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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 60 - Drugs for Diabetes Mellitus > Flashcards

Chapter 60 - Drugs for Diabetes Mellitus Flashcards

1
Q

Diabetes poses risk for:

A

-heart attack
-stroke
-kidney failure
-blindness
-leg and foot amputations

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2
Q

When does T1DM develop?

A

during childhood or adolescence (maybe adulthood)

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3
Q

What % of DM cases are T1?

A

5%

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4
Q

What is the primary defect in T1DM?

A

destruction of pancreatic BETA cells due to an AUTOIMMUNE process

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5
Q

What group is currently facing the largest growth of T2DM cases?

A

indigenous people

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6
Q

What is the primary defect of T2DM?

A

insulin resistance and impaired insulin secretion

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7
Q

T2DM is linked to ________ and __________

A

weight gain and obesity

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8
Q

What are short-term diabetes complications?

A

-hyperglycemia
-ketoacidosis
-hypoglycemia

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9
Q

What are long-term diabetes complications?

A

-macrovascular damage (heart disease, htn, stroke)
-microvascular damage (retinopathy, nephropathy, sensory/motor neuropathy, gastroparesis, amputation, erectile dysfunction)

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10
Q

What does the placenta produce that can enhance diabetes in pregnant women?

A

hormones that antagonize insulin action

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11
Q

Why is diabetes during pregnancy dangerous?

A

affects mom and can be teratogenic

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12
Q

How do you treat diabetes during pregnancy?

A

-monitor BG levels
-adjust insulin and food intake

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13
Q

How is gestational diabetes (developed during pregnancy) treated?

A

-monitor BG
-control diet
-insulin (prevent birth defects)

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14
Q

____% of gestational diabetes patients develop T2DM within 10-15 years.

A

30%

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15
Q

Women who give birth to babies >___ lbs are at greater risk of developing diabetes later on.

A

9

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16
Q

What does the hemoglobinA1C test show?

A

-average blood sugar level for past 2-3mo
-% of Hb coated with sugar

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17
Q

What is the A1C goal for diabetics?

A

<7%

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18
Q

What is a normal A1C?

A

6%

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19
Q

What is a good A1C for frail elderly folks?

A

<8.5%

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20
Q

What tests are based on glucose?

A

-fasting PG
-random PG
-oral glucose tolerance test

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21
Q

What is prediabetes?

A

a state that places an individual at high risk of developing diabetes

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22
Q

What are the criteria for prediabetes?

A

-impaired FG
-impaired GT
-A1C 6.0-6.4%

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23
Q

What are the criteria for DIAGNOSING diabetes?

A

-FPG >7.0 mmol/L
-A1C >6.5%
-2hPG in a 75g OGTT >11.1 mmol/L
-random PG >11.1 mmol/L

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24
Q

What is a good diet for T1DM?

A

-maintaining glycemic index
-eat higher-glycemic-load food

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25
Q

What drugs reduce risk for diabetic nephropathy?

A

ACEI or ARB

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26
Q

What drugs are used for dyslipidemia?

A

statins

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27
Q

What is the time target to achieve A1C levels with T2DM?

A

by 3 months

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28
Q

What is step 1 in T2DM management?

A

lifestyle then add metformin

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29
Q

What is step 2 in T2DM management?

A

lifestyle, metformin, + another drug

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30
Q

What is step 3 in T2DM management?

A

add another drug (maybe insulin)

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31
Q

What is step 4 in T2DM management?

A

add insulin

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32
Q

What drug should be added to T2DM pts with CV dx?

A

SGLT2 inhibitor with CV benefits

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33
Q

What number indicates hypoglycemia?

A

below 2.8 mmol/L

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34
Q

What are the early symptoms of hypoglycemia?

A

-confusion
-irritability
-tremor
-sweating

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35
Q

What are the later symptoms of hypoglycemia?

A

-hypothermia
-seizures
-coma
-death

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36
Q

IV 50% dextrose in water is used to __________ BG

A

elevate

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37
Q

What is an injection used to elevate BG?

A

glucagon

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38
Q

What are the ae of glucagon injection?

A

N&V

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39
Q

Who is an exception and has a higher A1C goal?

A

-limited life expectancy
-frail elderly
-end of life

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40
Q

Lispro, aspart, and glulisine are all what type of insulin?

A

short duration: rapid acting

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41
Q

Regulin insulin (humulin R) is what type of insulin?

