EXAM 3 - pathopharm II - insulin and type 2 meds

insulin is prescribed to patients based on what 3 things?

1. onset

2. peak

3. duration

what is onset?

amount of time it takes for insulin to reach the bloodstream

what is peak?

time in which insulin reaches maximum strength

what is duration?

time it takes body to use up insulin

what are insulin analogs?

mimic body's natural pattern of insulin release

what kind of insulin do rapid analogs mimic?

bolus of insulin that the pancreas would normally give with meals

what kind of insulin do basal analogs mimic?

insulin that is normally secreted every hour by the pancreas to maintain homeostasis

what is the strength of insulin?

U-100, or 100 units per 1 mL of liquid

how many units is 10 mL of insulin?

1000 units

what is the phrase we use for rapid acting insulin analogs?

15 minutes feels like an hour in 2-4 rapid responses

what is the onset, peak, and duration of rapid acting insulin analogs?

onset: 15 min

peak: 1 hour

duration: 2-4 hours

what do we base the dose of rapid acting insulin analogs off of?

carb counting - with meals

what are the 3 rapid acting insulin analogs?

1. glulisine

2. aspart

3. lispro

rapid acting insulin analogs: clear or cloudy?

clear

what are the AE of rapid acting insulin analogs?

hyperglycemia (at peak), hypokalemia, anaphylaxis

when should rapid acting insulin analogs be avoided?

hypoglycemia

rapid acting insulin analogs should always be given with...

other long acting/basal insulin analogs

what major consideration should we consider with rapid acting insulin analogs?

do not mix with other insulins in SQ infusion pump

when should rapid acting insulin analogs be given?

15 min before or within 20 minutes of meal

what is the brand name of insulin aspart?

Novolog

what is the brand name of insulin lispro?

Humalog

what insulins are FDA approved to be given IV?

insulin aspart, Humalog R, Novolog R

what is the phrase we use for short acting insulin?

30 minutes ago, a short-staffed nurse that was assigned rooms 2-3 picked up rooms 3-6

what is the onset, peak, and duration of short acting insulin?

onset: 30 minutes

peak: 2-3 hours

duration: 3-6 hours

what are the short acting insulins?

regular insulins: Humulin R, Novolin R

is short acting insulin clear or cloudy?

clear

what are the AE of short acting insulins?

hyperglycemia (at peak), hypokalemia, anaphylaxis

when should you avoid giving short acting insulin?

in hypoglycemia

what is the phrase for intermediate acting insulins?

peds nurses play hero between 2-4 shifts for 4-12 hours to 12-18 year olds

what is the onset, peak, and duration of intermediate acting insulins?

onset: 2-4 hours

peak: 4-12 hours

duration: 12-18 hours

what are the intermediate acting insulins?

NPH insulins - Humulin N, Novolin N

what does intermediate acting insulin control?

post-prandial hyperglycemia (after meals)

is intermediate acting insulin clear or cloudy?

cloudy

what are the AE of intermediate acting insulins?

hyperglycemia (at peak), hypokalemia, anaphylaxis

when should you avoid giving intermediate acting insulins?

in hypoglycemia

what route are all insulins given unless FDA approved for IV?

SQ

when are hypoglycemic reactions more likely to occur in intermediate acting insulins?

mid to late afternoon

what is another name for long acting insulin analogs?

basal analogs

what is the phrase for long acting insulin analogs?

the 2 long nursing shifts never peaked but lasted 24 hours

what is the onset, peak, and duration of long acting insulin analogs?

onset: 2 hours

peak: no peak

duration: 24 hours

what are the long acting insulin analogs?

glargine and detemir

what do long acting insulin analogs do?

provide a basal insulin level (homeostatic)

what is the major nursing consideration to remember with long acting insulin analogs?

DO NOT mix or dilute with ANY other insulin or solutions

what are the AE of long acting insulin analogs?

hyperglycemia (at peak), hypokalemia, anaphylaxis

when should you avoid giving long acting insulin analogs?

hypoglycemia

when are long acting insulin analogs administered?

at bedtime

T/F: you can administer long acting insulin analogs through a pump, just not with other insulins

false; no pumps

T/F: you can inject insulins in the same site every time as long as its not long-acting insulin analogs

false; change sites

when should we use insulin cautiously (3)?

