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Human regular insulin T&P Answer: T: anti diabetic drug, pancreatic hormone
P:short-acting hypoglycemia drug
Human Regular insulin indications Answer: Maintain blood glucose levels within normal
limits
stimulation of growth hormone secretion in the evaluation of growth hormone deficiency
Treatment of hyperkalemia to promote a shift of potassium into cells
Human Regular insulin most often used in combination with Answer: intermediate or long
lasting insulin to achieve 24 hour glucose control
Human Regular insulin only insulin that can be given_____ Answer: IV
Human Regular insulin adverse effects Answer: Hypoglycemia
Rebound hyperglycemia (somogyi phenomenon)
Irriatation at injection site, including lipohypertrophy (accumulation of fat in the area of
injection
Weight gain
Hypokalemia
Human Regular insulin contraindications Answer: Contra: Beef & pork insulins in people
with hypersensitivity to these animal proteins, patient with hypoglycemia,
Caution: pregnancy, renal impairment or failure, fever, thyroid disease, elderly, children or
infants, patient with hypokalemia
Human Regular insulin drug interactions Answer: Use cautiously with drugs that can
produce hypoglycemia: sulfonylureas, meglitinides, beta-adrenergic blockers, salicylate,
anabolic steroids, monamine oxidase inhibitors (MAOI's), and alcohol
Drugs that antagonize glucose-lowering effects: dextrothyroxine, corticosteroids,
epinephrine or norepinephrine, furosemide, and thiazide diuretics
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,ACE inhibitors increase insulin sensitivity and may enhance the hypoglycemic effects of
insulin
Human Regular insulin pregnancy category Answer: Insulin glargine: C
other forms of insulin category B
Human Regular insulin treatment of overdose Answer: Concentrated source of glucose
(dextrose), such as D5W, or glucagon, by the parental route
Glyburide T & P Answer: T: anti diabetic drug
P:sulfonylurea
Glyburide indications Answer: Type 2 diabetes to lower blood glucose levels
Glyburide can be used _____ or in combination with another ____ _____ _____ Answer:
alone
oral hypoglycemic drug
Glyburide should only be used if Answer: diet & exercise have proven ineffective in
controlling the elevated blood glucose levels
List & describe two types of glyburide available Answer: Conventional form (DiaBeta,
Micronase)
Micronized form (Glynase)
Glynase allows for lower doses, compared to conventional form.
Glucovance is a combination product that contains glyburide and metformin
Glyburide adverse effects Answer: HYPOGLYCEMIA: patients at increased for
hypoglycemia are those with renal or hepatic insufficiency, those consuming improper diet,
elders, or malnourished
Excessive exercise or alcohol also increases risk for hypoglycemia
Heartburn, nausea, vomiting, diarrhea, pruritus, erythema, urticaria, photosensitivity,
blurred vision
Rare though serious adverse effects: hepatoxicity, cholestatic jaundice, aplastic anemia,
leukopenia (reduction in # of white blood cells), thrombocytopenia (deficiency of
platelets), and agranulocytosis (increased vulnerability to infection)
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,Glyburide contraindications/ precautions Answer: Contraindications:
-known sensitivity to sulfa or thiazide diuretics,
-as the primary treatment for type 1 diabetes, diabetic coma, or DKA
Caution
-Patient with renal or hepatic disease
-If used during pregnancy should be discontinued 1 month before pregnancy as newborns
can develop severe hypoglycemia lasting several days
Glyburide drug interactions Answer: Alcohol can cause hyperglycemia or hypoglycemia
resulting in disulfiram-type response: severe nausea, vomiting, flushing, and palpitations
Drugs that can increase hypoglycemia when taken with glyburide: oral anticoagulants,
MAOIs, probenecid, sulfonamides, chloramphenicol, oxyphenbutazone, phenylbutazone,
salicylate, and clofibrate
Glyburide pregnancy category Answer: C
Glyburide herbal/food Answer: Can cause hypoglycemia: Ginseng, garlic, black cohosh,
juniper berries, fenugreek, coriander, or dandelion root
Glyburide treatment of overdose Answer: Concentrated source of glucose
MEtformin T&P Answer: T: Antidiabetic drug
P: biguanide
Metformin indications Answer: Lowers blood glucose levels in type 2 diabetes who are
unable to control glucose levels with diet & exercise
children 10 & over
Metformin describe regular release tablets Answer: Administered once or twice daily,
absorption decreased with food, peak plasma level is 2.5 hours
