Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology II > Diabetes Medication > Flashcards

Diabetes Medication Flashcards

1
Q

what fasting plasma glucose and HbAIC levels consistute

  • pre-diabetes?
  • diabetes?
A
  • fasting plasma glucose
    • prediabetes: 100-125
    • diabetes: 126 +
  • HbA1C:
    • prediabetes: 5.7-6.4%
    • diabetes: 6.5% +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what “random” blood sugar levels are indicative of

  • pre-diabetes?
  • diabetes?

how are these levels obtained?

A
  • pre-diabetic = 140 mg/dL
  • diabetic = 200 mg/dL +

measured by oral glucose tolerance test (OGTT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the treatment target for diabetes is a HbA1c of?

A

< 7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

discuss the mechanism by which glucose stimulate insulin secretion

A
  • glucose enters beta cells on pancreas via GLUT-2 transporters
  • it is phosphorylated to G-1-P by glucokinase, which traps it in the cell
  • enters the glycolitic pathway to become ATP
  • elevation in ATP/ATP ratio blcks ATP-sensitive K+ channel, trapping K+ in the cell
  • the cells depolarizes, which opens voltage gated Ca++ channels
  • increased cytosolic Ca++ triggers exocytosis of insulin granules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

once released, how does insulin induce gucose uptake?

A

by inducing translalocation of GLUT-4, the glucose receptor on adipose & muscle cells, to he membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

insulin replacement therapy - includes

  • what classes of drugs?
    • what are the drugs in each class?
      • in which formulation is each drug?
  • when is each class used?
A
  • short duration - used to manage postprandial (post-meal) glucose
    • rapid acting short duration:
      • lispro / aspart - injected
      • afrezza - inhaled
    • slower acting short duration
      • human insulin
  • long duration - used for basal control of glucose
    • glargine - injected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

glargine

  • what kind of drug?
  • how is it given?
A
  • long duration insulin replacement
  • injected sub-Q
    • given once daily - manages glucose for 24 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the major adverse effects of insulin replacement use?

how are each of these AEs managed?

A
  • insulin overdose - can cause
    • hypoglycemia
      • tx:
        • dextrose
        • glucagon
    • hypokalemia
      • tx
        • K+ supplements
  • insufficient insulin - can cause
    • ketoatcidosis (d/t prolonged hyperglycemia)
      • this can lead to coma/death
      • tx
        • inc insulin dose (monitor K+)
        • water / Na+ replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pramlintide

  • what kind of drug?
  • MOA?
  • clinical uses?
  • AEs?
  • drug-drug interaction?
A
  • is an amylin mimetic
  • clinical uses: management of post-prandial glucose levels in of Type I &Type II diabetes
  • MOA:
    • delays gastric emptying
    • suppresses glucagon secretion
  • AEs
    • nausea
    • hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the ways of treating pre-diabetes?

what is the goal of treaing pre-diabetes?

A

goal is to prevent/delay entry into Type II diabetes

  • treatments
    • lifestyle
      • weight (calorie restriction)
      • exercise: aerobic and resistant training both improve insulikn sensitivity
    • pharmaceutical
      • metformin - is the best available choice, tho technically not FDA approved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ideal diet for tx of type II diabetes

A

–Carbohydrates 60-70%

–Protein 15-20%

–Polyunsaturated fat 10%

–Saturated fat less than 10%

–Cholesterol- less than 300 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

metformin

  • MOA
  • indications
  • AEs/CIs
  • drug-drug interactions
A
  • MOA: suppresses gluconeogeneis
  • indication:
    • type 2 diabetes
    • can be used for pre-diabetes, but not technically FDA approved
  • AEs:
    • common: GI - nausea/flutulence/diarrhea, subside over time
    • rare: lactic acidosis
  • CI: in pts with GRF < 30 mL/min
  • drug-drug interactions:
    • nephrotoxic contrast agents
    • acarbose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which patients must temporarily discontinue metformin?

A

those needing imaging that requires nephrotoxic contrast agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

sulfonuyreas

  • include what drugs?
  • MOA?
  • AEs?
  • drug-drug interactions?
A
  • tolbutamide, glyburide
  • MOA:
    • induce insulin release:
      • bind ATP sensitive K+ channels in beta cells –> membrane depolarizes –> Ca++ influx induces insulin release
  • AEs:
    • hypoglycemia
  • drug-drug interactions
    • ethanol - facial flushing
    • beta-blockers: b-blockers blunt drug effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

repaglinide

  • what kind of drug?
  • MOA?
  • AEs/CIs?
  • drug drug interactions?
A
  • a meglitide
  • MOA:
    • induces insulin release:
      • bind ATP sensitive K+ channels in beta cells –> membrane depolarizes –> Ca++ influx induces insulin release
  • AE
    • hypoglycemia
  • drug-drug interactions:
    • gemfibrozil (a trigclyeride lowering drug): is a potent CYP2C8 inhibitor, which metabolizes repaglinide ​
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what drugs interact with gemfibrozil?

what should pts on gemfibrozil be given instead?

