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Pharmacology > Diabetes Medications > Flashcards

Diabetes Medications Flashcards

1
Q

What do alpha cells of the pancreas secrete?

A

Glucagon, problucagon

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2
Q

Beta cells from the pancreas secrete

A

Insulin
C-peptide
Proinsulin
Amylin

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3
Q

Delta cells from the pancreas secrete what?

A

Somatostatin

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4
Q

Epsilon cells from the pancreas secrete what?

A

Ghrelin

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5
Q

G cells from the pancrease secrete

What about F cells?

A

Gastrin

Pancreatic polypeptide

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6
Q

What are the 8 reasons for Hyperglycemia aka Ominous Ocete?

A
  1. Increase glucose reabsorption
  2. Increased lipolysis
  3. Decreased incretin effect
  4. Impaired insulin secretion
  5. Increased glucagon secretion
  6. Increased hepatic glucose production
  7. Neurotransmitter dysfunction
  8. Decreased glucose uptake
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7
Q

slide 12

A

slide12

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8
Q

Definition of Type 1 diabetes?

A

Autoimmune B-cell destruction, leading to insulin deficiency

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9
Q

Definition of Type 2 diabetes?

A
  1. Progressive loss of B-cell insulin secretion due to insulin resistance
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10
Q

Definition of Gestational diabetes?

A

Diabetes diagnosed int eh second or third trimester of pregnancy

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11
Q

Signs and Symptoms of Type 1 DM

A
  1. Polyuria, polydipsia, polyphagia
  2. Weight loss
  3. Lethargy accompanied by hyperglycemia
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12
Q

Signs and symptoms of Type 2 DM

A
  1. Lethargy
  2. Polyuria, nocturia, and polydipsia can be present
  3. Significant weight loss is less common
  4. Most patients are overweight of obese
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13
Q

In additional to medication what other modification must been done according to the ADA algorithm?

A

Lifestyle management may reveal that 1-2 foods might be the cause of hyperglycemia, need to correct this first

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14
Q

What drinks can a diabetic who is hypoglycemia take to help?

A

15 g of simple carbohydrate (eg, 8 oz [240 mL] orange juice or milk, 4 glucose tables, or 1 tube of glucose gel and then retest BG 15 minutes later.

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15
Q

Criteria to diagnose Diabetes Melitus

A
  1. FPG >126 (or equal)
  2. 2 hour BG >200 (or equal) during OGTT
  3. A1c >6.5 (or equal)
  4. Symptomatic RBG >200 (or over)
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16
Q

Prediabetic A1c levels?

A

5.7-6.4

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17
Q

Metabolic syndrome

A

Central obesisty plus any two of the following

(1) raised triglycerides (≥ 150 mg/dL)
(2) reduced HDL cholesterol (< 40 mg/dL) in males or < 50 mg/dL in females)
(3) increased blood pressure (systolic BP ≥ 130 mm Hg, diastolic BP ≥ 85 mm Hg, or treatment of previously-diagnosed hypertension)
(4) raised fasting plasma glucose (≥ 100 mg/dL) or previous diagnosis of type 2 DM

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18
Q

What are are considered modifiable care in managing hyperglycemia?

A

Behavioral health
Motivational interviewing
Nutrition for weight loss
Exercise for weight loss managment

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19
Q

Microvascular complications in DM

A
  1. Retinopathy
  2. Neuropathy
  3. Nephropathy
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20
Q

Macrovascular complications in DM

A
  1. Coronary Heart Disease
  2. Hypertension
  3. Peripheral vascular disease
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21
Q

What are the 5 interventions for complications and mortality

A
  1. Smoking cessation
  2. Blood pressure control
  3. Metformin
  4. Lipid reduction
  5. Glycemic control
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22
Q

When performing SBGM what does Fasting glucose help measure

A

Measures the effectiveness of basal insulin or agents which decrease hepatic gluconeogenesis overnight (“leaky liver”)

23
Q

When performing SBGM what does Pre-meal blood sugar?

A

To help calculate bolus dose of insulin or agents given to improve insulin secretion

24
Q

When performing SBSM what does Post meal blood sugar (2 hour post prandial) measure?

