Antidiabetic Agents Flashcards
Lispro (Humalog)
Apart (Novolog)
Glulisine (Apidra)
are _____ action drugs = a short duration
Rapid
Regular (Huminlin R, Novolin R)
are ______ acting = slower acting drugs
Short
Neutral Protamine Hagedorn (NPH) have an __________ duration.
Intermediate
Detemir (Levir)
Glargine (Lantus)
have a ______ duration (basal insulin)
Long
Degludec (Tresbia) is ________ acting (basal insulin analogue)
Ultralong
_______ 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
Rapid:
Lispro (Humalog)
Apart (Novolog)
Glulisine (Apidra)
Regular
What insulin?
Dosing is often given twice a day (before breakfast and supper) in combination with short acting insulin.
(clear-cloudy mixing)
Neutral Protamine Hagedorn (NPH)
Dosing given as basal insulin coverage - Rapid or short-acting insulins are added for mealtime coverage.
Detemir (Levir)
Glargine (Lantus)
Degludec (Tresbia)
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
Amylin Mimetics
pramlintide (Symlin)
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
Incretin Mimetics (-tide)
exanatide (Byetta)
exanatide ER (Bydureon); liraglutide (Victoza)
albiglutide (Tanzeum)
dulaglutide (Trulicity)
(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
Sulfonylureas
Glipizide (Glucotrol)
Glyburide (Micronase)
Glimepride (Amaryl)
Zide Ride Pride
(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
Meglitinides
(-linide)
Repaglinide (Prandin)
Nateglinide (Starlix)
(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
Biguanides
Metformin (Glucophage)
(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
Thiazolidinediones (TZDs)
Pioglitazone (Actos)
(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
Alpha-Glucosidase inhibitors
Acarbose (Precose)
Miglitol (Glyset)
(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
Dipeptidly Peptidase - 4 Inhibitor (DPP-4)
(-liptin)
Sitaglipitin (Januvia)
Saxagliptin (Onglyza)
Alogliptin (Nesina)
Linagliptin (Trajenta)
(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
Sodium-Glucose Co-Transporter 2 Inhibitors
(-liflozin)
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
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
Study
Detemir Glargine
Onset
none. 70 m
Peak
6-8 h None
Duration
12-24 h *24 h
Study
Clear fluid, given subQ/IV
Rapid
*Controls postprandial (PP) rise in glucose
Given before and after meals
Lispro
Clear fluid, given subQ/IV
Rapid
*Control postprandial risk in glucose
Given before meals
Aspart
Human insulin, given subQ/IV
Slower
(stop giving when glucose = 250, not 110)
Regular
Cloudy fluid
Intermediate
NOT given at mealtime to control postprandial hyperglycemia
Given in combo with short-acting
(clear-cloudy)
NPH (neutral protamine hagedorn)
Not for postprandial hyperglycemic
Long (but can be intermediate)
SubQ 1-2 times a day
NO mixing with other insulins
Detemir
NEVER GIVEN IV
Long (24 hr)
NO mixing with other insulins
SubQ 1x a daily at night
Glargine (24hr duration)
Hypoglycemia
lipohyperthrophy
hypokalemia
are what?
Adverse effects of insulins
- thiazides
- steriods
- sympathomimetics
> > _________ glucose
increase
- sulfonylueras
- glinides
- alcohol
are __________ (additive)
Synergistic (two or more drugs with similar effects)
- Injectable Amylin
- Delay Gastric emptying
DM type 1 and 2
- Suppress glucagon release
- *Increase satiety (feeling full) in brain»_space; decreases appetite
- Injection site irritation
Injectable Amylin
-pramlintide
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
(-tide)
- exenatide
- liraglutide
