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Pharm Unit 5 > Diabetes Mellitus 1 and 2 > Flashcards

Diabetes Mellitus 1 and 2 Flashcards

1
Q

Type 1 diabetes means; type 2 diabetes means; another common form of diabetes:

A

beta-cell destruction (autoimmune usually); progressive insulin secretory defect;
gestational diabetes mellitus (during pregnancy you have increased insulin resistance)

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2
Q

A couple techniques allowing for health providers and patients to assess effectiveness of management plan on glycemic control:

A
  1. patient self-monitoring of blood glucose (SMBG)

2. continuous glucose monitoring systems (CGMS)

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3
Q

After a meal, what happens with insulin and glucagon in diabetics?

A

Insulin is lower than usual, glucagon is higher

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4
Q

Incretin hormones:

A
  1. synthesized in the L cells, primarily the ileum and colon
  2. produced in response to incoming nutrients (orally more so than IV)
  3. stimulate insulin secretion
    Most important is GLP-1!!!!
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5
Q

GLP-1 actions:

A
  1. enhances glucose-dependent insulin secretion
  2. slows gastric emptying
  3. suppresses glucagon secretion
  4. promotes satiety
  5. receptors in the islet cells, CNS, elsewhere
  6. metabolized rapidly by DPP-4
    (DR SIGG)
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6
Q

GLP-1 release is

A

reduced in type 2 diabetes

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7
Q

At the time of type 2 diabetes diagnosis, initiate

A

metformin therapy along with lifestyle interventions, unless metformin is contraindicated; if type 2 diabetes has symptomatic and/or elevated blood glucose levels or A1C, consider insulin therapy, with or without additional agents

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8
Q

If noninsulin monotherapy at max tolerated dose not achieving or maintaining A1c target over 3 months

A

add second oral agent, GLP-1 receptor agonist, or insulin

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9
Q

Metformin (Glucophage)

A

Class: Biguanide
Mech: Activates hepatic AMP-kinase and inhibits mito isoform of glycerophosphate dehydrogenase; decreases hepatic glucose production
Thera: First-line therapy in diabetes due to no weight gain or hypoglycemia, reduction in cardiovascular events and mortality; maybe less cancer
Important SE’s: Lactic acidosis (rare)
Other SE’s: GI (diarrhea, abdominal discomfort, N & V), B12 deficiency
Misc: Contraindicated in renal impairment; cheap

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10
Q

Glipizide (Glucotrol)
Glyburide (Micronase)
Glimepiride (Amaryl)
Gliclazide (Diamicron)

A

Class: Sulfonylurea
Mech: Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release
Thera: Reduction in cardiovascular events and mortality
Important SE’s: Weight gain; hypoglycemia; could blunt myocardial ischemic preconditioning
Misc: Cheap

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11
Q

Repaglinide (Prandin); Nateglinide (Starlix)

A

Class: Meglitinide
Mech: Closure of ATP-sensitive K+ channels on β-cell plasma membrane –> stimulation of insulin release
Thera: Used with meals (short-acting)
Important SE’s: Weight gain; hypoglycemia (less than sulfonylureas); could blunt myo ischemic preconditioning, dosing frequency
Misc: Short acting;

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12
Q

Pioglitazone (Actos)

A

Class: Thiazolidinedione
Mech: Binds PPAR-γ, a nuclear transcription factor; increases peripheral insulin sensitivity
Thera: No hypoglycemia; increase HDL cholesterol while decreasing triglycerides; maybe reduction in MI’s
Important SE’s: Weight gain; edema; heart failure; bone fractures;
Other SE’s: Increased risk of bladder cancer
Misc: generics available

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13
Q

Rosiglitazone (Avandia)

A

Class: Thiazolidinedione
Mech: Binds PPAR-γ, a nuclear transcription factor; increases peripheral insulin sensitivity
Thera: No hypoglycemia
Important SE’s: Weight gain; edema; heart failure; bone fractures; increased cardiovascular events, LDL cholesterol goes up
Misc: Expensive; contraindicated in heart disease

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14
Q

Acarbose (Precose); Miglitol (Glyset)

A

Class: α-glucosidase inhibitor
Mech: Competitively inhibit enzymes that break down carbohydrates into simple sugars, delaying GI carbohydrate absorption & reduces postprandial glucose levels
Thera: Nonsystemic medication that decreases postprandial glucose; weight neutral and no hypoglycemia
Important SE’s: GI (gas, flatulence, diarrhea), dosing frequency, modest reduction in A1c
Misc: Taken with each carbohydrate containing meal

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15
Q

Exenatide (Byetta); Liraglutide (Victoza); Albiglutide, dulaglutide

A

Class: GLP-1 receptor agonist
Mech: Activates GLP-1 receptor in β-cells, endocrine pancreas, and brain; increases insulin secretion and decreases glucagon secretion in a glucose-dependent fashion; slows gastric emptying, increases satiety
Thera: Leads to weight reduction; may improve β-cell mass
Important SE’s: Acute pancreatitis; GI (nausea, vomiting, diarrhea)
SE’s: hypoglycemia (less than sulfonylureas; caution with renal insufficiency
Misc: Injection only; expensive

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16
Q

Sitagliptin (Januvia); Vildagliptin (Galvus); Saxagliptin (Onglyza); Linagliptin (Tradjenta)

A

Class: DPP-4 inhibitor
Mech: Inhibition of GLP-1 metabolism, increasing GIP and GLP-1 concentration; increases insulin and glucagon secretion
Thera: No hypoglycemia, weight neutrality
Important SE’s: Urticaria/angioedema; pancreatitis
Misc: Expensive

17
Q

Canagliflozin (Invokana)

A

Class: SGLT2 inhibitor
Mech: Redfuces glucose resorption in the kidney; increases urinary glucose excretion
Thera: No hypoglycemia; weight loss possible
Important SE’s: UTIs; genital mycotic infections; volume depletion; hyperkalemia; hypersensitivity; increased LDL chol
Misc: Expensive

18
Q

Colesevelam (Welchol)

A

Class: Bile acid sequestrant
Mech: Binds bile acids/cholesterol, and decreses hepatic glucose production
Thera: No hypoglycemia; decreased LDL cholesterol
Important SE’s: Increase in triglycerides
Other SE’s: Constipation; may interfere with absorption of other medications, modest A1c reduction

19
Q

Most common consequence with sulfonylurea and insulin traetment; who will it more likely happen to? What increases risk?

