Pharmacotherapy of Injectable Medications Flashcards
(92 cards)
1
Q
What are the rapid acting insulins used for bolus dosing?
A
Humalog, Admelog, Novolog, Fiasp, Apidra, Afrezza, Lyumjev
2
Q
Which insulins are Lispro?
A
Humalog, Admelog, and Lyumjev
3
Q
Which insulins are Aspart?
A
Novolog and Fiasp
4
Q
Which insulin is Glusine?
A
Apidra
5
Q
What insulin out of the rapid actings also has a U-200 strength?
A
Humalog/Lispro
6
Q
What is the onset for Humalog, Novolog, and Apidra?
A
15-30 min
7
Q
What is the onset for Admelog and Fiasp?
A
5 min
8
Q
What is onset for Afrezza?
A
10-15 min
9
Q
What is the onset for Lyumjev?
A
15 min
10
Q
What is the peak for Rapid Acting?
A
2 hrs
11
Q
What is the duration for Rapid Acting?
A
3-5 hrs
12
Q
What is the Dosing Frequency for Rapid Acting?
A
Take it right before you eat
13
Q
What are the Short Acting insulins?
A
Humulin R and Novolin R
14
Q
What strength does Humulin R offer that is different than the usual U-100?
A
U-500
15
Q
What is the onset for Short Acting Insulin?
A
30-60 mins
16
Q
What is the peak of Short Acting Insulin?
A
2-3 hrs
17
Q
What is the duration for Short Acting insulin?
A
6-8 hrs
18
Q
When do you dose Short Acting Insulin?
A
30 mins before meals
19
Q
What are the Intermediate Acting Insulins?
A
Humuluin N and Novolin N –> NPHs
20
Q
What is the onset for Intermediate Acting Insulin?
A
2-4 hrs
21
Q
What is the peak for Intermediate Acting Insulin?
A
4-6 hrs
22
Q
What is the duration for Intermediate Acting Insulin?
A
8-12 hrs
23
Q
When converting NPH to Glargine how do you dose the Glargine?
A
80% off the total daily dose of the NPH dose
24
Q
What are the Long Acting Insulins?
A
Lantus, Levemir, Toujeo, Tresiba, Basaglar, Semglee
25
What are the Glargine insulins?
Lantus, Toujeo, Basaglar, and Semglee
26
What insulin is Detemir?
Levemir
27
What insulin is Degludec?
Tresiba
28
What long acting insulin offers U-300?
Toujeo
29
What long acting insulin offers U-200?
Tresiba
30
What's the onset for Long Acting Insulins?
2hrs
31
What is the peak for Lantus?
Peak-Less
32
What is the duration for Toujeo?
36 hrs
33
What is the duration for Tresiba?
42 hrs
34
What is the duration for Basaglar?
30 hrs
35
What is the duration for all other long acting insulins?
24hrs
36
Humulin 70/30 is composed of what
70 NPH
30 Regular
37
Novolin 70/30 is composed of what?
70 NPH
30 Regular
38
Humalog 75/25 is composed of what?
75 Lispro Protamine
25 Lispro
39
Novolog 70/30 is composed of what?
70 Aspart Protamine
30 Aspart
40
What is Soliqua a combination of?
Insulin Glargine and Lixisenatide GLP-1, there is a cap on the dose due to GLP-1
41
What is Xultophy composed of?
Insulin degludec and Liraglutide GLP-1, there is a cap on GLP-1
42
An insulin regimen should:
Mimic the natural physiologic process the closest
43
Which insulin comes in an inhalation form?
Afrezza
44
What are the unit cartridges for Afrezza? How long are they good for?
4, 8, 12 unit
15 days
45
What is the black box warning for Afrezza?
Risk of acute bronchospasm with patients who have chronic lung disease, COPD, or asthma
46
What is InPen and what can it be used with?
Resuable pen device that is compatible with: Humalog, Novolog, or Fiasp U-100
47
What is the best way to assess Bolus Insulin?
FSBS 4 hours after the meal for which it was intended to cover
48
What is the best way to assess Basal Insulin?
FSBS in the AM fasting
49
What is U-100 equate to?
10 mL vial = 1000 units
50
How long does insulin last once you start using it?
28 days
51
What long acting insulins should NOT be mixed with any other insulin?
Glargine and Detemir
52
What insulins can be mixed with NPH?
Aspart, Glulisine, Lispro, and Regular
53
What are the potential causes of hypoglycemia?
Too much insulin, skipped /smaller meal, greater than usual physical activity
54
How to treat hypoglycemia?
