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Endocrinology > Diabetic Therapy Lecture PDF > Flashcards

Diabetic Therapy Lecture PDF Flashcards

1
Q

Secretion of insulin is triggered by these 5 things

A
  • glucose
  • amino acids
  • fatty acids
  • ketone bodies
  • Epi/norepi
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2
Q

Absence of insulin transfers us from a ___ state to a ___ state

A

anabolic, catabolic (in absence of insulin we see glycogen converted to glucose, gluconeogenesis, and decreased cellular uptake of glucose)

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3
Q

Therapeutic uses of insulin (3)

A
  • diabetes mellitus (type 1 all patients and some type 2)
  • IV for diabetic ketoacidosis
  • treatment of hyperkalemia (pulls K+ intracellularly
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4
Q

Why were animal sources of insulin discontinued?

A

Because they differ slightly from human insulin, antibodies may develop

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5
Q

Recombinant human insulin analogs

A

Bioidentical insulin grown in e coli or yeast that has been slightly modified to have a different time course (either shorter or longer acting)

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6
Q

Rapid acting insulin analog time frame compared to regular

A

5-30 minutes, 30-60 (but have a shorter duration of action in 3-5 hours, are more convenient because can be administered with or just before a meal

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7
Q

Metformin (glucophage) function

A

-Drug of choice for initial treatment of type 2 diabetes, when not A1C goal reached can use additional agents depending on comorbidities (SGL2 inhibitors)

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8
Q

If max dose of 2 drugs insufficient to achieve glycemic control, then…

A

….insulin or another drug can be added

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9
Q

Sulfonylureas function

A

PO drugs derivatives from sulfonamides administered to reduce plasma glucose levels

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10
Q

Principal differences between first and 2nd gen sulfonylureas

A

Second gen are much more potent at lower doses and serious interactions are less common and are therefore widely used and generally superior

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11
Q

3 second gen sulfonylureas

A
  • Glipizide (glucotrol)
  • glyburide
  • glimepiride
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12
Q

Sulfonylureas mech of action

A

Stimulate release of insulin from pancreatic tissues by binding receptor sites on B cell causing depolarization triggering increase in intracelular calcium and thus insulin release (pancreas must be able to produce insulin for them to be effective, with prolonged use agents enhance cellular sensitivity to insulin thru unknown mechanism)

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13
Q

Sulfonylureas ADR’s (4)

A
  • Hypoglycemia (tell patients not to skip meals)
  • weight gain 5-10 pounds
  • hematologic reactions such as lekupenia or thrombocytopenia
  • disulfuram like reaction (flushing, palpitations, nausea reported with use when drinking on chlorpropamide ( a gen 1 agent)
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14
Q

Metformin mech of action

A
  • lowers blood glucose primarily thru decreasing hepatic gluconeogenesis and secretion of glucagon like peptide
  • does not stimulate insulin release from pancreas and does not actively drive down blood glucose levels posing little to any added risk of hypoglycemia when used alone
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15
Q

Metformin therapeutic use (4)

A
  • monotherapy in patients whose blood sugar levels are not controlled by diet or exercise alone
  • combo therapy with other antidiabetic agents such as sulfonylureas
  • PCOS off labeled use
  • Cardiovascular reduction in risk of MI
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16
Q

Metformin ADR’s (3)

A
  • GI effects
  • Decreased B12 and folic acid absorption which can lead to deficiencies (not recommended to supplement with metformin)
  • Lactic acidosis in patients with low GFR
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17
Q

Acarbose (precose) drug class and mech of action

A
  • alpha glucosidase inhibitor
  • oral agent that reversibly inhibits alpha glucosidase, and enzyme present in brush border mucosa of small intestine, slows rate at which complex polysaccharides and sucrose are digested resulting in lower postprandial blood glucose conc
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18
Q

Acarbose (precose) ADR (1)

A

-GI effects due to fermentation of unabsorbed carbohydrate

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19
Q

Miglitol (glyset) function

A

Delays carb conversion of oligosaccharides and complex carbs to glucose decreasing postprandial rise in blood glucose

20
Q

Thiazolidinediones function and mech of action

A
  • Antidiabetic agents that work primarily by decreasing insulin resistance
  • Decrease insulin resistance by activating a specific receptor type in the cell nucleus known as PPAR gamma, as a result insulin responsive genes are turned on that hep regulate carbohydrate and lipid metabolism, cellular response to insulin is increased promoting uptake
21
Q

Thiazolidinediones ADR’s (4)

A
  • Uncertain if benefits outweigh risks
  • Heart failure
  • weight gain
  • anemia
22
Q

Rosiglitazone (avandia) drug class, function and ADR’s (3)

A
  • Thiazolidinediones
  • Approved for monotherapy or with metformin for treatment of type 2 diabetes
  • edema, weight gain, mild anemia
23
Q

