Pharm

Pharmacology: Drug Preparation Sheet

Generic and Other Trade Names

  • NPH Insulin

    • Trade Names: HumuLIN N, HumuLIN N KwikPen, NovoLIN N, NovoLIN N FlexPen

  • Captopril

    • Trade Name: No trade name available

NPH Insulin

Normal Dose and Route

  • Dosage: Depends on blood glucose and other factors

    • SUBQ: 0.5-1 unit total insulin/kg/day

  • Onset:

    • SUBQ: 2-4 hrs

    • 70% NPH/30% R Insulin mixture: 30 min

  • Peak:

    • SUBQ: 4-10 hrs

    • 70% NPH/30% R Insulin mixture: 2-12 hrs

  • Duration:

    • SUBQ: 10-16 hrs

    • 70% NPH/30% R Insulin mixture: 24 hrs

Classification and Reason for Prescription

  • Therapeutic Class: Antidiabetics, Hormones

  • Pharmacologic Class: Pancreatics

  • Indications: Control of hypoglycemia in patients with diabetes mellitus

  • Mechanism of Action (MOA): Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production.

Nursing Considerations Prior to and After Administration

  • Assessment:

    • Assess for symptoms of hypoglycemia such as:

    • Anxiety

    • Restlessness

    • Tingling in hands, feet, lips

    • Monitor body weight (changes may necessitate insulin dose adjustments)

  • Administration:

    • Administer PO 1-2 hours prior to meals

    • Medication may be crushed if patient has swallowing difficulties

    • Can dissolve medication with 25-100 ml of water, shake for 5 min, and have patient take within 30 min

Patient Family Teaching

  • Instruct on proper administration technique

  • Demonstrate technique for mixing insulin

  • Caution against sharing pen devices due to risk of bloodborne pathogens

  • Educate that medication controls hyperglycemia but does not cure diabetes; therapy is long-term

  • Encourage compliance with nutritional diet and daily exercise; advise provider if nausea, vomiting, or fever develops.

Adverse Effects

  • Local:

    • Cutaneous amyloidosis

    • Erythema

    • Lipodystrophy

    • Pruritus

    • Swelling

  • Endocrine:

    • Hypoglycemia

  • Miscellaneous:

    • Hypersensitivity reactions

    • Anaphylaxis

    • Hypokalemia

Drug Interactions

  • Beta blockers and clonidine may mask signs and symptoms of hypoglycemia

  • Several drugs (corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, rifampin) increase insulin requirements

  • Alcohol, ACE inhibitors, MAO inhibitors, Octreotide, oral hypoglycemic agents, and salicylates may decrease insulin requirements

  • Pioglitazone may increase risk of fluid retention and worsen heart failure

Lab Considerations

  • Monitor glucose every 6 hrs

  • A1C

  • Serum potassium

Captopril

Normal Dose and Route

  • Dosage: 450 mg/day (maximum dose)

  • Onset:

    • PO: 15-60 min

  • Peak:

    • 60-90 min

  • Duration:

    • 6-12 hrs

Classification and Reason for Prescription

  • Therapeutic Class: Antihypertensives

  • Pharmacologic Class: ACE Inhibitors

  • Indications:

    • Hypertension

    • Heart Failure (HF)

    • Treatment for diabetic nephropathy in type 1 diabetes mellitus with retinopathy

  • MOA: ACE inhibitors block the conversion of angiotensin I to vasoconstrictor angiotensin II, lowering blood pressure. They also increase plasma renin levels and decrease aldosterone levels.

Nursing Considerations Prior to and After Administration

  • Monitor BP and pulse

  • Assess for signs of angioedema (e.g., swelling of face, extremities, eyes, lips, tongue, difficulty swallowing, or breathing)

  • Monitor weight to resolve fluid overload

Patient Family Teaching

  • Educate on daily medication adherence and timing; in case of missed dose, take immediately unless it’s near the next dose (do not double dose)

  • Advise to continue using medication even if feeling well; do not discontinue without consulting provider

  • Educate on proper technique for taking blood pressure

  • Caution against using salt substitutes or foods high in potassium or sodium

  • Instruct to switch positions slowly to minimize risk of hypotension

Adverse Effects

  • CNS:

    • Dizziness

    • Fatigue

    • Headache

    • Insomnia

  • Respiratory: Cough

  • Cardiovascular:

    • Hypotension

    • Chest pain

    • Palpitations

    • Tachycardia

  • Gastrointestinal:

    • Taste disturbance

    • Abdominal pain

    • Anorexia

    • Constipation

    • Diarrhea

    • Nausea

    • Vomiting

  • Genitourinary: Proteinuria, renal impairment

  • Dermatological: Rash, pruritus

  • Miscellaneous: Angioedema, fever

  • Hematological: Agranulocytosis, neutropenia

Drug Interactions

  • Concurrent use with sacubitril increases risk for angioedema; do not switch within 36 hrs

  • Hypotension may occur with potassium supplements or potassium-sparing diuretics

  • Risk of hyperkalemia, renal dysfunction, hypotension, and syncope increases with angiotensin II receptor blockers

  • NSAIDs and COX-2 inhibitors may negate antihypertensive effects and increase renal dysfunction risk

  • Food may decrease absorption of captopril; must take 1 hr before meals

Lab Considerations

  • Monitor aldosterone levels

  • Effects:

    • Lowers BP in hypertensive patients

    • Improves HF symptoms

    • Decreases progression of diabetic nephropathy

  • Cautions: Increased risk for orthostatic hypotension with use of alcohol, prolonged standing, exertion, and hot weather

  • Educate to contact provider ASAP for rash, mouth sores, sore throat, fever, swelling, or difficulty swallowing or breathing

  • Encourage compliance with weight loss, low sodium diet, no smoking, moderate alcohol intake, and stress management; medication controls hypertension but does not cure it.

Antidotes

  • NPH Insulin:

    • Mild hypoglycemia may be treated with oral glucose

    • Severe hypoglycemia: IV glucose, glucagon, or epinephrine

  • Captopril:

    • No specific antidote; may use Naloxone to block and reverse hypotensive actions

Lab Tests for Monitoring

  • Captopril:

    • BUN, serum creatinine, electrolytes, serum potassium, CBC with differential (every 2 weeks for 3 months then periodically for neutropenia risk; discontinue if neutrophil count < 1000/mm^3)

    • Increase in AST, ALT, alkaline phosphate, bilirubin, uric acid, glucose

    • Urine protein monitoring for 1 year for patients with renal impairment or receiving >150 mg/day