Treat with 15-20 g of CHO, repeat as necessary OR use glucagon if unconscious
55
Lipodystrophy
Affects the absorption of insulin, aka it becomes erratic so therefore, you must stop using that injection site for a couple of weeks
56
Lipoatrophy
Concavities around the injection site resulting from loss of adipose tissue
57
Lipohypertrophy
Abnormal growth of fat, results from months to years of infection at the same site
58
What is a Correction Factor CF?
Adds additional units of insulin to the insulin dose if preprandial BS is elevated
59
What is the correction factor equation?
1500 divided by total daily dose
60
Does Type 1 DM require basal and bolus insulin coverage? Are the doses large or small?
Both, and insulin doses tend to be smaller
61
What is the total daily insulin requirement range?
0.2-1.0 unit/kg/day
62
What percent of insulin daily should be basal?
50-70%
63
What percent of insulin daily should be bolus?
30-50%
64
What is the Fixed Dose Approach?
1. Find total daily dose = 0.2-1.0 unit/kg/day
2. Find basal (multiply by 50-70% of total)
3. Final bolus (multiply by 30-50% of total)
4. Divide total bolus by 3 to find unit amount for each meal
65
If an NPH is used how do you split up dosing?
2/3 AM
1/3 PM
66
What is the Insulin to CHO Ratio I:CHO
The amount of insulin needed to cover the CHO eaten to avoid postprandial BS elevation
67
What is the equation to find I:CHO starting ratio?
500 divided by total daily dose
68
What is the CHO Counting Approach?
1. Find total daily dose = 0.2-1.0 unit/kg/day
2. Find basal (multiply by 50-70% of total)
3. Use 500/total daily dose to find I:CHO for bolus
4. Ratio utilized for overall day
69
Does Type 2 DM require basal and bolus insulin coverage? Are the doses large or small?
Initiated on basal insulin first, much higher doses due to insulin resistance
70
What are the barriers to insulin use?
Insulin training, need for more SMBG, need for intensive monitoring, cost, fear of needs/hypoglycemia, and association with failure
71
What are the indications to start insulin?
Hyperglycemia despite 2-3 oral agents, GLP-1 agonists are not an option, glucose toxicity, pregnancy, CI to oral, acute hyperglycemia, hospital administration, and cost
72
What is the glucose levels seen in glucose toxicity?
>300
73
What happens with oral therapy with insulin?
Metformin maintained unless CI
Oral agents often maintained when basal is added
All orals are DC when bolus is added
74
What is the basal insulin equation for Type 2 DM?
0.1-0.2 units/kg/day or 10-25 units/daily, should never exceed 25 units for starting dose
75
What is the bolus insulin protocol for Type 2 DM?
Add bolus insulin if postprandial BS are elevated
10% of basal insulin or 4 units fixed before meals
76
How do you titrate basal insulin?
If fasting BS is high, titrate by 10-15% of total daily dose every 3-7 days
77
How do you titrate bolus insulin?
Is preprandial BS is high, adjust I:CHO ratio
78
What is a tighter I:CHO ratio, and how is CHO changed?
Tighter Ratio = Decreased CHO number
Used when BS is elevated
79
What is a looser I:CHO ratio, and how does CHO change?
Looser Ratio = Increase CHO Number
Used when BS is low
80
What is Dawn Phenomenon?
Increase glucose production in response to awakening, usually accompanied by increase insulin production
81
What is the Smogyi Effect?
Nocturnal hypoglycemia in which counter regulatory hormones increase glucose production
82
DAWN vs SMOGYI
Dawn = high at waking
Smogyi = low at night, high in the morning
83
When do you measure FSBS to distinguish between the two?
3 AM or 3-4 HRS prior to waking
84
If 3AM BS = LOW, what effect is it
Smogyi, bedtime insulin is too much
85
If 3AM BS = Normal/High, what effect is it?
DAWN, bedtime insulin not enough
86
What are the components of an insulin pump?
Basal rate, bolus infusion, reservoir, and insulin used
87
What is the unit for basal rate on an insulin pump?
units/hr
88
How much does the reservoir hold?
176-315 units
89
What insulins can be used in an insulin pump?
Novolog, Humalog, Apidra, Fiasp, and Admelog, ONLY RAPID
90
What are the advantages of insulin pumps?
Avoids multiple daily injections, adjust basal rate prior to waking for DAWN, improved control
91
What are the disadvantages of insulin pumps?
Still requires glucose monitoring, DKA risk, scare tissue, skin irritation
92
What are the favorable patient characteristics for an insulin pump?
Need for bolus and basal, ability to CHO count, at least 6 MONTHS of documented blood sugar logs
