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Chap - 23


all insulins are U-100 meaning there are 100 __ of insulin in __ 1 mL. units; each
Lispro insulin (Humalog) is one of the __ __ insulins rapid acting
aspart (Novolog) is rapid acting insulin
insulin onset 15 min; peak 30min-1hr; duration 3h rapid acting
insulin onset 30min-1h; peak 2-5h; duration 5-8h short acting
regular insulin still acts __ __ very fast
regular insulin is usually ordered for __ __ doses sliding scale
regular insulin is usually ordered based on __ __ levels blood glucose
brand of regular insulin, which is also manufactured by other companies with different brand names such as Novolin R Humulin R
insulin onset 1-2.5h; peak 6-12h; duration 16-24h intermediate acting
only intermediate insulin used now is NPH insulin
Lente insulin has been discontinued
brand name for NPH insulin NovonlinN or HumulinN
insulin onset 2h; peak 10-18h or no peak; duration >24h long acting
many patients w/diabetes that has stabilized are using newer __ acting insulins. long
brand name for long acting insulin that has been discontinued Ultralente
an advantage of glargine (Lantus) is that the insulin does not have a __ so there is a more steady level of insulin in the body peak
long acting insulin detemir (Levemir)
sometimes __ __ of insulin will be mixed in one syringe prior to injection two types
some patients are able to use a __ __ preparation made by the manufacturer combination insulin
mixture of insulin is 50% NPH insulin and 50% regular insulin Humulin 50/50
insulin is 70% NPH insulin and 30% regular insulin Novolin 70/30
are to be used for the measurement and administration of U-100 insulin only insulin syringes
insulin syringes must not be used to measure other medications that are measured in units
standard U-100 insulin syringe; one side of the insulin syringe calibrated in odd-number two-unit increments and the other side calibrated in even-number two-unit increments 100 units insulin syringe
Lo-Dose U-100 insulin syringe; calibrated for each 1 unit; measures up to 50 units per 0.5 mL 50 unit insulin syringe
Lo-Dose U-100 insulin syringe; measures up to 30 units per 0.3 mL 30 unit insulin syringe
specific techniques to measure an accurate dose and the regular insulin; __ is always drawn up first clear
before mixing two insulins together, the __ of the two medications must be verified compatibility
for __ __ storage, insulin may be kept at room temperature short term
HumaPen LUXURA HD Insulin Pen
HumaPen LUXURA HD is made for use with __ 3mL cartridges Humalog
HumaPen MEMOIR Insulin Pen w/memory
MiniMed 508 simple insulin pump
MiniLink transmitter is used with an insulin pump to monitor glucose
wireless insulin pump w/remote OmniPod
increase insulin production from the pancreas and improve peripheral insulin activity sulfonylureas
delay digestion of complex carbohydrates and subsequent absorption of glucose alpha-glucosidase inhibitors
decrease hepatic glucose output and enhance insulin sensitivity in muscle Biguanides
stimulate beta cells of the pancreas to produce insulin meglitinides
decrease insulin resistance and improve sensitivity to insulin in muscle thiazolidinediones
rosiglitazone (Avandia), thiazolidinedione
repaglinide (Prandin) & Nateglinide (Starlix) meglitinide
metformin (Glucophage) Biguanides
acarbose (Precose) alpha-glucosidase inhibitor
glyburide (DiaBeta), chlorpropamide (Diabinese), & glipizide (Glucotrol) sulfonylurea
refers to internal secretion (hormone) produced by a ductless gland secreting directly into the bloodstream endocrine
endocrine system drugs include natural hormone secreted by the ductless glands or __ __ synthetic substitutes
located at base of brain; regulates function of other glands; called master gland pituitary gland
somatropin, adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), & gonadotropic hormones (FSH, LH, & LTH) are the four hormones secreted by pituitary gland
somatotropin, called human growth hormone (HGH), is secreted by the __ lobe of the pituitary anterior
HGH regulates __ growth
