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Injectable DM Drugs Insulin

What is the three main functions of insulin? 1- converts glucose --> glycogen 2 - enhance the uptake of glucose by muscle cell 3- regulates converting glucose --> fat --> store it in the adipose tissue
Which insulin formulation is used to mimic the basal insulin/ mealtime insulin? - basal insulin: long acting or intermediate acting insulin - mealtime: rapid or short acting
list the names of rapid acting insulin? - aspart - novoLOG - lispro - humaLOG - glulisine - soloStar - afrezza inhaler
What is the recommended timing for dosing rapid acting insulin? - given within 15 min prior to meal 2/2 rapid acting with short duration - given immediately after the meal
What are the common warning of using rapid acting insulin? ** hypoglycemia ** HYPO KALEMIA ** renal/hepatic
What are the most common side effects of rapid acting insulin? - Wt gain - LIPODYSTROPY - injection reaction - peripheral edema
What is the suffix for Rapid Acting insulin? LOG
When is the use of rapid acting inhaler Afrezza C/I? - Asthma - COPD - Chronic lung ds
Which Rapid acting insulin needs detailed medical history, physical examination, and spirometry FEV1 prior to initiation? The rapid acting insulin inhaler -- Afrezza 2/2 - BBW of acute bronchospasm in pt with chronic lung ds - warning of reduction in pulmonary function FEV1 , lung cancer and DKA
What are some common side effect while using Afrezza? - cough - throat pain
What is the main monitoring parameter for the use of Afrezza? FEV1 - pulmonary function test
Which cases is the use of Afrezza NOT recommended? - pt who smokes - pt who recently stops smoking
What are the available concentration of Lispro? - HumaLOG kwikPen 100 units/ml - HumaLOG kwik Pen 200 units/ml
list the names of short acting regular insulin? - Regular insulin: 1- aspart: novoLIN -R/ novoLin-R ReliOn 2- lispro: humaLIN -R - concentrated Regular insulin: 1- Lispro: HumaLIN-R U-500
What is the recommended timing for dosing Short acting regular insulin? - 30 min prior to meal
Which insulin formulation can be used in IV solutions? SHORT acting REGULAR insulin
which insulin are available without Rx? -short acting regular insulin: NOVOLIN-R, HUMULIN- R - itermediate acting insulin: NPH ( HUMULIN-N, NOVOLIN-N) - Pre mixed insulins: HUMULIN 70/30, HUMULIN70/30 pen, NOVOLIN70/30
When is HumuLINR U500 is indicated? - 5X more concentrated than Humulin-R - when pt needs > 200 units/day - should be dispensed with U-500 syringe
Which insulin products can NOT be mixed with other insulin? - short acting regular insulin: HumuLIN-R U500 - long acting insulin : detemir, glargine, degludec
What are some recommendations to avoid Humulin-R U-500 dosing errors? - avoid using other syringes - avoid transfer pen- syringe - don't GIVE IT OTHER THAN SC
List the names of intermediate acting insulin products? - NPH insulin: 1- HUMULIN-N, HUMULIN-N pen 2- NOVOLIN-N, NOVOLIN-N ReliON
What is the suffix for short acting regular insulin? LIN-R
what is the suffix for intermediate acting insulin? LIN-N
when mixing short or rapid acting with intermediate acting, what should be considered? - draw the clear solution first
Which long acting insulin has acidic pH? Glargine ( lantus)
Which long acting insulin causes sting feeling upon injection? Glargine ( Lantus) 2/2 to acidic pH
list the name of long acting insulin products? - detemir ( levemir) - glargine ( lantus, toujeo, basagl) - Degludec( tresiba) -
What is the common insulin conc of long acting insulin products? - U100units/ml EXCEPT: TRESIBA : insulin degludec 200 units/ml and Toujeo ( glargine) 300 units/ml
what is the recommended dosing for short acting insulin? - meal time dosing
what is the recommended dosing for intermediate acting insulin? - once or twice a day
what is the recommended dosing for long acting? once at bedtime OR 2x/day
when should Afrezza oral inhalation powder be replaced? every 15 days
What are the individual components of the following pre mixed rapid and intermediate acting products? Novolog and Humalog 70/30 premixed - NovoLog mix 70/30: 70 aspart protamine suspension and 30 aspart - HumaLog mix 75/25 : 75 lispro protamine suspension and 25 lispro - Humalog mix 50/50: 50 lispro protamine and 50 lispro *******************
What are the individual components of the following pre mixed short and intermediate acting products? HumuLin and NovoLin 70/30 - HumuLin 70/30: 70 NPH + 30 short acting regular lispro - Novolin 70/30: 70 NPH + 30 short acting regular aspart
What combination of drugs should never be used? - insulin + SU + Meglitinides 2/2 hypoglycemia risk
What is the common insulin conc? and what are the exceptions? - the common conc is 100 units/ml - exception: 1- rapid acting Humolog kwikpen 200unit/ml 2- short acting regular insulin: HumLIN-R U 500 3- long acting insulin: tresiba flex touch U200 and Toujeo solostar U300
what is the common size of insulin vial? and what are the exceptions? - 10 ml - except Humulin-R U 500 20 ml
what is the common size of insulin pen? and what are the exceptions? - 3ml - except toujeo 1.5 ml
What is the route of insulin administration using insulin pump? - SC
What insulin is used in insulin pump? - short acting regular insulin LIN-R - rapid acting insulin Log
which pt population are good candidate for the use of insulin pump? - type -1 - NOT appropriate for newly diagnosed pt
