Diabetes Not Insulin Flashcards
2 drugs that sensitize the body to insulin ( decrease insulin resistance) and/or control hepatic glucose production (decrease hepatic formation of glucose)
- ”glitazones”:: pioglitazone (Actos)
2. biguanides:: metformin (Glucophage)
2 Drugs that stimulate the pancreas to make more insulin
- Sulfonylureas: glipizide (Glucotrol XL)
- meglitindes: repaglinide (Prandin)
Secrete More Please
Drugs that slow the absorption of starches
Alpha-glucosidase inhibitors: acarbose (Precose)
Drugs that act on incretins
- “gliptins” DPP-4 inhibitors:Sitagliptin (Januvia)
2. Incretin mimetics: GLP-1 Receptor Agonist- Exanatide (Byetta)
drugs that Manipulate kidney excretion of glucose
- SGLT-2 inhibitors : canagliflozin (Invokana)
keep it flozin
drugs that are synthetic amylin
Amylin Mimetic: Pramlintide (Symlin)
6 ways non insulin drugs can control diabetes
- sensitize the body to insulin and/or control hepatic glucose production
- stimulate the pancreas to make more insulin
- slow the absorption of starches
- act on incretins
- Manipulate kidney excretion of glucose
- Synthetic amylin
prototype for biguanides
metformin (Glucophage)
how dooes metformin (Glucophage) fxn?
biguanide
-(1) decrease hepatic formation of glucose and (2) reducing insulin resistance (endogenous and exogenous)
non insulin drug that is drug of choice for most patients?
metformin
side effects of metformin
GI (anorexia, nausea, diarrhea, weight loss, FLATULENCE), Lactic acidosis risk (rare)
s/s of lactic acidosis from metformin ? What patient population does it occur in?
EMERGENCY- malaise, hyperventilation, somnolence
‣ occurs w/ renal impairment, infection, liver disease, cimetidine use, alcoholic
‣ take patients off metformin in the hospital
which non insulin DM drug has risk of B12 and folic acid deficiency?
(biguanide)
-metformin
does metformin have a risk of hypoglycemia?
• Low to No risk of hypoglycemia when used alone
which non insulin DM drug has IV contrast contraindication?
(biguanide)
metformin
what happens w/ IV contrast dye and metformin? how do we prevent it?
stop for 1-2 days before IV contrast test and for 48 hours.
• Can cause Acute Renal Failure—which can lead to lactic acidosis.
*Acute Renal Failure or CKD IV or V patients at risk for this.
prototype for sulfonylureas?
glipizide (Glucotrol XL)
how does glipizide (Glucotrol XL) fxn?
(Sulfonylureas)
Act by (1) stimulating the release of insulin from islet cells and by (2) increasing the sensitivity of insulin receptors on target cells
*note have to have a pancreas that can make insulin still –> not for type 1 diabetics
side effects of glipizide?
(Sulfonyurea)
- Common: HYPOGLYCEMIA
- Other: antabuse effect, weight gain
which non insulin DM drug has side effect of antabuse effect?
glipizide
Take glipizide with or without meal?
with a meal
drug drug interactions for glipizide?
(sulfonylurea)
NSAIDs, sulfonamides, alcohol , cimetidine –> increase hypoglycemia response
prototype for Glinides (Meglitinides)
repaglinide (Prandin)
how do repaglinide (Prandin) fxn?
Glinides (Meglitinides)
Act by stimulating the release of insulin from islet cells
*not for type 1 diabetes- need pancreas that can make insulin
onset and duration of repaglinide (Prandin)
Onset: rapidly
Duration: short
side effects of repaglinide (Prandin)
Hypoglycemia, weight gain
when to take repaglinide (Prandin) in relation to food?
Take with meal or 30 minutes before
prototype for Thiazolidinediones (TZD) or “glitazones”
pioglitazone (Actos)
how does pioglitazone (Actos) fxn?
Thiazolidinediones (TZD) or “glitazones”
Work by (1) decreasing insulin resistance and (2) suppress glucose production by the liver **same way metformin (biguanide) fxns!
side effects of pioglitazone (Actos)
Common Side Effects: upper respiratory infection, headache, sinusitis, myalgia
Other Side Effects: fluid retention (Caution in HF), weight gain, bladder cancer, fractures
*use caution in HF (onset and exacerbation)
do not use pioglitazone (Actos) w/ which patient population b/c of side effect of fluid retention?
heart failure
prototype for Alpha-glucosidase Inhibitors
acarbose (Precose)
how does acarbose (Precose) fxn?
Alpha-glucosidase Inhibitors
Slows digestion of starches in the gut by blocking enzyme that breaks down starches
• “a” “carb” “ohhhh”
side effects of acarbose (Precose)
◦ GI (abdominal cramping, diarrhea, flatulence, borborygmus)
◦ Long term: liver dysfunction
i LIVE(r) for Carbs
when do we take acarbose (Precose) in relation to food?
