Pharmacotherapy of Injectable Medications Flashcards
What are the rapid acting insulins used for bolus dosing?
Humalog, Admelog, Novolog, Fiasp, Apidra, Afrezza, Lyumjev
Which insulins are Lispro?
Humalog, Admelog, and Lyumjev
Which insulins are Aspart?
Novolog and Fiasp
Which insulin is Glusine?
Apidra
What insulin out of the rapid actings also has a U-200 strength?
Humalog/Lispro
What is the onset for Humalog, Novolog, and Apidra?
15-30 min
What is the onset for Admelog and Fiasp?
5 min
What is onset for Afrezza?
10-15 min
What is the onset for Lyumjev?
15 min
What is the peak for Rapid Acting?
2 hrs
What is the duration for Rapid Acting?
3-5 hrs
What is the Dosing Frequency for Rapid Acting?
Take it right before you eat
What are the Short Acting insulins?
Humulin R and Novolin R
What strength does Humulin R offer that is different than the usual U-100?
U-500
What is the onset for Short Acting Insulin?
30-60 mins
What is the peak of Short Acting Insulin?
2-3 hrs
What is the duration for Short Acting insulin?
6-8 hrs
When do you dose Short Acting Insulin?
30 mins before meals
What are the Intermediate Acting Insulins?
Humuluin N and Novolin N –> NPHs
What is the onset for Intermediate Acting Insulin?
2-4 hrs
What is the peak for Intermediate Acting Insulin?
4-6 hrs
What is the duration for Intermediate Acting Insulin?
8-12 hrs
When converting NPH to Glargine how do you dose the Glargine?
80% off the total daily dose of the NPH dose
What are the Long Acting Insulins?
Lantus, Levemir, Toujeo, Tresiba, Basaglar, Semglee
What are the Glargine insulins?
Lantus, Toujeo, Basaglar, and Semglee
What insulin is Detemir?
Levemir
What insulin is Degludec?
Tresiba
What long acting insulin offers U-300?
Toujeo
What long acting insulin offers U-200?
Tresiba
What’s the onset for Long Acting Insulins?
2hrs
What is the peak for Lantus?
Peak-Less
What is the duration for Toujeo?
36 hrs
What is the duration for Tresiba?
42 hrs
What is the duration for Basaglar?
30 hrs
What is the duration for all other long acting insulins?
24hrs
Humulin 70/30 is composed of what
70 NPH
30 Regular
Novolin 70/30 is composed of what?
70 NPH
30 Regular
Humalog 75/25 is composed of what?
75 Lispro Protamine
25 Lispro
Novolog 70/30 is composed of what?
70 Aspart Protamine
30 Aspart
What is Soliqua a combination of?
Insulin Glargine and Lixisenatide GLP-1, there is a cap on the dose due to GLP-1
What is Xultophy composed of?
Insulin degludec and Liraglutide GLP-1, there is a cap on GLP-1
An insulin regimen should:
Mimic the natural physiologic process the closest
Which insulin comes in an inhalation form?
Afrezza
What are the unit cartridges for Afrezza? How long are they good for?
4, 8, 12 unit
15 days
What is the black box warning for Afrezza?
Risk of acute bronchospasm with patients who have chronic lung disease, COPD, or asthma
What is InPen and what can it be used with?
Resuable pen device that is compatible with: Humalog, Novolog, or Fiasp U-100
What is the best way to assess Bolus Insulin?
FSBS 4 hours after the meal for which it was intended to cover
What is the best way to assess Basal Insulin?
FSBS in the AM fasting
What is U-100 equate to?
10 mL vial = 1000 units
How long does insulin last once you start using it?
28 days
What long acting insulins should NOT be mixed with any other insulin?
Glargine and Detemir
What insulins can be mixed with NPH?
Aspart, Glulisine, Lispro, and Regular
What are the potential causes of hypoglycemia?
Too much insulin, skipped /smaller meal, greater than usual physical activity
How to treat hypoglycemia?
