DM Flashcards
Lispro/Humalog
ultra short acting. only one approved for pump use. onset of axn: 15-30 min, give w/in 15 min or right after meals. peak axn: 30 min-2.5 hr. duration of axn: 3-6.5 hrs.
Aspart/Novolog
short-acting, rapid onset of axn. onset of axn: 10-20 min, give 5-10 min before meals. peak: 1-3 hrs. DOA: 3-5 hrs.
Insulin glulisine/Apidra
short-acting. rapid onset of axn. onset of axn: 10-15 min, give w/in 15 min or right after meals. peak: 1-1.5 hrs. DOA: 3-5 hrs.
Regular Insulin/ Humulin R/ Novolin R
short-acting. onset: 30 min-1hr. peak: 2-3 hrs. DOA: 4-6 hrs. only insulin that can be admin’d IV.
NPH/ Novolin N/ Humulin N
intermediate acting. onset: 1-2 hrs. peak: 6-14 hrs. DOA: 16-24 hrs.
Insulin glargine/ Lantus
long-acting. onset: clinical effect ~1hr after inj. peak: none. DOA: >/= 24hrs.
Insulin determir/ Levemir
long-acting. onset: unkn, but appears to be ~ 1-2hrs from PK graphics. peak: 6-8 hrs. DOA: dose dependent.
sulfonylureas 1st generation.
chlorpropamide (diabinese), tolazamide (tolinase), tolbutamide (orinase).
sulfonylureas 2nd generation.
glipizide (glucatrol), glyburide (diabeta, micronase, prestabs), glimepiride (amaryl).
non-sulfonylurea beta cell stimulator
meglitinide (prandin)
sulfonylurea & non-sulfonylurea drugs
beta cell stimulator. insulin secretagogue. effective only in pt’s w/ fxning pancreas (insulin resistance). Primary AE: hypoglycemia esp in impaired renal fxn or hepatic fxn. use w/ caution in pt’s w/ sulfa all.
biguanides= metformin (glucophage)
insulin sensitizer via inc’d peripheral glucose uptake & utilization. 1st line tx. reduces hepatic glucose production & intestinal glucose absorption. contraind. in impaired renal fxn. hypoglycemia not an issue. monitor Cr- do NOT initiate or cont w/ impaired renal fxn (general >1.5males, >1.4females). avoid use in HF. AE: GI in nature (n/v, diarrhea, abd bloating, metallic taste)- effects usually transient & resolve w/ cont’d use. rare risk of lactic acidosis.
Alpha-glucosidase inhibitors
Acarbose (Precose), Miglitol (Glyset)
alpha-glucosidase inhibitors
delays intestinal carb absorption by reducing post prandial* digestion of starches & disaccharides via enzyme axn inhibition. inhibits enzyme ___ in GI tract. ‘starch blockers.’ cause wt loss to a degree. indicated for obese diabetics but contraind. in pt nl wt. AE: diarrhea, abd pain, & gas. taken w/ 1st bite of meal. avoid use in IBD & impaired renal fxn.
Thiazolidinediones (TZDs or glitazones)
Pioglitazone (Actos), Rosiglitazone (Avandia)
TZDs or glitazones
inc insulin sensitivity by inching # of receptor sites, inc’d receptor sensitivity, & enhance glucose uptake. axn at PPAR-y receptors found in muscle, adipose, & other tissue. makes you use insulin better- hypoglycemia not an issue. onset: up to 12 wks for full effect. favorable lipid axn- inc’s HDL, dec triglycerides. edema risk inc’s when use w/ insulin or SU. monitor liver fxn- if ALT rises >3x upper limit, d/c.
Incretin Mimetic/ Glucagon-like peptide (GLP)-1 agonist
Exenatide (Byetta, Bydureon), Liraglutide (Victoza). inj only
incretin mimetic/ GLP-1 agonist
stim insulin production in response to inc in plasma glucose. dec’s post meal glucose output (by dec’ing glucagon secretion), inc’s satiety, regulates gastric emptying (inhibits glucagon release postprandial). slows gastric emptying, often leading to appetite suppression & wt loss. peaks 2 hrs after SC admin. hypoglycemia when given w/ sulfonylurea but not alone or w/ other hypoglycemics. SE: GI (n/v, diarrhea). excreted renally- contraind. in renal impairment. admin’d SC before 2 lg’est meals of day.
Dipeptidyl peptidase-4 (DPP-4) inhibitor
Sitagliptin (Januvia), saxagliptin (onglyza), linagliptin (tradjenta)
DPP-4 inhibitor
inc’s levels of incretin, inc’ing synthesis & release of insulin from pancreatic beta cells & dec’ing release of glucagon from pancreatic alpha cells. inhibits inactivation of incretin in the stomach (incretin stim insulin production, dec’s hepatic glucose production. axn is glucose depending. AE: nasopharyngitis, HA. excreted renally- monitor kidney fan, contraind in renal failure. monitor for pancreatitis.
