Insulin
How long is the action of Novalog and Humalog? (Hint: rapid, short, intermediate, or long acting?)
Rapid action
Is metformin harder on the liver or the kidneys?
The kidneys
What are the three adverse effects of insulin medication?
1. lipodystrophy
2. Weight gain
3. Hypoglycemia
What is the mechanism of action of aldosterone? (Bonus 100 points if you can name the three effects aldosterone has on the circulatory system)
allows sodium to be reabsorbed back into the blood stream, which can cause increased blood volume, increased blood pressure, and edema
What are the indications for adrenal drugs?
True or false: Intermediate acting insulin is the only type of insulin that can be administered via IV
False. Short acting insulin is the only insulin that can be administered via IV for patients who have diabetic ketoacidosis
Sulfonylureas stimulates the release of insulin, but decrease the secretion of what hormone?
Glucagon, meaning sulfonylureas can cause hypoglycemia since glucagon isn't being secreted when glucose levels are low
Name a few physiological signs that someone may be hypoglycemic
shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor, and mental status changes
Mechanism of action of glucocorticoid drugs
decreases permeability of the capillaries, decreases migration of the white blood cells, and reduces fever
What are the contraindications of adrenal drugs?
exacerbation of glaucoma, cataract formation, peptic ulcer disease, and DM, as well as sepsis, systemic fungal infections, and varicella
Insulin detemir requires once a day dosing only, but how many times is insulin glargine administered in a day?
Twice daily at the same time each day
What are the two sulfonyleurea drugs that have a rapid onset of action and a short duration of action?
Glipizide and glimepiride
Name the injectable antidiabetic drug that was the first of its kind to be approved for type 1 diabetes since insulin
Pramlintide (inject 15-60 mcg for Type 1 DM, and then inject 60-120 mcg for Type 2 DM)
Name what each of the following corticosteroids are indicated for:
1. fludrocrotisone
2. methylprednisolone
3. prednisone
4. aminogluthemide
1. fludrocrotisone -> Addison's disease
2. methylprednisolone -> Anti-inflammatory and immunosuppressant
3. prednisone -> asthma, tendonitis/bursitis
4. aminogluthemide -> Cushing's disease
edema, hypertension, mood swings, psychotic impairment, insomnia, hyperglycemia, ecchymosis, and acne
Order the following insulin from the most rapid acting to the most long acting insulin:
1. Insulin detemir (Levemir)
2. Insulin lispro (Humalog)
3. Insulin aspart (Novolog)
4. Insulin regular (Humulin and Novolin R)
5. Insulin glargine (Lantus)
6. Insulin isophane (NPH)
1. Insulin aspart (Novolog)
2. Insulin lispro (Humalog)
3. Insulin regular (Humulin and Novolin R)
4. Insulin isophane (NPH)
5. Insulin detemir (Levemir)
6. Insulin glargine (Lantus)
This is the one oral antidiabetic where it is safe to miss doses if the patient will not eat
Repaglinide. Repaglinide also works similarly as the sulfonylureas, so you should not combine repaglinide with sulfonylureas.
What's one way to care for a patient with minor hypoglycemia?
Give them 15 grams of carbohydrates, which could mean orange juice or graham crackers!
What is one vital sign we particularly want to monitor when giving someone a corticosteroid?
Blood pressure
Name some long term effects of adrenal drugs
Name the three interactions of insulin
1. Beta-adrenergic blockers, which causes hypoglycemia
2. Corticosteroids, which causes hyperglycemia
3. Alcohol, which causes hypoglycemia
This drug works by decreasing insulin resistance by enhancing the sensitivity of insulin receptors.
Pioglitazone
How would you treat a patient if they had more major hypoglycemia? (Hint: There are three ways)
1. dissolving tablets of concentrated glucose
2. push intravenous glucose
3. SQ injection of glucagon
What are the 4 interactions with corticosteroids?
1. potassium wasting diuretics
2. Aspirin and NSAID's
3. Immunosuppressant therapy
4. Anti-diabetic drugs
Name some ways we can generally educate our patient when they are on adrenal drugs
Be aware of infection, take medication at the same time with food to prevent nausea and ulcerations, increase exercise with calcium supplements and weight bearing exercises, and limit salt and carb intake