1. stress or infection

2. renal/hepatic impairment

3. pregnancy

how does stress/infection affect insulin?

decreases insulin requirements (don't need as much to work) 1

how does renal/hepatic impairment affect insulin?

decrease insulin requirements (don't need as much to work)

how does pregnancy affect insulin?

increases insulin requirements (need more to work)

what drugs increase the effects of insulin, causing hypoglycemia (5)?

1. ACE inhibitors

2. alcohol

3. oral antidiabetic drugs

4. antimicrobials

5. beta-blockers

what drugs decrease the effects of insulin, causing hyperglycemia (7)?

1. adrenergics

2. anabolic corticosteroids

3. estrogens and oral contraceptives

4. glucagon

5. levothyroxine

6. phenytoin

7. thiazide diuretics

what is the inhaled insulin?

afrezza

inhaled insulin cannot be used as a substitute for...

long acting/basal insulins

what are the AE of Afrezza?

bronchospasm, cough, hypoglycemia, anaphylaxis, hypokalemia

T/F: a patient on Afrezza no longer needs to be on injectable insulin

false

when should a patient avoid afrezza?

if they smoke or have a hx of smoking, or any lung disease (asthma, COPD, active lung cancer)

when is afrezza administered?

at the beginning of each meal (rapid acting)

what can increase absorption of afrezza if taken together?

inhaled albuterol

how do amylin analogs help insulin lower blood glucose (3)?

1. delays gastric emptying (increase satiety)

2. decrease post-prandial insulin rise

3. decrease glucagon

what is the amylin analogs used for treatment of diabetes?

pramlintide acetate

how is pramlintide administered?

SQ at minimum 2 inches away from insulin injection sites

when is pramlintide administered?

before meals with >250 calories or with >30 g of carbs

what is the BEST treatment for type 2 diabetes?

diet and exercise

how are all type 2 diabetes meds administered besides exanatide?

PO

what is the prototype sulfonylurea?

glyburide

how does glyburide work?

lowers glucose by increasing secretion of insulin from the pancreas, causing insulin sensitivity, and decreasing glucose production from the liver

how is dosing determined with glyburide?

give the lowest dose necessary

what group is more sensitive to glyburide?

older adults

what are the AE of glyburide?

hypoglycemia

when is glyburide administered?

before breakfast

what 2 groups should avoid taking glyburide?

1. pts with hypersensitivity to sulfa

2. pts with severe renal impairment

what is the prototype alpha-glucoaidase inhibitor?

acarbose

how does acarbose work?

slows digestion of starchy foods, delaying the absorption of sugar into blood

how is dosing determined with acarbose?

start at low doses and gradually increase

what kind of hyperglycemia does acarbose control?

postprandial

what are the AE of acarbose?

1. gastric upset with bloating and diarrhea

2. leukopenia, thrombocytopenia, and anemia (pancytopenia)

what type 2 meds do NOT cause hypoglycemia?

acarbose, metformin, and exanatide

acarbose decreases levels of ___________

digoxin

when is acarbose administered?

with first bite of meal 3x a day

what kind of drug is acarbose known as?

antihyperglycemic

what kind of drug is metformin known as?

antihyperglycemic

what is the prototype biguanide?

metformin

how does metformin work?

reduces the production of glucose by the liver and decreases intestinal absorption of glucose

what are the AE of metformin?

lactic acidosis and GI upset

when is metformin administered?

with meals to avoid GI upset

why do most people stop taking metformin?

GI upset

what is the BBW on metformin?

pts 80 years and older should not take because of the risk of lactic acidosis

what should patients on metformin avoid, why, and for how long?

contrast iodine; d/t renal failure and lactic acidosis; separate by 48 hours

what is the prototype thiazolidinedione?

rosiglitazone maleate

how does rosiglitazone work?

inhibits production of new glucose from non-carb molecules (gluconeoenesis), causing insulin resistance

what are thiazolidinediones called?

insulin sensitizers

how long does it take rosiglitazone to work?

3-4 months

what are the AE of rosiglitazone (6)?

1. stroke

2. angioedema

3. liver injury

4. dyspnea

5. upper respiratory infections

6. sinusitis

when is rosiglitazone administered?

with or without meals

what is the prototype meglitinide?

repaglinide

how does repaglinide work?

acts by stimulating release of insulin from pancreatic islet cells

what are the AE of repaglinide (2)?

1. hypoglycemia

2. angina