A

short duration: short acting

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42
Q

nph insulin (Humulin N) and mixed insulin are what type of insulin?

A

intermediate duration and acting

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43
Q

Glargine and detemir are what type of insulin?

A

long duration: long acting

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44
Q

Insulin degludec has the longest duration of ____h

A

24

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45
Q

What is the onset of Lispro?

A

15-30 min after SubQ injection

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46
Q

What is the duration of Lispro?

A

3-6hrs

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47
Q

When should Lispro be injected relative to food?

A

-5-10 mins before food or 20mins after

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48
Q

Can you mix lispro with NPH insulin?

A

yes only if used immediately

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49
Q

What is the onset of gluslisine?

A

10-30 mins

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50
Q

How long does glulisine last?

A

3-5hrs

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51
Q

Can you mix glulisine with other insulin?

A

NO

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52
Q

What is the onset of humulin R?

A

30-60mins

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53
Q

How long does humulin R last?

A

up to 10hrs

54
Q

What is NPH (humulin N) insulin used for?

A

glycemic control between meals and overnight (injected 2-3x daily)

55
Q

Which is the only insulin that can be mixed with short-acting insulin?

A

NPH (humulin N)

56
Q

What is special to note about NPH/humulin N?

A

it is a cloudy suspension that must be rolled before administration

57
Q

What is the duration of glargine insulin?

A

20-24hrs

58
Q

Does glargine insulin have a peak?

A

no

59
Q

Why does glargine insulin have pain at the injection site?

A

it has an acidic pH

60
Q

What is the duration of detemir insulin?

A

16-24hrs

61
Q

Detemir and degludec insulin shouldn’t be given ___

A

IV or mixed

62
Q

What is the duration of degludec insulin?

A

12-42 hrs

63
Q

What is the MOA of icodec insulin (ultra-long acting)?

A

binds reversibly to albumin in circulation and is released slowly

64
Q

What must icodec be mixed with?

A

rapid or short acting insulin to cover mealtime requirements

65
Q

ICODEC can be combined with…

A

oral T2DM agents

66
Q

What are the adverse effects of ultra-long acting ICODEC?

A

-hypoglycemia
-weight gain
-peripheral edema
-injection site rxn

67
Q

How often is icodec administered?

A

weekly

68
Q

Can you mix long-acting insulins?

A

no

69
Q

Do you draw up short or long acting insulin first?

A

shortest

70
Q

Insulin is measured in ________

A

units

71
Q

Insulin requires a _________

A

double signature

72
Q

All patients with T___DM require insulin

A

1

73
Q

When is IV insulin used?

A

diabetic ketoacidosis

74
Q

Insulin aids in the diagnosis of _____ deficiency

A

growth hormone (GH)

75
Q

When is sliding scale used for insulin dosing?

A

-hospitalized patients
-pts on TPN or tube feedings

76
Q

What are complications of insulin treatment?

A

-hypoglycemia
-lipohypertrophy
-allergic reactions
-hypokalemia

77
Q

Insulin promotes uptake of ____ by cells

A

K+

78
Q

When should non-insulin antidiabetics?

A

-active hypoglycemia
-liver or kidney disease
-heart failure

79
Q

What category of drug is Metformin?

A

Biguanides

80
Q

What is the first choice drug for T2DM?

A

Metformin

81
Q

What is another use for Metformin?

A

polycystic ovary syndrome

82
Q

How does Metformin act?

A

inhibits glucose production in the liver and increases insulin sensitivity and cellular glucose uptake

83
Q

What are the adverse effects of Metformin?

A

-GI upset
-B12 deficiency
-lactic acidosis (rare)

84
Q

How is metformin excreted?

A

unchanged in urine

85
Q

Does metformin undergo hepatic metabolism?

A

no

86
Q

What does metformin interact with?

A

alcohol - causes lactic acidosis

87
Q

How do sulfonylureas act?

A

stimulate insulin secretion from beta cells and improves sensitivity to insulin, lowering BG

88
Q

Chloropropamide and tolbutamide are ____ gen sulfonylureas

A

1st

89
Q

GLYBURIDE, glimepiride, gliclazide are ____ gen sulfonylureas

A

2nd

90
Q

Sulfonyleureas should not be used when…

A

the patient has a sulfa allergy

91
Q

What are the side effects of sulfonylureas?

