Diabetes Drugs Flashcards
What are the micro vascular complication associated with diabetes?
Retinopathy neuropathy, neuropathy
What are the macro vascular complications of diabetes?
Coronary heart disease stroke, myocardial infarction
When is insulin indicated?
Type 1, LADA, GDM, and type 2 as step therapy.
When is insulin recommended in type 2?
10% HGBA1C 10% or BG or > 300 and unexpected weight loss
What are the three rapid acting insulin’s?
Aspart, glulisine, lispro
Short acting insulin type?
Human regular?
What is the intermediate acting insulin?
NPH
What is the long acting (basal) insulin?
Glargine, detemir, degludec
Which insulin lasts for 42 hours?
Degludec
Which insulin is ULTRA rapid acting
Inhaled afrezza
What is basal insulin used for?
Maintain insulin of NPO patients
What is the goal of basal insulin?
To supress hepatic glucose production, and improve fasting hyperglycemia
Which insulin cannot be mixed with other insulin?
Glargine the basal insulin
What is the drug of choice for patient with gestational diabetes?
Glargine
Which insulin can you use in both type one and two
Degludec
Which insulin has no true peak and is marketed as a premix insulin with Aspart
Degludec
When should glulusine insulin be administered?
30 minutes prior to meals
Which insulin’s are available over-the-counter
NPH regular and 7030 premix
Which insulins are available premixed
NovoLog, Humalog, humulin, and novolin
What is the goal of basil bowl is coverage
To avoid hypoglycemic and hypoglycemic values by suppressing hepatic glucose production and improved fasting hyperglycemia
When a ministering replacement therapy and people with type two diabetes, how is insulin given?
50% of the total daily insulin dose is given as basal and 50% as a bonus divided up before breakfast lunch and dinner
How do you dose correction doses
One unit for acting insulin for every 25 mg that the glucose is above target
What is split mixed dose?
Pre breakfast and pre dinner dose of an intermediate insulin like lispro or regular.
How is basal bolus dosed by three injections?
Three injections daily as preprandial, regular or Lispro and then basal and bolus was pre-meals right insulin.
How is basal bolus dosed by four inductions daily?
Preprandial regular or Lispro and then intermediate acting NPH at a.m. and HS
Which two insulins are bolus insulin
Preprandial regular or Lispro
What are the basal insulin?
Glargine, detemir, and degludec
What is the rate of CSII?
.4-2 units an hour
Which diabetic medication do you use for PCOS?
Metformin
What are the major drug interactions of insulin?
Beta blockers, levothyroxine, alcohol, corticosteroids, and thiazide diuretics
Why must insulin be given by induction and not orally?
Insulin is the protein digested in the stomach for this reason it may not administered orally
Which type of insulin is preferred for these in continuous subcutaneous insulin?
Rapid acting
What is the first line pharmacologic treatment recommended for gestational diabetes?
Insulin
Which insulin could be administered IV
Regular
What should you take into account when choosing what to start a patient on?
Amount and rapidity of the glucose lowering required, adverse effects, the possible min glycemic effects like lipid lowering, compliance issues, and cost.
When are oral meds considered?
They are add on meds after hgba1c gangs be reached after 3 months of injections.
How should you dose metformin?
Start at a low dose and titrate up to 1000mg twice daily. Max dose is 2550. Dose with meals.
How is glocophage XR different from metformin
It is extended related and increased aborsption with food
At what GFR should you discontinue metformin?
30
When is metformin contraindicated?
When GFR is less than 30 alcohol use disorder, cardio, respiratory insufficiency, hypersensitivity, and greater than 80 years old unless they have a normal creatinine clearance
What labs did you check with metformin once a year?
LFTs and creatinine
What medication causes decreased serum B12 levels
Metformin
Which alpha glucosidase inhibitor has less drug interactions?
Miglitol
When do you see benefits of TZDs
6-12 weeks
T or F TZDs cause hypoglycemia
False
Which diabetic medication would you take if you also want to lower triglycerides?
TZDs
How is TZDs metabolized?
CYP3A4 and CYP2C8
Which medication causes increased bone fracture rates in women and risk for bladder cancer
TZDs
What are the common adverse reactions to TZD’s?
Sinusitis, myalgia, fluid retention, edema, delusional, anemia, and weight gain
When are SGLT2 inhibitors recommended
Type two diabetes and people that are high risk for atherosclerotic cardiovascular disease
What are advantages of SGLT 2 inhibitors?
Moderate lowering glucose levels, weight loss, reducing blood pressure, low risk of hypoglycemia effective as monotherapy or combo
What are the adverse reactions of SGLT – two inhibitors
Increase potassium increased genital yeast infections increased risk for renal insufficiency, hypovolemia or the side of hypotension UTI and non-HDL cholesterol
At what GFR level should you avoid starting? SGLT – two inhibitors
60
At the four classes of oral agents which one binds to enzyme and slows absorption of carbohydrates
Alpha glucosidase inhibitors
Which class of oral agents reduces absorption of filtered glucose from the renal tubular lumen increasing urinary excretion of glucose
SGLT – two inhibitors
Which drug class is a selective agonist for PPARY
TZD
What is the oral GLP1
Semaglutide rybelsus
What are the most common incretin hormones?
GIP and GLP1
How does GIP differ from GLP in the gut?
GIP does not slow gastric motility
What are GLP one receptor agonist contraindicated?
Type 1 DM, DKA, gastroparesis, reglan use, pancreatitis, and for bydureon a history of thyroid cancer
Which DPP4 inhibitors has the best compliance?
Linagliptin
Which DPP4 has the longest half life?
Alogliptin
Where do TZDs act in the body?
The liver, skeletal muscle, and adipose tissue.
Where do incretins works?
The guy, brain, and pancreas.
Where do SGLT-2 inhibitors work in the body?
Renal tubules to decrease glucose reabsorption
What are the two non insulin injectable classes?
GLP-1 incretin or amylimomimetics
How do sulfonyureas work?
The stimulate the pancreas to release more insulin
Which generation of sulfonureas is more frequently prescribed?
Second gen
When is glyburide contraindicated?
In hepatic and renal disease
Which sulfonureas has the shortest half life and is more commonly prescribed?
Glipizide
How is glimepiride given?
Once daily as mono therapy or with insulin
How should sulfonylureas be given in regard to meals?
With meals except for glipizide which is 30 min prior to meals.
Why should patients with angina avoid sulfonylureas?
They can cause myocardial ischemia
What are the two meglitinides?
Repaglinide and nateglinide
When should dose with meglitinides in regard to food?
With 15 minutes of meals
Which oral agent is more likely to cause hypoglycemia
Sulfonylureas and meglitinides
What is the side effect of metformin that becomes less bothersome overtime?
G.I. upset
