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Pharmacology II > Ch 35 Diabetes > Flashcards

Ch 35 Diabetes Flashcards

1
Q

insulin aspart (novolog)

A
  • rapid acting
  • mealtime insulin
  • onset: 10-20 min
  • peak: 40-50 min
  • duration: 3-5 hr
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2
Q

insulin lispro (humalog)

A
  • rapid acting
  • mealtime insulin
  • onset: 15-30 min
  • peak: 30-90 min
  • duration: 3-5 hr
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3
Q

insulin glulisine (apidra)

A
  • rapid acting
  • mealtime insulin
  • onset: 20-30 min
  • peak: 30-90 min
  • duration: 1-2.5 hr
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4
Q

regular insulin (humulin-R, novolin-R)

A
  • short acting
  • drug of choice IV treatment for DKA
  • onset: 30-60 min
  • peak: 2-5 hr
  • duration: 5-8 hr
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5
Q

insulin NPH (humulin-N, novolin-N)

A
  • intermediate acting
  • lower cost option for basal but has to be taken twice a day
  • erratic absorption and interpatient variability
  • onset: 1-2 hr
  • peak: 4-12 hr
  • duration: 18-24 hr
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6
Q

insulin glargine (lantus)

A
  • long acting
  • basal levels for glycemic control throughout the day
  • onset: 1-1.5 hr
  • peak: none
  • duration: 20-24 hr
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7
Q

insulin detemir (levemir)

A
  • long acting
  • basal levels for glycemic control throughout the day
  • onset: 1-2 hr
  • peak: 6-8 hr
  • duration: up to 24 hr
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8
Q

insulin degludec (tresiba)

A
  • long acting
  • basal levels for glycemic control throughout the day
  • onset: 1-2 hr
  • peak: none
  • duration: >24 hr
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9
Q

inhaled insulin

A
  • rapid onset
  • 5-10 hr duration
  • alternative route of administration to injection
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10
Q

glipizide (glucotrol)

A
  • sulfonylurea
  • increase insulin secretion
  • may decrease insulin resistance
  • used in combination with metformin
  • begin with daily low dose and increase until either glycemic control, AE too much, or max dose
  • AE: hematological reactions, cholestasis, N/V, rashes
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11
Q

glimepiride (amaryl)

A
  • sulfonylurea
  • increase insulin secretion
  • may decrease insulin resistance
  • used in combination with metformin
  • begin with daily low dose and increase until either glycemic control, AE too much, or max dose
  • AE: hematological reactions, cholestasis, N/V, rashes
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12
Q

glyburide (diabeta)

A
  • sulfonylurea
  • increase insulin secretion
  • may decrease insulin resistance
  • used in combination with metformin
  • begin with daily low dose and increase until either glycemic control, AE too much, or max dose
  • AE: hematological reactions, cholestasis, N/V, rashes
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13
Q

repaglinide (prandin)

A
  • meglitinide
  • increase insulin release
  • can be combined with metformin but no other antidiabetic or insulin
  • 1st line for type 2
  • intended to be taken before meals
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14
Q

nateglinide (starlix)

A
  • meglitinide
  • increase insulin release
  • can be combined with metformin but no other antidiabetic or insulin
  • 1st line for type 2
  • intended to be taken before meals
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15
Q

acarbose (precose)

A
  • antihyperglycemic
  • inhibits glucosidase which is required to breakdown complex sugars
  • decreases glucose absorption and postprandial glucose levels
  • taken with meals
  • lower impact on HgB A1C
  • hypoglycemia needs to be treated with glucose, not sucrose
  • AE: flatulence, abd bloating
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16
Q

miglitol (glyset)

A
  • antihyperglycemic
  • inhibits glucosidase which is required to breakdown complex sugars
  • decreases glucose absorption and postprandial glucose levels
  • taken with meals
  • lower impact on HgB A1C
  • hypoglycemia needs to be treated with glucose, not sucrose
  • AE: flatulence, abd bloating
17
Q

metformin (glucophage)

A
  • antihyperglycemic by reducing the number and affinity of insulin receptors
  • DOC 1st for type 2
  • positive effect on plasma lipids
  • AE: diarrhea, lactic acidosis
  • contraindicated for GFR <30
18
Q

pioglitazone (actos)

A
  • antihyperglycemic
  • increase insulin sensitivity and decrease insulin resistance
  • suppress hepatic glucose output
  • effect takes 4-6 weeks
  • AE: edema, increase plasma volume, increase HF, MI, CVA risk
  • may raise bladder cancer incidence
19
Q

pramlintide (symlin)

A
  • rarely used
  • analogue of amylin which blunts postpandrial glycemia
  • used in type 1 and 2 treated with insulin
  • given SQ at mealtimes
  • co dosing with insulin increases hypoglycemia
  • AE: N/V, anorexia, headache
20
Q

exenatide (byetta)

A
  • GLP 1 agonist
  • stimulate glucose dependent insulin secretion in response to GI glucose intake
  • increase glucose uptake by muscle and adipose
  • decrease glucagon secretion
  • slow gastric emptying, increase satiety, decrease food intake
  • 2nd or 3rd line for type 2 (can be combined with sulfonylurea/metformin)
  • preferred to insulin as add on due to better A1C reduction and lack of weight gain
  • AE: nausea, pancreatitis
21
Q

liraglutide (victoza)