A
  1. Measures the effectiveness of bolus insulin or agents given to increase levels of insulin (pancreas “poop out”)
  2. Helps determine needed food intake changes

***Most useful for Type 2 DM

25
Q

What is the purpose of measuring Bedtime blood sugar

A

To avoid early A.M. lows from insulins or oral agents

26
Q

What are ADA glycemic recommendations for:

A1c

Preprandial capillary plasma glucose

Peak postprandial capillary plasma glucose

A
  1. A1c: <7.0%
  2. Preprandial capillary plasma glucose: 80-130 mg/dL
  3. Peak postprandial capillary plasma glucose: <180 mg/dL
27
Q

What are AACE/ACE glycemic recommendations for

A1c

Preprandial capillary plasma glucose

Peak postprandial capillary plasma glucose

A

A1c: <6.5

Pre: <110 mg/dL

Post: <140 mg/dL

**More stringent

28
Q

Symptoms of HYPOglycemia?

A 
Weakness/Fatigue
Irritability
Shaking
Fast heartbeat
Sweating
Hunger
Impaired vision
29
Q

What are are Symptoms of HYPERglycemia

A
  1. Extreme thirst
  2. Frequent urination
  3. Dry skin
  4. Hunger
  5. Blurred vision
  6. Drowsiness
  7. Nausea
30
Q

Which diabetic medication has the highest rate of efficacy?

A

Insulin an anabolic hormone, causes weight gain

31
Q

Which medications cause weight gain?

A

a. Thizolidinediones
b. Sulfonylureas
c. Insulin

32
Q

Meformin:

Class?
MOA?
Dosing key?

A

a. Biguanides
b. Enhances insulin sensitivity of hepatic and peripheral (muscle tissues) allowing for increased glucose uptake
c. Key start slow and go slow (take smallest dose with largest meal)

33
Q

What drug class does Thizolidinediones (TZD) fall under?

MOA?

A

a. Glitazones

MOA: Enhances insulin sensitivity in muscle, liver, and fat tissues indirectly

34
Q

What is fist line medications for DM

A

Metformin/Biguanides

35
Q

What are examples of Sulfonylureas?

A

Glipizide

Glimerpiride

36
Q

What are examples of Metaglinides?

A

“Glinides”

Regaglinide
Nateglinide

37
Q

What are side effects of Sulfonylureas and Metaglinides?

A

Weight gain

Hypoglycemia

38
Q

Examples of GLP-1 agonists

A 
Exenatide (Byetta)
Liraglutide (Victoza)
Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
Semaglutide (Ozempic)
Lixisenatide (Adlyxin)
39
Q

MOA for GLP-1 agonists

A 
Enhances insulin secretion
Suppresses inappropriately high postprandial glucagon secretion
Decreases hepatic glucose production
Increases satiety
Slows gastric emptying
Weight loss***
40
Q

DPP-4 inhibitors drugs?

A

“Gliptins”

Sitagliptin
Saxagliptin
Linigliptin

41
Q

MOA of DPP-4 inhibitors

A

Prolongs the half-life of endogenous produced GLP-1

42
Q

SGLT-2 inhibitors drugs?

A

“Gliflozins”

Canagliflozins
Dapafliflozins

43
Q

MOA of SGLT-2 lowers

A

Lowers the renal tubular threshold for glucose reabsorption

glucosuria occurs at lower plasma glucose concentrations

44
Q

alpha-Glucosidase inhibitors?

A

Acarbose

Miglitol

45
Q

MOA of alpha-Glucosidase inhibitors?

A

Breakdown of sucrose and complex carbohydrates in the small intestine, prolonging carbohydrate absorption

46
Q

What are side effects of alpha-Glucosidase inhibitors?

A

Flatulaence, bloating, abdominal discomfort, diarhea

47
Q

What is key when treating hyperglycemia with Sulfonylureas?

A

Only take with 60 g or less with carbs

48
Q

What causes the Somogyi effect?

A

Most likley to occur following episode of untreated nighttime hypoglycemia, resulting in high blood sugar levels in the morning

49
Q

How can the Somogyi Effect be prevented?

A

Check their blood glucose levels in the middle of the night (for example, around 3 AM)

Increase food intake or lower insulin dose in the evening.

50
Q

When treating hypoglycemia what type of sugars should you treat with?

A

with glucose (dextrose) products or glucagon, not sucrose

51
Q

Side effects of TZD?

A

Weight gain
CHF risk
Moderate fracture risk

52
Q

What is the Dawn Phenomenon?

A

Surge of hormones that the body produces daily in the early morning hours before waking

53
Q

How does the Dawn Phenomenon differ in diabetes?

A

People with diabetes don’t have normal insulin responses to adjust for this, and may see their fasting glucose go up

The rise in glucose is mostly because the body is making less insulin and more glucagon (a hormone that increases blood glucose) than it needs

The less insulin made by the pancreas, the more glucagon the pancreas makes as a result.

Pharmacology (12 decks)

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