Take with first bite of food!
Does acarbose (Precose) have risk for hypoglycemia?
monotherapy = no
w/ insulin or sulfonylurea Glipizide = risk of hypogly
if you have hypoglycemia with acarbose (Precose) how do you treat it?
oral glucose (sucrose will NOT work)
prototype for SGLT-2 Inhibitors
canagliflozin (Invokana)
So (much) Glucose Leaving (my) Tubes –> Kidneys
how does canagliflozin (Invokana) fxn?
Increases glucose secretion through urine by inhibiting SGLT-2
-work on kidney
admin/route for canagliflozin (Invokana)
pill Q daily
side effects of canagliflozin (Invokana) (regular and serious)
Side Effects: Genital fungal infections, UTI and increased urination, Weight loss
Serious Side Effects: DKA, urosepsis, pyelonephritis, increased risk of amputation
***watch for signs of dehydration
what are incretins? what do they do? (6)
hormones secreted by the intestine following a meal when bld glucose is elevated.
• signal the pancreas to increase insulin section
• signal the liver to stop producing glucagon
• Slow gastric emptying
• Stimulate insulin release from pancreas
• Inhibit postprandial release of glucagon
• Suppress appetite
prototype for GLP-1 Receptor Agonist/Mimetics
Exanatide (Byetta)
how does Exanatide (Byetta) fxn?
synthetic GLP-1 that mimics the action of incretins
actions of incretins:
• signal the pancreas to increase insulin section
• signal the liver to stop producing glucagon
• Slow gastric emptying
• Stimulate insulin release from pancreas
• Inhibit postprandial release of glucagon
• Suppress appetite
when do we give Exanatide (Byetta) in relation to food? (route?)
SQ BID 30-60 min before meal
which incretin DM drug has a 1/week formulation available?
Exanatide (Byetta)
onset of Exanatide (Byetta) ?
Onset: 30-60 min
regular and rare side effects of Exanatide (Byetta)
Side Effects: significant nausea, vomiting and diarrhea,
Rare Side Effects: Risk of pancreatitis, renal failure and hypersensitivity reactions
–>Give w/ low fat diet to decrease nausea
does have Exanatide (Byetta) have risk of hypoglycemia?
• Hypoglycemia IF combined with sulfonylureas
admin consideration for other drugs w/ Exanatide (Byetta)
• Give oral drugs 1 hour before injection b/c slows gastric motility
prototype for DPP-4 Inhibitors?
: “gliptins” —-> Sitagliptin (Januvia)
how does Sitagliptin (Januvia)fxn?
enhances the action of incretin hormones
actions of incretin hormone:
• signal the pancreas to increase insulin section
• signal the liver to stop producing glucagon
• Slow gastric emptying
• Stimulate insulin release from pancreas
• Inhibit postprandial release of glucagon
• Suppress appetite
patients do not have to be able to make insulin to use sitagliptin- true or false
FALSE
actions of Sitagliptin (incretin hormone enhancer) are dependent on insulin :: patient must be able to make some insulin
regular and rare side effects of sitagliptin
DPP-4 Inhibitors
Side effects: cold symptoms
Rare Side Effects: pancreatitis, hypersensitivity reactions
admin for Sitagliptin (Januvia)- food? frequency?
One pill once a day with/without food
prototype for Amylin Mimetics
Pramlintide (Symlin)
how does Pramlintide (Symlin) fxn?
amylin mimetic
co released w/ insulin
• Delays gastric emptying
• Suppresses glucagon secretion
• Decreases postprandial glucose elevation
Pramlintide (Symlin) for type 1 or 2 DM?
both!
Amylin Mimetic
when do we take Pramlintide (Symlin) in relation to food? how do we admin?
Taken at meals SQ, Can’t be mixed in syringe with insulin
consideration for other oral meds with Pramlintide (Symlin)
Take any oral drugs 1 hour before injection
side effects of Pramlintide (Symlin)
hypoglycemia (only if used w/ insulin!, occurs 3 hours after injection!), Nausea, vomiting, anorexia
will Pramlintide (Symlin) cause hypoglycemia?
only if used w/ insulin
occurs within 3 hours of injection !
3 DM drugs for preggos?
- NPH/Regular insulin
- Glargine (Lantus)/ aspart (Novalog)
- Metformin (Glucophage)
initially treat hypoglycemia with….
• Food: 15G carbohydrates
◦ Glucose tablets, 120 cc OJ or non diet soda, 3-4 pieces candy, 1 TBSP sugar
• Administration of D50 (Dextrose 50%) IV – irritating to veins
patients need to be able to maintain blood glucose after hypoglycemic event so give them….
protein
home emergency injection of what for hypoglycemia?
glucagon
–> take 20 min to regain cosciousness
