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Pharmacology > Ex3 Diabetes > Flashcards

Ex3 Diabetes Flashcards

1
Q

Short duration rapid faster acting prototype:

A

insulin lispro

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2
Q

When is insulin lispro used

A

before meals and basal control`

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3
Q

short duration slower acting protoyope:

A

regular insulin`

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4
Q

when is regular insulin used

A

before meals and basal control

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5
Q

does regular insulin require a prescription?

A

no

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6
Q

Intermediate duration slow acting insulin:

A

NPH

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7
Q

how often is NPH insulin given

A

twice daily

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8
Q

a cloudy suspension

A

NPH, intermediate duration insulin

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9
Q

can you mix NPH with short acting insulins

A

yes

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10
Q

long duration slowest acting insulins

A

insulin glargine (glantis) , and insulin detemir

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11
Q

glargine and detemir given when

A

once daily usually HS

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12
Q

ultra long duration insulins

A

glargine (toujeo), degludec (tresiba)

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13
Q

ultralong duration insulins given when

A

once daily

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14
Q

ultralong duration insulins mimic what

A

basal control

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15
Q

common sites for subq injections

A
  • upper arm
  • abdomen (fastest)
  • thigh (slowest)
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16
Q

why rotate injection sites

A

to avoid lipohypertrophy

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17
Q

hypoglycemic

A

<70

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18
Q

s/s(x) of hypoglycemia
rapid fall in blood sugar:

A

increase HR, sweating, shakiness,

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19
Q

s/s(x) of hypoglycemia
slow fall in blood sugar:

A

confusion, fatigue, drowsiness

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20
Q

pts at risk for hypoglycemia

A
  • decrease food intake
  • vomiting
  • increase exercise/activity
  • alcohol intake
    uncontrolled diabetes
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21
Q

interventions for hypoglycemia conscious:

A
  • glucose tabs, OJ, soda, candy
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22
Q

interventions for hypoglycemia unconsious

A
  • D50 IV orGlucagon SQ/IM
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23
Q

first line therpay for type 2 diabetes

A

Metformin

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24
Q

(Biguanide) Metformin Pharmacokinetics

A

inhibits glucose production –> lowers blood glucose without causing hypoglycemia

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25
taken with meals?
Metformin, Sulfonylurea: glipizide, acarbose
26
Adverse effects of Metformin
GI effects B12 deficiency lactic acidosis - don't take w/alcohol excreted by kidneys (renal dosing check GFR)
27
oldest class of anti-hyperglycemics
sulfonylurea: glipizide
28
Pharmacokinetics sulfonylurea: glipizide
- stimulates insulin secretion (pancreas) - increase insulin sensitivity
29
adverse effects of sulfonylurea: glipizide
- hypoglycemia (!!!!!) - no alcohol
30
how does TZD: pioglitazone work
increase insulin sensitivity (tissues) inhibits glucose production (glycogenolysis)
31
TZD pioglitazone metabolized by CYP enzyme T or F
T
32
pioglitazone half life?
T1/2 is 16-24 hrs
33
adverse side effects pioglitazone
FLuid retention (don't use in heart failure pts) Drug interactions: Gemfibrozil and Rifampin (CYP inhibitors) Risk of bladder cancer (long term use) Risk of fractures in women Possibly hepatotoxic
34
acarbose
alpha glucosidase inhibitor
35
acarbose pharmacokinetics
delays carb absorption
36
adverse effects acarbose
frequent GI distress decreased iron absorption possible liver dysfunction hypoglycemia
37
Sitagliptin
dipeptidyl peptidase - 4 (DPP-4)
38
Stagliptin pharmacokinetics
enhances incretin hormones - stimulates insulin secretion (pancreas) suppresses post - prandial release of glucagon
39
adverse side effects of Sitagliptin
pancreatitis - rare severe upper and persistant upper abdominal pain vomiting
40
canagliflozin
soidum-glucose Co-transported 2 (SGLT-2)
41
canagliflozin pharmacokinetics
inhibits SGLT-2 in the kidneys decreases reabsorption of glucose increases urinary glucose excretion
42
canagliflozin half life
12 hrs = 1 daily dosing
43
canagliflozin adverse side effects
increase urination (dehydration, hypotension) UTIs/fungal infections/ genital necrotizing infections
44
GLucagon- like peptide
non - insulin injectables (1 is also PO)
45
short acting exenatide (Byetta)
1-2 x day
46
long acting exenatide (bydureon)
1 x week
47
how do exenatides work
- mimic incretin hormones: - stimulate insulin secretion (pancreas) -suppress post-prandial release of glucagon - slow gastric emptying - suppresses appetite
48
adverse side effects of exenatide
GI effects hypoglycemia pancreatitis renal impairment
49
Diabetic Ketoacidosis
- actue - Type 1 DM complication
50
Diabetic Ketoacidosis treatment
- fluid replacement - slow adjustment of plasma glucose - potassium issues - sodium bicarb
51
Hyperosmolar Hyperglycemic (nonketotic) State (HHS) treatment
52
what 2 problems does an insulin deficiancy cause in DKA
altered fat metabolism altered glucose metabolism
53
HbA1C goal
<7%
54
What are the main differences between the 5 types of insulin?
- appearance - time course - route of administration - concentration
55
what are insulin precatution
- all cary risk of hypoglycemia - higher risk with shorter-acting - concentration measured in units
56
lispro onset
15-30 min
57
lispro peak
0.5-2.5 hr
58
lispro duration
3-6hr
59
Regular onset
30-60min
60
Regular peak
1-5hr
61
regular duration
6-10hr
62
NPH onset
60-120min
63
NPH peak
6-14hr
64
NPH duration
16-24hr
65
Glargine (100) onset
100min
66
glargine ( 100) peak
none
67
glargine (100) duration
18-24hr
68
detemir onset
60-120 min
69
detemir peak
none
70
detemir duration
12-24hr
71
glargine (300) onset
360min
72
glargine (300) peak
none
73
glargine (300) duration
>24hr
74
degludec onset
30-90
75
degludec peak
none
76
degludec duration
>24hr
77
insulin lispro color
clear
78
insulin lispro given how? never how?
only subq (injection or pump) never IV
79
Regular insulin color
clear
80
Regular insulin given how
subq (injection or pump) or IV (only insulin given IV) fun fact: available without a prescription
81
how do oral insulin meds work
- glycogenolysis (inhibition of glucose production) - increases insulin sensitivity (decrease insulin resistance) - stimulates insulin secretion (pancreas) - delays carb absorption (gut) - enhances incretin hormones - suppresses post-pranial release of glucagon - inhibits SGLT-2 in kidney

Pharmacology (8 decks)

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