Med Practicum

Pharmacology Study Notes

NPH Insulin

• Generic and Trade Names:

  • Generic: NPH Insulin

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

• Dosage and Route:

  • Depends on blood glucose and other factors.

  • Administration: SUBQ (Subcutaneous)

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

• Onset, Peak, Duration:

  • Onset:

  • SUBQ: 2-4 hours

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

  • Peak:

  • SUBQ: 4-10 hours

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

  • Duration:

  • SUBQ: 10-16 hours

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

• 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; inhibits hepatic glucose production.

• Nursing Considerations:

  • Assess for symptoms of hypoglycemia, including:

  • Anxiety, restlessness, tingling in hands, feet, lips.

  • Monitor body weight; changes may necessitate adjustments in insulin dose.

  • Administer PO medication 1-2 hours prior to meals.

  • Medication can be crushed for patients with swallowing difficulties.

  • Medication may be dissolved in 25-100 mL of water; shake for 5 minutes and administer within 30 minutes.

• Patient Family Teaching:

  • Instruct on proper administration technique.

  • Demonstrate mixing technique for insulin.

  • Caution against sharing pen devices (risk of bloodborne pathogens).

  • Explain the importance of medication in controlling hyperglycemia without curing diabetes (long-term therapy).

• Adverse Effects:

  • Local: Cutaneous amyloidosis, erythema, lipodystrophy, pruritus, swelling.

  • Endocrine: Hypoglycemia.

  • Miscellaneous: Hypersensitivity reactions, anaphylaxis, hypokalemia.

• Drug Interactions:

  • Beta-blockers and clonidine may mask symptoms of hypoglycemia.

  • 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 worsening heart failure.

• Lab Considerations:

  • Monitor glucose every 6 hours.

  • A1C levels.

  • Serum potassium.

Captopril

• Generic and Trade Names:

  • Generic: Captopril

  • Trade: No specific trade name provided.

• Dosage and Route:

  • Maximum dosage: 450 mg/day.

  • Administration: PO (by mouth).

• Onset, Peak, Duration:

  • Onset:

  • PO: 15-60 min

  • Peak:

  • 60-90 min

  • Duration:

  • 6-12 hrs

• Therapeutic Class:

  • Antihypertensives

• Pharmacologic Class:

  • ACE Inhibitors

• Indications:

  • Treatment of hypertension.

  • Heart failure (HF).

  • Treatment for diabetic nephropathy in patients with type 1 diabetes and retinopathy.

• Mechanism of Action (MOA):

  • ACE inhibitors block the conversion of angiotensin I to angiotensin II (a vasoconstrictor), thereby lowering blood pressure.

  • They increase plasma renin levels and decrease aldosterone levels.

• Nursing Considerations:

  • Monitor blood pressure and pulse.

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

  • Monitor weight for resolution of fluid overload.

• Patient Family Teaching:

  • Educate the patient to take the medication consistently at the same time each day.

  • Advise to take missed doses immediately unless close to next dose (do not double dose).

  • Instruct them to continue taking the medication even if feeling better; do not discontinue without consulting a provider.

  • Educate on the proper technique for taking blood pressure.

  • Caution against salt substitutes or potassium-rich foods.

  • Advise to change 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 the risk of angioedema (do not use within 36 hours of switching).

  • Hypotension may occur when using potassium supplements or potassium-sparing diuretics.

  • Increased risk of hyperkalemia, renal dysfunction, hypotension, and syncope with angiotensin II receptor blockers.

  • NSAIDs and COX-2 inhibitors may inhibit the antihypertensive effect and increase the risk for renal dysfunction.

  • Food may decrease the absorption of captopril; must be taken 1 hour before meals.

• Lab Considerations:

  • Monitor aldosterone levels.

  • BUN and serum creatinine levels.

  • Electrolytes and serum potassium.

  • Complete blood count with differential prior to therapy, then every 2 weeks for 3 months, and then periodically to monitor for neutropenia (discontinue if neutrophil count <1000/mm³).

  • Increased levels of AST, ALT, alkaline phosphatase, bilirubin, uric acid, and glucose may occur.

  • Urine protein should be monitored periodically for one year for patients with renal impairment or those receiving >150 mg/day.