Treat with 15-20 g of CHO, repeat as necessary OR use glucagon if unconscious
Lipodystrophy
Affects the absorption of insulin, aka it becomes erratic so therefore, you must stop using that injection site for a couple of weeks
Lipoatrophy
Concavities around the injection site resulting from loss of adipose tissue
Lipohypertrophy
Abnormal growth of fat, results from months to years of infection at the same site
What is a Correction Factor CF?
Adds additional units of insulin to the insulin dose if preprandial BS is elevated
What is the correction factor equation?
1500 divided by total daily dose
Does Type 1 DM require basal and bolus insulin coverage? Are the doses large or small?
Both, and insulin doses tend to be smaller
What is the total daily insulin requirement range?
0.2-1.0 unit/kg/day
What percent of insulin daily should be basal?
50-70%
What percent of insulin daily should be bolus?
30-50%
What is the Fixed Dose Approach?
- Find total daily dose = 0.2-1.0 unit/kg/day
- Find basal (multiply by 50-70% of total)
- Final bolus (multiply by 30-50% of total)
- Divide total bolus by 3 to find unit amount for each meal
If an NPH is used how do you split up dosing?
2/3 AM
1/3 PM
What is the Insulin to CHO Ratio I:CHO
The amount of insulin needed to cover the CHO eaten to avoid postprandial BS elevation
What is the equation to find I:CHO starting ratio?
500 divided by total daily dose
What is the CHO Counting Approach?
- Find total daily dose = 0.2-1.0 unit/kg/day
- Find basal (multiply by 50-70% of total)
- Use 500/total daily dose to find I:CHO for bolus
- Ratio utilized for overall day
Does Type 2 DM require basal and bolus insulin coverage? Are the doses large or small?
Initiated on basal insulin first, much higher doses due to insulin resistance
What are the barriers to insulin use?
Insulin training, need for more SMBG, need for intensive monitoring, cost, fear of needs/hypoglycemia, and association with failure
What are the indications to start insulin?
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
What is the glucose levels seen in glucose toxicity?
> 300
What happens with oral therapy with insulin?
Metformin maintained unless CI
Oral agents often maintained when basal is added
All orals are DC when bolus is added
What is the basal insulin equation for Type 2 DM?
0.1-0.2 units/kg/day or 10-25 units/daily, should never exceed 25 units for starting dose
What is the bolus insulin protocol for Type 2 DM?
Add bolus insulin if postprandial BS are elevated
10% of basal insulin or 4 units fixed before meals
How do you titrate basal insulin?
If fasting BS is high, titrate by 10-15% of total daily dose every 3-7 days
How do you titrate bolus insulin?
Is preprandial BS is high, adjust I:CHO ratio
What is a tighter I:CHO ratio, and how is CHO changed?
Tighter Ratio = Decreased CHO number
Used when BS is elevated
What is a looser I:CHO ratio, and how does CHO change?
Looser Ratio = Increase CHO Number
Used when BS is low
What is Dawn Phenomenon?
Increase glucose production in response to awakening, usually accompanied by increase insulin production
What is the Smogyi Effect?
Nocturnal hypoglycemia in which counter regulatory hormones increase glucose production
DAWN vs SMOGYI
Dawn = high at waking
Smogyi = low at night, high in the morning
When do you measure FSBS to distinguish between the two?
3 AM or 3-4 HRS prior to waking
If 3AM BS = LOW, what effect is it
Smogyi, bedtime insulin is too much
If 3AM BS = Normal/High, what effect is it?
DAWN, bedtime insulin not enough
What are the components of an insulin pump?
Basal rate, bolus infusion, reservoir, and insulin used
What is the unit for basal rate on an insulin pump?
units/hr
How much does the reservoir hold?
176-315 units
What insulins can be used in an insulin pump?
Novolog, Humalog, Apidra, Fiasp, and Admelog, ONLY RAPID
What are the advantages of insulin pumps?
Avoids multiple daily injections, adjust basal rate prior to waking for DAWN, improved control
What are the disadvantages of insulin pumps?
Still requires glucose monitoring, DKA risk, scare tissue, skin irritation
What are the favorable patient characteristics for an insulin pump?
Need for bolus and basal, ability to CHO count, at least 6 MONTHS of documented blood sugar logs
