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Pharm 2 > Diabeties > Flashcards

Diabeties Flashcards

1
Q

Normal:
Fasting blood glucose
GGT
A1c

A
  1. <100
  2. <140
  3. <5.7%
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2
Q

Prediabeties
fasting blood glucose
GGT
A1c

A
  1. 100-126
  2. 140-199
  3. 5.7-6.4%
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3
Q

Diabetes
fasting blood glucose
GGT
A1c

A
  1. > 200
  2. > 140
  3. > 6.5%
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4
Q

Type 1 diabetes

A
  • Autoimmune diabetes - against pancreatic beta cells and to insulin
  • Islet cells develop fibrosis and atrophy
  • Antibodies are glutamic acid decarboxylase
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5
Q

C-peptide

A

proinsulin= insulin + cpeptide
( spilt in endocutic vesicles w.in the pancreas)
- pts newly dx with DM may have cpeptide measured as a means of distinguishing type 1 and 2
- measured b.c insulin in peripheral vasculature is lower than in the portal vein

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6
Q

what are c-peptide levels in DM 1 vs 2

A

1: low
2: high

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7
Q

type 2 diabetes

A
  • insulin resistance which arises over time.
  • relative insulin deficiency in addition to excess hepatic glucose production
  • no antibodies
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8
Q

diabetes 1.5

A
  • latent onset adult diabetes
  • insulin resistance like 2 but antibodies like 1
  • therefor they will respond to lifestyle change/drugs but then
  • usually need insulin
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9
Q

name the medications for type 2 diabetes

A

Biguanides
Sulfonylureas
Meglitinides (Non-sulfonylurea secretagogues)
Alpha-glucosidase inhibitors
Thiazolidinediones (TZDs) aka Glitazones
Dipeptidyl peptidase-4 (DPP-4) inhibitors

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10
Q

overview of DM2 meds

  1. metformin
  2. sulfonylurase
  3. alpha-glucosidase inhibitors
  4. thiazolidinedione’s
  5. DPP-4
A
  1. inhibits glucose production by liver and decrease insulin resistance
  2. increase secretion of insulin
  3. delay absorption of glucose by the intestines
  4. decrease insulin resistance
  5. promote release of insulin from the pancreas after eating a meal
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11
Q

pregnancy and diabetic meds

A

use insulin and not oral meds in type 2 moms

type 1 moms: increase insulin dose esp. in 3rd trimester b.c human placental lactogen decreases insulin sensitivity

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12
Q

Biguandes

A
  • metformin
  • increases hepatic glucose production and increased insulin sensitivity
  • alone generally does not cause hypoglycemia
  • similar to french liac
  • Cat b in preg ( no risk)
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13
Q

metformin/glucophage

A
  • reduces fasting glucose and non-fasting glucose and A1c
    -can have a modest reduction in weight
  • decreased DM related end points
    SE: abdominal cramps and nausea, metallic taste, B12 def ( supplement with b complex), lactic acidosis ( dont use drug w/ renal failure, decrease ETOH use)
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14
Q

what is metformin effect on the membrane

A

gives dositive changes to the membrane displacing divalent cations such as calcium

-results in impaired calcium availability at the ileal lumen it many disrupt the calcium-dependent process of vitamin B12 absorption that many cause deficiency

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15
Q

metformin and major surgery

A

major surgery or the use of an iodinated contrast material can also increase the risk for renal insufficiency.

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16
Q

sulfonylureas

A
  • stimulates intact beta cells to release more insulin ( interacts with aTP sensitive potassium channels in the beta cell membrane)
  • SE: weight gain
  • avoid in preg and lac ( cause fetal hypoxia from med insuced hyper-insulinemia- stims the extraction of o2 from blood
  • usu one dose in the morning
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17
Q

effects blocking potassium channels by sulfonylureas

A

the time the beta cell spends in the calcium release stage of cell signaling is increased which initiates more insulin release from the affected beta cell.

18
Q

what are the first generation sulfonlyureas

A
  • Chlorpropamide (Diabinese)
  • Tolbutamide (Orinase
  • Seldom used
19
Q

what are the second generation sulfonylureas

A

Glipizide (Glucotrol)( causes more hypoglycemia)

Glyburide (Micronase,
Diabeta)

Glimepiride* (Amaryl).(also third generation

20
Q

what are the adverse effects?

