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Pharm 201 > Chapter 44 > Flashcards

Chapter 44 Flashcards

1
Q

ACE inhibitors and insulin

A

increase sensitivity to insulin

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2
Q

Drugs that cause hyperglycemia

A

Phenytoin
Steroids
Diuretics

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3
Q

Drugs that cause hypoglycemia

A 
Lithium
ACE inhibitors (lisinopril)
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4
Q

A1C level in diabetes

A

> 6.5%

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5
Q

Insulin adverse effects

A

hypoglycemia

WT gain

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6
Q

Basal insulin (Long-acting)

A

given to all Type 1 and most Type 2 DM patients

ok if eating or not (Lantus/Glargine or NPH).

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7
Q

Nutritional or Pre-meal insulin or Prandial insulin

A

given with meals in anticipation of increased glucose load (scheduled Aspart or Lispro)

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8
Q

Correction or Supplemental insulin

A

Short acting insulin (Aspart or Lispro) given to cover high glucose level prior to meals

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9
Q

Insulin and contraceptives

A

↓FBS and insulin resistance

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10
Q

Humalog KwikPen

A

containing 3 mL (300 units) of U-100 insulin

prime with 2 units to a stream of insulin before each injection

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11
Q

DM common complications

A

neuropathy, nephropathy, retinopathy, vascular disease

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12
Q

sudden onset Hypoglycemia sx

A

Pale, cool skin
Tachycardia, palpitations,
Confusion, dizziness, shakiness
Sweating, moist skin

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13
Q

slow onset Hypoglycemia sx

A

Fatigue, weakness, HA, tremors

Causes: ↑ exercise ↑insulin, ↓ food intake

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14
Q

Hypoglycemia tx

A

15gm sugar
wait 15 min
15gm sugar

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15
Q

glucagon administration

A

can only give 1x/24 hours

do not give in liver disease as there are no glucose stores

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16
Q

Oral Antidiabetic Agents

A 
Sulfonylureas
Meglitinides (similar to sulfonyureas)
Biguanides
Thiazolidinediones (TZD)
Alpha-glucosidase Inhibitors
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17
Q

Sulfonylureas functions/teaching

A

Stimulate insulin from pancreas beta cells

Take same time each day

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18
Q

Sulfonylureas adverse effects

A

weight gain, hypoglycemia, heartburn, dizziness, HA, drowsiness, tremors, palpitations, sweating
drink ETOH =flushing, ↑ HR, nausea, blood dyscrasias, jaundice

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19
Q

Sulfonylureas ex

A

chlorpropamide (Diabinese), glyburide (Micronase, Diabeta), glimepiride (Amaryl), glipizide (Glucotrol)

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20
Q

Drug Interactions with Sulfonylureas causing hyperglycemia

A

Steroids
Estrogen
Thiazides
Epinephrine

21
Q

Drug Interactions with Sulfonylureas causing hypoglycemia

A

ETOH
Coumadin
ASA
Zantac (GERD)

22
Q

Meglitinides (Prandin) function

A

Stimulates mealtime insulin from pancreatic islet cells (similar to Sulfonylureas)

23
Q

Meglitinides (Prandin) teaching

A

take at the same time
must eat before taking
2-4 hour duration

24
Q

Meglitinides (Prandin) ending

A

ide

Ide rather have my pancreas secrete insulin

25
Q

Biguanide function

A

Prevents the liver from breaking down glycogen into glucose, ↑ tissue sensitivity to insulin
↑ glucose absorption in cells & lowers total & LDL cholesterol

26
Q

Biguanide example

A

Metformin (Glucophage) 1000 mg/day

27
Q

Biguanide adverse effects

A

flatulence, weakness, upset stomach

28
Q

Biguanide teaching

A

Ø wt gain or hypoglycemia, lactate = lactic acidosis in patients with impaired liver (or elderly)

29
Q

Thiazolidinediones (glitazones) function

A

Inhibit hepatic gluconeogenesis & ↓ insulin resistance

30
Q

Thiazolidinediones (glitazones) adverse effects

A

may cause cardiovascular event
HA, myalgia, anorexia, jaundice, dark urine
fluid retention, weight gain, Ø hypoglycemia- only with insulin/Sulfonylureas

31
Q

Thiazolidinediones (glitazones) dosing

A

Optimal ↓ing of blood glucose may take 3-4 months

32
Q

Thiazolidinediones (glitazones) contraindications

A 
liver failure (monitor LFT's)
HF
33
Q

Thiazolidinediones (glitazones) middle

A

azo

34
Q

Alpha-Glucosidase Inhibitors mechanism of action

A

delays CHO digestion

35
Q

Alpha-Glucosidase Inhibitors adverse effects

A

GI issues, liver impairment, hypoglycemia only with insulin/Sulfonylureas, tremors, palpitations, sweating

36
Q

Alpha-Glucosidase Inhibitors teaching

A

Garlic & ginseng may cause hypoglycemia

37
Q

Alpha-Glucosidase Inhibitors examples

A

Acarbose (Precose) & Miglitol (Glyset)

38
Q

Pramlintide (Symlin)

A

Amylin Analog
amylin missing in type 1
can be used in type 1 or 2

39
Q

Pramlintide (Symlin) mechanism of action

A

slows food absorption

decreases glucagon

40
Q

Pramlintide (Symlin) adverse effects

A

hypoglycemia, GI (N&V, abdominal pain, anorexia), dizziness, fatigue, HA

41
Q

Exenatide (Byetta)

A

Incretin Mimetic (GLP-1 Agonist)

42
Q

Exenatide (Byetta) mechanism of action

A

Enhance insulin secretion after release from the gut into the systemic circulation

43
Q

Exenatide (Byetta) adverse effects

A

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

44
Q

Exenatide (Byetta) dosing

A

Combine Metformin or Metformin & a sulfonylurea (↓ A1c by 0.4—0.9%)

45
Q

Exenatide (Byetta) beneficial effects

A

no appetite, wt loss

46
Q

Sitagliptin Phosphate (Januvia) mechanism of action

A

Blocks DPP-4 which wants to inactivate incretins (GLP-1)

47
Q

Sitagliptin Phosphate (Januvia) route

A

PO

1x daily

48
Q

Sitagliptin Phosphate (Januvia) adverse effects

A

nasopharyngitis, URI, HA, hypoglycemia with sulfonylurea & metformin, GI (abdominal pain, diarrhea), serious allergic reactions (anaphylactoid reactions, angioedema
Stevens-Johnson syndrome)

Pharm 201 (24 decks)

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