A
  • GLP 1 agonist
  • stimulate glucose dependent insulin secretion in response to GI glucose intake
  • increase glucose uptake by muscle and adipose
  • decrease glucagon secretion
  • slow gastric emptying, increase satiety, decrease food intake
  • 2nd or 3rd line for type 2 (can be combined with sulfonylurea/metformin)
  • preferred to insulin as add on due to better A1C reduction and lack of weight gain
  • AE: nausea, pancreatitis
  • linked to thyroid CA in animals
22
Q

lixisenatide (adlyxin)

A
  • GLP 1 agonist
  • stimulate glucose dependent insulin secretion in response to GI glucose intake
  • increase glucose uptake by muscle and adipose
  • decrease glucagon secretion
  • slow gastric emptying, increase satiety, decrease food intake
  • 2nd or 3rd line for type 2 (can be combined with sulfonylurea/metformin)
  • preferred to insulin as add on due to better A1C reduction and lack of weight gain
  • AE: nausea, pancreatitis
23
Q

dulaglutide (trulicity)

A
  • GLP 1 agonist
  • stimulate glucose dependent insulin secretion in response to GI glucose intake
  • increase glucose uptake by muscle and adipose
  • decrease glucagon secretion
  • slow gastric emptying, increase satiety, decrease food intake
  • 2nd or 3rd line for type 2 (can be combined with sulfonylurea/metformin)
  • preferred to insulin as add on due to better A1C reduction and lack of weight gain
  • AE: nausea, pancreatitis
24
Q

semaglutide (ozempic)

A
  • GLP 1 agonist
  • stimulate glucose dependent insulin secretion in response to GI glucose intake
  • increase glucose uptake by muscle and adipose
  • decrease glucagon secretion
  • slow gastric emptying, increase satiety, decrease food intake
  • 2nd or 3rd line for type 2 (can be combined with sulfonylurea/metformin)
  • preferred to insulin as add on due to better A1C reduction and lack of weight gain
  • AE: nausea, pancreatitis
25
Q

sitagliptin (januvia)

A
  • DPP 4 inhibitor
  • inhibits the enzyme that breaks down DPP-4
  • can be used as initial monotherapy for type 2, but metformin still preferred
  • no hypoglycemia or GI effect
  • safe in renal insufficiency
  • well suited for older or frail
26
Q

linagliptan (tradjenta)

A
  • DPP 4 inhibitor
  • inhibits the enzyme that breaks down GLP-1
  • can be used as initial monotherapy for type 2, but metformin still preferred
  • no hypoglycemia or GI effect
  • safe in renal insufficiency
  • well suited for older or frail
27
Q

saxagliptin (onglyza)

A
  • DPP 4 inhibitor
  • inhibits the enzyme that breaks down GLP-1
  • can be used as initial monotherapy for type 2, but metformin still preferred
  • no hypoglycemia or GI effect
  • safe in renal insufficiency
  • well suited for older or frail
28
Q

alogliptin (nesina)

A
  • DPP 4 inhibitor
  • inhibits the enzyme that breaks down GLP-1
  • can be used as initial monotherapy for type 2, but metformin still preferred
  • no hypoglycemia or GI effect
  • safe in renal insufficiency
  • well suited for older or frail
29
Q

bromocriptine (cycloset)

A
  • not part of diabetes assoc recommendation
  • rarely used
  • D2 agonist that may improve insulin resistance
30
Q

canagliflozin (invokana)

A
  • SGLT2 inhibitor
  • reduce reabsorption of filtered glucose in renal tubule
  • not to be used with GFR <50
  • tend to lower BP and promote weight loss
  • not as effective to reduce A1C
  • AE: UTI, yeast infection, osmotic diuresis, dehydration, acute renal injury, osteoporosis/fractures
31
Q

dapagliflozin (farxiga)

A
  • SGLT2 inhibitor
  • reduce reabsorption of filtered glucose in renal tubule
  • not to be used with GFR <50
  • tend to lower BP and promote weight loss
  • not as effective to reduce A1C
  • AE: UTI, yeast infection, osmotic diuresis, dehydration, acute renal injury, osteoporosis/fractures
32
Q

empagliflozin (jardiance)

A
  • SGLT2 inhibitor
  • reduce reabsorption of filtered glucose in renal tubule
  • not to be used with GFR <50
  • tend to lower BP and promote weight loss
  • not as effective to reduce A1C
  • AE: UTI, yeast infection, osmotic diuresis, dehydration, acute renal injury, osteoporosis/fractures
33
Q

ertugliflozin (steglatro)

A
  • SGLT2 inhibitor
  • reduce reabsorption of filtered glucose in renal tubule
  • not to be used with GFR <50
  • tend to lower BP and promote weight loss
  • not as effective to reduce A1C
  • AE: UTI, yeast infection, osmotic diuresis, dehydration, acute renal injury, osteoporosis/fractures

Pharmacology II (19 decks)

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