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
2
Q
insulin lispro (humalog)
A
- rapid acting
- mealtime insulin
- onset: 15-30 min
- peak: 30-90 min
- duration: 3-5 hr
3
Q
insulin glulisine (apidra)
A
- rapid acting
- mealtime insulin
- onset: 20-30 min
- peak: 30-90 min
- duration: 1-2.5 hr
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
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
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
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
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
9
Q
inhaled insulin
A
- rapid onset
- 5-10 hr duration
- alternative route of administration to injection
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
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
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
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
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
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
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
sitagliptin (januvia)
- 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
linagliptan (tradjenta)
- 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
saxagliptin (onglyza)
- 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
alogliptin (nesina)
- 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
bromocriptine (cycloset)
- not part of diabetes assoc recommendation
- rarely used
- D2 agonist that may improve insulin resistance
30
canagliflozin (invokana)
- 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
dapagliflozin (farxiga)
- 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
empagliflozin (jardiance)
- 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
ertugliflozin (steglatro)
- 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
