WGU D441 Pharmacology Study Guide:
Diabetes & Antidysrhythmic Drugs
Overview
Diabetes
Pancreas
• Produces two hormones that help regulation of glucose
homeostasis
o Insulin
o Glucagon
• Glycogen – excess glucose stored in liver and skeletal muscle
tissue
• Glycogenolysis – conversion of glycogen into glucose when
needed
Nonpharmacologic Treatment
Interventions
• Type 1: always requires insulin therapy
• Type 2:
o Weight loss
o Improvced dietary habits
o Smoking cessation
o Reduced alcohol consumption
o Regular physical activity
Insulins
Rapid Acting Insulin
• Lispro, Aspart, Glulisine
• Most rapid onset of action – 5-15 minutes
• Peak – 1-2 hours
• Duration – 3-5 hours
• Patient MUST eat a meal after injection
• Givent subcutaneously or continuous infusion pump; NO IV
• Insulin Lispro
o Similar action to endogeneous insulin
• Insulin Aspart
• Insulin Glulisine
, • Afrezza
o Inhaled insulin
o Peak of 12-15 minutes
o Short duraction of action 2-3 hours
o Administered within 20 minuetes before meal
o Must be given in conjunction with long acting
insulins or oral diabetic agents
o Side effects – hypoglycemia, cough, throat pain
o Contraindication – smokers and chronic lung diseases
o Black box warning – risk of acute bronchospasms
Short Acting Insulins
Regular Insulin (Humnlin R)
• Administration
o IV Bolus
o IV Infusion
▪ Onset – immediately
▪ Duration – 2-6 hours
o Intramuscular
o Subcutaneously
▪ Onset – 30-60 minutes
▪ Peak – 2.5 hours
▪ Duration – 6-10 hours
Intermediate Acting Insulin
Insulin Isophane Suspension (NPH)
• Cloudy appearance
• Often combined with regular insulin
• Onset – 1-2 hours
• Peak – 4-8 hours
• Duration – 10-18 hours
Long Acting Insulin
Insulin Glargine (Lantus)
• Clear colorless solution
• Constant level os insulin in body
• Dosed once daily or every 12 hours
• Basal insulin
• Onset – 1-2 hours
• Peak – none
• Duration – 24 hours
Insulin Detemir (Levemir)
,
, • Duraction of action is dose dependent
• Lower doses require twice day dosing
• Higher doses may be given once daily
Non Insulin Medication
Biguanides
• Metformin
o Mechanism
▪ Decrease production of glucose by the liver
▪ Decrease intestinal absorption of glucose
▪ Increase uptake of glucose
▪ Do not increase insulin secretion from pancreas
o Adverse effects
▪ GI issues
▪ Reduced vitamin B123 levels
▪ Lactic acidosis rarely
o Contraindication
▪ Renal disease
▪ Hepatic disease
o DOES NOT CAUSE HYPOGLYCEMIA
Sulfonylureas
• Second Generation – glimepiride, glipizide, glyburide
o Mechanism
▪ Stimulate insulin secretion from the beta
cells of the pancreas, thus increasing insulin
levels
▪ Beta cell function must be present
▪ Improve sensitivity to insulin in tissue
▪ Results in lower blood glucose
o Adverse Effects
▪ Hypoglycemia
▪ Hematologic effects
▪ Nausea
▪ Epigastric fullness
▪ Heartburn
Diabetes & Antidysrhythmic Drugs
Overview
Diabetes
Pancreas
• Produces two hormones that help regulation of glucose
homeostasis
o Insulin
o Glucagon
• Glycogen – excess glucose stored in liver and skeletal muscle
tissue
• Glycogenolysis – conversion of glycogen into glucose when
needed
Nonpharmacologic Treatment
Interventions
• Type 1: always requires insulin therapy
• Type 2:
o Weight loss
o Improvced dietary habits
o Smoking cessation
o Reduced alcohol consumption
o Regular physical activity
Insulins
Rapid Acting Insulin
• Lispro, Aspart, Glulisine
• Most rapid onset of action – 5-15 minutes
• Peak – 1-2 hours
• Duration – 3-5 hours
• Patient MUST eat a meal after injection
• Givent subcutaneously or continuous infusion pump; NO IV
• Insulin Lispro
o Similar action to endogeneous insulin
• Insulin Aspart
• Insulin Glulisine
, • Afrezza
o Inhaled insulin
o Peak of 12-15 minutes
o Short duraction of action 2-3 hours
o Administered within 20 minuetes before meal
o Must be given in conjunction with long acting
insulins or oral diabetic agents
o Side effects – hypoglycemia, cough, throat pain
o Contraindication – smokers and chronic lung diseases
o Black box warning – risk of acute bronchospasms
Short Acting Insulins
Regular Insulin (Humnlin R)
• Administration
o IV Bolus
o IV Infusion
▪ Onset – immediately
▪ Duration – 2-6 hours
o Intramuscular
o Subcutaneously
▪ Onset – 30-60 minutes
▪ Peak – 2.5 hours
▪ Duration – 6-10 hours
Intermediate Acting Insulin
Insulin Isophane Suspension (NPH)
• Cloudy appearance
• Often combined with regular insulin
• Onset – 1-2 hours
• Peak – 4-8 hours
• Duration – 10-18 hours
Long Acting Insulin
Insulin Glargine (Lantus)
• Clear colorless solution
• Constant level os insulin in body
• Dosed once daily or every 12 hours
• Basal insulin
• Onset – 1-2 hours
• Peak – none
• Duration – 24 hours
Insulin Detemir (Levemir)
,
, • Duraction of action is dose dependent
• Lower doses require twice day dosing
• Higher doses may be given once daily
Non Insulin Medication
Biguanides
• Metformin
o Mechanism
▪ Decrease production of glucose by the liver
▪ Decrease intestinal absorption of glucose
▪ Increase uptake of glucose
▪ Do not increase insulin secretion from pancreas
o Adverse effects
▪ GI issues
▪ Reduced vitamin B123 levels
▪ Lactic acidosis rarely
o Contraindication
▪ Renal disease
▪ Hepatic disease
o DOES NOT CAUSE HYPOGLYCEMIA
Sulfonylureas
• Second Generation – glimepiride, glipizide, glyburide
o Mechanism
▪ Stimulate insulin secretion from the beta
cells of the pancreas, thus increasing insulin
levels
▪ Beta cell function must be present
▪ Improve sensitivity to insulin in tissue
▪ Results in lower blood glucose
o Adverse Effects
▪ Hypoglycemia
▪ Hematologic effects
▪ Nausea
▪ Epigastric fullness
▪ Heartburn
