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Pharmacology Spring 2021 > Endocrine: Insulin > Flashcards

Endocrine: Insulin Flashcards

1
Q

Types of insulin

A
  1. rapid acting
  2. short acting
  3. intermediate acting
  4. long acting
  5. Mixed Combo acting
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2
Q

Generic and brand name for rapid acting insulin

A
  1. Lispro (Humalog)

2. Aspart (Novalog)

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3
Q

Generic and brand name for short acting insulin

A
  1. Regular (Humulin R)

2. Regular (Novolin R)

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4
Q

Generic and brand name for intermediate acting insulin

A
  1. NPH (Humulin N)

2. NPH (Novolin N)

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5
Q

Generic and brand name for long acting insulin

A
  1. Glargine (Lantus)

2. Detemir (Levemir)

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6
Q

Generic and brand name for mixed combo acting insulin

A

70/30 (NPH/Regular)

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7
Q

Are oral or injected antidiabetics more effective?

A

Injected

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8
Q

Why are oral antidiabetics less effective?

A

The GI tract breaks down the protein molecule before it reaches the bloodstream

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9
Q

What is insulin absorption dependent on?

A
  1. Injection site
  2. Pts blood supply
  3. Degree of tissue hypertrophy
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10
Q

What other forms of administration of insulin are there?

A
  1. IV bolus
  2. IV infusion
  3. IM injection
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11
Q

What type of insulin can be given IV and IM?

A

Regular

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12
Q

Where is insulin absorbed?

A

Blood stream

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13
Q

Where is insulin distributed?

A

Throughout the body

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14
Q

What tissues in the body respond to insulin?

A
  1. Liver
  2. Adipose tissue
  3. Muscle
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15
Q

Where is insulin metabolized?

A

Mostly:

  1. Liver

Lesser extent:

  1. Kidneys
  2. Muscle
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16
Q

How is insulin excreted?

A
  1. Feces

2. Urine

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17
Q

What type of hormone is insulin?

A

Anabolic

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18
Q

What are Anabolic hormones responsible for?

A

building

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19
Q

What is insulin responsible for?

(see How insulin aids glucose
uptake, page 410.)

A

Promotes:

  1. Storing of glucose as glycogen
  2. An increase in protein and fat synthesis
  3. A deceleration of the breakdown of glycogen, protein, and fat
  4. A balance of fluids and electrolytes.
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20
Q

Where is insulin normally produced?

A

Beta cells of the pancreas

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21
Q

How does insulin aid in glucose uptake?

A

SEE PHOTO IN FOLDER ON PHONE

  1. Insulin binds to an insulin receptor on surface of cell
  2. Insulin and its receptor move into cell
  3. Which activates glucose transporter channel to move to the surface of cell
  4. Channel allows glucose to enter the cell
  5. The cell can then use glucose for metabolism
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22
Q

What is an associated symptom of hyperglycemia?

A

Osmotic diuresis

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23
Q

In addition to aiding in glucose uptake what else does insulin do for DM?

A
  1. Correct the polyuria (urination)
  2. Correct polydipsia (thirst)
  3. Facilitates the movement of
    potassium from the extracellular fluid into the cell
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24
Q

How does insulin correct polyuria and polydipsia?

A

By decreasing blood sugar

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25
Q

Whos is insulin indicated for?

A

Type 1 DM and Type 2 when:

  1. Other methods of controlling BS have failed or are contraindicated
  2. BS levels are elevated during
    periods of emotional or physical stress (Infection, surgery, or med therapy)
  3. Oral antidiabetic drugs are contraindicated d/t pregnancy/ hypersensitivity
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26
Q

What are complications of DM that insulin can be used to treat?

A
  1. diabetic ketoacidosis (DKA)

2. hyperosmolar hyperglycemic nonketotic (HHNK)

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27
Q

Which complication of DM treated with insulin is more common in Type 1 DM?

A

diabetic ketoacidosis (DKA)

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28
Q

Which complication of DM treated with insulin is more common in Type 2 DM?

A

hyperosmolar hyperglycemic nonketotic (HHNK)

29
Q

What condition can insulin treat other than DM?

A

Hyperkalemia

30
Q

What is Hyperkalemia?

A

Elevated serum potassium

31
Q

How does insulin treat Hyperkalemia?

A
  1. Potassium moves with
    glucose from the bloodstream into the cell
  2. Lowers serum potassium
    levels
32
Q

What is a nursing consideration when administering insulin?

A

Monitor the patient for:

  1. Hypoglycemia
  2. Hypersensitivity reactions
33
Q

In what way can other drugs interact with insulin to produce undesirable effects?

A

They can…

  1. Increase the effects
  2. Reduce the effects
  3. Prolong the effects
34
Q

What results if a drug interaction with insulin causes a reduction of its effects?

A

May cause hyperglycemia

35
Q

What results if a drug interaction with insulin causes a prolonged effect?

A

May mask S&S of hypoglycemia

36
Q

Which drugs can interact with insulin to result in an increase the effects?

A
  1. Anabolic steroids
  2. Salicylates
  3. Alcohol
  4. Sulfa drugs
  5. ACE inhibitors
  6. Propranolol
  7. Guanethidine
  8. MAOIs
37
Q

Which drugs can interact with insulin to result in a reduction of its effects?

A
  1. Corticosteroids
  2. Sympathomimetic drugs
  3. Isoniazid
  4. Thyroid hormones
  5. Niacin
  6. Furosemide
  7. Thiazide diuretics
38
Q

Which drugs can interact with insulin to result in prolonged effects?

A

Beta Blockers

39
Q

What are adverse reactions to insulin?

A
  1. Hypoglycemia
  2. Somogyi effect
  3. Hypersensitivity reactions
  4. Lipodystrophy
  5. Insulin resistance
40
Q

What is Somogyi effect?

A

Hypoglycemia followed by rebound

hyperglycemia

41
Q

What is Lipodystrophy

A

Disturbance in fat deposition

42
Q

What to monitor for when administering insulin

A
  1. BS before and during therapy
  2. Glycosylated hemoglobin level
  3. Injection sites
43
Q

In what situations should you monitor a patient on insulin more frequently?

A
  1. Under stress
  2. Unstable
  3. Pregnant
  4. Recently diagnosed
  5. Dietary changes
  6. NPO
  7. N&V
  8. Taking drugs that interact
44
Q

What should be monitored if a patients BS level is elevated?

A

Urine ketone level

45
Q

Why should you monitor injection sites?

A

For local reactions

46
Q

Insulin outcome goals

A
  1. BS in normal limits
  2. Patient follows recommended diet
  3. Risk of injury to patient minimized
  4. Patient/family demonstrate understanding of drug therapy
47
Q

In what special circumstances is regular insulin indicated?

A
  1. Circulatory collapse
  2. DKA
  3. Hyperkalemia
48
Q

What is done if insulin resistance occurs?

A

Large insulin doses are needed

49
Q

When is a patient considered to have severe insulin resistance?

A

Daily dose is >200 U

50
Q

What is prescribed for a patient with insulin resistance?

A

U-500 insulin

51
Q

What type of insulin is U-500 insulin?

A

Concentrated regular insulin

52
Q

How should U-500 insulin be stored? Why?

A
  1. In in the same area as other insulin preparations

2. If given to non diabetic patient can cause overdose

53
Q

How do you mix an insulin suspension?

A

Gently rotate vial between your

palms

54
Q

Which insulin should be given before meals?

A

Rapid acting insulin

55
Q

How long before meals should Rapid acting insulin be administered?

56
Q

Which insulin cant be diluted?

A

Long acting insulin

57
Q

Which insulin cant be mixed?

A

Long acting insulin

58
Q

Which insulin cant be given IV?

A

Long acting insulin

59
Q

Which insulin can be mixed?

A

Regular insulin can mix with NPH

60
Q

When drawing up regular insulin and NPH into one syringe what is important to remember?

A
  1. Regular must be drawn up first

2. Give immediately

61
Q

What can occur if you draw up regular insulin and NPH in the same syringe and do not give it immediately?

A

Loss of potency

62
Q

If a patient is switching from separate injections to a prepared mixture what can occur?

A

May alter the patient’s response

63
Q

When should you NOT use insulin?

A
  1. Changed color
  2. Become clumped/granular
  3. Expired
64
Q

What is important to remember when administering IV?

A
  1. Regular
  2. Inject directly at ordered rate
  3. Into vein
  4. Through intermittent infusion device OR
  5. Into a port close to the IV access site
65
Q

If giving continuous infusion what is important to remember?

A

Infuse the drug diluted in normal saline solution at the prescribed rate

66
Q

How to administer insulin subcutaneously

A
  1. Pinch a fold of skin w the fingers
    starting at least 30 (7.6 cm) apart
  2. Insert the needle at a 45- to
    90-degree angle
  3. Press but don’t rub the site after injection
  4. Rotate and chart injection sites (to avoid overuse of one area)
67
Q

A patient with diabetes may achieve better control if injection sites are….

A

Rotated within the same anatomic region

68
Q

What should be done if a patient has a hypoglycemic reaction?

A
  1. Give oral form of rapid-acting
    glucose (if the patient can swallow)
  2. Give glucagon or IV glucose (if the patient can’t be roused)
  3. Follow administration with a complex carb snack
69
Q

Insulin Patient Education

A
  1. Insulin relieves S&S but doesn’t cure DM- therapy is lifelong.
  2. BS monitoring is an essential to determining dosage/success of therapy
  3. Know proper use of equipment for monitoring BS level
  4. Follow the prescribed therapeutic regimen:
    * specific diet
    * weight reduction
    * exercise
    * personal hygiene (daily foot inspection)
    * avoid infection
  5. Review the timing of injections and eating-don’t skip meals.
  6. Measurement is very important- esp with concentrated regular insulin
  7. Magnifying sleeve or dose magnifier, may improve accuracy.
  8. Review with pt and family how to measure/give insulin
  9. Don’t alter the order in which insulin types are mixed
  10. Dont change model/brand of the syringe or needle
  11. Know S&S of hyperglycemia and hypoglycemia and what to do if they occur
  12. Wear/carry medical ID at all times.
  13. Have carbs (glucose tablets or candy) on hand for emergencies

Pharmacology Spring 2021 (22 decks)

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