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What are the common rapid-acting insulin?
- lispro (Humalog)
- aspart (NovoLog)
- glulisine (Apidra)
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What are the common short-acting insulin?
regular (Novolin R)
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What are the common intermediate-acting insulin?
- NPH (Humulin N)
- detemir (Levemir)
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What are the common long-acting insulin?
glargine (Lantus)
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What is the Onset, Peak, & Duration of rapid-acting insulin?
- Onset: 15-20 min
- Peak: 1-2 hr
- Duration: 3-4 hr
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What is the Onset, Peak, & Duration of short-acting insulin?
- Onset: 30 min
- Peak 2-4 hr
- Duration 5-8 hr
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What is the Onset, Peak, & Duration of intermediate-acting insulin?
- Onset: 1-1.5 hr
- Peak: 4-12 hr
- Duration 16-24 hr
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What is the Onset, Peak, & Duration of long-acting insulin?
- Onset: 2-4 hr
- Peak: none
- Duration 24 hr
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Which insulin are cloudy and clear?
Short-acting & Long-acting are clear insulin.
Intermediate-acting is cloudy insulin.
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Intervention for rapid-acting insulin?
- Give within 15 min of meal
- May be mixed with longer acting insulin
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Intervention for short-acting insulin?
- Only insulin given IV
- May be mixed with intermediate-acting insulin
- Used to treat DKA & newly dx T1DM
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Intervention for intermediate-acting insulin?
Given often in combination with regular insulin
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Interventino for long-acting insulin?
- Used as basal coverage once or twice daily
- Usually given at bedtime
- DO NOT MIX WITH ANY OTHER INSULIN
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S/S of hypoglycemia
- confusion
- cool pale skin
- nausea
- diaphoresis
- increase HR
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AE of insulin
- hypoglycemia
- lipodystrophy (fat wasting or accumulation)
- itching
- redness at site
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What drugs are in the class of Biguanide?
- metformin (Glucophage)
- metformin oral solution (Riomet)
- metformin extended release (Glucophage XR)
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Action of Biguanide class of drugs
- Reduces liver glucose production.
- Increases sensitivity to insulin.
- Improves glucose transport into cells.
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Assessments when taking Biguanide class of drugs
- Monitor BS.
- Observe for S/S of hypoglycemia.
- Assess renal/liver function at start & annually.
- Long term use - monitor folic acid & Vit B12.
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Interventions for the drug metformin
HOLD DOSE FOR ANY SURGERY/PROCEDURE WITH RESTRICTED INTAKE AND WHEN IV CONSTRAST MEDIA USED AND 48 HRS AFTERWARDS
Give with meal to minimize GI effect
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AE of Biguanide class
- abdominal bloating
- diarrhea
- N/V
- R/F lactic acidosis (especially if kidney problems)
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What drugs are in the class of Sulfonylureas?
- glipizide (Glucotrol)
- glyburide (Diabeta)
- glimepiride (Amaryl)
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Action of Sulfonylureas class of drugs
- Lowers BG by stimulating release of insulin from pancreas.
- Increasing insulin sensitivity.
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Assessments when taking Sulfonylureas class of drugs
- Monitor BS
- Observe for S/S of hypoglycemia
- Assess for allergies to sulfonamides
- Monitor BUN & creatinine
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Interventions for the drug class of Sulfonylureas
- Administer with 1st meal of day.
- Many drug to drug interactions.
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AE of Sulfonylureas class
- Hypoglycemia
- Wt. gain
- Photosensitivity
- Dizziness
- Kidney or liver dysfunction more susceptible to hypoglycemia
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What drugs are in the class of Meglitinides?
- repaglinide (Prandin)
- nateglinide (Starlix)
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Action of Meglitinide class of drugs
- Action similar to sulfonylureas but works at different receptor site.
- Faster onset and shorter duration.
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Assessments of Meglitinide class of drugs
- Monitor BS
- Observe for S/S of hypoglycemia
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Interventions for Meglitinides class of drugs
- Give up to 30 min before meals
- Rapid onset
- SKIP DOSE IF SKIPPING MEAL
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AE of Meglitinides class of drugs
- Hypoglycemia
- URI
- Cough
- Arthralgia
- Do not take with Lopid
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What drugs are in the class of Alpha-Glucosidase Inhibitors (starch blockers)?