growth abnormalities, treated by only endocrinologists, are a result of __ production of HGH insufficient
ACTH is available only for __ use as corticotropin parenteral
synthetic peptide of ACTH & used mainly for diagnosis of adrenocortical insufficiency cosyntropin (Cortrosyn)
treatment for pituitary associated disorders is usually reserved for the __, in which dosage is more easily regulated & available in __ form as well corticosteroids; oral
located adjacent to kidneys; secrete corticosteroids, which act on immune systems to suppress body's response to infection or trauma adrenal glands
relieve inflammation, reduce swelling & suppress symptoms in acute conditions corticosteroids
corticosteroids are used as __ therapy when pituitary/adrenal gland secretions are deficient replacement
corticosteroids are used for their anti-inflammatory & __ properties immunosuppressant
decreasing production of antibodies & phagocytes and depressing inflammatory reaction immunosuppressive
corticosteroid therapy is not __ curative
corticosteroid therapy is used as __ therapy with other medications supportive
reaction to insect bites, poison plants, chemicals, other meds, etc. in which there are symptoms of rash, hives, or anaphylaxis allergic reaction
corticosteroid therapy is used for __ __ of rheumatic/collagen disorders when only a few inflamed joints can be injected w/corticosteroids to decrease crippling, or in life-threatening situations acute flares-ups
corticosteroid therapy is used for acute flare-ups of __ __ conditions that do not respond to conservative therapy severe skin
in treatment of an acute flare-up of a skin condition, __ __ of corticosteroids are preferred to systemic therapy topical applications
corticosteroid therapy is used for __ __ disorders such as status asthmaticus and sarcoidosis acute respiratory
corticosteroid therapy for status asthmaticus is preferred as __ __ oral inhalations
corticosteroid therapy can be used to prevent __ __ disease in prematures hyaline membrane
corticosteroid therapy, in treatment of hyaline membrane disease, is administered __ to mother at least __ before delivery IM; 24h
when corticosteroid therapy is used in treatment of malignancies, other neoplastic drugs are used as part of the __ regime chemotherapy
in treatment of leukemia, lymphoma, & Hodgkin's disease the corticosteroid used is prednisone
used for treatment of nausea & vomiting associated w/chemotherapy dexamethasone
corticosteroid therapy is used in treatment of __ __ associated with a brain tumor or neurosurgery cerebral edema
in organ transplants, corticosteroid therapy is used w/other immunosuppressive drugs to prevent __ of transplanted organs rejection
corticosteroid therapy is used in treatment of __ __ due to adrenocortical insufficiency life-threatening shock
corticosteroid therapy used in treatment of shock, other than due to adrenocortical insufficiency, is considered controversial
corticosteroid therapy used in treatment of acute flare-ups of __ __ should only be used short-term to avoid hemorrhage ulcerative colitis
suppression of pituitary w/adrenal atrophy, body no longer produces its own hormone, can be caused by __ __ of corticosteroids prolonged administration
to minimize the effects of corticosteroids, when prolonged use is necessary, they are given by __ __ alternate-day therapy
withdrawal of corticosteroids, after prolonged use, should always be gradual via __ dosage tapering
can lead to acute adrenal insufficiency, shock, & even death corticosteroid abrupt withdrawal
in order to reduce systemic effects corticosteroids are administered for short-periods and __ if possible locally
oral corticosteroids are available in dose packs to facilitate dose tapering when used for acute episodes
when used for long periods corticosteroids can delay wound healing and increase susceptibility to infections
osteoporosis w/fractures, especially in older women , can result from __ use of corticosteroids long-term
children on long-term use of corticosteroids can experiencing stunting in growth, which is caused when there is premature closure of bone ends
