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Pharmacology Spring 2021: Set 2 > Endocrine Medications: Injectable Antidiabetics (excluding insulins) > Flashcards

Endocrine Medications: Injectable Antidiabetics (excluding insulins) Flashcards

1
Q

Other than insulin what types of injectable antidiabetic drugs are available?

A
  1. Amylin Agonists
  2. Glucagon-Like Peptide 1 Receptor Agonists (GLP-1)
  3. Glucagon
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2
Q

What are the generic and brand names of Amylin Agonists?

A

Pramlintide (Symlin)

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3
Q

What are the generic and brand names of Glucagon-Like Peptide 1 Receptor Agonists?

A
  1. Exenatide (Byetta)

2. Liraglutide (Victoza)

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4
Q

What is Amylin?

A

A peptide hormone that is cosecreted with insulin from the pancreatic beta-cell

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5
Q

How is Amylin and Insulin similar when considering patients with DM?

A

They are both deficient

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6
Q

How is Amylin and Insulin different when considering patients with DM?

A

Amylin is secreted in much smaller quantities than insulin (1% compared to insulin)

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7
Q

What is Amylin’s action normally?

A
  1. Inhibits glucagon secretion
  2. Delays gastric emptying
  3. Acts as a satiety agent
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8
Q

What is the action of Amylin Agonists drug therapy?

A

Works similarly to Amylin to reduce

  1. Weight
  2. BS levels
  3. Insulin doses in insulin-taking diabetics
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9
Q

Who are Amylin Agonists indicated in?

A

Type 1 and type 2 DM

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10
Q

When should Amylin Agonists be administered?

A

Before meals

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11
Q

How are Amylin Agonists administered?

A

SC injection

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12
Q

Why are Amylin Agonists not approved yet in some countries (such as UK)?

A

Significantly raise the risk of severe hypoglycemia

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13
Q

Pros of Amylin Agonist therapy?

A

Blocks the release of glucagon when it is not needed (such as in response to eating)

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14
Q

Cons of Amylin Agonist therapy?

A

Blocks glucagon from raising blood glucose levels when sugar levels are low

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15
Q

Adverse effects of amylin agonists?

A
  1. N&V
  2. Headache
  3. hypoglycemia (if taken with insulin)
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16
Q

What do GLP-1 drugs do?
What is glucagon-like peptide 1?
What does glucagon-like peptide 1 do?
What else can GLP-1 drugs treat?
How to GLP-1 drugs help with weight loss?
What other antidiabetic drug boosts weight loss?
Other than diabetic control and weight loss What are the pros to GLP-1s and SGLT-2 inhibitors
What are side effects of GLP-1s?
What occurs to side effects after taking GLP-1s for awhile?
What can increase risk of hypoglycemia when taking GLP-1s?
Who should not take GLP-1s?
What have studies done on rats with GLP-1s proven?
Who are GLP-1s indicated for?

A
  • Mimic the action of glucagon-like peptide 1
  • A hormone
  • Stimulates insulin secretion after meals which lowers BS levels
  • They help with weight loss
  • It’s uncliear but it is known that they: 1. suppress appetite 2. slow movement of food from stomach to sm intestine
  • SGLT-2 inhibitors
  • May lower the risk of 1. Heart disease 2. HF 3. Stroke 4. Kidney disease ALSO may improve: 1. BP 2. cholesterol levels
    1. N&V 2. Diarrhea 3. hypoglycemia
  • They subside
  • Taking another BS lowering medication (ex: sulfonylureas and insulin)
  • Personal or family history of 1. Medullary thyroid cancer 2.Multiple endocrine neoplasia 3. Pancreatitis
  • A link with thyroid tumors
  • Type 2 DM
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17
Q

What is glucagon-like peptide 1?

A

A hormone

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18
Q

What does glucagon-like peptide 1 do?

A

Stimulates insulin secretion after meals which lowers BS levels

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19
Q

What else can GLP-1 drugs treat?

A

They help with weight loss

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20
Q

How to GLP-1 drugs help with weight loss?

A

It’s unclear but it is known that they:

  1. suppress appetite
  2. slow movement of food from stomach into small intestine
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21
Q

What other antidiabetic drug boosts weight loss?

A

SGLT-2 inhibitors

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22
Q

Other than diabetic control and weight loss what are the pros to GLP-1s and SGLT-2 inhibitors?

A

May lower the risk of:

  1. Heart disease
  2. HF
  3. Stroke
  4. Kidney disease

May improve:

  1. BP
  2. cholesterol levels
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23
Q

What are side effects of GLP-1s?