A
  1. repaglinide:
  2. - glitazones: rosiglitazone, pioglitazone

these pts should be switched to fenofibrate

17
Q

which diabetes drugs induce insulin secretion by blocking ATP sensitive K+ channels?

A
  • sulfonylureas: tolbatamide, glyburide
  • repaglinide
18
Q

thiozolidinediones

  • includes what drugs?
  • MOA?
  • AEs/CIs?
  • drug drug interactions?
A
  • -glitazones: rosiglitazone, pioglitazone
  • MOA:
    • an insulin sensitizer:
      • _​​_activates PPAR gamma, which turns on genes that inc cellular repsonse to insulin
  • AEs:
    • fluid retention: edema / congestive HF
    • possible MI risk
  • drug-drug interactions:
    • gemfibrozil (trigclyceride lowering drug) inhibits CYP-2C8, which metabolizes rosiglitazone
19
Q

acarbose

  • MOA
  • AES
  • drug drug interactions
A
  • alpha-glucosidase inhibitors
  • MOA:
    • delays absorption of carbohydates from the intestine
      • inhibits alpha-glucosidase (breaks down carbs)
  • AE:
    • GI: flatulence / cramps / abdominal distension / diarrhea
  • drug-drug interactions:
    • metformin: GI effects compound
20
Q

glucagon-like peptide (GLP-1) agonists

  • includes what drugs
  • MOA
  • indications
  • AEs?
A
  • - glutides: liraglutide, dulagutide & exantide ​​
  • MOA: stimulates glucose dependent insulin release
  • indications:
    • liraglutide
      • used for weight loss
      • may reduce the risk of cardiac events
  • AE:
    • hypoglycemia
21
Q

DDP-4 inhibitors

  • what drugs?
  • MOA?
  • indications?
  • AEs?
A
  • - gliptin: saxagliptin, alogliptin, linagliptin
  • MOA: maintains high level of incretin hormones
    • inhibits dipeptidyl peptidase-4 (DPP-4), the metabolizer of incretin hormones (GLP-1, CCK, secretin, gastrin, B-agonists), which increase insulin secretion
  • indications:
    • Type 2 diabetes
  • AE
    • hypoglycemia
    • renal problems
22
Q

SLGT-2 inhibitors

  • which drugs?
  • MOA?
  • indications?
  • AEs/CIs?
  • drug drug interactions
A
  • glifozin - canaglifozin, dapaglifozin, empafligozin
  • MOA:
    • inhibit glucose reabsorption at gut / kidney by inhibitng Na/glucose symporters
  • indications
    • type 2 diabetes
    • may reduce CV risk
  • AEs: urinary tract infections
  • drug drug interactions: rifampicin (with canaglifozin)
23
Q

which diabetes drugs reduce CV risk?

A
  • Metformin
  • GLP-1 agonists (liraglutide)
  • SGLT-2 inhibitors (glifozin)
24
Q

which two diabetes drugs cause significant GI AEs?

A
  • metformin
  • acarbose
25
Q

what are the sulfonyureas?

A
  • tolbutamide
  • glyburide
26
Q

- gliptins: saxagliptin, alogliptin, linagliptin

are in what drug class?

A

DDP-4 (incretin metabolizer) inhibitors

27
Q

which diabetes drugs can cause hypoglycemia?

A

high risk

  • insulin supplements - lispro, alezza, glargine
  • drugs that induce insulin release
    • sulfonuryeas - tolbutamide, glyburide
    • regalinitide

low risk (high when combined with other drugs)

  • DDP-4 inhibitors (-gliptins)
  • GLP-1 agonists (- glutides)
28
Q

glitazones: rosiglitazone, pioglitazone

are what drugs?

have what AEs?

A
  • thiazolidinediones
  • AEs
    • fluid congestion / edema / CHF
    • possible MI risk
29
Q

which diabetes drug can interact with alcohol?

A

sulfonylureas - tolbutamide, glyburide

30
Q

what is the general progression treatment of type II diabetes?

A

start of with

  • lifestyle change + metformin + two hypoglycemic drugs

if not controlled,

  • three hypoglycemic drugs

if still not controlled

  • hypoglycemic drugs + insulin
31
Q

what is the general treatment plan for type I diabetes?

A
  • lifestyle control
  • insulin

Pharmacology II (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions