endocrine/metabolic drugs

Question 1

insulin ; humulin ; novalog ; novolin

Answer 1

Class: Antihyperglycemic; hormone

MOA: lowers blood glucose by stimulating glucose uptake by the cells.

Pharmacokinetics: rapid absorption; Onset 30-60 min SQ, 10-30 min IV Duration 5-7 hrs SQ, 30-60 min IV

Indications: control of hyperglycemia. Used to treat DKA, hyperkalemia

AR/SE: hypoglycemia

Contraindications: known allergy, hypoglycemia

Dosage: per order (normal would be 5-10 units IV or 5-20 IM in the pre-hospital seting)

Question 2

glucagon

Answer 2

Class: Hormone; antihypoglycemic

MOA: hormone excreted by alpha cells in pancreas. Increases the level of circulating blood sugar by stimulating the release of glycogen which breaks down and becomes glucose. Also inhibits the synthesis of glycogen from glucose. Also has positive inotropic effect on the heart.

Pharmacokinetics: onset: 5-20 min; Duration 1-2 hr

Indications: Acute management of severe hypoglycemia when administration of glucose is not feasible; Beta blocker and calcium channel blocker overdose.

AR/SE: N/V, hypotension

Contraindications: known allergy

Dosage: 1 mg for hypoglycemia; may be repeated in 15 min if needed.

Special Considerations: For use when an IV cannot be established. Recent studies show that glucagon may be effective when administered intranasally too.

Question 3

dextrose ; d10, d25, d50

Answer 3

Class: Carbohydrate, hyperglycemic

MOA: increases the circulating blood sugar level to normal.

Pharmacokinetics: absorbs rapidly, onset: about 1 minute, duration: varies

Indications: treat coma caused by hypoglycemia or from unknown cause, also treat AMS caused by hypoglycemia.

AR/SE: aggravate hypertension and CHF, neurologic symptoms in the alcoholic pt.

Contraindications: known allergy, pts with
intracranial pressure or intracranial hemorrhage.

Dosage: 25 grams D50 for adults; 0.5-1 g/kg Dextrose for peds (diluted to D25 or D10 per protocol)

Special Considerations: Pediatric patients less than 2 receive D10, over 2 years receive D25. Alcohol dependent pts with thiamine deficiency can develop Wernick-Korsakoff encephalopathy.

Question 4

thiamine ; vitamin b1

Answer 4

Class: vitamin

MOA: required for metabolism of carbohydrates.

Pharmacokinetics: Onset: rapid; Duration: varies

Indications: thiamine deficiency, for the
prevention of Wernicke-Korsakoff syndrome; coma of unknown origin with suspected hx of alcoholism.

AR/SE: vascular collapse, hypotension, vaosodilation, angioedema.

Contraindications: known allergy.

Dosage: 100 mg IV/IM