long-term use of corticosteroids can lead to __ disorders, incl. cushingoid state, amenorrhea, & hyperglycemia endocrine
petechiae, __ __, skin thinning & tearing can be caused by long-term use of corticosteroids easy bruising
corticosteroids should be used in only __ __ along w/appropriate anti-infectives when patient has viral or bacteria infections life-threatening situations
corticosteroids should only be used during __ __ if specific therapy is concurrent fungal infections
corticosteroids cause __ __ for patients with hypothyroidism & cirrhosis exaggerated responses
corticosteroids are __ for patient w/hypertension or CHF contraindicated
in patients with diabetes corticosteroids __ hyperglycemia increase
for patients with glaucoma corticosteroids may increase __ __ intraocular pressure
corticosteroids may precipitate __ in patient with history of gastric/esophageal irritation ulcers
corticosteroids are contraindication for patients with __ disorders or seizures thromboembolic
when taking corticosteroids with barbiturates, phenytoin, & rifampin dosage __ required adjustment
estrogen & oral contraceptives may __ corticosteroids potentiate
NSAIDs used w/corticosteroids, aspirin may increase risk of __ __ GI ulceration
interaction when diuretics, which potentiate __ depletion, are administered w/corticosteroids which also result in __ loss potassium
pituitary drug; IM, subQ repository gel for injection; trade name for corticotropin (ACTH) HP Acthar
pituitary drug; IM, IV, subQ for adrenocortical insufficiency; trade name for cosyntropin Cortrosyn
adrenal corticosteroid; PO, IM for replacement therapy; trade name for cortisone Cortone
adrenal corticosteroid; PO, IN, IM, inhalation; trade name for dexamethasone Decadron
adrenal corticosteroid; PO, for orthostatic hypotension; trade name for fludrocortisone Florinef
adrenal corticosteroid; PO, IV, deep IM, SubQ intraarticular; trade name for hydrocortisone Cortef, Solu-Cortef
adrenal corticosteroid; PO, IV, deep IM, intraarticular; trade name for methlyprednisone Depo-Medrol, Medrol, Solu-Medrol
adrenal corticosteroid; PO tab or sol; do not confuse w/prednisolone; trade name for prednisone Deltasone, Sterapred
adrenal corticosteroid; PO, IM; trade name for triamcinolone Aristocort, Kenalog
thyroid preparations are used in __ __ for hypothyroidism caused by diminished/absent thyroid function replacement therapy
generally preferred because their hormonal content is standardized & effects are predictable synthetic thyroid agents
congenital; requires immediate treatment to prevent mental retardation cretinism
endocrine condition(s) due to simple goiter myxedema & adult hypothyroidism
causes slowed metabolism w/symptoms ranging from fatigue, dry skin, weight gain, sensitivity to cold, irregular menses, & mental deterioration if left untreated hypothyroidism
hypothyroidism is diagnosed by __ __ before medication is given blood test
with a patient is euthyroid the use of thyroid agents in __ __ is contraindicated, ineffective, & dangerous; leads to decrease in normal thyroid function & possible cardiac arrhythmias weight reduction
__ hypothyroidism is rare transient
thyroid replacement therapy must be __ __ __ continued for life
monitoring thyroid drug therapy for __ __ and periodic lab tests are recommended toxic effect
when receiving orders for levothyroxine, caution is advised about __ __ placement decimal point
when receiving orders for levothyroxine, caution is advised about dose conversions between __ & __ as medication errors have occurred mg; mcg
toxic effects are the result of __ of thyroid & are manifested in the signs of __ overdosage; hyperthyroidism
palpitations, tachycardia, cardiac arrhythmias, >BP, nervousness, tremor, headache, insomnia, weight loss, diarrhea, abdominal cramps, intolerance to heat, fever, excessive sweating, & menstrual irregularities are signs of __ __ or __ toxic effects; hyperthyroidism
thyroid replacement therapy is contraindicated, or advised to use w/extreme caution, for patients w/ cardiovascular disease incl. angina pectoris MI & __ hypertension
