Diabetes Flashcards
Severe Hypoglycemia tx
Diazoxide: glucagon agonist which opens potassium channels, inhibiting insulin from being released. IV.
Reversal with beta blockers
Affects: nausea vomiting, hypokalemia, no pheochromocytoma pts
Type I Tx
Insulins, rapid, intermediate, or slow acting, also ultra long acting
Need to ingest carbs prior each pump.
Humalog/insulin lispro
rapid: proline and lysine 3-4h, insulin pumps Aa: hypoglycemia, rxns at injection site, allergies, swelling, itching/rash
NPH:
intermediate: 4-12 h.Can be mixed with rapid acting analogs, needs proteolytic enzyme digestion to absorb insulin
Glargine and detemir: arg
long: Arg broad plasm plateau, slow depo of release at injection site, splubel at acidic pH. Cannot be mixed with other analogs
Insulin degludec(Tresiba)
ultra long:42h, sub q 1x/day, can be mixed with short acting
Inhalational insulin
Technosphere insulin(afrezza): big ass surface area for absorption, fast onset, 3h only
Can cause coughing, no smokies
Adjuvant Tx to type i
Amylin analog to assist insulin lower glucose
Pramlintide: type i or type ii dbs. Aa: anorexia, feeding carsb can b an issue due to delayed gastric emptying
Sulfonylureas:
blocks atp sensitive k channel, membrane depol, calcium channels open, insulin release. 1st gen have lower affinity, 2nd gen higher affinity and preferred drugs nowadays
Tolbutamide:
Sulfonylurea, not as high affinity, excreted via kidneys, AA weight gain, sun and skin rxns, GI distress, dark urine. No type i diabetics, renal insuff, hepatic disease
Glimepiride and Glipizide:
Sulfonylureas,when metformin is contraindicated, again no renal insuff, hepatic issue, caution with elderly bc of hypoglycemia
Meglitinide analogs:glinides
block k channel on islet cells. Taking 30 min before meals, causes hypoglycemia. Similar to binding of sulfonylureas but has an extra binding site. AA: Hypoglycemia
Reaglinide
metabolized by cyp2C90 and 3A4
Nateglinide:
metabolized by cyp2C90 and 3A4, adjunctive to metformin
AMPK activators
activates AMPK and reduces glucose production. MOA slightly unknown. Hypoglycemia is rare.
Metformin: not metabolized by liver, but don’t take CKD or renal failure. Increased risk of arctic acidosis. Interferes with cobalamin absorption. Halter also before imaging is done
TZDs Glitazones:
Increase GLUT1 and GLUT4 to increase insulins sensitivity, decreases resistance. Godo for also fatty liver disease. Can increase MI or angina. Activates PPAR-Y
Pioglitazone : 2C8/3A4
Rosiglitazone : 2C8/2C9
Incretin agonists GLP-1 and GIP aka Tides:
increases insulin release to lower plasma glucose, amplification due to GLP and GIPs, orla gives a bigger effect because of these two peptides interacting thru the gut for insulin secretion.
AA: pancreatitis
Exenatide and Dulaglutide:
incretin. adjunctive tx with metformin or metformin + sulfonylureas that need more glycemic control.
gliptins
helps incretins stay in the system longer to keep amplifying effect. JOIN PAIN aa
Sitagliptin
Saxagliptin
SGLT-2 Inhibitors Flozins:
block reabsorption in proximal tubule. Can cause hypotension bc of intravascular volume contraction
Contraindications for pts with CKD or renal insufficiency, can’t give to patients with beta cell failure or insulin deficiency
Canagliflozin
Dapagliflozin
