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vanessa endocrine ppnp > diabetes pharmacology > Flashcards

diabetes pharmacology Flashcards

1
Q

what is insulin usually used for?

A
  1. type 1 diabetes
  2. ketoacidosis
  3. type 2 (chronic)
  4. gestational DM
  5. hyperkalemia (too much potassium)
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2
Q

what are the different kinds of diabetes?

A
  1. rapid acting
  2. short acting
  3. intermediate
  4. long acting
  5. mixed
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3
Q

what are the different kind of rapid insulin?

A
  1. lispro, longest onset
  2. aspart
  3. glulisine
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4
Q

what is the onset of rapid acting insulin?

when to take the med

A

15mins onset

take medication with food

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5
Q

what are the different kind of short acting insulin?

A
  1. regular
  2. antrapid
  3. humulin R
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6
Q

what is the onset for short acting insulin?

when to take the medication?

A

30min-60min onset of action

take the medication 30min before food

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7
Q

what are the different type of intermediate insulin

A
  1. insulatard

2. humulin N

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8
Q

what is the onset of action for intermediate insulin?

when to take the medication?

A

1-4 hour onset of action

does not matter when medication is taken

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9
Q

what are the different long acting insulin?

A
  1. glargine

2. detemir

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10
Q

what is the onset of action for long acting insulin?

when to take the medication?

A

1-4 hour

does not matter when medication is taken

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11
Q

what are the different pre mixed insulin?

A
  1. mixtard 30 = 30regular(shortacting) 70intermediate

2. mixtard 50 = 50regular(shortacting) 50intermediate

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12
Q

what is the onset for premixed insulin?

when to take the medication?

A

30-60mins onset

taken immediately with food

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13
Q

what insulin are suitable for post prandial control?

A

rapid and short acting insulin help control the surge of sugar from meals

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14
Q

what insulin is suitable for fasting basal control?

A

intermediate and long acting insulin help control the sugar produced by the body

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15
Q

what are cloudy insulin ?

A

intermediate and longacting

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16
Q

what are clear insulin?

A

rapid and short acting insulin

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17
Q

what is the route of insulin?

A

usually S/C

emergency and ketoacaidosis IV (10min onset action)

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18
Q

which insulin take the longest to work? (longest onset of action)

A

NPH (intermediate insulin)

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19
Q

which insulin has the highest risk of hypoglycemia ?

A

NPH (intermediate)

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20
Q

what is antrapid sliding scale used for?

A

to correct any hyperglycemic episode

regular/ rapid acting insulin is given as S/C injection

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21
Q

example of antrapid sliding scale

A

10.1 - 14 give 2
14.1 - 18 give 4
18.1 - 22 give 6
more than 22 give 8

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22
Q

for patients going for surgery and on bolus and basal insulin what to do?

A
  1. continue basal or decrease percentage if needed
  2. stop bolus
  3. stop all PO medication
  4. start 5% dextrose drip
  5. sliding scale every 4 hours
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23
Q

for patients going for surgery on premixed insulin what to do?

A
  1. convert to basal insulin, follow the intermediate one
  2. stop all PO medication
  3. start dextrose 5%
  4. sliding scale every 4 hours

but do serve mixtard at dinner the day before

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24
Q

for patient going surgery without any insulin

A

for a short fasting (1 meal)

  • omit the PO drugs
  • start antrapid scale

for long fasting (2 meals or more)

  • omit PO drugs
  • start insulatard (0.1unit/kg)
  • start dextrose 5%
  • sliding scale every 4 hours
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25
Q

what is the first line diabetes drug?

A

metformin

26
Q

what is the mechanism of metformin?

A
  1. increase insulin sensitivity
  2. stimulate glycolysis in tissue (direct use of insulin by tissue)
  3. decrease gluconeogenesis in liver and kidney (formation of glucose)
  4. slow glucose absorption in GI tract
27
Q

what are the side effects of metformin?

A
  1. GI upset (nausea, bloating, diarrhoea)

2. reduced B12 absorption

28
Q

what are the contra for metformin?

A
  1. renal dysfunction (kidney)
  2. tissue not enough oxygen
  3. hepatic dysfunction (liver)
  4. alcoholism
29
Q

why is metformin a first line drug?

A
  1. cheap, safe

2. reduce the risk of cardiovasular risk and death

30
Q

what are the different classes of drugs for diabetes

A

insulin secretagogues
insulin sensitizer
insulin sparing agents

31
Q

what is under the insulin secretagogues ?

A

sulfonylurea

32
Q

what is under insulin sensitizer?

A

thiazolidinedione

biguanide

33
Q

what is under insulin sparing agents

A
  1. acarbose
  2. GLP 1 receptor agonist
  3. DPP 4 inhibitor
  4. SGLT2 inhibitor
34
Q

what is the easy way to remember sulfonylurea?

what are the medication for sulfonylurea

A

MIDE

Glibenclamide (longest acting)
tolbutamide
chlorpropamide

35
Q

what is the function of sulfonylurea?

