insulins/drug therapy

Question 1

RAPID ACTING (ex. L15PRO)

Answer 1

onset: 15 min
peak: 30 min - 1 hr
duration: 3 hours

Question 2

SHORT-ACTING (ex Humulin R, regular)

Answer 2

onset: 30 min
peak: 2 hrs
duration: 4-6 hrs

Question 3

INTERMIDEATE-ACTING (ex NPH)

Answer 3

onset: 1-2 hrs
peak: 8 hrs
duration: 12 hrs

Question 4

LONG ACTING

Answer 4

onset: 2-4 hrs
peak: none
duration: 24 hrs

Question 5

NO INSULIN IF

Answer 5

pt is NPO

Question 6

PEAK

Answer 6

maximum effect (pt may become hypoglycemic)

Question 7

if insulin cannot be mixed (ex lantus)

Answer 7

give 2 different injections

Question 8

draw up clear insulin (ex. Regular)

Answer 8

then cloudy insulin (ex. NPH)

Question 9

SULFONYLUREA AGENTS

Use in diabetics

Answer 9

• Glucotrol: increase insulin secretion in the treatment of type 2.
• Amaryl: used as single therapy or in combination w metformin or insulin in treatment of type 2.

Question 10

SULFONYLUREA AGENTS

Nursing interventions

Answer 10

• Glucotrol: teach pt to take 30 min before meals.
  Teach pt how to treat & prevent hypoglycemia.
  Monitor pts w impaired kidney function carefullly w hypoglycemia.
  *Amaryl: Teach pt to take as a single daily dose w the first meal of the day. Teach pt how to prevent & treat hypoglycemia.

Question 11

SULFONYLUREA AGENTS

Rational

Answer 11

• Glucotrol: Taking the drug 30 min before meal achieves the best after meal blood glucose concentration. Because the drug includes insulin secretion, hypoglycemia is possible. Drug is eliminated by kidneys, therefore pts w impaired kidneys have higher blood levels & are at risk for hypoglycemia. Damaging extended release form of drug causes rapid release, leading to hypoglycemia.
• Amaryl: Debilitated/malnourished puts or those w impaired kidney or liver function are more sensitive to blood glucose lowering effects of glimepiride.

Question 12

BIGUANIDES (Metformin)

Use in diabetes

Answer 12

Lowers both basal and postmeal blood glucose levels in pts w type 2 diabetes by reducing hepatic glucose production and tissue sensitivity to insulin.

Question 13

BIGUANIDES (Metformin)

Nursing interventions

Answer 13

Teach pts to take w food. Monitor liver & kidney function before starting metformin & after. Monitor cardiopulmonary throughout therapy. Monitor for conditions that increase risk of lactic acidosis. Withhold for 48hrs before use of iodinated contrast materials used in certain radiographic studies. Glucophage XL should be swallowed whole.

Question 14

BIGUANIDES (Metformin)

Rationals

Answer 14

Taking w food reduces adverse effects. Metformin should be used w caution w the older pt, since older adults may have reduced kidney function. Should not be used in pts w congestive heart failure, at risk for hypoperfusion and hypoxemia. Contraindicated in people w risk for lactic acidosis: reduced kidney function, liver impairment, respiratory insufficiency, severe infection, alcohol abuse.

Question 15

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

Answer 15

2-3 weeks