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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
Q

taken with meals?

A

Metformin, Sulfonylurea: glipizide, acarbose

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26
Q

Adverse effects of Metformin

A

GI effects
B12 deficiency
lactic acidosis - don’t take w/alcohol
excreted by kidneys (renal dosing check GFR)

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27
Q

oldest class of anti-hyperglycemics

A

sulfonylurea: glipizide

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28
Q

Pharmacokinetics sulfonylurea: glipizide

A
  • stimulates insulin secretion (pancreas)
  • increase insulin sensitivity
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29
Q

adverse effects of sulfonylurea: glipizide

A
  • hypoglycemia (!!!!!)
  • no alcohol
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30
Q

how does TZD: pioglitazone work

A

increase insulin sensitivity (tissues)
inhibits glucose production (glycogenolysis)

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31
Q

TZD pioglitazone metabolized by CYP enzyme T or F

A

T

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32
Q

pioglitazone half life?

A

T1/2 is 16-24 hrs

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33
Q

adverse side effects pioglitazone

A

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
Q

acarbose

A

alpha glucosidase inhibitor

35
Q

acarbose pharmacokinetics

A

delays carb absorption

36
Q

adverse effects acarbose

A

frequent GI distress
decreased iron absorption
possible liver dysfunction
hypoglycemia

37
Q

Sitagliptin

A

dipeptidyl peptidase - 4 (DPP-4)

38
Q

Stagliptin pharmacokinetics

A

enhances incretin hormones
- stimulates insulin secretion (pancreas)
suppresses post - prandial release of glucagon

39
Q

adverse side effects of Sitagliptin

A

pancreatitis
- rare
severe upper and persistant upper abdominal pain
vomiting

40
Q

canagliflozin

A

soidum-glucose Co-transported 2 (SGLT-2)

41
Q

canagliflozin pharmacokinetics

A

inhibits SGLT-2 in the kidneys
decreases reabsorption of glucose
increases urinary glucose excretion

42
Q

canagliflozin half life

A

12 hrs = 1 daily dosing

43
Q

canagliflozin adverse side effects

A

increase urination (dehydration, hypotension)
UTIs/fungal infections/ genital necrotizing infections

44
Q

GLucagon- like peptide

A

non - insulin injectables
(1 is also PO)

45
Q

short acting exenatide (Byetta)

A

1-2 x day

46
Q

long acting exenatide (bydureon)

A

1 x week

47
Q

how do exenatides work

A
  • mimic incretin hormones:
  • stimulate insulin secretion (pancreas)
    -suppress post-prandial release of glucagon
  • slow gastric emptying
  • suppresses appetite
48
Q

adverse side effects of exenatide

A

GI effects
hypoglycemia
pancreatitis
renal impairment

49
Q

Diabetic Ketoacidosis

A
  • actue
  • Type 1 DM complication
50
Q

Diabetic Ketoacidosis treatment

A
  • fluid replacement
  • slow adjustment of plasma glucose
  • potassium issues
  • sodium bicarb
51
Q

Hyperosmolar
Hyperglycemic
(nonketotic)
State (HHS) treatment

A
52
Q

what 2 problems does an insulin deficiancy cause in DKA

A

altered fat metabolism
altered glucose metabolism

53
Q

HbA1C goal

A

<7%

54
Q

What are the main differences between the 5 types of insulin?

A
  • appearance
  • time course
  • route of administration
  • concentration
55
Q

what are insulin precatution

A
  • all cary risk of hypoglycemia
  • higher risk with shorter-acting
  • concentration measured in units
56
Q

lispro onset

A

15-30 min

57
Q

lispro peak

A

0.5-2.5 hr

58
Q

lispro duration

A

3-6hr

59
Q

Regular onset

A

30-60min

60
Q

Regular peak

A

1-5hr

61
Q

regular duration

A

6-10hr

62
Q

NPH onset

A

60-120min

63
Q

NPH peak

A

6-14hr

64
Q

NPH duration

A

16-24hr

65
Q

Glargine (100) onset

A

100min

66
Q

glargine ( 100) peak

A

none

67
Q

glargine (100) duration

A

18-24hr

68
Q

detemir onset

A

60-120 min

69
Q

detemir peak

A

none

70
Q

detemir duration

A

12-24hr

71
Q

glargine (300) onset

A

360min

72
Q

glargine (300) peak

A

none

73
Q

glargine (300) duration

A

> 24hr

74
Q

degludec onset

A

30-90

75
Q

degludec peak

A

none

76
Q

degludec duration

A

> 24hr

77
Q

insulin lispro color

A

clear

78
Q

insulin lispro given how? never how?

A

only subq (injection or pump)
never IV

79
Q

Regular insulin color

A

clear

80
Q

Regular insulin given how

A

subq (injection or pump) or IV
(only insulin given IV)

fun fact: available without a prescription

81
Q

how do oral insulin meds work

A
  • 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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