MA Medication Primer

Your role: identify, gather, route

You do not need to be a clinician. You need to read a medication name correctly, notice when something does not match, and know who gets it next. Most of your work is on the phone, so the Phone scripts tab has what to say.

Match exactly. Brand, strength, concentration (U-100 vs U-300), device (pen vs vial) and how often it is taken all have to match the prescription and the chart.
Never substitute on your own. Similar drugs are not interchangeable. Novolog and Fiasp contain the same insulin but are different products. Only a provider changes a prescription. The one clinic exception is a cost or insurance switch between brands of the same insulin, such as Novolog and Fiasp or Lantus and Toujeo (see Phone scripts).
Urgent or clinical? Message the in-person staff in CLIQ. Paste the patient's Elation chart URL, give as much detail as you can (what the patient said, symptoms, readings, medicine and last dose, callback number, pharmacy), and make sure someone acknowledges it.
Never advise doses. Do not tell a patient to take more, less, skip, or change timing. Take the message and route it. The one exception is the low blood sugar script on the Look-alikes & hand-offs tab, which you read while a provider is being alerted.
When unsure, ask. A 30-second question to a provider is always cheaper than a wrong refill.

The question that started this: Novolog vs Fiasp

Novolog

Insulin aspart
Rapid-acting mealtime insulin
Taken about 0 to 20 minutes before a meal
Pens (FlexPen), vials, cartridges

Fiasp

Insulin aspart plus niacinamide (vitamin B3)
Rapid-acting, starts a little faster
Taken at the start of a meal or up to 20 minutes after
Pens, vials, pump cartridges

What this means for you: they are the same insulin in two products. If the pharmacy calls about Fiasp when Novolog is on the chart, ask why. If insurance or cost drove the switch, it is okay to proceed and note it in the chart. For any other reason, or if a dose change comes up, route it to the provider.

Pick a module

Picture guideSee how insulin and diabetes pills work, with drawings and plain words. FlashcardsFlip through every medicine and term. Missed cards come back. Sort gameTap the right family for each medicine name. Quick rounds. Phone scriptsWhat to say on pharmacy and patient calls. InsulinRapid, long-acting, mixed. Pens, vials, concentrations, storage. Drug lookupSearch any brand or generic: insulin, GLP-1, oral diabetes, thyroid, devices. Look-alikes & hand-offsNames that get mixed up, and what to escalate right away. TermsA1c, BID, PRN, TSH, PA and the rest of the shorthand. Quiz29 questions with explanations. Pass mark 80%.

The picture guide

No medical background needed. Here is how diabetes and thyroid medicines work, in pictures and everyday words.

Two kinds of insulin, one day

Think of a marathon runner and a sprinter. The marathon runner (background insulin, like Lantus or Tresiba) jogs steadily all day. The sprinter (mealtime insulin, like Novolog, Fiasp or Humalog) dashes in when food arrives, then fades. Fiasp is a slightly quicker sprinter than Novolog.

What a patient is holding

Insulin pen

Prefilled. The patient dials the number of units. Needs pen needles, which are a separate prescription.

Vial and syringe

The patient draws insulin into a syringe. Needs syringes, also a separate prescription.

Insulin pump

A small machine that drips rapid-acting insulin all day through a thin tube and a patch on the skin.

Pump cartridge

Fiasp PumpCart is a prefilled cartridge that loads into a pump. It is not a pen, and a pen cannot go in a pump.

Glucose sensor (CGM)

A small disc on the arm or belly reads sugar all day and sends it to a phone. Like a smoke detector for sugar.

Clear or cloudy?

Most insulin is clear. NPH and premixed insulins (like Novolog Mix 70/30) are cloudy and get rolled gently before use.

Where each medicine works

1Brain. GLP-1 shots (Ozempic, Mounjaro) help you feel full sooner.
2Stomach. GLP-1 shots slow how fast food leaves it.
3Pancreas, the insulin maker. GLP-1 shots, Januvia and glipizide-type pills all nudge it to release more insulin.
4Liver. Metformin tells it to make less sugar.
5Kidneys. Jardiance and Farxiga let extra sugar leave in the urine.
6Thyroid, the body's thermostat. Levothyroxine replaces the hormone. Methimazole turns an overactive thyroid down.
7Under the skin. Insulin shots go into the fat layer (belly, thigh or arm) and move into the blood.

