insulins Flashcards
Regular insulin compatible with
All insulins except glargine and glulisine
Insuline detemir compatible with
Must be given alone
insulin isophane suspension (NPH) when do you administer
30-45 min after meal.
Adverse effects of insulin
shock, death, weight gain, lipodystrophy at injection site
Drug that antagonize hypoglycemic effect insulin
Corticosteroids, niacin, thiazide, loop diuretics, thyroid hormone, sympathomometics
which insulin should not be used in breast-feeding women
Insuline glargine(lantus)
drugs that increase insulins hypoglycemic effect
Alcohol, anabolic steroids, slufa drugs, MAOI,salicylates
how do non-slective beta blockers interact w/insulin
mask the tachycardia from hypoglycemia
when do you give reg. insulin
30-60 min before a meal or on a sliding scale
when do you give long acting insulin glargine
only once or twice daily dosing
Reg insulin: duration
short acting
Insulin Gargine (lantus) duration
Long-acting
Insulin detemir (Levemir) duration
Intermediate
Insulin idophane suspension (NPH) duration
current only available intermediate-acting insulin
Reg insulin onset, peak
30-60 min, 2.5hr
Insulin isophane suspension (NPH) onset, peak
1-2hr, 4-8 hr
insulin glargine onset, peak
1-2hr, none
most common oral drug for type 2 diabetes
metformin (glucophage)
How does Metformin work
decrease glucose production by liver and decrease intestinal absorption of glucose and improve insulin receptor sensitivity
Contraindications for metformin
renal disease (metformin excreted by kidney=accumulation and lactic acidosis) Also Alcoholics, liver disease, heart failure, cardiopulmonary disease
AE: metformin
GI problems: bloating, nausea, crampin, feeling of fullness, diarrhea effects usually self-limiting less SE when start w/ low dose Decreased absorbtion of Vit B12 and folic acid
less common SE metformin
metal taste in mouth and reduced vit B12 levels
Interactions w/metformin
radiology dyes=renal failure and lactic acidosis, also interacts w/cimetidine, digoxin, propranolol
pioglitazone (Actos) is what class of drug
Thiazolidinediones
How does piogliazone work?
reduce insulin resistance by enhancing the sensitivity of insulin receptors also directly stimulate peripheral glucose uptake and storage, as well as inhibit glucose and triglyceride production in liver.
Pioglitazone indications
Type 2 diabetes: high cost, lost of AE, and slow onset=reserved for pt who can’t tolerate glucose control w/ metformin
only thiazolidinediones approved for use w/ insulin
pioglitazone
AE: pioglitazone
increase risk for Heart fail, peripheral edema, weight gain, reduced bone mineral density, increased risk of fracture, increased MI
interactions w/pioglitazone
serum concentrations inc. w/ CYP3A4 inhibitor such as erythromycin and ketoconazole
How does arcbose (Precose) work
delays glucose absorption
How do you administer arcbose (Precose)
must be administered w/ food
Contraindications for arcbose (Precose)
many adverse GI effects. inflammatory bowel disease, intestinal obstruction, malabsorption syndrome
AE: arcbose (Precose)
flatulance, diarrhea, abdominal pain NO Hypoglycemia or weight gain.
glipizide (Glucotrol)duration
rapid onset, short duration
glipizide (Glucotrol) contraindicated
drug allergy, type 1 brittle diabetes, NOT contraindicated for renal failure
glipizide (Glucotrol) when to dose
30 min before meal
Sitagliptin (Junuvia) indications
mgmt of type 2 diabetes as monotherapy or a combination but NOT with insulin
drug interactions w/Sitagliptin (Junuvia)
Sulfonylurea cause hypoglycemia
AE Sitagliptin (Junuvia)
none
treat hypoglycemia with
Iv glucose or sub-Q glucagon
Nurse action prior to admin glucagon
roll pt. to side because they will most likely vomit.
which insulin should be withdrawn first? Reg. or NPH.
clear (reg or rapid acting) followed by NPH (intermediate)
oral anti-diabetic meds administered when
30 min before meal
pt. on metformin undergoing test w/contrast dye
must dicontinue metformin prior to test and restart after test and evaluation of renal status
