Key Takeaways
- Diabetes medications include insulin (various types with different onsets/durations), metformin (first-line oral), and newer agents like GLP-1 agonists (-glutide) and SGLT2 inhibitors (-gliflozin).
- Thyroid medications (levothyroxine) should be taken on an empty stomach 30-60 minutes before breakfast for optimal absorption.
- Inhaled corticosteroids (-sone, -nide) are maintenance therapy for asthma; short-acting beta-agonists (albuterol) are rescue medications.
- Refrigerated medications (2-8°C/36-46°F) include insulin, many vaccines, and some antibiotics; freezing can destroy potency.
- Proper storage includes protecting light-sensitive medications (amber vials) and maintaining controlled room temperature (20-25°C/68-77°F).
Last updated: January 2026
Endocrine, Respiratory Medications and Storage Requirements
Quick Answer: Endocrine medications treat diabetes (insulin, metformin), thyroid disorders (levothyroxine), and hormone conditions. Respiratory medications include rescue inhalers (albuterol) and maintenance therapy (inhaled corticosteroids). Proper storage is critical - many medications require refrigeration, light protection, or specific temperature ranges.
Diabetes Medications
Insulin Types and Timing
| Category | Generic/Brand | Onset | Peak | Duration |
|---|---|---|---|---|
| Rapid-acting | lispro (Humalog) | 15-30 min | 0.5-2.5 hr | 3-5 hr |
| Rapid-acting | aspart (NovoLog) | 15-30 min | 1-3 hr | 3-5 hr |
| Rapid-acting | glulisine (Apidra) | 15-30 min | 1-1.5 hr | 3-5 hr |
| Short-acting | regular (Humulin R, Novolin R) | 30-60 min | 2-4 hr | 5-8 hr |
| Intermediate | NPH (Humulin N, Novolin N) | 1-2 hr | 4-12 hr | 14-24 hr |
| Long-acting | glargine (Lantus, Basaglar) | 2-4 hr | No peak | 20-24 hr |
| Long-acting | detemir (Levemir) | 3-4 hr | 6-8 hr | Up to 24 hr |
| Ultra-long | degludec (Tresiba) | 1-2 hr | No peak | 42+ hr |
Insulin Storage:
- Unopened: Refrigerate (2-8°C/36-46°F); do NOT freeze
- In-use: Room temperature for 28 days (most types)
- Never freeze: Freezing destroys insulin potency
Oral and Non-Insulin Injectable Diabetes Medications
| Class | Generic Name | Brand Name | Key Points |
|---|---|---|---|
| Biguanide | metformin | Glucophage | First-line; hold before contrast; GI side effects |
| Sulfonylurea | glipizide | Glucotrol | Hypoglycemia risk |
| Sulfonylurea | glyburide | DiaBeta | Hypoglycemia risk; avoid in elderly |
| Sulfonylurea | glimepiride | Amaryl | Once daily |
| DPP-4 Inhibitor | sitagliptin | Januvia | Weight neutral |
| DPP-4 Inhibitor | linagliptin | Tradjenta | No renal adjustment |
| SGLT2 Inhibitor | empagliflozin | Jardiance | CV benefits; UTI risk |
| SGLT2 Inhibitor | canagliflozin | Invokana | Weight loss; DKA risk |
| SGLT2 Inhibitor | dapagliflozin | Farxiga | Heart failure benefits |
| GLP-1 Agonist | semaglutide | Ozempic (inj), Wegovy (weight) | Weekly injection; GI side effects |
| GLP-1 Agonist | liraglutide | Victoza, Saxenda (weight) | Daily injection |
| GLP-1 Agonist | dulaglutide | Trulicity | Weekly injection |
Exam Tip: Know the difference between rapid-acting and long-acting insulins, and that most insulins should be refrigerated until opened.