A
  • hypoglycemia esp. in pts with renal or hepatic impairment

- weight gain

21
Q

which sulfonylurea has has increased incidence of hypoglycemia?

A

Gyburide ( glucotorl

22
Q

when do sulfonylureas become ineffective

A

after 5-10 years

23
Q

triple therapy

A

initial use of sulfonylurea’s alone does not work in 10-20% of patients. so some docs combine the following

  1. sulfonylureas,
  2. biduanide (metformin)
  3. TZD

to avoid insulin, this is discouraged .

24
Q

Meglitinides

A
  • stimulate beta cells to release insulin
  • AKA non-sulfonurea secretagogues
  • before meals 3-4x a day
  • bind Atp senistive potassium channelson beta cells = increase insulin release
  • cause hypoglycemia and weight gain
  • approved for combined use with meformin or glitazone ( but avoid with sulfa)
  • absorbed from th GI tract causing peak in insulin in 30-40 min and rapidly cleared
25
Q

what are the two drug forms of Meglitinides

A
  • Nateglinide (Starlix) -less effective than prandin ( but just as effective as sulfa)
  • Repaglinide (Prandin).
26
Q

thiazolidinedione’s / glitazones

A
  • improve insulin sensitivity in skeletal muscle, fat and liver cells also decrease hepatic glucose production
  • dose once a day
  • 6-14 wks to achieve max Fx
  • can be combined with metformin or sulfa
  • increase risk for congestive heart failure
  • liver function test should be done before prescribing retest in 1 + 3 mon for elevated ALT
27
Q

what are some examples of thiazolaidinediones?

A

Rosiglitazone (Avandia)

Pioglitazone (ACTOS) - only drig approved for combination with insulin!

  • both associated with an decreased bone density and increased bone fracture
28
Q

alpha-glucosidase inhibitors

A

alpha glucosidase is an enzyme which lines the brush border, inhibiting this interferes with the hydrolysis of carbohydrates and delaying absorption of glucose and other monosaccharides

  • taken with meal
  • will not cause hypoglycemia unless taken with other oral meds
  • cat b in preg
  • interferes with the break down of sucrose ( tx hypoglycemia with glucose)
  • contraind: intestinal Dz
29
Q

what are the sx associated with unabsorbed carbs

A

abdominal pain, diarrhea, and flatulence due to osmotic effects and bacterial fermentation

30
Q

acarbose

A
  • alpha-glycosidease inhib
  • associated rarely with moderate transaminase elevatio and although considered to be a rare event fatal hepatic failure has been reported
31
Q

Sitagliptin/januvia

DPP-4 inhibitor

A
  • by preventing the inactivation of GLP-1 and GIP inactivation, potentiates the duration of the effects of insulin following a meal
32
Q

list some of the hypo glycemic combinations

A
  • Glucovance/ Metformin and Glyburide
  • Metaglip/ Metformin and Glipizide
  • Avandamet/ Metformin and Rosiglitazone
33
Q

meds for type 2

A

start with metformin
then add sulpha
then add insulin ( lantus)

34
Q

injectable agents

A

Pramlintide (synthetic amylin) and Exenatide

35
Q

Pramlintide/ Symlin

A
  • used for type one of type 2
  • (amylin) slows gastric emptying and promotes satiety - prevents spikes after a meal
  • allows pts to use less insulin
  • can not be combined with in sulin
  • usu given to type 1 or 2 who are not reaching their tx goals
36
Q

what is the only drug with the FDA approval for lowering blood sugar in type 1

A

symlin

37
Q

how is pramlintide administered

A

injectable, at meal time, this improved A1c w/o hypo glycemia or wt gain

actually caused wt loss

38
Q

what are the side effects of pramlintide

A

nausea ( improves over time as pt finds optimal dose)

39
Q

Exenatide/Byetta

A

new class of drugs referred to as incretin mimetics

  • for type 2
  • lowers blood glucose by increasing insulin secretion
40
Q

why does exenatide not cause hypoglycemia

A

b.c it only has effect in the presence of elevated blood glucose .

hypoglyciemia can occur in the presence of hypoglycemics (sulfa)

  • may have some weight loss

Pharm 2 (16 decks)

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