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Diabetes & Antihyperglycemics Flashcards

1
Q

Why is insulin injected or inhaled?

A

It is destroyed in the GI tract

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2
Q

How is insulin classified?

A

Peak and duration

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3
Q

What type of DM is insulin ALWAYS required for?

A

Type I

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4
Q

Intensive insulin Tx regimens include:

A
  • Multiple daily injections

- Continuous subcutaneous insulin injection (CCIJ) - insulin pump

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5
Q

FPG levels must be higher than ____ to indicate a diagnosis of diabetes?

A

> 126 mg/dL

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6
Q

Plasma glucose levels higher than _____ suggests diabetes. Patients must also display S/S of _____, _____, and rapid weight loss.

A

200 mg/dL, polyuria, polydipsia

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7
Q

What is an indication of HgbA1C value of 5.5%

A

Normal range

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8
Q

“Prediabetes” is defined by impaired fasting plasma glucose between ____ - _____ mg/dL or impaired glucose tolerance (2-hour OGTT result of _____ - _____ mg/dL).

A

100, 125, 140, 199

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9
Q

Individuals who do not have diabetes, 2-hour glucose levels will be below _____ mg/dL

A

140

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10
Q

Individuals who do have diabetes, 2-hour glucose levels will be below _____ mg/dL

A

200

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11
Q

What type of medication can help protect against diabetic nephropathy

A

ACE inhibitors or ARB

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12
Q

For patients with DM, target values for blood glucose are ______ before meals and _____ at bedtime.

A

90 - 130 mg/dL, 100 - 140 mg/dL

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13
Q

The metabolic actions of insulin are primarily _____.

A

anabolic

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14
Q

Insulin deficiency promotes hyperglycemia by three mechanisms:

A

(1) increased glycogenolysis, (2) increased gluconeogenesis, and (3) reduced glucose utilization

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15
Q

Sulfonylureas MOA

A

Promotes insulin release from pancreas by blocking K+ channels on beta cells (opens Ca+ channels) –> stimulates insulin release

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16
Q

Sulfonylureas Therapeutic uses

A

DM2 and MODY

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17
Q

Sulfonylureas should be used in conjunction with…

A

lifestyle changes (diet & exercise)

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18
Q

Sulfonylureas side effects

A

Hypoglycemia
If BG is high Sulfonylureas will be therapeutic
Weight gain
CV toxicity

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19
Q

Sulfonylureas drug interactions

A

Avoid alcohol –> flushing, palpations, possible hypoglycemia

Avoid pregnancy

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20
Q

Sulfonylureas drug names

A

Glipzide (Glucotrol)
Glyburide (Diabeta Micronase)
Glimepiride (Amaryl)
Chlorporpamide

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21
Q

Secretagogues includes

A

Sulfonylureas & Meglitinides

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22
Q

Sulfonylureas onset is:

A

Rapid response

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23
Q

Meglitinides drug names

A

Repagunide (Prandin)

Natelinide (Starlix)

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24
Q

Meglitinides onset is:

A

short-acting (oral form)