What is the recommended initial insulin dose for type-1 vs. Type-2? - type 1: 0.6 units/kg/day using actual body wt - type II: 0.1-0.2 units/kg/day using actual body wt ( OR 10 units/day )
what are the two insulin dosing strategies ? - basal/ bolus strategy: 50% TDD basal long acting ( once at bed time) and 50% TDD bolus rapid ( the bolus is further divided into 3 x/day) - NPH/ regular strategy:2/3 NPH intermediate and 1/3 NPH short regular ( 2x/day together prior to meal)
Which insulin dose is usually adjusted based on the patient sensitivity and needs? - mealtime ( bolus) - ICR: insulin to carb ratio allows bolus adjustment - ICR: is used to determine the # grams of carbs covered by the patient bolus
what is the rule of 500 in ICR? - rapid acting: 500/TDD= grams of carbs covered by 1 units
what is the rule of 450 in ICR" - short regular acting 450/TDD = grams of carbs covered by 1 unit
example of 500-ICR and 450-ICR? - e.g: TDD is 60 u, insulin used: Novolog ( rapid acting) , 500-ICR = 500/60 - 500-ICR: 500/60= 8 gr carbs IF NovoLIN-R ( regular short): 450-ICR = 450/60= 7.5 gram carbs
What is the correction factor and correction dose insulin? - it's the additional units of insulin ( correction dose) needed to bring the pt blood glucose to normal level - add the correction dose to the normal meal dose - other words: correction dose + daily meal dose
what is the difference between ICR and correction dose? - ICR: determine # gram of carbs pt can take based on his/her TDD of insulin - Correction dose: # of insulin units added to the normal units of insulin given prior to meal to bring blood sugar to normal level
what is the 1800 and 1500 correction factor rules ? - 1800 for shot acting insulin; 1800/TDD= correction factor - 1500 for rapid acting insulin; 1500/TDD=correction factor
What is the correction dose? - the correction dose= blood glucose now - target blood glucose / correction factor - the correction dose is then added to the normal daily dose
correction dose example: pt on Novolin-R 60 units. BG target 130 and current is 180; what is the correction dose? - calculate correction factor for regular insulin= 1800/60= 30 - correction dose= 180-130/30= 2 units - the total dose admin = normal daily dose + correction dose = 60+2= 62 units
When is it recommended to start insulin in type II DM? - A1c> 10% - TG> 300 - pt fails multiple regimens - start pt on 0.1-0.2 units/kg/day or 10 units/day - increase by 10-15% or 2-4 units once or twice/ week - basal-bolus still can be used if A1c is not controlled
What is the common conversion ratio for most insulin products? - 1:1 except 1- NPH ( intermediate) BID --> long acting ONCE= use 80% of TDD 2- long acting Toujeo U300 ONCE --> long acting U100 ONCE = use 80% of TDD
what are some counseling point a pt should know while using insulin suspension and/or pen? - for suspension: DO not shake - pen: invert 4-5X
What are some counseling point a pt should know while mixing insulin? - draw the clear insulin first - recommends injecting air into the cloudy insulin , then inject air into the clear insulin before drawing
What is the best site for insulin SC injection/administration? - The abdominal area: best absorption
what is the angle of insertion for insulin SC injection? - 90 unless pt is thin 45
what are some counseling point pt should know about insulin SC injection? - rotate the site of injection -
why should the pt wash hand with warm water prior to testing and dry hand very well? - warm water: increase the blood circulation - dry hand: as water can cause reading error
what are some tips pt can follow to minimize finger pain while testing? - lance the finger on the side; fever nerves - keep hand below the heart level
what are some other alternative testing sites? - forearm - thigh - palm
what is the stability of insulin injectable drugs? - if unopened and refrigerated: stable until the expiration date - room temperature, different stability ; product specific
what is the stability of the following injectable insulin medications at room temperature? 1- Afreezza, humalog 50/50, humulin 70/30: 2- xultophy 100/3.6 3- symlin, victoza and byetta pen 4- novolin R U100, toujeo, levemir vial/pen 1-10 days 2- 21 days 3- 30 days 4- 42 days ( 6 weeks)
Which injectable insulin medication has the least stability at room temp? and which medication has the longest duration of stability? - shortest: Afrezza if opened ( 3 days) - longest: tresiba pen ( 56 days)
What is the recommended size/volume of syringe for insulin injections? - use the smallest syringe that can hold the dose - the smaller the easier to read the scale - draw up the correct dose
What is the size of the syringe to inject the following # of insulin units? 1- less than 30 2- 30-49 3- > 50 1- <30 --> use 0.3 ml 2- 30-49 --> use 0.5 ml 3- > 50 --> use 1.0 ml *** if humuLin-R U 500: use the U500 syringe
When the 1/2" needles is recommended? what other sizes? - obese pt - leakage of drug after removing the needle other sizes: 1/2", 5/16, 3/16, 5/32
Which multi-dose pens do NOT include needles? 1- FlexPEN: 2- KwikPEN: humalog, humulin basglar 3- FlexTouch: levemir/ tresiba 4- SoloStar : toujeo/ lantus 5- GLP-1 agonist: byetta/ victoza, Adlyxin 6- Pramlintide: symlinPEN
Created by: Smoham38



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