A
  1. N&V
  2. Diarrhea
  3. Hypoglycemia
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24
Q

What occurs to side effects after taking GLP-1s for awhile?

A

They subside

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25
Q

What can increase risk of hypoglycemia when taking GLP-1s?

A

Taking another BS lowering medication (ex: sulfonylureas and insulin)

26
Q

Who should not take GLP-1s?

A

Personal or family history of:

  1. Medullary thyroid cancer
  2. Multiple endocrine neoplasia
  3. Pancreatitis
27
Q

What have studies done on rats with GLP-1s proven?

A

A link with thyroid tumors

28
Q

Who are GLP-1s indicated for?

A

Type 2 DM

29
Q

What is the action of Glucagon?

A

Raises BS levels

30
Q

What is Glucagon?

A

Hormone

31
Q

Where is glucagon normally produced?

A

In alpha cells of the islets of Langerhans in the pancreas

32
Q

How does glucagon raises glucose levels?

A

SEE DIAGRAM IN PHOTOS ON PHONE

  1. Stimulates the formation of adenylate cyclase in the liver cell.
  2. Adenylate cyclase then converts ATP to cAMP
  3. cAMP initiates a series of reactions resulting in active a phosphorylated glucose molecule
  4. In this phosphorylated form, the large glucose molecule can’t pass through the cell membrane
  5. Glycogenolysis occurs
  6. The liver removes the phosphate group and allows the glucose to enter the bloodstream
  7. Raising BS levels
33
Q

How is glucagon administered?

A

Injection by:

  1. SC
  2. IM
  3. IV
34
Q

How fast is Glucagon absorbed?

A

Rapidly

35
Q

Where is Glucagon distributed?

A

Throughout the body

36
Q

Where is Glucagon metabolized?

A
  1. Liver
  2. Kidneys
  3. Plasma at its tissue receptor sites in plasma membranes
37
Q

How is Glucagon excreted?

A
  1. Bile

2. Urine

38
Q

By which processes does Glucagon regulate the rate of glucose production?

A
  1. Glycogenolysis
  2. Gluconeogenesis
  3. Lipolysis
39
Q

What is Glycogenolysis

A

The conversion of glycogen back into glucose by the liver

40
Q

What is Gluconeogenesis

A

The formation of glucose from free fatty acids and proteins

41
Q

What is Lipolysis

A

The release of fatty acids from adipose tissue for conversion to glucose

42
Q

Who is Glucagon indicated in?

A
  1. Emergency treatment of severe hypoglycemia

2. Radiologic examination of the GI tract

43
Q

Why is Glucagon indicated for Radiologic examination of the GI tract?

A

It reduces GI motility

44
Q

What drugs does Glucagon interact with?

A

Oral anticoagulants

45
Q

What occurs when Glucagon is administered with oral anticoagulants?

A

Increases risk of bleeding

46
Q

Adverse reactions to glucagon?

A

Adverse reactions to glucagon are rare

47
Q

What is important to asses when administering glucagon?

A
  1. BS level

2. Adverse reactions/interactions

48
Q

When should you increase monitoring of BS in DM patients?

A

During periods of increased stress including:

  1. Infection
  2. Fever
  3. Surgery
  4. Trauma
49
Q

What is important to remember to do when administering glucagon by IM injection?

A

Reconstitute in…

  1. 1-unit vial with 1mL of diluent
  2. 10-unit vial with 10 mL of diluent
50
Q

What is important to remember to do when administering glucagon by IV injection?

A

A drip infusion which is compatible with glucagon, may be used.

51
Q

What is a drip infusion which is compatible with glucagon?

A

Dextrose solution

52
Q

What drip infusion is not compatible with glucagon?

A

Chloride solutions

53
Q

What occurs if IV glucagon is administered in a chloride solution?

A

It forms a precipitate

54
Q

At what rate should glucagon be administered by IV injection?

A

2 to 5 min

55
Q

Once lethargic patient is aroused by use of glucagon what is the next action?

A

Give additional carbohydrates

56
Q

Why should additional carbohydrates be administered after glucagon works?

A

To prevent a secondary hypoglycemic

episode

57
Q

If a patient has a hypoglycemic event what is important for the provider to know?

A

If glucagon was used

58
Q

In which patients experiencing a hypoglycemic episode may glycogen not work for?

A

An unstable DM pt

59
Q

If glycogon does not work for patient what action should be taken?

A

Give IV dextrose 50%

60
Q

When might a patient not be able to retain some form of sugar?

A

N&V

61
Q

At what point should a provider be notified if patient is unable to retain some form of sugar?

A

one hour

Pharmacology Spring 2021: Set 2 (14 decks)

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