Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OU Module Endo Fall 2018 > Pharmacotherapy of Injectable Medications Exam 2 > Flashcards

Pharmacotherapy of Injectable Medications Exam 2 Flashcards

1
Q

What are the rapid acting insulin?

A
  • Insulin lispro (Humalog, Admelog)
  • Insulin aspart (Novolog, Fiasp)
  • Insulin glulisine (Apidra)
  • Afrezza
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When can you take Fiasp?

A
  • before meals
  • during meals
  • 20 min after meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Rapid acting advantages

A
  • Quicker onset
  • Shorter duration
  • Less hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rapid acting disadvantages

A

• Expensive
• Patients who
graze may need a longer acting insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Rapid acting pearls

A

• Can be administered closer to meals
• More closely mimics
physiologic action of insulin
• Insurance tends to dictate insulin chosen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the short acting insulin?

A

Regular insulin (Humulin R, Novolin R)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Short acting advantages

A
  • Less expensive

* Relion brand $24.99/vial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Short acting disadvantages

A
  • More hypoglycemia

* Less convenient time course (PK) of activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Short acting pearls

A

Administered 30 min before meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the intermediate acting insulin?

A

Insulin (Humulin N, Novolin N)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intermediate acting advantages

A
  • Less expensive Relion $24.99
  • Can be mixed with other insulins
  • Peak can be helpful in some patients to cover lunch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intermediate acting disadvantages

A

• Less consistent absorption
• With peak, hypoglycemia is a risk
• Does not
provide 24-hr coverage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Intermediate acting pearls

A

Converting NPH to

glargine, dose glargine at 80% of the total daily NPH dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the long acting insulin?

A
  • Insulin Glargine (Lantus, Toujeo, Basaglar)
  • Insulin Detemir (Levemir)
  • Insulin Degludec (Tresiba)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Long acting advantages

A
  • Effective once daily

* Peak-less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Long acting disadvantages

A
  • Can’t be mixed with other insulin
  • Expensive
  • May need twice daily dosing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Long acting pearls

A

Insurances usually have 1 brand they prefer over another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the combination insulin products?

A
  • Humulin 70/30 (70% NPH* 30% Regular)
  • Novolin 70/30 (70% NPH 30% Regular)
  • Novolog Mix 70/30 (70% Aspart protamine 30% Aspart)
  • Humalog Mix 75/25 or 50/50 (75% Lispro protamine 25% Lispro or 50% of each )
  • Ryzodeg 70/30 (70% degludec 30% aspart)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you mimic the natural physiologic process of insulin release in the body?

A
  • pure basal with bolus insulin regimen

- true basal (Lantus and Levemir) and a true rapid (Humalog and Novolog)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different concentrations of insulin?

A
  • U-300 Toujeo
  • U-200 Humalog
  • U-500 Humulin R
  • everything else is U-100
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

monitoring parameters for insulin to assess efficacy

A
  • A1c is inadequate at assessing the effectiveness

* Time frame after the duration of action to asses previous dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Afrezza

A
  • Bolus insulin delivered via inhalation
  • 4, 8, or 12 unit cartridges
  • Black box warning/BBW: risk of acute bronchospasm with patients who have chronic lung disease, COPD, or asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are things to educate the pt about in order to avoid short term complications?

A
  • goal: help through adjustment period
  • Insulin therapy (injection technique, time/action profile of insulin, hypoglycemia)
  • Self-monitoring of blood glucose and technique
  • Treating hypoglycemia (including glucagon use)
  • Sick day rules
  • Meal planning
  • Urine testing for ketones
  • Regain lost weight may be a good thing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are things to educate the pt about in order to avoid long term complications?

A
  • Maintain euglycemia and adjust with lifestyle changes
  • Maintain normal growth and development
  • Prevent macrovascular / microvascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are diet related goals to avoid long term complications?

