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Endocrine Module > Pharmacotherapy of Injectable Medications > Flashcards

Pharmacotherapy of Injectable Medications Flashcards

1
Q

What are the rapid acting insulins used for bolus dosing?

A

Humalog, Admelog, Novolog, Fiasp, Apidra, Afrezza, Lyumjev

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2
Q

Which insulins are Lispro?

A

Humalog, Admelog, and Lyumjev

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3
Q

Which insulins are Aspart?

A

Novolog and Fiasp

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4
Q

Which insulin is Glusine?

A

Apidra

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5
Q

What insulin out of the rapid actings also has a U-200 strength?

A

Humalog/Lispro

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6
Q

What is the onset for Humalog, Novolog, and Apidra?

A

15-30 min

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7
Q

What is the onset for Admelog and Fiasp?

A

5 min

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8
Q

What is onset for Afrezza?

A

10-15 min

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9
Q

What is the onset for Lyumjev?

A

15 min

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10
Q

What is the peak for Rapid Acting?

A

2 hrs

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11
Q

What is the duration for Rapid Acting?

A

3-5 hrs

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12
Q

What is the Dosing Frequency for Rapid Acting?

A

Take it right before you eat

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13
Q

What are the Short Acting insulins?

A

Humulin R and Novolin R

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14
Q

What strength does Humulin R offer that is different than the usual U-100?

A

U-500

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15
Q

What is the onset for Short Acting Insulin?

A

30-60 mins

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16
Q

What is the peak of Short Acting Insulin?

A

2-3 hrs

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17
Q

What is the duration for Short Acting insulin?

A

6-8 hrs

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18
Q

When do you dose Short Acting Insulin?

A

30 mins before meals

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19
Q

What are the Intermediate Acting Insulins?

A

Humuluin N and Novolin N –> NPHs

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20
Q

What is the onset for Intermediate Acting Insulin?

A

2-4 hrs

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21
Q

What is the peak for Intermediate Acting Insulin?

A

4-6 hrs

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22
Q

What is the duration for Intermediate Acting Insulin?

A

8-12 hrs

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23
Q

When converting NPH to Glargine how do you dose the Glargine?

A

80% off the total daily dose of the NPH dose

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24
Q

What are the Long Acting Insulins?

A

Lantus, Levemir, Toujeo, Tresiba, Basaglar, Semglee

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25
Q

What are the Glargine insulins?

A

Lantus, Toujeo, Basaglar, and Semglee

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26
Q

What insulin is Detemir?

A

Levemir

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27
Q

What insulin is Degludec?

A

Tresiba

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28
Q

What long acting insulin offers U-300?

A

Toujeo

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29
Q

What long acting insulin offers U-200?

A

Tresiba

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30
Q

What’s the onset for Long Acting Insulins?

A

2hrs

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31
Q

What is the peak for Lantus?

A

Peak-Less

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32
Q

What is the duration for Toujeo?

A

36 hrs

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33
Q

What is the duration for Tresiba?

A

42 hrs

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34
Q

What is the duration for Basaglar?

A

30 hrs

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35
Q

What is the duration for all other long acting insulins?

A

24hrs

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36
Q

Humulin 70/30 is composed of what

A

70 NPH
30 Regular

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37
Q

Novolin 70/30 is composed of what?

A

70 NPH
30 Regular

38
Q

Humalog 75/25 is composed of what?

A

75 Lispro Protamine
25 Lispro

39
Q

Novolog 70/30 is composed of what?

A

70 Aspart Protamine
30 Aspart

40
Q

What is Soliqua a combination of?

A

Insulin Glargine and Lixisenatide GLP-1, there is a cap on the dose due to GLP-1

41
Q

What is Xultophy composed of?

A

Insulin degludec and Liraglutide GLP-1, there is a cap on GLP-1

42
Q

An insulin regimen should:

A

Mimic the natural physiologic process the closest

43
Q

Which insulin comes in an inhalation form?

A

Afrezza

44
Q

What are the unit cartridges for Afrezza? How long are they good for?

A

4, 8, 12 unit
15 days

45
Q

What is the black box warning for Afrezza?

A

Risk of acute bronchospasm with patients who have chronic lung disease, COPD, or asthma

46
Q

What is InPen and what can it be used with?

A

Resuable pen device that is compatible with: Humalog, Novolog, or Fiasp U-100

47
Q

What is the best way to assess Bolus Insulin?

A

FSBS 4 hours after the meal for which it was intended to cover

48
Q

What is the best way to assess Basal Insulin?

A

FSBS in the AM fasting

49
Q

What is U-100 equate to?

A

10 mL vial = 1000 units

50
Q

How long does insulin last once you start using it?

A

28 days

51
Q

What long acting insulins should NOT be mixed with any other insulin?

A

Glargine and Detemir

52
Q

What insulins can be mixed with NPH?

A

Aspart, Glulisine, Lispro, and Regular

53
Q

What are the potential causes of hypoglycemia?

A

Too much insulin, skipped /smaller meal, greater than usual physical activity

54
Q

How to treat hypoglycemia?

