Diabetes Flashcards
Where does diabetes hurt?
Everywhere
Who does diabetes hurt?
Everyone
Lispro (Humalog)
Glulisine (Apidra)
Aspart (Novolog)
Class: Short acting Insulin
Mechanism of action: hexamers and dimers bind 300xs weaker
Indication: injected 15min before eating
Pharmacological effects: peak action in minutes (shorter than regular insulin). duration less than an hour. Reduces after meal hyperglycemic episodes and hypoglycemia later.
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Detemir (Levemir)
Class:Long acting insulins
Mechanism of action: Human insulin that binds to albumin via a fatty acid linkage
Indication: basal therapy in type 1 and add on therapy for type 2
Pharmacological effects: slow absorption and longer duration fo action (up to 24hrs)
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs: no drug interactions with other protein bound drugs
oContraindications:
oWhich analgesic can the patient take:
Glargine (lantus)
Class: Long acting Insulin
Mechanism of action: pH of 4, solution is neutralized in body, insulin precipitates into crystals which are slowly absorbed over 24hrs
Indication: 1daily at bed time
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider: more pain at injection site
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Pramlintide (Symlin)
Class: synthetic analog of human amylin
Mechanism of action: decreases glucose levels in the 3 hrs after meals. Provides a more “tight” control of glucose levels
Indication: used only in combination with insulin in type 1 and 2. Injection before meals
Pharmacological effects: slows gastric emptying, suppresses glucagon secretion, mediates modulation of appetite (basically what Amylin would do)
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Exenatide (Byetta)
Drug that is from the Gila Monster
Class: Incretin Mimetic
Mechanism of action: 1st phase insulin response
Indication: type 2 only
Pharmacological effects:slows gastric emptying
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Glyburide, Glipizide (DiaBeta, Glucotral)
Class: Sulfonylureas
Mechanism of action: Stimulate insulin release by blocking ATP dependent K+ current in pancreatic Beta cells (less potassium present, more calcium, which stimulates insulin)
Indication: oral hyperglycemic agent
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider: hypoglycemia, nausea and vomiting, weight gain
oContraindicated drugs: increase effect of sulfa: Azole antifungals, Salicylates (ASA), Sulfonamides, NSAIDS, Tricyclic Antidepressants; decrease effect of sulfa: corticosteroids
oContraindications:
oWhich analgesic can the patient take: Not ASA or NSAIDS
Metformin (Glucophage
Class: Biguanide
Mechanism of action: Inhibition of hepatic glucose production
Indication:
Pharmacological effects: dec hepatic gluconeogenesis, improve tissue sensitivity to insulin, dec peripheral glucose uptake, dec intestinal absorption of glucose
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Class: Thiazolidinediones
Mechanism of action: Post-receptor insulin mimetic activity affecting insulin receptor kinase activity and insulin receptor phosphorylation
Indication:
Pharmacological effects: increase insulin sensitivity of tissues
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
Black Box Warning! inc the body’s tendency to accumulate fluids due to inadequate pumping from the heart. INC RISK OF CHF!
oContraindicated drugs: interact with ketoconazole
oContraindications:
oWhich analgesic can the patient take:
Acarbose (Precose)
Class: alpha glucosidase inhibitors
Mechanism of action: competitive and reversible inhibitor of alpha glucosidase, hydrolase, pancreatic alpha amylase
Indication:
Pharmacological effects: delay in breakdown of carbohydrates to glucose
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Sitaglipitin (Januvia)
Class: Dipeptidyl peptidase 4 inhibitor
Mechanism of action: slows the inactivation of incretin hormones by inhibiting DPP-4
Indication:
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Prandin (Repaglinide)
Class: meglitinide
Mechanism of action: Closes ATP dependent K+ channels in Beta cells
Indication:
Pharmacological effects: Stimulates release of insulin
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Clinic Guidelines for Diabetic Pt
Appt after a meal
Morning appts best
Gentle handling of tissue
No ASA with Sulfonamides
Whipples Triad
1-blood sugar less than 65
2-symptoms of catecholamine release (sweating, shaky hands)
3-improvement of symptoms with glucose administration
