NR293 PHARMACOLOGY FINAL EXAM PART 2 STUDY GUIDE 2025

RAPID ACTING INSULIN - -onset: 15 minutes peak: 30-90 minutes insulin lispro (Humalog) insulin aspart (NovoLog) insulin glulisine (Apidra) SHORT ACTING INSULIN - -*onset: 30-60 minutes peak: 2-4 hours* regular insulin (Humulin R) regular insulin (Novolin R) INTERMEDIATE ACTING INSULIN - -*onset: 1-3 hours* *peak: 8 hours* NPH insulin (Humulin N) NPH insulin (Novolin N) LONG-ACTING INSULIN - -*onset: 1-2 hours* *no peak* *duration: 18-24 hours* insulin glargine (Lantus) insulin detemir (Levemir) PRE-MIXED INSULIN - -*onset = 30-60 minutes* *peak: varies* NR293 70% NPH/30% Reg (Humulin 70/30) 70% NPH/30% Reg (Novolin 70/30) 50% NPH/50% Reg (Humulin 50/50) REGULAR INSULIN - -the only insulin that can be administered via IV route used to treat diabetic ketoacidosis or diabetic coma HYPOGLYCEMIA - -occurs when blood glucose is less than 70 mg/dL HYPOGLYCEMIA - SIGNS & SYMPTOMS - -*Early Signs* confusion irritability tremor sweating *Late Signs* hypothermia seizures BLOOD SUGAR MNEMONIC - -HOT AND DRY = SUGAR HIGH COLD AND CLAMMY = GIVE THEM CANDY INSULIN - INDICATIONS - -used for glycemic control of diabetes mellitus (type 1, type 2, gestational) INSULIN THERAPY FOR TYPE 2 DIABETES MELLITUS - INDICATIONS - -when oral antidiabetic medications, diet, and exercise are unable to control blood glucose levels. severe renal or liver disease is present. painful neuropathy is present. undergoing surgery or diagnostic tests. experiencing severe stress such as infection and trauma. NR293 NR293 undergoing emergency treatment of diabetes ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome requiring treatment of hyperkalemia. WHEN MIXING INSULINS - -*clear before cloudy* 1.) inject air into the cloudy vial 2.) inject air into the clear vial 3.) withdraw clear insulin 4.) withdraw cloudy insulin ADA GLYCEMIC GOAL - -hemoglobin A1C level of less than 7% ADA FASTING BLOOD GLUCOSE GOAL - -80- 130 mg/dL SULFONYLUREAS - -second generation oral antidiabetic drugs glipizide (Glucotrol) glyburide (Diabeta) glimepiride (Amaryl) SULFONYLUREAS - MECHANISM OF ACTION - -bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin decrease secretion of glucagon SULFONYLUREAS - INDICATIONS - -for patients who still have functioning beta cells in the pancreas best for early stages of type 2 diabetes SULFONYLUREAS - CONTRAINDICATIONS - -hypoglycemia conditions that predispose to hypoglycemia potential allergy to sulfonamide antibiotics SULFONYLUREAS - ADVERSE EFFECTS - -hypoglycemia NR293 NR293 NR293 weight gain skin rash nausea epigastric fullness heartburn CORTICOSTEROIDS - -can cause an increase in blood glucose levels METFORMIN (GLUCOPHAGE) - INDICATIONS - -first-line oral drug for the treatment of type 2 diabetes also treats polycystic ovary syndrome (PCOS) as an off-label use METFORMIN (GLUCOPHAGE) - MECHANISM OF ACTION - -*decreases insulin resistance* decreases glucose production by the liver decreases glucose absorption from the GI tract METFORMIN (GLUCOPHAGE) - CONTRAINDICATIONS - -patients with renal disease/renal dysfunction *serum creatinine levels* 1.5 mg/dL (males) 1.4 mg/dL (females) alcoholism metabolic acidosis hepatic disease heart failure conditions that predispose to tissue hypoxia and increase the risk for lactic acidosis METFORMIN (GLUCOPHAGE) - INTERACTIONS - -avoid alcohol when taking this medication due to an increased risk for hypoglycermia METFORMIN (GLUCOPHAGE) - ADVERSE EFFECTS - -abdominal bloating NR293 NR293 nausea cramping a feeling of fullness diarrhea metallic taste hypoglycemia reduction in vitamin B12 levels after long-term use lactic acidosis LACTIC ACIDOSIS - SIGNS & SYMPTOMS - -hyperventilation cold and clammy skin muscle pain abdominal pain dizziness irregular heartbeat METFORMIN (GLUCOPHAGE) - PATIENT TEACHING - -take medication with meals to reduce GI upset BASAL-BOLUS THERAPY - -A long-acting insulin (insulin glargine) is used to *mimic the basal secretion of a healthy pancreas* and constant delivery of an amount of insulin then the bolus is used (insulin lispro or insulin apart) to control increases in daily blood glucose levels MAXIMUM DOSE FOR ACE