Medication Math Skill Packet

Fasting Blood Glucose: Normal

70-100

Fasting Blood Glucose: Pre-diabetes

100-125

Fasting Blood Glucose: Diabetes

126 or higher

A1C Levels: Normal

Less than 5.6%

A1C Levels: Pre-diabetes

5.6%- 6.9%

A1C Levels: Diabetes

7.0% or higher

OGTT Level: Normal

Less than 140

OGTT Level: Pre-diabetes

140-199

OGTT Level: Diabetes

200 or higher

Rapid-Acting Insulin Analogues: NAMES

Lispro (Humalog, Admelog), Aspart (Fiasp, NovoLog), Glulisine (Apidra)

Rapid-Acting Insulin Analogues: ONSET

10-15mins

Rapid-Acting Insulin Analogues: PEAK

60mins

Rapid-Acting Insulin Analogues: DURATION

2-4hrs

Rapid-Acting Insulin Analogues: ROLE

Covers insulin needs for meals eaten at the same time as the injection

• Can be used in insulin pumps

Short-Acting Insulin (Regular): NAMES

Regular Insulin (Humilion R, Novolin R, Velosulin R)

Short-Acting Insulin (Regular): ONSET

30mins

Short-Acting Insulin (Regular): PEAK

2-3 hrs

Short-Acting Insulin (Regular): DURATION

3-6 hrs

Short-Acting Insulin (Regular): ROLE

covers insulin needs for meals eaten within 30 min

• Given IV and Insulin drip or insulin pump

• May be mixed with NPH (regular first SC injection)

Intermediate-Acting Insulin: NAMES

NPH (N) (Humulin N, Novolin N, ReliOn)

Intermediate-Acting Insulin: ONSET

2-4hrs

Intermediate-Acting Insulin: PEAK

4-12 hrs

Intermediate-Acting Insulin: DURATION

12-18 hrs

Intermediate-Acting Insulin: ROLE

covers insulin needs for about ½ day or overnight

• can be combined with rapid- or short-acting insulin

Long-Acting Insulin Analogues: NAMES

Detemir (Levemir), glargine (basaglar, Lantus)

Long-Acting Insulin Analogues: ONSET

2-4hrs

Long-Acting Insulin Analogues: PEAK

Does not peak

Long-Acting Insulin Analogues: DURATION

Up to 24 hrs

Long-Acting Insulin Analogues: ROLE

covers insulin needs for about 1 full day

• often combined when needed w/ rapid- or short-acting insulin (NEVER mixed together in same syringe)

Ultra Long-Lasting Insulin: NAMES

Degludec (Tresiba), glargine u300 (Toujeo)

Ultra Long-Lasting Insulin: ONSET

6 hours

Ultra Long-Lasting Insulin: PEAK

does not peak

Ultra Long-Lasting Insulin: DURATION

Lasts 36+ hours

Ultra Long-Lasting Insulin: ROLE

Offer sustained coverage with low potential for hypoglycemia

• Typically concentrated

• Large doses in less volume

• improving absorption

The administration of insulin places the patient at risk of hypoglycemia begins upon

onset

Greatest risk for hypoglycemia

peak

Duration of action is..

how long the risk for hypoglycemia is present

Enoxaparin (Lovenox) : INDICATION

Prophylaxis & treatment of DVT

Enoxaparin (Lovenox) : ACTION

DIRECT: Potentiates the action of antithrombin, inactivates coagulation factor Xa

Enoxaparin (Lovenox) : ONSET

unkown

Enoxaparin (Lovenox) : DURATION after discontinued

24hrs

Enoxaparin (Lovenox) : TX

usually short term

Enoxaparin (Lovenox): ROUTE

subcutaneous

Enoxaparin (Lovenox) : LAB TEST

Not required

Enoxaparin (Lovenox) : Normal times

N/A

Enoxaparin (Lovenox): Therapeutic levels

N/A

Enoxaparin (Lovenox): Adverse effects

Bleeding, heparin-induced thrombocytopenia (HIT, 25%)

Enoxaparin (Lovenox): ANTIDOTE

Protamine Sulfate

Heparin: Indication

Treatment of VTE (PE, DVT); prevents further extension of existing thrombi or new clot formation; no effect on existing clots

Heparin: Action

INDIRECT: Enhances inhibitory effects of antithrombin III, preventing the conversion of fibrinogen to fibrin, prothrombin to thrombin

