AX Presentation (Antidiabetic) Flashcards
what is the mechanism of action for Glipizide(2)?
- stimulates pancreatic islet cells which causes them to create more insulin
- increases sensitivity to insulin at receptor sites
describe absorption of Glipizide
1) rapidly and completely absorbed in the GI tract
2) absorption unaffected by food but causes it to be delayed by 40 minutes
describe metabolism of glipizide
may be slowed in patients with renal impairment and renal failure
describe excretion of glipizide
may be slowed in patients with renal impairment and renal failure
what are the indications for glipizide?
type 2 diabetes mellitus
what are the contraindications associated with glipizide?
1) diabetic ketoacidosis
2) sulfonamide sensitivity
what is the drug class/action of glipizide?
- antidiabetic agent; blood glucose lowering agent
- alimentary tract and metabolism
what is the class/action of NPH/isophane insulin(3)?
- antidiabetic agent (insulin and analogs)
- alimentary tract and metabolism
- intermediate-acting and short-acting human insulin and analog combination
what is the mechanism of action for NPH insulin?
- exogenous insulin that functions as a substitute for the endogenous hormone
lowers blood glucose by:
- stimulating glucose uptake in the skeletal muscle and fat
- inhibiting hepatic glucose production
- inhibition of lipolysis and proteolysis
- enhanced protein synthesis
what is the therapeutic effect of NPH insulin?
control of hyperglycemia in diabetic patients
what are the indications for NPH insulin(2)?
1) diabetes type 1
2) diabetes type 2
what are the contraindications associated with NPH insulin?
hypoglycemia
describe the absorption of NPH insulin
slower onset and longer duration of action than regular insulin, but not as long as the long-acting insulins
what is the metabolism of NPH insulin?
metabolized by the liver, kidneys, spleen, and muscle
describe the distribution of NPH insulin
identical to endogenous insulin
what are some side effects of NPH insulin(8)?
1) hypoglycemia (can be life-threatening)
2) hypokalemia
3) cutaneous amyloidosis
4) erythema
6) lipodystrophy
7) pruritis
8) swelling
what are some side effects of glipizide(8)?
1) photosensitivity
2) rash
3) hypoglycemia
4) hyponatremia
5) constipation
6) cramps
7) thrombocytopenia
8) dizziness
what is the class of glucagon?
- pancreatic hormones
what is the mechanism of action for glucagon?
1) activates hepatic glucagon receptors which promotes glycogen breakdown in the liver
* releases glucose and increases blood glucose within minutes
2) relaxes smooth muscles in the gastrointestinal tract (temporarily inhibits peristalsis)
what are the therapeutic effects of glucagon?
1) increases blood glucose levels
2) relaxation of GI musculature, facilitating radiographic examination
what are the indications for glucagon?
1) acute management of hypoglycemia
2) facilitation of radiographic examination
3) betablocker overdose
4) calcium channel blocker overdose
describe the absorption of glucagon
well absorbed following IM, intranasal, and SUBQ administration.
- IV maximal glucose concentration: 5-20 minutes
- IM maximal glucose concentration: 30 minutes
- SUBQ maximal glucose concentration: 30-45 minutes
- intranasal maximal glucose concentration: 15 minutes
describe the distribution of glucagon
extensively distributed to tissues
describe the metabolism of glucagon
extensively degraded by the liver, kidneys, and plasma
what is the half-life values (plasma, intranasal, and IM) for glucagon?
- plasma half-life: 8-18 minutes
- intranasal half-life: 35 minutes
- IM injection half-life: 45 minutes
what are the side effects/adverse reactions of glucagon(8)?
1) epistaxis
2) red/itchy/watery eyes
3) itchy throat
4) nasal congestion
5) rhinorrhea
6) sneezing
7) headache
8) cough
what is the class/action of insulin glargine (Lantus)
- alimentary tract and metabolism
- antidiabetic agents
- long-acting human insulin and analogs
what is the mechanism of action of insulin glargine (Lantus)?
- binds to insulin receptors stimulating glucose uptake in muscles and adipose tissue and inhibits hepatic glucose production
- regulates fat metabolism
- regulates protein metabolism
describe the absorption of insulin glargine (Lantus)
more stable in acidic conditions
what is the onset and duration of action with insulin glargine (Lantus)?
onset: 1-2 hours
duration of action: 24 hours
describe the metabolism of insulin glargine (Lantus)
1) metabolized primarily in the liver
2) 2 metabolites are formed M1 and M2
describe the excretion of insulin glargine (Lantus)
- primarily in kidneys
- can be excreted in breast milk
what is the half-life of insulin glargine (Lantus)?
unknown
what are the indications for insulin glargine(Lantus)?
1) gestational diabetes
2) neonatal diabetes
3) type 1 diabetes
4) type 2 diabetes when lifestyle mods are insufficient
what is the mechanism of action with regular insulin?
facilitates the uptake of glucose in muscle and adipose tisssue and inhibits hepatic glucose production
what is the routes of regular insulin?
can be SUBQ or IV
describe the IV onset and duration of action and peak of regular insulin
onset: 15 minutes
peak: 15-30 minutes
duration of action: 30-60 minutes
describe the onset and peak of regular insulin administered SUBQ
onset: begins approx. 30 minutes after injection
peak: 1.5-3.5 hours
when is it best to administer regular insulin?
30 minutes before meal
describe the metabolism of regular insulin
metabolized by liver, kidneys, and peripheral tissues
how is regular insulin excreted?
mostly by the kidneys
what are the indication for regular insulin?
1) diabetic ketoacidosis
2) type 1 diabetes
3) type 2 diabetes
4) gestational diabetes
5) neonatal diabetes
what are the contraindications for regular insulin?
hypoglycemia
what are acting lengths of regular, NPH, and lantus?
regular insulin - short acting
NPH - intermediate
Glargine (Lantus) - long acting
describe the frequency of NPH, regular, and glargine
regular - with meals
NPH - 2 times daily BID
Lantus - daily QD
which insulins can be administered IV?
regular insulin only. lantus and NPH need to be administered SUBQ
which insulins are high alert medications?
regular, lantus, and NPH
