Diabetes Pharmacology Flashcards

Question

Metglitindies Names MOA when are they used Side Effects

Answer 1

Names : Glitinides - nateglinide - repaglinide **MUST be taken WITH MEALS** MOA - stimulate insulin release from the beta cells: but in **response to glucose** - these are glucose dependnt medications!!!!! **DO NOT USE with sulfonyureas!!! too similar in their MOA as they both act on the beta cells** when are they used - taken with meals: there to help control post-prandial glucose spikes Side Effects - **hypoglycemia** - dizzy - URI

Answer 2

Names - Acarbose - Miglitol - **taken with meals: help to control post prandial glucose** MOA - inhibit the hydrolysis and ingestion of carbyhydrates, disaccharides and the absorbtion of glucose from the GI tract Place In thearpy - post-pradial gucose control Side Effects: think GI issues - flatulence - diarrhea - abd. pain

Answer 3

Name - Pramlintide MOA - taken before meals: there to help prolong gastric emptying & reduce the postpradial glucose spike: because less is being released over time - can help with satiety too since its delaying teh emptying of stomach & decrese caloric intake Place in thearpy - postprandial glucose control - taken with insulin: can reduce amount of bolus insulin needed by 50% Side Effects - **BBW: severe hypoglycemia when its taken with insulin** - headache - N/V - anorexia

Answer 4

also called, coverage, pradial insulin RAPID ACTING - Aspart (Novolog) - Lispro (Humalog) - Glulisine (Apidra or Lyumjev) **all the above bolus insulins peak quickly, within approx. 15-30 minutes to cover the post meal spike and then are gone within hours** SHORT ACTING R (Regular insulin) = least like normal physiological insulin levels : in that it takes longer to peak and lasts longer in the system

Answer 5

insulin which covers for the whole day INTERMEDIATE ACTING N (NPH) - may need to dose 2x daily - **peaks** - risk of hypoglycemia - **can be mixed physically with bolus insulin** Detemir (Levemir) = often dosed 2x daily **has a flat peak** LONG ACTING Glargine (Lantus) = **peakless!!!** - no risk of hypoglycemia because its peakless Degludec (Tresibia)

Answer 6

70/30 - NPH (intermediate insulin) + regular insulin or protamine aspart (a shorter acting insulin) 75/25 50/50 first # = intermediate second # =short/rapid insulin

Answer 7

Inhaled Insulin (Afrezza) **a BOLUS insulin**: therefore you still need basal coverage Contraindicated in - COPD - asthma - other chronic lung diseases WARNINGs - lung cancer - pulmonary lung function - smokers

Answer 8

- if A1c is > 10% at dx. put them on dual therapy: insulin + other (metformin usually) - if you have tried other medications and they are still not to goal, add on insulin **Always start with adding basal insulin!!!** - start them on approx. 10 units a day or .1-.2 units per kg of body weight/per day - then increase/titrate up from there 2 units per 3 days until their fpg is at goal

Answer 9

- weight gain - hypoglycemia Hypoglycemia Levels Level 1: glucose < 70 Level 2: glucose < 54 Levels 3: severe event - AMS/phsycailly altered - required assistance to treat Symptoms of hypoglycemia - tremor - sweating - tachycardic - dizzy - anxious - thristy - burry vision - weak/fatigue - HA - irritable/confused - syncope **alwasy check glucose level first before treating**

Answer 10

For a Conscious Patient (glucose < 70) **15-15 rule** - give 15 grams of carbohydrates - wait 15 minutes - recheck sugar - keep repeating until glucose increased - then make sure they eat something (15 grams carbs = 3/4 glucose tablets, 1/4 cup juice, 1/2 can regular soda, 8oz milk) For Unconscious Patient - glucagon pen

Answer 11

**preferred way is patient to titrate themselves** - increase units every few days until FPG is within range - example: increase 2 units every 3 days until goal FPG Other Way = Provider Titrates - increased dose by 2-4 units every 1xor 2x weekly **if hypoglycemic: decrease the dose by 10-20%** then slowly up dose again

Answer 12

CVD: hypertension, dyslipidemia, CHD retinopathy neuropathy nephropathy

Answer 13

Immunizations - flu - pneumococcal - hepatitis - zoster - HPV - COVID dental visits Q6 months yearly albumin:creatitine ratio dilated eye exams neuropathy screening (monofilament testing) yearly

Answer 14

**reassess treatment every 3-6 months** consider... - fasting plasma glucose: should be between 80-130 - PPG: should be < 180 - amoutn of A1C lowering: should be around 7% watch: adding noninsulin therapy to metformin may not lower A1c as much as you want if the A1c is so high

Answer 15

Metformin - keep on board: helps with weight (avoids gain) - adding this + insulin = good results Sulfonureas **take off** - controversial if you keep these on board - discontinue if you use bolus thearpy for sure TZDs **take off** - decrease dose or discontinue if you start insulin - **increased peripheral edema risk** good to keep on board - SGLT2 - DPP4 - GLP-1

Answer 16

**always adjust the insulin to change the glucose levels which are a result of whatver happened before example: midmorning spike: due to breakfast poor control** (also consider food intake too while adjusting insulin) Problem = fasting glucose - too high? increase basal insulin - too low? decreased basal Problem = 2 hours post breakfast - too high? increase bolus **with breakfast** - too low? decrease bolus same goes for lunch and dinner

Answer 17

Downside - decreased flexibility in timing and variety of meals and activities - difficut to titrate dosing upsides - fewer injections Good For - those unwilling to inject multiple times a day - those unwilling to check glucose multiple times a day - those who have predicable/routine life & eat the same meals **always find appropriate dose first before switching**

Answer 18

- start at intermdeiatie dose and decrease by 20% - then titrate up from there

Answer 19

**if they are having post-prandial spikes and it just after one meal!!!** - can start with giving after largest meal or evenly split to every meal **start with 4 untis or 10% of their total daily dose of basal** then can titrate up 1-2 units or 10-15% twice weekly