47. Antidiabetic Medications Flashcards
causes of hyperglycemia (ominous octet)
- decreased glucose uptake (muscles)
- NT dysfunction
- increased hepatic glucose production
- increased glucagon secretion
- decreased insulin secretion
- decreased incretin effect
- increased lipolysis
- increased glucose reabsorption (kidneys)
MOA of insulin
- promote use of glucose by body cells
- store glucose as glycogen in muscles
Meds that increase glucose (need higher insulin dose)
- thiazides
- glucocorticoids
- estrogen
- thyroid drugs
Meds that decrease glucose (need lower insulin dose)
- TCAs
- MAOIs
- ASA (not major)
- oral anticoagulants (not major)
3 types of rapid-acting insulin (clear)
- lispro
- aspart
- glulisine
onset of action, peak, and duration of rapid acting insulin
- onset: 15-30 min
- peak: 30-90 min
- duration: 3-5 hrs
type of short-acting insulin (clear)
regular
onset of action, peak, and duration of short-acting insulin
- onset: 30 min
- peak: 2.5-5 hrs
- duration: 4-12 hrs
type of intermediate-acting insulin (cloudy)
NPH (insulin isophane)
onset of action, peak, and duration of intermediate-acting insulin
- onset: 1-2 hrs
- peak: 4-12 hrs
- duration: 14-24 hrs
type of long-acting insulin (clear)
glargine
onset of action and duration of long-acting insulin
- onset: 1-1.5 hrs
- duration: 24 hrs
when is long-acting insulin generally given
once a day (in morning or at bedtime)
What types of insulins are combined together?
- short and intermediate
- rapid and intermediate
when is rapid-acting insulin given
0-15 minutes before meal
when is short-acting insulin given
about 30 minutes before a meal
when is intermediate-acting insulin given
AC & HS (before meals and before bed)
insulin injection sites
- ABD
- arm
- thighs
- buttocks
What class of medication is Metformin
Biguanides
MOA of metformin
- decreasing hepatic production of glucose from stored glucose (prevents rise in glucose but doesn’t cause drop in glucose)
- may increase insulin receptor sensitivity
Why isn’t metformin recommended for patients w/ renal impairment?
they are at risk for lactic acidosis
Why should metformin be held 48 hours before and after a procedure using contrast dye?
can cause renal failure or lactic acidosis
side effects of metformin
- nausea
- diarrhea (biggest complaint)
T/F: metformin causes renal failure
False; drug is not damaging but can cause lactic acidosis if kidneys can’t clear the medication
What class of medication is glipizide
sulfonylurea (chemically similar to sulfa abx)
MOA of glipizide
directly stimulates beta cells to secrete insulin (onset in 90 minutes -> given before meal)
Side effects of glipizide
- weight gain (can make type 2 DM worse)
- does not work longterm
What class of medication is sitagliptin phosphate
incretin modifier (DPP4 inhibitor)
MOA of sitagliptin phosphate
increases level of incretin hormones -> increases insulin secretion and decreases glucagon secretion to reduce glucose production
Use of sitagliptin phosphate
adjunct to tx w/ exercise and diet to reduce fasting and post-prandial glucose levels
What class of medication is Dulaglutide?
glucagon-like peptide 1 agonists
MOA of dulaglutide
- enhancement of glucose-dependent insulin secretion
- slowed gastric emptying
- reduction of postprandial glucagon and food intake
side effects of dulaglutide
- GI distress (due to slowed gastric emptying)
- hypoglycemia (due to combo of meds)
- weight loss
how is dulaglutide administered
injectable given once a week
What class of medication is Empagliflozin
selective sodium-glucose transporter 2 (SGLT-2)
MOA of Empagliflozin
promote renal excretion of glucose (does not change amount of urine produced)
contraindications for Empagliflozin
GFR < 45 or Hx of DKA
side effects of Empagliflozin
- candidiasis (genital yeast infection)
- cystitis
- hypoglycemia (due to combo of meds)
- hypotension (glucose in urine takes water with it)
What class of medication is Rosiglitazone
Thiazolidinediones (TZD)
MOA of Rosiglitazone
decrease insulin resistance and improve blood glucose control
contraindications of Rosiglitazone
- not to be used for mono therapy
- class 3 and 4 heart failure due to dose-related fluid retention
What class of meds are meglitinides like Repaglinide similar to?
- similar to sulfonureas (Glipizide)
- simular MOA (stimulate beta cells to release insulin)
- similar side effects
contraindications of Repaglinide
liver failure due to decreased liver metabolism rate -> leads to drug accumulation and hypoglycemia
What class of medication is Acarbose
Alpha-Glucosidase inhibitors
MOA of Acarbose
inhibits digestive enzymes in the small intestine responsible for release of glucose from the complex cards in the diet
Use of Acarbose
intended for pts who don’t achieve results w/ diet alone
T/F: Acarbose causes hypoglycemia
False; simply delays glucose release which reduces post-prandial hyperglycemia
What drugs is used for hypoglycemia
Glucagon (hypoglycemia emergency drug)
How to treat hypoglycemia in alert and unconscious patients
- alert: give oral glucose (juice (short acting) and food (longer acting))
- unconscious: D50 IV push if IV access; glucagon injection if no IV access
