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Pharm > DM > Flashcards

DM Flashcards

1
Q

Dx of DM

A

A1c >6.5%
fasting plasma glucose >126mg/dL
oral glucose tolerance test >200 mg/DL

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2
Q

prediabetes

A

fasting plasma glucose between 100 and 125 mg/dL

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3
Q

glycemic targets for non-pregnant w/ dm

A

A1C <7.0%
premeal plasma glucose 80-130mg/dL
peak post meal glucose >180mg/dL

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4
Q

Tight glycemic control benefits

A

decrease in:
kidney disease
neuropathy
opthalmic complications

MI, angina

more hypoglycemic episodes

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5
Q

Short duration: rapid acting

A

Lispro - injectable (SQ)

onset: 10-30 min
peak: 30 min - 2.5 hours
duration: 3-6 hours

immediately before eating, or after eating in some patients

can be mixed with NPH in same syringe

Afrezza - inhaled

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6
Q

education for rapid acting

A

rotate sites
s/s hypoglycemia (tachy, sweaty,
hygiene (at site and hands)
storage - fridge 3mo
1 mo not in fridge
avoid direct sunlight

prefilled syringes - 1-2 weeks in fridge

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7
Q

short duration: short acting

A

regular insulin
humulin R, novolin R

Clear
SQ, IM, IV
can be mixed with NPH

onset: 30-60 minutes
peak: 1-5 hours
duration: 6-10 hours

U100 and U500
U500 only for pts with insulin resistance, never given IV

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8
Q

Intermediate acting

A

NPH
Humulin N, Novolin N

Cloudy
2x daily SQ
only mix with short-acting and rapid-acting in the syringe (clear before cloudy)

onset: 1-2 hours
peak: 6-14 hours
duration: 16-24 hours

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9
Q

long duration

A

insulin glargine (lantus)
insulin detemir (levemir)

1xdaily
incidence of hypoglycemia not as common
clear, SQ only

onset: 1-2 hours
peak: none
duration: 24 hours

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10
Q

ultra long duration

A

Insulin Glargine (U-300) (same as lantus but 3x more concentrated)
Insulin Degludec (U100, U200)

1x/day
prefilled pens only, SQ only
onset: 6 hrs
peak: none
duration: >24 hrs

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11
Q

Somogye Effect

A

aka “rebound hyperglycemia”
treated with bedtime snack
morning blood sugar is elevated

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12
Q

dawn phenomenon

A

occurs in sleep for all people
hormone release to maintain and restore cells that cause glucose to rise
persons with DM have hyperglycemia upon wakening
treated with increasing night-time insulin

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13
Q

Biguanides (metformin)

A

can be used in pregnancy
MOA: decreases production glucose in liver, increases binding of insulin to receptors, reduces slightly the glucose absorption in gut, DOES not promote insulin release (does not promote hypoglycemia - safe to skip meals or eat irregularly)

ADRs: n/d, rare but srs - lactic acidosis
renal insufficiency - accumulates to toxicity - avoid in renal pts
HOLD for 48 hrs prior to contrast media

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14
Q

roles of insulin

A
  • Moves glucose from blood –> muscle, liver, fat cells
  • Stimulates storage of glucose in liver and muscle
  • Enhances storage of dietary fats in adipose tissues
  • Transports amino acids into the cell
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15
Q

s/s hypoglycemia

A

shaky, decreased LOC, confusion, diaphoretic, early-tachy (can look like stroke or drunk)

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16
Q

sulfonylureas

A

stimulates the release of insulin, some also inc sensitivity
glipizide, glyburide, glimepiride

ADRs: hypoglycemia, weight gain,
disulfiram-like rxn with alcohol
d-d - bblkrs diminish benefit (suppress insulin release, suppress s/s hypoglycemia)
avoid in pregnancy

17
Q

meglitinides

A

MOA: stimulates pancreatic release of insulin, equal in efficacy to sulfonylureas

quick onset, short duration - pt should eat w/in 30 minutes, skip if don’t eat
ADR: hypoglycemia

18
Q

Thiazolidinediones (glitazones)

A

MOA: decreases insulin resistance/increases insulin sensitivity

ADRs:
contraindicated in HF patients (fluid retention) peripheral edema
Weight gain
low risk for hypoglycemia
Low risk- hepatic dysfxn

19
Q

Alpha-glucosidase

A

Acarbose
MOA: delays absorption of carbs - blocks enzyme in small intestine. Decreases postprandial glucose spike
T2dm not otherwise controlled with other agents

ADRs:
will NOT produce hypoglycemia
GI side effects common- gas
can decrease absorption of iron

20
Q

Dipeptidyl Peptidase-4 inhibitors (DPP-4 inhibitors) (gliptins)

A

Sitagliptin
MOA: enhances action of Incretin hormones
incretin hormones: released after eating, stimulate pancreas to release insulin, inhibits glucagon secretion, slows gastric emptying, suppresses appetite

ADRs: pancreatitis (rare) - should be taught s/s (severe abd pain)
hypersensitivity rxns (rare)

21
Q

Sodium-Glucose Co-transporter 2 inhibitors (SGLT2)

A

Canagliflozin, Dapagliflozin, Empagliflozin
MOA: block reabsorption of glucose - more exreted in urine
T2dm failing to reach glycemic goals

ADRs: infections - genital fungal, UTI, increased urination
Hypotension
Avoid in renal insufficiency

22
Q

non insulin injectables

A

GLP-1 receptor agonist - incretin mimetics (t2dm only)
Amylin Mimetic (both t1 and t2) - preamlintide

23
Q

GLP-1 receptor agonists - incretin mimetics

A

ty2dm only
endogenous incretins slow gastric emptying, stimulate insulin release, suppress appetite - improve glucose control and assist weight loss
exenatide, liraglutide, dulaglutide

exenatide - SQ, used in combo w/ metformin or sulfonylurea

ADRs: pancreatitis (severe abd pain), care with PO drugs since slows gastric motility

24
Q

Amylin Mimetic

A

pramlintide
type 1 and type 2
Injectable- administered b4 meals - different site than mealtime insulin

MOA: analog of amylin - supplements effect of mealtime insulin - delay gastric emptying and suppress glucagon release
- reduces post-prandial glucose levels and fluctuations

ADR:
hypoglycemia - insulin doses may need to be reduced
N/v/d

25
Q

other medications helpful in DM

A

ace inhibitor/ARB - reduces nephropathy progression, rxed if albuminuria is present or HTN w/o albuminuria

Statins - reduce cholesterol, shown to reduce CV events (even in non HL pts)

26
Q

moderate to severe hypoglycemia

A

IV dextrose
parenteral glucagon (by rx)
-prefilled syringes admin IM, SQ, IV
-releases stored glucose from liver - 10 minutes to start elevating BGL
-pt may vomit after admin

if FSBG - 50-70 and can swallow, admin 1 juice, recheck. >50 2 juices

Pharm (11 decks)

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