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Pharmacology and Therapeutic Terminology > Diabetes - Chapter 26 > Flashcards

Diabetes - Chapter 26 Flashcards

1
Q

Diabetes Mellitus

A
  • A metabolic disorder characterized by hyperglycemia (high blood glucose) because:
  • Pancreas does not produce any insulin
  • Pancreas produces not enough insulin
  • Cells of the body do not respond appropriately to insulin
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2
Q

Hormone Regulation of Blood Glucose Levels

A
  • Glucose is obtained from digestion and absorption of ingested food and is also made in the liver and muscles
  • Absorbed glucose is carried by the blood to all cells of the body
  • B cells in the pancreas release insulin in response to rising blood sugar
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3
Q

Diabetes Complications

A
  • Retinopathy
  • Blindness
  • Blurred vision
  • Nephropathy
  • Stroke
  • Heart attack
  • Hypertension
  • Angina
  • Hyperlipidemia
  • Infections
  • Amputations
  • etc.
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4
Q

Types of Diabetes Mellitus

A
  • Prediabetes
  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes
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5
Q

Prediabetes

A

-BG level higher than normal; 50% progress to diabetes

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6
Q

Type 1 Diabetes

A
  • Autoimmune disease

- Immune system attacks and destroys B-cells resulting in a total lack of insulin production

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7
Q

Type 2 Diabetes

A
  • Most common

- Pancreas does not produce enough insulin and/or cells become resistant to insulin

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8
Q

Gestational Diabetes

A

-Occurs in about 3-20% of all pregnant women

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9
Q

Risk Factors for Type 2 Diabetes

A
  • Age
  • Family history
  • Genetics
  • Having gestational diabetes
  • Diagnosis of prediabetes
  • High blood pressure
  • High cholesterol
  • Overweight
  • Sleep apnea
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10
Q

Symptoms of Type 1 and 2 Diabetes Mellitus

A
  • Hyperglycemia
  • Extreme fatigue
  • Increased thirst
  • Frequent urination
  • Constant hunger
  • Weight loss
  • Blurred vision
  • Diabetic ketoacidosis
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11
Q

Diagnostic Tests for Diabetes

A
  • Fasting blood glucose test
  • Oral glucose tolerance test
  • Random blood glucose
  • Hemoglobin A1c
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12
Q

Lifestyle Modifications for Diabetes Mellitus

A
  • Weight loss
  • Physical activity
  • Stop smoking
  • Eat low glycemic index foods
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13
Q

Pharmacy Supplied Diabetic/Insulin Supplies

A
  • Syringes
  • Pen needles
  • Blood glucose testing strips
  • Lancets
  • Alcohol swabs
  • Sharps disposal
  • Infusion sets for pumps
  • Insulin pens
  • Blood glucose meters
  • Urine strips for ketones and/or glucose
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14
Q

Pharmacological Management of Diabetes Mellitus

A
  • Insulin
  • Sulfonylureas
  • Biguanides
  • a-Glucose inhibitors
  • Meglitinides
  • Thiazolidinediones
  • Dipeptidyl peptidase-4 inhibitors
  • Incretin mimetics
  • SGLT2 inhibitors
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15
Q

Insulin

A
  • Is the only drug administered for type 1 diabetes
  • Administered subcutaneously, only regular insulin can be administered intravenously
  • Measure in 100 units/mL
  • Schedule II
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16
Q

Insulin Dosage Delivery Systems

A
  • Vial
  • Cartridge pen
  • Prefilled disposable pan
  • Pump
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17
Q

Insulin Storage Conditions

A
  • Protect from extremes in heat and cold
  • Refrigerate unopened vials
  • Vial or pen in use may be stored at room temp for 28 days
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18
Q

Insulin Tech Note

A
  • Regular insulin may be administered IV
  • when mixing insulin in a single syringe, if one is cloudy, it gets drawn up second
  • Rapid acting insulins cannot be mixed with other insulins
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19
Q

Insulin Examples

A
  • insulin aspart
  • insulin aspart/insulin aspart protamine crystals
  • insulin detemir
  • insulin glargine
  • insulin glulisine
  • insulin lispro
  • insulin lispro/insulin lispro protamine
  • insulin NPH
  • insulin NPH/insulin regular
  • insulin regular
  • porcine insulin isophane
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20
Q

