Mosby's 2014 Nursing Drug Reference (218 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTApidra, Apidra SoloStar
NovoLOG, NovoLOG Flexpen, NovoLOG Pen Fill, NovoMix 30
, Novo Rapid
Humalog
OTC
)
Humulin R, NovoLIN R, ReliOn R
concentrated (Rx)
Humulin R U-500
suspension (NPH) (
OTC
)
Humulin N, NovoLIN ge NPH,
NovoLIN N, NovoLIN N Prefilled, ReliOn N
Levemir
Lantus
suspension and
regular insulin (Rx)
Humulin 70/30, Humulin 30/70, NovoLIN 70/30 Prefilled, ReliOn 70/30
suspension (NPH) and
insulin mixtures (Rx)
Humulin 50/50
Humalog KwikPen Mix 50/50, Humalog Mix 25, Humalog Mix 50, Humalog Mix 75/25, Humalog Mix 50/50
NovoLOG 70/30, NovoLOG Mix Flexpen Prefilled Syringe 70/30
Func.class.:
Antidiabetic, pancreatic hormone
Chem. class.:
Modified structures of endogenous human insulin
Do not confuse:
Lantus
/lente
NovoLIN 70/30 PenFill
/NovoLIN 70/30 Prefilled
Decreases blood glucose; by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (processed by recombinant DNA technologies)
Type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes; insulin lispro may be used in combination with sulfonylureas in children >3 yr
Hypersensitivity to protamine; creosol (aspart)
Precautions:
Pregnancy (B) lispro, detemir, regular aspart; (C) all others
Calculator
• Adult/adolescent/child ≥4 yr: SUBCUT
dosage individualized, give within 15 min before or 20 min after starting a meal;
Adult: IV
dilute to 1 unit/ml in inf systems with 0.9% NaCl, use PVC Viaflex inf bags and PVC tubing, use dedicated line
• Adult/adolescent/child ≥6 yr: INTERMITTENT SUBCUT
Total daily dose is given as 2-4 inj/day just before beginning of meal; in general, 50%-70% of total daily insulin may be given as insulin aspart, remainder should be intermediate-or long-acting insulin;
CONTINUOUS SUBCUT
used with external insulin pump via cont SUBCUT insulin inf (CSII), insulin dose should be based on insulin dose from previous regimen
• Adult/adolescent/child ≥3 yr: SUBCUT
15 min before meals;
CONT SUBCUT INF (external insulin pump):
total daily dose should be based on insulin dose from previous regimen, 50% of total dose can be given as meal-related boluses, remainder as basal inf
• Adult: SUBCUT
1/2-1 hr before meals
• Adult: SUBCUT
dosage individualized by blood, urine glucose; usual dose 7-26 units; may increase by 2-10 units/day if needed
• Adult/adolescent/child ≥2 yr: SUBCUT
1-2×/day; if 1×, give with evening meal
• Adult and child ≥6 yr: SUBCUT
10 international units/day, range 2-100 international units/day
• Adult: IV
5-10 units, then 5-10 units/hr until desired response, then switch to
SUBCUT
dose;
IV/INF
2-12 units (50 units/500 ml of normal saline)
• Child: IV
0.1 units/kg
• Adult and child: SUBCUT
0.5-1 units/kg/day qid given 30 min before meals
• Adolescent: SUBCUT
0.8-1.2 mg/kg/day; this dosage is used during rapid growth
Available forms:
NPH
Inj 100 units/ml;
regular
inj 100 units/ml, cartridges 100 units/ml;
insulin analog
inj 100 units/ml;
isophane insulin
inj 100 units/ml, cartridges 100 units/ml;
insulin lispro
100 units/ml, 1.5-ml cartridges,
insulin lispro
Humalog Pen sol for inj 100 units/ml;
insulin glulisine
inj 100 units/ml;
insulin glargine
inj 100 units/ml;
insulin detemir
inj 100 units/ml in 10 vials, 3-ml cartridges;
insulin aspart
inj 100 mg/ml (Flexpen, Pen Fill)
•
After warming to room temp by rotating in palms to prevent injecting cold insulin; use only insulin syringes with markings or syringe matching units/ml; rotate inj sites within one area: abdomen, upper back, thighs, upper arm, buttocks; keep record of sites
•
Increased dosages if tolerance occurs
•
Premixed insulins, NPH are cloudy suspensions
•
Regular human insulin, rapid-acting analogs, long-acting analogs are clear; do not use if cloudy, thick, or discolored
CONT SUBCUT route (insulin infusion CSII)
•
Do not mix with other insulins when using a pump
•
Insulin lispro 3-ml cartridges to be used in Disetronic H-TRON plus V100 pump using Disetronic rapid inf sets; inf set and cartridge adapter should be changed q3days; replace 3-ml cartridge q6days
•
Dilute to 1 international unit/ml in inf systems with 0.9% NaCl using PVC viaflex inf bags and PVC tubing; use dedicated line; do not admix
When regular insulin is administered IV, monitor glucose, potassium often to prevent fatal hypoglycemia, hypokalemia
•
IV direct, undiluted via vein,
Y
-site, 3-way stopcock; give at ≤50 units/min
•
By cont inf after diluting with IV sol and run at prescribed rate; use IV inf pump for correct dosing; give reduced dose at serum glucose level of 250 mg/100 ml
Additive compatibilities:
Cimetidine, lidocaine, meropenem, ranitidine, verapamil
Y-site compatibilities:
Amiodarone, ampicillin, ampicillin/sulbactam, aztreonam, ceFAZolin, cefoTEtan, DOBUTamine, esmolol, famotidine, gentamicin, heparin, heparin/hydrocortisone, imipenem/ cilastatin, indomethacin, magnesium sulfate, meperidine, meropenem, midazolam, morphine, nitroglycerin, oxytocin, PENTobarbital, potassium chloride, propofol, ritodrine, sodium bicarbonate, sodium nitroprusside, tacrolimus, terbutaline, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, vit B/C