A

Hypoglycemia;
type 1 more than type 2;
think over 60, impaired renal function, poor nutrition, liver disease, increased physical activity, longer duration of diabetes

20
Q

Symptoms of hypoglycemia:

A
  1. confusion, slurred speech, dizzy
  2. shaking, nervousness, sweating, palpitations
  3. extreme hunger
  4. tingling of hands, tongue, lips
  5. vision change, poor coordination
  6. unresponsiveness, unconsciousness or seizures
21
Q

Glucagon emergency kit given only when

A

pt unconscious or unable to swallow; type 1 should always have a prescription, while the type 2 had previously severe low blood sugar

22
Q

Severe hypoglycemia in the hospital requires

A

use of IV DEXTROSE!!!

23
Q

Many patients with diabetes will need

A

multiple therapies to attain glycemic target levels long term (oral agent monotherapy won’t get to A1c goal)

24
Q

Therapeutic inadequacy is

A

failure to reach targeted treatment goals, with dietary noncompliance and physical inactivity being contributing factors; maybe stress, insulin resistance

25
Q

Amylin is released with ____ from ____ cells in response to eating; absent in what and variable in what? Mech of action?

A

insulin; beta; type 1 diabetes, type 2 diabetes;

  1. slow gastric emptying
  2. suppress postprandial glucagon secretion
  3. may reduce appetite
26
Q

Pramlintide (Symlin)

A

Class: Amylin analog
Mech: Mimics amylin: slows gastric emptying, suppresses postprandial glucose secretion, may reduce appetite
Thera: Used with short or rapidly acting insulin;
Important SE’s: Hypoglycemia (significant risk)
Other SE’s: GI side effects (especially nausea), decreased appetite
Misc: Injected; must be given with meals

27
Q

Some indications for insulin:

A
  1. significant hyperglycemia at presentation
  2. hyperglycemia on max doses of oral agents
  3. decompensation (uncontrolled weight loss, acute injury, stress, infection, MI)
  4. surgery
  5. pregnancy
  6. serious renal or hepatic disease
28
Q

Regular insulin

A

Class: Short-acting insulin
Mech: OoA: 30-60 min; PA: 1-5 hrs; DoA: 6-8 hrs
Important SE’s: Hypoglycemia, weight gain
Other SE’s: Lipoatrophy, lipohypertrophy, allergic reaction
Misc: Can be mixed w/NPH; can be given IV

29
Q

NPH (Humulin N)

A

Class: Intermediate insulin
Mech: OoA: 1-4 hrs; PA: 4-10 hrs; DoA: 14-24 hrs
Important SE’s: Hypoglycemia, weight gain
Other SE’s: Lipoatrophy, lipohypertrophy, allergic reaction
Misc: Can be mixed w/Regular

30
Q

Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)

A

Class: Rapid-acting insulin
Mech: OoA: 5-30 min; PA: 0.5-3 hrs; DoA: 3-5 hrs
Thera: Bolus insulin
Important SE’s: Hypoglycemia, weight gain
Other SE’s: Lipoatrophy, lipohypertrophy, allergic reaction
Misc: Expensive

31
Q

Detemir (Levemir)

A

Class: Intermediate insulin
Mech: OoA: 3-4 hrs; PA: 4-8 hrs; DoA: 6-24 hrs
Thera: At higher doses, can be basal insulin (lower doses it is intermediate-acting)
Important SE’s: Hypoglycemia, weight gain
Other SE’s: Lipoatrophy, lipohypertrophy, allergic reaction
Misc: Should not be mixed or diluted with any other insulin preparations

32
Q

NPL, NPA

A

Class: Intermediate insulin (premixed insulins)
Mech: OoA: 1-4 hrs; PA: 4-10 hrs; DoA: 14-24 hrs
Important SE’s: Hypoglycemia, weight gain
Other SE’s: Lipoatrophy, lipohypertrophy, allergic reaction

33
Q

Glargine (Lantus)

A

Class: Long-acting insulin
Mech: OoA: 2-3 hrs; PA: none; DoA: 24-30 hrs
Thera: Basal insulin
Important SE’s: Hypoglycemia, weight gain
Other SE’s: Lipoatrophy, lipohypertrophy, allergic reaction
Misc: Should not be mixed

34
Q

What particular insulins should be used for type 1 and type 2?

A

Rapid-acting and basal for type 1; mixed for type 2

35
Q

Premixed insulin advans, disadvans?

A

Advans: 1. convenient 2. potentially longer shelf life 3. fewer dosing errors 4. simple (pens and not syringes);
disadvans: 1. hypoglycemia risk 2. harder to treat short-term high or low blood glucose levels; RARELY used in type 1 diabetes!!

36
Q

Time course and action of insulin preps:

A

Individual variation and variations dependent on DOSE; regional differences in insulin absorption (e.g. faster in the thigh than abdomen) but rotate sites within region or use specific regions for specific times of day

Pharm Unit 5 (9 decks)

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