Chapter 44 Flashcards
ACE inhibitors and insulin
increase sensitivity to insulin
Drugs that cause hyperglycemia
Phenytoin
Steroids
Diuretics
Drugs that cause hypoglycemia
Lithium ACE inhibitors (lisinopril)
A1C level in diabetes
> 6.5%
Insulin adverse effects
hypoglycemia
WT gain
Basal insulin (Long-acting)
given to all Type 1 and most Type 2 DM patients
ok if eating or not (Lantus/Glargine or NPH).
Nutritional or Pre-meal insulin or Prandial insulin
given with meals in anticipation of increased glucose load (scheduled Aspart or Lispro)
Correction or Supplemental insulin
Short acting insulin (Aspart or Lispro) given to cover high glucose level prior to meals
Insulin and contraceptives
↓FBS and insulin resistance
Humalog KwikPen
containing 3 mL (300 units) of U-100 insulin
prime with 2 units to a stream of insulin before each injection
DM common complications
neuropathy, nephropathy, retinopathy, vascular disease
sudden onset Hypoglycemia sx
Pale, cool skin
Tachycardia, palpitations,
Confusion, dizziness, shakiness
Sweating, moist skin
slow onset Hypoglycemia sx
Fatigue, weakness, HA, tremors
Causes: ↑ exercise ↑insulin, ↓ food intake
Hypoglycemia tx
15gm sugar
wait 15 min
15gm sugar
glucagon administration
can only give 1x/24 hours
do not give in liver disease as there are no glucose stores
Oral Antidiabetic Agents
Sulfonylureas Meglitinides (similar to sulfonyureas) Biguanides Thiazolidinediones (TZD) Alpha-glucosidase Inhibitors
Sulfonylureas functions/teaching
Stimulate insulin from pancreas beta cells
Take same time each day
Sulfonylureas adverse effects
weight gain, hypoglycemia, heartburn, dizziness, HA, drowsiness, tremors, palpitations, sweating
drink ETOH =flushing, ↑ HR, nausea, blood dyscrasias, jaundice
Sulfonylureas ex
chlorpropamide (Diabinese), glyburide (Micronase, Diabeta), glimepiride (Amaryl), glipizide (Glucotrol)
Drug Interactions with Sulfonylureas causing hyperglycemia
Steroids
Estrogen
Thiazides
Epinephrine
Drug Interactions with Sulfonylureas causing hypoglycemia
ETOH
Coumadin
ASA
Zantac (GERD)
Meglitinides (Prandin) function
Stimulates mealtime insulin from pancreatic islet cells (similar to Sulfonylureas)
Meglitinides (Prandin) teaching
take at the same time
must eat before taking
2-4 hour duration
Meglitinides (Prandin) ending
ide
Ide rather have my pancreas secrete insulin
Biguanide function
Prevents the liver from breaking down glycogen into glucose, ↑ tissue sensitivity to insulin
↑ glucose absorption in cells & lowers total & LDL cholesterol
Biguanide example
Metformin (Glucophage) 1000 mg/day
Biguanide adverse effects
flatulence, weakness, upset stomach
Biguanide teaching
Ø wt gain or hypoglycemia, lactate = lactic acidosis in patients with impaired liver (or elderly)
Thiazolidinediones (glitazones) function
Inhibit hepatic gluconeogenesis & ↓ insulin resistance
Thiazolidinediones (glitazones) adverse effects
may cause cardiovascular event
HA, myalgia, anorexia, jaundice, dark urine
fluid retention, weight gain, Ø hypoglycemia- only with insulin/Sulfonylureas
Thiazolidinediones (glitazones) dosing
Optimal ↓ing of blood glucose may take 3-4 months
Thiazolidinediones (glitazones) contraindications
liver failure (monitor LFT's) HF
Thiazolidinediones (glitazones) middle
azo
Alpha-Glucosidase Inhibitors mechanism of action
delays CHO digestion
Alpha-Glucosidase Inhibitors adverse effects
GI issues, liver impairment, hypoglycemia only with insulin/Sulfonylureas, tremors, palpitations, sweating
Alpha-Glucosidase Inhibitors teaching
Garlic & ginseng may cause hypoglycemia
Alpha-Glucosidase Inhibitors examples
Acarbose (Precose) & Miglitol (Glyset)
Pramlintide (Symlin)
Amylin Analog
amylin missing in type 1
can be used in type 1 or 2
Pramlintide (Symlin) mechanism of action
slows food absorption
decreases glucagon
Pramlintide (Symlin) adverse effects
hypoglycemia, GI (N&V, abdominal pain, anorexia), dizziness, fatigue, HA
Exenatide (Byetta)
Incretin Mimetic (GLP-1 Agonist)
Exenatide (Byetta) mechanism of action
Enhance insulin secretion after release from the gut into the systemic circulation
Exenatide (Byetta) adverse effects
hypoglycemia (↑ incidence with other agents), GI (N/V/D, anorexia), pancreatitis, dizziness HA, injection site reactions, antibody formation
do not give if hx of pancreatitis
Exenatide (Byetta) dosing
Combine Metformin or Metformin & a sulfonylurea (↓ A1c by 0.4—0.9%)
Exenatide (Byetta) beneficial effects
no appetite, wt loss
Sitagliptin Phosphate (Januvia) mechanism of action
Blocks DPP-4 which wants to inactivate incretins (GLP-1)
Sitagliptin Phosphate (Januvia) route
PO
1x daily
Sitagliptin Phosphate (Januvia) adverse effects
nasopharyngitis, URI, HA, hypoglycemia with sulfonylurea & metformin, GI (abdominal pain, diarrhea), serious allergic reactions (anaphylactoid reactions, angioedema
Stevens-Johnson syndrome)