Generic: insulin aspart

A

NovoRapid

-Rapid acting

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21
Q

Generic: insulin aspart/ insulin aspart protamine crystals

A

NovoMix 30

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22
Q

Generic: insulin detemir

A

Levemir

-Long acting

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23
Q

Generic: insulin glargine

A

Lantus

-Long acting

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24
Q

Generic: insulin glulisine

A

Apidra

-Rapid acting

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25
Q

Generic: insulin lispro

A

Humalog

-Rapid acting

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26
Q

Generic: insulin lispro/ insulin lispro protamine

A

Humalog Mix 25

Humalog Mix 50

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27
Q

Generic: insulin NPH

A

Humulin-N
Novolin ge NPG

-Intermediate acting

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28
Q

Generic: insulin NPG/ insulin regular

A

Humulin 30/70
Novolin ge 30/70
novolin ge 40/60
Novolin ge 50/50

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29
Q

Generic: insulin regular

A

Humulin-R
Novolin ge Toronto

-Short acting

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30
Q

Generic: porcine insulin isophane

A

Hypurin NPH
Hypurin Regular

-intermediate short

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31
Q

Insulin ADR’s

A
  • Hypoglycemia
  • Weight gain
  • Pain or irritation at injection site
  • Fat accumulation or loss at injection site
  • Hypokalemia
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32
Q

Symptoms of Hypoglycemia

A
  • Shakiness
  • Dizziness
  • Nervousness
  • Sweating a lot
  • hunger
  • Headache
  • Pale face
  • Passing out
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33
Q

Treatment Options for Mild to Moderate Hypoglycemia

A
  • 15g glucose tables
  • 15 mL table sugar dissolved in water
  • 175 mL juice or regular soft drink
  • 6 lifesavers
  • 15 mL honey
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34
Q

Hypoglycemia Treatment if Patient is Unconscious

A
  • Glucagon kit

- IV glucose

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35
Q

Diabetic Ketoacidosis (DKA)

A
  • Is a life threatening condition; Cells cannot get the glucose needed for energy due to a lack of insulin
  • High levels of glucose remain in the blood but cannot be transported into cells
  • Ketone bodies enter the bloodstream, causing a chemical imbalance
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36
Q

Causes of DKA

A
  • too low insulin
  • Having a severe infection or other illness
  • Severe dehydration
  • Combination of these things

-Most common in type 1 but can occur in type 2

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37
Q

Symptoms of DKA

A
  • Flushed, hot, dry skin
  • Blurred vision
  • Feeling thirsty and urinating a lot
  • Drowsiness
  • Rapid, deep breathing
  • Strong fruity breath odour
  • Loss of appetite, vomiting, etc.
  • confusion
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38
Q

Sulfonylureas

A

-AKA oral hypoglycemic agents

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39
Q

Sulfonylureas MOA

A
  • Stimulate insulin release from pancreatic B-cells
  • Decrease glycogenolysis
  • Increase insulin binding
  • Increase insulin receptor sensitivity
40
Q

First Generation Sulfonylureas examples

A
  • tolbutamide

- chlorpropamide

41
Q

Generic: tolbutamide

A

tolbutamide

Orinase

42
Q

Generic: chlorpropamide

A

chlorpropamide

Diabinese

43
Q

Second Generation Sulfonylureas Examples

A
  • glyburide
  • glicazide
  • glimepiride
44
Q

Generic: glyburide

45
Q

Generic: gliclazide

A

Diamicron

Diamicron MR

46
Q

Generic: glimepiride

47
Q

Sulfonylureas ADR’s

A
  • Hypoglycemia
  • Weight gain
  • Nausea/vomiting
  • Abdominal pain
  • Diarrhea
  • Headache
  • Dizziness
48
Q

Sulfonylureas Warning Labels

A
  • TAKE WITH BREAKFAST OR FIRST MEAL OF THE DAY
  • AVOID PROLONGUED EXPOSURE TO SUNGLIGHT
  • AVOID ALCOHOL
  • SWALLOW WHOLE; DONT CRUSH OR CHEW
49
Q

Biguanides

A

Classified as antidiabetic agents

50
Q

Biguanides MOA

A
  • Increases peripheral glucose uptake and utilization in skeletal muscles and adipose tissue
  • Lowers postprandial plasma glucose
51
Q

Biguanides Examples

A

-metformin

52
Q

Generic: metformin

A

Glucophage
Glumetza

  • Bid ot tid, Glumetza is ER so once daily
  • Always with meals
53
Q

Metformin ADR’s

A
  • Gas
  • Heartburn
  • Metallic taste in mouth
  • Mild stomachache
  • Nausea
  • Weight loss

-Lactic acidosis

54
Q

Biguanides Warning Labels

A
  • TAKE WITH FOOD
  • SWALLOW WHOLE; DONT CRUSH OR CHEW
  • AVOID ALCOHOL
55
Q

Alpha-Glucosidase Inhibitors

A
  • Reduce peak plasma glucose levels

- Not used as monotherapy, adjunct only

56
Q

Alpha-Glucosidase Inhibitors MOA

A

-Inhibit the action of a-glocosidases therefore prolong the digestion of carbohydrates and delay their absorption in the small intestine

