REGULAR insulin needed to return their blood glucose to a normal range

1500/TDD = correction factor for 1 unit of rapid-acting insulin

Blood glucose now - target blood glucose divided by correction factor = correction dose

30
Q

Initiation of insulin for type 2 DM dosing guidance

A

0.1-0.2 unitskg/day (using ABW) or 10 units/day

Titrate by 10-15% or 2-4 units once or twice weekly to reach fasting glucose goal

31
Q

Dosing conversion among insulins

A

Most 1:1 unit-to-unit dose conversion

Converting from twice daily NPH to once daily insulin glargine (Lantus, Toujeo, Basaglar) - use 80% of the total daily NPH dose as the initial dose of insulin glargine

32
Q

Insulin injection counseling points

A

Roll vial if a suspension, do not shake
Abdomen pref’d injection site
Draw up clear before cloudy if mixing insulin (NPH cloudy)
Rotate injection site along the abdomen

33
Q

Expiration date of insulin

A

If refrigerated and unopened, stable until expiration date on the label

Stability at room temperature varies, most are 28 days

34
Q

Syringe/needle recommendations

A

Smaller syringe barrel = easier it is to read scale markings in order to draw up an accurate dose

35
Q

Define HHS

A

Hyperglycemia hyperosmolar state, often occurs in T2DM
Serum ketones are negligible or not present because patient with type 2 diabetes has enough insulin to suppress ketogenesis

BG > 600
High serum osmolality > 320
Extreme dehydration
Altered consciousness
pH > 7.3, bicarbonate > 15 mEq/L
36
Q

Define DKA

A

Diabetic ketoacidosis
Occurs in type 1 diabetes often due to insulin non-compliance
Ketones are present

BG > 250
Ketones in urine and serum or fruity breath
Anion gap (arterial pH < 7.35 and anion gap > 12)

37
Q

Do not use if eGFR or CrCL < 30

A

Metformin

SGLT2 inhibitors (Canagliflozin (invokana), Dapagliflozin (Farxiga), and empagliflozin (Jardiance))

Exenatide (GLP-1, Byetta)

Glyburide

38
Q

Do not use in heart failure

A

TZD’s (Pioglitazone (actos), rosiglitazone (avandia))

alogliptin, saxagliptin

39
Q

Do not use in peripheral neuropathy, PAD, or diabetic foot ulcers

A

Canagliflozin (SGLT-2)

40
Q

Do not use in gastroparesis or other GI disorders

A

GLP-1 agonists, (Exenatide (Byetta, Bydureon), Liraglutide (Victoza), Dulaglutide (Trulicity), Albiglutide (Tanzeum), Lixisenatide (Adlyxin)

pramlintide

41
Q

Do not use in sulfa allergy

A

Sulfonylureas

42
Q

Do not use in G6PD deficiency

A

Sulfonylureas

43
Q

Agents w risk of lactic acidosis

A

Metformin

44
Q

Agents w risk of hepatotoxicity

A

TZD’s (Pioglitazone (actos), rosiglitazone (avandia))

alogliptin

45
Q

Agents w risk of hypotension/dehydration

A

SGLT-2 inhibitors (Canagliflozin (invokana), Dapagliflozin (Farxiga), and empagliflozin (Jardiance))

46
Q

Agents w risk of UTI/genital infections

A

SGLT-2 inhibitors (Canagliflozin (invokana), Dapagliflozin (Farxiga), and empagliflozin (Jardiance))

47
Q

Agents w risk of potassium abnormalities

A

Canagliflozin (hyperkalemia) (SGLT-2)

Insulin (hypokalemia)

48
Q

Agents w risk of pancreatitis

A

DPP-4 inhibitors (Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina))

GLP-1 agonists (Exenatide (Byetta, Bydureon), Liraglutide (Victoza), Dulaglutide (Trulicity), Albiglutide (Tanzeum), Lixisenatide (Adlyxin)

49
Q

Agents w risk of hypersensitivity rxns

A

Sulfonylureas

DPP-4 inhibitors (Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina))

50
Q

Agents w risk of ketoacidosis

A

SGLT-2 inhibitors (when BG < 250 mg/dL)

Canagliflozin (invokana), Dapagliflozin (Farxiga), and empagliflozin (Jardiance)

51
Q

Agents w risk of cancer

A

Pioglitazone, dapagliflozin (bladder cancer)

GLP-1 agonists (thyroid cancer) (Exenatide (Byetta, Bydureon), Liraglutide (Victoza), Dulaglutide (Trulicity), Albiglutide (Tanzeum), Lixisenatide (Adlyxin)

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