A

it increases the secretion of insulin

sulfonylurea binds to its receptors on the K+ ATP channels causing them to close and the cell will depolarise causing Ca channel to open and secrete insulin

36
Q

what are the key adverse effect of sulfonylurea ?

A
  1. hypoglycemia
  2. weight gain
  3. allergic skinrash
  4. bone marrow damage
  5. increased CVS death
37
Q

what kind of patient profile will have a higher risk of hypoglycemia ?

A

Elderly
poor renal function
hepatic dysfunction
people with irregular eating habits

38
Q

what is the easy memorizing for thiazolidinedione ?

what are the medication for thiazolidinedione?

A

ZONE
rosiglitazone
pioglitazone

39
Q

what is the mechanism for thiazolidinedione?

A

bind to PPAR and upregulate

  1. lipoprotein protease (convert triglycerol to glycerol and fatty acids)
  2. fatty acid transport protein ( transport into cell)
  3. Glut 4 transport of glucose into the cell for storage

helps to decrease triglyceride in body
reduce glucose output
increase glucose uptake into muscle tissue
increase insulin sensitivity at adipose tissue and muscles

40
Q

what are the adverse effects of thiazolidinediones (TZD)

A
  1. hypoglycemia (when with sulfonylureas or insulin)
  2. hepatotoxicty
  3. fluid retention, peripheral edema, increased risk of hF
  4. weight gain
41
Q

will obese patient be suitable for TZD

A

Ideally not recommended as the drug can cause weight gain

42
Q

contra of TZD

A

liver disease

heart failure

43
Q

what is the name of drug for alpha glucosidase inhibitor?

A

acarbose : glucobay

can be used as monotherapy or with sulfonylurea / biguanide

44
Q

what is the mechanism of acarbose?

A

acts as competitive inhibitor and bind to glucosidases and delay the digestion of polysaccarides and the increase in blood glucose level will be less steep\

by decreasing the amount of glucose in the body, the amount of insulin produced by the body decreases too

45
Q

when to take acarbose?

A

taken just before ingesting a meal

46
Q

what are the side effects of acrabose ?

A
  1. elevated liver enzymes
  2. flatuence (farting)
  3. diarrhoea (no longer digesting the food)
47
Q

what kind of patients are contra for acrabose

A

Gastrointestinal diseases like Inflammatory bowel disease

severe renal and hepatic disease

48
Q

which two drugs work on the same pathway?

A

Dipeptidyl peptidasae-4 inhibitors,

GLP-1 receptor agonist

49
Q

what are is the easy name for GLP-1 receptor agonist ?

what are the names of the drugs of GLP-1 receptor agonist?

A 
TIDE 
exenatide
liraglutide 
albiglutide 
dulaglutide
50
Q

what is the mechanism of GLP-1 receptor agonist ?

A

GLP is usually released in small and large intestine in response to presence of food

agonist increases insulin release and reduce glucagon’s secretion

51
Q

how are GLP-1 administered?

A

subcutaneosly

52
Q

what is the easy name for DPP-4inhibitors?

what are the medication name of dpp4 inhibitors

A

LIPTIN

sitagliptin 
saxagliptin
linagliptin
alogliptin
vildagliptin
53
Q

what is the mechanism of DPP4 inhibitors ?

A

DPP 4 usually deactivate GLP, therefore DPP4 will allow GLP to be active

54
Q

what are the adverse effect of GLP-1 agonist and DPP4 inhibitor ?

A

GI related issues

pancreatitis (not recommended for patients with a history of pancreatitis

55
Q

what are the benefits of GLP-1 agonist and DPP4 inhibitors ?

A

Weight loss

improved cardiovascular outcomes

56
Q

what is the easy names for SGLT2 inhibitors ? Sodium glucose co transporter inhibitor
what are the drug names of SGLT2 inhibitors ?

A

GLIFLOZIN
canagliflozin
dapagliflozin
empagliflozin

57
Q

what is the mechanism of SGLT2 inhibitors ?

A

they block the reabsorption of glucose in the kidney to increase glucose excretion, thus lower blood glucose levels

also allow increased insulin sensitivity and uptake of glucose in muscle cells

58
Q

what are the patients that you usually use SGLT2 inhibitors on?

A

diabetes with cardiovascular disease

reduced risk of hospitalizaton due to heart failure and reduced risk of worsening renal function

59
Q

what are the adverse effect of SGLT2 inhibitors?

A

increased genital infections

urinary tract infection due to more glucose in urine= infection

60
Q

Which hypoglycemic agents are associated with weight gain?

A

sulfonyureas
thiazolidinedione
meglitinides

61
Q

Which hypoglycemic agents are associated with more favorable cardiovascular disease outcomes?

A

Metformin, SGLT-2 inhibitors, GLP-1 receptor agonist

vanessa endocrine ppnp (8 decks)

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