57
Q

Alpha-Glucosidase Inhibitors Examples

58
Q

Generic: acarbose

59
Q

Alpha-Glucosidase Inhibitors ADR’s

A
  • GI gas
  • Bloating
  • Abdominal pain
  • Diarrhea
60
Q

Alpha-Glucosidase Inhibitors Warning Labels

A

-MUST BE TAKEN WITH THE FIRST BITE OF EACH MEAL

61
Q

Meglitinides

A
  • Common ending: “glinide”

- Stimulate insulin secretion from pancreatic beta cells

62
Q

Meglitinides Examples

A
  • nateglinide

- replaglinide

63
Q

Generic: nateglinide

64
Q

Generic: replaglinide

65
Q

Meglitinides ADR’s

A
  • Hypoglycemia
  • Nausea/vomiting
  • Headache
66
Q

Meglitinides Warning Labels

A
  • MUST ONLY BE TAKEN IMMEDIATELY PRIOR TO MEALS TO AVOID SERIOUS HYPOGLYCEMIA
  • SKIP A MEAL, SKIP A DOSE
67
Q

Thiazolidinediones

A
  • Common ending: “glitazone”
  • Called “insulin sensitizers”
  • use limited to patients that do not respond to other agents
68
Q

Thiazolidinediones MOA

A
  • Increase tissue sensitivity
  • Increase uptake of glucose in the liver and muscles
  • Reduce plasma fasting glucose concentrations, insulin resistance, and A1c
69
Q

Thiazolidinediones Examples

A
  • pioglitazone
  • rosiglitazone
  • rosiglitazone/metformin
70
Q

Generic: pioglitazone

71
Q

Generic: rosiglitazone

72
Q

Generic: rosiglitazone/metformin

73
Q

Thiazolidinediones ADR’s

A
  • Headache
  • Weight gain
  • Diarrhea
  • Nausea/vomiting
  • Muscle pain
  • Blurred vision
  • Hypoglycemia
74
Q

Dipeptidyl Peptidase-4 Inhibitors

A
  • Common ending: “gliptin”

- Potentiate the action of GLP-1 and GIP leading to an increase in release of insulin and a decrease in glucagon

75
Q

Dipeptidyl Peptidase-4 Inhibitors Examples

A
  • linagliptin
  • saxagliptin
  • sitagliptin
  • alogliptin
76
Q

Generic: linagliptin

77
Q

Generic: saxagliptin

78
Q

Generic: sitagliptin

79
Q

Generic: alogliptin

80
Q

Dipeptidyl Peptidase-4 Inhibitors Combinations Examples

A
  • saxagliptin/metformin
  • sitagliptin/metformin
  • linaglipton/metformin
  • alogliptin/metformin
81
Q

Generic: saxagliptin/metformin

A

Komboglyze

82
Q

Generic: sitagliptin/metformin

83
Q

Generic: linagliptin/metformin

A

Jentadueto

84
Q

Generic: alogliptin/metformin

85
Q

Dipeptidyl Peptidase-4 Inhibitors ADR’s

A
  • Hypoglycemia
  • Gas
  • Heartburn
  • Nausea
  • Metallic taste
  • Stuffy, runny nose
86
Q

Incretin Mimetics (Glucagon-like Peptide {GLP-1} receptor agonist)

A
  • GLP-1 is an incretin
  • Stimulate GLP-1 receptors in the a and B-cells in the pancreas
  • Delay gastric emptying
  • Decrease appetite
87
Q

Incretin Mimetics Examples

A
  • exenatide

- liraglutide

88
Q

Generic: exenatide

A

Byetta

-Bid before am and pm meals

89
Q

Generic: liraglutide

A

Victoza

-once daily

90
Q

Incretin Mimetics ADR’s

A
  • Nausea

- Pancreatitis with liralgutide (rare)

91
Q

SGLT2 Inhibitor

A
  • Adjunct, oral agent for type 2 only
  • Inhibits sodium-glucose cotransporter 2 in the kidneys
  • allows more glucose to go into urine instead of being reabsorbed
92
Q

SGLT2 Inhibitors Examples

A
  • cangliflozin

- dapagliflozin

93
Q

Generic: cangliflozin

94
Q

Generic: dapagliflozin

95
Q

SGLT2 Inhibitors ADR’s

A
  • Increased risk of yeast infections and UTI’s

- Hyperkalemia

Pharmacology and Therapeutic Terminology (97 decks)

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