Simplified picture, not to scale.

Blood sugar zones: when to speak up

Under 54Urgent lowAlert the in-person staff now. Read the low blood sugar script.

54 to 69LowWith shakiness, sweating or confusion: alert the in-person staff and read the script.

70 to 180Usual goal rangeFor many people. The provider sets each person's goal. No action needed.

181 to 300HighWrite it down for the provider. Not urgent on its own.

Over 300, or HIVery highWith vomiting, trouble breathing or extreme thirst: alert the in-person staff now.

Zones tell you when to speak up. They are not for treating or changing doses.

Decode the drug name

The ending of the generic name tells you the family, even if you have never seen the drug.

If the name has	It is	Examples
insulin ___	Insulin (a shot)	insulin aspart (Novolog, Fiasp), insulin glargine (Lantus)
-tide	GLP-1 type weekly or daily shot	semaglutide (Ozempic), tirzepatide (Mounjaro), liraglutide (Victoza)
-gliflozin	SGLT2 pill (kidneys flush sugar)	empagliflozin (Jardiance), dapagliflozin (Farxiga)
-gliptin	DPP-4 pill	sitagliptin (Januvia), linagliptin (Tradjenta)
glipizide, glimepiride, glyburide	Sulfonylurea pill. Can cause lows.	Glucotrol, Amaryl
metformin	The foundation diabetes pill	Glucophage. Also inside Janumet, Synjardy.
levo-, thyro-	Thyroid hormone pill	levothyroxine (Synthroid), liothyronine (Cytomel)
-azole at the end	Turns an overactive thyroid down	methimazole (Tapazole)

Insulin

Two jobs: mealtime insulin covers a meal, basal (background) insulin works around the clock. Many patients take both.

How long each type lasts

Approximate maximum duration. Varies from person to person. For recognition only.

The families

Family	Brands	Taken	Remember
Rapid-acting	Novolog, Fiasp (aspart) · Humalog, Admelog, Lyumjev (lispro) · Apidra (glulisine)	With meals	Clear. Starts in minutes. Lyumjev and Fiasp are the fastest-starting versions.
Regular (short)	Humulin R, Novolin R	About 30 minutes before meals	Slower and longer than rapid-acting. Sold without a prescription in the US, but insurance only covers it with one.
NPH (intermediate)	Humulin N, Novolin N	Usually once or twice daily	Cloudy, unlike every other insulin here. Needs gentle rolling before use.
Long-acting (basal)	Lantus, Basaglar, Semglee, Rezvoglar (glargine U-100) · Toujeo (glargine U-300) · Tresiba (degludec) · Levemir (detemir)	Once daily, same time	No peak, steady background. Levemir is being phased out, so expect provider-chosen replacements.
Premixed	Novolog Mix 70/30, Humalog Mix 75/25, Humulin 70/30, Novolin 70/30	Usually with breakfast and dinner	Two insulins in one pen. The numbers are the percentage split. Cloudy.
Insulin + GLP-1	Soliqua, Xultophy	Once daily	One pen, two drug classes. Counts as both when a form asks.
Inhaled	Afrezza	Start of meal	Powder cartridges, not an injection.

Concentration: the number after U

U-100 means 100 units in every 1 mL. It is the standard. Higher strengths exist and are easy to mix up:

U-200 Humalog KwikPen, Tresiba · U-300 Toujeo · U-500 Humulin R U-500 (five times standard, high-alert).

Toujeo and Lantus are both insulin glargine, in different pen strengths (U-300 and U-100). If a pharmacy calls about Toujeo when Lantus is on the chart, ask whether it was switched for cost or insurance. If yes, proceed with the refill. See the Phone scripts tab.

Pen, vial or cartridge

Pen: prefilled, dials in units, needs separate pen needles.

Vial: drawn into a syringe. Needs insulin syringes.

Cartridge or pump reservoir: goes in a reusable pen or an insulin pump.

Pen needles and syringes are separate prescriptions. A refill for insulin alone can leave the patient unable to inject.

Reading the pharmacy label: solution, pen, cartridge

The same insulin comes in different containers. The words on the prescription tell you which one. Each needs different supplies, so they are not interchangeable.

