Unit 1 Drugs Flashcards
(74 cards)
1
Q
Bolus Insulins?
A
Insulin Lispro (Humalog), Insulin Aspart (Novolog), Regular Insulin (Humulin R)
2
Q
Basal Insulins?
A
Insulin NPH (Neutral Protamine Hagedorn), Insulin Glargine (Lantus), Insulin Degludec (Tresiba)
3
Q
Premixed insulins?
A
Humulin 50/50
4
Q
Short duration, rapid acting insulin?
A
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
5
Q
Short duration, short acting insulins?
A
Regular insulin (humulin R)
6
Q
Intermediate duration insulin?
A
Insulin NPH
7
Q
Long Duration Insulin?
A
Insulin Glargine
8
Q
Ultra-long duration insulin
A
Insulin Degludec
9
Q
Combination insulin?
A
Humulin 50/50
10
Q
Insulin Lispro indication?
A
Used to control post cranial (post meal) increases in BGL
11
Q
Insulin lispro route?
A
Usually subcutaneous injection OR subcutaneous infusion pump
12
Q
When to administer insulin lispro?
A
Within 15 min before or just after meals
13
Q
Insulin lispro onset, peak and duration?
A
Onset: 15-30 min
Peak: 0.5-2.5 hr
Duration: 3-6 hr
14
Q
Insulin aspart indication?
A
Used to control post cranial (post meal) increases in BGL
15
Q
Insulin aspart route?
A
Usually subcutaneous injection OR subcutaneous infusion pump
16
Q
When to administer insulin aspart?
A
5-10 minutes before meals
17
Q
Insulin aspart onset, peak and duration?
A
Onset: 10-20min
Peak: 1-3 hr
Duration: 3-5 hr
18
Q
Regular Insulin indication?
A
Used to control post prandial (post meal) increases in blood glucose when given via subcutaneous injection
19
Q
Regular insulin route?
A
Can be used for subcutaneous injection, subcutaneous infusion pump and IV
(Given IV if in DKA or HHS)
20
Q
When to administer Regular insulin?
A
30 minutes before meals
21
Q
Regular insulin onset, peak and duration?
A
Onset: 30-60 min
Peak: 1-5hrs
Duration: 6-10hrs
22
Q
Insulin NPH indication?
A
Used to control blood sugars between meals and during the night
23
Q
Insulin NPH route?
A
Subcut only
24
Q
When to administer insulin NPH?
A
Twice daily at the same times each day (am + pm)
25
Insulin NPH onset, peak and duration?
Onset: 60-120min
Peak: 6-14hrs
Duration: 16-24hrs
26
Insulin Glargine indication?
Used to achieve full basal coverage for 24 hours
27
Insulin glargine route?
Subcut injection
28
When to administer insulin glargine?
Once or twice daily at the same times each day (Morning, afternoon or night)
29
Insulin Glargine onset, peak and duration?
Onset: 70min
Peak: none
Duration: 18-24hr
30
Insulin Degludec indication?
Used to achieve basal coverage for full 24hrs
31
Insulin degludec route?
Subcut injection (pre-filled pens only)
32
When to administer Insulin degludec?
Once daily
33
Insulin degludec onset, peak and duration?
Onset: 30-90
Peak: none
Duration: >24
34
Humulin 50/50 indication?
A single vial or cartridge contains a fixed ratio of insulin (% of rapid-acting or short-acting insulin to % of intermediate-acting insulin)
35
Humulin 50/50 route?
Subcut injection
36
Humulin 50/50 when to give?
Twice daily
37
Humulin 50/50 onset, peak and duration?
Onset: 15-30 in
Peak: 2-12hr
Duration:10-16hr
38
Insulin sensitizers?
Biguanide (metformin)
TZDs (rosiglitazone)
39
Incretin Agents
GLP 1 Receptor agonists (Liraglutide)
DPP 4 inhibitor (Sitagliptin)
40
Insulin Scretagogues
Sufonylureas (glicazide)
Meglitinides (repaglinide)
41
Miscellaneous (glucose wasters)
SGLT 2 Inhibitors (canaglifozin)
Alpha-glucosidase inhibitors (Acarbose)
42
# Biguanides
Metformin MOA?
Lowers BGL and improves tolerance in three ways
1- Inhibits glucose production in the liver
2- Sensitized insulin receptors in target tissues (fat and skeletal) > increasing glucose absorption
3- Slightly reduces glucose absorption in gut
| Does not directly impact glucose
43
# Biguanides
Metformin Indication
Type 2 DM
44
# Biguanides
Nursing considerations and advserse side effects of metformin?
Consider renal functioning
Adverse effects:
- GI disturbances
- Appetite suppression & weight loss
- Vit B and folic acid defciencies
- Lactic acidosis (rare)
| Lactict acidosis is only a risk when used in combo with ETOH
45
# Biguandes
Therapeutic effect of metformin?
Glycemic control
46
# Thiazolidinediones
Glitazones MOA?
Primary: Decreases insulin resistence in muscle and fat cells
Secondary: Decreases glucose production in the liver
| Results in increased response to insulin
47
# Thiazolidinediones
Indication for glitazones?
