Anti-diabetic Medications Flashcards
Short Duration Rapid Acting Insulins
- HUMALOG (LISPRO), NOVOLOG (ASPORT), APIDRA (GLULSINE)
- MOA: Lowers blood glucose by: stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production
- Used in conjunction with a long acting insulin
- Adverse: Hypoglycemia. Irritation and swelling at injection site
- Peak: After 30 mins
- Duration: 3-6 hrs
Short Duration-SLOWER Acting Insulins
-Regular: HUMALIN R, NOVOLIN R
-Insulin in purest form
- MOA: Regulates glucose metabolism. Lowers blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat. Inhibits hepatic glucose production
Adverse: Hypoglycemia, hypokalemia, weight gain
Onset: 30-60 mins
Peak: 1-5 hrs
Duration: 6-10 hrs
Intermediate Duration-NPH
- Cannot be given at mealtime
- Prepared by adding protamine which slows absorption
- Used to keep basal blood sugar at bay
Intermediate Duration-Determir (Levemir)
- slow onset, dose dependent duration
- MOA: regulates glucose metabolism
- Onset: 3-4 hr
- Peak onset: 6-8 hrs
- Duration: 24 hr (has to be given twice)
Hypoglycemia Symptoms
cold, clammy skin faintness hunger dizziness fast heartbeat irritability or impatience nervousness seizure
Long Acting Insulin- Glargine
- Commonly used with Humalog
- MOA: Regulates glucose metabolism. Stimulates peripheral glucose uptake
- Onset: 3-4 hr
- Duration: 24 hr (10.8hr-24hrs)
- NO PEAK, recommended at night
Biguanides
- Agents: METFORMIN
- Type 2 Diabetes, PCOS
- MOA: Decreases hepatic glucose production; decreases GI glucose absorption; increases target cell insulin sensitivity
- Adverse: GI disturbances (diarrhea), myalgia, weakness, LACTIC ACIDOSIS
- Implications: Hold w/ IV dye studies, caution in heart failure, can cause B-12 and folate deficiencies
Glucagon for hyperglycemia
- Treatment: IV glucose that quickly raises blood glucose
- Will not work in starvation, effects seen after 20 mins
Diazoxide
- Raises blood glucose
- MOA: Inhibits the release of insulin from the pancreas, given for disorders that cause pancreas to over secrete insulin
Sulfonylureas
- TOLBUTAMIDE (Orinase), GLIPIZIDE (Glucotrol), GLYBURIDE (Micronase)
- Type 2 diabetes
- MOA: Stimulates the release of insulin from the pancreas
- Adverse: hypoglycemia; weight gain
- Considerations: Drug interactions w NSAIDS, sulfa drugs, alcohol causes a disulfiram like reaction
Disulfiram Reaction
Nausea, copious vomiting,, flushing, palpitations, headache, sweating, thirst, chest pain, weakness, blurred vision
Meglitinides (Glinides)
- REPAGLINIDE, NATEGLINIDE
- Type 2 Diabetes
- MOA: stimulates the release of insulin from the pancreas
- Adverse effects: Hypoglycemia
- Considerations: Must always be followed by a meal.
Thiazolidinediones (TZDs)
- PIOGLITAZONE; ROSIGLITAZONE
-MOA: Improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness; reduces insulin resistance, decreases glucose production by liver
Adverse: Hypoglycemia, weight gain
Considerations: Report signs of heart failure, increased fracture risk, monitor ALT levels
Alpha-Glucosidase Inhibitors
-ACARBOSE (Precose), MIGLITOL (Glycet)
-Type 2 diabetes
- MOA: Lowers blood glucose by inhibiting the enzyme alpha-glucosidase in the GI tract. DELAYS and reduces glucose absorption
Adverse: GI disturbances, iron deficiency anemia
-Considerations: Does not cause hypoglycemia as mono therapy
Incretin Enhancer (Gliptins)
- aka Dipeptidyl Peptidase
SITAGLIPTIN, SAXTAGLIPTINS, ALOGLIPTIN, LINAGLIPTIN - MOA: Enhances the action of incretin hormones by inhibiting dipeptidyl peptidase, results in increased levels of active incretin hormones. Hormones released by intestines throughout the day.
- Adverse: Headache, pancreatitis, URI, UTI, inflammation of nasal pathway
