1. lifestyle + metformin 2. lifestyle + metformin + one drug (start when diagnosed if A1C over 7.5) 3. 3 drugs 4. insulin + drugs

Diabetes Meds (Pharm test 6) Flashcards by Emily Simonaitis

Rapid Acting Insulin

Lispro, Aspart, Glulisine, Afrezza

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Rapid acting onset peak and duration

onset: 10-30 min
Peak: 30-2.5 hours
Duration 3-6 hours

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When should you take lispro or rapid acting insulin?

immediately before or after eating

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contraindication to affreza

Chronic lung disease

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Short acting insulins

Regular (humulin R, Novalin R)

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Short acting peak, onset, duration

onset: 30-60min
peak: 1-5hr
dur: 6-10 hr

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Route of rapid acting (lispro, Humalog)

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Route of short acting

SQ, IM, IV

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Strength (dose) of short acting

100u and 500u, 500u is only for those with insulin resistance and is never given IV

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Intermediate insulin

NPH (humulin N, novolin N)

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Intermediate onset peak duration

Onset: 1-2hr
peak: 1-5hr
dur: 16-24hr

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route and timing of NPH

SQ, 2x per day

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Long duration insulins

glargine and detemir (Lantus and Levemir)

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Route and timing of long durration

SQ 1x per day

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long duration onset, peak, and durration

onset: 1-2 hr
peak: none
dur: 24 hr

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ultra long insulin

glargine toujeo and deluded tresiba

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ultra long route

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ultra long onset peak durration

Onset: 6 hr
Peak: none
dur: over 24 hour

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Glargine toujeo vs lantus

toujeo = 3x as concentrated as lantus

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ADR’s of Insulin

hypoglycemia
lipodystrophy (lump or dent under skin from injecting in the same spot, can make absorption slower)

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Somogye Effect

rebound hyperglycemia
when blood sugar drops during the night and body releases cortisol to increase glucose

treat with a bedtime snack

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Dawn Phenomenon

hormones released to maintain and repair cells (GH, cortisol, catecholamines)

causes increase in glucose
anyone with DM then has hyperglycemia in the morning

treat with increase night time insulin

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Insulin Storage

refrigerated until expired

if open, can be left out for one month or refrigerated for 3 months

room temp insulin causes less irritation

prefilled syringes can stay 1-2 wks in the fridge

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Type 2 four steps

lifestyle + metformin
lifestyle + metformin + one drug (start when diagnosed if A1C over 7.5)
3 drugs
insulin + drugs

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Biguanide example

metformin

Biguanide: Metformin MOA

decrease glucose from liver increase insulin binding to receptors decrease glucose absorption in the gut (does NOT promote insulin release)

Biguanide: metformin ADR

decreased appetite (can be good in DM pts) Nausea, Diarrhea Lactic acidosis

Lactic acidosis

Hyperventilation, myalgia, malaise, somnolence lactic acidosis in those with renal insufficiency leads to toxic accumulation of metformin

Biguanides: metformin interaction

ETOH = lactic acidosis Iodine IV contrast = renal failure and lactic acidosis, wait 48 hr before or after contrast

Can metformin be used in pregnancy? Does metformin cause hypoglycemia?

Yes No

Sulfonylureas examples

gilprizide, glyburide, glimepiride

Sulfonylureas : gilprizide, glyburide, glimepiride MOA

stimulate the release of insulin

Do we use the first gen of sulfonylureas?

Sulfonylureas: gilprizide, glyburide, glimepiride ADR

hypoglycemia weight gain

Sulfonylureas : gilprizide, glyburide, glimepiride interactions

ETOH= disulfam reaction (palpitations, flushing, nausea) Beta blockers = suppress insulin release, mask hypoglycemia

Can you have sulfonylureas in pregnancy? Does it cause hypoglycemia

no yes

Meglitinides example

Repaglinide Nateglinide

Meglitinides: repaglinide, nateglinide MOA

stimulate insulin release from pancreas (equal effect to sulfonylureas) quick onset, short durration

Meglitinides: repaglinide, nateglinide when to take

immediately before a meal or skip if not eating eat within 30min of taking

meglitinides: repaglinide, nateglinide ADR

Hypoglycemia

Do meglitinides cause hypoglycemia?

yes

Thiazolinides examples

pioglitazone (most common) rosiqltazone (not used)

Thiazolinides: pioglitazone MOA

decrease insulin resistance

Do thiazolinides cause hypoglycemia

low risk

Thiazolinides are contraindicated in:

Heart failure

Alpha-glucosidase inhibitors example

acarbose

Alpha-glucosidase inhibitors: acarbose MOA

delays carb absorption (blocks enzyme in small intestine that breaks down complex carbs into monosaccharides)

Alpha glucosidase inhibitors: acarbose ADR

GI effects Decrease Iron absorption (causes anemia)

DPP4 inhibitors ending

gliptins (sitagliptin)

DPP4 inhibitors: gliptins MOA

enhance action of incretin hormone

incretins do what?

released after eating, stimulate pancreas to release insulin inhibit glucagon secretion slow gastric emptying decrease apetite

DPP$ inhibitors: gliptins ADR

pancreatitis hypersensitivity

Do alpha glucosidase inhibitors cause hypoglycemia

Sodium-glucose co transporter 2 inhibitor examples (SGLT2-inh)

canagliflozin, dapagliflozin, empagliflozin

SGLT2-inh: gliflozin MOA

blocks reabsorption of glucose in kidneys, causes excretion "sugar be flozin out of your pee"

SGLT2-inh: gliflozin ADR

UTI Genital fungal infection increased urination

Non-insulin injectable agents

GLP-1 receptor agonist (incretin mimetics) (exenatide) and Amylin Mimetics (pramlintide)

GLP-1 receptor agonist example

exenatide

Amylin mimetic example

pramlintide

GLP-1: exenatide MOA

incretin mimetic incretins released from GI after eating slow gastric emptying stimulate release of insulin (overworking pancreas) decrease appetite

benefit of GLP-1 exenatide

improve glucose control and cause weight loss

route of GLP 1 exenatide

SQ only

What can GLP 1 exenatide be use in combination with

metaformin or sulfonylurea drugs

GLP 1 exenatide ADR

pancreatitis hypoglycemia when combined with sulfonylurea GI upset Slow gastric motility (care with PO drugs)

Can GLP 1 cause hypoglycemia

when used with sulfonylurea

Amylin mimetic: pramlintide What type of DM is this used for? MOA

used in type 1 and 2 DM supplements effects of mealtime insulin delays gastric emptying and suppresses glucagon release decrease post-prandial glucose levels decrease glucose fluctuations

Amylin mimetic: pramlintide ADR

Hypoglycemia (may need to decrease insulin dose)

Ace inhibitors/arbs in diabetes

decrease risk of diabetic nephropathy progression prescribed if too much albumin in urine or used for HTN without high albumin

Statins in DM

decrease cholesterol decrease cardiac events in pts with normal cholesterol

Diabetes Meds (Pharm test 6) Flashcards

(69 cards)