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UNRS 113 > Antidiabetic Drugs > Flashcards

Antidiabetic Drugs Flashcards

1
Q

What is diabetes mellitus?

A

A disorder of carbohydrate metabolism that involves either a deficiency of insulin, a resistance of tissue to insulin, or both

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2
Q

What are the signs and symptoms of diabetes mellitus?

A 
Elevated fasting blood glucose (> 126 mg/dL)
Hemoglobin A1C ≥ 6.5%
Polyuria
Polydipsia
Polyphagia
Glycosuria
Unexplained weight loss
Fatigue
Blurred vision
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3
Q

What is polyuria?

A

Excessive production of urine

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4
Q

What is polydipsia?

A

Excessive thirst

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5
Q

What is polyphagia?

A

Excessive hunger

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6
Q

What is glycosuria?

A

Excessive sugar in urine

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7
Q

What is the normal range of blood sugar?

A

70 - 100

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8
Q

What is type 1 diabetes mellitus characterized by?

A

Lack of insulin production

Production of defective insulin

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9
Q

What kind of treatment do patients with type 1 diabetes need?

A

Exogenous insulin

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10
Q

How many cases of diabetes mellitus are type 1?

A

10%

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11
Q

What are the complications of type 1 diabetes?

A 
Diabetic ketoacidosis (DKA)
Hyperosmolar nonketotic syndrome (HHNS)
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12
Q

What is the function of insulin?

A

Lowers blood sugar levels by storying sugar in fat tissue, muscle, and liver to be used for energy later

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13
Q

What is the function of glucagon?

A

Increases blood sugar level by releasing glucose from fat tissue when needed for energy

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14
Q

How many cases of diabetes mellitus are type 2?

A

90%

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15
Q

What causes type 2 diabetes?

A

Insulin deficiency

Insulin resistance

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16
Q

What causes insulin resistance?

A

Reduced number of insulin receptors

Insulin receptors are less responsive or defective

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17
Q

What are comorbid conditions of type 2 diabetes?

A 
Obesity
Coronary heart disease
Dyslipidemia
Hypertension
Microalbuminemia
Increased risk for thrombotic events
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18
Q

What are the comorbidities of type 2 diabetes collectively called?

A

Metabolic syndrome

Syndrome X

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19
Q

What is gestational diabetes?

A

Hyperglycemia that develops during pregnancy

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20
Q

What can happen to 30% of patients who have had gestational diabetes?

A

May develop type 2 diabetes within 10 - 15 years

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21
Q

What are the major long-term complications of type 1 and 2 diabetes?

A

Macrovascular (atherosclerotic plaque)

Microvascular (capillary damage)

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22
Q

Which structures are involved in the macrovascular complication of diabetes?

A

Coronary arteries
Cerebral arteries
Peripheral vessels

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23
Q

Microvascular complication of diabetes include which conditions?

A

Retinopathy
Neuropathy
Nephropathy

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24
Q

What are the acute diabetic complications?

A

DKA (diabetic ketoacidosis)

HHNS (hyperosmolar hyperglycemic syndrome)

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25
Q

What are the conditions that characterize DKA (diabetic ketoacidosis)?

A 
Hyperglycemia
Ketones in the serum
Acidosis
Dehydration
Electrolyte imbalnce
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26
Q

How many newly diagnosed type 1 diabetic patients also present DKA?

A

25 - 30%

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27
Q

How long is the duration of symptoms of DKA and HHNS?

A

DKA: < 2 days
HHNS: > 5 days

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28
Q

What is the average age of patients with DKA and the average age of patients with HHNS?

A

DKA: < 40 years old
HHNS: > 40 years old

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29
Q

What is the serum glucose level in patients with DKA and the serum glucose level in patients with HHNS?

A

DKA: < 600 mg/dL
HHNS: > 600 mg/dL

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30
Q

What is the screening recommendation concerning diabetes?

A

Patients 45 years and older are recommended to be screened every 3 years

31
Q

What are prediabetic characteristics?

A

HbA1C of 5.7 - 6.4%

Fasting plasma glucose levels ≥ 100 mg/dL, but < 126 mg/dL

32
Q

What are the nonpharmacologic treatment interventions for type 1 diabetes?

A

Needs insulin therapy

33
Q

What are the nonpharmacologic treatment interventions for type 2 diabetes?

A 
Weight loss
Improved dietary habits
Smoking cessation
Reduced alcohol consumption
Regular physical exercise
34
Q

What are the glycemic goals of treatment of diabetes?

A

HbA1C < 7%
Fasting blood glucose goal for diabetic patients 70 - 130 mg/dL
Know estimated average glucose

35
Q

What are the treatments for type 1 diabetes?

A

Insulin therapy

36
Q

What are the treatments for type 2 diabetes?

A

Lifestyle changes
Oral drug therapy
Insulin when the above no longer provide glycemic control

37
Q

What is the mechanism of action and drug effects of insulin?

A

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

38
Q

What are the indications of insulin?

A

Type 1 and 2 diabetes

39
Q

What are the interactions with insulin?

A

Corticosteroids, diuretics, thyroid drugs, nonselective beta blockers: interferes with insulin and can mask tachycardia from hypoglycemia

Hypoglycemic drugs: additive effects

40
Q

What are the major classes of insulin?

A

Rapid-acting
Short-acting
Intermediate acting
Long acting

41
Q

Which drugs are in the class of rapid-acting insulin?

A

Humalog
Novolog
Apidra

42
Q

What is the onset of action of rapid-acting insulin?

A

5 - 15 minutes

43
Q

What is the peak of rapid-acting insulin?

A

1 -2 hours

44
Q

What is the duration of rapid-acting insulin?

A

3 - 5 hours

45
Q

When can you administer rapid-acting insulin?

A

Patient must eat a meal right after injection

46
Q

What is the route of administration for rapid-acting insulin?

A

SQ (subcutaneous)

SQ infusion pump

47
Q

What is the appearance of insulin?

A

Clear

48
Q

Which drugs are in the class of short-acting insulin?

A

Humulin R

Regular insulin

49
Q

What is the route of administration for short-acting insulin?

A

IV bolus
IV infusion
IM (intramuscular)
SQ (subcutaneous)

50
Q

What is the onset of action of short-acting insulin (SQ route)?

A

30 - 60 minutes

51
Q

What is the peak of short-acting insulin (SQ route)?

A

2.5 hours

52
Q

What is the duration of short-acting insulin (SQ route)?

A

6 - 10 hours

53
Q

Which drugs are in the class of intermediate-acting insulin?

A

Insulin isophane suspension (NPH)

54
Q

What is the appearance of intermediate-acting insulin?

A

Cloudy

55
Q

What is the onset of action of intermediate-acting insulin?

A

1 - 2 hours

56
Q

What is the peak of intermediate-acting insulin?

A

4 - 8 hours

57
Q

What is the duration of intermediate-acting insulin?

A

10 - 18 hours

58
Q

What is intermediate-acting insulin often combined with?

A

Regular insulin

59
Q

Which drugs are in the class of long-acting insulins?

A 
Insulin glargine (Lantus)
Insulin detemir (Levemir)
60
Q

What does Lantus do for the body?

A

Provides a constant level of insulin in the body

61
Q

How often is Lantus (insulin glargine) administered to a patient?

A

Usually dosed once daily, but can be dosed every 12 hours

62
Q

What is the onset of action of long-acting insulin?

A

1 - 2 hours

63
Q

What is the peak of long-acting insulin?

A

None

64
Q

What is the duration of Lantus (insulin glargine)?

A

24 hours

65
Q

What is the duration of Levemir (insulin detemir)?

A

Duration of action is dose dependent

66
Q

How often is Levemir (insulin detemir) administered to a patient?

A

Lower doses require twice-daily dosing

Higher doses may be given once daily

67
Q

What are the indications of oral antidiabetic drugs?

A

Type 2 diabetes

68
Q

What does effective treatment of type 2 diabetes require?

A

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)

69
Q

What does the 2015 ADA guidelines recommend on how to treat new-onset type 2 diabetes?

A

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

70
Q

Which drugs are biguanides?

A

Metformin (glucophage)

71
Q

What is metformin used for?

A

First-line drug and most commonly used oral drug for treating type 2 diabetes

72
Q

What is the mechanism of action of biguanides?

A

Decreases glucose production by the liver

May also decrease intestinal absorption of glucose and improve insulin receptor sensitivity

73
Q

What are the indications of biguanides?

A

Newly diagnosed type 2 diabetes

74
Q

What are the contraindications of biguanides?

A

Renal disease

Renal dysfunction

UNRS 113 (7 decks)

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