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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Drugs for Diabetes Mellitus - Ch. 60 > Flashcards

Drugs for Diabetes Mellitus - Ch. 60 Flashcards

1
Q

What can untreated diabetes lead to?

A

Heart disease
kidney disease
eye disease
Erectile dysfunction (impotence)
Nerve damage
Immunosuppression
Poor wound healing

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2
Q

What are symptoms of diabetes mellitus?

A

Unusual thirst
Frequent urination
Weight change (gain or loss)
Extreme fatigue
Blurred vision
Frequent infections
Slow healing cuts/bruises
Numbness/tingling in hands and feet
Trouble getting an erection

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3
Q

What percent of people have each type of diabetes mellitus?

A

Type 1 = ~10%
Type 2 = ~90%

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4
Q

What is Type 1 diabetes?

A

Lack of insulin production
Production of defective insulin

-Need exogenous insulin

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5
Q

What complications can arise due to type 1 DM?

A

Retinopathy
Nephropathy
Neuropathy
Diabetic ketoacidosis (DKA)

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6
Q

What drug therapies are available for Type 1 DM?

A

Insulin (required treatment)
Certain oral antihyperglycemic agents can be used as adjuctive agents

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7
Q

What is Type 2 DM?

A

Cause by insulin deficiency and/or insulin resistance

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8
Q

What is insulin resistance?

A

Reduced number insulin receptors
Receptors less responsive

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9
Q

What is Gestational diabetes?

A

Hyperglycemia onset during pregnancy that resolves at the end of pregnancy

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10
Q

What medications are used for Gestational diabetes?

A

Insulin is normally medication of choice
Metformin may be used

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11
Q

What testing is available for diabetes mellitus?

A

Blood glucose measurement
Glucose tolerance test
% HbA1c (glycated hemoglobin)
Average blood glucose over the past 3 months

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12
Q

What is glycated Hb?

A

Glucose + hemoglobin

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13
Q

Compare the proportion life-time of RBCs 3 months in non-diabetic and diabetics? (HbA1c)

A

Non-diabetic = 4-5.9%
Diabetic = >6.5%

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14
Q

What are insulins?

A

Function as a substitute for endogenous hormone
Effects are the same as normal endogenous insulin

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15
Q

What do insulins improve a diabetic’s ability to do?

A

Take up glucose into cells
Make proteins and TGs
Make glycogen from glucose in liver
Convert glucose to fatty acids in adipose tissue

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16
Q

What are the types of insulins?

A
  1. Rapid-acting
  2. Short-acting
  3. Intermediate-acting
  4. Long-acting
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17
Q

What is the onset of Rapid-acting?

A

10-15 minutes

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18
Q

What is the peak of rapid-acting?

A

60-90 minutes

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19
Q

What is the duration of rapid-acting?

A

3-5 hours

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20
Q

Examples of rapid-acting insulins?

A

Insulin lisper (Humalog)
Insulin aspart (NovoRapid)

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21
Q

When is rapid-acting insulin taken?

A

With each meal

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22
Q

What is the onset of short (fast) acting?

A

30-60 minutes

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23
Q

What is the peak of short acting?

A

2-3 hours

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24
Q

What is the duration of short-acting?

A

6-7 hours

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25
Q

Example of short-acting insulin?

A

Regular insulin (Humulin R or Novalin R)

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26
Q

How is regular insulin administered?

A

SC
IV infusion pump
IM (rarely)

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27
Q

What is the onset of intermediate-acting?

A

1-3 hours

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28
Q

What is the peak of intermediate-acting?

A

5-8 hours

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29
Q

What is the duration of intermediate-acting?

A

10-18 hours

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30
Q

Example of intermediate-acting insulin?

A

NPH (neutral protamine Hagedorn)

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31
Q

What is NPH?

A

Intermediate-acting insulin:
Isophane insulin suspension
Cloudy appearance

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32
Q

What insulins are basal therapy insulins?

A

Intermediate and long-acting

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33
Q

What is the onset of long-acting?

A

90 minutes

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34
Q

What is the peak of long-acting?

A

No pronounced peak

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35
Q

What is the duration of long-acting insulin?

A

24 hours

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36
Q

Example of long-acting insulins?

A

Insulin glargine (Lantus)

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37
Q

What is insulin glargine?

A

Long-acting insulin
Clear, colourless solution

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38
Q

What does diabetes Canada recommend the use of to achieve good glycemic control?

A

Base insulins + rapid acting insulins

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39
Q

What are the 3 components of BBIT?

A
  1. Basal insulin (long-acting)
  2. Bolus (short-acting or meal-time) insulin
  3. Correction insulin
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40
Q

What is the target glucose range for BBIT?

A

5-10 mmol/L

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41
Q

What is the purpose of BBIT?

A

Prevents blood sugar highs and lows

42
Q

What can occur if too much insulin is taken?

A

Hypoglycemia

43
Q

What is the alert value for Hypoglycaemia?

A

<3.9 mmol/L

44
Q

What are the levels for Hypoglycemia?

A

Level 1 - 3.0 & 3.9 mmol/L

Level 2 - <3.0 mmol/L

Level 3 - Needs assistance to treat

45
Q

What are warning signs of hypoglycemia?

A

CNS effects
SNS activation (gives early symptoms)

46
Q

What can hypoglycaemia possibly cause?

A

Coma and death

47
Q

What does insulin interact with?

A

B-Blockers
Alcohol
Glucocorticoids
Epinephrine
Furosemide and thiazide diuretics

48
Q

What happens when Beta blockers interact with insulins?

A

Increase hypoglycaemic effect
-Blood glucose lowers

49
Q

What do Beta-blockers do to lower blood glucose levels?

A

Reduce glycogenolysis (glycogen to glucose)
-Exacerbates insulin-induced hypoglycemias
Also can mask signs of SNS activation
(tachycardia, palpations)

50
Q

What happens when Alcohol interact with insulins?

A

Increase hypoglycaemic effect
-Blood glucose lowers

51
Q

What does alcohol do to lower blood glucose levels?

A

Reduces liver glycogenolysis

52
Q

What happens when Glucocorticoids interact with insulins?

A

Reduce effect of insulin
-Blood glucose levels increase

53
Q

What happens when Epinephrine interacts with insulins?

A

Reduce effect of insulin
-Blood glucose levels increase

54
Q

What happens when furosemide and thiazide diuretics interact with insulins?

A

Reduce effect of insulin
-Blood glucose levels increase

55
Q

What should you ensure when insulin is ordered?

A

Correct route
Correct type
Timing of the dose
Correct dose
-Second check, co-sign

56
Q

What are diabetes drugs used for?

A

Lower blood glucose levels in patients with type 2 diabetes in addition to diet and lifestyle changes

57
Q

What diabetes drugs target the pancreas?

A

Insulin secretagogues

58
Q

What are Insulin secretagogues?

A

Increase insulin production in Type 2 DM
Act on Beta cells of pancreas

59
Q

What are the classes of Insulin secretagogues?

A
  1. Suphonylureas
  2. Non-suphonylureas
60
Q

What are examples of Suphonylureas?

A

Glyburide

chlorpropamide, tolbutamide
glimepiride,
glipizide (Glucotrol)

61
Q

What does glyburide do?

A

Stimulate insulin secretion from beta cells
Improve sensitivity to insulin in muscles, liver and fat (easier to take up)
Decreasing rate of insulin metabolism and breakdown via liver

62
Q

What is the most common adverse effect of sulphonylureas?

A

Hypoglycemia
-usually mild but can be severe

63
Q

When are sulphonylureas taken?

A

Taken with breakfast
usually one per day (orally)

64
Q

What are Non-suphonylureas?

A

meal-time drugs
Short-half life

65
Q

Examples of Non-suphonylureas?

A

Repaglinide, nateglinide

66
Q

What is the difference between the classes of Insulin secretagogues?

A

Same drug target but different duration of action

67
Q

Examples of Thiazolidinediones (TZDs)?

A

Rosiglitazone
pioglitazone

68
Q

How are Thiazolidinediones (TZDs) administered?

A

PO

69
Q

What are incretins?

A

Released by intestinal contents to stimulate insulin release

-GLP-1 ((glucagon-like peptide-1) and GIP
(glucose-dependent insulinotropic peptide)

70
Q

What breakdown incretins?

A

Enzyme DPP-4
dipeptidyl-peptidase 4

71
Q

What diabetes drugs act on the incretin pathway?

A

Gliptins (DPP-4 inhibitors)
incretin mimetics
SGLT-2 inhibitors

72
Q

Examples of Gliptins (DPP-4 inhibitors)?

A

Sitagliptin (Januvia)
saxagliptin
linagliptin

73
Q

Examples of incretin mimetics?

A

Excenatide (byetta)
liraglutide, semaglutide, dulaglutide (daily/weekly)

New drug: Tirzepatide (GIP and GLP-1 agonist)

74
Q

What is Exenatide?

A

Synthetic form of a saliva protein of the Gila monster
-Synthetic GLP-1 mimetic

75
Q

What adverse effects are associated with incretin mimetics?

A

Decrease appetite (weight loss drug)
Major AE = GI upset

76
Q

What do DPP-4 enzyme inhibitors (Gliptins) do?

A

Reduce incretin metabolism
-High plasma incretin levels

77
Q

How are Gliptins administered?

A

Oral once daily with or without food
-type 2 only

78
Q

How is Exenatide administered?

A

SC

79
Q

What diabetic oral drug site of action is the liver?

A

Biguanides

80
Q

Example of biguanide?

A

Metformin (oral)

81
Q

What does metformin do?

A

Decrease hepatic production of glucose
Increase tissue sensitivity to insulin, increases uptake of glucose

82
Q

Metformin does NOT cause what?

A

Hypoglycemia
-Doesn’t increase insulin secretion from the pancreas

83
Q

What can metformin use lead to?

A

Net weight loss

84
Q

What adverse effects are associated with Metformin?

A

GI disturbances: nausea, diarrhea, decreased appetite
Lactic acidosis -rare, 50% mortality

85
Q

When is lactic acidosis caused by metformin a concern?

A

People who have renal insufficiency

86
Q

When is metformin taken?

A

2-3/day with meals to reduce GI adverse effects

87
Q

What is the newest group of type 2 DM drugs?

A

Na-Glucose transporter inhibitors

88
Q

What do Na-Glucose transporter inhibitors do?

A

Inhibit glucose transporter in the nephron (PT)
sodium-glucose transporter subtype 2 (SGLT2)
loss of glucose in urine (plus water)

89
Q

Examples of Na-Glucose transporter inhibitors?

A

Canagliflozin
Dapagliflozin
empagliflozin

90
Q

What adverse effects are associated with Na-Glucose transporter (SGLT-2) inhibitors?

A

Increased urination
-hypotension, dizziness possible
UTIs

91
Q

What do Thiazolidinediones (TZDs) do?

A

Decrease insulin resistance
“insulin sensitising agents”
Increase glucose uptake and use in skeletal muscle
Inhibit glucose and TG production in the liver

92
Q

What warnings are there for rosiglitazone (advandia) use?

A

Increased risk of angina, MI and heart failure

93
Q

What are other injectable diabetes drugs are there?

A

Amylin mimetics

94
Q

What is amylin?

A

Co-released with insulin
=delays gastric emptying and inhibits glucagon secretion
-reduce postprandial glucose

95
Q

Example of amylin mimetic?

A

Pramlitide

96
Q

What is Pramlintide?

A

Acts as amylin
Supplement to insulins (Type 1 and 2)
SC INJECTION

97
Q

What do alpha-glucosidase inhibitors do?

A

Reversibly inhibit the enzyme alpha-glucosidase in the brush border of the small intestine
Inhibits digestion of oligo and disaccharides

Delayed absorption of glucose

98
Q

Examples of alpha-glucosidase inhibitors?

A

Acarbose
Miglitol

99
Q

How must alpha-glucosidase inhibitors be taken?

A

With meals to prevent excessive postprandial blood glucose elevations

100
Q

What do oral/non-insulin agents interact with?

A

Glucocorticoids

101
Q

What does glucorticoids do to oral/non-insulin agents?

A

Decrease the effect of hypoglycaemic medication
-increase blood glucose

102
Q

If hypoglycemias occurs what should you do?

A

Give glucagon if required
Eat 120-200 mL clear fruit juice, glucose tablets/gel, tsp of corn syrup/honey or drink a non-diet soda
After liquid snack eat a meal soon like crackers or half a sandwich
monitor blood glucose

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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