- acarbose (Precose)
- miglitol (Glyset)
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Action of startch blockers
- Works in intestines to slow digestion of carbs.
- Delays and reduces glucose absorption.
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Assessments of starch blockers class of drugs
- Monitor BS
- Observe for S/S of hypoglycemia after meals
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Interventions of starch blockers class of drugs
- GIVE WITH FIRST BITE OF EACH MEAL
- If hypoglycemia, treat with glucose (tabs or gel) or milk
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AE of starch blockers class of drugs
- Abdominal pain
- Diarrhea
- Flatulence
- Risk of hypoglycemia if taken with other diabetic medications
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What drugs are in the class of Thiazolidinediones (TZD)?
- rosiglitazone (Avandia)
- pioglitazone (Actos)
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Action of TZD
- Improves insulin sensitivity in muscle cells
- Decreases insulin resistance
- Enhances insulin action
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Assessments of TZD class of drugs
- Monitor BS
- Observe for S/S of hypoglycemia if taking insulin
- Assess for edema
- S/S of HF and elevated liver enzymes
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Interventions of TZD class of drugs
- Administer with or without food
- BLACK BOX WARNING FOR AVANDIA: INCREASE RISK FOR MI, CVA, DO NOT USE WITH HF
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AE of TZD class of drugs
- May cause increase total cholesterol and LDL
- HF, edema, wt. gain
- Metabolized entirely by liver, so should not be used with liver dysfunction
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What drugs are in the class of Incretin mimetic
- exenatide (Byetta)
- liraglutide (Victoza)
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Action of Incretin mimetic class of drugs
- Mimics action of incretins (gut hormones) by stimulating insulin secretion and inhibiting glucagon after ingestion of carbohydrates
- Promotes feeling of satiety
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Assessments of Incretin mimetic class of drugs
- Monitor BS
- Observe for S/S of hypoglycemia especially when taking TZDs
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Intervention of Incretin mimetic class of drugs
- Only used in T2 DM
- SQ injection from pre-filled pen into thigh or abdomen before breakfast/dinner
- Used with biguanide and/or sulfonylurea
- Profoundly slows gastric emptying & can affect absorption of oral meds
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SE of Incretin mimetic class of drugs
- Diarrhea
- N/V (usally with first doses)
- Dizziness
- H/A
- Minimal R/F hypoglycemia
- Acute pancreatitis & kidney problems have been associated with Byetta use
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What drugs are in the class of Dipeptidyl Peptidase IV Inhibitor (DPP-4)
- sitagliptin (Januvia)
- saxagliptin (Onglyza)
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Action of DPP-4
DPP-4 (an enzyme that breaks down incretin hormones), is inhibited increasing & prolonging action of incretin hormones by slowing inactivation
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Assessments of DPP-4 class of drugs
- Monitor S/S of hypoglycemia especially if taken with sulfonylureas
- Assess renal function tests before starting & regularly during therapy
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Interventions of DPP-4 class of drugs
- 24 hr duration of action
- Decrease dose if renal dysfunction
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SE of DPP-4 class of drugs
- Stuffy or runny nose
- Sore throat
- URI
- H/A
- Nausea
- Diarrhea
- does not cause wt. gain
- Pancreatitis
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What drugs are in the class of Amylin Mimetic?
pramlinitide (Symlin)
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Action of Amylin Mimetic class of drugs
- Mimics action of amylin (pancreatic hormone) that controls after meal glucose by slowing gastric emptying
- Suppressing glucagon secretion
- Triggering satiety (decrease caloric intake & wt. loss)
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Assessments of Amylin Mimetic class of drugs
- Monitor BS
- Assess for S/S of hypoglycemia within 3 hrs of injection when used with insulin
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Intervention of Amylin Mimetic class of drugs
- Dose depends on T1 or T2 DM
- Used in conjunction with insulin therapy
- Administered as SQ STAT before meals (2 separate syringes must be used)
- DO NOT MIX WITH INSULIN
- Rapid onset
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AE of Amylin Mimetic class of drugs
- Severe hypoglycemia when used with insulin
- May need to reduce insuln dose
- Nausea, vomitting, anorexia
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