thyroid replacement therapy is contraindicated, or advised to use w/extreme caution, for older patients because it may precipitate __ cardiac pathology dormant
thyroid replacement therapy is contraindicated, or advised to use w/extreme caution, for patients w/ adrenal insufficiency because __ required first corticosteroids
thyroid replacement therapy is contraindicated, or advised to use w/extreme caution, for patients w/diabetes because close monitoring of __ __ is required blood glucose
thyroid replacement therapy may cause potentiation of oral anticoagulant effects if added after __ therapy stabilizes warfarin
thyroid replacement therapy interaction with insulin & oral hypoglycemics & __ __ necessary dosage adjustment
thyroid replacement therapy interaction with __ decreases response of thyroid medications soy
patients being treated w/thyroid meds should not change the __ or to a __ without physician approval brand; generic
used to relieve symptoms of hyperthyroidism in prep for surgical or radioactive iodine therapy antithyroid agents
side effects of __ __rare & may include rash uticaria, pruritus, blood dyscrasias (especially agranulocytosis) antithyroid agents
__ or __ w/antithyroid agents applies to prolonged therapy, patients >40yr, pregnant/lactating, & hepatic disorders contraindications; caution
antithyroid agent interactions w/other drugs causing __ are potentiated agranulocytosis
patients being treated w/antithyroid agents should notify the physician immediately of signs of illness, incl. chills, fever, rash, sore throat, malaise, & __ jaundice
thyroid agent; 25-200mcg daily; levothyroxine trade name is Synthroid, Levothroid, Levoxyl
thyroid agent; 60-180mcg daily; thryoid trade name Armour Thyroid
antithyroid agent; tabs 5-30mg daily, divided doses; methimazole trade name is Tapazole
antithyroid agent; tabs 100-150mg daily, divided doses; propylthiouracil trade name is PTU
antithyroid agent; tabs 130mg daily for treatment of radiation emergencies; potassium iodide trade name is Iostat. Thyro-Block
administered to lower glucose levels in those w/impaired metabolism of carbohydrates, fats & proteins antidiabetic agents
classified as insulin dependent type1 or non-insulin dependent type2 diabetes mellitus
formerly described as maturity-onset diabetes because it was usually found in adults >40yr; insufficient production of insulin from islets of Langerhans in pancreas Type1
increase in children & young adults due to obesity at earlier age Type2
type2 patient who fail to maintain satisfactory blood glucose levels w/diet & oral antidiabetic agents require insulin replacement therapy
insulin indicated for __ __ at time of surgery, fever, severe trauma, infections, serious renal/hepatic dysfunction, endocrine dysfunction, gangrene, or pregnancy stable type2
regular insulin is used in the ER treatment of diabetic __ or __ ketoacidosis; coma
insulin must be administered __ because it is destroyed in __ __ parenterally; GI tract
inhaled form of insulin; became avail. mis-2006 Exubera
Exubera is contraindicated for smokers & those with COPD/asthma because of respiratory side effects
all __ __ products are pork, beef-pork, biosynthetic human, or analog injected insulin
capable of causing antigenic reactions, and rarely used today pork & beef-pork insulins
biosynthetic insulins are referred to as "human" because their __ __ structure is identical to naturally occurring human insulin amino acid
differs from human insulin only by substitution or position changes in the human insulin molecule, which mimics normal insulin secretion better than traditional insulins analog insulins
biosynthetic & analog insulins are created using __ __ technology recombinant DNA
__ __ differ mainly on their onset, peak, & duration of action insulin preparations
rapid acting & have very short duration of action; clear; onset approx. 15 min, peak 1/2 to 1h & last approx. 3h; only subQ Aspart & lispro
rapid acting and of short duration; only type to be administered intravenously & subcutaneously regular insulin
