Diabetes Flashcards
What are the rapid-acting insulins?
Insulin lispro (Humalog) Insulin aspart (NovoLog) Insulin glulisine (Apidra)
What is the short-acting insulin?
Regular insulin
What is the intermediate acting insulin?
NPH/Isophane Insulin
What are the long acting insulins?
Insulin glargine
Insulin detemire
Which groups of insulin can be given IV?
Rapid-acting and short-acting
What are normal responses to insulin?
Blood glucose level decreases
Blood pyruvate and lactate increase
Inorganic phosphate decreases
Plasma potassium decreases
Who should you never give insulin to?
hypokalemia
What are some causes of hypoglycemia? How do you treat in an emergency situation?
Vigorous exercise
Failure to eat
Over indulgence in alcohol; Give 50-100 ml of 50% glucose solution IV and 0.5-1 mg glucagon injection
What drugs are sulfonylureas? What is their MOA?
Glyburide (Micronase) Glipizide (Glucotrol) Glimepriride (Amaryl) Tolbutamine (Orinase) Tolazamide (Tolinase) Chlorpropamide (Diabinese) They stimulate insulin release from pancreatic beta cells by blocking the K+ channel and causing depolarization, potentiate action at target cells
What are the first gen sulfonylureas? Second gen?
TCT, GGG
What is the safest sulfonylurea for use in elderly patients?
Tolbutamine (Orinase)
What are the primary adverse side effects of sulfonylureas?
•All sulfonylureas can cause hypoglycemia -More in long-lasting agents –2nd gen. agents typically better –Can be caused by drug interactions •Some GI side effects (2nd gen better) •Weight gain
What are in the class of meglitinides that are secretagogues but can be used with a sulfa allergy and with better likelihood of euglycemia?
RegaGLINIDE (Prandin) and NateGLINIDE (Starlix)
What are the two Thiazolidinediones? What is their MOA?
Pioglitazone
Rosiglitazone
Ligands of the nuclear PPARg receptor which can cause post-receptor insulin-mimetic action, upregulates GLUT4 receptors and insulin uptake enzymes
What is the one biguanide?
Metformin
What are the indications for TCDs?
Decreases HbA1c, MAY BE USEFUL FOR PROPHYLAXIS OF TYPE 2 DM (Pio only)
What are CI to TCD?
LIVER DZ
CHF
ROSIGLITAZONE BLACK BOX MI/ANGINA!
What is the MOA for Acarbose and Miglitol?
Inhibit alpha-glucosidases in small intestine delayed carbohydrate digestion and absorption
What are two indications for using alpha glucosidase inhibs?
decreases post prandial serum glucose
WEIGHT NEUTRAL
Which two drugs are synthetic GLP1 that are resistant to degradation by DPPIV? What are two potential benefits to using these drugs?
Exenetide and liraglutide; may increase B cell number and function, slows gastric emptying so it leads to weight loss
What is one absolute contraindication for liraglutide use?
THYROID CANCER-Black box
What is one rare but serious side effect of incretin mimetics?
Pancreatitis
What is the MOA for DPP-IV inhibs? What are they?
Potentiates effects of incretins by acting as a direct inhibitor of DPP-IV; SitaGLIPTIN SaxaGLIPTIN LinaGLIPTIN AloGLIPTIN
What are some compelling indications for DPPIV use?
to decrease HbA1c and weight neutral
What is the MOA for amylin-like peptide Pramlintide?
Works with insulin to regulate postprandial glucose by ↓ Gastric emptying without altering the overall absorption of nutrients,
suppression of postprandial glucagon secretion
centrally-mediated modulation of appetite
↓ caloric intake
What are two compelling uses for pramlintide?
As adjunct to insulin therapy in TYPE 1 and 2
WEIGHT LOSS
How is pramlintide administered?
SQ injection TID, similar to insulin. post prandial only!
What is the MOA of Bromocriptine? What are two benefits to its use?
Dopamine agonist; prevents somogyi reaction (MORNING SURGE and ↓ postmeal plasma glucose levels due to enhanced suppression of hepatic glucose production
THIS MEANS IT POTENTIALLY REDUCES THE CARDIOVASCULAR END POINT PROBLEMS IN DIABETICS
What are contraindications to bromocriptine use?
Pgn and lactation
What is the only drug FDA approved for Type 1 DM? What is one FDA drug used off label for Type 1?
Pramlintide; acarbose or miglitol