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25
Meglitinides side effects:
Hypoglycemia | Weight gain
26
Meglitinides MOA
Promotes insulin release from pancreas by blocking K+ channels on beta cells (opens Ca+ channels) --> stimulates insulin release
27
Meglitinides Therapeutic uses
Type 2 DM & MODY | Significantly reduced postprandial blood glucose
28
When do you administer Meglitinides
Given 15-30 minutes before each meal
29
Biguanides drug names
Metformin (Glucophage)
30
Biguanides MOA
Inhibits glucose production in liver Slightly reduces glucose absorption in gut (intestines) Sensitizes insulin receptors in target tissue
31
Biguanides Therapeutic uses
Glycemic control Prevention of Type 2 DM (can delay development in high risk individuals (benefits: young, overweight) -Control for GDM
32
Metformin is well known for being...
the drug choice for initial therapy in most patients with Type 2 DM
33
Biguanides Pharmacokinetics
Slowly absorbed from the small intestine NOT metabolized (excreted unchanged by the kidneys)
34
Biguanides adverse effects
Accumulate to toxic levels w/renal failure) Lactic acidosis (inhibits mitochondrial oxidation of lactic acid) --> medical emergency/ immediate attention (esp. in those with elevated serum creatine, liver disease or conditions associated with hypoxemia or dehydration)
35
Biguanides side effects
Decreased appetite, nausea, diarrhea, decreases absorption of B12 and folic acid (deficiency)
36
Biguanides benefits
- Does NOT produce hypoglycemia - Weight neutral - Improve lipid profiles
37
Biguanides drug interactions
Alcohol can inhibit breakdown of lactic acid Discontinue prior to surgery and diagnostic testing using IV contrast material
38
Alpha-Glucosidase Inhibitors
Acarabose (Precose) | Miglitol (Glyset)
39
Alpha-Glucosidase Inhibitors MOA
Delays absorption of dietary carbs Alpha-glucosidase: enzyme located in brush border of cells lining the intestine (when enzyme is inhibited, digestion of carbs is delayed --> reduction of BG after a meal)
40
Alpha-Glucosidase Inhibitors Therapeutic uses
Type 2 DM Lowers A1C levels (great glycemic control) Mainly postprandial BG lowering
41
Alpha-Glucosidase Inhibitors Pharmacokinetics
- Only 2% of dose is absorbed as active drug --> systemic effects are minimal - In the gut, drug is converted to inactive products by bacteria and digestive enzymes
42
Alpha-Glucosidase Inhibitors adverse effects
Hypoglycemia does not occur when used alone Long-term, high dose therapy --> liver dysfunction (liver function tests every 3 months)
43
Alpha-Glucosidase Inhibitors side effects
GI issues: flatulence, cramps, abdominal distention, diarrhea, rumbling bowel sounds Can cause decreased absorption of iron (risk of anemia)
44
Alpha-Glucosidase Inhibitors drug interactions
Table sugar is not effective in reversing low BG Bad for those who have bowel disease, liver diseases and renal dysfunction
45
Incretins
GLP-1 agonists | DPP-4 inhibitors
46
GLP-1 agonists drug names
1. Exenatide (Byetta) 2. Liraglitide 3. Albiglutide 4. Dulaglutide 5. Exenatide
47
DPP-4 inhibitors drug names
1. Sitagliptin (Januvia) 2. Saxagliptin 3. Alogliptin 4. Linagliptin
48
GLP-1 agonists therapeutic uses
Injectable adjunctive therapy to improve glycemic control in Type 2 DM (SQ injection)
49
DPP-4 inhibitors therapeutic uses
Used solo or in conjunction with diet and exercise
50
DPP-4 inhibitors pharmacokinetics
Undergoes rapid & nearly complete absorption in presence or absence of food - Peak: 1-4 hours after dose - Half-life: 12 hours
51
GLP-1 agonists pharmacokinetics
Peak: 2.1 hours Half-life: 2.4 hours Excreted unchanged in urine
52
GLP-1 agonists adverse effects
Can accumulate to toxic levels (pts with renal failure) | Risk of pancreatitis
53
DPP-4 inhibitors adverse effects
Can accumulate to toxic levels (pts with renal failure) | Risk of pancreatitis
