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drugs for diabetes mellitus Flashcards

1
Q

untreated diabetes can lead to

A
  • heart disease
  • kidney disease
  • eye disease
  • erectile dysfunction
  • nerve damage
  • immunosuppression
  • poor wound healing
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2
Q

symptoms of diabetes

A
  • unusual thirst
  • frequent urination
  • weight change
  • fatigue or lack of energy
  • blurred vision
  • frequent infections
  • cuts/bruises slow healing
  • tingling or numbness in hands or feet
  • trouble getting or maintaining an erection
  • asymptomatic
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3
Q
A
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3
Q

type one diabetes mellitus

A

lack of insulin production
- need exogenous insulin

production of defective insulin
- need exogenous insulin

complications: retinopathy, nephropathy, neuropathy, diabetic ketoacidosis (DKA)

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4
Q

drug therapy for T1DM

A

insulin
- and certain oral antihyperglycemic agents can be used as adjunctive agents

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5
Q

type 2 diabetes mellitus

A

most common (90%)

caused by insulin deficiency and/or insulin resistance

many tissues are resistant to insulin
- reduced number of insulin receptors
- insulin receptors are less responsive

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6
Q

gestational diabetes

A

hyperglycemia onset during pregnancy and resolves at end of pregnancy
- insulin usually medication of choice (metformin may be used)

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7
Q

testing for diabetes mellitus

A
  • blood glucose measurement
  • glucose tolerance test
  • %HbA1c (glycated hemoglobin)
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8
Q

measuring HbA1C

A

glycated Hb = glucose + Hb
- non diabetic proportion over lifetime of RBC 3 months: 4-5.9%
- diabetic > 6.5%

measure of the average blood glucose over the past 3 months

target for patients with diabetes is 7%

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9
Q

treatment of diabetes mellitus

A

insulins: recombinant human insulins

non-insulin drugs
- oral
- injectables

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10
Q

DM medication sites of action

A
  • liver
  • muscle and fat cells
  • pancreas
  • intestine
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11
Q

insulins info

A

function as a substitute for endogenous hormone
- effects are the same as normal endogenous insulin

improves ability to: take glucose into cells, make proteins and triglycerides, make glycogen from glucose in liver, convert glucose to fatty acids in adipose tissue

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12
Q

types of insulin

A
  • rapid acting
  • short acting
  • intermediate acting
  • long acting
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13
Q

rapid acting insulins

A
  • onset: 10-15 minutes
  • peak of action: 60-90 minutes
  • duration:3-5 hours

insulin lispro
- taken with each meal

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14
Q

short (fast acting)

A
  • onset: 30-60 minutes
  • peak 2-3 hours
  • duration 6-7 hours

regular insulin (humulin R)
- SC, IV infusion pump

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15
Q

intermediate acting

A
  • onset 1-3 hours
  • peak 5-8 hours
  • duration. 10-18 hours

NPH
- cloudy

basal therapy

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16
Q

long acting insulin

A
  • onset 90 minutes
  • no pronounced peak
  • duration 24 hours

insulin glargine (lantus)

basal therapy

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17
Q

combination insulin products

A

some com premixed in one solution
- basal insulins and rapid acting insulins together achieve best glycemic control

18
Q

basal bolus insulin therapy

A

3 components:
- basal insulin (long acting)
- bolus insulin (short acting)
- correction insulin

target range of 5-10mmol/L
- prevents blood sugar highs and lows

19
Q

hypoglycemia (too much insulin)

A

alert value of <3.9 mmol/L
- level 1: 3-3.0 mmol/L
- level 2: <3.0 mmol/L
- level 3 (need assistance to treat

  • CNS effects
  • SNS activation (give early symptoms)
  • possible coma and death
20
Q

hypoglycemia symptoms

A
  • trembling
  • palpitations
  • sweating
  • anxiety
  • hunger
  • nausea
  • tingling
  • difficulty concentrating
  • confusion, weakness, drowsy, vision changes
  • slurred speech, headache, dizziness
21
Q

interactions with insulins

A

increase hypoglycemic effect so will lower blood glucose levels
- b blockers (propranolol): reduce glycogenolysis, can mask signs of SNS activation
- alcohol: reduces liver glycogenolysis

reduce effect of insulin so will increase blood glucose levels:
- glucocorticoids
- epinephrine
- furosemide and thiazide diuretics

