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46 Cards in this Set
- Front
- Back
Rapid-acting Insulins |
lispro (Humalog) aspart (Novolog) glulisine (Apidra) |
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Short-acting Insulins |
Regular (Humulin R) Regular (Novolin R) |
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Intermediate-acting Insulins |
NPH (Humulin N) detemir (Levemir) |
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Long-acting Insulins |
glargine (Lantus) |
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Rapid-acting Insulin time/action profile |
onset: 15-30 minutes peak: 0.5-2.5 hours duration: 3-6 hours |
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Short-acting Insulin time/action profile |
onset: 0.5-1 hour peak: 1-5 hours duration: 6-10 hours
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Intermediate-acting Insulin time/action profile |
onset: 1-2 hours peak: 6-14 hours duration: 16-24 hours |
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Long-acting Insulin time/action profile |
onset: 70 minutes peak: none duration: 24 hours
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Premixed Insulins: Humulin 70/30 Humalog 75/25 |
70% NPH (inter.) and 30% regular (short-acting) 75% lispro protamine (int.) and 25% lispro (rapid) |
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Insulin action |
1. increases cellular uptake of glucose ---> decrease serum glucose 2. converts glucose --> glycogen 3. moves K+ into cells as well |
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Hypoglycemia: Abrupt Onset |
SNS Clinical Manifestations:
tachycardia, palpitations, diaphoresis, shakiness |
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Hypoglycemia: Gradual Onset |
PNS Clinical Manifestations:
headache, tremor, weakness |
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Insulin Interactions |
Sulfonylureas, meglitinides, BB's, ETOH --> hypoglycemia < 50 mg/dl |
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Insulin Interactions |
thiazide diuretics, glucocorticoids --> increase serum glucose |
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Insulin Interactions |
BB's mask s/s of hypoglycemia --> teach client not to rely on s/s, but rather to carefully monitor BG, maintain regular eating schedule, and take extra glucose during insulin peak action times |
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Mixing Insulin: Four Steps |
" Draw up Clear Before Cloudy"
1. Inject air into Cloudy NPH 2. Inject air into Clear Regular 3. Turn Regular bottle upside-down and draw up (Fill) Regular dose 4. Draw up Cloudy NPH
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Oral Antidiabetics: Sulfonylureas |
MOA: increases pancreatic insulin secretion |
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Oral Antidiabetics: Meglithinides |
MOA: increases pancreatic insulin secretion |
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Oral Antidiabetics: Biguanides |
MOA: reduces hepatic gluconeogenesis, increase glucose uptake by muscle cells
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Oral Antidiabetics: Thiazolidinediones (Glitazones) |
MOA: decreases cellular insulin resistance, increases glucose uptale, and decreases glucose production |
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Oral Antidiabetics: Alpha Glucosidase Inhibitor |
MOA: slows carbohydrate absorption and digestion |
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Oral Antidiabetics: Gliptins |
MOA: insulin release and glucagon decrease (glucagon stimlulates BG increase)
Specifically, lowers fasting/ postprandial BG |
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Sulfonylureas |
chlorpropamide (Diabinese) tolbutamide (Orinase) glipizide (Glucotrol) glyburide (Diabeta) glimepiride (Amaryl) |
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Meglitinides |
repaglinide (Prandin) nateglinide (Starlix) |
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Biguanides |
metformin HCL (Glucophage) |
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Thiazolidinediones (Glitazones) |
pioglitazone (Actos) |
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Alpha Glucosidase Inhibitor |
acarbose (Precose) miglitol (Glyset) |
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Gliptins |
sitagliptin (Januvia) |
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AR/INT: metformin HCL
GI |
AR: GI: A-N-V --> 3-4kg weight loss INT: monitor s/s
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AR/INT: metformin HCL
Vit. B/ folic acid deficiency |
AR: Vit. B, folic acid deficiency r/t decreased absorption INT: provide supplements as prescribed |
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AR/INT: metformin HCL
Lactic acidosis: HIGH ALERT! |
HIGH ALERT!!! This AR has a 50% mortality rate
AR: Lactic acidosis AEB hyperventilation, myalgia, sluggishness, somnolence INT: hold med, inform HCP immediately (severe lactic acidosis is treated w/ hemodialysis)
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AR/INT: pioglitazone
Fluid retention |
AR: Fluid retention INT: monitor for edema, weight gain, s/s of HF |
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AR/INT: pioglitazone
Increased LDL |
AR: Increased LDL INT: monitor LDL levels |
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AR/INT: pioglitazone
Hapatotoxicity |
AR: hepatotoxicity INT: monitor ALT/ AST, jaundice, and dark urine |
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AR/INT: acarbose
Intestinal effects |
AR: intestinal effects AEB abd. distention, crampin, hyperactive BS, diarrhea, excessive gas INT: monitor effects on client |
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AR/INT: acarbose
Anemia |
AR: anemia r/t decreased Fe absorption INT: monitor H/H, Fe |
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AR/INT: acarbose
Hepatotoxicity |
AR: hepatotoxicity r/t long term therapy INT: monitor ALT/AST, advise client that normal liver function will resume with cessation of acarbose
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CI: Pregnancy Risk Category C
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glipidize, repaglinide, pioglitazone
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CI: Pregnancy Risk Category B (generally avoided in preg/lact, but HCP may prescribe) |
metformin, acarbose, sitagliptin |
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Oral antidiabetics precautions: renal failure, hepatic dysfunction, HF
CI: DKA |
Rationale: drug may accumulate --> hypoglycemic effect |
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CI: metformin HCL |
severe infection, shock, any hypoxic condition (ex. COPD)
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CI: acarbose |
GI disorders (inflammatory disease,ulceration, obstructions)
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CI: pioglitazone |
severe HF, hx of bladder cancer, active hepatic disease
use w/ caution in mild HF, elderly |
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Interactions: glipizide |
ETOH --> disulfiram reaction (severe N-V, flushing and palpatations)
Sulfonamide abx, NSAIDS, ranitidine (Zantac), cimetidine (Tagamet) --> additive hypoglycemic effect
BBs --> mask SNS s/s of hypoglycemia (tachycardia, tremors, palpitations, diaphoresis) |
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Interactions: repaglinde and pioglitazone |
gemfibrozi (Lopid) --> hypoglycemia |
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Interactions: metformin HCL |
ETOH --> lactic acidosis (potentially fatal)
iodine-containing contrast media --> GI effects, hypoglycemia
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