A
  • Provide adequate calories to maintain normal growth and development of children and ideal body weight in all others
  • Provide adequate calories for exogenous insulin
  • Normalize glucose and lipid concentrations and blood pressure
  • Minimize excursions in blood glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Afrezza stability

A
  • cartridges good for 15 days
  • good for 10 days at room temp
  • opened cartridges must be used within 3 days
27
Q

insulin and hypoglycemia

A
  • more common

- unawareness more common

28
Q

What are potential causes of hypoglycemia?

A
  • Too much insulin
  • Skipped, delayed or smaller meal
  • Greater than usual physical activity
29
Q

insulin and weight gain

A
  • more the blood glucose comes down as a result of insulin therapy, the more weight will be gained
  • can avoid through diet and exercise
  • may be a desired effect for patient with type 1 who is under-weight
30
Q

What are the lipodystrophy?

A
  • Lipoatrophy

- Lipohypertrophy

31
Q

Lipoatrophy

A
  • concavities around the injection sites resulting from loss of adipose tissues
  • likely from insulin antibody destruction
  • looks like a crater
32
Q

Lipohypertrophy

A
  • abnormal growth of fat
  • results from many months to years of injection into the same site
  • rotation of injection sites prevents this
33
Q

DM I broad concepts

A
  • require basal and bolus
  • typically do not have insulin resistance
  • want to mimic body’s normal physiologic production
  • combo products are harder to manage
34
Q

DM I insulin initiation

A
  • Total daily insulin requirement usually ranges from 0.21.0 unit/kg/day
  • 50-70% of daily insulin should be basal
  • 30-50% should be bolus
35
Q

What is the fixed dose approach?

A
  • for DM I
  • set amount of insulin per meal
  • 30% of daily dose / 3
36
Q

What is the CHO counting approach?

A
  • Method of bolus dosing in which the patient estimates the total CHO contained in a meal and bases the bolus insulin dose accordingly
  • 1 unit of bolus insulin will usually cover 15g of CHO
  • Can use equation to more accurately define a starting ratio: 500* divided by total daily dose (TDD)
37
Q

What is a correction factor?

A
  • Adds additional units of insulin to the insulin dose if preprandial BS is elevated
  • A common CF is 1 unit of insulin for every 50 mg/dL that BS is >130 mg/dL (common preprandial goal)
  • Correction Factor Equation: 1500* div by TDD
38
Q

DM II broad concepts

A
  • want to mimic body’s normal physiologic production
  • needs insulin later in the disease process
  • basal initiated first
  • glucose levels do not fluctuate
  • insulin doses are higher due to resistance
39
Q

effects of insulin

A
  • Lowers hepatic glucose output
  • Increases endogenous insulin secretion
  • Increases incidence of hypoglycemia
  • Does not worsen insulin resistance or worsen cardiac disease
40
Q

Disadvantages of insulin

A
  • Weight gain

* Hypoglycemia (lower occurrence in DM II than DM I)

41
Q

Barriers to insulin use

A
  • Insulin training
  • Need for more SMBG
  • Need for more intensive monitoring by health care provider
  • Cost
  • Fear of: needles, hypoglycemia, more severe disease, weight gain
  • Association with failure
42
Q

Indications to start insulin

A
  • Hyperglycemia despite maximal doses of 2-3 oral agents
  • Glucose toxicity
  • Pregnancy
  • C/I to oral agents
  • Acute hyperglycemia
  • Hospital admission
43
Q

What do you do with oral treatment when pt is put on insulin?

A
  • Metformin is always maintained unless C/I
  • Oral agents often maintained when basal is added
  • Once bolus added, other orals often titrated off
44
Q

What is the advantages of concurrent oral and insulin DM therapy?

A
  • Glycemic control is not worsened early in the titration phase of insulin
  • Lower insulin dose can be administered
  • Weight gain may be attenuated
45
Q

What is the disadvantages of concurrent oral and insulin DM therapy?

