DM Flashcards
Insulin Lispro
+2
type
PK
Aspart and glulisine
Human insulin analogs (no PD changes)
rapid acting and short duration
Regular insulin S.C vs I.V
PK
difference
rapid onset short duration
S.C-slowly releases becuase with Zn
IV-crisis situations
Isphane NPH
PK
special
intermediate acting
takes 2-5 hours to work beucase has to get rid of postive binding
highly unpredictable
Glargine (+2)
- PK
- vs others
Long actin-slow onset and long duration-flat profile
glargine (shorttest)>Detemir>Delude (longest)
Afrezz
- PK
- side fx
Inhalable
-rapid acting with quick peak
cough, thraot pain, hypoglycemia
Glyburide \+2 type+mech difference side fx met
oral
Glipizide and glimepiride
sulfonylureas=stim insulin secretion from B cells, and decrease glucagon in cirlcation (need working B cells to use)
Glip short t1/2, glimepridie longest T1/2
weight gain and hypoglycemia/NV
- gly liver and kideny met
- glim liver met
Repaglinide
+1 (and difference)
mech
contraindicated
oral
Netaglinide (quicker onset and shorter duration, but only liver)
-can give @ very reduced renal fxn
samne mech as sulonylureas but newer versions (better control)
hypoglycemia
Hypersens or DKA
Metformin
- type
- mech (2)
- side fx 3
- contraindicated2
oral
biguanide
Decrease hepatic glucose output and increase insulin sensitivity
Lactic acidosis (if patient is dehydrated), GI disturbances, B12 def
low GFR, ALCOHOLISM
Exenatide
- type
- +4 and timing
- side fx
- contraindication
GLP1 agonist (GLP stimultaes inuslin secretion and is inactivated by DPP4)
Exenatide (1x daily)Liraglutide Daily), lixisenatide (daily), dulaglutide (weekly), albiglutide (weekly)
NVD and hypoglycmia when used with sullonylureas
kidney problems
Sitagliptin
-type
+3
-metabolism
DPP inhibitors (DPP4 inactivates GLP1 inhibiting inuslin secretion and also supresses glucagon prod)
saxagliptin, linagliptin, alogliptin
renal excretion
Canagliflozin -type \+2 use 3 side fx
SGLT inhibitors-inhibit resorption of glucose
Dapaglifozin and empagliflozin\
only DM1
icnrease DKA risk ,vaginal yeast infection, UTI
Pramlintide
- type
- use
- side fx
- contraindication
amylin agonists (hormone secreted by beta cells)->slows gastric emptying and reduices glucagon prod
use as adjuct
N and hypoglycemia
contraindicated in GI motility d/o
Pioglitazone -type \+1 side fx 2 contra indications 2
oral
Thiazolidinediones
- increase peripheral insulin sensitivity
- reduce gluconeogensis
- wiork via PPARgamma->REGULATED TRANSCRIPTION OF GENES INVOLVED IN GLUCOSE UTILZIATION
Rosiglitazone=>CHF!!!!
modest weight gain and liver damge
CYP3a4/CHF
acarbose
-type
+1
side fx/contra
oral
alpha glucosidase inhibitors-competitve inhibitor of alpha glucosidase-cant digest carbs to absorbale monosacs (no abosrptioN)
miglitol
GI distrub, IBD
Colesevelam
- what is it
- mech
- side fx
bile acid binding resin
modest efficacy (DM2)-unclear mech
GI, incrase plasma TAGs