Metformin describe solution (Riomet) Answer: Administered once or twice daily,
absorption slightly increased with food, peak plasma levels 2.3 hours
Metformin describe sustained release (Fortamet, Glucophage, XR, and Glumetza) Answer:
Extended duration
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, Administered once daily, absorption significantly increased with food, peak plasma 6-8
hours
Metformin reduces ____ and _____ glucose levels. Because it does not promote ______
release, it does not cause ______ Answer: fasting & postprandial
insulin
hypoglycemia
Able to lower glucose levels in patients who no linger secrete insulin
In addition to lowering blood glucose metformin lowers _____ levels, lowers total and low
density lipoprotein (LDL) cholesterol levels, and _____ weight loss Answer: triglyceride
promotes
Metformin off label use Answer: Treat women with polycystic ovary syndrome
Restores normal menstrual cycles and ovulation
Metformin adverse effects Answer: Most common: Gi related including nausea, vomiting,
abdominal discomfort, metallic taste, diarrhea, anorexia, and moderate weight loss
May also cause headache, dizziness, agitation, and fatigue
Metformin Black box warning Answer: Lactic acidosis is a rare, though potentially fatal
adverse effect of metformin therapy
Risk of lactic acidosis increased with renal insufficiency or any condition that puts them at
risk for increased lactic acid production, such as liver disease, severe infection, excessive
alcohol intake, shock, or hypoxemia
Metformin contraindications/ precautions Answer: Contraindications
- impaired renal function, heart failure, history of lactic acidosis, concurrent serious
infection, any condition that predisposes patient to hypoxemia.
-2 days prior to and 2 days after receiving IV radiographic contrast
Cautiously
-anemia, diarrhea, vomiting, dehydration, fever, gastroparesis, GI obstruction, older adults,
hyperthyroidism, pituitary insufficiency, trauma, or during pregnancy and lactation
Safety in children under 10 has not been established
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
HERE! LEARN, PRACTICE & EXCEL!
Human regular insulin T&P Answer: T: anti diabetic drug, pancreatic hormone
P:short-acting hypoglycemia drug
Human Regular insulin indications Answer: Maintain blood glucose levels within normal
limits
stimulation of growth hormone secretion in the evaluation of growth hormone deficiency
Treatment of hyperkalemia to promote a shift of potassium into cells
Human Regular insulin most often used in combination with Answer: intermediate or long
lasting insulin to achieve 24 hour glucose control
Human Regular insulin only insulin that can be given_____ Answer: IV
Human Regular insulin adverse effects Answer: Hypoglycemia
Rebound hyperglycemia (somogyi phenomenon)
Irriatation at injection site, including lipohypertrophy (accumulation of fat in the area of
injection
Weight gain
Hypokalemia
Human Regular insulin contraindications Answer: Contra: Beef & pork insulins in people
with hypersensitivity to these animal proteins, patient with hypoglycemia,
Caution: pregnancy, renal impairment or failure, fever, thyroid disease, elderly, children or
infants, patient with hypokalemia
Human Regular insulin drug interactions Answer: Use cautiously with drugs that can
produce hypoglycemia: sulfonylureas, meglitinides, beta-adrenergic blockers, salicylate,
anabolic steroids, monamine oxidase inhibitors (MAOI's), and alcohol
Drugs that antagonize glucose-lowering effects: dextrothyroxine, corticosteroids,
epinephrine or norepinephrine, furosemide, and thiazide diuretics
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,ACE inhibitors increase insulin sensitivity and may enhance the hypoglycemic effects of
insulin
Human Regular insulin pregnancy category Answer: Insulin glargine: C
other forms of insulin category B
Human Regular insulin treatment of overdose Answer: Concentrated source of glucose
(dextrose), such as D5W, or glucagon, by the parental route
Glyburide T & P Answer: T: anti diabetic drug
P:sulfonylurea
Glyburide indications Answer: Type 2 diabetes to lower blood glucose levels
Glyburide can be used _____ or in combination with another ____ _____ _____ Answer:
alone
oral hypoglycemic drug
Glyburide should only be used if Answer: diet & exercise have proven ineffective in
controlling the elevated blood glucose levels
List & describe two types of glyburide available Answer: Conventional form (DiaBeta,
Micronase)
Micronized form (Glynase)
Glynase allows for lower doses, compared to conventional form.
Glucovance is a combination product that contains glyburide and metformin
Glyburide adverse effects Answer: HYPOGLYCEMIA: patients at increased for
hypoglycemia are those with renal or hepatic insufficiency, those consuming improper diet,
elders, or malnourished
Excessive exercise or alcohol also increases risk for hypoglycemia
Heartburn, nausea, vomiting, diarrhea, pruritus, erythema, urticaria, photosensitivity,
blurred vision
Rare though serious adverse effects: hepatoxicity, cholestatic jaundice, aplastic anemia,
leukopenia (reduction in # of white blood cells), thrombocytopenia (deficiency of
platelets), and agranulocytosis (increased vulnerability to infection)
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,Glyburide contraindications/ precautions Answer: Contraindications:
-known sensitivity to sulfa or thiazide diuretics,
-as the primary treatment for type 1 diabetes, diabetic coma, or DKA
Caution
-Patient with renal or hepatic disease
-If used during pregnancy should be discontinued 1 month before pregnancy as newborns
can develop severe hypoglycemia lasting several days
Glyburide drug interactions Answer: Alcohol can cause hyperglycemia or hypoglycemia
resulting in disulfiram-type response: severe nausea, vomiting, flushing, and palpitations
Drugs that can increase hypoglycemia when taken with glyburide: oral anticoagulants,
MAOIs, probenecid, sulfonamides, chloramphenicol, oxyphenbutazone, phenylbutazone,
salicylate, and clofibrate
Glyburide pregnancy category Answer: C
Glyburide herbal/food Answer: Can cause hypoglycemia: Ginseng, garlic, black cohosh,
juniper berries, fenugreek, coriander, or dandelion root
Glyburide treatment of overdose Answer: Concentrated source of glucose
MEtformin T&P Answer: T: Antidiabetic drug
P: biguanide
Metformin indications Answer: Lowers blood glucose levels in type 2 diabetes who are
unable to control glucose levels with diet & exercise
children 10 & over
Metformin describe regular release tablets Answer: Administered once or twice daily,
absorption decreased with food, peak plasma level is 2.5 hours
Metformin describe solution (Riomet) Answer: Administered once or twice daily,
absorption slightly increased with food, peak plasma levels 2.3 hours
Metformin describe sustained release (Fortamet, Glucophage, XR, and Glumetza) Answer:
Extended duration
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, Administered once daily, absorption significantly increased with food, peak plasma 6-8
hours
Metformin reduces ____ and _____ glucose levels. Because it does not promote ______
release, it does not cause ______ Answer: fasting & postprandial
insulin
hypoglycemia
Able to lower glucose levels in patients who no linger secrete insulin
In addition to lowering blood glucose metformin lowers _____ levels, lowers total and low
density lipoprotein (LDL) cholesterol levels, and _____ weight loss Answer: triglyceride
promotes
Metformin off label use Answer: Treat women with polycystic ovary syndrome
Restores normal menstrual cycles and ovulation
Metformin adverse effects Answer: Most common: Gi related including nausea, vomiting,
abdominal discomfort, metallic taste, diarrhea, anorexia, and moderate weight loss
May also cause headache, dizziness, agitation, and fatigue
Metformin Black box warning Answer: Lactic acidosis is a rare, though potentially fatal
adverse effect of metformin therapy
Risk of lactic acidosis increased with renal insufficiency or any condition that puts them at
risk for increased lactic acid production, such as liver disease, severe infection, excessive
alcohol intake, shock, or hypoxemia
Metformin contraindications/ precautions Answer: Contraindications
- impaired renal function, heart failure, history of lactic acidosis, concurrent serious
infection, any condition that predisposes patient to hypoxemia.
-2 days prior to and 2 days after receiving IV radiographic contrast
Cautiously
-anemia, diarrhea, vomiting, dehydration, fever, gastroparesis, GI obstruction, older adults,
hyperthyroidism, pituitary insufficiency, trauma, or during pregnancy and lactation
Safety in children under 10 has not been established
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
