Insulin Administration Quiz

Endocrine System Drugs

• Various types of drugs are used to treat disorders related to the endocrine system.
• Specific drugs are categorized based on the target gland.

Drugs for Pituitary Disorders

• Growth Hormones: These treat growth hormone deficiencies.

  • Examples: mecasermin, somatropin
  • Side effects can include headache, vomiting, fatigue, and muscle pain.

• Growth Hormone Receptor Antagonist: These treat acromegaly.

  • Examples: Pegvisomant, Octerotide
  • Side effects include diarrhea, nausea, and blurred vision.

Antidiuretic Hormones

• These treat diabetes insipidus.
  • Examples: Vasopressin, Desmopressin acetate
  • Side effects: water intoxication, and hypertension
  • Interventions include monitoring weight, intake, and output.

Drugs for Thyroid Disorders

• Hypothyroidism: Levothyroxine

  • Side effects: signs of hyperthyroidism
  • Interventions: Monitor T3, T4, and TSH levels; take drug in the morning 30-60 minutes before meals; monitor pulse rate.

• Hyperthyroidism:

  • Drugs: Propylthiouracil (PTU), Methimazole, Potassium iodide, Iodine solution (Lugol's Solution) Iodine 131
  • Side effects: Signs of hypothyroidism.
  • Interventions: Monitor T3, T4 & TSH levels; Monitor weight; Take with meals

Foods that Block Thyroid Gland Function

• Cruciferous vegetables, Cauliflower, Cabbage, Turnips, Strawberries, Peaches, Spinach, Kale, Brussels sprouts, Radish and Peas

PTU

• Causes agranulocytosis.
• Monitor for fever and sore throat.
• Check CBC with differential for neutropenia.

Parathyroid Drugs

• Vitamin D Supplements: Ergocalciferol (Vit. D₂), Cholecalciferol (Vit. D₃)

  • Side effect: Hypervitaminosis D

• Bisphosphonates and Calcium Regulating Drugs: Alendronate, Calcitonin salmon, Zoledronate, Risedronate sodium, Ibandronate, Etidronate disodium

  • Side effects: Stomach pain, Constipation, Diarrhea, Flatulence, nausea

• Oral Calcium Supplements: Calcium carbonate (Tums), Calcium acetate

  • Side effect: Gastric upset

Hyperparathyroidism and Hypercalcemia Drugs

• Drugs: Gallium nitrate, Cinacalcet hydrochloride, Paricalcitol, Doxercalciferol
• Side effects: Nausea, Vomiting, and Diarrhea
• Interventions: Foods rich in Calcium

Vitamin D and Calcitonin Function

• Vitamin D: Enhances absorption of calcium in the gastrointestinal tract.
• Calcitonin: Decreases serum calcium and inhibits bone breakdown.

Mineralocorticoids

• Fludrocortisone Acetate: Replaces hormones in Addison's disease.
  • Side effects: Signs of Cushing's syndrome, Gastrointestinal bleeding
  • Interventions: Take drugs with food or milk; High potassium diet

Glucocorticoids

• Function: Fights inflammation, Treats allergy, Helps cope with stress.
• Examples: Dexamethasone, Prednisone, Hydrocortisone
• Side Effects: Cushing's syndrome, Hypernatremia, Hypokalemia, Hyperglycemia, Osteoporosis, Weight gain, Mood swings, Cataracts, Acne
• Interventions: Monitor blood sugar, High potassium diet, Monitor for gastrointestinal bleeding; Take drug in the morning

Androgens

• Methyltestosterone: Replaces androgen hormones, treats certain types of breast cancers, Risk for prostate cancer
• Side Effects: Masculinization, Priapism, Acne
• Interventions: Menstrual irregularities, Changes in libido, take with food or snacks.

Steroid Drugs

• Should not be stopped abruptly
• Takes time for adrenal gland to produce its own steroids
• Dose must be tapered to prevent a fatal adrenal crisis

Drugs for Diabetes Mellitus

• Rapid Acting Insulin:

  • Clear
  • Other Names: Insulin aspart (NovoLog), Insulin glulisine (Apidra), Insulin lispro (Humalog)
  • Onset → 15 minutes
  • Peak → 30 – 90 minutes
  • Duration → 3 – 5 hours
  • Implications: Given immediately before meals, Given SQ or IV, May mix with NPH insulin

• Short Acting Insulin:

  • Clear
  • Other Names: Insulin regular (Humulin R, Novolin R)
  • Onset → 30 – 60 minutes
  • Peak → 2 – 4 hours
  • Duration → 5 – 8 hours
  • Implications: Given 30 minutes before meals; given SQ or IV; May mix with NPH insulin

• Intermediate Acting Insulin:

  • Cloudy
  • Other Names: Insulin NPH human (Humulin N, Novolin N)
  • Onset → 1 – 3 hours
  • Peak → 8 hours
  • Duration → 12 – 16 hours
  • Implications: Lowers blood glucose elevations when RA insulins stop working; Given SQ; May mix with RA or SA insulin

• Long Acting Insulin:

  • Clear
  • Other Names: Insulin glargine (Lantus, Toujeo), Insulin detemir (Levemir)
  • Onset → 1 hour
  • Peak → Lantus - NO PEAK, Levemir - 6 – 8 hours
  • Duration → 20 – 24 hours
  • Implications: Lowers blood glucose elevations when RA insulins stop working; Given SQ; Usually taken once a day; May mix with RA or SA insulin

• Mixed Insulin:

  • Cloudy
  • Other Names: Humulin 70/30, novolin 70/30, Relion 70/30
  • Onset → 30 minutes
  • Peak → 2 – 12 hours
  • Duration → 24 hours
  • Implications: Usually taken once daily; Given SQ; Do not mix with other insulins

Insulin Injection Tips

• Know peak times of insulin medications (period where clients most likely develop hypoglycemic or insulin reactions).
• Rotate injection sites (to prevent lipodystrophy, erratic insulin absorption).

Insulin FAQs

• Insulin is not given orally because it is destroyed by gastric secretions.
• Injection sites: Abdomen (preferred), posterior arm, anterior thigh, and hips.
• Why rotate injection sites To prevent lipodystrophy that will result into erratic insulin absorption.
• Needle gauge: 27-29 gauge, 1/2-inch.
• Rolling insulin vials between palms: to properly dissolve, restores appearance.
• Shaking vials is not recommended, bubbles will expand insulin volume.
• Drawing insulin: Draw clear insulin from clear vial first then cloudy insulin vial (maintain purity and clarity).
• Insulin mix compatibility: Glargine (Lantus), and Insulin detemir (Levemir) are not compatible for mixing with other types.
• Injection angle: Subcutaneously at 45-90 degrees; 45-60 degrees in thin clients.
• Aspiration needed: No.

Complications

• Dawn Phenomenon: Due to decreased effect of bedtime insulin dose, hyperglycemia between 2:00 & 8:00 AM (early morning). May need to increase insulin dose.
• Somogyi Phenomenon: A "rebound hyperglycemia" in response to low blood glucose at night. May need to decrease the insulin dose or provide snacks at bedtime.

Oral Hypoglycemic Agents

• Sulfonylureas (Stimulator): Stimulates pancreatic insulin secretion

  • Examples: Glipizide, Chlorpropamide, Glimepiride, Glyburide, Tolbutamide

• Meglitinides (Stimulator): Stimulates pancreatic insulin secretion

  • Examples: Nateglinide, Repalinide

• Biguanides (Sensitizer): Increases insulin sensitivity

  • Example: Metformin

• Alpha-Glucosidase Inhibitors: Blocks the metabolism of carbohydrates.

  • Examples: Acarbose, Miglitol

• Thiazolidinediones (Sensitizer): Increases insulin sensitivity and Decreases glucose production by the liver.

  • Examples: Pioglitazone, Rosiglitazone

Non-Insulin Drugs for Diabetes Mellitus

• Amylinomimetic: Reduces glucagon secretion after meals.

  • Examples: Pramlintide
  • Side effects: Anorexia, weight loss, hypoglycemia
  • Interventions: Avoid drinking alcohol

• DPP-4 Inhibitors: Reduces glucagon; Risk for pancreatitis.

  • Examples: oGliptin, Saxagliptin, Sitagliptin, Linagliptin
  • Side effects: Headache, Runny nose, Chills
  • Interventions: Report severe abdominal pain (pancreatitis)

• Glucagon-Like Peptides (GLP-1 Receptor Agonists): Increases insulin, decreases glucagon; all are injectables (subcutaneous)

  • Hormones stimulate insulin secretion after eating before blood glucose becomes elevated.
  • Examples: Albiglutide, Exenatide, Liraglutide, Dulaglutide
  • Side effects: Nausea, vomiting, diarrhea, dizziness
  • Interventions: Report severe abdominal pain (pancreatitis)

• Sodium Glucose Transporter 2 (SGLT2) Inhibitors: Prevents the kidney from retaining glucose.

  • Examples: Dapagliflozin (Farxiga), Empagliflozin, Canagliflozin
  • Side effects: Hypotension, Dehydration, Glycosuria, Weight loss
  • Interventions: Monitor for dehydration

• Inhaled Insulin: Ultra-rapid acting insulin (faster than rapid acting insulins).

  • Example: Afrezza
  • Side effects: Hypoglycemia, cough, sore throat. Avoid in clients with asthma and COPD.