A
  • Cost
  • Increase risk of hypoglycemia
  • Pill burden
46
Q

Insulin types in DM II

A
  • basal insulin is usually the first step

* Pre and postprandial to assess need for bolus insulin

47
Q

DM II insulin initiation

A
  • Start basal insulin at 10 units daily OR at 0.1 – 0.2 units/kg/day
  • Basal: Titrate dose adjusting dose 10-15% or 2-4 units every 3-7 days
  • Add bolus insulin if post prandial BS are elevated and morning fasting is at goal (bolus is usually 30% of daily insulin)
  • Bolus: Titrate by ~10% increments
48
Q

Dawn Phenomenon

A
  • Diurnal physiologic pattern in which our bodies increase glucose production in response to awakening and usually accompanied by increase insulin production.
  • Patients with diabetes don’t have the increase in insulin so hyperglycemia results
  • elevated morning BS due to diurnal rise in glucose production
49
Q

Smogyi effect

A
  • Hyperreactive hyperglycemia in response to nocturnal hypoglycemia in which counter-regulatory hormones increase glucose production
  • BS drops too low during the night causing release of counterregulatory hormones and elevated BS in the morning
  • can be suspected if there is a normal bedtime BS
50
Q

How do you assess if a pt has dawn pheno or smogyi effect?

A

• 3 AM or 3-4 hrs prior to waking FSBS are the best way to distinguish between
the two
• 3:00AM BS = LOW = SMOGYI = Bedtime insulin is too much
• 3:00AM BS = Normal to high = DAWN = Bedtime insulin not enough

51
Q

insulin titration

A
  • SMBG is needed for each time that insulin is dosed
  • can be made every 3-7 days
  • Basal insulin: Fasting BS (titrate by ~10-15% of TDD)
  • Bolus insulin: Preprandial BS -> Adjust I:CHO ratio, usually increments of 2-3
  • Fixed insulin dose, adjust by ~10%
52
Q

How do you make an I:CHO tighter / looser?

A
  • Tighter ratio = decrease CHO number

* Looser ratio = increase CHO number

53
Q

What are the components of insulin pumps?

A
  • Basal rate: rate of insulin delivered per hour to replace basal insulin injections
  • Bolus infusion: extra insulin to cover for food
  • Reservoir: insulin container in the pump
  • Insulin
54
Q

What are the insulin used with insulin pump therapy?

A
  • Novolog (more heat stable)
  • Humalog
  • Apidra
55
Q

Advantages of pump over injections

A
  • Avoids multiple daily injections
  • Convenient and quick to dose for meals
  • Automated help with CHO
  • Considers “insulin on board”
  • Ability to set different bolus patterns
  • Adjust basal rate prior to waking for Dawn Phen.
  • Typically improved control
56
Q

Disadvantages of pump over injections

A
  • Cost
  • Wearing infusion set
  • Training
  • More glucose monitoring
  • DKA risk if reservoir runs empty, tubing loose, etc.
  • Need to revert to injections if pump malfunctions
  • Scar tissue around cannula can occur
  • Skin irritation
  • Fluctuating glycemia around transition
57
Q

What makes a person a candidate for insulin pump therapy?

A
  • Current need for bolus and basal insulin
  • Access to pump and ongoing access for supplies
  • Ability and willingness to CHO-count
  • Ability and willingness to learn to use the pump device
  • Willingness to monitor
  • Has at least 6 months of documented blood sugar logs
58
Q

Rapid acting onset, peak, duration

A
  • Onset: 5-15 min
  • Peak: 1-2 hrs
  • Duration: 2-4 hrs
59
Q

Short acting onset, peak, duration

A
  • Onset: 30-60 min
  • Peak: 2-3 hrs
  • Duration: 6-8 hrs
60
Q

Intermediate acting onset, peak, duration

A
  • Onset: 2-4 hrs
  • Peak: 4-6 hrs
  • Duration: 8-12 hrs
61
Q

Long acting onset, peak, duration

A
  • Onset: Variable
  • Peak: Variable
  • Duration: ~24
62
Q

Levemir peak, duration

A
  • Peak: 6-10 hrs

- Duration: ~24

63
Q

Tresiba peak, duration

A
  • Peak: 9 hrs
  • Duration: 42
  • being studied with every other day dosing
64
Q

Basaglar peak, duration

A
  • Peak: 12 hrs

- Duration: 30

OU Module Endo Fall 2018 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions