Names and pronunciation
(in′su-lin) Afrezza
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Drug reference
(in′su-lin) Afrezza
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Func. class.: Antidiabetic—insulin
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ACTION: Endogenous insulin regu- lates carbohydrate, fat, and protein metab- olism by the storage of and inhibiting the breakdown of glucose, fat, and amino acids. Insulin decreases glucose concen- trations by the uptake of glucose in muscle and adipose tissue, and by inhibiting hepatic glucose production. Insulin also regulates fat metabolism by the storage of fat and inhibiting the mobilization of fat for energy in adipose tissues (lipolysis and free fatty acid oxidation)
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USES: Diabetes mellitus types 1 and 2
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CONTRAINDICATIONS: Hyper- sensitivity, lung cancer, hypoglycemia, smoking Precautions: Hepatic disease, renal impairment, renal failure, diabetic keto- acidosis (DKA), hypokalemia, pregnancy, breastfeeding, child <18 yr
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Black Box Warning: Asthma, COPD, pul- monary disease Black Box Warning: Acute bronchospasm
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SIDE EFFECTS CNS: Headache, fatigue GI: Nausea, diarrhea MISC: Urinary tract infection, weight gain, hypokalemia, peripheral edema RESP: Cough, throat irritation/pain, productive cough, decreased pulmo- nary function tests, bronchitis, acute bronchospasm ENDO: Hypoglycemia
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INTERACTIONS Increase: inhaled insulin effect—broncho- dilators, other inhaled products, agonists, salicylates, alcohol, fenfluramine, MAOIs Increase: heart failure, ischemic events— pioglitazone, troglitazone hypoglycemia—β-blockers, Increase: ACE inhibitors, angiotensin II receptor antagonists, disopyramide, guanethidine, octreotide Increase or decrease: hypoglycemic effects—cloNIDine, metoclopramide, tegaserod, testosterone derivatives, or anabolic steroids Increase: hyperglycemia—niacin (nico- tinic acid), bumetanide, furosemide, torsemide Decrease: hypoglycemic effects— dextrothyroxine, triamterene, thiazide diuretics; thyroid hormones, estrogens, progestins, or oral contraceptives; dan- azol, corticosteroids, EPINEPHrine
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DOSAGE AND ROUTES • Adult: INH: (type 1) the average initial dose is 0.5-0.6 unit/kg/day, usually ≥3 administrations/day; (type 2) the average initial dose is 0.2-0.6 unit/kg/day. When used in combination with oral hypoglyce- mic agents, may only need a single dose of a longer-acting insulin at a dosage of 10 units or 0.2 unit/kg/day
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Available forms: Inhalation 4 units powder in 4-, 8-, 12-unit cartridges
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Administer: • Give by inhalation only; use at begin- ning of a meal (blue cartridge = 4 units of regular insulin, green cartridge = 8 units of regular insulin), multiple car- tridges may be needed, for single-use only, inhaler should be discarded after 15 days; store unopened cartridge pack- ages in refrigerator; if not refrigerated, use within 10 days • Sealed (unopened) blister cards and strips must be used within 10 days. Car- tridges left over in an opened strip must be used within 3 days. Remove a blister card from the foil package
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Assess: • Fasting blood glucose, A1c may be drawn to identify treatment effectiveness • Urine ketones during illness, insulin requirements may increase during times of stress, trauma, illness, surgery • Hypoglycemic reaction can occur dur- ing peak times (sweating, weakness, dizziness, chills, confusion, headache, nausea; rapid, weak pulse) • Hyperglycemia: acetone breath, poly- uria, fatigue, polydipsia, flushed dry skin, lethargy • Smoking status: not recommended in current smokers or those with recent cessation • Beers: avoid in older adults; higher risk of hypoglycemia without improve- ment in hyperglycemia management
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Evaluate: • Therapeutic response: decrease in blood glucose levels
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blurred vision occurs, not to op- erate machinery until effect is known, do not change corrective lenses for at least 1 month • To keep all insulin equipment available at all times • That product does not cure, but con- trols symptoms • To carry ID as diabetic • About the symptoms of hypoglycemia, hyperglycemia, ketoacidosis • About dosage and how to use product, that the rest of the plan must be followed; I do not change the dose without pre- scriber approval; cartridges should be at room temperature for 10 min, do not invert inhaler, do not leave used cartridge in the inhaler HIGH ALERT INSULINS Rapid Acting
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• Adult: INH: (type 1) the average initial dose is 0.5-0.6 unit/kg/day, usually ≥3 administrations/day; (type 2) the average initial dose is 0.2-0.6 unit/kg/day. When used in combination with oral hypoglyce- mic agents, may only need a single dose of a longer-acting insulin at a dosage of 10 units or 0.2 unit/kg/day
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