Diabetes Mellitus (Ch 60) Flashcards
Adverse effects of Sulphonylureas: glyburide? When is it taken?
Hypoglycemia is most common adverse effect usually mild but can be severe (because it is forcing the pancreas to produce insulin)
Taken with breakfast (usually one/day)
Example of an insulin Sulphonylureas?
glyburide
What is very important when administering Human-Based insulins?
time frames of insulins are essential to know
If hypoglycemia occurs what should we do?
-Give glucagon
-Have the client et 120 - 200mL of clear fruit juice, glucose tablets or gel
-After the liquid snacks have the client eat their meal soon or give a small snack such as crackers (carbohydrates and protein)
Monitor blood glucose levels
Example of Alpha-glucosidase inhibitors? What do they cause?
-acarbose
-miglitol
Cause a delayed absorption of glucose
What drug interactions do we need to bear in mind with insulins? (increase hypoglycemic effects)
-Increase hypoglycemic effect so will lower blood glucose levels
-B-Blockers (eg propranolol)
reduce glycogenolysis (glycogen to glucose) and sings of hypoglycaemia
-Also can mask signs of SNS activation (tachycardia, palpitations)
When are short acting insulins administered? Onset? peak? duration?
Short (fast) acting
onset 30-60 minutes
peak 2 -3 hours
duration 6-7 hours
given with meals
Boxed warning for TZD (rosiglitazone)?
Boxed Warning for rosiglitazone (Avandia)
Increased risk of angina, MI and heart failure (plasma volume)
Example of Medication Interactions with oral/non-insulin agents? What do they do?
Glucocorticoids:
decrease the effect of hypoglycemic medication
Cortisol-like drugs cause an increase in blood glucose
What do TZDs decrease?
-rosiglitazone (Avandia), other glitazones
-Decrease insulin resistance
-“Insulin sensitizing agents”
Incretins mechanism of action? What do they stimulate and break down?
-Intestinal contents release incretins (GLP-1 and GIP)
Stimulate insulin release
Inhibit glucagon release
-Incretins broke down by the enzyme DPP- 4
dipeptidyl-peptidase 4
SGLT2 Inhibitors – Adverse Effect
Increased urination
possible hypotension/dizziness
UTIs
not surprising
What do we measure for Diabetes Mellitus?
-Measure HbA1C
-Measure of the average blood glucose over the past 3 months
Example of a Amylin Mimetic? What does it inhibit?
Pramlintide
-delays gastric emptying and inhibits glucagon secretion
-reduce postparandial glucose
-Given as an injectable
Adverse effects of insulin?
Life threatening hypoglycemia can occur with insulin
Early signs of hypoglycemia: rapid onset
agitation, irritable
headache
sweating
shaky and tremors
pale
Others: tachycardia, flushing, hunger
What interactions of agents reduces the effect of insulin?
Reduce effect of insulin: so will increase blood glucose levels
Glucocorticoids
When are Rapid-insulins administerd? onset? peak of action? Ex?
-Given with meals
-Onest: 10-15min
-Duration: 3-5 hours
-Peak of action: 60-90min
-Insulin lispro
How does long-acting insulin work? onset? Peak? Duration? What kind of therapy is it used for? Ex?
Long acting:
onset 90 minutes
NO pronounced PEAK
duration 24 hours
Ex.) Insulin glargine (Lantus)
Clear, colourless solution
Basal therapy
What is Sitagliptin? how is it administered? What does it inhibit? When is it given?
-DPP-4 enzyme inhibitors reduce incretin metabolism (reduced glucose
“gliptins”) (breaks down incretin)
-Given oral once daily with or without food ‘
*Used for type 2 only
Ex of incretin mimetic? SC administered administration
Exenatide (GLP1) administered IM (needle pen)
How do Insulins function as?
Function as a substitute for endogenous hormone
(Effects are the same as normal endogenous insulin)
Mecanism of action for Sulphonylureas: glyburide? (oral) What do they improve? What do they decrease?
Stimulate insulin secretion from pancreatic beta cells = increasing insulin levels
Beta cell function must be present
Improves sensitivity to insulin in muscles, liver and fat
tissues take up and store glucose more easily
liver by decreasing the rate of insulin metabolism and breakdown
*Forces insulin to produce insulin)
Diabetes drugs that interact with the incretin pathway?What do they inhibit?
-sitagliptin (given oral)
-excenatide
SGLT-2 inhibitors
What do Alpha-glucosidase inhibitors (oral) inhibit? What is the result? what must it be taken with?
Reversibly inhibit the enzyme alpha-glucosidase in the brush border of the small intestine:
-acarbose
-miglitol
Inhibits digestion of oligo- and disaccharides
Result: delayed absorption of glucose
Must be taken with meals to prevent excessive postprandial blood glucose elevations