A

Treat with 15-20 g of CHO, repeat as necessary OR use glucagon if unconscious

55
Q

Lipodystrophy

A

Affects the absorption of insulin, aka it becomes erratic so therefore, you must stop using that injection site for a couple of weeks

56
Q

Lipoatrophy

A

Concavities around the injection site resulting from loss of adipose tissue

57
Q

Lipohypertrophy

A

Abnormal growth of fat, results from months to years of infection at the same site

58
Q

What is a Correction Factor CF?

A

Adds additional units of insulin to the insulin dose if preprandial BS is elevated

59
Q

What is the correction factor equation?

A

1500 divided by total daily dose

60
Q

Does Type 1 DM require basal and bolus insulin coverage? Are the doses large or small?

A

Both, and insulin doses tend to be smaller

61
Q

What is the total daily insulin requirement range?

A

0.2-1.0 unit/kg/day

62
Q

What percent of insulin daily should be basal?

A

50-70%

63
Q

What percent of insulin daily should be bolus?

A

30-50%

64
Q

What is the Fixed Dose Approach?

A
  1. Find total daily dose = 0.2-1.0 unit/kg/day
  2. Find basal (multiply by 50-70% of total)
  3. Final bolus (multiply by 30-50% of total)
  4. Divide total bolus by 3 to find unit amount for each meal
65
Q

If an NPH is used how do you split up dosing?

A

2/3 AM
1/3 PM

66
Q

What is the Insulin to CHO Ratio I:CHO

A

The amount of insulin needed to cover the CHO eaten to avoid postprandial BS elevation

67
Q

What is the equation to find I:CHO starting ratio?

A

500 divided by total daily dose

68
Q

What is the CHO Counting Approach?

A
  1. Find total daily dose = 0.2-1.0 unit/kg/day
  2. Find basal (multiply by 50-70% of total)
  3. Use 500/total daily dose to find I:CHO for bolus
  4. Ratio utilized for overall day
69
Q

Does Type 2 DM require basal and bolus insulin coverage? Are the doses large or small?

A

Initiated on basal insulin first, much higher doses due to insulin resistance

70
Q

What are the barriers to insulin use?

A

Insulin training, need for more SMBG, need for intensive monitoring, cost, fear of needs/hypoglycemia, and association with failure

71
Q

What are the indications to start insulin?

A

Hyperglycemia despite 2-3 oral agents, GLP-1 agonists are not an option, glucose toxicity, pregnancy, CI to oral, acute hyperglycemia, hospital administration, and cost

72
Q

What is the glucose levels seen in glucose toxicity?

A

> 300

73
Q

What happens with oral therapy with insulin?

A

Metformin maintained unless CI
Oral agents often maintained when basal is added
All orals are DC when bolus is added

74
Q

What is the basal insulin equation for Type 2 DM?

A

0.1-0.2 units/kg/day or 10-25 units/daily, should never exceed 25 units for starting dose

75
Q

What is the bolus insulin protocol for Type 2 DM?

A

Add bolus insulin if postprandial BS are elevated
10% of basal insulin or 4 units fixed before meals

76
Q

How do you titrate basal insulin?

A

If fasting BS is high, titrate by 10-15% of total daily dose every 3-7 days

77
Q

How do you titrate bolus insulin?

A

Is preprandial BS is high, adjust I:CHO ratio

78
Q

What is a tighter I:CHO ratio, and how is CHO changed?

A

Tighter Ratio = Decreased CHO number
Used when BS is elevated

79
Q

What is a looser I:CHO ratio, and how does CHO change?

A

Looser Ratio = Increase CHO Number
Used when BS is low

80
Q

What is Dawn Phenomenon?

A

Increase glucose production in response to awakening, usually accompanied by increase insulin production

81
Q

What is the Smogyi Effect?

A

Nocturnal hypoglycemia in which counter regulatory hormones increase glucose production

82
Q

DAWN vs SMOGYI

A

Dawn = high at waking
Smogyi = low at night, high in the morning

83
Q

When do you measure FSBS to distinguish between the two?

A

3 AM or 3-4 HRS prior to waking

84
Q

If 3AM BS = LOW, what effect is it

A

Smogyi, bedtime insulin is too much

85
Q

If 3AM BS = Normal/High, what effect is it?

A

DAWN, bedtime insulin not enough

86
Q

What are the components of an insulin pump?

A

Basal rate, bolus infusion, reservoir, and insulin used

87
Q

What is the unit for basal rate on an insulin pump?

A

units/hr

88
Q

How much does the reservoir hold?

A

176-315 units

89
Q

What insulins can be used in an insulin pump?

A

Novolog, Humalog, Apidra, Fiasp, and Admelog, ONLY RAPID

90
Q

What are the advantages of insulin pumps?

A

Avoids multiple daily injections, adjust basal rate prior to waking for DAWN, improved control

91
Q

What are the disadvantages of insulin pumps?

A

Still requires glucose monitoring, DKA risk, scare tissue, skin irritation

92
Q

What are the favorable patient characteristics for an insulin pump?

A

Need for bolus and basal, ability to CHO count, at least 6 MONTHS of documented blood sugar logs

Endocrine Module (16 decks)

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