Diabetes Rx Flashcards
NPH peak and duration
peak 4-12
duration 18-26
(intermediate acting)
mechanism acarbose
inhibits enteric enzymes that break down complex carbs > malabsorption
general goals for glycemic control
fasting+preprandial glucose 70-120mg%
2 hour Post pandrial glucose, < 180mg%
Hgba1C
DPP4 inhibitor, mechanism
Sitagliptin
inhbition of DPP-4 prevents degradation of GLP-1 to prolong action in portal circulation
Mitiglinide mechanism
binds to sulfonylurea K channel to increase insulin secretion
(OK in patients with Renal failure, vs sulfonylurea drugs)
3x dail dosing
sulfonylurea (glipizide, glyburide, glimepiride) side effects
hyponatremia
disulfiram like reaction
Rashes/GI upset
drug interactions (warfararin
hypoglycemia
GLP-1 analogs,
mechanism
Exenatide + liraglutide
long acting analog, increases beta cell mass
inhibits glucagon secretion
promotes weight loss
sulfonyurea drugs
mechanism+duration
stimulate insulin secretion by pancreas
(glipizide, glyburide, glimepiride)
(all 15-24)
insulin side effects
hypoglycemia
insulin allergy
lipoatrophy or lipihypertrophy
insulin edema
“weight gain”
at high doses: atherosclerosis, increased cancer (?)
glucosidase inhibitors, mechanism
Acarbose
inhibits enteric enzymes that break down compelx carbohydrates, causing malabsorption > reduces post-prandial hyperglycemia
insulin analogs
Lispro insulin
insulin aspart
insulin glargine peak and duration
no peak
24-36 hours
(long acting)
insulin detemir peak and time course
6-14 peak
24 duration
stimulates insulin secretion at pancreas
sulfonylureas
(glipizide, glyburide, glimeiride)
contraindications metformin
Renal insufciency
Elderly
CHG
Home oxygen
acute illness
binge drinking+ liver dysfunction
mechanistic advantage Lispro insulin, insulin aspart
(insulin analogs)
do not form hexamers as does regular insulin, allowing them to have a quicker onset of action more similar to normal meal-induced secretion
Sitagliptin mechanism
DPP-4 inhbitor > slows degradation of GLP-1 in portal circulation
SGTP-2 inhibitor, mechanism
canagliflozin
inhibits transport at sodium glucose transporter in proximal tubule
>glucose wasting in urine
Canagliflozin mechanism
side effects
inhibits SGTP glucose transporter in proximal tubule > glucose wasting in urine
increase risk of genital yeast infection
only insulin for IV use
regular insulin
cloudy suspension aggregated with protamine and zinc
longer time course
NPH insulin
decreases peripheral insulin resistance
decreases central insulin resistance
central - metformin
perpheral - Thiazolidinediones (rosiglitazone, pioglitazone)
long acting insulin analogs and specific mechanism
insulin glargine - soluble at pH4, poorly at pH7
SubQ, forms fine percipitate in interstitial fluids
**Insulin detemir - **self-association at SubQ sites, also binds to albumin in blood stream
thiazolidinediones mechanism
(rosiglitazone, pioglitazone)
side effects
activate PPAR to increase peripheral insulin sensitivity
liver toxicity
weight gain and fluid retention
contraindicated in heart failure
Rosiglitazone - ishemic cardiac events, increased bladder cancer
Exanatide+liraglutide mechanism and side effects
SubQ long acting analog, increases beta cell mass
inhibits glucagon secretion
promotes weight loss
nausea, emyesis, diarrhea, headaches, possible pancreatitis
Lispro insulin and insulin aspart
Peak and duration
Peak - 0.7
duration 2
(short acting)
Metformin mechanism and side effects
reduce insulin resistance in liver
most side effects GI
lactic acidosis (do not prescribe in renal failure)