Label says	What it is	Patient also needs	How much insulin
"Solution" (100 units/mL)	The vial. A bottle the patient draws from.	Insulin syringes. Some pump users fill their pump from a vial.	10 mL = 1,000 units
"Solution pen-injector"	A prefilled pen (FlexPen, FlexTouch, KwikPen). Dial the units and inject.	Pen needles	3 mL = 300 units per pen
"Cartridge" (PenFill)	A small insulin cartridge that loads into a reusable pen. Not a prefilled pen.	A compatible reusable pen and pen needles	3 mL = 300 units
Fiasp "PumpCart"	A prefilled cartridge made for an insulin pump. It cannot be used in a pen.	The matching pump and infusion sets	1.6 mL = 160 units

Example: "Fiasp solution," "Fiasp FlexTouch solution pen-injector" and "Fiasp PumpCart" are the same insulin in three containers. A patient who uses a pump cannot use the pen, and a patient who injects cannot use the PumpCart. If the pharmacy offers a different container than the prescription, ask the pharmacy what they have and route it to the provider.

Units matter for refills. A vial lasts far longer than one pen, so "refill too soon" rejections depend on the container.

Storage, in plain terms

Unopened insulin lives in the refrigerator and is never frozen. An opened pen or vial can usually stay at room temperature for about 28 days, then it is thrown away even if some remains. Tresiba and Toujeo allow longer (about 56 days). Heat and sunlight ruin it. The package insert is the final word. If a patient says insulin was left in a hot car or froze, route it to a provider.

Flashcards

Tap the card to flip it. Say the answer out loud first. Mark "Need practice" and the card comes back soon.

Sort game

A medicine name appears. Tap the family it belongs to. Twelve per round, in a new order each time.

Phone scripts

Most of your work happens on the phone. Here is what to say and what to do on the calls you will get most.

Draft for provider review. The pharmacy-call script is clinic policy. The others are starting points for Dr. Varughese and the clinical team to adjust. Before sharing any patient information, confirm identity the way the clinic requires.

Pharmacy calls about a different brand of the same insulin

Examples: the chart says Lantus and the pharmacy calls about Toujeo, or the chart says Novolog and they call about Fiasp. Each pair is the same insulin (glargine, or aspart) sold under different brand names.

Ask: "Why are you calling about Toujeo when Lantus is on the chart? Was it switched because of cost or insurance?" (Same question for Fiasp and Novolog.)
If yes, cost or insurance: it is okay to proceed with the refill of the brand the pharmacy asked about. Leave the number of units exactly as written. Add a note in the chart that the pharmacy switched brands for cost or insurance, so the provider sees it.
If no, unsure, or anyone mentions changing the dose: say "Let me check with the provider and call you right back," and route it.

Only for brands of the same insulin. Aspart: Novolog, Fiasp. Lispro: Humalog, Admelog, Lyumjev. Glargine: Lantus, Basaglar, Semglee, Rezvoglar, Toujeo. A switch to a different insulin, Ozempic to Wegovy, or metformin IR to ER still goes to the provider.

The refill does not match the chart

Say: "Can you spell the full name for me and read the strength on the box? Is it the vial, the pen, or the pump cartridge?"

Do: write down the name, strength, whether it is a vial, pen or pump cartridge, and how often. Route it to the provider the same day. Never approve a different brand, strength or device on your own (apart from the same-insulin cost switch above).

Patient says they are out of insulin

Say: "Which insulin is it, and when was your last dose? I am flagging this to the in-person staff right now."

Do: mark it same-day urgent. Ask for the pharmacy name and phone number so the provider can act quickly.

Patient on a weekly shot has belly pain or keeps vomiting

Say: "I am getting the in-person staff on the line for you now. Please stay on the phone."

Do: alert the in-person staff immediately. If they say they cannot keep fluids down, have trouble breathing, or pass out, tell them to call 911.

Patient asks "should I change my dose?"

Say: "I cannot change doses, but I will get your question to the provider today."

Do: write the question and the recent sugar readings word for word. Route it as same-day.

Patient says their sugar is low

Say and do: use the low blood sugar script. Alert the in-person staff at the same time.

Every call

Confirm identity per clinic policy. Repeat the medicine name and strength back to the caller. Write down the call-back number. End with what happens next and when.

Drug lookup

Type a brand or generic name. Use the filters to browse one family at a time.

Brand	Generic	Type	Form	How often	MA note

Look-alikes and hand-offs

Wrong-drug errors usually come from names that look or sound alike. Slow down on these pairs.