54
GLP-1 agonists side effects
Hypoglycemia (dose related) N and V, diarrhea, headache, weight loss (GI SE) Weight loss
55
DPP-4 inhibitors side effects
UTI, headache, nasal passage & throat inflammation, constipation, dizziness, pancreatitis Myalgias (muscle pain) & arthralgias (joint pain)
56
DPP-4 inhibitors benefits
- Neutral hypoglycemia | - Neutral on weight
57
GLP-1 agonists drug interactions
Only used in pregnant women if benefits outweigh risks Delays gastric emptying (can slow down absorption of oral drugs) *Give drugs @ least 1 hr. before GLP-1*
58
SGLT2 drug names
Canaglifiozin (Invokana) | Dapaglifiozin (Farxiga)
59
SGLT2 MOA
Blocks the reabsorption of glucose in the kidneys  bloodstream - Increase urinary glucose excretion - Lower BG levels
60
SGLT2 therapeutic uses
improved glycemic control
61
SGLT2 pharmacokinetics
Half-life: 12 hours (can be given once a day) | Peak: 1-2 hours
62
SGLT2 adverse effects
- Hypoglycemia - Female genital fungal infections - GU/vaginal yeast infection - UTI - Increased urination - Postural hypotension & dizziness (older adults)
63
SGLT2 side effects
-Weight loss
64
SGLT2 Benefits:
- Reduction in systolic BP | - Weight loss
65
SGLT2 drug interactions
Co-administration can decrease efficacy
66
Rapid-Acting drug names
Lispro (Humalog) Aspart (NovoLog) Glulisine (Apidra)
67
Rapid-Acting onset
10-30 minutes
68
Rapid-Acting peak
1/2 - 3 hours
69
Rapid-Acting duration
3-6 hours
70
Rapid-Acting characteristics
CLEAR: very rapid onset, start meal within 5-10 minutes. Safe to mix with NPH, but must be administered immediately “Band-aid to situations”
71
Short-Acting drug names
(Humulin-R) | Novolin-R
72
Short-Acting onset
1/2 - 1 hour
73
Short-Acting peak
1-5 hours
74
Short-Acting duration
6-10 hours
75
Short-Acting characteristics
CLEAR: the only insulin that may be given intravenously (IV). Used during surgery, in diabetic emergencies, during periods of stress, and for rapid action before meals. (Usually used in hospitals, not home use)
76
Intermediate-Acting drug names
(Humulin-N) | Novolin-N
77
Intermediate-Acting onset
1-2 hours
78
Intermediate-Acting peak
6-14 hours
79
Intermediate-Acting duration
16-24 hours
80
Intermediate-Acting characteristics
CLOUDY: Addition of zinc and protamine to regular insulin alters onset, peak and duration of action. NOT to be given by intravenous (IV) route! Can be mixed with rapid or short acting insulin
81
Combination Therapy (Pre-mixed) drug names
NPH/Regular 70/30 NPH/Regular 50/50 Humalog Mix 75/25 Humalog Mix 50/50
82
Combination Therapy (Pre-mixed) characteristics
Mixtures of insulin have the same effect as if they were injected in separate syringes. Both combinations are CLOUDY. Should NOT be used for intravenous (IV) infusion, as they both contain protamine and zinc.
83
Combination Therapy (Pre-mixed) benefits
Theses combinations were developed to more closely stimulate the varying levels of endogenous insulin excretion. Secondarily, the pre-mixed insulins may increase the ease of self-administration
84
Long-acting drug names
Glargine (Lantus) | Detemir (Levemir)
85
Long-acting onset
1-2 hours
86
Long-acting peak
none
87
Long-acting duration
18 - 24+ hours
88
Long-acting charecteristics
CLEAR: Not to be mixed with any other type of insulin. (Usually home use/discharge use)
89
What is the only type of insulin that is appropriate for mixing with short-acting insulins?
NPH (Neutral Protamine Hagedorn) Humulin N Novolin N
90
IV insulin is used to treat what?
Diabetic ketoacidosis
91
Analgesics
NSAIDS non-NSAIDS Opioids
92
Antiretrovirals MOA
nuclueotide analog reverse transcriptase inhibitor
93
Give an example of an antiretroviral
Truvada
94
Give an example of an
anticoagulants
95
Give an example of an antibiotics
penicillin / amoxicillin

Nursing (18 decks)

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