Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Insulin lispro

(Humalog)

&

Insulin Aspart

(Novolog)

Rapid acting insulin

Onset: 5-15 min.

Peak: 1-2 hours

Duration: 4-6 hours

Mainly Type I Diabetes

~ take w/in 15 min. of meal

~ fast acting, short duration

~ should be clear

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

  Regular Insulin

(Humulin R,

Novolin R,

Velosulin BR)

Short- acting insulin

Onset: 30-60 min

Peak: 2-4 hours

Duration: 6-10 hours

Type I Diabetes

~ slower onset but longer duration than rapid

~ can have sliding scale

Can be given by IV

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Insulin Isophane Suspension

(NPH)

&

Insulin Zinc Suspension

(Lente)

Intermediate acting insulin

Onset: 1-2 hours

Peak: 4-8 hours

Duration: 10-18 hours

Type I Diabetes

Slower onset but more prolonged

Should appear cloudy

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Extended insulin zinc suspension

(Ultralente)

Long acting insulin

Onset: 2-4 hours

Peak: 8-14 hours

Duration: 18-24 hours

Is cloudy

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Glargine

(Lantus)

Long acting insulin

Onset: 1-2 hours

Peak: Flat

Duration: 24 hours

Is clear

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Must give alone due to low pH of diluent

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Glipizide

(Glucatrol)

Oral antidiabetic-

Sulfonylureas ~ 2^nd gen.

Stimulates insulin secretion from the beta cells of the pancreas

~very rapid onset of action

~ give 30 min. before meals

Type II diabetes

Hematologic system- agranulocytosis, hemolytic anemia, jaundice, hypoglycemia, hemolytic anemia

Contra: not for Type I

Interactions: warfarin, aspirin, digoxin, insulin, diuretics, beta blockers, corticosteroids, MAOI’s, NSAID’s

Metformin

(Glucophage)

Oral antidiabetic-

Biguanides

Inhibits hepatic glucose production and increases the sensitivity of peripheral tissue to insulin

*does not cause hypoglycemia

Type II diabetes (Best type II med)

Helps decrease weight

Affects GI tract- bloating, nausea, cramps, diarrhea

Rare: lactic acidosis

Contra: preg., renal disease, HF, acidosis

Interaction: digoxin, diuretics, alcohol,

Rosiglitazone

(Avandia)

Oral antidiabetic-

Thiazolidenediones (TZD)

Decreases insulin resistance by enhancing the sensitivity to insulin

Type II diabetes

Hepatic toxicity might occur

Weight gain, edema, anemia

Measure ALT before treatment & every 2 mo for 1 year

Haloperidol

(Haldol)

Older antipsychotics

High potency

Blocks the receptors to which dopamine normally binds

Works best on “positive” symptoms (hallucinations, delusions)

High EPS (Extrapyramidal symptoms) due to dopamine blockage

~ less sedation, long duration

~ photosensitivity, sedation, constipation

~ use small doses, esp. w/ geriatrics

Contra: Not for pts w/ PD

Chlorpromazine

(Thorazine)

Older antipsychotics

Low potency

Blocks the receptors to which dopamine normally binds

For “positive” psychotic

Also for relief of N/V, hiccups, porhyria and preop sedation

Low EPS

~ High rate of sedative, anticholinergic and CV SE’s

Orthostatic hypotension, constipation

NMS- SE of antipsychotics – lead pipe rigidity

All antipsychotics: antacids reduce absorption

For side effects, take benzotropine (Cogentin) or Benadryl (neither work for TD because it is irreversible)