22
Q

insulin client care implications

A

ensure:
- right route
- right type
- timing of dose
- correct dosage

insulin orders always second checked with another nurse

23
Q

drugs for diabetes indications

A

lower blood glucose levels in patients with T2DM
- alone or in combination
- in addition to diet and lifestyle changes

24
Q

insulin secretagogues

A

target the pancreas
- act on beta cells
- increase insulin production in T2DM

25
Q

2 classes of insulin secretagogues

A

1) sulfonylureas
- glyburide

2) non-sulfonylureas (mealtime drugs, short half life)

same drug target but different duration of action

26
Q

other diabetes drugs

A

biguanides
- metformin

thiazolidinediones
- rosiglitazone

27
Q

diabetes drugs: incretin pathway and others

A

gliptins (DPP-4 inhibitors)
- sitagliptin

incretin mimetic
- exenatide

SGLT-2 inhibitors

28
Q

biguanides

A

metformin
- decrease hepatic production of glucose
- increase tissue sensitivity to insulin = increase uptake of glucose

  • does not increase insulin secretion from the pancreas (doesn’t cause hypoglycemia)
  • net weight loss
29
Q

biguanides AE

A
  • GI disturbances: nausea, diarrhea, increased appetite (taken 2-3/day with means to reduce GI disturbances)
  • lactic acidosis: rare but 50% mortality (concern in renal insufficiency)
30
Q

sulphonylureas

A

glyburide
- stimulate insulin secretion from pancreatic beta cells = increasing insulin levels (beta cell function must be present)
- improves sensitivity to insulin in muscles, liver and fat so they can take up and store glucose more easily
- decrease rate of insulin metabolism and breakdown by the liver

31
Q

sulphonylureas AE

A

hypoglycemia (mild-severe)

taken with breakfast (1/day)

32
Q

what are incretins

A
  • released by intestinal contents
  • GLP and GIP
  • stimulat insulin release

incretins broken down by enzyme DPP-4
- dipeptidyl-peptidase 4

33
Q

incretin mimetic

A

exenatide
- synthetic form of a saliva proteins of the gila monster (synthetic GLP)
- SC administration

34
Q

incretin AE

A

decreases appetite
- useful in obesity linked diabetes
- weight loss drug

major adverse effect
- GI upset

35
Q

DPP-4 inhibitors

A

reduce incretin metabolism
- higher plasma incretin level
- sitagliptin
- sometimes used with metformin
- only for T2DM
- oral once daily with or without food

36
Q

Na glucose transporter inhibitors

A
  • newest type of T2DM drugs
  • inhibit glucose transporter in nephron (PT)
  • loss of glucose (& water) in urine
  • canagliflozin
37
Q

SGLT2 inhibitors adverse effect

A

-increased urination (possible hypotension/dizziness)
- UTIs

38
Q

thiazolidinediones

A
  • rosiglitazone
  • decrease insulin resistance
  • insulin sensitizing agents
  • increase glucose uptake and use in skeletal muscle
  • inhibit glucose and triglyceride production in the liver
39
Q

thiazolidinediones AE

A

increased risk of angina, MI, heart failure

40
Q

pramlintide

A
  • amylin mimetic
  • amylin co released with insulin: delays gastric emptying and inhibits glucagon secretion
  • supplement to insulins (T1 and 2DM)
  • SC injetion
41
Q

medication interactions with oral/non-insulin agents

A

glucocorticoids
- decrease effect of hypoglycemic medication
- cortisol life drugs cause increased blood glucose

42
Q

antihyperglycemic agents: client care implications

A
  • assess for signs of hypoglycemia
  • if hypoglycemia occurs: give glucagon if required, have alert client eat 12-200 mL of clear fruit juice, glucose tablets/gel, teaspoon of corn syrup, or honey, non-diet soft drink, after liquid snack have client eat meal soon or give snack of carbs and protein
  • monitor blood glucose levels

pharm (29 decks)

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