Heparin: Onset

Rapid: 20-60 min (SC); IV is immediate

Heparin:Duration after discontiuned

SC = 12-24 hrs; IV = 2-6 hrs

Heparin: TX

as needed

Heparin: Route

SC or IV

Heparin: Lab Test

PTT

Heparin: Normal times

PTT 30-40 sec

Heparin: Therapeutic

PTT: 1.5-2.5

Heparin: Adverse Effects

Bleeding, HIT

Heparin: Antidote

Protamine Sulfate

Warfarin (Coumadin): Indication

Prophylaxis & treatment of VTE (PE/DVT); stroke prevention in persons with AF, or cardiac valve replacement

Warfarin (Coumadin): Action

VITAMIN K ANTAGONIST: Interferes with hepatic synthesis of vitamin K- dependent clotting factors II, VII, IX, X

Warfarin (Coumadin): Onset

Delayed: 2-5 days

Warfarin (Coumadin): Duration after dicontinued

2-5 days

Warfarin (Coumadin): TX

short term or years

Warfarin (Coumadin): Route

PO

Warfarin (Coumadin): Lab test

PT/INR

Warfarin (Coumadin): Normal Times

PT 11-12.5 sec; INR 0.8-1.1

Warfarin (Coumadin): Therapeutic levels

T 1.5-2 times normal values; INR 2-3

Warfarin (Coumadin): Adverse Effects

Bleeding and acute renal failure

Warfarin (Coumadin): Antidote

Vitamin K

Rivaroxban (Xarelto) & Apixban (Eliquis): Indication

Prevention of stroke & embolism due to non-valvular related AF, e.g., prevention of post-ortho surgical VTE

Rivaroxban (Xarelto) & Apixban (Eliquis): Action

DIRECT: inactivates coagulation factor Xa, thus inhibits clotting

Dabigatran (Pradaxa): Indication

Prevention of stroke & embolism due to non-valvular related AF

Dabigatran (Pradaxa): Action

DIRECT: Potentiates the action of antithrombin

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): ONSET

1-3hrs

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): DURATION after discontinued

12-14hrs

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): TX

years

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): ROUTE

PO

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa):]: LAB TEST

creatinine clearance

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): NORMAL Times

N/A

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): THERAPEUTIC levels

N/A

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): Adverse Effects

Bleeding and acute reneal failure

Rivaroxban (Xarelto) & Apixban (Eliquis) AND Dabigatran (Pradaxa): Antidote

Charcoal (within 2-3 hours of last intake) or nonactivated or activated PCC; hemodialysis

Bleeding can occur spontaneously above

PTT > 100 seconds and PT > 30 seconds

What does antithrombotic therapy reduce the risk of?

AF, stroke, ACS, heart valve/surgical replacement complications, VTE (PE/DVT), hypercoagulable states, and stent clotting

What is the antagonist listed for antithrombotic therapy?

Vitamin K

How long before a procedure may antithrombotic therapy need to be discontinued?

5–7 days before the procedure; clarify with MD/NP/PA

When may antithrombotic therapy be resumed after a procedure?

within 24 hours after the procedure with an MD/NP/PA order

Aspirin (ASA): drug type? main use? duration? what if bleeding occurs?

antiplatelet agent, prevention of stroke and sometimes MI, 7-10days, give platelets

NSAIDs: drug type? main use? duration? what if bleeding occurs?

antiplatelet agent, various types used primarily for pain control, hold

Dipyridamole (Persantine): drug type? main use? duration? what if bleeding ocurs?

antiplatelet agent, prevetion of stroke, 2-3 days, hold

Clopidogrel (Plavix): drug type? main use? duration? what if bleeding ocurs?

antiplatelet agent, prevention of MI and stroke with PVD, 3-5 days, hold

Ticlopidine (Ticlid): drug type? duration? what if bleeding occurs?

antiplatelet agent, 10-14days, hold

Blood Pressure: NORMAL

Less than 120 / Less than 80; reasses in 1 yr

Blood Pressure: Elevated

120-129/ less than 80; reassess in 3-6 months

Blood Pressure: Stage 1 HTN

130-139/ 80-89; reassess 3-6 months

Blood Pressure: Stage 2 HTN

140 or higher / 90 or higher

Blood Pressure: Severe HTN w/ no s/s

higher than 180/ higher than 120

Blood Pressure: Hypertensive emergency w/ s/s

Higher than 180/ higher than 120

Diagnoses of HTN

based on at least 2 consecutive BP readings, ensuring that the patient’s arm is relaxed, well-supported, and at the level of the heart when BP is taken