Pair	Difference
Novolog / Novolin	Novolog is rapid-acting aspart. Novolin is human insulin (R, N or 70/30).
Humalog / Humulin	Humalog is rapid-acting lispro. Humulin is human insulin. Humulin R U-500 is a concentrated, high-alert product.
Novolog / Fiasp	Same insulin (aspart). Fiasp starts a little faster. A cost or insurance switch is okay to proceed with. See Phone scripts.
Lantus / Toujeo	Same insulin (glargine), different pen strength (U-100 vs U-300). A cost or insurance switch between glargine brands is okay to proceed with. See Phone scripts.
Toujeo / Tresiba	Different long-acting insulins with names that look alike on a screen.
Januvia / Janumet	Janumet is Januvia plus metformin.
Januvia / Jardiance	Januvia is a DPP-4 pill. Jardiance is an SGLT2 pill.
Ozempic / Wegovy	Same drug (semaglutide). Ozempic is for type 2 diabetes. Wegovy is for weight and heart risk. Insurance treats them differently.
Mounjaro / Zepbound	Same drug (tirzepatide). Mounjaro for diabetes, Zepbound for weight and sleep apnea.
Ozempic / Rybelsus	Both semaglutide for diabetes. Ozempic is a weekly shot, Rybelsus is a daily pill.
Victoza / Saxenda	Same drug (liraglutide). Victoza for diabetes, Saxenda for weight.
glipizide / glimepiride / glyburide	Three different sulfonylureas, all can cause low blood sugar. Read every letter.
metformin IR / ER	Immediate release versus extended release. Not interchangeable on the label.
levothyroxine brands	Synthroid, Levoxyl, Unithroid, Euthyrox. Patients are often kept on one brand, so do not swap.

Draft for provider review. The escalation lists below are a starting point. Dr. Varughese and the clinical team should adjust them to match clinic protocol before staff rely on them.

Low blood sugar script

NowPatient is awake and can swallow

Use this when a patient reports sugar under 70 with shakiness, sweating or confusion, or any reading under 54. Alert the in-person staff at the same time. Do not wait until after the call.

Say: "Please have 15 grams of fast sugar right now." That is half a cup (4 oz) of juice or regular soda, 3 to 4 glucose tablets, or 1 tablespoon of sugar or honey.
Say: "Check your sugar again in 15 minutes."
If it is still under 70, repeat the sugar and the 15-minute recheck. Tell the provider the numbers.
Once it is above 70, the patient should eat a snack or meal. A provider follows up.

Tell the patient or someone with them to call 911 (you cannot call US 911 from abroad), then alert the in-person staff in CLIQ, if the patient cannot swallow, is passed out, is having a seizure, cannot follow instructions, or is still under 70 after two rounds.

Skip peanut butter, cheese, chocolate and ice cream for the first fix. Fat and protein slow how fast sugar reaches the blood. They are good for the snack afterward.

When to hand off

NowInterrupt the in-person staff

Blood sugar under 70 with shakiness, sweating, confusion, or any reading under 54. Read the low blood sugar script above while someone alerts the in-person staff.
Very high sugar with vomiting, trouble breathing, extreme thirst, or a meter reading of HI
Severe belly pain or vomiting that will not stop, especially on a GLP-1 shot
Chest pain, fainting, stroke symptoms, or trouble breathing: tell the patient to call 911
Insulin pump failure or alarm the patient cannot clear
Patient took the wrong insulin or a much larger dose than intended

TodayFlag for same-day review

Patient is out of insulin, or will run out today or tomorrow
Any refill where the drug, strength, concentration or device differs from the chart (except a cost or insurance switch between brands of the same insulin, see Phone scripts)
Pharmacy says the drug is out of stock or the insurance changed brands
Patient asks whether to change a dose, skip a dose, or take it at a different time
New rash, swelling or injection-site reaction
Insulin was frozen, overheated, or past 28 days open

YouStaff can handle

Entering and routing a refill that matches the chart exactly
Starting a prior auth and collecting diagnosis, A1c and past drugs for the provider
Confirming pharmacy, insurance and pickup details
Scheduling labs and visits
Asking the patient for the full drug name and strength so the provider sees it

Terms and shorthand

Search or browse by group.

Term	Plain meaning	Group

Knowledge check

29 scenario questions, shuffled each time. You see the explanation after each answer. Pass mark is 80%.