all insulins, other than regular insulin can only be given subQ
regular insulin is sometimes __ __ isophane/zinc insulin in same syringe combined with
when two insulins are ordered at same time the regular insulin should be drawn into the syringe first
combinations of NPH & regular insulin; rapid onset w/duration up to 24h Humulin 70/30, Novolin 70/30, Reg. Iletin II
not compatible with any other of the types of insulins insulin glargine
blood is tested for glucose & specific amount of regular insulin is administered subQ based on glucose level shown by test sliding scale administration
Aspart trade name Novolog
Lispro trade name Humalog
intermediate; onset 1-2.5h, peak 6-12h, duration 16-24h; Isophane (NPH) trade name Humulin N., Novolin N., NPH Iletin II
intermediate; onset 1-2.5h, peak 6-12h, duration 16-24h; Lente trade name Humulin L., Novolin L., Lente Iletin II
long; onset 2h, no peak, duration>24h; Glargine trade name Lantus
long; onset 2h, no peak, duration>24h; Ultralente trade name Humulin U
mixture; peak 7-12h, duration 16-24h; NPH/Reg 70/30 or 50/50; trade name Humulin/Novolin
mixture; peak 7-12h, onset 5min, duration 1-24h; NPL/Lispro trade name Humalog Mix 75/25
open vials may be stored at __ __ without loss of potency for one month room temperature
anterior lobe hormone ___ is called the human growth hormone somatotropin
antithyroid agents are used to relieve symptoms of __ in prep for surgical or radioactive iodine therapy hyperthyroidism
in 911 treatment of diabetic ketoacidosis/come, __ __ is administered IV regular insulin
osteoporosis, gastric irritation/ulceration, endocrine disorders, increased susceptibility to infection, fluid & electrolyte imbalance are __ __ __ of corticosteroid use potential side effects
alpha-glucosidase inhibitors, i.e. acarbose (Precose), delay digestion of complex carbs & absorption of glucose, resulting in a(n) __ rise in blood glucose following meals smaller
when instructing patients about insulin injections, they should be encouraged to __ injection sites rotate
most insulin in use today is U-100, which means there are 100 units of insulin per milliliter
major side effects of sulfonylureas include gastrointestinal distress, weakness & fatigue, and hypoglycemia
initial treat of hypoglycemia in a patient who is conscious is 4oz of __ __, candy, honey, or syrup orange juice
because of increase in obesity, more children & young adults are developing __ __ Type2 diabetes
only type to be administered IV & subQ is regular insulin
endocrine system drugs include natural hormones or __ __ synthetic substitutes
stimulate beta cells of pancreas to produce insulin repaglinide (Prandin)
insulin overdose, insufficient food intake, excessive exercise, & change in type of insulin are conditions that lead to development of hypoglycemia
initial treatment of hypoglycemia in a patient who is __ includes:administering either 50% glucose IV or glucagon IV/IM unconscious
when patient is diagnosed w/hypothyroidism the preferred thyroid replacement therapy includes synthetic agents, i.e. levothyroxine
lower blood glucose by decreasing insulin resistance/improving sensitivity to insulin in muscle & adipose tissues thiazolidinediones
metformin (Glucophage) can be used as __ monotherapy or in combination w/sulfonylureas initial
when preparing insulin administration it is essential that someone else compare dosage is syringe with dosage ordered to prevent errors
a patient who develops an allergic reaction to poison ivy, __ corticosteroid therapy is indicated local
decrease hepatic glucose output & enhance insulin sensitivity in muscle biguanides
contraindicated in older adult patients and those w/cardiovascular disease, adrenal insufficiency & diabetes thyroid replacement therapy
patient w/Type2 diabetes, who requires oral antidiabetic meds, should take the medication in a single dose __ __ or 2divided doses, __ morning & evening meals before breakfast; before
the most common oral hypoglycemic drugs are classified as sulfonylureas
