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Pharmacology > Antidiabetic Agents > Flashcards

Antidiabetic Agents Flashcards

1
Q

Lispro (Humalog)
Apart (Novolog)
Glulisine (Apidra)

are _____ action drugs = a short duration

A

Rapid

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2
Q

Regular (Huminlin R, Novolin R)

are ______ acting = slower acting drugs

A

Short

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3
Q

Neutral Protamine Hagedorn (NPH) have an __________ duration.

A

Intermediate

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4
Q

Detemir (Levir)
Glargine (Lantus)
have a ______ duration (basal insulin)

A

Long

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5
Q

Degludec (Tresbia) is ________ acting (basal insulin analogue)

A

Ultralong

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6
Q

_______ acting insulin
Used as nutritional insulin and must be given prior to mealtime.

_______ insulin can be given about 30 minutes before mealtime

These can also be used as correction does or sliding scale insulins

A

Rapid:
Lispro (Humalog)
Apart (Novolog)
Glulisine (Apidra)

Regular

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7
Q

What insulin?

Dosing is often given twice a day (before breakfast and supper) in combination with short acting insulin.

(clear-cloudy mixing)

A

Neutral Protamine Hagedorn (NPH)

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8
Q

Dosing given as basal insulin coverage - Rapid or short-acting insulins are added for mealtime coverage.

A

Detemir (Levir)
Glargine (Lantus)
Degludec (Tresbia)

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9
Q

Non-Insulin Injectables!

Supplement to mealtime insulin for both type 1 and type 2 diabetics

Actions: reduces postprandial glucose levels by delaying gastric emptying and decreasing the release of glucagon

*Adverse Effects: risk of hypoglycemia when administered with insulin

Considerations: Dosing is prior to major meals

A

Amylin Mimetics

pramlintide (Symlin)

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10
Q

Non-Insulin Injectables!

Adjuvant therapy to improve glycemic control in patients with type 2 diabetes

Actions:

  • slows gastric emptying - -
  • stimulates glucose dependent release of insulin
  • inhibits postprandial glucagon release
  • promotes satiety

Adverse effects:

  • GI effects are common
  • additive hypoglycemia with sulfonylureas
  • contraindicated in patients with history of medullary thyroid cancer or multiple endocrine neoplasia syndrome
  • oral contraceptives and antibiotics should be taken at least one hour before administering exenatide
A

Incretin Mimetics (-tide)

exanatide (Byetta)
exanatide ER (Bydureon); liraglutide (Victoza)
albiglutide (Tanzeum)
dulaglutide (Trulicity)

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11
Q

(Oral Antidiabetic Agents)

Action:

  • increases insulin secretion
  • Increase tissue response to insulin
  • Long duration 18-72 hours

Side Effect:

  • weight gain
  • hypoglycemia with impaired *renal function
  • Disulfiram (alcohol)
  • Caution with beta blockers
  • Sulfa allergy
A

Sulfonylureas

Glipizide (Glucotrol)
Glyburide (Micronase)
Glimepride (Amaryl)

Zide Ride Pride

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12
Q

(Oral Antidiabetic Agents)

Action:

  • Increases insulin
  • Short duration 4 hours

Side Effect:

  • Hypoglycemia
  • liver impairment when given with *gemfibrozil
  • Must be followed within 30 minutes by meal
A

Meglitinides

(-linide)

Repaglinide (Prandin)
Nateglinide (Starlix)

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13
Q

(Oral Antidiabetic Agents)

1st choice for DM type 2

Action:

  • decrease glucose production by *liver
  • decrease glucose absorption in *gut
  • increase glucose uptake by *muscle

Side Effect:

  • GI Effects: nausea and abdominal cramps
  • lactic acidosis rare but fatal (increased by alcohol)
  • Obese insulin - resistant patients
  • impaired renal function
  • stop drug for 48 hours following IV dye studies
  • Oral only approved for pregnancy
  • Folate deficiency in pregnancy
A

Biguanides

Metformin (Glucophage)

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14
Q

(Oral Antidiabetic Agents)

Action:
- Decrease insulin resistance 
- increase glucose uptake by muscle 
- decrease glucose by liver 
(Insulin sensitizers - lowers blood sugar and increase muscle, fat, and liver's sensitivity to insulin)

Side Effect:

  • Upper respiratory infection
  • headache
  • HF greatest concern
  • edema
  • Monitor liver function (ATLs)
  • Increased fractures in women
  • (Bladder cancer)
  • Avoid class III / IV HF drugs
A

Thiazolidinediones (TZDs)

Pioglitazone (Actos)

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15
Q

(Oral Antidiabetic Agents)

  • Action:
  • lowers postprandial blood levels
  • inhibits CHO
  • Side Effect:
  • GI symptoms: abdominal discomfort/Bloating
  • Iron deficiency anemia
  • Liver dysfunction
  • Monotherpay = no hypoglycemia
  • when combined with insulin or sulfonylurea possible hypoglycemia
  • Must use *glucose not sucrose to treat hypoglycemia
A

Alpha-Glucosidase inhibitors

Acarbose (Precose)
Miglitol (Glyset)

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16
Q

(Oral Antidiabetic Agents)

DM Type 2

Action:

  • *enhances actions of incretin hormone
  • stimulates glucose-dependent release of insulin
  • suppress postprandial release of glucagon
  • Side Effect:
  • Upper respiratory infection
  • inflammation of nasal passages
  • oral with or without food
  • excreted by kidneys, reduce creatinine clearance
A

Dipeptidly Peptidase - 4 Inhibitor (DPP-4)

(-liptin)

Sitaglipitin (Januvia)
Saxagliptin (Onglyza)
Alogliptin (Nesina)
Linagliptin (Trajenta)

17
Q

(Oral Antidiabetic Agents)

Action:
- blocks the reabsorption of filtered glucose in the renal tubules = excess glucose through urine

Side Effect:

  • UTI
  • Yeast infection
  • Postural hypotension in elder
  • reduced blood sugar independently of insulin
  • risk of DKA
A

Sodium-Glucose Co-Transporter 2 Inhibitors

(-liflozin)

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

18
Q

Lispro Aspart Glulisine
Onset
*15-30 m 10-20 m 10-15 m

Peak
30-150 m 60-180 m 30-90 m

Duration
3-6.5 h 3-5 h 3-5 h

A

Study

19
Q

Detemir Glargine
Onset
none. 70 m

Peak
6-8 h None

Duration
12-24 h *24 h

A

Study

20
Q

Clear fluid, given subQ/IV

Rapid

*Controls postprandial (PP) rise in glucose

Given before and after meals

A

Lispro

21
Q

Clear fluid, given subQ/IV

Rapid

*Control postprandial risk in glucose

Given before meals

A

Aspart

22
Q

Human insulin, given subQ/IV
Slower
(stop giving when glucose = 250, not 110)

A

Regular

23
Q

Cloudy fluid

Intermediate

NOT given at mealtime to control postprandial hyperglycemia

Given in combo with short-acting
(clear-cloudy)

A

NPH (neutral protamine hagedorn)

24
Q

Not for postprandial hyperglycemic

Long (but can be intermediate)

SubQ 1-2 times a day

NO mixing with other insulins

A

Detemir

25
Q

NEVER GIVEN IV

Long (24 hr)

NO mixing with other insulins

SubQ 1x a daily at night

A

Glargine (24hr duration)

26
Q

Hypoglycemia
lipohyperthrophy
hypokalemia

are what?

A

Adverse effects of insulins

27
Q
  • thiazides
  • steriods
  • sympathomimetics

> > _________ glucose

A

increase

28
Q
  • sulfonylueras
  • glinides
  • alcohol

are __________ (additive)

A

Synergistic (two or more drugs with similar effects)

29
Q
  • Injectable Amylin
  • Delay Gastric emptying

DM type 1 and 2

  • Suppress glucagon release
  • *Increase satiety (feeling full) in brain&raquo_space; decreases appetite
  • Injection site irritation
A

Injectable Amylin

-pramlintide

30
Q

Injectable Incretin

DM type 2

Released from GI tract after meals to decrease appetite

  • *delays gastric emptying
  • inhibit postprandial release of glucagon
  • stim glc-dependent release of insulin

Suppress appetite

A

(-tide)

  • exenatide
  • liraglutide

Pharmacology (9 decks)

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