Diabetes Medications Flashcards
What are the measurable treatment goals for treating Diabetes Mellitus?
Try diet and lifestyle changes 1st
Hgb A1C < 7.0%
LDL < 100
TG < 150
What is Type 1 Diabetes characterized by?
Uncontrolled Type 1 Diabetes can result in what medical condition?
Childhood / Adolescent diabetes
Defect / Destruction of pancreatic beta cells
Can lead to ketoacidosis
T/F
Ketoacidosis is more common in Type 1 Diabetes than Type 2 Diabetes.
True
There is minimal risk of ketoacidosis in Type 2 diabetes.
What is Metformin’s mechanism of action?
What are some potential side effects that you should educate your Type II Diabetic PT about?
Decreases hepatic glucose production
Decreases intestinal glucose absorption
NO IMPACT on BETA CELLS
~~No hypoglycemia, No weight gain!~~
S/E: Lactic acidosis (DO NOT GIVE IF HEPATIC or RENAL IMPAIRMENT)
WEIGHT LOSS –> from decreased glucose absoprtion
MACROCYTIC ANEMIA (from decreased B12 absorption)
What class of medication does metformin belong to?
What side effects
Biguanides
When should adults be screened for Diabetes?
BMI > 25 kg/m^2
Age > 45 y.o.
When can Diabetes be definitively diagnosed? (with what lab values?)
Fasting plasma glucose >126 mg/dL
~~Fasting glucose must be > 8hrs
Random plasma glucose >200 mg/dL with
~~Polyuria, Polydipsia, unexpl. weight loss
Hgb A1c - >6.5%
Oral glucose tolerance test (OGTT): 2hr plasma > 200 mg / dL
Which type of Diabetes primarily associated with Ketoacidosis?
Why?
Type 1 Diabetes
Body resorts to breaking down fat and proteins for energy source –> results in ketone bodies which are very acidic (thus reducing blood pH)
Chronic hyperglycemia (long-term uncontrolled diabetes) can present with what possible complications in your 75 y/o PT who has been Dx’d more than 20 years ago?
i.e. What should your PE revolve around and r/o primarily?
Macrovascular Dz (CVA, MI, HTN)
Microvascular Dz (Skin ulcers, gangrene, kidney Dz)
Retinopathy (Blindness) –> retinal capillary damage from microaneurysms and microvascular damage
Nephropathy (Primary cause of M & M in DM Type 1 PTs)
Sensory/Motor Neuropathy (Nerve degeneration)
ED –> Secondary to vessel injury & neuropathy Rx –> Sildenafil (Viagara)
When attempting to treat diabetes in a 30 year old Pregnant patient; what considerations should be taken into account?
How many times should mom monitor her glucose level?
Placenta produces hormones that antagonize insulin
Coritsol is produced 3x as much in preg.
~~Promotes hyperglycemia
Six to seven times daily.
What are two of the longest acting Insulin Therapy’s which can be prescribed?
Detemir (Levemir)
Glargine (Lantus)
NPH IS INTERMEDIATE-LONG ACTING AND IS USUALLY MAINSTAY Tx for DM2
When would NPH be indicated for PTs?
DM Type 2
Tx of Dawn Phenomena: Give injection of NPH before bedtime
~~Blunt the “rebound” hyperglycemia which was previously occurring in later hours of sleep from regulatory hormone surge
What is the mechanism of action for SGLT-2 Inhibitors?
What are some medications which fall into this class?
Increase glucose excretion (which lowers the renal glucose burden)
SGLT-2 Inhibitors –> -LIFLOZINs
Canagliflozin
Dapagliflozin
What are GLP-1 Agonists mechanism of action for Diabetic Tx?
What are some examples of potential SE associated with these medications?
What are two examples of GLP-1 Agonists?
When is it contraindicated?
MOA:
Mimics incretin –> increases INSULIN SECRETION
Delays gastric emptying
SE: HYPOGLYCEMIA
PANCREATITIS
Exenatide (Byetta)
Liraglutide (Victoza)
CI: Gastroparesis Hx
What is the mechanism of action of Sulfonylureas?
What are some examples of these medication
Stimulate beta-cells to release more INSULIN (CP450 metabolized)
Glyburide
Glipizide (Glucotrol)
Glimepiride
SE Include: HYPOglycemia, Sulfa allergy, WEIGHT GAIN!!