if a patient's blood glucose is >350 call physician for dosage
if a patient's blood glucose is 301-350 administer 12 units of regular insulin
if a patient's blood glucose is 251-300 administer 8 units of regular insulin
if a patient's blood glucose is 200-250 administer 5units of regular insulin
if a patient's blood glucose is <200 administer no insulin
undiagnosed diabetes, insulin dose insufficient, infections, surgical/other trauma, emotional distress, other endocrine disorders, & pregnancy can result in hyperglycemia
dehydration & excessive thirst, anorexia & unexplained weight loss in adults <40yr, polyuria, fruity breath, lethargy, weakness, flu symptoms, & coma (if untreated), vision problems & ketoacidosis are all symptoms of hyperglycemia
includes IV fluids to correct electrolyte imbalance & regular insulin added to IV fluids are treatment of acute hyperglycemia
insulin is antagonized by corticosteroids or __, necessitating __insulin dosage epinephrine; increased
oral contraceptives & estrogen may also __ insulin requirements increase
Propranolol w/insulin poses risk of hypoglycemia or hyperglycemia
when taken w/insulin: alcohol, MAOIs, salicylates, or anabolic steroids have __ of hypoglycemic effect potentiation
increased perspiration, irritability, confusion/bizarre behavior tremor, weakness, headache/tingling of fingers, blurred/double vision, loss of consciousness & convulsions, in older diabetics may mimic CVA are all symptoms of hypoglycemia
excessive amounts of sugar or frequent overdoses of insulin may result in __ hyperglycemia from accelerated release of glucagon rebound
rebound hyperglycemia Somogyi effect
involves reduction of insulin dosage w/continuous monitoring of blood glucose treatment for Somogyi effect
oral diabetic agents are not a substitute for dietary management
principal therapy for management of Type2 diabetes is weight reduction & modified diet
excessive weight gain after 40yr, polydipsia, polyuria, excessive weakness, poor circulation/healing, visual problems are all symptoms of Type2 diabetes
oral antidiabetic agents are available in several pharmacological classes with differing mechanism of action, offering different avenues for reducing glucose levels
oral diabetic agents that work at different sites are often __ and some may be used in combination w/one another or w/insulin synergistic
sulfonylureas are the __ hypoglycemic drugs oral
__ sulfonylureas have higher potency, better tolerance, & fewer drug interactions 2nd-generation
sulfonylureas work by increasing insulin production from the pancreas & by improving __insulin activity peripheral
side effects from alpha-glucosidase inhibitors can include elevated __ __, which are dose-related, generally asymptomatic, & reversible liver enzymes
for patients w/impaired liver/kidney function, IBD/intestinal obstruction, pregnancy/lactating, or children alpha-glucosidase inhibitors are contraindicated or to be used with extreme caution
acarbose can interact w/alpha-glucosidase inhibitors because __ __ reduce the effect digestive enzymes
serum digoxin concentrations should be __ when used with alpha-glucosidase inhibitors reduced
estrogen & oral contraceptives can impair glucose __ when taken w/alpha-glucosidase inhibitor tolerance
biguanides can produce __ __ in patients w/history of ketoacidosis, severe dehydration, cardiorespiratory insufficiency, renal dysfunction, & chronic alcoholism w/liver damage lactic acidosis
hypoglycemia is a __ __ of biguanides side effect
biguanides are __ for patients w/impaired liver/kidney function, CHF, pregnant/lactating, in children & elderly contraindicated
biguanides w/administration of __ __ could result in acute alteration of renal function radiocontrast dye
for patients taking biguanides, metformin should be __ prior to tests w/radioactive dye withheld
biguanides, metformin, can cause a(n) __ __ when takes w/alcohol, calcium channel blockers, cimetidine, furosemide, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, vancomycin, & amiloride increased effect
