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Pharmacology > Drugs For Diabetes Mellitus (60) > Flashcards

Drugs For Diabetes Mellitus (60) Flashcards

1
Q

How many people worldwide have diabetes

A

422 million

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2
Q

(Canada) what population is more likely to develop diabetes

A

Indigenous

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3
Q

T1DM

A

Lack of insulin production

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4
Q

T2DM

A

Insulin resistance

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5
Q

What are you measuring when testing for DM

A

HbA1C

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6
Q

DM is measured over the past _ months

A

3

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7
Q

Insulins function as

A

Substitute for endogenous hormone
-effects are the same as normal endogenous insulin

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8
Q

Insulins improve the diabetics ability to

A

-take up 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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9
Q

Very important that we know what about the insulins

A

Time frames

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10
Q

Rapid acting insulin (onset, peak, duration)

A

onset: 10-15 minutes
Peak: 60-90
Duration: 3-5 hours

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11
Q

Rapid acting insulin

A

Most rapid onset of action with a short duration
-taken with EACH meal

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12
Q

Examples of rapid acting insulin

A

Insulin lispro

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13
Q

Short acting insulin (onset, peak, duration)

A

Onset: 30-60 minutes
Peak: 2-3 hours
Duration: 6-7 hours

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14
Q

Example of short acting insulin

A

Regular insulin
-can be SC, IV, or IM

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15
Q

Intermediate acting insulin (onset, duration, peak)

A

Onset: 1-3 hours
Peak: 5-8 hours
Duration: 10-18 hours

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16
Q

Examples of intermediate acting insulin

A

NPH
-cloudy appearance

Basal therapy

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17
Q

Human based insulins (onset, peak, duration)

A

Onset: 90 minutes
Peak: no pronounced peak
Duration: 24 hours

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18
Q

Examples of long acting

A

Insulin glargine and basal therapy

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19
Q

Diabetes Canada recommends use of what two insulins

A

Basal insulins + rapid acting insulins

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20
Q

Combination insulin products

A

Come premixed in one solution

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21
Q

Three components of BBIT

A

Basal insulins, bolus insulins, correction insulin
-basically: long acting, short acting, correction

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22
Q

BBIT has a target range of

A

5 to 10 mmol/L

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23
Q

BBIT prevents

A

Blood sugar highs and lows

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24
Q

What is the level of hypoglycaemia

A

Less than 3.9mmol/L

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25
Q

What causes hypoglycaemia

A

Too much insulin

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26
Q

Warning signs of hypoglycaemia comes as

A

-CNS effects
-SNS activation
-can lead to possible come and death

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27
Q

Symptoms of hypoglycaemia

A

Trembling, palpitations, sweating, anxiety, hunger, nausea, tingling, difficulty concentrating, confusion, weakness, drowsiness, vision changes, slurred speech, headache, dizziness

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28
Q

Interactions of B blockers and alcohol with insulins will…

A

Increase hypoglycaemic effect so will lower blood glucose levels

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29
Q

B blockers reduce

A

Glycogenolysis
-and also masks signs of SNS activity which are symptoms of hypoglycaemia

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30
Q

Alcohol reduces

A

Liver glycogenolysis

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31
Q

When insulin is ordered, ensure

A

-correct route
-correct type of insulin
-timing of the dose
-correct dose

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32
Q

diabetes drugs

A

Insulin secretagogues
-increase insulin production in T2DM

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33
Q

Diabetes drugs act on

A

Beta cells of pancreas

34
Q

2 classes of insulin secretagogues

A
  1. Sulphonylureas
  2. Non sulphonylureas
35
Q

Example of sulphonylureas

A

Glyburide

36
Q

Example of biguanides

A

Met Forman

37
Q

Examples of thiazolidinediones

A

Rosiglitazone

38
Q

Two examples of gliptins and incretin mimetic

A

Sitagliptin and excenatide

39
Q

Biguanides act on what site of the body?

A

Liver

40
Q

Metformin is administered

A

Orally

41
Q

Metformin MOA (2)

A
  1. decrease hepatic production of glucose
  2. Increase tissue sensitivity to insulin = increase uptake of glucose
42
Q

Oral drugs/Metformin does not

A

-Increase insulin secretion from the pancreas
-hypoglycaemia
-weight loss

43
Q

AE of Metformin

A

-gi disturbances
-lactic acidosis

44
Q

Where in the body does glinidies and sulfonylureas work?

A

Pancreas

45
Q

Glyburide MOA

A

-stimulate insulin secretion from beta cells
-improves sensitivity to insulin in muscles, liver and fat
-improves liver by decreasing rate of insulin metabolism

46
Q

AE Glyburide

A

Hypogylcemia

47
Q

Glyburide is taken

A

With breakfast
-usually one a day

48
Q

Intestinal contents release

A

In retina

49
Q

Examples of in retina

A

GLP1 and GIP

50
Q

Incretins stimulate

A

Insulin release

51
Q

Incretins are broken down by what enzyme?

A

DPP-4

52
Q

Where do DPP 4 act?

A

In the pancreas

53
Q

Example of Incretins as a drug

A

Exenatide

54
Q

Exenatide

A

Synthetic form of a saliva protein of the GLP 1 mimetic

55
Q

Exenatide Incretins end in

A

“glutide”

56
Q

Exenatide is given

A

SC

57
Q

Incretins decrease

A

Appetite
-useful in obesity linked diabetes
-weight loss drug

58
Q

Major AE of Incretins

A

GI upset

59
Q

New incretin mimetic

A

Tirzepatide
-GIP and GLP 1 agonist

60
Q

Result of Incretins DPP 4 enzyme inhibitors

A

Reduce incretin metabolism, resulting in higher plasma incretin level

61
Q

Example of DPP 4 enzyme inhibitors

A

Sitagliptin

62
Q

Sitagliptin

A

Used alone or in combination with Metformin
-for type 2 diabetes only

63
Q

What is the newest group of drugs for type 2 DM

A

Na-glucose transporter inhibtiors

64
Q

Na-glucose transporter inhibtiors

A

Newest group of T2DM

65
Q

Example of Na-glucose transporter inhibtiors

A

Canagliflozin

66
Q

What is the glucose transporter in nephron

A

Sodium glucose transporter subtype 2

67
Q

SGLT2 inhibitors AE

A

Increased urination and UTIs

68
Q

Thiazolidinediones act in the

A

Muscle and fat cells

69
Q

Thiazolidinediones

A

-Increase glucose uptake and use in skeletal muscle
-inhibit glucose and triglycerides produce in the liver

70
Q

Example of Thiazolidinediones

A

Rosiglitazone

71
Q

Rosiglitazone

A

Decrease insulin resistance
-insulin sensitizing agents

72
Q

Boxed warning for Rosiglitazone

A

Increased risk of angina, MI and heart failure

73
Q

Amylin mimetic

A

Amylin co released with insulin
-delaying gastric emptying and inhibits glucagon secretion
-reduce postparandial glucose

74
Q

Pramlintide

A

Acts as Amylin
-supplement to insulins
-SC

75
Q

Alpha glucoseidase inhibitors

A

Reversible inhibit the enzyme alpha glucosidaase in the brush border of small intestine

76
Q

Alpha glucoseidase inhibitors inhibits digestion of

A

Oligo and disaccharides

77
Q

Result of Alpha glucoseidase inhibitors

A

Delayed absorption of glucose

78
Q

Alpha glucoseidase inhibitors must be + why

A

Taken with meals to prevent excessive postprandial blood glucose elevations

79
Q

Medication interactions with oral/non insulin agents

A

Glucocorticoids
-decrease effect of hypoglycaemic medication
-cortisol like drugs increase blood glucose

80
Q

If hypoglycaemia occurs have the client eat

A

120 to 200mL of clear fruit juice, glucose tablets or gel

81
Q

After the liquid snack have the client

A

Eat their meal soon or, give a small snack such as crackers or half a sandwich
-carbohydrates and protein!!!!!

Pharmacology (37 decks)

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