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Endo II > Antidiabetics, Insulin, + Incretins > Flashcards

Antidiabetics, Insulin, + Incretins Flashcards

1
Q

Insulin maintenance therapy

A
  • admin S.C.

- Afrezza inhalation

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2
Q

Hyperglycemia emergencies

A

IV regular insulin

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3
Q

Ultra-short insulins

A
  • Insulin lispro (Humalog)
  • Insulin aspart (Novolog)
  • Insulin glulisine (Apidra)
  • Inhaled Afrezza
  • Prior to meals for post-prandial glucose
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4
Q

Short-acting insulin

A
  • Regular insulin

- IV for DKA; SC for normal maintenance postprandial glucose

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5
Q

Intermediate acting insulin

A
  • NPH Insulin (Humilin/Novolin)
  • maintains fasting blood glucose levels
  • given w/ regular/ultrafast insulin
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6
Q

Long-acting insulin

A
  • insulin glargine (Lantus)
  • insulin detemir (Levemir)
  • insulin degludec (Tresiba)
  • Once-daily maintenance insulin levels
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7
Q

Long-lasting Combo

A
  • Insulin degludec/liraglutide
  • Fasting + Postprandial glucose levels
  • ONLY DMT2
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8
Q

Novolog 70/30 mix coverage

A
  • Covers Postprandial AND fasting
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9
Q

Insulin Drug interactions

A
  • B-Blockers: Reduce hyperglycemic action; inhibit GNG + Glycogenolysis
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10
Q

Which of the following statements is correct?
A. Insulin can be administered orally
B. Insulin is always required therapy in Type II diabetes
C. Protamine is added to insulin to decrease the rate of absorption of the hormone
D. Insulin is a steroid hormone
E. Insulin acts by binding to receptors in the nucleus of target tissues

A

C. Protamine is added to insulin to decrease the rate of absorption of the hormone

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11
Q

Insulin secretagogues

  • Mech
  • AE
  • Drug interactions
A
  • Sulfonylureas and
    Meglitinides
  • Stimulate the release of insulin from b-cells in the pancreas by closing K Channels causing membrane depolarization; inhibit alpha cell secretion of glucagon
  • AE: Hypoglycemia; Weight gain; N/V; Anemia
  • DI: Highly bound to plasma proteins; Sulfonamides, Salicylates, clofibrate, phenylbutazone
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12
Q

First-Generation Sulfonylureas

- Use

A
  • Tolbutamide; Tolazamide; Chlorpropamide

- Fasting + Postprandial hyperglycemia

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13
Q

Tolbutamide Duration + Breakdown

A
  • Short (6-10 H)

- rapidly oxidized in liver -> Safest for geriatric diabetes

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14
Q

Tolazamide DOA

A

intermediate 10-14 H

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15
Q

Chlorpropamide

  • DOA
  • PK
  • Contra
A
  • DOA: Slow; 48-60 H
  • PK: slowly metabolized in liver; 25% excreted in urine unchanged
  • Contra: elderly + hepatic/renal insufficiency
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16
Q

Second Generation Sulfonylureas

  • Use
  • Caution
A
  • Glipizide (XR), Glimepiride
  • Use: Fasting + Postprandial;
  • Caution: Elderly + CV
17
Q

Meglitinides

- use

A
  • Repaglinide
  • Nateglinide
  • Postprandial hyperglycemia
18
Q

Biguanide

  • MOA
  • Use
  • PK
  • AE
  • Contra
A
  • Metformin
  • does not involve b-cells; DEC hepatic GNG; DEC Glucose absorption
  • Fasting + Postprandial
  • Dur 10-12H; Excreted by kidneys unchanged
  • GI disturbance; Lactic Acidosis
  • Contra: Renal/hepatic Dx
19
Q

Thiazolidinediones

  • MOA
  • USE
  • AE
A
  • Pioglitazone; Rosiglitazone
  • MOA: Stimulate PPAR-y-receptor; INC sensitivity to insulin
  • Use: Fasting and post-postprandial
  • SE: Anemia, Edema, HF, + MI
20
Q

a-Glucosidase Inhibitors

  • MOA
  • Use
  • AE
A
  • Acarbose; Miglitol
  • inhibitors of a-glucosidase; delay absorption of Carbs
  • Post-prandial
  • AE: GI effects
21
Q

Incretin Mimetics

  • MOA
  • AE
  • Use
A
  • Exenatide
  • Liraglutide
  • Dulaglutide
  • Semaglutide
  • Lixisenatide
  • Use: Post-prandial + Basal glucose
  • INC insulin; Inhibit glucagon
  • AE: Hypoglycemial Pancratitis + P-Cancer??
22
Q

Which Incretin Mimetic is only for postprandial hyperglycemia?

A

Exenatide (Byetta)

23
Q

Dipeptidyl Peptidase-4 Inhibitors

  • MOA
  • AE
A

▪Sitagliptin (Januvia)
▪Saxagliptin (Onglyza)
▪Linagliptin (Tradjenta)
▪Alogliptin (Nesina)
- MOA: Inhibits DPP-4 -> INC Insulin release; inhibits glucagon
- AE: Upper RTI, Headache, Pancreatitis, Hypoglycemia, Allergic rxn, Lymphopenia

24
Q

Sodium-Glucose Co-Transporter 2 Inhibitors

  • MOA
  • AE
A 
▪Canagliflozin (Invokana)
▪Dapagliflozin (Farxiga)
▪Empagliflozin (Jardiance)
▪Ertugliflozin (Steglatro)
- MOA: Inhibits sodium-glucose co-transporter 2; Decreases renal glucose reabsorption
- AE: Hypoglycemia; Ketoacidosis
25
Q

Biggest Goal of Diabetes management

A
  • Reduces risk of vascular complications
26
Q

Cardiac effects glucagon

A
  • ionotrope

- chronotrope via INC cAMP

27
Q

Clinical use Glucagon

A
  • Severe hypoglycemia
  • Radiology of Bowel
  • B-blocker poisoning

Endo II (18 decks)

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