Pioglitazone (ACTOS) drug class, function, ADR’s (3)

A
  • Thiazolidinedions
  • Approved for monotherapy or with metformin for treatment of diabetes
  • Fractures, bladder cancer, hepatotoxicity
24
Q

Metiglinides (Glinides) function

A

Short acting agents for type 2 diabetes with same mech of action as sulfonylureas, tend to be shorter acting tho and are taken with each meal

25
Q

DPP-4 inhibitors mech of action and therapeutic use (1)

A

Promote glycemic control by enhancing the actions of incretin hormones, potentiating glucose dependent secretion of insulin and suppress glucagon secretion, produce modest reductions in A1C levels when used as monotherapy
-2nd line therapy as add on to metformin

26
Q

Sitagliptin (Januvia) drug class, function, and ADR’s (3)

A
  • DDP inhibitor
  • Approved for PO monotherapy or in combo with other antidiabetic drugs for treatment of type 2 diabetes
  • URI, headaches, pancreatitis
27
Q

SGLT2 inhibitors mech of action and other benefit

A
  • Block SGLT2 transporters decreasing renal glucose reabsorption and increasing urinary glucose excretion, reducing fasting and prepreandial blood glucose levels
  • Reduction in SBP reducing CV risk
28
Q

SGLT2 inhibitors ADR’s (3)

A
  • frequent mycotic genital and urinary tract infection
  • fournier gangrene (necrotizing infection of external genitalia, perineum, and perianal region)
  • acute kidney injury
29
Q

Bromocriptine (cycloset) function, mech of action, and other beneficial use

A
  • Approved as adjunct to diet and exercise to treat type 2 diabetes as monotherapy or in conjunction with metformin
  • unknown mechanism but dopamine agonist
  • breast milk production inhibition
30
Q

Glucagon like peptide 1 (GLP1) receptor agonists function and mech of action

A
  • injectable agents administered SC for treatment of type 2 diabetes
  • Have same physiologic effect as endogenous incretins slowing gastric emptying stimulation of glucose dependent release of insulin and inhibition of postprandial release of glucagon
31
Q

Exenatide drug class and function

A
  • GLP-1 agonist

- type 2 diabetes adjunct to metformin and/or sulfonyurea in pts without adequate glycemic control

32
Q

GLP 1 agonist ADR’s (2)

A
  • pancreatitis

- thyroid carcinomas

33
Q

Pramlintide (symlin) drug class and function

A
  • synthetic analog of human amylin (amylin mimetic)
  • approved for adjunctive treatment for patients with type 1 or 2 diabetes who inject insulin at mealtimes and have failed to achieve glucose control
34
Q

3 frequently used rapid acting insulin analogs

A
  • Aspart
  • glulisine
  • lispro (humalog)
35
Q

Lispro (humalog) rapid absorption mech of action

A

-unlike most insulin, avoids self association to form hexamers unlike most insulins and thus attains more rapid absorption and onset of action (15 min)

36
Q

Air inhaled insulin (Afrezza) function and ADR’s (3)

A
  • Inhaled rapid acting dry powder formulation of recombinant human insulin approved for treatment of adults with type 1 or 2 DM
  • Throat pain, cough, FEV1 decline
37
Q

Regular insulin (humulin R) function

A

Unmodified crystalline insulin that is short acting soluble insulin, after SC injection forms small hexamers delaying absorption and onset to .5-1 hour, with peak action occurring 2.5-5 hours, and lasting 4-12 hours

38
Q

Regular U-500 insulin function (Humulin)

A

Normal insulin indicated in patients who require >200 units/day specifically targeting insulin resistant patients with severe type 2 diabetes, exhibits both a bolus and basal effect and can be used as monotherapy in some cases for type 2 diabetics

39
Q

Examples of long acting insulin (3)

A
  • Lantus
  • levemir
  • toujeo
40
Q

Lantus function

A

Long acting peakless insulin analog, mimics basal effects of insulin secreted by healthy pancreas

41
Q

Administration of insulin

A

Must be given by injection or inhalation because it is degraded in the stomach as a peptide

42
Q

Insulin injection sites

A

Since absorption varies among sites, it is recommended to make injections in one particular area, but sites should be rotated in that area to help limit lipohypertrophy

43
Q

Complications of insulin therapy (3)

A
  • hypoglycemia (blood glucose <70 mg/dL)
  • diabetic coma
  • hypokalemia (can impact heart)
44
Q

Treatment of hypoglycemia in patients (3)

A
  • oral sugar supplements (NOT chocolate or hard piece of candy - aspiration risk if loss of gag reflex or unconscious)
  • IV dextrose
  • Glucagon
45
Q

2 causes of diabetic coma that must be determined

A
  • hypoglycemic requiring withholding of insulin

- ketoacidosis which requires insulin

Endocrinology (19 decks)

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