47. Antidiabetic Medications

Question 1

causes of hyperglycemia (ominous octet)

Answer 1

• 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)

Question 2

MOA of insulin

Answer 2

• promote use of glucose by body cells

- store glucose as glycogen in muscles

Question 3

Meds that increase glucose (need higher insulin dose)

Answer 3

• thiazides
• glucocorticoids
• estrogen
• thyroid drugs

Question 4

Meds that decrease glucose (need lower insulin dose)

Answer 4

• TCAs
• MAOIs
• ASA (not major)
• oral anticoagulants (not major)

Question 5

3 types of rapid-acting insulin (clear)

Answer 5

• lispro
• aspart
• glulisine

Question 6

onset of action, peak, and duration of rapid acting insulin

Answer 6

• onset: 15-30 min
• peak: 30-90 min
• duration: 3-5 hrs

Question 7

type of short-acting insulin (clear)

Answer 7

regular

Question 8

onset of action, peak, and duration of short-acting insulin

Answer 8

• onset: 30 min
• peak: 2.5-5 hrs
• duration: 4-12 hrs

Question 9

type of intermediate-acting insulin (cloudy)

Answer 9

NPH (insulin isophane)

Question 10

onset of action, peak, and duration of intermediate-acting insulin

Answer 10

• onset: 1-2 hrs
• peak: 4-12 hrs
• duration: 14-24 hrs

Question 11

type of long-acting insulin (clear)

Answer 11

glargine

Question 12

onset of action and duration of long-acting insulin

Answer 12

• onset: 1-1.5 hrs

- duration: 24 hrs

Question 13

when is long-acting insulin generally given

Answer 13

once a day (in morning or at bedtime)

Question 14

What types of insulins are combined together?

Answer 14

• short and intermediate

- rapid and intermediate

Question 15

when is rapid-acting insulin given

Answer 15

0-15 minutes before meal

Question 16

when is short-acting insulin given

Answer 16

about 30 minutes before a meal

Question 17

when is intermediate-acting insulin given

Answer 17

AC & HS (before meals and before bed)

Question 18

insulin injection sites

Answer 18

• ABD
• arm
• thighs
• buttocks

Question 19

What class of medication is Metformin

Answer 19

Biguanides

Question 20

MOA of metformin

Answer 20

• decreasing hepatic production of glucose from stored glucose (prevents rise in glucose but doesn’t cause drop in glucose)
• may increase insulin receptor sensitivity

Question 21

Why isn’t metformin recommended for patients w/ renal impairment?

Answer 21

they are at risk for lactic acidosis

Question 22

Why should metformin be held 48 hours before and after a procedure using contrast dye?

Answer 22

can cause renal failure or lactic acidosis

Question 23

side effects of metformin

Answer 23

• nausea

- diarrhea (biggest complaint)

Question 24

T/F: metformin causes renal failure

Answer 24

False; drug is not damaging but can cause lactic acidosis if kidneys can’t clear the medication

Question 25

What class of medication is glipizide

Answer 25

sulfonylurea (chemically similar to sulfa abx)

Question 26

MOA of glipizide

Answer 26

directly stimulates beta cells to secrete insulin (onset in 90 minutes -> given before meal)

Question 27

Side effects of glipizide

Answer 27

- weight gain (can make type 2 DM worse) | - does not work longterm

Question 28

What class of medication is sitagliptin phosphate

Answer 28

incretin modifier (DPP4 inhibitor)

Question 29

MOA of sitagliptin phosphate

Answer 29

increases level of incretin hormones -> increases insulin secretion and decreases glucagon secretion to reduce glucose production

Question 30

Use of sitagliptin phosphate

Answer 30

adjunct to tx w/ exercise and diet to reduce fasting and post-prandial glucose levels

Question 31

What class of medication is Dulaglutide?

Answer 31

glucagon-like peptide 1 agonists

Question 32

MOA of dulaglutide

Answer 32

- enhancement of glucose-dependent insulin secretion - slowed gastric emptying - reduction of postprandial glucagon and food intake

Question 33

side effects of dulaglutide

Answer 33

- GI distress (due to slowed gastric emptying) - hypoglycemia (due to combo of meds) - weight loss

Question 34

how is dulaglutide administered

Answer 34

injectable given once a week

Question 35

What class of medication is Empagliflozin

Answer 35

selective sodium-glucose transporter 2 (SGLT-2)

Question 36

MOA of Empagliflozin

Answer 36

promote renal excretion of glucose (does not change amount of urine produced)

Question 37

contraindications for Empagliflozin

Answer 37

GFR < 45 or Hx of DKA

Question 38

side effects of Empagliflozin

Answer 38

- candidiasis (genital yeast infection) - cystitis - hypoglycemia (due to combo of meds) - hypotension (glucose in urine takes water with it)

Question 39

What class of medication is Rosiglitazone

Answer 39

Thiazolidinediones (TZD)

Question 40

MOA of Rosiglitazone

Answer 40

decrease insulin resistance and improve blood glucose control

Question 41

contraindications of Rosiglitazone

Answer 41

- not to be used for mono therapy | - class 3 and 4 heart failure due to dose-related fluid retention

Question 42

What class of meds are meglitinides like Repaglinide similar to?

Answer 42

- similar to sulfonureas (Glipizide) - simular MOA (stimulate beta cells to release insulin) - similar side effects

Question 43

contraindications of Repaglinide

Answer 43

liver failure due to decreased liver metabolism rate -> leads to drug accumulation and hypoglycemia

Question 44

What class of medication is Acarbose

Answer 44

Alpha-Glucosidase inhibitors

Question 45

MOA of Acarbose

Answer 45

inhibits digestive enzymes in the small intestine responsible for release of glucose from the complex cards in the diet

Question 46

Use of Acarbose

Answer 46

intended for pts who don't achieve results w/ diet alone

Question 47

T/F: Acarbose causes hypoglycemia

Answer 47

False; simply delays glucose release which reduces post-prandial hyperglycemia

Question 48

What drugs is used for hypoglycemia

Answer 48

Glucagon (hypoglycemia emergency drug)

Question 49

How to treat hypoglycemia in alert and unconscious patients

Answer 49

- alert: give oral glucose (juice (short acting) and food (longer acting)) - unconscious: D50 IV push if IV access; glucagon injection if no IV access