Typ2 DM (used as an add on to metformin)
| Requires insulin to work so is only used in T2DM
48
# Thiazolidinediones
Glitazones Therapeutic effect?
Glycemic control
49
# Thiazolidinediones
Glitazones adverse effects?
- Upper respiratory tract infection, headache, sinustis
- Heart failure secondary to renal retention of fluid
- Should not be used in combination with insulin > increased fluid retention
| Generally well tolerated
50
# GLP-1 Receptor agonists
Liraglutide MOA?
Activates receptors for GLP-1
- slows gastric emptying
- decreases appetite
- increases insulin and decreases glucagon
51
# GLP-1 Receptor agonists
Liraglutide indication?
Type 2 DM
used off label for weightloss
| Only noninsulin injectable agent
52
# GLP-1 Receptor agonist
Liraglutide adverse side effects?
- pain at injection site
- diarrhea, nausea, constipation
- Anaphylaxis
- Pancreatitis
- Black box: thyroid cancer
| Due to delayed gastric emptying, may affect other medication absorption
53
# Dipeptidyl Peptidase-4 inhibitors
Gliptins MOA?
- Prevents glucose levels from spiking after eating
- DPP-4 is an enzyme that inactivates incretin hormones
- By blocking DPP-4, incretin hormones are NOT inactivated
- Enchances the actions of incretin hormones (Increase insulin secretion, supress glucagon secretion, reduces liver production of glucose, delays gastric emptying)
54
# Dipeptidyl Peptidase-4 inhibitors
Gliptins indication?
Type 2 DM
55
# Dipeptidyl Peptidase-4 inhibitors
Therapuetic and adverse effects of gliptins?
Therapeutic
- Reduction in blood sugar
Adverse
- Hypoglycemia when used with sulfonylurea
- Pancreatitis (severe yet rare)
- Hypersensitivity (anaphylaxis and Steven Johnsons)
56
# Sulfonylureas
Glicazide MOA?
Stimulates the release of insulin from the pancreatic beta cells, and may increase target cell sensitivity to insulin
| Secretagogues: Drugs that increase insulin secretion
57
# Sulfonylureas
Indication for glicazides?
Type 2 DM
58
# Sulfonylureas
Nursing considerations for glicazides?
Alcohol consumption can potentiate hypoglycemic effect of this drug
59
# Sulfonylureas
Therapeutic and adverse effects of glicazides?
Therapeutic
- Glycemic control
Adverse
- Hypoglycemia- delivers a dose dependent reduction in blood glucose
- Weight gain
60
# Meglitinides
Repaglinide MOA?
Stimulation of pancreatic insulin release > more short acting than glyburie
| Because it is short acting it is taken before meals
61
# Meglitinides
Indication for repaglinide?
Type 2 DM
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# Meglitinides
Therapeutic effect of repaglinide?
Glycemic control > lowers BGL in patients with T2DM
63
# Meglitinides
Nursing considerations for repaglinide?
- Shorter acting (30min-1hr)
- Rapidly absorbed and then eliminated rapidly
- Peak within 1 hour, returning to baseline by after 4 hours
64
# Meglitinides
Adverse effects of repaglinide?
Hypoglycemia > Pts must eat within 30 min of taking this drug
- weight gain
65
# Alpha Glucosidase Inhibitors
Acarbose MOA?
- Delays absorption of dietary carbs, therby reducing increase blood glucose after a meal
- Alpha-glucoside is an enzyme located in the intestine that normally breaks down carbs for absorption > the drig inhibits the enzyme, slowing digestion of carbs
| lowers A1C levels
66
# Alpha Glucosidase Inhibitors
Indication for acarbose?
Type 2 DM
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# Alpha Glucosidase Inhibitors
Therapeutic effect of arcabose?
- Reduction in postprandial rise in BGL
- Reduce in A1C levels
68
# Alpha Glucosidase Inhibitors
Nursing considerations for Acarbose?
- very little pf the drug is absorbed as an actice drug - reduced systemic side effects
- Not a commonly used medication due to its side effects
- Taken with first bite of each main meal beacuse action is in the intestinal tract
69
# Alpha Glucosidase Inhibitors
Adverse effects of acarbose?
- Flatulence, cramps, digestion, hyperactive bowel sounds, diarrhea
- Anemia (risk for malabsorption of iron)
- Long term can lead to liver dsyfunction
| Give glucose for hypoglycemia not surcrose due to delayed absorption
70
# SGLT 2
Canagliflozin MOA, Class and trade name?
MOA
- Inhibits SGLT-2 in the kidney > reduces reabsorption of glucose
- Increases urinary glucose excretion
Class: SGLT2 Inhibitors
Tradename: Invokana
71
# SGLT 2
Canagliflozin indication?
Type 2 DM
72
# SGLT 2
Canagliflozin therapeutic effect?
- Improves glycemic control
- Improves weightloss
73
# SGLT 2
Canagliflozin adverse effects?
- yeast infections in women
- UTI
- Hyponatremia (dehydration)
- Postural hypotension and diziness
| Infections caused by increased sugar in urine
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