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Pharmacology > Antidiabetics > Flashcards

Antidiabetics Flashcards

1
Q

Types of diabetes mellitus

A

Type 1, type 2, secondary, gestational

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2
Q

Normal range for blood glucose

fasting

A

70-99 mg/dL

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3
Q

What is A1c?

A

representation of blood glucose levels over past three months

measures amount of glucose bound to RBC Hb

below 5.7% –> normal
5.7% - 6.4% –> prediabetic
≥ 6.5% –> diabetic (7.0% @ VA)

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4
Q

Difference between human insulin and human insulin analogs?

A

both duplicate effects of pancreatic insulin, but analogs have various available changes to onset and duration

Humalin, Novolin vs. lispro, aspart

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5
Q

Types of insulin

A

rapid, short, intermediate, long, combination

rapid and short are “clears”, intermediates are “cloudy”, longs are analogs, combos are NPH/regular (short)

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6
Q

What is the antidote to insulin?

A

Sugar

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7
Q

Rapid-acting insulin

A
  • Clear, subQ
  • lispro, aspart, glulisine, and oral inhalation

see individual cards for o/p/d of each

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8
Q

Insulin lispro

A

Onset 15-30 min, peak 30-90 min, duration 3-5 hr

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9
Q

Insulin aspart

A

Onset 10-20 min, peak 40-50 min, duration 3-5 hr

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10
Q

Insulin glulisine

A

Onset 20-30 min, peak 55 min, duration 1.5 hr

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11
Q

Oral inhalation insulin

A

Onset 12-15 min, peak 53 min, duration 2.5 hr

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12
Q

Short-acting insulin

A
  • Clear, subQ or IV
  • insulin regular

see individual card for o/p/d

only insulin that can be given IV

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13
Q

Insulin regular

A
  • SubQ: onset 30 min, peak 1.5-3.5 hr, duration 4-12 hr
  • IV: onset 15 min, peak 15-30 min, duration 2-6 hr
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14
Q

Intermediate-acting insulin

A
  • Cloudy, subQ
  • Insulin isophane NPH

see individual card for o/p/d

Cloudiness due to protamine (protein) additive to prolong action of insulin

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15
Q

Insulin isophane NPH

A

Onset 1.5 hr, peak 4-12 hr, duration 14-24 hr

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16
Q

Long-acting insulin

A
  • analogs, continuous, subQ, cannot be combined with any other type
  • glargine, detemir, degludec

often given at bedtime

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17
Q

Insulin glargine

A

Onset 1-1.5 hr, peak none, duration 24 hr

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18
Q

Insulin detemir

A

Onset 1-2 hr, peak 6-8 hr, duration 24 hr

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19
Q

Insulin degludec

A

Onset 1 hr, peak 12 hr, duration 42 hr

20
Q

Combination insulin

A
  • Combo of short/intermediate or rapid/intermediate, subQ
  • NPH 70/regular 30, NPH 50/regular 50
21
Q

Sliding-scale insulin

A
  • scale based on individual’s blood sugars, gives correlating insulin dose
  • allows for more coverage in times of stress/illness/meds/etc.
  • involves rapid or short acting insulin
22
Q

Hypoglycemia (insulin shock)

A
  • Symptoms: nervousness, tremors, lack of coordination, cold and clammy skin, headache, confusion
  • Treatment: oral sugar or D5 injection if airway is non-maintainable
23
Q

Somogyi effect

A

Rapid decrease in blood sugar in the predawn hours (2-4am) that stimulates a large hormonal surge to increase blood sugar, causing a rebound high

Managed by monitoring BG during those hours and reducing HS insulin

24
Q

Lipodystrophy

A

tissue changes caused by repeated injections at the same site

lipoatrophy (dimple), lipohypertrophy (lump)

prevented by rotating injection sites

25
Q

Dawn phenomenon

A
  • hyperglycemia upon awakening
  • symptoms: headache, night sweats, nightmares

Managed by increasing HS insulin

26
Q

Diabetic ketoacidosis

A

hyperglycemia and inability to metabolize sugars leads to catabolism of fatty acids subsequent accumulation of ketones

potassium unable to penetrate cells d/t increased sugar on cells, accumulation occurs and leads to cardiovascular issues

27
Q

What is the criteria for oral hypoglycemics?

A
  • Type 2 (must have a pancreas that makes some insulin)
  • onset at ≥40 years old
  • diagnosis <5 years
  • normal to overweight
  • fasting BG ≤200mg/dL
  • <40 units of insulin required today
  • normal renal and hepatic function
28
Q

8 for class

What are the classes of oral antidiabetics?

A

Sulfonylureas (1st & 2nd gen), biguanides, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, incretin modifiers, incretin mimetics, amylin analogues

see individual cards for specifics

29
Q

Sulfonylureas

A
30
Q

Biguanides

A
31
Q

Alpha-glucosidase inhibitors

A
32
Q

Thiazolidinediones

A
33
Q

Meglitinides

A
34
Q

Incretin modifiers

A
35
Q

Incretin mimetics

A
36
Q

Amylin analogues

A
37
Q

Hyperglycemic drugs

A

used to raise blood sugar

38
Q

Glucagon

A
  • hormone secreted by alpha cells in pancreas
  • increase BG by stimulating glycogenolysis and gluconeogenesis
  • used after insulin-induced hypoglycemia when other methods not available

takes 10 minutes for onset

39
Q

Diazoxide

A
  • increase BG by inhibiting insulin release from beta cells
  • stimulate release of epinephrine from adrenal medulla
  • used for chronic hypoglycemia caused by hyperinsulinism
  • not indicated for hypoglycemic reaction
40
Q

Which complementary/alternative therapy can lower insulin requirements?

A

Chromium

41
Q

Which complementary/alternative therapies can cause increased insulin levels and/or hypoglycemia?

w/ insulin and/or oral antibiotic drugs

9

A

Black cohosh, garlic, bitter melon, aloe, gymnema, ginseng, bilberry, hawthorn, ginko (if taken w/ glipizide)

42
Q

Which complementary/alternative therapies decrease the therapeutic effect of insulin and oral antidiabetics?

Cause hyperglycemia

A

Rosemary, stinging nettle

43
Q

Which complementary/alternative therapy may improve insulin sensitivity?

A

Milk thistle

44
Q

Which complementary/alternative therapy may enhance the effectiveness of metformin, increase pioglitazone levels, and decrease the effectiveness of tolbutamide?

A

Ginko

45
Q

Which complementary/alternative therapy may alter the metabolism of repaglinide and affect BG when taken with tolbutamide?

A

St. John’s wort

Pharmacology (15 decks)

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