Pharm Notes Exam III

Pharm Notes Exam III - Diabetes Mellitus disorder of...

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Diabetes Mellitus – disorder of carbohydrate metabolism – inability to utilize carbohydrates, accumulation of ketone bodies from the metabolism of protein and fat, high blood glucose, Type I – insulin-dependent (10%), Type II – non insulin-dependent, ketosis-resistant Desired glycemic control o Pre-meal plasma glucose: 90-130 mg/dL o Peak post-meal plasma glucose: below 180 mg/dL Powerpoint, handout Insulin – stimulates cellular uptake of glucose, amino acids, and potassium, promotes synthesis of complex organic molecules, required by all Type I diabetics and by some with Type II Diabetes Drugs Lispro (humalog) – actions similar to regular human insulin, offers insulin-using people with diabetes greater flexibility when scheduling meals, works best when taken within 15 minutes before a meal o Adverse effect – hypoglycemia (if you take it and don’t eat, or don’t eat enough) Insulin aspart – analog of human insulin with rapid onset and short duration, similar to insulin lispro, should be given immediately before meals or immediately after, use in combination Insulin glulisine – synthetic analog or natural insulin, rapid onset, short duration, must be given 15 minutes before eating or within 20 minutes after starting eating (pp) Regular insulin – 4 routes (SC, IM – rarely used), inhalation, and IV - *only insulin that can be given by IV), used for routine treatment, clear solution, two concentrations available: U100 and U500 Neutral protamine hagedorn (NPH) – delays absorption, used for daylong control – usually given 2x/day, cloudy in appearance, *only longer-acting insulin suitable to mix with regular insulin and regular insulin is always drawn up first Insulin detemir – slow onset and dose-dependent duration of action, slower onset and longer duration than NPH, clear solution Insulin glargine – used for once-daily to treat type I and II, usually taken at bedtime but can be taken in morning or after dinner, no peak in action – blood levels remain relatively constant less risk of hypo or hyperglycemia Human Insulin – genetically engineered, identical to ours, manufactured in lab (powerpoint) Total dose/day - .5-.6 units/kg/day for Type I, .2-.6 units/kg/day for type II Insulin Dosing Schedule Conventional (pp) – 2/3 15-30 min before breakfast, 1/3 15-30 minutes before dinner, need to have a snack before bedtime to avoid nocturnal hypoglycemia Intensified conventional (pp) – Tight control – most frequent complication is hypoglycemia, helps to delay onset of complications Insulin pumps – deliver basal infusion of insulin plus a bolus dose before each meal, basal infusion is usually 1 unit/hour, can be programmed to meet patient’s needs, insulin delivered through subcutaneous needle through abdomen Jet injectors – jets insulin through the skin without a needle Trying to surgically implant beta cells and having some success Drug interactions Any drug that causes hypoglycemia will intensify the hypoglycemia if on insulin (alcohol, beta blockers,
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Pharm Notes Exam III - Diabetes Mellitus disorder of...

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