Drug: Hydrocodone/APAP

Smith, John – Week 1 Drug Monograph

1. Brand Name and Generic Name: Levemir (detemir)

2. Drug Class: Long-acting insulin for management of diabetes mellitus

3. Mechanism of Action: Regulates glucose metabolism by binding to insulin receptors; decreases blood glucose by uptake of glucose at the cellular level into skeletal muscle and fat; inhibits the output of glucose from the liver; inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis

4. Available Dosage Forms: Levemir FlexPen 100 U/1 mL, Levemir FlexTouch 100U/1 mL, Levemir 100U/1 mL

5. Indications with applicable dosing:

• Treatment of Type 1 and Type 2 Diabetes Mellitus o Adult –

! Inject 1/3 daily insulin requirement QD (once daily) with evening meal or at bedtime; rapid or short-acting insulin should be administered for total remaining daily insulin requirement

! Inject 1/3 daily insulin requirement divided into equivalent doses and administered BID (twice daily) with evening meal or at bedtime; rapid or short-acting insulin should be administered for remaining total daily insulin requirement

! Maximum daily dose – Patient specific o Pediatric –

! Inject 1/3 daily insulin requirement QD (one daily) with evening meal or at bedtime; rapid or short-acting insulin should be administered for total remaining daily insulin requirement

! Inject 1/3 daily insulin requirement divided into equivalent doses and administered BID (twice daily) with evening meal or at bedtime; rapid or short-acting insulin should be administered for remaining total daily insulin requirement

! Maximum daily dose – Patient specific

6. Route of Administration: a. For subQ use in the thigh, abdominal wall, or upper arm b. 4-mm, 5-mm or 6-mm needles are recommended in all patients

c. Inject at a 90 degree angle except when injecting into limbs, a slim abdomen or in thinner children (use a skin fold with a 4-mm or 5-mm needle

7. Contraindications: Hypersensitivity to insulin detemir or other ingredients

8. ADR (>10%): Hypoglycemia (low blood sugar), rash or redness at injection

site

9. Nursing Considerations: a. HbA1C – Should be monitored at least twice yearly in patients

achieving treatment goals and every 3 months in those who are not at goal

b. HbA1c goal is < 7% according to the ADA and HcA1c goal of < 6.5% according to AACE/ACE

c. SMBG – At least daily; pre-prandial goal of 70-130 mg/dL d. Signs and symptoms of hypoglycemia (excess sweating, hunger,

blurred vision, fatigue, dizziness, confusion, shaking, weak, fast or irregular heart beat)

e. Do not share needles due to the risk of transmission of hepatitis, HIV or other bloodborne pathogens.

f. For subQ use in the thigh, abdominal wall, or upper arm g. Rotate injection sites h. Visually inspect solution prior to administration and only use if

appears clear and colorless i. Do not mix or dilute with other insulin or insulin products; however

mixing in the same syringe with insulin aspart may be appropriate j. 4-, 5- or 6-mm needles are recommended in all patients k. Inject at a 90 degree angle except when injecting into limbs, a slim

abdomen or in thinner children (use a skin fold with a 4- or 5-mm needle

l. Encourage patient to avoid consumption of alcohol as this may lead to hypoglycemia

m. Discuss treatment options for hypoglycemia i. Four glucose tablets one tube of glucose gel ii. 1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced

sugar n. Promote a healthy, well-balance diet and daily exercise of moderate

intensity

10. References Levemir. In: DRUGDEX® System. Version 5.1. Greenwood Village, CO: Thomson

Reuters (Healthcare) Inc. [updated 2016, cited 2018 Aug 14]. Available from http://www.micromedexsolutions.com/micromedex2/librarian/.

Levemir [package insert]. Plainsboro, NJ: Novo Nordisk; 2015.

Woo T., R. M. (2016). Pharmacotherapeutics for advanced practice nurse prescribers

Fourth Ed. Philadephia: F.A. Davis Company. U.S. Department of Health and Human Services, National Institutes of Health,

National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Hypoglycemia. Retrieved from https://www.niddk.nih.gov/health- information/diabetes/overview/preventing-problems/low-blood-glucose- hypoglycemia.

Please check the sample on the next PDF attachment.

Drug: Hydrocodone/APAP

The drug monograph should contain the following information (in this order) and should be numbered with the titles bolded as follows.

Brand and Generic Name:

Drug Class:

Mechanism of Action:

Available Dosage Forms:

Indications with applicable dosing (include typical daily doses):

Route of Administration:

Contraindications:

ADR (>10%):

Nursing Considerations:

Two (2) References in APA Format

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