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Pharm > Diabetes Meds (Pharm test 6) > Flashcards

Diabetes Meds (Pharm test 6) Flashcards

1
Q

Rapid Acting Insulin

A

Lispro, Aspart, Glulisine, Afrezza

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2
Q

Rapid acting onset peak and duration

A

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

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3
Q

When should you take lispro or rapid acting insulin?

A

immediately before or after eating

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4
Q

contraindication to affreza

A

Chronic lung disease

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5
Q

Short acting insulins

A

Regular (humulin R, Novalin R)

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6
Q

Short acting peak, onset, duration

A

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

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7
Q

Route of rapid acting (lispro, Humalog)

A

SQ

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8
Q

Route of short acting

A

SQ, IM, IV

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9
Q

Strength (dose) of short acting

A

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

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10
Q

Intermediate insulin

A

NPH (humulin N, novolin N)

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11
Q

Intermediate onset peak duration

A

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

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12
Q

route and timing of NPH

A

SQ, 2x per day

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13
Q

Long duration insulins

A

glargine and detemir (Lantus and Levemir)

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14
Q

Route and timing of long durration

A

SQ 1x per day

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15
Q

long duration onset, peak, and durration

A

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

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16
Q

ultra long insulin

A

glargine toujeo and deluded tresiba

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17
Q

ultra long route

A

SQ

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18
Q

ultra long onset peak durration

A

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

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19
Q

Glargine toujeo vs lantus

A

toujeo = 3x as concentrated as lantus

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20
Q

ADR’s of Insulin

A

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

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21
Q

Somogye Effect

A

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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22
Q

Dawn Phenomenon

A

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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23
Q

Insulin Storage

A

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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24
Q

Type 2 four steps

A
  1. lifestyle + metformin
  2. lifestyle + metformin + one drug (start when diagnosed if A1C over 7.5)
  3. 3 drugs
  4. insulin + drugs
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25
Q

Biguanide example

A

metformin

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26
Q

Biguanide: Metformin MOA

A

decrease glucose from liver
increase insulin binding to receptors
decrease glucose absorption in the gut

(does NOT promote insulin release)

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27
Q

Biguanide: metformin ADR

A

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

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28
Q

Lactic acidosis

A

Hyperventilation, myalgia, malaise, somnolence

lactic acidosis in those with renal insufficiency leads to toxic accumulation of metformin

29
Q

Biguanides: metformin interaction

A

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

30
Q

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

A

Yes
No

31
Q

Sulfonylureas examples

A

gilprizide, glyburide, glimepiride

32
Q

Sulfonylureas : gilprizide, glyburide, glimepiride MOA

A

stimulate the release of insulin

33
Q

Do we use the first gen of sulfonylureas?

A

no

34
Q

Sulfonylureas: gilprizide, glyburide, glimepiride ADR

A

hypoglycemia
weight gain

35
Q

Sulfonylureas : gilprizide, glyburide, glimepiride interactions

A

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

36
Q

Can you have sulfonylureas in pregnancy?
Does it cause hypoglycemia

A

no
yes

37
Q

Meglitinides example

A

Repaglinide
Nateglinide

38
Q

Meglitinides: repaglinide, nateglinide MOA

A

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

39
Q

Meglitinides: repaglinide, nateglinide when to take

A

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

40
Q

meglitinides: repaglinide, nateglinide ADR

A

Hypoglycemia

41
Q

Do meglitinides cause hypoglycemia?

A

yes

42
Q

Thiazolinides examples

A

pioglitazone (most common)
rosiqltazone (not used)

43
Q

Thiazolinides: pioglitazone MOA

A

decrease insulin resistance

44
Q

Do thiazolinides cause hypoglycemia

A

low risk

45
Q

Thiazolinides are contraindicated in:

A

Heart failure

46
Q

Alpha-glucosidase inhibitors example

A

acarbose

47
Q

Alpha-glucosidase inhibitors: acarbose MOA

A

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

48
Q

Alpha glucosidase inhibitors: acarbose ADR

A

GI effects
Decrease Iron absorption (causes anemia)

49
Q

DPP4 inhibitors ending

A

gliptins (sitagliptin)

50
Q

DPP4 inhibitors: gliptins MOA

A

enhance action of incretin hormone

51
Q

incretins do what?

A

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

52
Q

DPP$ inhibitors: gliptins ADR

A

pancreatitis
hypersensitivity

53
Q

Do alpha glucosidase inhibitors cause hypoglycemia

A

no

54
Q

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

A

canagliflozin, dapagliflozin, empagliflozin

55
Q

SGLT2-inh: gliflozin MOA

A

blocks reabsorption of glucose in kidneys, causes excretion

“sugar be flozin out of your pee”

56
Q

SGLT2-inh: gliflozin ADR

A

UTI
Genital fungal infection
increased urination

57
Q

Non-insulin injectable agents

A

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

58
Q

GLP-1 receptor agonist example

A

exenatide

59
Q

Amylin mimetic example

A

pramlintide

60
Q

GLP-1: exenatide MOA

A

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

61
Q

benefit of GLP-1 exenatide

A

improve glucose control and cause weight loss

62
Q

route of GLP 1 exenatide

A

SQ only

63
Q

What can GLP 1 exenatide be use in combination with

A

metaformin or sulfonylurea drugs

64
Q

GLP 1 exenatide ADR

A

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

65
Q

Can GLP 1 cause hypoglycemia

A

when used with sulfonylurea

66
Q

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

A

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

67
Q

Amylin mimetic: pramlintide ADR

A

Hypoglycemia (may need to decrease insulin dose)

68
Q

Ace inhibitors/arbs in diabetes

A

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

69
Q

Statins in DM

A

decrease cholesterol
decrease cardiac events in pts with normal cholesterol

Pharm (9 decks)

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