Antidiabetic Drugs Flashcards
What is diabetes mellitus?
A disorder of carbohydrate metabolism that involves either a deficiency of insulin, a resistance of tissue to insulin, or both
What are the signs and symptoms of diabetes mellitus?
Elevated fasting blood glucose (> 126 mg/dL) Hemoglobin A1C ≥ 6.5% Polyuria Polydipsia Polyphagia Glycosuria Unexplained weight loss Fatigue Blurred vision
What is polyuria?
Excessive production of urine
What is polydipsia?
Excessive thirst
What is polyphagia?
Excessive hunger
What is glycosuria?
Excessive sugar in urine
What is the normal range of blood sugar?
70 - 100
What is type 1 diabetes mellitus characterized by?
Lack of insulin production
Production of defective insulin
What kind of treatment do patients with type 1 diabetes need?
Exogenous insulin
How many cases of diabetes mellitus are type 1?
10%
What are the complications of type 1 diabetes?
Diabetic ketoacidosis (DKA) Hyperosmolar nonketotic syndrome (HHNS)
What is the function of insulin?
Lowers blood sugar levels by storying sugar in fat tissue, muscle, and liver to be used for energy later
What is the function of glucagon?
Increases blood sugar level by releasing glucose from fat tissue when needed for energy
How many cases of diabetes mellitus are type 2?
90%
What causes type 2 diabetes?
Insulin deficiency
Insulin resistance
What causes insulin resistance?
Reduced number of insulin receptors
Insulin receptors are less responsive or defective
What are comorbid conditions of type 2 diabetes?
Obesity Coronary heart disease Dyslipidemia Hypertension Microalbuminemia Increased risk for thrombotic events
What are the comorbidities of type 2 diabetes collectively called?
Metabolic syndrome
Syndrome X
What is gestational diabetes?
Hyperglycemia that develops during pregnancy
What can happen to 30% of patients who have had gestational diabetes?
May develop type 2 diabetes within 10 - 15 years
What are the major long-term complications of type 1 and 2 diabetes?
Macrovascular (atherosclerotic plaque)
Microvascular (capillary damage)
Which structures are involved in the macrovascular complication of diabetes?
Coronary arteries
Cerebral arteries
Peripheral vessels
Microvascular complication of diabetes include which conditions?
Retinopathy
Neuropathy
Nephropathy
What are the acute diabetic complications?
DKA (diabetic ketoacidosis)
HHNS (hyperosmolar hyperglycemic syndrome)
What are the conditions that characterize DKA (diabetic ketoacidosis)?
Hyperglycemia Ketones in the serum Acidosis Dehydration Electrolyte imbalnce
How many newly diagnosed type 1 diabetic patients also present DKA?
25 - 30%
How long is the duration of symptoms of DKA and HHNS?
DKA: < 2 days
HHNS: > 5 days
What is the average age of patients with DKA and the average age of patients with HHNS?
DKA: < 40 years old
HHNS: > 40 years old
What is the serum glucose level in patients with DKA and the serum glucose level in patients with HHNS?
DKA: < 600 mg/dL
HHNS: > 600 mg/dL
What is the screening recommendation concerning diabetes?
Patients 45 years and older are recommended to be screened every 3 years
What are prediabetic characteristics?
HbA1C of 5.7 - 6.4%
Fasting plasma glucose levels ≥ 100 mg/dL, but < 126 mg/dL
What are the nonpharmacologic treatment interventions for type 1 diabetes?
Needs insulin therapy
What are the nonpharmacologic treatment interventions for type 2 diabetes?
Weight loss Improved dietary habits Smoking cessation Reduced alcohol consumption Regular physical exercise
What are the glycemic goals of treatment of diabetes?
HbA1C < 7%
Fasting blood glucose goal for diabetic patients 70 - 130 mg/dL
Know estimated average glucose
What are the treatments for type 1 diabetes?
Insulin therapy
What are the treatments for type 2 diabetes?
Lifestyle changes
Oral drug therapy
Insulin when the above no longer provide glycemic control
What is the mechanism of action and drug effects of insulin?
Used as a substitute for endogenous insulin hormone
Restores diabetic patient’s ability to:
-Metabolize carbohydrates, fats, and proteins
-Store glucose in liver
-Convert glycogen to fat stores
What are the indications of insulin?
Type 1 and 2 diabetes
What are the interactions with insulin?
Corticosteroids, diuretics, thyroid drugs, nonselective beta blockers: interferes with insulin and can mask tachycardia from hypoglycemia
Hypoglycemic drugs: additive effects
What are the major classes of insulin?
Rapid-acting
Short-acting
Intermediate acting
Long acting
Which drugs are in the class of rapid-acting insulin?
Humalog
Novolog
Apidra
What is the onset of action of rapid-acting insulin?
5 - 15 minutes
What is the peak of rapid-acting insulin?
1 -2 hours
What is the duration of rapid-acting insulin?
3 - 5 hours
When can you administer rapid-acting insulin?
Patient must eat a meal right after injection
What is the route of administration for rapid-acting insulin?
SQ (subcutaneous)
SQ infusion pump
What is the appearance of insulin?
Clear
Which drugs are in the class of short-acting insulin?
Humulin R
Regular insulin
What is the route of administration for short-acting insulin?
IV bolus
IV infusion
IM (intramuscular)
SQ (subcutaneous)
What is the onset of action of short-acting insulin (SQ route)?
30 - 60 minutes
What is the peak of short-acting insulin (SQ route)?
2.5 hours
What is the duration of short-acting insulin (SQ route)?
6 - 10 hours
Which drugs are in the class of intermediate-acting insulin?
Insulin isophane suspension (NPH)
What is the appearance of intermediate-acting insulin?
Cloudy
What is the onset of action of intermediate-acting insulin?
1 - 2 hours
What is the peak of intermediate-acting insulin?
4 - 8 hours
What is the duration of intermediate-acting insulin?
10 - 18 hours
What is intermediate-acting insulin often combined with?
Regular insulin
Which drugs are in the class of long-acting insulins?
Insulin glargine (Lantus) Insulin detemir (Levemir)
What does Lantus do for the body?
Provides a constant level of insulin in the body
How often is Lantus (insulin glargine) administered to a patient?
Usually dosed once daily, but can be dosed every 12 hours
What is the onset of action of long-acting insulin?
1 - 2 hours
What is the peak of long-acting insulin?
None
What is the duration of Lantus (insulin glargine)?
24 hours
What is the duration of Levemir (insulin detemir)?
Duration of action is dose dependent
How often is Levemir (insulin detemir) administered to a patient?
Lower doses require twice-daily dosing
Higher doses may be given once daily
What are the indications of oral antidiabetic drugs?
Type 2 diabetes
What does effective treatment of type 2 diabetes require?
Lifestyle modifications
Careful monitoring of blood glucose levels
Therapy with one or more drugs
Treatment of associated comorbid conditions (e.g. high cholesterol, high blood pressure)
What does the 2015 ADA guidelines recommend on how to treat new-onset type 2 diabetes?
Lifestyle interventions and the oral biguanide drug metformin
If the above intervention does not reach HbA1C goals after 3 -6 months, additional treatment with a second oral agent should be added
Which drugs are biguanides?
Metformin (glucophage)
What is metformin used for?
First-line drug and most commonly used oral drug for treating type 2 diabetes
What is the mechanism of action of biguanides?
Decreases glucose production by the liver
May also decrease intestinal absorption of glucose and improve insulin receptor sensitivity
What are the indications of biguanides?
Newly diagnosed type 2 diabetes
What are the contraindications of biguanides?
Renal disease
Renal dysfunction