metformin should be held the day of & 48h __ administration of radiopaque contrast media after
repaglinide can be used as __ or in combination w/metformin monotherapy
GI effects, hypoglycemia, & upper respiratory infection, sinusitis, arthralgia, & headache are all side effects of meglitinides
for patient w/diabetic ketoacidosis, impaired liver function, pregnancy/lactating and use in children meglitinides are contraindicated
repaglinide should be administered before meals to maximize absorption
meglitinides may __ or __ effects of gemfibrozil (Lopid) enhance; prolong
thiazolidinediones can be used as a monotherapy or __ with a sulfonylurea, insulin, or metformin concomitantly
weight gain, fluid retention, edema, URI, sinusitis, pharyngitis, headache, myalgia, & anemia are all side effects of thiazolidinediones
hypoglycemia is a side effect when thiazolidinediones are taken with insulin or oral hypoglycemics
for patient w/chronic renal insufficiency, impaired liver function, CHF, pregnancy/lactating & children thiazolidinediones are contraindicated
thiazolidinediones may cause resumption of __ in post-menopausal patients ovulation
thiazolidinedione, pioglitazone, taken w/oral contraceptives may __ effectiveness reduce
thiazolidinedione, pioglitazone, taken w/ketoconazole or itraconazole can cause potentiation of __ __ hypoglycemic effect
does not inhibit any of the major cytochrome enzymes responsible for drug metabolism/drug interactions seen w/other oral antidiabetic agents rosiglitazone
diabetic properly balanced diet consists of restricted calories, avoiding simple sugars, alcohol, & foods high on Glycemic Index
white bread, white potatoes & white rice are high on Glycemic Index
complex carbs (i.e. whole-grain breads & cereal & brown rice are low on Glycemic Index
on a properly balanced diabetic diet should be low in fats, high in __, and includes adequate fluid intake fiber
both types of diabetics should take oral/insulin medication at the same time everyday
unopened vials of insulin should be stored at 2-8ºC and should not be subjected to freezing
avoid exposure of insulin to extreme temperatures & direct sunlight
if a patient increases exercise or reduces amount of food intake they should notify a physician because __ insulin may be required less
1st-generation sulfonylurea; 250-1500mg/day ac or divided; acetohexamide trade name is Dymelor
1st-generation sulfonylurea; 100-500mg/day w/meal (do not use for older adults); chlorpropamide trade name is Diabinese
1st-generation sulfonylurea; 100-1000mg/day or divided ac; tolazamide trade name is Tolinase
1st-generation sulfonylurea; 250-3000mg/day or divided; tolbutamide trade name is Orinase
2nd-generation sulfonylurea; 1-5mg/day w/meal; glimepiride trade name is Amaryl
2nd-generation sulfonylurea; 2.5-40mg/day ac or divided; glipizide trade name is Glucotrol
2nd-generation sulfonylurea; 5-20mg/day w/meal; glipizide trade name is Glucotrol XL
2nd-generation sulfonylurea; 1.25-20mg/day or divided w/meal; glyburide trade name is DiaBeta, Micronase
2nd-generation sulfonylurea; 1.5-12mg/day w/meal; glyburide trade name is Glynase
alpha-glucosidase inhibitor; 25-100mg TID, w/1st bite of meal; acarbose trade name is Precose
alpha-glucosidase inhibitor; 25-100mg TID, w/1st bite of meal; miglitol trade name is Glyset
biguanide; 500-2,550mg/day divided w/meals; metformin trade name is Glucophage
biguanide; 500-2,000mg/day divided w/meals; metformin trade name is Glucophage XR
meglitinide; 60-120mg TID w/meals; nateglinide trade name is Starlix
meglitinide; 0.5-4mg BID divided; repaglinide trade name is Prandin
thiazolidinedione; 15-45mg/day; pioglitazone trade name is Actos
thiazolidinedione; 4mg/day or BID divided; rosiglitazone trade name is Avandia
combination; 1.25/250-10/2,000mg/day BID w/meals; glyburide/metformin trade name is Glucovance
combination; 2/500-8/2,000mg/day w/meals or divided; rosiglitazone/metformin trade name is Avandamet
in older adults, start w/the __ __ possible titrating __ to desired glycemic control lowest dose; upward
to mix isophane & zinc insulin gently __; do not __ rotate; shake