A

-hypoglycemia
-weight gain
-headache
-GI upset
-photosensitivity
-cardiotoxicity

92
Q

What do sulfonylureas interact with?

A

alcohol

93
Q

What kind of drug is Repaglinide?

A

a meglitinide

94
Q

How does repaglinide act?

A

stimulates insulin release by blocking ATP-sensitive K+ channels on beta cells - and facilitating CA2+ influx

95
Q

What is repaglinide used for?

A

T2DM

96
Q

What are the adverse effects of Repaglinide?

A

-hypoglycemia (more flexible with food intake - eat within 30 mins of taking drug)

97
Q

What group is Pioglitazone?

A

thiazolidinedione

98
Q

How does Pioglitazone act?

A

reduce glucose levels by decreasing insulin resistance

99
Q

What are the adverse effects of pioglitazone?

A

-edema
-URT infection
-headache
-sinusitis
-myalgia
-risk of HF

100
Q

What group is acarbose in?

A

alpha-glucosidase inhibitor

101
Q

How does acarbose act?

A

on the brush border of the intestine to delay absorption of carbohydrates

102
Q

What are the adverse/side effects of acarbose?

A

-flatulence
-cramps
-abdominal distention
-diarrhea
-liver dysfunction (increase LFTs)
-renal failure

103
Q

What % of acarbose is converted to inactive products via bacteria and enzymes?

A

2%

104
Q

Acarbose should be avoided with chronic ______ disease

A

GI

105
Q

How is acarbose doses?

A

with first bite of meal

106
Q

Sitagliptin is what kind of drug?

A

dipetidyl peptidase-4 inhibitors aka gliptins

107
Q

How does sitagliptin act?

A

slows breakdown of incretin hormones and increases insulin secretion - HIGHLY SPECIFIC FOR DPP-4 receptor, suppresses glucagon

108
Q

Sitagliptin undergoes ___________ absorption and is excreted ___________ in urine

A

extensive; unchanged

109
Q

What are the side/adverse effects of sitagliptin?

A

-sore throat
-headache
-nausea
-diarrhea
-weight loss
-pancreatitis
-hypersensitivity reaction

110
Q

Sitagliptin has a minimal risk of ______________

A

hypoglycemia

111
Q

What kind of drug is canagliflozin?

A

SGLT-2 inhibitor

112
Q

What are side effects of canagliflozin?

A

-genital fungal infections in female patients
-UTIs
-increased urination
-hypotension

113
Q

What drug group is Liraglutide and semaglutide (Ozempic)?

A

glucagon-like peptide-1 receptor agonists

114
Q

How does liraglutide act?

A

slow gastric emptying that stimulates glucose-dependent insulin release and reducing apetitie

115
Q

What are the side/adverse effects of liraglutide?

A

-GI upset
-injection site pain
-pancreatitis

116
Q

What is the xultophy injection made of?

A

insulin degludec and liraglutide

117
Q

Xultophy is not used in…

A

-children
-adolescents
-pregnancy
-family hx of thyroid carcinoma (RISK FOR C-CELL TUMORS)

118
Q

Xultophy should not be…

A

administered IV or mixed

119
Q

Do not use Xultophy for T_DM

A

1

120
Q

What are the side effects of Xultophy?

A

-N&V
-constipation
-headache
-lowered appetite
-hypoglycemia

121
Q

What are the cardinal features diabetic ketoacidosis and hyperosmolar hyperglycemic state?

A

-hyperglycemic crisis
-fluid and electrolyte loss
-life-threatening

122
Q

Is hyperglycemia more severe with DKA or HHS?

A

HHS

123
Q

Is ketoacidosis present in HHS?

A

no

124
Q

Diabetic Ketoacidosis is characterized by:

A

-hyperglycemia
-ketoacids
-acidosis
-coma

125
Q

Altered glucose metabolism causes:

A

-hyperglycemia
-water loss
-hemoconcentration

126
Q

Altered fat metabolism causes production of ____________

A

ketoacids

127
Q

What is the treatment for diabetic ketoacidosis?

A

-fluid and electrolytes
-insulin replacement
-bicarbonate for acidosis

128
Q

What happens to blood in a hyperosmolar hyperglycemic state?

A

blood thickens

129
Q

When does HHS occur?

A

-T2DM acute infection, illness, or stress

130
Q

Untreated HHS can lead to…

A

-coma
-seizures
-death

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (18 decks)

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