Insulin Flashcards
(22 cards)
Rapid Acting Insulin
Lispro (NovoRapid) Aspart (Humalog) O: 5-15 mins D: 3-6 Hrs Admin: immediately prior to eating (food in front of them)
Short Acting Insulin
Actrapid O:30-60 mins D: 7 (6-8) hours 30 mins before meals Mimics human insulin
Intermediate Insulin
Humalin Neutral Protamine Haegdorn (NPH) Humulin N & Novolin N Lente Humalin Neutral Protamine Hagedorn (NHP) O: 1-3 hrs D: 16-24 hrs Daily or BD without food
Long Acting
Glargine (Lantus) UltraLente (Humulin U) O: 4-6 hrs D:24-28hrs Admin: bedtime, OD
Premixed Biphasic
Mixtard 20/80 O/P: 2-8hrs D: 24 hrs Mixtard 50/50 O/P:2-12 hrs D: 24hrs OD/BD with food Pros: one injection per day
Biguanides
Metformin - first line of therapy, unless renal, hepatic or cardiac impairment, or very elderly.
Increase glucose uptake and utilisation in skeletal muscle. decreases gluconeogenesis. increases insulin sensitivity.
s/e: N&V, diarrhoea, metallic taste in mouth. not compatible with alcohol.
Sulfonylureas
Gliclazide, glipizide
enhances the release of insulin from beta cells, and increases cellular sensitivity to insulin.
s/e: hypoglycaemia, esp in renal and hepatic impairment due to build up of the drug,
“Glitazones” Thiazolidinedione
Rosiglitazone Trolitazone 2nd preference after Metformin*** Increases sensitivity of peripheral tissues and liver to insulin. therefore decreases insulin resistance. full effects take a few weeks. s/e: fluid retention and weight gain
Acarbose
Inhibits alpha-glucosidase.
delays digestion and absorption of carbohydrates in small intestine.
3 x daily w/ meals
Incretin enhancers
Sitagliptin
Exenatide
used as add-on therapy to Metformin
stimulates glucose dependant insulin release. enhances Beta cell proliferation. reduces post-meal glucose levels. delays gastric emptying and decreases appetite.
Hydrocortisone
short acting glucocorticoid - which is a corticosteroid
duration: 8-12hrs
use: anaphylaxis
Prednisolone
Intermediate acting glucocorticoid
duration: 24hrs-36hrs
use: asthma, arthritis, dermatitis
Dexamethasone
Long acting glucocorticoid
duration: 2-3 days
use: asthma, croup, COPD
Anaphylaxis treatment
Adrenaline 500mcg IM in the thigh - improves airway patency, increases BP, stops mast cell degranulation.
IV fluids, 02 if required, ?anti-histamine, steroids; hydrocortisone short acting
Demopressin
Diabetes insipidus - potent vasoconstrictor
Heparin
Action: Binds to antithrombin III and inactivating Factor Xa and IIa (thrombin). Therefore prevents prothrombin –> thrombin
Dose 2/3 x day (half life 1-6hrs) IV/SC
Indications: PE, DVT prophylaxis, CVA, Acute MI
Adverse effects:
Bleeding, Hypersensitivity - thrombocytopenia
MONITOR: Activated partial thromboplastin time APTT. N: 26-39 H: 50-90 secs
Overdose: protamine sulfate
Enoxaparin (Low Molecular Weight Heparin)
Action: Inactivates Xa therefore preventing conversion of prothrombin to thrombin.
Fixed dose schedule SC.
No APTT monitoring, predictable effect on pt
Indications: prevent DVT post op, trauma and spinal injury
Nursing: Teds, hydration, mobilisation
Warfrin
Action: Vit K antagonist inhibits Vit K reductase and therefore blocks synthesis of Vit K dependant factors (II, VI, IX, X)
Takes 2-3 days for peak effect
Indication: prophylaxis thrombosis/embolism from AF, heart valves ,DVT
MONITOR: INR, N: 1, W: 2-3
Always need to take same brand of medication
Adverse effects: Bleeding, drug interactions
Rivaroxaban
Action: direct reversible dose-dependent competitive inhibitor of Factor Xa. binds directly to active site
Oral
Asprin
Antiplatelet
irreversibly combines with COX enzyme preventing thromboxane (platelets less sticky)
Indication: prophylaxis MI
Adverse Effects: GIT, Allergy, Bleeding
Clopidogrel (antiplatelet)
Inhibits platelet aggregation, prevents fibrin links between platelets.
Indication: pt’s coronary stent, peripheral & cerebral vascular disease
Thrombolytic
Streptokinase
Tenecteplase
used to dissolve clots through converting plasminogen to plasmin which dissolves fibrin
Adverse effects: Bleeding, allergy, fever, hypotension