Thyroid Medications
Hypothyroid Treatment
| Generic Name | Brand Name | Key Points |
|---|---|---|
| levothyroxine | Synthroid, Levothroid | NTI drug; take on empty stomach |
| liothyronine (T3) | Cytomel | Faster acting; rarely used alone |
| desiccated thyroid | Armour Thyroid | Natural product; variable potency |
Levothyroxine Counseling Points:
- Take 30-60 minutes before breakfast on empty stomach
- Take 4 hours apart from calcium, iron, antacids
- Consistent brand recommended (NTI drug)
- Monitor TSH levels regularly
Hyperthyroid Treatment
| Generic Name | Brand Name | Key Points |
|---|---|---|
| methimazole | Tapazole | First-line; once daily |
| propylthiouracil (PTU) | Various | Reserved for first trimester pregnancy |
Corticosteroids
Systemic Corticosteroids
| Generic Name | Brand Name | Relative Potency | Key Points |
|---|---|---|---|
| prednisone | Deltasone | 4 | Most common oral; take with food |
| prednisolone | Prelone | 4 | Liquid available for children |
| methylprednisolone | Medrol | 5 | Dose pack common |
| dexamethasone | Decadron | 25 | Long-acting; high potency |
| hydrocortisone | Cortef | 1 | Also used topically |
Side Effects of Long-term Use: Osteoporosis, hyperglycemia, weight gain, adrenal suppression Important: Do not stop abruptly after prolonged use - taper gradually
Topical Corticosteroid Potency
| Potency | Examples | Use |
|---|---|---|
| Low | hydrocortisone 1% | Face, intertriginous areas |
| Medium | triamcinolone 0.1% | Body, moderate inflammation |
| High | fluocinonide 0.05% | Thick skin areas, severe inflammation |
| Very High | clobetasol 0.05% | Resistant conditions; limit duration |
Respiratory Medications
Asthma/COPD Medications
| Class | Generic Name | Brand Name | Key Points |
|---|---|---|---|
| SABA (Rescue) | albuterol | ProAir, Ventolin, Proventil | Rescue inhaler; quick onset |
| SABA | levalbuterol | Xopenex | R-isomer of albuterol |
| LABA | salmeterol | Serevent | Twice daily; maintenance only |
| LABA | formoterol | Foradil | Twice daily; faster onset |
| ICS | fluticasone | Flovent | Most commonly prescribed ICS |
| ICS | budesonide | Pulmicort | Nebulizer form available |
| ICS | beclomethasone | QVAR | HFA formulation |
| ICS/LABA combo | fluticasone/salmeterol | Advair | Maintenance; twice daily |
| ICS/LABA combo | budesonide/formoterol | Symbicort | Maintenance; twice daily |
| LAMA | tiotropium | Spiriva | Once daily; COPD maintenance |
| LAMA | umeclidinium | Incruse Ellipta | Once daily; COPD |
Inhaled Corticosteroid Counseling: Rinse mouth after use to prevent thrush (oral candidiasis)
Other Respiratory Medications
| Generic Name | Brand Name | Class | Key Points |
|---|---|---|---|
| montelukast | Singulair | Leukotriene inhibitor | Once daily at bedtime |
| theophylline | Theo-24 | Methylxanthine | NTI drug; many interactions |
| ipratropium | Atrovent | SAMA | Can combine with albuterol |
| benzonatate | Tessalon Perles | Antitussive | Do not chew; numbing |
Medication Storage Requirements
Temperature Categories
| Storage Term | Temperature Range | Examples |
|---|---|---|
| Frozen | -25 to -10°C (-13 to 14°F) | Certain vaccines |
| Refrigerated | 2-8°C (36-46°F) | Insulin, many vaccines, some antibiotics |
| Controlled Room Temperature | 20-25°C (68-77°F) | Most medications |
| Cool | 8-15°C (46-59°F) | Some suppositories |
Common Refrigerated Medications
| Medication Type | Examples | Notes |
|---|---|---|
| Insulins | All types | Do not freeze; 28 days at RT once opened |
| Vaccines | Most vaccines | Follow specific requirements |
| Eye drops | Latanoprost (Xalatan) | Refrigerate until opened |
| Antibiotics | Reconstituted amoxicillin suspension | 14 days refrigerated |
| Biologics | Adalimumab (Humira), Etanercept (Enbrel) | Do not freeze |
| Suppositories | Promethazine, some compounded | Prevent melting |
Light-Sensitive Medications
| Medication | Protection Required |
|---|---|
| Nitroglycerin | Amber glass container; replace after opening |
| Furosemide (injection) | Store in dark; use amber syringes |
| Methotrexate | Light-sensitive; use amber vials |
| Nifedipine | Light-sensitive |
| Multivitamins with B12 | Light degrades vitamins |
| Nitroprusside | Wrap in foil during administration |
Special Handling Requirements
| Medication | Requirement |
|---|---|
| Nitroglycerin SL | Original glass container; no cotton; 6-month expiration once opened |
| Dabigatran (Pradaxa) | Keep in original container; dispense with desiccant |
| Oral contraceptives | Room temperature; avoid heat |
| Fentanyl patches | Room temperature; fold and dispose properly |
| Vaccines | Cold chain management; document temperatures |
Beyond-Use Dating for Reconstituted Products
| Product Type | Typical BUD |
|---|---|
| Amoxicillin suspension | 14 days refrigerated |
| Azithromycin suspension | 10 days at room temperature |
| Cephalexin suspension | 14 days refrigerated |
| Reconstituted injectables | Per manufacturer; often 24 hours |
Exam Tip: Memorize storage temperatures, know which medications need refrigeration, and remember that insulin should NEVER be frozen. Light-sensitive drugs require amber containers or foil wrapping.
Test Your Knowledge
Which insulin type is considered "rapid-acting" with an onset of 15-30 minutes?
A
B
C
D
Test Your Knowledge
A patient taking levothyroxine should be counseled to:
A
B
C
D
Test Your Knowledge
What is the proper storage temperature range for refrigerated medications like insulin?
A
B
C
D
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